Initial Part Research Articles

Inovasi Kebijakan Publik Melalui Aplikasi Terintegrasi

This research aims to analyze the implementation of public policies through integrated applications, with a case study on the Samarinda Integrated Application (SANTER). The SANTER application is part of the Samarinda City Government's initiative to realize the smart city concept, which aims to improve the efficiency of public services, strengthen transparency, and facilitate interaction between the government and the community. This study uses Edward III's theory of public policy implementation, which includes four main elements: communication, resources, disposition, and bureaucratic structure. The analysis was conducted by collecting secondary data from annual reports, user satisfaction surveys, and news articles related to the implementation of the SANTER application. The results show that effective communication between the government, policy implementers, and the community is crucial to the success of this application. Adequate human resources and technology are also key factors, although there are still challenges in terms of limited resources at the sub-district and village levels. The disposition or attitude and commitment of public officials towards the SANTER application is very positive, as demonstrated by the full support of the mayor and heads of relevant agencies. An efficient bureaucratic structure and good coordination between agencies also played an important role in the implementation of this application.

Integrating community health workers into HIV care clinics: a qualitative study with health system leaders and clinicians in the Southern United States

BackgroundCommunity health workers (CHWs) can support patient engagement in care for a variety of health conditions, including HIV. This paper reports on the experiences of HIV clinics and health departments that integrated CHWs into their health systems as part of a capacity-building initiative to address HIV-related disparities in the United States.MethodsSemi-structured interviews were conducted with key informants (n = 14) in two Ryan White HIV/AIDS program jurisdictions: Mississippi (jurisdiction covers the entire state) and the city of New Orleans, Louisiana. This work was part of a larger evaluation of an initiative that used a Learning Collaborative model to facilitate the implementation of evidence-informed interventions to address HIV care continuum gaps in four jurisdictions. The two jurisdictions that focused on integrating CHWs into HIV care clinics and support service agencies were selected for this sub-analysis. Interview participants included HIV clinic leaders and staff, health department leaders, and other Learning Collaborative leaders. Interview transcripts were coded and analyzed for themes related to the acceptability, feasibility, and perceived impact of CHW integration.ResultsOverall, participants expressed interest in having support from CHWs at HIV clinics and service agencies to assist with patient retention and engagement efforts. However, there were challenges integrating CHWs into existing systems (e.g., gaining access to electronic health records, changing policies to conduct home visits, and clarifying roles and scope of work). Negotiating contracts and accessing funding for CHW positions presented major challenges that often contributed to turnover and conflicts around scope of practice. When health departments leveraged existing funding streams to support CHW positions, the clinics and agencies where the CHWs worked had limited flexibility over the hiring process.ConclusionsOur findings reinforce the value and acceptability of CHWs as part of the workforce in HIV clinical and support service settings; however, integrating CHWs into clinics and service agencies required effort. Training the CHWs was not sufficient; other staff and clinicians had to understand the role of CHWs to facilitate their integration into health systems. Resources are needed to support organizations in incorporating CHWs effectively, and long-term, flexible sources of funding are necessary for these positions.

Topographic and Geodetic Survey for Samarkand's Administrative Boundaries

General Background: Administrative and territorial boundary delineation is vital in the effective governance and economic planning of urban regions globally, with digital technologies increasingly integrated into these processes for accuracy and efficiency. Specific Background: In Uzbekistan, the city of Samarkand’s administrative boundaries are undergoing significant realignment as part of a broader initiative to incorporate strategic urban centers and enable digital land management across administrative zones. Knowledge Gap: Existing methods lack precise integration with digital geospatial frameworks, leaving a gap in high-resolution topographic data essential for clear administrative delineation. Aims: This study seeks to develop and apply an accurate, digitally supported methodology for determining the boundaries of Samarkand's administrative units using advanced geodetic and topographic techniques. Results: By utilizing the CREDO DAT program, this study achieved precise boundary coordinates through the automated processing of survey points, and further analysis was conducted using the Panorama program for detailed map orientation. Novelty: This research presents a unique approach by integrating CREDO DAT with geospatial tools in administrative boundary demarcation, enabling accurate and reproducible results that surpass traditional methods in efficiency and scalability. Implications: The findings support the strategic planning of Samarkand’s infrastructure and resource allocation while also laying the groundwork for applying similar methodologies in other urban regions, advancing Uzbekistan’s digital transformation efforts in land management.Highlights: Digital tools enhance accuracy in administrative boundary mapping. CREDO DAT and Panorama software streamline data processing for precise mapping. This method supports effective urban planning and resource management in Samarkand. Keywords: Administrative Zones, Border, Territory, District, City

Loneliness and Social Isolation in Older Adults in Latvia and Iceland During COVID-19

Abstract Background The COVID-19 pandemic has significantly impacted the mental health and wellbeing of older populations across Europe, exacerbating feelings of loneliness and social isolation, known risk factors for poor physical and mental health outcomes. This study aims to understand the extent and implications of these changes in Latvia and Iceland, providing essential insights for targeted public health interventions. Methods This comparative study utilized data from two key sources: the Survey of Health, Ageing, and Retirement in Europe (SHARE) for Latvia and the HL20 study for Iceland, focusing on individuals aged 67 and above. Both quantitative surveys were conducted during the pandemic, offering data on health status, loneliness, and social isolation. A novel approach was applied in analyzing older populations to standardize comparisons between the two distinct datasets. This methodological innovation is part of a bilateral EEA initiative FM2021/23 aimed at strengthening research collaboration between Latvia and Iceland. Descriptive statistics and the Pearson Chi-square test were used to compare outcomes between the two countries and within demographic subgroups. Results The study revealed stark differences between the two countries: 80% of Latvian older adults reported social isolation compared to 42.7% in Iceland. Similarly, 45% of Latvians experienced loneliness versus 30% of Icelanders. Significant associations were found between social isolation, loneliness, and deteriorating mental and physical health, with worse outcomes noted in socially isolated individuals. Conclusions Our findings demonstrate a clear link between social isolation and adverse health outcomes among the older adults, exacerbated by the COVID-19 pandemic. The study supports the need for proactive public health measures in Latvia and Iceland, including the development of community engagement programs and mental health support services tailored to the needs of older adults. Key messages • Study shows significant health impact of social isolation among older adults in Latvia and Iceland, highlighting urgent need for targeted public health interventions. • Effective public health strategies and innovative digital outreach can mitigate adverse effects of loneliness and isolation observed in older populations.

Versatile video assignment improves undergraduates’ learning and confidence

This mixed methods study examines an explanatory video assignment designed to operationalize contemporary theory about cognition, metacognition, and inclusive teaching. This project grew from a professional learning community of post-doctoral teaching fellows who were involved in course redesign as part of a campus-wide active learning initiative. A team of pedagogical experts, teaching fellows, and faculty designed this video assignment to increase opportunities for students to share their perspectives while practicing a powerful learning strategy. Instructional teams implemented different versions of the video assignment in three courses across two departments. An experimental research component isolated the impact of the assignment on learning and confidence, and a mix of quantitative and qualitative analyses provided evidence about students’ experiences with the assignment. We found that students expressed learning and confidence gains beyond those due to typical course activities. Qualitative evidence suggested that students experienced the assignment as valuable for their learning and that the assignment enhanced self-expression. The assignment was effective in both face-to-face and remote settings, implemented either as a course requirement or extra-credit option. This versatile video assignment presents a practical way to enrich the student experience.

The Effects of Comprehensive and Coordinated Tier 1 Classroom Reading Instruction Implemented within a Multi-Tiered System of Support (MTSS) Framework as Part of a State Reading Initiative

The Effects of Comprehensive and Coordinated Tier 1 Classroom Reading Instruction Implemented within a Multi-Tiered System of Support (MTSS) Framework as Part of a State Reading Initiative

Digital Rupiah as An Alternative Digital Transaction in Indonesia

Digitalization in the financial industry revolutionized the transaction system with the emergence of Cryptography-based Digital Currencies. It has recently evolved into digital currencies issued by central banks, known as Central Bank Digital Currency (CBDC). Bank Indonesia responds by developing a plan to release Digital Rupiah as part of the digital transformation initiative in the national payment system. This study aims to determine the authors' interest in discussing Indonesia's CBDC as seen through article publication trends. This research uses the systematic literature review (SLR) method. The results show that there is an increasing trend in the publication of articles on Digital Rupiah. The published articles discuss Digital Rupiah from various sides such as legality, implementation mechanism, challenges opportunities and impacts, to its potential implementation.

Clinical implementation of the Validated Intraoperative Bleeding Scale: Perioperative patient management and effective team communication from the nurses' perspective.

Major bleeding represents a critical scenario that can quickly evolve into life threatening, thereby compromising patient safety. A Validated Intraoperative Bleeding Scale called VIBe Scale was introduced and studied as part of a quality improvement initiative. This study evaluated the clinical implementation of the VIBe Scale in perioperative patient management and team communication from the nurses' perspectives. A descriptive study was undertaken, incorporating introductory lecture, simulation of major bleeding event and post-lecture questionnaire with 33 operating room nurses. Despite many participants not previously having experience of the VIBe Scale in practice, over two-thirds reported the scale could improve situational awareness. Furthermore, nearly two-thirds reported they could see the utility of the VIBe Scale as a tool to improve communication. Our study shows that the VIBe Scale is an easily understood concept, has the potential to increase situational awareness and can support team communication around intraoperative bleeding events.

Using the IFASIS (Inventory of Factors Affecting Successful Implementation and Sustainment) to Advance Context-Specific and Generalizable Knowledge of Implementation Determinants: Case Study of a Digital Contingency Management Platform.

Background Contingency management (CM) is the most effective treatment for stimulant use disorder but is underutilized by opioid treatment programs (OTPs), despite the high prevalence of stimulant use in this setting. As part of a state-wide initiative, we piloted a novel assessment, the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS), to examine determinants of implementation of a digital CM platform across a set of OTPs. We describe how the IFASIS was used to elucidate both generalizable and context-specific implementation determinants, and to guide the provision of implementation facilitation. Methods Six OTPs received a multi-level implementation strategy (including facilitation) to promote programmatic uptake of a digital CM platform. Pre-implementation, OTPs completed the IFASIS, a 27-item questionnaire that assesses both the valence (positive/negative) and importance of determinants across 4 domains: outside the organization, within the organization, about the intervention, and about intervention recipients. OTP staff completed the IFASIS as a team, identifying consensus ratings during recorded discussions. Transcripts of IFASIS recordings were analyzed using rapid qualitative analysis. Quantitative IFASIS results were aggregated into medians and ranges within and across organizations. Implementation facilitation meeting notes were analyzed to examine how the IFASIS was used to guide facilitation. Results Quantitative ratings and qualitative feedback revealed common barriers to implementation of the digital CM platform, including a lack of sustainable funding sources, absence of external and organizational policies, insufficient higher-level leadership support, and mixed attitudes among staff members toward CM. Common implementation facilitators included enthusiasm and commitment among organization leadership and the perception that the digital CM platform would reduce the workload and burden on OTP counselors. The IFASIS was used to guide facilitation in several ways, including stimulating discussion about barriers and facilitators, brainstorming strategies to address barriers rated as "very important", and identifying facilitators that could be harnessed as part of implementation efforts. Conclusions The IFASIS identified important determinants of CM implementation in OTPs and was instrumental in shaping facilitation. The IFASIS may be a valuable assessment for the implementation science community to identify and address generalizable and context-specific implementation determinants.

Reduced muscle mass is an important part of Global Leadership Initiative on Malnutrition criteria in nutritional diagnosis of hepatocellular carcinoma

BackgroundThe Global Leadership Initiative on Malnutrition criteria (GLIM) was established to build a global consensus on the diagnostic criteria for malnutrition. The study aimed to assess the prevalence of the malnutrition diagnosed by GLIM criteria for patients with hepatocellular carcinoma (HCC), and to determine the role of the reduced muscle mass defined by CT scans in the GLIM criteria.MethodsThis cohort research was conducted on adult cirrhotic patients with HCC. The risk of malnutrition was screened by Nutritional Risk Screening 2002 (NRS-2002), and malnutrition was diagnosed by GLIM criteria. The third lumbar vertebrae (L3-SMI) were used to represent the muscle mass in GLIM criteria. The variables associated with overall mortality were assessed by multivariate Cox regression analyses.ResultsThe incidence of malnutrition diagnosed by GLIM criteria was 49.7% (179/360) in patients with HCC. If reduced muscle mass was not included in GLIM criteria, the prevalence of malnutrition was 31.7% (114/360). GLIM-defined malnutrition (HR = 1.979, 95%CI 1.019–3.841, P = 0.044) was independently associated with overall mortality in patients with HCC. However, the GLIM-defined malnutrition (without muscle mass) was not associated with overall mortality (HR = 0.863, 95%CI 0.399–1.867, P = 0.709).ConclusionsSkeletal muscle mass is an integral component of the GLIM criteria for patients with HCC. The malnutrition is common in patients with HCC, and malnourishment is associated with higher overall mortality. GLIM criteria are recommended to assess the nutritional status of hospitalized patients with HCC, which is recommended and can be used as the basis for nutritional interventions.

Analysis of fatigue fracture mechanism of laser spiral welding of dissimilar metals of 6082 high strength aluminum alloy and DP980 high strength dual phase steel

This paper investigates the relationship between weld quality, influencing factors, microstructure and mechanical properties of laser spiral dissimilarity welding of 6082 high-strength aluminum alloy and DP980 high-strength dual-phase steel, focusing on the fatigue properties and fracture mechanism of 6082-DP980 dissimilar metal welded joints. The research shows that intermetallic compound layers (IMCs) dominate the fatigue crack initiation stage and part of the crack extension stage, two fatigue crack initiation modes are obtained, one is the main crack initiation mode along the FeAl and FeAl2 interlayer, and the other is the secondary crack initiation mode along the Fe3Al and FeAl interlayer. In the crack propagation stage, due to the diffusion of Fe and Al elements generated by IMCs during the welding process, solid solution strengthening, intergranular strengthening and grain boundary strengthening, in the fatigue crack propagation stage formed a hardened zone, hindering the main crack to continue to expand along the IMCs, the main crack shifted to the expansion of the 6082 base material, thus extending the fatigue life.

Guideline concordance of aspirin use for primary prevention in adult outpatients

AbstractRecent guidelines have recommended a reduced role for primary prevention aspirin use, which is associated with an increased bleeding risk. This study aimed to characterize guideline-discordant aspirin use among adults in a community care setting. As part of a quality improvement initiative, patients at 1 internal medicine and 1 family medicine clinic affiliated with an academic hospital were sent an electronic survey. Patients were included if they were at least 40 years old, had a primary care provider at the specified site, and were seen in the last year. Patients were excluded if they had an indication for aspirin other than primary prevention. Responses were collected from 15 February to 16 March 2022. Analyses were performed to identify predictors of primary prevention aspirin use and predictors of guideline-discordant aspirin use; aspirin users and nonusers were compared using Fisher exact test, independent samples t tests, and multivariable logistic regression. Of the 1460 patients sent a survey, 668 (45.8%) responded. Of the respondents, 132 (24.1%) reported aspirin use that was confirmed to be for primary prevention. Overall, 46.2% to 58.3% of primary prevention aspirin users were potentially taking aspirin, contrary to the guideline recommendations. Predictors of discordant aspirin use included a history of diabetes mellitus and medication initiation by a primary care provider. In conclusion, primary prevention aspirin use may be overutilized and discordant with recent guideline recommendations for approximately half of the patients, suggesting a need for aspirin deimplementation. These efforts may be best focused at the primary care level.

Integrating ethics and democratic principles in chemistry education: a case study

Abstract This study presents a novel approach to integrating ethics and core values into chemistry education through the module “Culture of Democracy Through the Didactics of Chemistry.” Developed as part of a broader initiative aimed at educating future teachers for democracy and human rights, this module explores the ethical dimensions of chemical knowledge and its social and environmental impact. Utilizing the Council of Europe’s Reference Framework of Competences for Democratic Culture, it introduces pre-service teachers to concepts such as responsibility, human dignity, and the rule of law. The module involved six pre-service teachers and two schoolteacher-mentors. Key activities included student-led discussions, such as exploring personal responsibility and moral dilemmas in chemistry, exemplified by the Heinz dilemma, and engaging in discourse on the possibility of breaking a law for morally justifiable reasons to comprehend the delicate balance between legal duties and moral responsibilities. Through reflective exercises and collaborative learning, pre-service teachers engage critically with the ethical implications of their future profession. Initial feedback highlights the value of integrating ethical discussions into chemistry education, fostering deeper reflection and a sense of responsibility among pre-service teachers. The study provides a valuable framework for educators integrating ethics into science curricula, fostering responsible chemistry practice aligned with social values.

Socioeconomic and demographic factors predictive of same day access utilization in outpatient radiation oncology.

Access to medical care extends to not only the timely and appropriate receipt of services but also addresses inclusivity and underlying determinants of health. Given that patients from disadvantaged backgrounds have been shown to be more likely to experience delays in care, a same day access scheduling initiative was proposed to address this equity issue. Therefore, this study aims to evaluate our experience, focusing on identifying socioeconomic and demographic patterns of same day access utilization. From March 2021 to January 2023, all patients referred for new consultation to a tertiary care-based radiation oncology department were offered same day appointments as part of a prospective pilot initiative. Descriptive statistics were used to identify factors predictive of utilization. On multivariate analysis, patient characteristics independently associated with higher odds of same day access utilization included low-income status ([OR]=3.70, 95% CI (1.47-6.14)) and Black or Latino race ([OR]=4.05, 95% CI: 1.72-9.11). While we were unable to acquire data on actual clinical outcomes for patients opting for same day appointments, the enthusiasm for this program was obvious. Patients from disadvantaged backgrounds and vulnerable segments of the population were more likely to elect for same day appointments. Implications on health equity are discussed. Patient-centered approaches to overcome barriers of access can potentially help ensure that care is equitable. Our findings, representing the first published data analyzing a longitudinal experience with same day appointments in oncology, strongly suggest that certain disadvantaged populations may benefit more from access initiatives.

Assessing the use of unstructured electronic health record data to identify exposure to firearm violence.

Research on firearm violence is largely limited to people who experienced acute bodily trauma and death which is readily gathered from Inpatient and Emergency Department settings and mortality data. Exposures to firearm violence, such as witnessing firearm violence or losing a loved one to firearm violence, are not routinely collected in health care. As a result, the true public health burden of firearm violence is underestimated. Clinical notes from electronic health records (EHRs) are a promising source of data that may expand our understanding of the impact of firearm violence on health. Pilot work was conducted on a sample of clinical notes to assess how firearm terms present in unstructured clinical notes as part of a larger initiative to develop a natural language processing (NLP) model to identify firearm exposure and injury in ambulatory care data. We used EHR data from 2012 to 2022 from a large multistate network of primary care and behavioral health clinics. A text string search of broad, gun-only, and shooting terms was applied to 9,598 patients with either/both an ICD-10 or an OCHIN-developed structured data field indicating exposure to firearm violence. A sample of clinical notes from 90 patients was reviewed to ascertain the meaning of terms. Among the 90 clinical patient notes, 13 (14%) notes reflect documentation of exposure to firearm violence or injury from firearms. Results from this study identified refinements that should be considered for NLP text classification. Unstructured clinical notes from primary and behavioral health clinics have potential to expand understanding of firearm violence.

Evaluating the Sabah Pay Mobile Application (e-Wallet) using the Technology Acceptance Model

The Sabah Pay e-wallet has been introduced as a digital payment solution in the state of Sabah, Malaysia, as part of a digital transformation initiative. However, there is a lack of comprehensive understanding regarding its user acceptance and the factors influencing it. Specifically, there is a need to investigate whether users perceive Sabah Pay as useful and easy to use. This research problem arises due to the importance of user acceptance in the success and sustainability of the e-wallet. Hence, we used the technology acceptance model (TAM) to analyse the perceived usefulness (PU) and customer satisfaction in using the Sabah Pay mobile application and the relationship between perceived ease of use (PEOU) and customer satisfaction using the Sabah Pay mobile application. The Cronbach's Alpha and composite reliability values are higher than 0.7, and the average variance extracted (AVE) is higher than 0.5, which supports the TAM constructs' convergence validity. The square root of AVE for each construct is higher than the corresponding correlations between constructs, which suggests the discriminant validity of the constructs. We used the Partial least squares structural equation modelling (PLS-SEM) to assess the data from the 173 respondents who reported using the Sabah Pay mobile application. We found that PU did not significantly affect customer satisfaction (CS), with a p-value of 0.207, although the path coefficient is 0.109, thus disproving the null hypothesis (H1). However, we supported the second hypothesis (H2) by observing that PEOU substantially impacted CS, with a p-value of 0.000 and a path coefficient of 0.614. The correlation indices demonstrated a satisfactory relationship between the data and the model. This research adds to the body of knowledge on mobile payment platforms by shedding light on perceived usefulness and ease of use factors that most affect users' happiness with Sabah Pay. The study suggests and identifies extensive research into potential customer satisfaction aspects like safety, trust, and value. This study's findings have real-world applications for practitioners and regulators looking to improve the mobile payment platform user experience and, by extension, boost customer happiness and adoption rates.

Transformation Pathways: Drumul Taberei Neighbourhood - a Positive Energy District?

Abstract Positive Energy Districts (PED) have surged in prominence amidst Europe’s ambitious climate targets and the fluctuating energy landscape, influenced notably by geopolitical uncertainties such as the Ukraine conflict. Aligned with European and national priorities, which emphasises the renovation of its housing stock as part of the Renovation Wave initiative, PED emerges as a viable solution for urban areas. However, the challenge remains in how PED can address energy poverty, promote renewable energy, and align with renovation priorities of the outdated infrastructures (including buildings). The KINETIC project addresses PED transformation challenges at the neighbourhood level by deploying an intensive co-creation process for identifying key transformation directions. The Romanian DEMO area (along with DK and IT study cases) is the Drumul Taberei neighbourhood in Bucharest Sector 6, a dense neighbourhood composed of multifamily buildings realised in the 60s and 70s during the communist regime. The area needs comprehensive regeneration and renewal initiatives. If proven feasible through mathematical modelled data paired with strategic integrated planning, the outcomes of KINETIC for the Drumul Taberei neighbourhood will be able to revolutionise the future rehabilitation project of collective housing districts in Romania, and beyond. The paper will outline PED transformation pathways stemming from initial co-design workshops involving local stakeholders. It will also explore collaboration and investment prospects between municipality-housing associations and NGOs. Given the privately owned housing estate and state-funded rehabilitation, the project will assess innovative models to meet PED’s ambitious goals.

Innovative Timber Upcycling: Digital Strategies for Prolonging Timber Lifespan and Promoting Reuse.

Abstract This paper explores the intersection of digital and ecological transitions, crucial for achieving the European Green Deal’s sustainability targets. The construction sector, traditionally reliant on a linear “take-make-dispose” model, is gradually integrating timber, favored for its lower environmental impact compared to steel and concrete. Our research enhances the reuse of timber from demolition sites, leveraging digital technologies to extend the lifespan of timber elements and improve its carbon sequestration capabilities. This research is part of a broader initiative, the DeDa research, at the School of Architecture and Design, University of Camerino, focusing on sustainable material management in post-disaster areas. These areas, seen as ‘material banks,’ pose unique challenges due to the abundance of materials that are difficult to manage. The research comprises three integrated phases: establishing a digital material bank of timber elements, design optimization with available elements and their automated assembly. This system is underpinned by an ecosystem of digital technologies, including photogrammetric surveying, computational design, and robotic manufacturing. Considering the currently low technological level of conventional building processes, this work maintains a highly experimental character. However, presenting this research provides an opportunity to explore how digital technologies might promote circular-based building processes and encourage a shift in perspective and practices within the building industry.

The Prevalence of Frailty Among People Experiencing Homelessness Attending a Primary Care Clinic: A Service Evaluation and Quality Improvement Initiative

Abstract Background Frailty is traditionally considered a geriatric syndrome though can present at a younger chronological age among people experiencing homelessness (PEH) due to risk factors such as poor nutrition, addiction and loneliness. Our walk-in primary care clinic for PEH has not previously recorded frailty status or prevalence among attendees, which would provide an opportunity to offer effective, evidence-based interventions. As part of a quality improvement initiative (QI), we evaluated frailty prevalence to improve our service to PEH. Methods The frailty status of adults presenting consecutively to a general practitioner at an urban, walk-in primary care clinic in Ireland dedicated to PEH was measured each Monday during a service evaluation in the first two months of 2024. Frail Scale (criteria: fatigue, resistance, ambulation, illness and weight loss; 0=robust, 1-2=pre-frail, 3-5=frail)) and the Clinical Frailty Scale (CFS) were used. Results 73 adults presented (median age 41.5), 21 female (28.8%)). 24 were frail on the Frail Scale (32.9% of total presenting), of which 4 were female (19.0% of females presenting) and 20 were male (38.5% of males presenting). 43 were pre-frail on the Frail Scale (58.9% of total presenting), of which 15 were female (71.4% of females presenting) and 28 were male (53.8% of males presenting). The median CFS was 4 (vulnerable). The most common frailty indicators were fatigue (68.5%) and weight loss (64.4%). Conclusion Frailty and pre-frailty were highly prevalent among PEH at our primary care clinic. A third were frail and over half pre-frail. The prevalence of this reversible syndrome had not previously been evaluated. Our findings underline the opportunity to improve our service by screening for frailty among PEH and offer appropriate interventions to reverse frailty and build resilience. Service evaluation and QI initiatives can enable application of research evidence and improvement of real-world clinical care.

“Addressing the Silent Need”

Abstract Background Clinical Specialist Teams (CST) are a foundational component of the Integrated Care Programme for Older Persons (ICPOP) providing care for older adults with complex needs, completing Comprehensive Geriatric Assessments (CGA) and supporting goals until outcomes are optimised (HSE, 2021). WHO (2014) estimates 400 million individuals worldwide are affected by hearing loss, with prevalence increasing with age. The WHO in 2024 recommended targeted hearing screening and interventions in older age. NICE guidelines (2023) issued specific recommendations for adults with suspected or diagnosed dementia or mild cognitive impairment (MCI). The aim of this study was to review current practice of sensory assessment with respect to these recommendations. Methods This is a retrospective audit to evaluate current practice against established standards and to identify areas for improvement to achieve best practice. This will form part of an ongoing quality improvement initiative. Data was collected using a team designed tool gathering information on sensory assessment, interventions and onward referrals. A sample of 65 ICPOP clients was chosen from the last quarter of 2023. Results Preliminary results: Conclusion Screening rates for sensory impairment in the CST is high but needs improvement to reach the target of 100%. Referral onto appropriate services for specialised sensory intervention is actioned adequately, but there is need for the CST to advise timely hearing and vision testing to clients in order to adhere to international guidelines, especially those clients with dementia/MCI.