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McGettigan L, Abdullahi AS, Loughlin KM, Lyons C, Reddin C, Keane O. 35 GERIATRIC EMERGENCY MEDICINE (GEM) ’ PEARLS AND PITFALLS’- AN INTERDISCIPLINARY APPROACH TO EDUCATION. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In recent years we have seen increased awareness of the terms ‘frailty’ and ‘GEM’ in many of our Emergency Departments (ED). A clear understanding of these terms within the context of ED is essential to provide a holistic care and to best meet the needs of older adults. It has been highlighted internationally that current training programmes do not sufficiently address learning needs of trainees to optimise care of this cohort of patients. The European Geriatric Medicine Society and the European Society for Emergency Medicine has attempted to address this gap through the introduction of a core GEM curriculum in 2016, however, at a local level many EDs are not utilising this resource for a number of reasons including lack of awareness and prioritisation of other local learning needs as determined by specialist training. To address the GEM learning needs at a local level an initiative idea was trialled in the form of a GEM teaching wall with dedicated monthly topics chosen from the above curriculum.
Methods
The initiative was led by a Senior Physiotherapist working on the Frailty Intervention Therapy Team and a Senior House Officer (SHO) working in ED with collaboration from other ED members as identified. A brainstorming session took place to identify potential topics. A poster was created by the project leads each month focusing on a core topic including an overview on the subject, national/international guidelines and top tips how to best manage in ED. Relevant team members contributed to different topics. Monthly posters were displayed in the ED.
Results
The project has been successfully running for 4 months with topics including Abdominal pain, Silver trauma Delirium and Falls.
Conclusion
GEM teaching is a cornerstone of successful management of older adults presenting to our EDs. Novel MDT teaching approaches can address the identified learning gap in this area and highlight international recommendations with minimum cost.
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Affiliation(s)
| | | | | | - C Lyons
- Beamount Hospital , Dublin, Ireland
| | - C Reddin
- Beamount Hospital , Dublin, Ireland
| | - O Keane
- Beamount Hospital , Dublin, Ireland
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Reddin C, Hanrahan C, Murphy R, Costello M, Waters R, O'Donnell M. 312 DOES EXCLUDING PATIENTS WITH ORTHOSTATIC HYPOTENSION AFFECT SAFETY ESTIMATES IN HYPERTENSION TRIALS? A SYSTEMATIC REVIEW AND COMPARATIVE META-ANALYSIS. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In order to apply the findings of antihypertensive randomised controlled trials to older adults, it is important to understand the populations included and consider the generalizability of the results to cohorts that may have been excluded. The purpose of this study was to determine whether participants with orthostatic hypotension were included in randomised controlled trial of antihypertensive therapy and whether adverse event rates of particular importance to this cohort; namely falls or syncope differed based on their exclusion.
Methods
We performed a systematic review and meta-analysis of randomised controlled trials comparing antihypertensives to placebo, combination of antihypertensive agents compared to fewer antihypertensive or higher compared to lower blood pressure targets that reports falls or syncope outcomes. A random-effects meta-analysis was used to estimate a pooled treatment-effect overall in subgroups of trials which excluded patients with orthostatic hypotension and trials which did not exclude patients with orthostatic hypotension. Difference in treatment effect was assessed by testing P for interaction. The primary outcome measure was falls events.
Results
Forty-Seven trials were included, including 18 trials which excluded those with orthostatic hypotension and 29 trials which did not exclude those with orthostatic hypotension. Thirteen trials (n=94,222) reported falls. The baseline incidence of falls in the control group was 4.8% in trials which excluded orthostatic hypotension compared to 8.8% in trials which did not exclude participants with orthostatic hypotension. The association of antihypertensive treatment and falls was similar for trials which excluded those with orthostatic hypotension (OR 1.00; 95%CI, 0.89-1.13) and trials which did not exclude those with orthostatic hypotension (OR, 1.02; 95%CI, 0.88 –1.18).
Conclusion
The exclusion of patients with orthostatic hypotension may under-estimate the event rate of adverse events such as falls but does not appear to affect relative risk estimates associated with antihypertensives.
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Affiliation(s)
- C Reddin
- University Hospital Galway , Galway, Ireland
- National University of Ireland , Galway, Galway, Ireland
- Wellcome Trust – HRB, Irish Clinical Academic Training , Ireland, Ireland
| | - C Hanrahan
- University Hospital Galway , Galway, Ireland
| | - R Murphy
- University Hospital Galway , Galway, Ireland
- National University of Ireland , Galway, Galway, Ireland
| | - M Costello
- University Hospital Galway , Galway, Ireland
- National University of Ireland , Galway, Galway, Ireland
| | - R Waters
- University Hospital Galway , Galway, Ireland
| | - M O'Donnell
- University Hospital Galway , Galway, Ireland
- National University of Ireland , Galway, Galway, Ireland
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Murphy R, McCarthy C, Reddin C, Canavan M, O’Dwyer C, Mulroy M, O'Donnell M. 310 A COMPARATIVE ANALYSIS OF THE IRISH POST-GRADUATE GERIATRIC TRAINING SCHEME WITH THE EUROPEAN POST-GRADUATE CURRICULUM IN GERIATRIC MEDICINE. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Minimum training recommendations to become a specialist geriatrician in the EU have been published. In this study we sought to evaluate the curriculum of the higher specialist training scheme in Geriatric Medicine in Ireland and examine how it compares with the knowledge recommendations from the European post-graduate curriculum in Geriatric medicine, which is endorsed by both the European Geriatric Medicine Society (EuGMS) and the European Academy of Medicine of Ageing (EAMA).
Methods
In this study we examined the content of didactic study-day lectures given over a five-year rolling period which is the minimum duration of the higher specialist training programme in Geriatric medicine in Ireland. We also examined the published Irish curriculum and compared how both the Irish curriculum and content of the study-days matches up with the 36 items that are identified as the core knowledge content in the European post-graduate curriculum.
Results
There were 24 study days delivered over a five-year time period. The Irish geriatric medicine curriculum formally outlined that 30 of the 36 knowledge areas proposed in the European curriculum should be formally covered during post-graduate geriatric training in Ireland. The European curriculum recommended formal teaching in sarcopenia, sleep disorders, tissue viability, iatrogenic care delivered disorders, sexuality in older adults and geron-technology/e-health, none of which were referred to in the Irish curriculum. However, despite this discrepancy, formal teaching was delivered on 92% (n = 33) of proposed areas. Pain assessment, sleep disorders and tissue viability were areas not covered in Irish didactic study-days. 24 of 36 topics were covered at least twice.
Conclusion
There was high concordance between the content of the Irish and European post-graduate curriculum in Geriatric medicine. Benchmarking against European training standards is an opportunity to ensure that parity of education and training is achieved across the EU.
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Affiliation(s)
- R Murphy
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - C McCarthy
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - C Reddin
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - M Canavan
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
| | - C O’Dwyer
- St. Vincent’s University Hospital Department of Geriatric Medicine, , Ireland
| | - M Mulroy
- Our Lady of Lourdes Hospital , Drogheda, Louth, Ireland
| | - M O'Donnell
- Galway University Hospital Department of Geriatric & Stroke Medicine, , Galway, Ireland
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Mc Carthy CE, O'Malley K, Mannion E, Geoghegan J, Costello M, Conry M, Flanagan L, Corry M, Reddin C, Murphy R, Waters R, O'Donnell M, Robinson S, Canavan M. 102 PROMOTING BRAIN HEALTH IN AN INTEGRATED CARE OUTREACH PROGRAMME. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
Lifestyle modifications, in older at risk populations, may prevent or slow the rate of cognitive decline. Promotion of brain health has been recommended by the WHO and other governing bodies. Supporting patients in making these lifestyle changes, however, can be complex. Generic guidance may not apply to all in a heterogenous and frail patient cohort, when physical mobility may be limited and weight loss/nutrition a concern. We sought to review current practices and barriers to brain health guidance in a regional integrated care outreach programme (ICOP).
Methods
From March–June’21 the comprehensive geriatric assessment (CGA) of consecutive patients were reviewed. Those presenting with cognitive complaints, for their first assessment, were included. Demographic data and data on screening for hearing impairment and sleep disturbance were collected, in addition to information on physical activity and nutritional risk. Whether information and guidance on aspects of brain health was given was also assessed.
Results
30 patients met the inclusion criteria. The mean age was 80.3 and the mean clinical frailty scale (CFS) was 4.4. Hearing impairment was present in 20% (n = 6), with no information available in 10% (n = 3). All patients were screened for sleep disturbance, with 13% (n = 4) not fully satisfied with their sleep. Mobility aids, assistance or supervision were required in 40% (n = 12), and 23% (n = 7) were at medium or high malnutrition risk. Only 30% (n = 9) cooked their own meals. Generic brain health advice, or advice about sleep was documented in 30 (n = 9), without hearing impairment advice documented in any patient.
Conclusion
There are several barriers to brain health advice in the ICOP setting, with only 30% of patients having brain health advice documented. We are currently developing patient information leaflets on brain health, that will take potential barriers into account. Dedicated and specific information on local hearing services is also in development, as part of an ongoing quality improvement project.
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Affiliation(s)
- C E Mc Carthy
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - K O'Malley
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - E Mannion
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - J Geoghegan
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M Costello
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - M Conry
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - L Flanagan
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M Corry
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - C Reddin
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - R Murphy
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - R Waters
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M O'Donnell
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
| | - S Robinson
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
| | - M Canavan
- Galway Integrated Care for Older Persons , Department of Geriatric Medicine, , Galway, Ireland
- University Hospital Galway , Department of Geriatric Medicine, , Galway, Ireland
- HRB Clinical Research Facility, National University of Ireland , Galway, Galway, Ireland
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Murphy RP, Reddin C, Murphy EP, Waters R, Murphy CG, Canavan M. Key Service Improvements After the Introduction of an Integrated Orthogeriatric Service. Geriatr Orthop Surg Rehabil 2019; 10:2151459319893898. [PMID: 31853381 PMCID: PMC6906332 DOI: 10.1177/2151459319893898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/11/2019] [Indexed: 11/20/2022] Open
Abstract
Introduction: Models of orthogeriatric care have been shown to improve functional outcomes for
patients after hip fractures and can improve compliance with best practice guidelines
for hip fracture care. Methods: We evaluated improvements to key performance indicators in hip fracture care after
implementation of a formal orthogeriatric service. Compliance with Irish Hip Fracture
standards of care was reviewed, and additional outcomes such as length of stay, access
to rehabilitation, and discharge destination were evaluated. Results: Improvements were observed in all of the hip fracture standards of care. Mean length of
stay decreased from 19 to 15.5 days (mean difference 3.5 days; P <
.05). A higher proportion of patients were admitted to rehabilitation (16.7% vs 7.9%,
P < .05), and this happened in a timelier fashion (17.8 vs 24.8
days, P < .05). We found that less patients required convalescence
post-hip fracture. Discussion: A standardized approach to integrated post-hip fracture care with orthogeriatrics has
improved standards of care for patients. Conclusion: Introduction of orthogeriatric services has resulted in meaningful improvements in
clinical outcomes for older people with hip fractures.
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Affiliation(s)
- R P Murphy
- Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway, Ireland
| | - C Reddin
- Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway, Ireland
| | - E P Murphy
- Department of Orthopedics and Trauma, University Hospital Galway, Galway, Ireland
| | - R Waters
- Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway, Ireland
| | - C G Murphy
- Department of Orthopedics and Trauma, University Hospital Galway, Galway, Ireland
| | - M Canavan
- Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway, Ireland
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