• In-hospital training in addiction medicine: A mixed-methods study of health care provider benefits and differences.

      Gorfinkel, Lauren; Klimas, Jan; Reel, Breanne; Dong, Huiru; Ahamad, Keith; Fairgrieve, Christopher; McLean, Mark; Mead, Annabel; Nolan, Seonaid; Small, Will; et al. (2019-01-28)
      Hospital-based clinical addiction medicine training can improve knowledge of clinical care for substance-using populations. However, application of structured, self-assessment tools to evaluate differences in knowledge gained by learners who participate in such training has not yet been addressed. Participants (n = 142) of an elective with the hospital-based Addiction Medicine Consult Team (AMCT) in Vancouver, Canada, responded to an online self-evaluation survey before and immediately after the structured elective. Areas covered included substance use screening, history taking, signs and symptoms examination, withdrawal treatment, relapse prevention, nicotine use disorders, opioid use disorders, safe prescribing, and the biology of substance use disorders. A purposefully selected sample of 18 trainees were invited to participate in qualitative interviews that elicited feedback on the rotation. Of 168 invited trainees, 142 (84.5%) completed both pre- and post-rotation self-assessments between May 2015 and May 2017. Follow-up participants included medical students, residents, addiction medicine fellows, and family physicians in practice. Self-assessed knowledge of addiction medicine increased significantly post-rotation (mean difference in scores = 11.87 out of the maximum possible 63 points, standard deviation = 17.00; P < .0001). Medical students were found to have the most significant improvement in addiction knowledge (estimated mean difference = 4.43, 95% confidence interval = 0.76, 8.09; P = .018). Illustrative quotes describe the dynamics involved in the learning process among trainees. Completion of a hospital-based clinical elective was associated with improved knowledge of addiction medicine. Medical students appear to benefit more from the addiction elective with a hospital-based AMCT than other types of learners.
    • Interventions to develop collectivistic leadership in healthcare settings: a systematic review.

      De Brún, Aoife; O'Donovan, Roisin; McAuliffe, Eilish (BMC Health Services Research, 2019-01-25)
      Collective or shared leadership approaches have been associated with team performance outcomes in several sectors. Based on this evidence, there have been calls for more inclusive approaches to leadership in healthcare settings, but guidance on how to achieve collective leadership is lacking. This study synthesised knowledge of interventions to introduce collectivistic leadership in healthcare settings. The databases of PubMed, PsychInfo, ABI Inform, Cochrane and CINAHL and three grey literature databases were searched. Studies from any country were included if they reported on the development and evaluation and/or implementation of training/interventions to develop collectivistic leadership and reported individual and/or team-level outcomes. Results were synthesised using a narrative approach. The searches yielded 4448 records of which 21 met the eligibility criteria and were reviewed. Studies used a variety of interventions; eleven employed a team training approach, four described co-leadership, three explored service improvement, two detailed co-design approaches and one described an individual team development intervention. Most demonstrated moderate to good success in enabling collectivistic leadership, with benefits reported in staff engagement, satisfaction, and team performance. Whilst collectivistic leadership interventions have demonstrated positive outcomes, there is a need for more rigor and consistency in the evaluation of interventions aimed at developing collectivistic leadership approaches in health settings.
    • The Burden of Severe Lactational Mastitis in Ireland from 2006 to 2015

      Cooney, F; Petty-Saphon, N; Department of Public Health, Dr Steevens' Hospital (irish Medical Journal, 2019-01-15)
    • Integration of a recent infection testing algorithm into HIV surveillance in Ireland: improving HIV knowledge to target prevention.

      Robinson, E; Moran, J; O'Donnell, K; Hassan, J; Tuite, H; Ennis, O; Cooney, F; Nugent, E; Preston, L; O'Dea, S; et al. (Epidemiology & Infection, 2019-01-01)
    • Performing diagnostic radial access coronary angiography on uninterrupted direct oral anticoagulant therapy: a prospective analysis.

      Chongprasertpon, Napohn; Zebrauskaite, Aiste; Coughlan, John Joseph; Ibrahim, Abdalla; Arnous, Samer; Hennessy, Terence; Kiernan, Thomas John (Open Heart, 2019-01-01)
      This was a prospective observational analysis of 49 patients undergoing elective diagnostic coronary angiography while receiving uninterrupted anticoagulation with direct oral anticoagulants. This population was compared with a control group of 49 unselected patients presenting to the cardiology service for elective diagnostic coronary angiography. Continuous variables were analysed using the independent samples t-test and categorical variables using Pearson's χ2 test.
    • Physical activity programs for older people in the community receiving home care services: systematic review and meta-analysis.

      Burton, Elissa; Farrier, Kaela; Galvin, Rose; Johnson, Shanthi; Horgan, N Frances; Warters, Austin; Hill, Keith D (2019-01-01)
      The proportion of older adults is increasing around the world and most wish to live in their home until they die. To achieve this, many will require services in the home to remain living independently. To maintain function (ie, strength, balance, and endurance), physical activity needs to be undertaken on a regular basis, and is essential as a person ages. Unfortunately, as people age there is a tendency to reduce activity levels, which often leads to loss of function and frailty, and the need for home care services. This updated systematic review includes a mix of study methodologies and meta-analysis, and investigated the effectiveness of physical activity/exercise interventions for older adults receiving home care services. Eighteen studies including ten randomized controlled trials meeting the selection criteria were identified. Many of the studies were multi-factorial interventions with the majority reporting aims beyond solely trying to improve the physical function of home care clients. The meta-analysis showed limited evidence for effectiveness of physical activity for older adults receiving home care services. Future exercise/physical activity studies working with home care populations should consider focusing solely on physical improvements, and need to include a process evaluation of the intervention to gain a better understanding of the association between adherence to the exercise program and other factors influencing effectiveness.
    • Five-year standardised mortality ratios in a cohort of homeless people in Dublin

      Ivers, Jo-Hanna; Zgaga, Lina; O'Donoghue-Hynes, Bernie; Heary, Aisling; Gallwey, Brian; Barry, Joe (BMJ Open, 2019-01)
    • Adverse pregnancy outcomes and longterm risk of maternal renal disease: a systematic review and metaanalysis protocol

      Barrett, Peter M; McCarthy, Fergus P; Kublickiene, Karolina; Evans, Marie; Cormican, Sarah; Judge, Conor; Perry, Ivan J; Kublickas, Marius; Stenvinkel, Peter; Khashan, Ali S (BMJ Open, 2019)
    • Irish general practitioners' view of perinatal mental health in general practice: a qualitative study.

      Noonan, Maria; Doody, Owen; O'Regan, Andrew; Jomeen, Julie; Galvin, Rose (BMC Family Practice, 2018-12-13)
      Identification of perinatal mental health problems and effective care for women who experience them are important considering the potentially serious impact that they may have on the wellbeing of the woman, her baby, family and wider society. General practitioners (GPs) play a central role in identifying and supporting women and this study aimed to explore GPs' experiences of caring for women with perinatal mental health problems in primary care. The results of this study may provide guidance to inform policy, practice, research and development of curriculum and continuous professional development resources. In-depth semi-structured interviews were undertaken between March and June 2017 with GPs (n = 10) affiliated with a University training programme for general practice in Ireland. Thematic data analysis was guided by Braun and Clarkes (2013) framework. Data were categorised into three themes with related subthemes: identification of perinatal mental health problems, decision making around perinatal mental health and preparation for a role in perinatal mental health. GPs described the multifaceted nature of their role in supporting women experiencing perinatal mental health issues and responding to complex psychological needs. Inbuilt tools on existing software programmes prompted GPs to ask questions relating to perinatal mental health. Limited access to referral options impacts on assessment and care of women. GPs desire further continuous professional development opportunities delivered in an online format and through monthly meetings and conference sessions. GPs require access to culturally sensitive; community based perinatal mental health services, translation services and evidence based perinatal psychological interventions. A standardised curriculum on perinatal mental health for trainee GPs needs to be established to ensure consistency across primary care and GP education should incorporate rotations in community and psychiatry placements.
    • Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users.

      Klimas, Jan; Fairgrieve, Christopher; Tobin, Helen; Field, Catherine-Anne; O'Gorman, Clodagh SM; Glynn, Liam G; Keenan, Eamon; Saunders, Jean; Bury, Gerard; Dunne, Colum; et al. (2018-12-05)
      Problem alcohol use is common among people who use illicit drugs (PWID) and is associated with adverse health outcomes. It is also an important factor contributing to a poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opioid overdose in PWID. To assess the effectiveness of psychosocial interventions to reduce alcohol consumption in PWID (users of opioids and stimulants). We searched the Cochrane Drugs and Alcohol Group trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO, from inception up to August 2017, and the reference lists of eligible articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction, International Harm Reduction Association, International Conference on Alcohol Harm Reduction and American Association for the Treatment of Opioid Dependence; and 2) online registers of clinical trials: Current Controlled Trials, ClinicalTrials.gov, Center Watch and the World Health Organization International Clinical Trials Registry Platform. We included randomised controlled trials comparing psychosocial interventions with other psychosocial treatment, or treatment as usual, in adult PWIDs (aged at least 18 years) with concurrent problem alcohol use.
    • National Audit of Hospital Mortality Annual Report 2017

      National Office of Clinical Audit (NOCA); National Office of Clinical Audit (National Office of Clinical Audit, 2018-12)
    • Barriers to progressing through a methadone maintenance treatment programme: perspectives of the clients in the Mid-West of Ireland's drug and alcohol services.

      Moran, Lisa; Keenan, Eamon; Elmusharaf, Khalifa (BMC Health Services Research, 2018-11-29)
      The 'perfect' journey through an Irish Methadone Maintenance Treatment Programme (MMTP) would have a client engage appropriately with all relevant services available to them, inclusive of psychiatry, counselling, out-reach support, nursing and psychology. Concurrently, a client would ideally adhere to their prescribed methadone-dosing regimen, until a client is stabilised allowing them to function optimally. At this point, a client should transfer to the GP community setting. Unfortunately, this fails to occur. To date, very few studies have specifically investigated the reasons why a cohort of clients remain 'trapped' in the high risk, specialist clinical setting. Qualitative detailed semi-structured interviews were undertaken with 17 clients of one of Ireland's Health Service Executive (HSE) Drug and Alcohol Services, entitled 'HSE Mid-West Limerick Drug and Alcohol Service'. Each client had a severe Opioid Use Disorder (OUD) and clients had spent on average 7.5 years engaging with the MMTP. Participants' life journey prior to an OUD included Adverse Childhood Experiences (ACEs) and early exposure to illicit drug use. Shared life events resulting in their initiating and sustaining an OUD involved continuous hardship into adulthood, mental illness and concurrent benzodiazepine use disorder, often resulting in harrowing accounts of participants' loneliness and lack of life purpose. Their living environments, an erroneous understanding of their illness and poor communication with allied health professionals further perpetuated their OUD. Positive factors influencing periods of abstinence were familial incentives and a belief in the efficacy of methadone. Clients own suggestions for improving their journeys included employing a multi-sectorial approach to managing OUD and educating themselves and others on opioid agonist treatments. If clients were not progressing appropriately, they themselves suggested enforcing a 'time-limit' on clients to engage with the programme or indeed for their treatment to be postponed. To optimise the functioning of the MMTP, three tasks need to be fulfilled: 1) Reduce the incidences of ACEs, 2) Diagnose and treat clients with a dual diagnosis 3) Educate clients, their families, the public and allied health care professionals on all aspects of OUD. A cross- departmental, inter-governmental approach is needed to address opioid misuse as a societal issue as a whole.
    • Irish Hip Fracture Database National Report 2017

      National Office of Clinical Audit; Health Service Executive (HSE) (National Office of Clinical Audit, 2018-11-29)
    • Wellbeing and Health in Ireland’s over 50s 2009-2016

      TILDA; Trinity College Dublin (The Irish Longitudinal Study on Ageing, 2018-11-28)
    • University students' awareness of causes and risk factors of miscarriage: a cross-sectional study.

      San Lazaro Campillo, Indra; Meaney, Sarah; Sheehan, Jacqueline; Rice, Rachel; O'Donoghue, Keelin (BMC Women's Health, 2018-11-19)
    • Self-management needs of Irish adolescents with Juvenile Idiopathic Arthritis (JIA): how can a Canadian web-based programme meet these needs?

      O'Sullivan, Grace; O'Higgins, Siobhán; Caes, Line; Saetes, Sophia; McGuire, Brian E; Stinson, Jennifer (Pediatric Rheumatology, 2018-11-08)
      Juvenile Idiopathic Arthritis (JIA) affects over 1000 children and adolescents in Ireland, potentially impacting health-related quality-of-life. Accessible self-management strategies, including Internet-based interventions, can support adolescents in Ireland where specialist rheumatology care is geographically-centralised within the capital city. This study interviewed adolescents with JIA, their parents, and healthcare professionals to (i) explore the self-management needs of Irish adolescents; and (ii) evaluate the acceptability of an adapted version of a Canadian JIA self-management programme (Teens Taking Charge: Managing Arthritis Online, or TTC) for Irish users. Focus groups and interviews were conducted with Irish adolescents with JIA (N = 16), their parents (N = 13), and Irish paediatric healthcare professionals (HCPs; N = 22). Adolescents were aged 12-18 (M Five themes emerged: independent self-management; acquiring skills and knowledge to manage JIA; unique challenges of JIA in Ireland; views on web-based interventions; and understanding through social support. Adolescents acknowledged the need for independent self-management and gradually took additional responsibilities to achieve this goal. However, they felt they lacked information to manage their condition independently. Parents and adolescents emphasised the need for social support and felt a peer-support scheme could provide additional benefit to adolescents if integrated within the TTC programme. All participants endorsed the TTC programme to gain knowledge about JIA and offered suggestions to make the programme relevant to Irish users. There is scope for providing easily-accessible, accurate information to Irish families with JIA. The acceptability of adapting an existing JIA self-management intervention for Irish users was confirmed.
    • Child & Adolescent Emergency Mental Health Crisis: A Neglected Cohort

      McNicholas, F; University College Dublin (Irish Medical Journal, 2018-11)
    • A Cross-Sectional Study of Antibiotic Prescribing for Childhood Upper Respiratory Tract Infections in Irish General Practice

      Maguire, F; Murphy, ME; Rourke, R; Morgan, F; Brady, G; Byrne, E; O’Callaghan, ME (Irish Medical Journal, 2018-11)
    • Ethnic Minority Health in Ireland-Co-creating knowledge (EMH-IC): a participatory health research protocol.

      Hannigan, Ailish; Basogomba, Alphonse; LeMaster, Joseph; Nurse, Diane; O'Reilly, Fiona; Roura, Maria; Villarroel, Nazmy; MacFarlane, Anne (BMJ Open, 2018-10-31)
      International policy recommends continuous, cost-effective monitoring of health data to enable health services to identify and respond to health inequities as experienced by different ethnic groups. However, there is a lack of routinely collected ethnicity data, particularly in primary care, and very little implementation research internationally to understand how ethnic identifiers are introduced, embedded and used in healthcare settings. This paper describes a protocol for a novel participatory health research project with the objective of building the evidence base on ethnic minority health in Ireland. Findings on the participatory appraisal of ethnic identifiers as an intervention to generate useful data about minority and majority ethnic groups will have relevance in other settings and countries. This multidisciplinary project is designed as a participatory health research study where all stakeholders, including ethnic minority communities, participate in co-design of the research protocol, project governance, collaborative data interpretation and disseminating findings. A national catalogue of all routinely collected health data repositories will be electronically searched for any repositories that contain information on ethnicity. A secondary quantitative analysis of a population-representative cohort study, Growing Up in Ireland, will be carried out to compare the health of ethnic minority and majority groups. A qualitative case study informed by normalisation process theory will be carried out at three primary care sites to monitor the implementation of an ethnic identifier and identify barriers and levers to implementation. Ethical approval for the qualitative case study has been granted by the Irish Council for General Practitioners (06/09/17). Permission to access data from Growing Up in Ireland has been granted by the Director General of the Central Statistics Office. Dissemination will be carried out at community events and academic conferences, in peer-reviewed journal publications, and through academic and healthcare provider networks.
    • Voices that matter: end-of-life care in two acute hospitals from the perspective of bereaved relatives.

      Donnelly, Sarah; Prizeman, Geraldine; Coimín, Diarmuid Ó; Korn, Bettina; Hynes, Geralyn (BMC Palliative Care, 2018-10-19)
      End-of-life care (EoLC) is an experience that touches the lives of everyone. Dying in an acute hospital is a common occurrence in developed countries across the world. Previous studies have shown that there is wide variation in EoLC and at times is experienced as being of poor quality. Assessing and measuring the quality of care provided is a key component of all healthcare systems. This paper reports on the qualitative analysis of open-ended free text questions that were asked as part of a post-bereavement survey conducted in two adult acute hospitals in Ireland. This was a quantitative descriptive post-bereavement postal survey, gathering data retrospectively from relatives or friends of patients who died, utilising an adapted version of the VOICES (Views of Informal Carers - Evaluation of Services) questionnaire. VOICES MaJam has 29 core questions, seven questions requesting personal demographic information and four open-ended questions gathering descriptive data about the care experience during the patient's last admission to hospital. A total of 356 valid questionnaires were returned. Qualitative data were managed, coded and analysed with NVivo 10, using a template analysis framework approach. Three quarters (75%: n = 268) responded to at least one of the open-ended questions. Several key themes emerged, indicating areas that require particular attention in EoLC. Two themes relate to how care needs are met and how the hospital environment has a critical influence on EoLC experiences. The remaining three themes relate more to the interpersonal context including whether patients are treated with dignity and respect, the psychological, emotional and spiritual needs of patients and their family members and communication. Acute hospitals need to ensure that patients and their relatives receive high quality EoLC. Seeking the views of bereaved relatives should be considered by all hospitals and healthcare settings to ascertain the quality of care at end of life. This study contributes to our understanding and knowledge of what good EoLC looks like and where care can be improved, thus enabling hospitals to direct and inform quality improvement.