bluuebunny/crossref_metadata_2025_split huggingface dataset:
92 CONTINUING TO ‘BE HIP’: ORTHOGERIATRIC SERVICE IMPROVEMENTS IN 2021
Authors: Thomas N , Stankard A , Cosgrave N , Conlon B , Monahan P , Halpin T , Britton D , Byrne P , McShane S , Sohail I , Grogan AM , Reilly A , Thapa A , Alsubaie N , Rane P , O'Connor J , Gray S , Kaja A , Gehani K , Kovalyshyn V , O'Brien H 
Published: October 2022

Abstract

Background
Scotland first demonstrated that adherence to nationally agreed hip fracture standards improve patient survival, reduces the duration of admission, and reduces the need for high dependency care. Our study aims to assess adherence to the Irish Hip Fracture Standards (IHFS) in our hospital for 2021 amidst the COVID-19 pandemic, translating to improved clinical outcomes for our patients.

Methods
The IHF database was retrospectively analysed, comparing quarters 1-4 in 2021 with our 2020 results.

Results
IHFS1, patient time to the ward &lt; 4hours, was maintained at 67% in 2021 versus 71% overall in 2020. There was improvement in IHFS2, time to surgery within 48 hours, up to 73% in 2021 versus 66% in 2020. IHFS3 was 4% in 2021 versus 3% overall in 2020. Further improvements were noted for IHFS4, with 95% of patients reviewed by a Geriatrician in 2021 versus 87% in 2020. IHFS5 also improved with 97% of patients receiving a bone health assessment in 2021 versus 87% in 2020. Moreover, IHFS6, improved with 97% of patients undergoing a specialised falls assessment in 2021 versus 87% in 2020.

Conclusion
The improvement in 2021 figures is reflective of the return of redeployed services during the COVID-19 pandemic inclusive of the Orthogeriatric Service, the Fracture Liaison Service Advanced Nurse Practitioner, the Trauma Co-ordinator, and the specialist Orthopaedic ward complete with its Orthopaedic nurses and Multi-Disciplinary Team, and improved Emergency Department pathways. These continued improvements in the IHFS further emphasise that success is dependent on a team that is joined at the hip
120 COMPARING THE FUNCTIONAL INDEPENDENCE MEASURE AND THE BARTHEL INDEX FOR ASSESSMENT OF OLDER ADULTS
Authors: Alookaran S , Cannon E , Williams D , O'Donnell M , Harty E , Shovlin L , McDonagh E , Cawley T , Drumm B , Kelly A , Porter S 
Published: October 2022

Abstract

Background
Measuring and reporting health outcomes have become an essential component to the rehabilitation of older persons that can be often complicated by increasing frailty and medical complexity. The Integrated Care Team for Older Persons (ICTOP) is a multidisciplinary service offering domiciliary based interventions over a 4-6 week period for those aged over 65 years, with a Rockwood Clinical Frailty scale (CFS) of 3-6. The Barthel Index is currently used in the ICTOP Comprehensive Geriatric Assessment (CGA). It is an ordinal scale and measures activities of daily living performance. Functional Independence Measure (FIM) is used to assess and grade a person’s functional status. The FIM and Barthel Index are well recognised validated tools. The objective is to measure which outcome is more comprehensive and sensitive for the patient cohort over the 6-week intervention.

Methods
Ethical approval was received for the study. The participants were recruited over a 3 month period and met ICTOP inclusion criteria .The sample size was 20.The FIM and Barthel Index scores were documented and recorded on initial CGA, and on discharge.

Results
Participants were aged between 72-91 years with a mean age of 82 years, 55 % of participants were moderately frail, 15% mildly frail, 10% vulnerable and 20% managing well as per categorisation using the CFS. On paired t-test the Barthel Index and FIM scores showed similar responses in the cohort. However, the FIM score was more sensitive. These findings suggest that the FIM score had no statistical significance over the Barthel Index in evaluating change in this cohort of patients.

Conclusion
This study has provided valuable information which will impact future practice for the ICTOP Team. It afforded an opportunity to monitor the Team’s practice and explore the most effective measurement tool for this cohort of participants.
149 A PROFILE OF THE COMMUNICATION NEEDS OF NEW PATIENTS ATTENDING A MEMORY ASSESSMENT AND SUPPORT SERVICE
Authors: Kennelly S , Loye J , O'Reilly S , Wall E 
Published: October 2022

Abstract

Background
Communication is a key factor in maintaining quality of life and well-being. This is of core importance for people with dementia who experience changes to their communication abilities. The role of the Speech and Language Therapist working with people with dementia is well documented. Speech and Language Therapists support people with communication and swallowing disorders however in practice the focus is often on swallowing disorders with less emphasis on communication. The recommended allocation of Speech and Language Therapy (SLT) for a Memory and Support Service (MASS) is 0.5 Senior Speech and Language Therapist. A pilot SLT service was trialled in a MASS to identify the SLT service needs and the benefit of introducing SLT earlier for people with Dementia.

Methods
A retrospective caseload review was completed of ten patients seen by SLT as part of the MASS assessment. Communication profiles and SLT interventions were analysed.

Results
The majority of the ten patients reviewed self-reported communication and speech and language changes, such as word finding difficulties and difficulties understanding conversations. Patient's self-report often corresponded with formal assessment results. On formal assessment 30% of patients presented with slight cognitive-communicative changes and 30% of patients presented with slight-mild cognitive-communicative changes. 10% of patients presented with mild cognitive-communicative changes and 30% of patients presented with mild-moderate cognitive-communicative changes. SLT interventions included conversational strategies, language strategies, language tasks and conversation partner training. 50% of patients were referred to Primary Care SLT.

Conclusion
SLT interventions support patients’ cognitive-communication abilities in dementia. SLT within a MASS adds clinical value by supporting assessment and diagnosis of dementia and developing patients’ communication profiles to highlight communicative abilities. Furthermore, SLT input supports developing communication strategies for the patient and communication partner training. In summary these interventions support improved quality of life and well-being for the person with dementia and their family.
154 ANALYSIS OF ELIGIBILITY FOR THROMBOLYSIS IN ISCHAEMIC STROKE PRESENTATIONS IN A UNIVERSITY TEACHING HOSPITAL IN 2021
Authors: Healy C , Noone I , Meagher MK , Cassidy T 
Published: October 2022

Abstract

Background
Since the National Institute of Neurological Disorders and Stroke (NINDS) tissue-type Plasminogen Activator (tPA) trial was published in 1995, thrombolysis has been a mainstay of treatment for ischaemic stroke presenting within the appropriate age-adjusted timeframe, in the absence of contraindications. In the Irish National Audit of Stroke (INAS) National Report 2020, a nationwide thrombolysis rate of 10.6% (Range of 4-22%) was achieved. Aims: (1) This study was designed to compare this centre’s rate in 2021; (2) Identifying any missed potentially suitable presentations.

Methods
A retrospective chart review of 2021 stroke presentations in this centre was performed using medical admission notes and electronic emergency department records. Excluding haemorrhagic causes, we looked at the presenting National Institutes of Health Stroke Scale (NIHSS), the presenting timeframe and any contraindications of thrombolysis therapy, in order to identify any potentially missed eligible presentations. We also compared the percentage of thrombolysed patients in this centre to the national average.

Results
Of the 425 stroke presentations, 74 (17.4%) were excluded as intra-cerebral haemorrhages. Of the remaining 351 presentations, 32 (9.1%) underwent thrombolysis therapy. 225 (64.1%) were not eligible for therapy due to a low or recovering NIHSS (score 0-4). A further 72 (20.5%) with a NIHSS&gt;5, were outside of the window of thrombolysis therapy. Of the remaining presentations, 13 (3.7%) were unsuitable due to anticoagulation use. The final 9 presentations (2.6%) were unsuitable due to other contraindications (previous intracranial haemorrhage, baseline modified Rankin ≥ 4). 18 (5.1%) of non-thrombolysed presentations had no contraindications to thrombolysis therapy aside from late presentation (excluding wake-up events).

Conclusion
While this centre’s thrombolysis percentage is lower than the national average in 2020, a review of presentations suggests no eligible candidates were missed. Therefore, variations in thrombolysis rates across Irish hospitals may reflect case mix variations rather than decision variations.
209 THE ADVANCED NURSE PRACTITIONER CANDIDATE: PALLIATIVE CARE IN END-STAGE DEMENTIA UTILISING A CARE COORDINATED APPROACH IN THE COMMUNITY SETTING
Authors: Mills D 
Published: October 2022

Abstract

Background
Palliative care in the context of dementia is a relatively new concept. Over recent years, there has been an increased emphasis on extending palliative care for those with dementia worldwide, supported by the 2014 white paper from the European Association of Palliative Care (EAPC) defining optimal palliative care for people with dementia. Individualized care coordination for older adults in the community improves high quality care and sets the scene for this care-coordinated approach initiative led by the Advanced Nurse Practitioner candidate (ANPc)

Methods
Developing a robust pathway of care in partnership with community palliative care service will enhance the support given to achieve optimal and quality driven palliative and end of life care outcomes. The pathways achieved involve a three-step integrated pathway structure. Step one involves care intervention by the ANPc, step 2 a care coordinated approach with the ANPc and Community Palliative Care Team (CPCT) and step 3 CPCT with collaborative interactions with the ANPc. Inclusion criteria include patients with end stage dementia who have reached a FAST scale of seven or over. All patients accepted onto this pathway must reside within the healthcare area set out and experience at least one or more symptoms resulting from their dementia.

Results
Results to date have shown how this pathway has achieved significant care interventions meeting the need of people living with dementia at end stages of their journey in the community setting. Additionally, families have indicated the overall satisfaction of the service and with significant reductions in Carer stress.

Conclusion
Research indicates that individualized care coordination in the community is crucial to optimise quality care interventions, which this pathway achieves.
241 STOPPCASCADE: DEVELOPMENT OF A NOVEL EXPLICIT SCREENING TOOL FOR POTENTIALLY CLINICALLY RELEVANT PRESCRIBING CASCADES IN OLDER ADULTS
Authors: Randles M , Gallagher P , O'Mahony D 
Published: October 2022

Abstract

Background
Prescribing cascades represent an important, often underrecognized, element of problematic polypharmacy. Cascades occur when an Adverse Drug Event (ADE) is misinterpreted as a new medical condition, with the subsequent prescription of another, potentially inappropriate drug. Our objective was to develop and validate an explicit list of potentially clinically relevant prescribing cascades in older adults to facilitate the detection of more common and clinically important prescribing cascades and assist clinicians in medication review.

Methods
A structured literature search of PubMed, Cinahl and Google Scholar was undertaken. Search terms included Prescribing Cascades OR Cascades OR Cascade AND Older Adults OR Adults Over 65 OR Older People OR Gero* OR Geri*. We included adults aged ≥65 including studies in all settings i.e. community, hospital and residential care. We included all study designs including reviews, experimental and observational studies, case series and case reports. We also included published abstracts from scientific meetings in the literature search. Studies that didn’t include prescribing cascades in the abstract, studies with no access to full text article or English version of article and studies exclusively describing patients aged ≤65 were excluded. A physiological systems-based short-list was compiled with Anatomical Therapeutic Chemical codes identifying the initial prescribed drug (Drug A). Three assessment panellists (academic geriatricians) were asked to evaluate each individual published cascade and the accompanying evidence using a 5-point Likert scale to evaluate each cascade for inclusion/exclusion in the list. Potential cascades scored Likert 4 or 5 by 2 or 3 of the panellists were included in the final list.

Results
131 potential cascades were reviewed by the panel, 71 individual cascades were accepted, involving 41 drugs/drug classes.

Conclusion
The STOPPCascade list comprises 71 potentially important prescribing cascades in older adults. This novel explicit list is designed to identify potential prescribing cascades and to facilitate appropriate deprescribing.
243 “WHAT DO OUR PATIENTS THINK?” CREATING A GERIATRIC INPATIENT QUESTIONNAIRE TO IDENTIFY PATIENTS’ OPINION ON DELIVERY OF HOLISTIC CARE
Authors: Walsh J , Awadalla R , Kovalshyn V , Stankard A , Cosgrave N , NiBhuachalla B , Mulroy M 
Published: October 2022

Abstract

Background
Our aim is to assess our patients’ opinion on the delivery of key principles of Geriatric care in order to identify areas for improvement and change. The prevalence of delirium in frail older patients on inpatient wards is a major issue, the management of which includes a ward based multi-disciplinary approach. This holistic approach to patient care is our goal, however it is not clear whether the experience of our patients matches our aims.

Methods
We developed a patient questionnaire consisting of 22 questions based on the core principles of good geriatric care. The survey included 3 questions on environment and privacy, 2 on mealtime, functional ability and assistance, 3 on continence management, 2 on mobility and rehabilitation, 6 on respect and autonomy, 2 on psychological and social aspects of care, 3 on pain and sleep, and 2 on safety and Covid-19. These questions also had a large degree of overlap in terms of core principles. We distributed the questionnaire prior to discharge in 3 different Geriatric care settings: one ward managing acute stroke with a majority of single rooms, one ward managing acute medical presentations with a majority of multi-occupancy bays and one ward in a non-acute hospital managing medical Geriatric patients undergoing rehabilitation.

Results
Some key issues were identified by the survey: 60% identified issues with the ward environment and privacy, 100% did not wear a mask on the ward unless specifically asked to do so, 80% wore pyjamas or hospital gown for the majority of their stay, 40% reported issues in terms of respect and autonomy, 40% had issues with poor sleep due to external factors, 20% felt that they had insufficient time with rehabilitation.

Conclusion
The survey was designed to assess the subjective experience of older inpatients, collecting qualitative data to highlight key areas of improvement to achieve holistic inpatient care.
268 AUDIT: GENERIC PRESCRIBING COMPLIANCE IN AN ACUTE HOSPITAL
Authors: Byrne L , Hussain A , Buckley E 
Published: October 2022

Abstract

Background
Generic prescribing is cost-effective, and evidence suggests that clinical outcomes compared with brand name products are largely equivalent. Hospital guidelines recommend that medications should be prescribed using the approved generic name, not the brand name. There are some exceptions to this. Anecdotal evidence suggests that medication reconciliation for patients on admission to hospital are charted by brand name rather than the generic title. To investigate this we conducted a four-day audit of the prescribing of medications on patients admitted to medical wards in an acute hospital.

Methods
This audit took place over a four-day period. The Kardex of each patient admitted to the three medical wards was reviewed. Patients admitted under cardiology, haematology and oncology were excluded. All medications including whether they were prescribed using the generic or brand name were collected. Statistical analysis was carried out using Microsoft Excel.

Results
A total of 33 kardexes were collected. Two hundred and fifty-seven prescribed medications were reviewed. Ninety-five were charted as brand names and 63% (n=162) were prescribed using the generic name. One hundred and eighteen different categories of medications were prescribed. Enoxaparin was prescribed using the brand name ten times and the generic title three times. The antibiotic Piperacillin/tazobactam was prescribed three times using the brand name and one time using the generic title. Of the eight times atorvastatin was prescribed, it was charted using the generic name seven times (88%).

Conclusion
Almost two-thirds of medications for patients admitted to medical wards are prescribed using generic titles. However, there is room for improvement. Of note, commonly prescribed medications such as enoxaparin and certain antimicrobials were prescribed using the brand name. Opportunities e.g., induction, grand rounds and Non-Consultant Hospital Doctor (NCHD) teaching sessions should be utilised to provide education on the importance of generic prescribing to all NCHDs admitting patients.
344 LONG-TERM OUTCOMES FOR HIP FRACTURE PATIENTS WHO HAVE RECEIVED A PERIOD OF INPATIENT REHABILITATION
Authors: Curtin C , Cullen S , Walsh M , Keyes S 
Published: October 2022

Abstract

Background
Twenty-eight percent of the 3,666 hip fractures reported by the Irish Hip Fracture Database (IHFD) in 2020 received a period of rehabilitation in an off-site facility nationally. Longer term outcomes for hip fracture patients are not yet included in the IHFD. This study aimed to describe recovery after hip fracture in patients admitted to a single inpatient rehabilitation facility.

Methods
Patients who experienced hip fracture between January 2020 and July 2020 were followed up for one year after their fracture. Baseline data was collected in relation to age, pre-fracture residence and New Mobility Score (NMS) and clinical frailty score. Residence, NMS and quality of life (EQ-5D-5L) were collected by a clinical physiotherapist at 30 days, 120 days and 1 year after hip fracture. Data was inputted and analysed using Microsoft Excel.

Results
Of 122 hip fracture patients admitted to rehabilitation,103 were followed up. The average age of patients was 79, 66% were female. The mortality rate was 9% (n=9) at 1 year follow up. Pre-fracture, n= 98 lived at home. Of these patients, 67%, 82% and 83% had returned home by 30 days, 120 days and 1 year. Pre-fracture 53% had high mobility levels (NMS&gt;6). Of these patient 4%, 27% and 34% had returned to this level by 30 days, 120 and 1 year. 70% of patients had a low mobility score (0-6 on NMS) and 30 % had a high mobility score (7-9) at 1 year follow-up. 56% and 4% of patients reported no pain and severe pain at 1 year post op, respectively. 45% of patients had no issues performing their usual activities and 4% had severe issues/an inability to perform their usual activities at 1 year.

Conclusion
Our results show that recovery after hip fracture is slow with many not achieving baseline mobility or return to pre-fracture function within the first year.
Compatibility of calcium chloride with milrinone, epinephrine, vasopressin, and heparin via in vitro testing and simulated Y-site administration
Authors: Kenneally Allison M , Agbana Preye , Gardner Brian , Bae Younsoo , Mitchell Trenika , Beckman Elizabeth J 
Published: October 2022

AbstractPurposeThe purpose of this study is to evaluate calcium chloride (CaCl) compatibility with commercially available and extemporaneously compounded milrinone, vasopressin, epinephrine, and heparin. This report describes 2 clinical scenarios in which patients experienced intravenous catheter precipitation when receiving multiple continuous infusions, including CaCl, and the results of an in vitro simulation of those scenarios. The hypothesis was that one or a combination of the medications would precipitate with CaCl.MethodsCaCl compatibility was tested in 3 stages to simulate clinical situations where line precipitation occurred. Multiple tests were conducted in each stage to determine if precipitation had occurred, including visual assessment, absorbance measurement at 650 nm, and pH measurement. First, milrinone, vasopressin, epinephrine, and heparin were mixed pairwise with CaCl in a test tube. Second, the medications were mixed in different combinations deemed likely to precipitate. Finally, 5 medications were infused via simulated Y-site administration. Incompatibility was defined as observed crystals, haziness, or turbidity upon visual inspection or absorbance of greater than 0.01 absorbance unit (AU). All solutions were tested at time 0 and at 20, 60, 240, and 1,440 minutes.ResultsAcross all tests, only a commercially available formulation of heparin 2 units/mL in 0.9% sodium chloride injection precipitated with CaCl, alone or in combination with other medications. Upon further review, it was found that this specific formulation of heparin contained a monohydrate and dibasic sodium phosphate buffer.ConclusionCaCl only precipitated with a commercially available heparin formulation that contained a phosphate buffer. CaCl was deemed to be compatible with all other medications and formulations tested.
The Balance of the Constitution
Authors: Ekins Richard 
Published: October 2022

Abstract:
The idea of balance in constitutional thought helps to illuminate what it is to be governed well. The article considers the idea of balance, beginning with John Finnis’s engagement with Gibbon’s Decline and Fall, and argues that the well-balanced constitution is stable rather than static, tempering public authority, which is to say disciplining and strengthening it. Anglo-American history confirms that the balance of a constitution is likely to change over time, not only because of unconstitutional action but also because of lawful exercise of power or changes in social and political conditions. In some cases, the balance may be lost, and may need now to be restored; in other cases, a new balance may have been struck. The article reflects on the institutional arrangements that characterize a well-balanced constitution, making clear the contribution that independent courts make (and the risks that misuse of judicial power may pose) and the importance of intelligently coordinating executive and legislative power. The people have a share in constitutional government, which requires a spirit of moderation and is put in doubt if the constitution is insulated from deliberate change.