bluuebunny/crossref_metadata_2025_split huggingface dataset:
205 DESIGN OF AN AMBULATORY CARE HUB IN AN OLDER PERSONS SETTING
Authors: Cronin A , Kennelly S 
Published: October 2022

Abstract

Background
The service was established to deliver rehabilitation based in a day care setting. The Multi-Disciplinary Team (MDT) allocated to cover the unit often had other clinical responsibilities. Therapy was delivered in silo with differing plans/goals for individual patients. There was often reduced with insufficient/no cover to the department. The department was closed during the pandemic. Upon reopening a decision was made to restructure service delivery. A pathway of change was decided on to move from a day care setting to an ambulatory hub model of care.

Methods
A Delphi method was undertaken and a review of processes conducted by the Clinical Nurse Manager 2 (CNM2). Consequently, all new referrals were screened and virtual telephone clinics held. Nursing Comprehensive Geriatric Assessments (CGA) were conducted on patients referred by their GP or who had not attended the Age-Related Healthcare Department within 6 months. This ensured clarity around patient needs. Individualised care plans were initiated before the patient’s medical appointment took place. Any urgent reviews were flagged to specific therapists by the CNM2.

Results
The service was restructured and is now interdisciplinary in approach. The Service moved from a day care setting reviewing approx. 60 patients weekly to an ambulatory care hub model with over 450 targeted interdisciplinary reviews weekly. A spreadsheet was developed and collated weekly by the CNM2 informing therapists of referrals received hence streamlining care- planning. This enabled MDT collaboration and merging of appointments to prevent multiple attendances. This development has been welcomed by patients and families.

Conclusion
The Ambulatory Care Hub operates at a maximum capacity with patient’s receiving targeted comprehensive interdisciplinary therapy input. There is a greater sense of teamwork within the department and patients benefit from this collaboration. This redesign has shown that a well-structured MDT provides essential support in many areas of disease management.
207 CLINICAL FRAILTY SCORE (CFS) IN THE ORTHOGERIATRIC POPULATION: DESCRIPTIVE ANALYSIS AND CHARACTERISTICS.
Authors: Cloney T , Crowley P , Rafferty M , Gannon E , Ahern E 
Published: October 2022

Abstract

Background
In a hospital in the South of Ireland, all older adults admitted with hip and other fragility fractures are co-managed by the Orthopaedic & Orthogeriatric services. Identifying a patient's Clinical Frailty Scale (CFS) has become a standard part of our comprehensive geriatric assessment for this cohort. We reviewed characteristics of those with documented CFS.

Methods
We retrospectively reviewed 5 years of the hospital's hip fracture database. The data was downloaded into an Excel spreadsheet where it was formatted and cleaned to binary data to enable accurate assessment. We sub-grouped the cohort based on admission, dating from July 2019 - the onset of co-management care and routine identification and documentation of CFS - to date (September 2021).

Results
1132 adults were admitted with hip fractures between July 1st 2019 and September 30th 2021. 65.8% of admissions were female. 944 (83.4%) had documented CFS. The median CFS is 5. 515 (54.5%) had a score 5 or greater. Of the 944 patients, 83.9% of were admitted from home, 13.7% from nursing home (NH) and 2.4% from an alternative healthcare facility. Frailer patients are more likely to be admitted from NH. 92.3% of patients with documented CFS had a 4-AT administered. 99.7% of patients with documented CFS had a New Mobility Score (NMS) documented. The median NMS was 5. Patients with lower NMS had a higher CFS. 83.4% of people were mobilised day 1 post-operatively, with rates decreasing in frailer patients. The majority of people admitted from home were discharged to rehab (64.5%) and home (22.2%). 2.4% of those admitted from home were discharged to NH, with 95% (18/19) having a CFS 5 of greater. 5.3% of patients died (50/944), with 92% of deaths having a CFS 5 or greater.

Conclusion
CFS may offer us information into care planning for the orthogeriatric population. More work needs to be done evaluate its usefulness.
210 AUDIT OF AN AUDIT: UNDERSTANDING THE INTERPRETATION AND REPORTING OF KEY PERFORMANCE VARIABLES OF THE IRISH NATIONAL AUDIT OF STROKE
Authors: McCartan D , McCormack J , Hickey A , Williams DJ , Harbison J 
Published: October 2022

Abstract

Background
The Irish National Audit of Stroke (INAS) coordinates the collection and analysis of key performance variables which can be interpreted as proxies of care quality in stroke. Time metrics such as “Time-to-CT” and “Time-to-Thrombolysis” reflect the organisation of in-hospital stroke care pathways, with shorter times reflecting better care coordination and quality. While the INAS data dictionary defines each variable, differing interpretations of a definition can impact on the exact data point collected. We wished to understand the interpretation and reporting of key performance variables at all clinical sites reporting to INAS.

Methods
An online survey in three parts was designed and distributed to 34 INAS audit co-ordinators along with the INAS dictionary definition of each data variable. Audit co-ordinators were asked to select the exact data point they collect for that variable from a dropdown list, with space also allotted for free-text entry of any challenges they may encounter for that variable.

Results
Responses were received from 11/34 audit co-ordinators, representing 10/24 hospitals. Variability was seen in the specific times selected for data points including hospital arrival time, team time, and brain imaging time. This variability was seen across sites and regions. Data points with less scope for interpretation such as thrombolysis or thrombolysis time showed less variability.

Conclusion
By understanding the scope of responses given to any data point definition and the challenges that may exist for audit co-ordinators, it is hoped to achieve a consensus approach to defining variables for a robust core data set. Future data definitions may be refined to assist in the collection of exact data points that are accurate, consistent and reproducible across hospital sites. In so doing, all key elements of a patient’s pathway can be captured accurately and compared with best practice guidelines with a view to optimising future care provision and service organisation.
211 ASSOCIATION OF PLASMA ANTIOXIDANTS AND COGNITIVE OUTCOMES IN NORTHERN IRISH MEN FROM PROSPECTIVE EPIDEMIOLOGICAL STUDY OF MYOCARDIAL INFARCTION (PRIME) STUDY
Authors: Marley A , Potter C , Passmore P , Linden G , McEvoy C , Patterson C , McGuinness B 
Published: October 2022

Abstract

Background
Oxidative stress and chronic inflammation have been demonstrated to contribute to cognitive decline in older age and the development of neurodegenerative disorders. Antioxidants have been revealed to help mitigate the effects of the damage caused by oxidative stress and inflammation, but their relationship with cognitive decline is not yet fully understood. The aim of this study was to investigate the association between various plasma antioxidant levels and cognitive status in participants from the Prospective Epidemiological Study of Myocardial Infarction (PRIME) study.

Methods
10,600 men were recruited to the PRIME study between 1991-1993 and have been followed up across eleven time points. Baseline health and lifestyle characteristics were assessed, and plasma antioxidants were obtained and quantified. Baseline cognitive status was screened in 2000 using Mini-Mental State Examination (MMSE). Follow up assessment of cognitive status was performed in 2015 with MMSE and Addenbrooke’s Cognitive Examination-Revised (ACE-R) examinations.

Results
2,009 men underwent cognitive assessment in 2000 and 873 men in 2015. At both 2000 and 2015 with the use of the MMSE and ACE-R examinations to assess cognitive status, serum concentration of all the antioxidants except for gamma-tocopherol and lycopene were higher in the men with better cognitive performance at a significant level of p&lt;0.05. Better cognitive performance was associated with more time spent in education and higher level of education achieved at a statistically significant level (p&lt;0.01). Furthermore, those with cognitive impairment were more likely to be older. After adjustments for lifestyle variables with a linear regression model, the only significant variable associated with cognition was time spent in education (B = 0.521, p= 0.02).

Conclusion
The findings suggest that the concentration of plasma antioxidants is associated with cognitive status. Smoking and education, as well as other lifestyle factors were, demonstrated to have an impact on cognitive status.
222 TOWARDS A DELIRIUM FRIENDLY EMERGENCY DEPARTMENT
Authors: Kajawo S , Linn M , Maher M , Rath S , Fitzmaurice K , Brolly A , Buckley M 
Published: October 2022

Abstract

Background
Delirium affects approx. 10-30 % of patients over the age of 65. Up to 70% of cases are missed in the Emergency Department (ED). Delirium results in increased morbidity, mortality, increased length of stay and decreased functional status with increased discharges to residential care centres. Delirium in the ED is an independent predictor of death within 6 months.

Methods
We completed an audit which showed 40% of those &gt; 65 years of age in the ED were delirious and 60% of those had dementia. None of these had been identified as delirious prior to review. We have approx. 5,000 patients &gt;75 years of age attending our ED annually (1/7th of presentations). This audit was used as a catalyst for our quality improvement project. We established a steering group with a small quality improvement sub-committee. We combed the literature, identified areas for improvement and costed our project. We also looked at reliance on 1:1 carers for those with delirium and potential benefits to patient, staff and management.

Results
We used the SPARK ignite programme as a means to gain momentum and also educate ourselves on business management and change management. We competed in the finals with our “delirium package” – focussing on orientation, stimulation, safety and education. These 4 pillars of delirium care have been shown to prevent delirium, reduce hospital stay for those with delirium and also augment their delirium cycle. Competing and winning a prize highlighted the importance of delirium care and brought our project to a bigger stage.

Conclusion
Due to our multi-disciplinary team composed of non-consultant hospital doctors, advanced nurse practitioners and occupational therapists, we have been able to introduce the national dementia programme for early identification of delirium in the emergency department. We now have a space for managing those with delirium and have received funding to put our package in place. This can be replicated in hospitals around the country highlighting the non-pharmacological treatments for delirium.
226 DUAL ANTI-PLATELET THERAPY: AUDIT OF COMMUNICATION OF DIAGNOSIS AND DURATION ACROSS PRIMARY AND SECONDARY CARE
Authors: McCaughey D , OHagan L 
Published: October 2022

Abstract

Background
Dual Anti-Platelet Therapy (DAPT) is indicated in vascular disease & duration of treatment depends on factors such as indication, age, bleeding risk, disease severity & co-morbidities. Inappropriately prolonged DAPT may increase the risk of major bleeding without a reduction in all-cause mortality and decisions for the duration of DAPT are best made by specialists in secondary care which should be communicated definitively to partners in primary care.

Methods
A retrospective search of patients prescribed Aspirin and a PY2 inhibitor from 01/01/2020 to 30/04/2022 was conducted. Patients were excluded if DAPT was not prescribed concurrently or if the patient deceased before the duration of DAPT had passed. Each record was evaluated to determine if: (1) Secondary care correspondence stated indication & duration of treatment; (2) Patients had stop dates for DAPT on their prescription; (3) Patients had been on DAPT for correct duration and (4) Any errors/improvements were identified.

Results
Number of patients met criteria = 81, Average Age = 69.7yrs, Male = 58%, Female = 42%. 12% of letters from Secondary Care did not specify a duration. 43% did not have a stop date on their prescriptions. 19% prescribed DAPT for the incorrect duration. 15% classified as having a serious medication error (DAPT &gt;3yrs, No obvious indication for DAPT, DAPT & Antithrombotic therapy without review). 14.8% not prescribed a PPI & 4.9% admitted to hospital with a GI bleed. 24.7% Patients prescribed Esomeprazole/Omeprazole & Clopidogrel

Conclusion
DAPT is an important pharmacotherapy intervention in the treatment of vascular disease, but it's duration should be regularly assessed by specialists and clearly communicated to prescribers in Primary care to optimise treatment and reduce bleeding risk. Clinical system warnings have now been utilised to alert prescribers to well defined time limits of DAPT and patients on less appropriate PPI's have been switched. Secondary care colleagues have been reminded of the importance of clear and concise communication of clinical interventions and plans.
229 NEW STROKE EARLY SUPPORTED DISCHARGE SERVICE PROVIDES ALTERNATIVE REHAB PATHWAY AND IMPROVES PATIENT AND ORGANISATIONAL OUTCOMES
Authors: O'Connor S , Conlon L , Carney M , Joseph H , Nolan-Shaw D , Hickey P 
Published: October 2022

Abstract

Background
Early Supported Discharge (ESD) for stroke is an international model of best care for stroke patients. ESD improves patient outcomes while facilitating a faster hospital discharge through providing stroke specific rehabilitation at home. ESD can be expected to improve disability outcomes and quality of life and reduce length of hospital stay. A pilot ESD service was introduced to this model 3 hospital in 2021 which encompasses a large geographical rural area that historically had an absence of Stroke rehabilitation services.

Methods
A retrospective review of routine data extracted from 57 patients accepted to the ESD service in 2021 was completed. This initial examination explored the effectiveness of ESD with the population in this rural area. Service Objectives as follows: (1) Improve patient’s functioning as measured by Functional Independence Measure (FIM) and Functional Assessment Measures (FAM); (2) Demonstrate a reduction in disability outcomes as evidenced on the Modified Rankin Scale (MRS); (3) Increase number of early supported discharges directly home for patients; and (4) Reduce length of hospital stay for patients post-stroke.

Results
Implementation of an ESD service over a 12-month period achieved the following: (1) 8.1% improvement in total FIM/FAM scores indicating positive functional outcomes and enhanced independence when discharged home with ESD; (2) A decrease in the average MRS score indicating improved disability outcomes; (3) 25% of all stroke patients in 2021 were discharged with ESD rehabilitation; (4) An increase of 12% in total number of discharges home post stroke from 2020 to 2021; (5) 244 bed saving days.

Conclusion
The introduction of an ESD service resulted in patient and organisational benefits. Participation in ESD rehabilitation had a positive impact on reduction of disability scores captured using MRS and improvements in functional outcome measure scores captured using the FIM/FAM.
230 DEVELOPMENT AND IMPLEMENTATION OF A STROKE PASSPORT IN THE HYPER-ACUTE STROKE UNIT: SUPPORTING PEOPLE POST-STROKE
Authors: O'Kane A , McCaffrey S , McNally S , Duffy F , Cassidy T 
Published: October 2022

Abstract

Background
A Multi-Disciplinary Team (MDT) approach is instrumental to post-stroke management in the Hyper Acute Stroke Unit (HASU). There is strong evidence highlighting the importance of patients’ social needs post-stroke (UK National Clinical Guideline for Stroke, 2016) and the need for a clear plan and resource combining both health and social care. This is outlined in the National Stroke Strategy (2020-2025). Stroke care involves a cohesive multi-disciplinary approach. In 2021, members of the MDT in HASU identified a service gap and implemented a unified tool. The aim of this project was to develop a user-friendly resource “Stroke Passport” to ensure the patient was central to their own stroke journey.

Methods
National and international guidelines were reviewed and benchmarking of other acute services was completed. The Stroke Passport was specialised to the HASU to include key stakeholders including stroke Consultant, stroke MDT and stroke Nursing Staff. Key stakeholders contributed to the development and adjustments were made after feedback. A sample of stroke patients piloted the passport (n=10). Education was provided for staff and patients through information sessions.

Results
This project resulted in the development of a resource that captured the following key areas:(i)Causes of Stroke (ii) Risk Factors (iii) Stroke Team (iv) Rehabilitation Goals (v) Useful Contacts (vi) and Medication List (vii). Qualitative feedback from the pilot study included: consistent awareness into stroke type, rehabilitation goals and discharge plan. The passport was successfully implemented to meet the organisational demands of the service while including the patient’s voice and is now embedded into standard practice in the HASU.

Conclusion
The development and implementation of a Stroke Passport ensured inclusion of the patient central to rehabilitation goal setting and discharge planning. The project supports an integrated approach to care and allows for patient centred care from admission to safe discharge.
232 WORKING-UP DEMENTIA, A RETROSPECTIVE COHORT STUDY OF REFERRALS TO A SPECIALIST DEMENTIA SERVICE
Authors: Loughlin E , Gibbons O , Burke S , Okon M , O'Sullivan F , Drumm B , O'Donnell M , Patel S , Hickey P , McCarthy G , O'Malley G 
Published: October 2022

Abstract

Background
Rates of dementia in Ireland are rapidly increasing in line with our ageing population. Cases are predicted to more than double in the next 30 years from a prevalence of 55,000 in 2018, to 141,000 in 2050. Dementia services will be placed under significant pressure. It is essential that patients referred to specialist memory services are appropriately worked-up prior to referral, to ensure efficiency and optimise the running of these services, and also to improve patient experience.

Methods
We carried out a retrospective review of patients referred to the Psychiatry of Later Life Team for specialist dementia care by General Practitioners. We obtained date of referral to the service, and carried out an electronic chart review to evaluate the work-up performed prior to referral. Our standard work-up criteria consisted of neuroimaging (CT brain or MRI brain), and blood tests including B12, folate, and thyroid function tests within 12-months. Results were analysed descriptively.

Results
104 patients were included in the study, from referrals dated Nov 2014-June 2019. Neuroimaging had been performed in 79.8% (n=83) prior to referral- 89.1% CT, 9.6% MRI, 1.2% both CT and MRI. Of those who had neuroimaging, n=37 had been performed in the previous 12-months, representing 35.6% of overall cohort. In terms of blood work-up, 23.1% (n=24) had bloods performed in the 12 months prior to referral- 70.8% B12, folate and thyroid function tests; 20.8% TFTS only; 8.3% B12 and folate levels only).

Conclusion
Referrals to specialist memory services by General Practice often lack the appropriate first line investigations, which introduces delay in review and the need for further assessment once baseline investigations have been done. There is a need for a standardised work-up prior to referral for optimum running of such services.
233 COGNITIVE OUTCOMES AFTER A FIRST EPISODE OF DELIRIUM IN HOSPITAL – RESULTS FROM AN ADVANCED NURSE PRACTITIONER DELIRIUM CLINIC
Authors: Ryan S , Sayers K , King L , Maher J , O'Reilly A , Donnellan C , Pillay I 
Published: October 2022

Abstract

Background
Cognitive outcomes for frail older adult inpatients with a first episode of Delirium are unknown. Aim: To determine cognitive outcomes of frail older inpatients after a first episode of Delirium.

Methods
Consecutive frail older inpatients with a 4AT score &gt;/= 4, without a previous history of cognitive impairment, over a 12-month period (January to December 2021) were invited for formal cognitive assessment 8-12 weeks after their delirium occurred. Collateral history, medication review, Addenbrookes (ACE III), bloods and CT brain were undertaken. Data was prospectively entered onto Excel and analysed using descriptive statistics.

Results
Fifty-one patients with a mean age of 82 years (SD=6) were referred to the Advanced Nurse Practitioner (ANP) Delirium Clinic. Median Clinical Frailty Score (CFS) was 6 with a male: female ratio of 1:2. Forty- seven percent (n=24) attended; 35 % (n-18) did not attend; 18 % (n=9) died prior to assessment. The ratio of male to female attendees was 1: 2.4. There was no difference in CFS or age between attenders and non-attenders. Thirty-three percent (n=8) of patients who attended had potentially reversible causes (high anti-cholinergic burden, folate deficiency, sleep disorder) of cognitive impairment requiring intervention. Sixty-seven percent (n=16) were diagnosed with dementia at the Delirium Clinic; 16.6% (n=4) were diagnosed with Mild Cognitive Impairment; 4% (n=1) had a resolved delirium; 8% (n=2) were referred to consultant Memory Clinic and one patient remained too unwell to assess. The median ACE III score of patients diagnosed with dementia was 54/100 (SD = 18).

Conclusion
Pro-active follow up of patients with a first episode of Delirium led to early diagnosis of dementia and mild cognitive impairment with supportive interventions. Earlier ANP intervention, during the acute phase of delirium, has been introduced in order to improve clinic attendance.
235 EYES WIDE SHUT: A CASE OF BILATERAL PTOSIS FOLLOWING STROKE
Authors: McDonnell M , Kelly N , Mullaney G , O'Malley T 
Published: October 2022

Abstract

Background
Bilateral ptosis is a rare manifestation of midbrain stroke. It has been reported in case studies only, with no data on incidence rate, and no published case report in Ireland to date.

Methods
This is a retrospective case study of a man admitted to an acute stroke unit following collapse and unresponsiveness. A review of his medical records and radiological database was conducted. A PUBMED database search was conducted to search for similar cases.

Results
We present the case of a man who had a witnessed collapse whilst farming and was brought to hospital and presented with a Glasgow Coma Scale of 3. Imaging showed a normal CT Brain. MRI revealed 2cm acute bilateral thalamic and midbrain infarction. Following a brief period in ICU he was transferred to the acute stroke unit for multidisciplinary care. Despite improvements in his medical status and communication efforts, his inability to open his eyes contributed to a persistently low GCS. Neurological assessment revealed bilateral ptosis, fixed dilated pupils and oculomotor paralysis. These symptoms had a profound impact on his stroke recovery, impeding assessments and interventions and engagement in all realms (swallow and communication; mobility and function, cognitive-perceptual) whilst also limiting opportunities for social interaction. Once staff became aware of the ophthalmoplegia, strategies were implemented to optimise his participation and provide opportunities of recovery. Three months post stroke, he began to experience some return of unilateral eye-opening and bilateral horizontal movements (with diplopia) which greatly improved his overall performance. He was then transferred to the rehabilitation unit where he continues to progress.

Conclusion
Bilateral ptosis post stroke is rare and has a debilitating effect on participation in all aspects of living and interaction with the environment. This presentation has previously been described as “reverse locked-in-syndrome” which accurately represents its impact.