Recent Submissions

  • Barriers and Facilitators for Implementing Paediatric Telemedicine: Rapid Review of User Perspectives.

    Tully, Louise; Case, Lucinda; Arthurs, Niamh; Sorensen, Jan; Marcin, James P; O'Malley, Grace; Obesity Research and Care Group, School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland. 2W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland. 3Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland. 4Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA, United States. (Open Access Frontiers, 2021-03-17)
    Background: COVID-19 has brought to the fore an urgent need for secure information and communication technology (ICT) supported healthcare delivery, as the pertinence of infection control and social distancing continues. Telemedicine for paediatric care warrants special consideration around logistics, consent and assent, child welfare and communication that may differ to adult services. There is no systematic evidence synthesis available that outlines the implementation issues for incorporating telemedicine to paediatric services generally, or how users perceive these issues. Methods: We conducted a rapid mixed-methods evidence synthesis to identify barriers, facilitators, and documented stakeholder experiences of implementing paediatric telemedicine, to inform the pandemic response. A systematic search was undertaken by a research librarian in MEDLINE for relevant studies. All identified records were blind double-screened by two reviewers. Implementation-related data were extracted, and studies quality appraised using the Mixed-Methods Appraisal Tool. Qualitative findings were analysed thematically and then mapped to the Consolidated Framework for Implementation Research. Quantitative findings about barriers and facilitators for implementation were narratively synthesised. Results: We identified 27 eligible studies (19 quantitative; 5 mixed-methods, 3 qualitative). Important challenges highlighted from the perspective of the healthcare providers included issues with ICT proficiency, lack of confidence in the quality/reliability of the technology, connectivity issues, concerns around legal issues, increased administrative burden and/or fear of inability to conduct thorough examinations with reliance on subjective descriptions. Facilitators included clear dissemination of the aims of ICT services, involvement of staff throughout planning and implementation, sufficient training, and cultivation of telemedicine champions. Families often expressed preference for in-person visits but those who had tried tele-consultations, lived far from clinics, or perceived increased convenience with technology considered telemedicine more favourably. Concerns from parents included the responsibility of describing their child's condition in the absence of an in-person examination. Discussion: Healthcare providers and families who have experienced tele-consultations generally report high satisfaction and usability for such services. The use of ICT to facilitate paediatric healthcare consultations is feasible for certain clinical encounters and can work well with appropriate planning and quality facilities in place.
  • Pediatric Weight Management Through mHealth Compared to Face-to-Face Care: Cost Analysis of a Randomized Control Trial.

    Tully, Louise; Sorensen, Jan; O'Malley, Grace; Obesity Research and Care Group, Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland. 2Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland. 3W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland. #Contributed equally. (JMIR Publications, 2021-09-14)
    Background: Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions. Objective: We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT). Methods: A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant. Results: In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at €142 (SD 23.7), whereas the cost per adolescent in the mHealth group was €722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was $1=€0.7525. The costs incurred for those who withdrew from the study ranged from €35 to €681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at €59,046 using the assessed approach. Conclusions: This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective. Trial registration: ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855.
  • Using genomics to examine the persistence of Streptococcus pneumoniae serotype 19A in Ireland and the emergence of a sub-clade associated with vaccine failures.

    Corcoran, M; Mereckiene, J; Cotter, S; Murchan, S; Lo, S W; McGee, L; Breiman, R F; Cunney, R; Humphreys, H; Bentley, S D; et al. (Elsevier, 2021-07-21)
    Background: Streptococcus pneumoniae serotype 19A remains a significant cause of invasive pneumococcal disease (IPD) in Ireland despite the successful introduction of a 13-valent pneumococcal conjugate vaccine (PCV13) in 2010 which reduced the overall incidence of IPD in children. Methods: Invasive Streptococcus pneumoniae serotype 19A isolates from the Irish reference laboratory between 2007-08 and 2017-18 were analysed using whole genome sequencing (WGS) to investigate the persistence of this vaccine-preventable serotype. We compared the entire national 19A collection to other international collections using a standardised nomenclature of Global Pneumococcal Sequencing Clusters (GPSC). Results: Expansion of GPSCs and clonal complexes (CCs) may have been associated with vaccine introduction and antimicrobial prescribing policies. A sub-clade of GPSC1-CC320 (n = 25) unique to Ireland, included five of the ten vaccine failures/breakthrough cases identified (p = 0.0086). This sub-clade was not observed in a global GPSC1-CC320 collection. All isolates within the sub-clade (n = 25) contained a galE gene variant rarely observed in a global pneumococcal collection (n = 37/13454, p < 0.001) nor within GPSC1-CC320 (n = 19/227) (p < 0.001). The sub-clade was estimated to have emerged at the start of the PCV-vaccine era (ancestral origin 2000, range 1995-2004) and expanded in Ireland, with most isolated after PCV13 introduction (n = 24/25). Conclusions: The identification of a sub-clade/variant of serotype 19A highlights the benefit of using WGS to analyse genotypes associated with persistence of a preventable serotype of S. pneumoniae. Particularly as this sub-clade identified was more likely to be associated with IPD in vaccinated children than other 19A genotypes. It is possible that changes to the galE gene, which is involved in capsule production but outside of the capsular polysaccharide biosynthesis locus, may affect bacterial persistence within the population. Discrete changes associated with vaccine-serotype persistence should be further investigated and may inform vaccine strategies.
  • NMIC Bulletin Sept 2020, Vol 26 No 2: Useful Medicines information resources for Healthcare Professionals

    National Medicines Information Centre (National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2020-09)
    Bulletin
  • NMIC bulletin Dec 2020, Vol 26; No. 3: Drug Interactions (1) – General Principles

    National Medicines Information Centre (National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2020-12)
    Bulletin
  • Haematological parameters and coagulation in umbilical cord blood following COVID-19 infection in pregnancy.

    Murphy, Claire A; O'Reilly, Daniel P; Edebiri, Osasere; Weiss, Luisa; Cullivan, Sarah; EL-Khuffash, Afif; Doyle, Emma; Donnelly, Jennifer C; Malone, Fergal D; Ferguson, Wendy; et al. (Elsevier, 2021-09-21)
    Objective: The aim of this study was to evaluate infants, born to women with SARS-CoV-2 detected during pregnancy, for evidence of haematological abnormalities or hypercoagulability in umbilical cord blood. Study design: This was a prospective observational case-control study of infants born to women who had SARS-CoV-2 RNA detected by PCR at any time during their pregnancy (n = 15). The study was carried out in a Tertiary University Maternity Hospital (8,500 deliveries/year) in Ireland. This study was approved by the Hospital Research Ethics Committee and written consent was obtained. Umbilical cord blood samples were collected at delivery, full blood count and Calibrated Automated Thrombography were performed. Demographics and clinical outcomes were recorded. Healthy term infants, previously recruited as controls to a larger study prior to the outbreak of COVID-19, were the historical control population (n = 10). Results: Infants born to women with SARS-CoV-2 had similar growth parameters (birth weight 3600 g v 3680 g, p = 0.83) and clinical outcomes to healthy controls, such as need for resuscitation at birth (2 (13.3%) v 1 (10%), p = 1.0) and NICU admission (1 (6.7%) v 2 (20%), p = 0.54). Haematological parameters (Haemoglobin, platelet, white cell and lymphocyte counts) in the COVID-19 group were all within normal neonatal reference ranges. Calibrated Automated Thrombography revealed no differences in any thrombin generation parameters (lag time (p = 0.92), endogenous thrombin potential (p = 0.24), peak thrombin (p = 0.44), time to peak thrombin (p = 0.94)) between the two groups. Conclusion: In this prospective study including eligible cases in a very large population of approximately 1500 women, there was no evidence of derangement of the haematological parameters or hypercoagulability in umbilical cord blood due to COVID-19. Further research is required to investigate the pathological placental changes, particularly COVID-19 placentitis and the impact of different strains of SARS-CoV-2 (particularly the B.1.1.7 and the emerging Delta variant) and the severity and timing of infection on the developing fetus.
  • Therapeutics Today September 2020

    National Medicines Information Centre; St James's Hospital (National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2020-09)
    Newsletter
  • Therapeutics Today July 2021 Number 7

    National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2021-07
    Newsletter
  • Therapeutics Today January 2021 Number 1

    National Medicines Information Centre (National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2021-01)
    NewSLETTER
  • Therapeutics Today February 2021 Number 2

    National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2021-02
    Newsletter
  • Therapeutics Today August 2021 Number 8

    National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2021-08
    Newsletter
  • Therapeutics Today June 2021 Number 6

    National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2021-06
    Newsletter
  • Therapeutics Today September 2021 Number 9

    National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2021-09
    Newsletter
  • Therapeutics Today April 2021 Number 4

    National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2021-04
    Newsletter
  • Therapeutics Today March 2021 Number 3

    National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2021-03
    Newsletter
  • Therapeutics Today December 2020 Number 12

    National Medicines Information Centre (National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2020-12)
    Newsletter
  • Therapeutics Today May 2021 Number 5

    National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2021-05
    Newsletter
  • Therapeutics Today November 2020

    National Medicines Information Centre (2020-11)
    Newsletter
  • Therapeutics Today October 2020

    National Medicines Information Centre (National Medicines Information Centre, St James's Hospital (SJ) Dublin 8, 2020-10)
    Newsletter

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