bluuebunny/crossref_metadata_2025_split huggingface dataset:
61 STROKE MIMIC CASE REPORT: A YOUNG PATIENT WITH COVID-19 REFERRED TO NEUROVASCULAR CLINIC SUBSEQUENTLY DIAGNOSED WITH SYSTEMIC ARTERIAL EMBOLI
Authors: Menagh C , Bowman M 
Published: October 2022

Abstract

Background
An independent 44 year-old is reviewed at Neurovascular Clinic with a suspected high-risk Transient-Ischaemic-Attack (TIA). He had a recent diagnosis of COVID-19. Investigations revealed multiple systemic arterial emboli responsible for his symptoms, rather than a cerebrovascular cause.

Methods
The patient attended our Neurovascular Clinic following a virtual Stroke Consultant telephone assessment 3 days previously, when he had been referred from his GP with a brief episode of left arm weakness. This was felt to be a high-risk TIA event. He had tested COVID-19 positive with mild flu-like symptoms 4 days prior to this event. He described sudden onset weakness involving the left forearm and wrist which became ‘floppy’. Symptoms had fully resolved within one hour. His only reported vascular risk factor was controlled essential hypertension. He was a life-long non-smoker with no family history of stroke. On examination his left arm felt significantly colder than the right. His radial pulses bilaterally were palpable with good volume. Blood pressure was satisfactory in both arms. No other focal neurology was found.

Results
Computed-Tomography (CT) angiogram of the left arm revealed an occlusion of the ulnar artery in the antecubital fossa, dilated aortic root, splenic infarcts and probable pulmonary emboli. CT pulmonary angiogram revealed large bilateral volume pulmonary emboli within both main pulmonary arteries extending into all lobar branches of both pulmonary arteries. A Patent Foramen Ovale was not seen on bubble-contrast transthoracic echocardiogram. Diffusion-weighted Magnetic-Resonance-Imaging (MRI) Brain was normal. Anticoagulation with Apixaban for 6 months was commenced for provoked emboli following consultation with our trust haematologist.

Conclusion
This case of a so-called “stroke mimic” highlights a pitfall of virtual assessment for neurovascular patients and the need for assessing in person those who we should have a higher suspicion for alternative pathology, especially in those who were recently COVID-19 positive given documented pro-thrombotic tendencies.
68 DEVELOPMENT OF AN IRISH HIP FRACTURE DATABASE FRAILTY INDEX: ASSOCIATIONS WITH LENGTH OF STAY, DELIRIUM, MORTALITY AND NURSING HOME ADMISSION
Authors: Walsh M , Brent L , Ahern E , Coughlan T , Ferris H , Romero-Ortuno R 
Published: October 2022

Abstract

Background
In older people, hip fracture can lead to adverse outcomes. Frailty, capturing biological age and vulnerability to stressors, can indicate those at higher risk. This study aimed to derive a frailty index (FI) in the Irish Hip Fracture Database (IHFD), to explore associations with prolonged length of hospital stay (LOS ≥ 30 days), delirium, inpatient mortality and new nursing home (NH) admission and to assess whether the FI added value to those predictions above and beyond age, sex, and pre-operative American Society of Anaesthesiology (ASA) score.

Methods
A 21-item FI was constructed with 16 dichotomous comorbidities, three 4-level ordinal pre-morbid functional variables (difficulty with indoor mobility, outdoor mobility, and shopping), and nursing home provenance (yes/no). The FI was computed as the proportion of items present, and divided into tertiles (low, medium, high risk). Independent associations between FI and outcomes were explored with logistic regression, from which we extracted adjusted Odds Ratios (aOR) and areas under the curve (AUC).

Results
From 2017-2020, the IHFD included 14,615 hip fracture admissions, mean (SD) age 80.4 (8.8), 68.9% women. Complete FI data was available for 12,502 (85.5%). By FI tertile (low to high risk), prolonged LOS proportions were 5.9%, 16.1% and 23.1%; delirium 5.5%, 13.5% and 17.6%; inpatient mortality 0.6%, 3.3% and 10.1%; and new nursing home admission 2.2%, 5.9% and 11.3%. All associations were statistically significant (p&lt;0.001) independently of age and sex. AUC analyses suggested that the FI score, added to age, sex, and ASA score, added value to the prediction of delirium and new NH admission (p&lt;0.05), and especially to prolonged LOS and inpatient mortality (p&lt;0.001).

Conclusion
A 21-item FI in the IHFD was a significant predictor of outcomes and added value to traditional risk markers. The utility of a routinely derived FI to more efficiently direct limited orthogeriatric resources requires further investigation.
70 THE RESPONSIVE NATURE OF AN INTEGRATED CARE COMMUNITY REHABILITATION TEAM THROUGHOUT THE COVID PANDEMIC
Authors: Synnott P , Alookaran S , O'Malley G , Hickey P , O'Sullivan F , Drumm B 
Published: October 2022

Abstract

Background
The Integrated Care Team (founded 2018) provides community rehabilitation in the home. The Covid 19 pandemic, a new Reablement Service (June 2020) and Community Falls Service (September 2020) led to changes in the service, providing access to comprehensive geriatric assessment in the community when hospital outpatient services were limited. The effect of these changes on patient cohorts are explored.

Methods
Anonymised patient data from the team database was extracted for each episode of care under the service from July 2019 to February (Pre-covid), March 2020 to December 2020 (initial lockdown period), and January 2021 to December 2021 and analysed for length of stay (LOS), discharge destination, and reason for referral. A further analysis of discharge summaries for patients with the longest LOS in each period was conducted to assess for factors influencing LOS with the team.

Results
500 episodes of care were captured during the study period, 137 pre-covid, 179 March to December 2020 and 184 in 2021.From Pre-covid to 2021, the average LOS increased from 45.9 days to 57 days. The annual number of new referrals seen by the team was similar across this period (194 in 2019, 204 in 2020 and 190 in 2021). 40 patients with the longest LOS were analysed. No long-stay patients benefited from respite or day-centre care during the studied period (compared to 46% of all patients in 2018). 70% lived alone, 65% had cognitive decline or dementia and only 41% required mobility aids while indoor. Clinical frailty scores were unavailable.

Conclusion
A changing patient cohort may account for the increased length of stay, with less frail patients benefiting from reablement and falls services on hospital discharge, while high levels of cognitive impairment and low mobility aid usage may indicate limited rehabilitation potential. Ongoing access to social prescribing outlets such as respite and daycare are essential to sustain patients in their own homes.
75 EVALUATING DEMENTIA PALLIATIVE CARE SERVICES ACROSS IRELAND AND THE UK USING THE RE-AIM FRAMEWORK
Authors: Rukundo A , Fox S , Timmons S , O'Connor N , Guerin S , Kernohan G , Drennan J , Murohy A 
Published: October 2022

Abstract

Background
Dementia is a life-limiting illness, requiring a Palliative Care (PC) approach from diagnosis. In Ireland, People with Dementia (PwD) and their families rarely receive PC in a timely manner. This study aimed to evaluate five exemplar community-based dementia PC services across Ireland and the UK (as identified by key stakeholders), to inform a new service delivery model.

Methods
Data from semi-structured interviews and focus groups with 29 service providers, and service activity data (n=5), was evaluated using the RE-AIM framework.

Results
‘Reach’ - Caseloads varied significantly between 3-154 active cases. Most services accepted self-referrals; all wanted earlier referrals. Factors influencing reach included co-location, dyadic participation, service flexibility, and others’ awareness of PC appropriateness and the service’s existence.
‘Effectiveness’ - All service users received holistic assessments, person-centred care, advanced care planning, continuity of care, improved service access and ‘care-for-the-carer’. Some services offered complimentary therapies, 24/7 phone support, and bereavement support; these were perceived to improve quality-of-life, comfort, and independence.
‘Adoption’ - Staff were highly invested; some provided their personal numbers to families. Outside staff were more willing to engage (refer/support) if shared governance, training was provided, or already familiar with dementia or the tools. Incentive programmes increased adoption rates.
‘Implementation ’ - All services evolved on an ad-hoc basis, with funding provided by local organisations, and a single ‘driving force’, typically a consultant/nurse. Services heavily relied on volunteers. Perceived “essential” elements included a dyadic approach, MDT involvement, open communication, forming relationships, reflective practices, dedicated staff with problem solving skills, and staff support/training.
‘Maintenance’ - All services continued after initial project funding; three increased their activities/reach over time.

Conclusion
Important features and facilitators of community-based dementia palliative care services have been identified. These results are informing the development of the novel Dementia Palliative Care model for use in Ireland (https://pallcare4dementia.com/).
94 WORKING TOWARDS AN AGE-FRIENDLY HEALTH SYSTEM IN AN IRISH MODEL FOUR TERTIARY REFERRAL HOSPITAL
Authors: Cloney TM , Gannon E , Nor NM , Daly B , Ahern E , Pillary I 
Published: October 2022

Abstract

Background
Traditional consult services represent an area where the evidence-based 4Ms framework might be applied. A 4M framework Comprehensive Geriatric Assessment (CGA) consult form may help standardise the assessment of older persons outside of geriatric medicine. We aimed to incorporate a concise CGA tool based on the 4Ms within a geriatric medicine consult form.

Methods
Data from 100 geriatric medicine consult forms was entered onto an excel database. Each component was analysed, using descriptive statistics, for accuracy in completion, ability to contribute to referrers knowledge and a modified Delphi consensus model was used to inform the creation of a 4M framework-based concise CGA within the consult referral form. Time to completion was monitored.

Results
The median age of referred patients was 79 with a male:female ratio of 1:1. The average number of co-morbidities was 6, with 75% of patients having a significant vascular history, 30% a history of falls, and 16% diagnosed with delirium. 72% were on 5 or more medications. 53% had a complete Barthel index, with a median score of 12/20. What matters to the patient, clinical frailty score, mood and mental health were not well captured by the existing consult. These were incorporated, following consensus, into a ‘little g’, which takes between 4 and 15 minutes depending on user experience and patient complexity.

Conclusion
An evidence-based consult form, based on 4Ms, has been developed. Next steps are to introduce it to the next cohort of interns and assess efficiency and outcomes.
101 UTILITY OF BONE TURNOVER MARKERS IN GUIDING ZOLEDRONIC ACID THERAPY AFTER STOPPING DENOSUMAB
Authors: McLoughlin S , O'Reilly E , Fitzpatrick D , Bradley E , Maher N , O'Carroll C , Steen G , Fallon N , Lannon R , McCarroll K 
Published: October 2022

Abstract

Background
Denosumab is commonly used to treat osteoporosis, but drug holidays are not an option, with a risk of rebound bone loss and vertebral fractures on stopping. However, data on therapy safety and efficacy is lacking beyond 10-years and switching treatment to bisphosphonates may be appropriate for some patients. Recent guidelines suggest treatment with Zoledronic Acid if stopping Denosumab, with consideration for a second dose based on subsequent Bone Turnover Markers (BTM). We aimed to assess BTM of older patients transitioned to Zoledronic acid after stopping Denosumab.

Methods
Patients who received Zoledronic acid 6 months after their last and final Denosumab injection were identified at our bone health clinic. We compared BTM on Denosumab therapy versus at 3 months post Zoledronic acid administration. BTM measured was cross linked C-Telopeptide of type I collagen (CTX ) (ng/ml).

Results
48 patients were included (mean age 70.6 years and 90% female, mean Denosumab treatment 4.6 years). Mean CTX at baseline was 0.09 and 0.29 at 3-months post Zoledronic acid (mean difference 0.20, P &lt;0.001). 40% of patients (19) had a CTX &gt;0.30 (above the therapeutic range) at 3 months and in those, mean CTX was 0.45. Duration of prior Denosumab therapy, baseline CTX or age did not predict either change in CTX or CTX rises above 0.30.

Conclusion
All patients had a significant elevation in BTM at 3-months after transitioning to Zoledronic acid. However, a high proportion (40%) had a rise in CTX above the therapeutic range. Recent guidelines suggest treatment of such patients with a second infusion of Zoledronic acid to suppress bone resorption and bone loss. This highlights the value of using BTM in guiding therapy post Denosumab cessation. We did not find any predictors of greater rebound bone turnover but sample size was small and likely to be underpowered.
106 MORTALITY FOLLOWING HIP FRACTURE AMONG NURSING HOME RESIDENTS
Authors: Crowley P , Cloney T , Ahern E 
Published: October 2022

Abstract

Background
Little is known about mortality following hip fracture among Nursing Home (NH) residents. Prognostic data is important to guide management, including osteoporosis treatment.

Methods
We conducted a retrospective cohort study of all patients admitted to an Irish tertiary hospital from NHs with hip fracture during the years 2017-2020 inclusive. Mortality was assessed at 90, 180 and 365 days (one-year) following admission.

Results
One patient was lost to follow up, leaving 233 in the analysis group. 147 were female. Mean age was 85. All-cause mortality was 18.03% at 90 days, 27.04% at 180 days and 37.34% at one year. One-Year Mortality (OYM) was 34.01% among females and 43.02% among males. Among those aged 90 or over, OYM was 45.59% (31/68), being 65.22% (15/23) among males and 35.56% (16/45) among females. In those aged 75 or over, OYM was 39.9% (81/203), being 48.57% (34/70) among males and 35.34% (47/133) among females. In those aged under 75, OYM was 20% (6/30). OYM was 42.31% (11/26) among those who could mobilise independently before fracture, 37.23% (51/137) among those requiring an aid, 33.9% (20/59) among those requiring assistance, and 45.45% (5/11) among those unable to mobilise. 62 Rockwood Clinical Frailty Scales (CFS) were recorded (median score 7, range 5-9). OYM was 0% (0/4) for CFS 5, 50% (8/16) for CFS 6, 31.43% (11/35) for CFS 7, 80% (4/5) for CFS 8 and 100% (0/2) for CFS 9.

Conclusion
Mortality among NH residents following hip fracture was highest in older males. While mobility before fracture was a poor predictor of mortality, CFS showed promise among a smaller sample size.
107 LESSONS LEARNED FOLLOWING COVID-19: PLANNING FOR FUTURE INFECTIOUS OUTBREAKS IN A RESIDENTIAL CARE SETTING
Authors: Doyle M , Louw J , Corry M 
Published: October 2022

Abstract

Background
During the COVID-19 pandemic, maintaining resident and staff safety was a key priority. This study explored the experiences of the nursing team in a residential care facility for older adults and we report on the lessons learned for future infection control outbreaks.

Methods
Following ethical approval, all members of the nursing team were invited to take part in a one-to-one virtual interview using Microsoft teams. Eleven interviews were conducted. The data were imported into NVIVO data management software and analysed using thematic analysis.

Results
The findings highlight the importance of preparedness in terms of ‘keeping the house in order’ by having policy, guidelines and staff training up-to-date, so that they are easily amended to meet unexpected challenges. Having advanced care planning as part of routine care will ensure that the wishes of the residents are always respected. Keeping the channels of communication open by embracing technology and being technology ready emerged as key to relationship centred care. This was important for maintaining relationships between staff, residents, and family/caregivers, and was essential for resident and family well-being, particularly for residents with cognitive impairment.

Conclusion
Scientific predictions indicate that the next pandemic may come sooner and be deadlier than COVID-19. Health care managers and staff need to be ready to ensure that quality care is maintained. In residential settings, disruption to routine care can be minimised by embedding aspects of care embraced during COVID-19, into routine practice. Advanced care planning, embracing technology, and ensuring staff training, policy and procedures are up-to-date will make sure they can be easily amended to address infection specific requirements and this, will enable health care workers respond to outbreaks efficiently.
112 A STUDY OF REFERRALS TO THE EMERGENCY DEPARTMENT FROM NURSING HOMES PRIOR TO AND IN THE CONTEXT OF COVID-19
Authors: Conlon C , Feeney L , Drumm B , O'Sullivan F 
Published: October 2022

Abstract

Background
As of July 2020 there were 32,000 residential places in Ireland. In the context of Covid-19,there was a rise in attendance at Emergency Departments( ED) of those aged above seventy. The objectives were to collect data on the profile of Nursing Home (NH) residents referred to ED, establish if meeting target Patient Experience Times (PET) in ED with NH residents and to compare attendances of NH residents prior to and in the context of Covid-19.

Methods
The study was performed in two phases, the first a retrospective study in June 2017 and the second an observational study in December 2021. A proforma was drawn up to collect data of interest inclusive of reason for referral, mode of referral and clinical frailty scale. The data was analyzed using SPSS.

Results
The initial study included ninety charts, the second phase included twenty-six charts. In the recent study the majority were male 62% (16/26), aged 81-90 years 38% (10/26) and severely frail (Clinical Frailty Scale=7 50% 12/26). The percentage of weekend referrals remained similar with 26% and 27% of referrals on Saturday and Sunday in the initial and subsequent study respectively. Regarding medical review prior to transfer, 58% (15/26) had medical review (previously 62 %), 42% (11/26) had not (previously 38%). Of those who had a medical review 46% (7/15) were via telephone by out of hours service compared to 25%(14/56) in the initial study. PETs were greater than six hours in 73% (19/26) of cases, previously 68%.

Conclusion
Overall this timely study illustrates a majority of NH residents are brought to the ED without being seen face-to-face by a General Practitioner and an increase in virtual assessments since the advent of Covid-19. It highlights how a regional hospital and the NHs it serves could benefit from a community geriatric team and will help inform service provision.
113 AUDIT: DELIRIUM RECOGNITION ON AN ACUTE MEDICAL WARD
Authors: Gibbons C , Harte O , O'Donnell G , Kelleher R , Mulpeter K 
Published: October 2022

Abstract

Background
One-third of older general medical patients have delirium; it is present in half of these patients on admission and develops during hospitalisation in the other half. Despite its high prevalence, delirium is frequently not recognised, evaluated or managed appropriately resulting in poor outcomes. Our aim was to assess whether or not delirium was being recognised and documented on the General Medical Wards (GMW).

Methods
We completed a prospective chart review using an audit tool on all patients aged ≥65 years on a GMW and a Specialist Geriatric Ward (SGW) over a 24-hour period. We screened all identified patients using the 4AT Test. The standard measured against was the HSE Guideline – Delirium on General Hospital Wards: Identifying Patients at Risk, Delirium Screening and Next Steps.

Results
We included 27 patients in the study (n=27) – median age was 80 years (range 65-90); 17 were male (62.96%); 10 were on a SGW (37.04%). There was a 4AT documented on 9 (n=10) of the patients on the SGW (90%) in comparison to 0 (n=17) on the GMW (0%).
We identified n=7 patients with a 4AT ≥4 consistent with acute delirium – 4 were on the SGW (57.14%). All 4 of these patients (n=4) were documented as delirious on the SGW (100%). Of the 3 patients identified on the GMW (n=3), 1 was documented as delirious (33.33%).
All patients with delirium (n=7) had non-pharmacological measures implemented (100%), most commonly catheter avoidance (100%), analgesia (100%) and regular mobilization (85.71%). Pharmacological management was administered in 2 cases (28.57%).

Conclusion
Our audit demonstrates that despite a high prevalence of delirium amongst older adults on GMWs, it remains under-recognized missing a pertinent opportunity to investigate and initiate management. This may result in adverse outcomes. The first step in improving care in older adults suffering from delirium is detection. Detection begins with screening.
114 THE EFFECTIVENESS OF A 26-WEEK CLASS AND HOME-BASED OTAGO EXERCISE PROGRAMME ON BALANCE CONFIDENCE AND PHYSICAL PERFORMANCE IN OLDER ADULTS
Authors: Curley M , Brady S , Tyndall F , McVeigh J , McCullagh R 
Published: October 2022

Abstract

Background
Falls have a substantial burden on the Irish economy and on the individual. The Otago Exercise Programme (OEP) is a cost-effective falls prevention programme that can prevent 35% of falls. This study aims to evaluate the effectiveness of a 26-week modified OEP using a combined delivery approach of physiotherapists and Exercise Therapists (ET) on balance confidence and physical performance in older adults in rural Ireland.

Methods
Study-design: A prospective pre-post single arm intervention study. Older adults (≥60 years) were recruited from HSE waiting lists for the OEP which consisted of a group-class (1x/week) and a home OEP (3x/week). Participants were assessed at baseline, 6, 16 and 26 weeks. Outcome measures (OMs) were compared pre and post intervention using Paired T-Tests and Wilcoxon Signed Ranks tests. A repeated-measures ANOVA compared OMs across the time points.

Results
Improvements were detected in the CONFbal scale (diff = 2.12, 95% CI=1.353-2.803, p&lt;0.01), 30-second sit-to-stand (diff = 3.49, CI= 2.361-4.201, p&lt;0.01), timed-up and go (diff = 2.38, CI=8.08-12.0, p&lt;0.01), functional reach (diff = 9.158, CI=6.758-11.294, p&lt;0.01), 180° turn (diff = 1.04, CI=3-5, p&lt;0.01), and the four-test balance scale (diff = 0.61, CI=1.0-3.0, p&lt;0.01). Significant changes are noted for each measure (p&lt;0.05) with small-moderate positive effects (ηp2=0.32-0.512). The most significant changes in the 180° turn are seen between week-0 (4.92 ±1.784) and week-6 (4.44 ±1.258) followed by a plateau in results.

Conclusion
Confidence and physical performance improved significantly pre and post intervention, suggesting the physiotherapist and ET combined delivery of the programme is effective. Static and dynamic balance improvements may plateau after 6-weeks of the OEP suggesting the participants may not have been adequately challenged. Lower limb strength and mobility continued to improve throughout suggesting the modified OEP is an effective intervention for older adults in Ireland.