bluuebunny/crossref_metadata_2025_split huggingface dataset:
137 VIRTUAL CONSULTATIONS IN GERIATRIC MEDICINE OUTPATIENT DEPARTMENTS; THE PERSPECTIVE OF GERIATRIC MEDICINE SPECIALIST TRAINEES
Authors: McFeely A , Davey N 
Published: October 2022

Abstract

Background
Covid-19 social distancing measures restricted access to outpatient services. “Virtual Clinics”(VCs) were introduced in Outpatients Departments (OPDs) to continue service provision. OPD experience is vital to geriatric medicine training. The geriatric medicine Higher Specialist Training (HST) curriculum requires annual OPD participation. This study sought to identify the impact of VCs on geriatric medicine training.

Methods
An online mixed-method questionnaire was developed and circulated among geriatric medicine specialist trainees. 20 closed-questions collected demographic information and considered opinion of VCs. 5 open-questions enabled respondents to expand views of VCs. Closed-questions responses underwent quantitative descriptive analysis. Open-question responses underwent qualitative thematic analysis.

Results
Response rate was 61.4%. 86.3% reported VCs were conducted via telephone calls. 58% didn't feel comfortable conducting VCs. 64.7% didn't feel VCs positively contributed to training. 90.2% stated Face-To-Face (FTF) clinics offer greater training opportunities. 74.51% stated they were less likely to discuss VCs with consultants(compared to FTF clinics). 98.04% hadn't received training in conducting VCs. Qualitative analysis revealed four main themes: (1) Patient Selection: certain patient cohorts are unsuitable for VCs. VCs are useful in relaying simple results; not for patients with complex needs; (2) Practical Considerations: there must be access to required technologies for patients and medical staff. Medicolegal concerns were raised by several respondents; (3) Patient Care: the inability to examine patients is a challenge which impacts patient care. The lack of non-verbal cues impeded communication; (4) Training Impact: Respondents felt VCs weren't beneficial to training. There was a sense that training opportunities had been missed.

Conclusion
This study found high rates of dissatisfaction with VCs among geriatric trainees. This may be due to: (1) Inadequate training/preparation; (2) Inappropriate patient selection or (3) Lack of video-conferencing technologies. There is a sense that VCs have negatively impacted geriatric medicine training. Current policy advocates for the continuation of VCs. If VCs continue, additional resources may be needed to address any accompanying training deficit.
138 ORTHOSTATIC CEREBRAL OXYGENATION AND THE RELATIONSHIP WITH SYMPTOMS, SUPINE HYPERTENSION AND ORTHOSTATIC HYPOTENSION
Authors: Newman L , O'Connor JD , Romero-Ortuno R , Reilly RB , Kenny RA 
Published: October 2022

Abstract

Background
Cerebral hypoperfusion is implicated as a cause of orthostatic symptoms such as dizziness and light-headedness. In older adults, Orthostatic Hypotension (OH) may co-exist with Supine Hypertension (SH), with greater cerebral dysfunction being reported in those with SH-OH. It remains unclear whether orthostatic symptoms are indicative of a higher cerebral hypotensive burden in older adults. This study assessed cerebral oxygenation in a cohort of older adults experiencing orthostatic symptoms, via an active stand challenge, as well as the relationship with OH and SH.

Methods
We utilized data from Wave 3 of the Irish Longitudinal Study on Ageing (TILDA). Cerebral oxygenation was continuously measured via near infrared-spectroscopy, and blood pressure via a Finometer. Logistic regression was employed to assess cerebral hemodynamics in the sample (N=2,737, mean age=65 years [range: 54-93 years]). Models were adjusted for covariates such as age, sex, standing speed, medications, and cardiovascular conditions.

Results
In the whole sample, 29% of participants reported symptoms, 13% experienced OH30 and 49% had SH. Those who reported symptoms were less likely to have supine hypertension (OR=0.73, p&lt;0.001), but were more likely to experience OH30 (OR=1.69, p=0.005). They were also more likely to experience a larger initial drop in cerebral oxygenation upon standing (β=-0.07%, p=0.006). However, symptoms were not associated with an impaired recovery in cerebral oxygenation at 30 seconds, or 3 minutes after standing.

Conclusion
Supine hypertension is somewhat protective against symptoms, but there is still a relatively large discord between symptoms, cerebral oxygenation and OH during orthostasis. This implies asymptomatic OH may also be a risk factor for adverse outcome. There is a need for routine screening of OH and SH in older adults.
141 THE INTENSE PROJECT: IMPROVING DEMENTIA CARE THROUGH SIMULATION OF SELF-EXPERIENCE
Authors: Hopper L , Collins R , Forristal K , Riello M , Conotter V , Meyer G , Vugt M 
Published: October 2022

Abstract

Background
The EC is concerned about the growing shortage of experienced health and social care professionals to care for people with dementia. Although specialized dementia education programs have begun to appear in recent years, a lack of consistency and adequate level of knowledge of dementia to anticipate the required treatment remains across Europe. The Improving demeNtia care Through Self-Experience (INTENSE) project supports the creation of skills improvement paths for professionals across Europe that incorporate and promote successful self-experience methodologies and practices to increase knowledge and understanding of the lived experience of dementia (e.g., Virtual Dementia Tours, role plays and practices of theatre workshops).

Methods
A systematic review of self-experience tools, training and interventions was conducted. Participatory stakeholder workshops were then held in Ireland, Italy, Germany and the Netherlands to explore ways in which self-experience could be used to better understand the experience of the person with dementia and how the simulation of self-experience could be incorporated into existing (or new) training programmes. Workshop discussions were transcribed and thematically analysed along with workshop outputs to develop the INTenSE toolkit and supporting platform.

Results
An INTenSE toolkit was developed containing interactive no-tech, low-tech and high-tech approaches to simulating self-experience. Training scenarios, facilitation approaches and sustainability plans were designed and a prototype of the INTenSE Platform (website to house and support use of the toolkit) was developed. Beta versions of each will be presented.

Conclusion
INTenSE has illustrated how participatory research can strengthen cooperation and exchange of experiences between organizations working in the field of dementia care; improve social awareness of the ability of self-experience to improve dementia care; promote the integration of self-experience practices in the training of health and social care professional; and highlight the potential for self-experience simulation to be incorporated into carer training and dementia awareness education, subject to the provision of appropriate supports.
145 ASSESSING MEDICINE LISTS: A QUALITATIVE STUDY WITH MULTIPLE STAKEHOLDERS
Authors: O'Donovan B , Kirke C , Pate M , McHugh S , Bennett K , Cahir C 
Published: October 2022

Abstract

Background
Multimorbidity and polypharmacy often result in numerous interactions with different Healthcare Professionals (HCPs) and many transitions of care. Keeping up-to-date medications list in people taking medicines and/or carers can reduce medication errors at care transitions. The HSE National Quality Improvement team is working on a national medication safety campaign which encourages people to keep lists. However, there is limited information about perceptions of Patient-Held Medication Lists (PHML) in clinical practice. The aim of this study was to examine attitudes to PHML among people taking/managing multiple medicines, HCPs; and how lists are used in practice.

Methods
Purposive sampling was employed and recruitment through relevant organisations, social media and snowballing methods. Semi-structured telephone interviews were conducted with 39 people; HCPs (N=21), patients/caregivers (N=18). Interviews were transcribed and thematically analysed with behavioural frameworks - the Consolidated Framework for Implementation Research (CFIR) and Theoretical Domains Framework (TDF).

Results
Three core themes were identified: Attitudes to PHML; Function and preferred features of PHML and Barriers and facilitators to future use of PHML. All participants thought keeping medication lists had benefits for both people and HCPs (e.g. empowering, improving adherence). All who were taking medicines used lists and found them useful in particular situations (e.g. emergencies). However, HCPs and patient/caregiver groups expressed concerns about their accuracy. It was felt that some individuals may have difficulties keeping an accurate PHML (e.g. older adults, on multiple/changing medications). The participants also differed on the level of detail that should be included in PHMLs. Most patients favoured simple lists but HCPs reported the lack of detailed information in PHML may be an issue.

Conclusion
Common concerns about the accuracy of PHML and diverging opinions on list content need to be addressed. Health promotion strategies which focus on promotion of lists by key HCPs and provide people with a variety of list options could increase the wider implementation of PHMLs.
146 GOLD STANDARD GOAL-SETTING: ARE WE HITTING THE MARK? IMPLEMENTING AN INTERDISCIPLINARY GOAL-SETTING PATHWAY IN STROKE REHABILITATION
Authors: Delaney S , Armstrong B , Gusha-Zinyemba N , Barry E , Johnson E , Saju B 
Published: October 2022

Abstract

Background
The cornerstone of rehabilitation is effective and realistic interdisciplinary goal-setting with patient and family engagement across the continuum of recovery. The Royal College of Physicians National Clinical Guidelines for Stroke (2016) highlights the importance of encouraging self-management and self-efficacy to support a more person-orientated approach. This quality improvement initiative aimed to introduce a structured interdisciplinary goal-setting pathway on a post-acute 14-bed stroke unit.

Methods
An interdisciplinary working group was established comprising of Physiotherapy, Occupational Therapy, Speech & Language Therapy, Medical Social Work and Nursing. Quality improvement methodology was used to sequentially implement change over a 6-month period. The restructure included the introduction of an initial and review goal-focused family meeting. An interdisciplinary tool was developed based on the East Kent Outcome System (EKOS). A series of workshops was delivered to support implementation.

Results
An interdisciplinary goal-setting pathway is currently being piloted for 6 months on the stroke unit. To date, 22 staff have been trained and 9 patients have progressed through the updated pathway. Analysis has provided useful clinical insights and qualitative feedback has been collated regarding the benefits of the early opportunity to meet the team, establishing patient’s personal goal priorities and clear timeframes.Furthermore, repeat trials followed by reflections have enabled the team to develop consistency and confidence in person-centred, interdisciplinary goal-setting. It is acknowledged that this initiative has been a significant change process for the team and that adjustments are being made, in line with the principles of quality improvement.

Conclusion
This person-orientated interdisciplinary process is evidence-based and in line with national standards and guidelines for stroke rehabilitation. Formal training in EKOS is planned and a clinical audit will follow the pilot phase to systematically evaluate the change in practice.
147 ESTABLISHING A PERI-OPERATIVE MEDICAL SERVICE (POMS) FOR OLDER PEOPLE IN UROLOGY
Authors: O'Donovan C , Samida S , Reynolds S , Miller P , Burrows S 
Published: October 2022

Abstract

Background
Older adults account for approximately 65% of patients undergoing urological procedures therefore as the population ages the demand is anticipated to rise. The benefits of Comprehensive Geriatric Assessment (CGA) have been proven in ortho-geriatrics and a number of surgical specialties but evidence in urology is lacking. The aim of this study was to assess the impact of a Peri-Operative Medical Service for older people (POMS) on patient outcomes in a urology inpatient population.

Methods
This was a single-centre retrospective study of patients ≥50 years with length of stay (LOS) &gt;1 day admitted over two four month periods in 2018 (Pre-intervention) and 2019 (Intervention). Group differences in LOS and complications were examined using univariate regressions and then adjusted for sex, emergency admission, severity of procedure and Charlson Co-morbidity Index which also accounts for age. Secondary outcomes were to record undiagnosed medical conditions identified and the interventions made by the POMS.

Results
There were a total of 218 admissions from 211 patients with equal numbers of admissions in both the pre-intervention and intervention groups. No significant differences were detected for LOS (median 3 vs 4 days, p=0.11) or complications (32(29%) vs 40(37%), p=0.23) between pre-intervention and intervention groups. A new medical diagnosis was made in 13 (12%) of the pre-intervention v 43(39%) of the intervention group (p&lt;0.001). The POMS recommended a change to management in 102 admissions (94%). The most common intervention was medication review: 64(59%) v 19(17%) (p&lt;0.001).

Conclusion
The Peri-Operative Medical Service for older people can improve patient management by identifying and managing medical issues, complications and geriatric syndromes that may otherwise have been missed.
151 A CROSS-SECTIONAL EXPLORATION OF INTERPROFESSIONAL COLLABORATION WITHIN INTEGRATED CARE TEAMS OPERATING UNDER THE NATIONAL INTEGRATED CARE PROGRAMME FOR OLDER PERSONS
Authors: O'Donnell D , Whitty H , Devaney C , Ahern E , Radomska A , Harnett PJ 
Published: October 2022

Abstract

Background
There is an evidence and practice gap in understanding the knowledge, skills, and behaviours required of Health Care Professionals (HCPs) for effective interprofessional collaboration in the context of integrated care for older people. Furthermore, little is known about the outcome factors that may be associated with effective interprofessional collaboration among HCPs working in integrated care teams for older people.

Methods
A cross-sectional representative survey of HCPs employed in the 30 integrated care teams (ICTs) operating under the National Integrated Care Programme for Older Persons was undertaken. The survey measured indicators of competence identified in a previously co-designed framework for core competencies for interprofessional collaboration within ICTs for older people.

Results
The study explores an association between competencies in interprofessional collaboration among HCPs employed in ICTs for older persons and factors associated with higher job satisfaction including psychological safety, trust, and work engagement. Findings elaborate on instances of service innovation which resulted from interprofessional collaboration within the team.

Conclusion
The study findings provide a baseline understanding of competencies for interprofessional collaboration within the ICTs operating in the NICPOP. This will support an implementation evaluation of the co-designed framework that will generate realist evidence regarding how ICTs for older people foster, enhance and sustain their proficiency in interprofessional collaboration. This realist evaluation will identify new models of interprofessional team working and explore the outcomes that are associated with interprofessional collaboration from the perspective of older people, their family carers, and HCPs who are working as part of an interprofessional team.
152 EXPLORATORY ANALYSIS OF TROPONIN AS BIOMARKER OF ACUTE ISCHAEMIC STROKE SUBTYPES IN A GROUP OF PATIENTS RECRUITED TO THE MIND STUDY
Authors: Bejleri J , Cvetkova J , Williams D , Pfeiffer S 
Published: October 2022

Abstract

Background
Stroke is a major common cause of acquired disability and death worldwide. Atrial dysfunction or cardiomyopathy, defined by the presence of specific serum biomarkers, ECG findings, or echocardiographic findings, increases the risk of atrial fibrillation, which has been implicated as a key risk factor for ischaemic stroke. There is now growing body of evidence which suggests that early positive troponin after ischaemic stroke may be independently associated with a cardiac embolic source. miRNA as Novel Diagnostic biomarker (MiND) is a current Irish-led research study whose aim is to discover a unique highly diagnostic and prognostic biomarker expressed in acute ischaemic stroke.

Methods
Data were retrospectively extracted from patients recruited to the MiND study with confirmed diagnosis of acute ischaemic stroke within 12 hours of symptoms onset having also undergone high-sensitivity troponin testing from July 2019 to November 2021. Stroke subtypes were classified as per ESUS criteria. Statistical analysis was carried out using STATA/SE, version 16.0.

Results
We identified 52 patients who had troponin performed within 12 hours of symptoms onset. Twenty-two patients were identified as having cardioembolic stroke (CE), 17 as non-cardioembolic stroke (NCE) and 13 as Embolic stroke of unknown source (ESUS). The mean age for each group was 77.5 (±9.8), 65.5 (±12.8) and 66.3 (±11.7) years, respectively. The rate of troponin positivity for each group was 55% (12/22), 29% (5/17) and 15% (2/13), respectively. The unadjusted logistic analysis revealed a positive association between CE stroke subtype and elevated troponin (OR 3.94, 95% 1.20-12.98, p = 0.024) and an inverse association between ESUS stroke subtype and elevated troponin (OR 0.24, 95% CI 0.05-1.21, p = 0.083).

Conclusion
Our analysis reveals that early positive troponin after ischaemic stroke is a strong predictor of CE stroke subtype but not of ESUS stroke subtype.
153 AN EVALUATION OF OLDER PERSONS WITH VESTIBULAR DYSFUNCTION AS IDENTIFIED DURING COMPREHENSIVE GERIATRIC ASSESSMENT
Authors: Sayers K , Treacy G , King L , Ryan S , Donnellan C 
Published: October 2022

Abstract

Background
Vestibular dysfunction accounts for 25% of dizziness complaints. In 30-50% of these cases, dizziness is attributed to Benign Paroxysmal Positional Vertigo (BPPV). Thirty percent of people will experience vestibular dysfunction in their lifetime, with likelihood increasing with age. Individuals with vestibular dysfunction are eight times more likely to experience a fall. Vestibular assessment and rehabilitation services can be difficult to access.

Methods
A Plan, Do, Study, Act (PDSA) cycle was undertaken. All referrals to the Older Persons’ Services Clinics from November 2021 to May 2022 were triaged by an Integrated Care Team for the Older Person and scheduled for Comprehensive Geriatric Assessment (CGA). In the course of CGA, patients who reported symptoms suggestive of vestibular dysfunction received assessment by a Physiotherapist with vestibular expertise. Results were entered on an Excel spreadsheet and analysed using descriptive statistics.

Results
Six patients (4 female, 2 male) received vestibular assessment and treatment. Mean age was 75 years (SD: 11) with median Clinical Frailty Score of 4 (vulnerable). Reported symptoms were dizziness (n=3) and spinning (n=3). Sixteen percent (n=1) reported a fall and 66% (n=4) reported fear of falling. All patients had symptom duration of &gt;2 years. Following vestibular assessment, the following diagnoses were made; right posterior canal BPPV, (n=2), vestibular migraine (n=2), right horizontal canal canalithiasis BPPV, with secondary diagnosis of persistent postural-perceptual dizziness (n=1) and left peripheral vestibular hypofunction due to vestibular neuronitis (n=1). The mean number of Physiotherapy visits per person was 4. Three patients reported full resolution of symptoms. The remaining 3 reported an improvement in symptoms and confidence to self-manage.

Conclusion
This small cohort of older persons with chronic vestibular dysfunction benefited from vestibular diagnosis and intervention. The next step of the process is to include specific vestibular screening questions into CGA. This will enable Integrated Care Team members to screen more specifically for vestibular dysfunction.
158 AN AUDIT ON DISCHARGE SUMMARIES IN A MEDICAL GERONTOLOGICAL WARD
Authors: Makhura RW , Nzeji C , Rahaman F , Fallon A 
Published: October 2022

Abstract

Background
Discharge summaries are an integral part of communication within healthcare to ensure safe care across settings. Alterations are documented and relayed between relevant healthcare professionals. This audit evaluates quality of discharge summaries from a medical gerontology ward against the National Standard for Patient Discharge Summary Information (HIQA)

Methods
A retrospective audit was carried out with data collected from a ward discharge registry over 3-months (February-April 2022) and associated discharge summaries.

Results
A total of 31 discharges (including death) were identified during the set period, 97% (n=30) of which had completed discharge summaries. Upon assessment against the standard, 100% (n=30) included details vital to patient identification including name, date of birth, gender and address. In addition,100% (n=30) included information on date of admission-discharge, clinical course, relevant investigations, treatments, procedures, discharge medications and details of the doctor completing the discharge summary. The audit identified that 20% (n=6) of summaries stated referral source, which is mandatory according to the standard. 13% (n=4) included dietary interventions and 0% included immunization information (whether as an inpatient or prior). Regarding information on further management, 77% (n=23) had guidance on follow-up hospital care, 27% (n=8) had information about social care actions, 20% had advice, recommendations and future plans documented and in 10% information was documented to be given to patient and carer.

Conclusion
Compliance with mandatory information including patient details, admission/discharge date, diagnoses, hospital course, and author fully met the standard. However, there was poor compliance with information relevant to continuation of patient care in the community. This is particularly relevant for older patients with multiple co-morbidities and complex care needs. Doctors working on this ward are receiving education regarding the importance of documentation of functional status, social care needs and diet at discharge. In future, mandatory documentation as part of electronic discharge summaries may improve compliance and continuity of care across settings.