The impact of early-onset hidradenitis suppurativa

Early-onset hidradenitis suppurativa can lead to significant impairments in a patient’s quality of life, especially for children and adolescents, who face challenges related to self-esteem and physical and emotional development. Prioritizing a review of paediatric patients who present with symptoms suggestive of HS can facilitate a timely diagnosis and allow for the initiation of early and effective management, which may limit the potential for long-term physical and psychological comorbidities to develop in the future.

Use of biologics for psoriasis in solid organ transplant recipients

Biologics have significantly advanced the treatment of inflammatory disorders, including psoriasis. However, their use in immunosuppressed patients, such as those with solid-organ transplants, is less understood. These patients often face dermatological issues, but inflammatory skin diseases are rare due to their immunosuppressive treatments. Our study aims to assess biologics' effectiveness in such immunocompromised patients. We report a case from our institution of a 29-year-old man with a history of psoriasis, who underwent a kidney transplant and later developed erythroderma. He did not respond to traditional treatments and was successfully treated with adalimumab, leading to the discontinuation of MMF. We also reviewed literature in solid organ transplant patients with psoriasis. Our findings, based on 10 articles, indicate a cautious approach to using biologics in this group, with further research needed for efficacy and safety.

'Growing up with a red nose': a patient's perspective on rosacea

We highlight the impact of rosacea in a young man, who presents a patient perspective on growing up with rosacea and how this impacted on his quality of life. Physicians should consider each patient’s unique concerns and perception of disease severity when prescribing a treatment plan.

Response to, 'Letter to the Editor on "Comparison of Social Media Content on Hidradenitis Suppurativa: A Cross-Sectional Study'

N/a.

Gridless adult cervical spine radiography and its' effect on image quality and radiation dose: A phantom study

INTRODUCTION

Imaging of the cervical spine in general radiography is most frequently performed using an anti-scatter grid. The purpose of this study was to investigate the effects of a gridless setting on image quality and radiation dose during digital radiography of the anteroposterior (AP) and lateral (LAT) cervical spine.

METHODS

A phantom study was performed with a variety of tube voltages (63-75 kV) with and without an anti-scatter grid. The tube current time product (mAs) and dose area product (DAP) were recorded and used to calculate effective dose (ED) and individual organ dose using PCXMC 2.0 software, as well as entrance surface dose (ESD) and objective image quality: signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective visual image quality grading characteristics (VGC) was performed by five qualified radiographers.

RESULTS

In a gridless setting, the AP and LAT positions showed significantly lower DAP (1.6 μGym2; 61.3 % and 1.6 μGym2; 51.2%), ESD (27.6 μGy; 57.3% and 77.2 μGy; 47.2%) and ED (4.2 μSv; 61.3% and 2.3 μSv; 48.9%). In a gridless setting in the AP position, there is a slight significant deterioration in image quality. In the lateral projection, on the other hand, the image quality without the use of grid was only significantly reduced in three of six criteria and there was no difference in the objective image quality between the two settings examined.

CONCLUSION

The results of this study show that gridless setting significantly decreases radiation dose and image quality, but the quality in the lateral projection is still acceptable for diagnostic purpose.

IMPLICATIONS FOR PRACTICE

The protocol without the use of the anti-scatter grid in cervical spine radiography leads to a reduction in the radiation dose in both projections, but the image quality in the AP is significantly reduced for all criteria examined, with a slight deterioration in image quality in the lateral projection.

Integrated omics analysis unveils a DNA damage response to neurogenic injury

Spinal cord injury (SCI) evokes profound bladder dysfunction. Current treatments are limited by a lack of molecular data to inform novel therapeutic avenues. Previously, we showed systemic inosine treatment improved bladder function following SCI in rats. Here, we applied multi-omics analysis to explore molecular alterations in the bladder and their sensitivity to inosine following SCI. Canonical pathways regulated by SCI included those associated with protein synthesis, neuroplasticity, wound healing, and neurotransmitter degradation. Upstream regulator analysis identified MYC as a key regulator, whereas causal network analysis predicted multiple regulators of DNA damage response signaling following injury, including PARP-1. Staining for both DNA damage (γH2AX) and PARP activity (poly-ADP-ribose) markers in the bladder was increased following SCI, and attenuated in inosine-treated tissues. Proteomics analysis suggested that SCI induced changes in protein synthesis-, neuroplasticity-, and oxidative stress-associated pathways, a subset of which were shown in transcriptomics data to be inosine-sensitive. These findings provide novel insights into the molecular landscape of the bladder following SCI, and highlight a potential role for PARP inhibition to treat neurogenic bladder dysfunction.

Desmoplasia in cutaneous squamous cell carcinoma with perineural invasion

This study examines the rate of desmoplasia in cutaneous squamous cell carcinoma with perineural invasion and the associated clinical outcomes.

Surgical procedures: are we working to capacity?

In this report, we examine the issue of consent for surgical procedures in patients who may have impaired cognition, and therefore may not have the mental capacity to provide consent. As the average age of our population continues to rise, we need to be cognizant of this when performing surgical procedures within dermatology. To explore how often doctors perform capacity assessments, we conducted a survey, which highlights the need to further incorporate this topic into dermatology training programmes, so that clinicians are equipped with the necessary skills to assess patients’ capacity to provide consent.

Living with neurofibromatosis

Neurofibromatosis type 1 is a genetic disorder that has a number of cutaneous manifestations. Although these lesions typically do not require any form of intervention, it is important for clinicians to be sensitive to the impact that this condition can have on patients’ quality of life regardless. This viewpoint highlights the difficulties encountered by our patient as a result of this condition.

The unspoken barriers to treatment for chronic plaque psoriasis

Research in dermatology that includes groups that have been historically marginalized is limited. Dermatologists should be vigilant to ensure that we are well-informed and respectful of the social and cultural traditions of our patients. In doing so, we can foster a strong patient–doctor relationship with all our patients and limit the potential for healthcare disparity across groups that have been historically marginalized.

Same-day surgery promotes sustainability in dermatology

This article reviews carbon dioxide emissions associated with travel to and from skin surgery appointments in a single department.

Comparison of Social Media Content on Hidradenitis Suppurativa: A Cross-Sectional Study

BACKGROUND

Research has shown that patients may turn to social media seeking information regarding diagnosis and treatment. This study aimed to analyze and compare content related to hidradenitis suppurativa (HS) using the "hashtag" tool across three of the most popular social media platforms to determine the information that patients are exposed to online.

METHODS

We identified hashtags across Instagram, TikTok, and Facebook for "#hidradenitissuppurativa." The top 50 videos returned by the algorithm across each site were selected for analysis. Data extracted for comparison included content creator demographics, number of followers, type of content (educational vs. noneducational), and associated hashtags.

RESULTS

Sixty-seven percent of posts were created by females (n = 101/150), 10% by males (n = 16/150), and 22% other (n = 33/150). Distribution was similar across all platforms. User accounts on TikTok have a significantly higher number of followers (median = 38,700, range = 902-17,600,000 followers) compared to Facebook (median = 1,375, range = 58-777,000 followers) and Instagram (median = 2,818, range = 57-9,800 followers).

CONCLUSION

This study suggests that there is a disproportionate number of patients creating content to raise awareness on HS on social media compared to patient support groups or medical professionals. We propose that social media is a useful platform that dermatologists and official institutional bodies can utilize as an alternative method of health promotion and patient education. Further research to explore social media trends across a range of dermatological conditions can help guide targeted education campaigns in the future.

Athena: Speciality Certificate Examination case for dermatopathology

This is a case for the Speciality Certificate Examination of a rare benign skin tumour and the associated histopathological features along with the histopathological features of differential diagnoses.

Staging cutaneous squamous cell carcinoma in an Irish cohort

We review staging systems for cutaneous squamous cell carcinoma.

When overtreatment of cutaneous malignancy becomes an unacceptable burden for patients with limited life expectancy: a patient's perspective

Concern has been raised that there is a potential for over treatment of NMSCs among older patients, given the relative low risk of the tumour to their health and the high burden of treatment. This article explores one patient’s perspective of the treatment of multiple NMSCs.

The Impact of a Phototherapy Service on Carbon Emissions and Suggestions for the Future Delivery of Sustainable Care

A cross-sectional study of the carbon emissions generated by patients attending a tertiary dermatology centre for phototherapy.

The grass is always greener on the nearer side

Global warming is becoming an increasingly urgent area of concern, and the field of healthcare is not exempt. This study examines the role that satellite clinics play in reducing the production of carbon emissions, and making our practice more sustainable and carbon-neutral as a result.

Neuropilin 2 Is a Novel Regulator of Distal Colon Contractility

Appropriate coordination of smooth muscle contraction and relaxation is essential for normal colonic motility. The impact of perturbed motility ranges from moderate, in conditions such as colitis, to potentially fatal in the case of pseudo-obstruction. The mechanisms underlying aberrant motility and the extent to which they can be targeted pharmacologically are incompletely understood. This study identified colonic smooth muscle as a major site of expression of neuropilin 2 (Nrp2) in mice and humans. Mice with inducible smooth muscle-specific knockout of Nrp2 had an increase in evoked contraction of colonic rings in response to carbachol at 1 and 4 weeks following initiation of deletion. KCl-induced contractions were also increased at 4 weeks. Colonic motility was similarly enhanced, as evidenced by faster bead expulsion in Nrp2-deleted mice versus Nrp2-intact controls. In length-tension analysis of the distal colon, passive tension was similar in Nrp2-deficient and Nrp2-intact mice, but at low strains, active stiffness was greater in Nrp2-deficient animals. Consistent with the findings in conditional Nrp2 mice, Nrp2-null mice showed increased contractility in response to carbachol and KCl. Evaluation of selected proteins implicated in smooth muscle contraction revealed no significant differences in the level of α-smooth muscle actin, myosin light chain, calponin, or RhoA. Together, these findings identify Nrp2 as a novel regulator of colonic contractility that may be targetable in conditions characterized by dysmotility.

217 THE USE OF SIILO MESSAGING APP BETWEEN HOSPITAL-BASED FRAILTY INTERVENTION THERAPY TEAM AND COMMUNITY-BASED EMERGENCY DEPARTMENT IN THE HOME TEAM

Background

Effective communication is an important component of any healthcare system. There is frequent communication of patient care and information between the EDITH (Emergency Department In The Home) and the FIT (Frailty Intervention Therapy) teams, which are based across two sites. Traditionally handovers between therapists were completed via email/ fax. Siilo is a secure medical messaging app designed to facilitate instant communication of patient information between healthcare professionals in a confidential manner.

Methods

A 3-month pilot of the Siilo app was commenced in August 2021 to improve the flow of information between teams, facilitate timely decision making and improve patient care. A questionnaire to rate speed, efficiency, accuracy, accessibility and confidentiality on a 4point scale was completed by all therapy staff members. Qualitative questions regarding positive and negative aspects, and future suggestions were included.

Results

Pre-pilot the median time from EDITH assessment to receipt of handover was 20 hours. During the pilot, median time to handover was 1 hour. Speed, efficiency and accessibility of communication between teams received a median rating of 2 (“average”) pre-pilot, increasing to 4 (“excellent”) during the pilot. Accuracy and confidentiality received a median rating of 3 (“good”) pre-pilot, improving to a median rating of 4 (“excellent”). 100% of respondents reported Siilo had a positive impact on decision making and on patient care.Qualitative themes included; earlier acute care discharge planning; ease of use and reduction in paperwork. Suggestions to further improve communication between the services were made and will be explored at a later date.

Conclusion

A significant reduction in time from assessment to handover improved the flow of communication between the teams, reduced duplication of assessments and improved patient care for older patients. Confidentiality and accuracy were maintained over this period. The use of the app will be continued and suggestions to further improve the integration between the services will be implemented.

215 WHAT VALUE DOES OCCUPATIONAL THERAPY ADD TO THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE?

Background

The EDITH team has provided an alternative care pathway for older adults with emergency care that takes place in the persons’ home. The EDITH service provides both medical and Occupational Therapy assessment and intervention in the home environment with onward referrals to appropriate agencies as indicated, thus negating the need for an emergency department presentation.

Methods

To assess consistency in OT practice and assessment, an audit was completed of OT logbooks and electronic patient data. Paper count method was used. Data gathered with regards to OT process and assessment.

Results

100% of patients had at least 1 type of OT assessment (e.g functional, home environment, falls prevention, cognitive etc), 80% had at least 2 and 43% had 3 or more types of OT assessments. 100% of patients had Clinical Frailty Scores completed, 100% had their living situation and level of care supports assessed and documented. 43% of patients received onwards referrals to community supports, day hospital, voluntary supports etc.

Conclusion

The OTs complete a thorough and multifactorial assessment of the older adult within the context of their home environment. This holistic assessment approach adds significant value to the overall EDITH assessment and service. It also ensures appropriate and relevant onwards referrals are completed. It is imperative to ensure value for money with regards to health care services. In line with the HSE “Value Improvement Programme” it is timely to review OT services and ensure they are delivering consistent, high quality and high value services for our stakeholders.

239 PATIENT PERCEPTIONS OF THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE

Background

The EDITH service provides an alternative to Emergency Department (ED) attendance for the older adult by providing emergency care in the person home. It is imperative to explore how this service is received by the key stakeholders in order to ensure it is meeting the needs of older adults and to improve and diversify same.

Methods

A patient feedback survey was circulated to patients and family members who received the EDITH service. A postal option and a QR code leading to an online option were utilised. 50 surveys were randomly selected for inclusion. Quantitative data was analysed via paper count method and thematic analysis was completed for the qualitative data.

Results

74% rated the service as “excellent”, 22% “very good” and 4% “good”. Alternative options to the service were identified as “going to ED” 22% , “going to GP” 22%, “waited until they would get better” 4%, “waited until they got worse” 2%, “would do nothing” 6%. 80% rated the combined expertise of a doctor and OT as “extremely important”, 94% rated the home visit aspect as “extremely important” and 90% rated ED avoidance as “extremely important”. Key themes that emerged regarding what the service does well included “personalised care”, “ED avoidance”, “compassion” and “timeliness of service”. Areas for improvement included “improving communication loop to both patients and/or community services! and “ability to directly access the service”. 95% of respondents advised they would or have already recommended the service to others. Of note, a key theme in the comments section was the need for a similar service in other hospitals.

Conclusion

The EDITH service appears to be meeting stake-holders expectations, areas for improvement have been identified and are currently being addressed. It is imperative to obtain the perception of the service user and to tailor interventions accordingly, this feedback is invaluable in order to meet future service needs.

228 LONG TERM OUTCOMES FOR FALLS PATIENTS WHO WERE TREATED BY THE EDITH (EMERGENCY DEPARTMENT IN THE HOME) SERVICE

Background

The EDITH service provides an alternative to an ED attendance for the older adult. Medical treatment and Occupational Therapy (OT) assessment take place within the patient’s home. Patients who experience an explained fall are routinely treated by the EDITH service, these patients receive OT falls prevention and home environment assessment as standard. It is imperative to assess the long-term outcomes for these patients in order to inform future service provision.

Methods

A total of 40 patients, who were referred following an explained fall to the EDITH service and remained at home following assessment, were selected for audit. These patients were seen over a 2-month period in 2021. Data were gathered with regards to ED presentations via healthcare records and mortality rates were captured via RIP.ie

Results

At 3 months, 4 patients had re-presented to ED with a fall and 3 required admission. At 6 months, 6 patients re-presented to ED with a fall with 5 requiring admission. At 9 months, 4 patients re-presented to ED with a fall and 3 required admission. 100% of patients had an OT home environment assessment and received advice regarding falls prevention. The average age of patient was 84 years. At 1 year, the mortality rate for this patient group was 10%.

Conclusion

Patients with explained falls that were treated by the EDITH service appear to have a reasonably low ED re-attendance rate at 3, 6 and 9 months for explained falls. This may be as a result of the tailored falls prevention education/home environment assessment that took place within the patient’s home by the OT. However further audit and a larger population group would be required to suggest a definite correlation between same.

157 STAFF MEMBERS’ PERSPECTIVES OF HOW TO INCREASE DEMENTIA-FRIENDLINESS IN AN ACUTE IRISH HOSPITAL SETTING

Background

Key principles from The Irish National Dementia Strategy promote accessibility and ease of understanding for those with dementia. Those who provide services and care to people with dementia have a key role to play in identifying gaps in existing service provision. Reduced compliance with National dementia guidelines and overall reduced dementia-friendliness were noted in a hospital-wide audit. It is imperative to seek opinions from those providing direct care to dementia patients on how we can improve dementia-friendliness at a service level.

Methods

Random selection was used to distribute staff questionnaires. An open-ended question was used to gather their perceptions on how this hospital can improve its dementia-friendliness at a service level.

Results

Forty-seven suggestions were collated across the hospital. Thematic analysis identified 11 different themes; increased staffing, environmental changes, the introduction of dedicated day rooms, increased signage, and introduction of activity boxes were the most common suggestions (68% of answers). Other suggestions included use of sensory items, increased staff education, orientation boxes and improved communication with patients.

Conclusion

Healthcare workers have an important role in driving and implementing changes in healthcare settings. Collating staff members’ perceptions of improving dementia-friendliness is invaluable given their role in providing services to people with dementia. Implementation of the above-mentioned changes must be explored in order to increase dementia-friendliness, to maintain high-quality service provision, and to ensure compliance with National standards.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Tick-borne Encephalitis Identified in Ireland: Diagnosis and Outcome

Presentation Tick borne encephalitis (TBE) is not endemic in Ireland and diagnostic tests are seldom requested. We describe the first notified case in Ireland. A 50-year-old female returned from Lithuania and presented with fever and new neurologic signs. Diagnosis TBE was diagnosed by detection of TBE virus specific antibodies in serum and cerebrospinal fluid (CSF). Treatment The patient was managed with observation and supportive care consisting of intravenous fluids and analgesia. Discussion The case highlights the importance of awareness of TBE among physicians and travellers to guide appropriate testing and vaccination. TBE is being recognised in non-endemic countries posing an emerging risk to public health.

Pompholyx as a side effect of intravenous immunoglobulin (IVIg)

Intravenous immunoglobulin (IVIg) is increasingly used across multiple specialties for the treatment of inflammatory and autoimmune diseases. Cutaneous reactions to IVIg are generally minor. Pompholyx is a common eruption of small vesicles on the palms, soles, and/or lateral aspects of the fingers. It has a multifactorial aetiology but is rarely attributed to being a drug-related side effect. We describe a 43-year-old woman presenting with peripheral sensory neuropathy who developed pompholyx eczema on both palms following treatment with IVIg.

Escharotic agents: a Victorian remedy in the 21st century

A 72-year-old woman had a warty growth 'burnt off' with a herbal remedy by a local farmer in rural Ireland. We saw the patient a number of years later in clinic and she brought the specimen with her, which was processed by the pathology department. We report her case and some interesting background information regarding escharotic agents.

145 EDITH (EMERGENCY DEPARTMENT IN THE HOME): FACTORS THAT INFLUENCE CONVEYANCE RATES TO HOSPITAL

Background

The EDITH team has provided an alternative care pathway for older adults in need of emergency services. Patients are attended to by a doctor and Occupational Therapist in their own home as an alternative to an emergency department presentation. The conveyance rate for transfers to hospital is 7.2% of total patients treated by the EDITH service. It is imperative to identify this patient group and look for commonalities in same. This assists with service planning and also identifies high risk patients who may need transfer to hospital; thus ensuring patients are prioritised appropriately within the service.

Methods

Following an audit of a subsample (n = 230) of the entire EDITH patient population (3,137 patients), 26 patients were transferred to hospital. Analysis of the Health Care Record was completed to identify similarities in this population group and compare same with the ‘typical patient profile’.

Results

It was found that 38% of patients had a recent ED presentation (in the past month) and 31% had a prolonged hospital stay (> 2 weeks in past year). 57% had a documented change in functional baseline over past 2 weeks. 46% of patients were transferred to level 4 acute hospitals for medical follow up and 54% were transferred to level 3 hospitals or rehabilitation facilities for MDT input. 77% of patients had a Clinical Frailty Scale score of 6 and above (moderately frail) compared with 62% of the non-conveyance population. Presenting complaints included: falls 35%, respiratory issues 12%, pain management 12%, gastrointestinal issues 12%.

Conclusion

Risk factors for conveyance to hospital for EDITH patients have been identified. This knowledge can potentially be used to triage patients and ensure timely review from EDITH for this high risk patient group.

215 WHAT IMPACT CAN ‘EMERGENCY DEPARTMENT IN THE HOME’ (EDITH) HAVE ON THE OLDER ADULT POPULATION PRESENTING WITH FALLS?

Background

EDITH is a frailty response service providing medical and occupational therapy input to older adults living within the catchment area of a level 4 acute hospital. EDITH aims to reduce avoidable Emergency Department (ED) attendances and utilise alternative care pathways. Falls are common among older people and are often associated with poorer outcomes. Traditionally, older patients who have had a fall and contact emergency services for assistance are transferred to the ED and this can be associated with elevated risks. Additionally, older patients who have had a fall and are discharged on scene by the emergency services are at greater risk of recurring falls in the absence of immediate onward referral to community falls prevention services (Nowak and Hubbard 2009).

Methods

Paper count method data collection was completed. Inclusion criteria included referrals from the National Ambulance Service within the last 6 months.

Results

75 patients met the inclusion criteria; 34 males, 41 females with an average age of 82. 11 patients were conveyed to hospital, giving a conveyance rate of 14.6%, the average conveyance rate for the EDITH service is 7.2%. 3 patients were conveyed to ED, while 8 patients were conveyed to the Medical Assessment Unit (MAU) in the local level 3 hospital. This resulted in 72% of patients that required hospital conveyance being streamed to the MAU; traditionally 100% of these patients would have presented to ED. Overall, 85.4% of patients seen remained at home.

Conclusion

EDITH are providing targeted medical and occupational therapy assessment(s) for older adults in their homes with successful outcomes. Implementation of alternative care pathways, reduction in avoidable ED attendances and prolonged independence in the home for this patient profile are some of the favourable findings.

Reference

1. Nowak A, Hubbard RE. (2009) Falls and frailty: lessons from complex systems. Journal of the Royal Society of Medicine. 102(3):98–102.

106 EDITH (EMERGENCY DEPARTMENT IN THE HOME): AN 18 MONTH AUDIT OF A NOVEL SERVICE

Background

The EDITH team has provided an alternative care pathway for older adults in need of emergency services. The traditional model, which involved the transport of an older adult to an emergency department has been replaced with emergency care that takes place in the persons’ home. The EDITH service provides both medical and Occupational Therapy assessment and intervention in the home environment with onward referrals to appropriate agencies as indicated, thus negating the need for an emergency department presentation.

Methods

Data from electronic patient records and OT logbooks were audited from the period 22/02/20 to 09/08/21. Data was gathered regarding attendances, outcomes and conveyance rates.

Results

Since its’ inception the EDITH service has treated 3,137 patients. Following treatment, 2,909 patients remained at home while 228 patients were transferred to hospital. This gives a conveyance rate of 7.2%. Three hundred and thirty six patients were referred to primary care or day hospital services. The average age of patients is 82 years and the average Manchester Triage category is priority 4. The EDITH service has saved the hospital 7.9 years of bed days (2,909 bed days) as these patients have not presented to the emergency department.

Conclusion

There is a growing body of evidence highlighting the detrimental impact a hospitalisation can have on an older adult (Mudge et al., 2019). There is a clear need for health care services to diversify in order to meet the needs of this ageing population. The EDITH service is leading this change in Irish healthcare by providing specialised emergency care and OT intervention for the older adult in their own homes.

Reference

1. Mudge et al. (2019). Hospital-Associated Complications of Older People: A Proposed Multicomponent Outcome for Acute Care. Journal of the American Geriatrics Society. 67(2).

107 EMERGENCY DEPARTMENT IN THE HOME, WHO IS THE EDITH PATIENT?

Background

The EDITH team has provided an alternative care pathway for older adults in need of emergency services. This vulnerable patient population receive emergency medical and occupational therapy treatment and intervention in their home environment. The typical patient profile is assumed to be ‘frail older adults’, but this needs to be more specifically defined within the clinical practice in EDITH.

Methods

A total of 230 electronic patient records were selected at random. Data was audited and analysed with regard to clinical descriptors for this patient population.

Results

Of the 230 patients treated, 26 were referred to hospital or rehabilitation facilities. This is a conveyance rate of 11% which is above the average rate of 7.2% for this service.

The Rockwood Clinical Frailty Scale (CFS): 22% had a CFS of 5 (mildly frail), 37% had a CFS of 6 (moderately frail), 22% had a CFS of 7 (severely frail), 3% had a CFS of 8 (very severely frail).

Living Status: 26% living alone, 48% living with family, 4% sheltered living accommodation and 22% in nursing homes.

Formal Supports: 37% have no formal supports, 18% have <10 hours per week, 19% have between 11–21 hours, 4% have 24-hour care and 22% reside in nursing homes.

Presenting complaint: 41% medically unwell, 23% fall, 14% functional decline, 9% pain, 5% infection, 5% orthopaedic and 2% confusion.

Ages range from 61 years to 100 years with an average age of 82 years.

Conclusion

It is imperative to identify the type of patient that uses this service, in order to plan for future service needs and ensure their current clinical care needs are being met. Of note, a significant proportion of patients are living alone, have high CFS scores and have no formal supports in situ.

Mindfulness-Based Compassion Training for Health Professionals Providing End-of-Life Care: Impact, Feasibility, and Acceptability

Background: Health professionals who care for patients and their families at the end of life (EOL) may experience gratitude, and enhanced spirituality and meaning in life, yet they are also at increased risk of psychological distress, compassion fatigue, and occupational burnout given the stressors they encounter in their work. Objectives: This research evaluated the feasibility and acceptability of a novel six-week mindfulness-based compassion training intervention, which was tailored to health professionals involved in EOL care ("MBCT4HP"), and explored its impact on levels of psychological distress, compassion fatigue, compassion satisfaction, occupational burnout, self-compassion, and mindfulness. Design: We adopted an observational, repeated measures pilot study. Setting/Subjects: Thirty-one health professionals participated. The intervention comprised six, weekly sessions (totaling seven hours) designed to foster compassion for self and others, including formal and informal compassion and mindfulness practices, daily home practice, and a reflective experiential pedagogy. Measurements: Validated outcome measures for anxiety, depression, and stress; compassion satisfaction, compassion fatigue (burnout, secondary traumatic stress); occupational burnout (emotional exhaustion, personal accomplishment, and depersonalization), self-compassion, and mindfulness were administered at baseline, end of intervention, and eight weeks postintervention. The feasibility and acceptability of the intervention was assessed using attendance records, home practice logs, and self-report satisfaction items. Descriptive statistics and Generalized Linear Mixed Models were used to analyze the data. Results: Participants reported that the sessions were useful, relevant, easy to understand, and that they gave them sufficient knowledge to implement the strategies learned. Levels of anxiety, compassion fatigue (burnout only), and emotional exhaustion decreased over time with some decay in effects at follow up, and levels of compassion satisfaction and self-compassion increased with time. Conclusions: The intervention was feasible and acceptable to health professionals involved in EOL care and had a positive impact on levels of anxiety, compassion fatigue (burnout), emotional exhaustion, compassion satisfaction, and self-compassion.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.