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Kelly M, Fullen BM, Martin D, Bradley C, McVeigh JG. eHealth interventions to support self-management: Perceptions and experiences of people with musculoskeletal disorders and physiotherapists - 'eHealth: It's TIME': A qualitative study. Physiother Theory Pract 2024; 40:1011-1021. [PMID: 36426843 DOI: 10.1080/09593985.2022.2151334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 10/25/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is increasing interest in the potential role of eHealth interventions to support self-management in people with musculoskeletal disorders (MSDs). The COVID-19 pandemic appears to have been a significant catalyst for the implementation of eHealth modalities into routine practice, providing a unique opportunity for real-world evaluation of this underutilized method of delivering physiotherapy. OBJECTIVE To explore the perceptions of eHealth-mediated supported self-management from the perspective of people with MSDs and physiotherapists who work in this clinical area. METHODS A qualitative interpretive descriptive approach was used. Semi-structured telephone interviews with 13 musculoskeletal physiotherapists and 13 people with musculoskeletal disorders were undertaken. Transcripts were analyzed using reflexive thematic analysis. RESULTS Three main themes were identified: 1) Flexibility within a blended care model; 2) eHealth as a facilitator of self-management support; and 3) Technology: Getting it right. Participants expressed concerns about assessment and diagnosis, establishing a therapeutic relationship and felt eHealth should be reserved for follow-up purposes. There was a consistent view expressed that eHealth could facilitate aspects of self-management support. A lack of resources and suboptimal user experience remains a challenge. CONCLUSIONS eHealth-mediated self-management support interventions were broadly acceptably, predominately as a follow-up option.
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Affiliation(s)
- Marie Kelly
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
- Department of Physiotherapy, Mercy University Hospital, Cork, Ireland
| | - Brona M Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Denis Martin
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Colin Bradley
- Department of General Practice, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Joseph G McVeigh
- Discipline of Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
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Kelly M, Fullen B, Martin D, Bradley C, O'Mahony B, McVeigh JG. Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - 'eHealth: It's TIME': a study protocol. HRB Open Res 2023; 5:73. [PMID: 37675192 PMCID: PMC10477747 DOI: 10.12688/hrbopenres.13611.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 09/08/2023] Open
Abstract
Background: Musculoskeletal disorders (MSDs) are a leading cause of global morbidity, with the burden expected to increase in the near future. Self-management, with the support of healthcare professionals, is recommended for many MSDs. However, frequent clinical contact is not feasible. Previous research has highlighted the need for a co-designed eHealth-mediated self-management follow-up support intervention which integrates remote monitoring and behavioural change. Thus, the current study aims to develop and design a user-centred, eHealth-mediated self-management support prototype for people with MSDs. Methods: A three-step, iterative system development cycle will be utilised to develop and design the "eHealth: It's TIME prototype". The three-step process will include creating website features and content using two sequential focus groups with people with MSDs (n = 6 - 8); heuristic testing using the 10 heuristic principles of Nielsen (n = 5); and usability testing through in-person 60-minute interviews with people with MSDs (n = 3 - 5) and musculoskeletal physiotherapists (n = 3 - 5). Conclusion: The eHealth: It's TIME prototype will be a systematically developed, follow-up self-management support intervention guided by behavioural change theory and the preferences of end users.
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Affiliation(s)
- Marie Kelly
- Discipline of Physiotherapy, University College Cork, Cork, Ireland
- Department of Physiotherapy, Mercy University Hospital, Cork, Ireland
| | - Brona Fullen
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Denis Martin
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Billy O'Mahony
- School of Computer Science and Information Technology, University College Cork, Cork, Ireland
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Sattar S, Papadopoulos E, Smith GVH, Haase KR, Kobekyaa F, Tejero I, Bradley C, Nadler MB, Campbell KL, Santa Mina D, Alibhai SMH. State of research, feasibility, safety, acceptability, and outcomes examined on remotely delivered exercises using technology for older adult with cancer: a scoping review. J Cancer Surviv 2023:10.1007/s11764-023-01427-9. [PMID: 37418170 DOI: 10.1007/s11764-023-01427-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Technology-based exercise is gaining attention as a promising strategy for increasing physical activity (PA) in older adults with cancer (OACA). However, a comprehensive understanding of the interventions, their feasibility, outcomes, and safety is limited. This scoping review (1) assessed the prevalence and type of technology-based remotely delivered exercise interventions for OACA and (2) explored the feasibility, safety, acceptability, and outcomes in these interventions. METHODS Studies with participant mean/median age ≥ 65 reporting at least one outcome measure were included. Databases searched included the following: PubMed, CINAHL, Embase, Cochrane Library Online, SPORTDiscus, and PsycINFO. Multiple independent reviewers completed screening and data abstractions of articles in English, French, and Spanish. RESULTS The search yielded 2339 citations after removing duplicates. Following title and abstract screening, 96 full texts were review, and 15 were included. Study designs were heterogeneous, and sample sizes were diverse (range 14-478). The most common technologies used were website/web portal (n = 6), videos (n = 5), exergaming (n = 2), accelerometer/pedometer with video and/or website (n = 4), and live-videoconferencing (n = 2). Over half (9/15) of the studies examined feasibility using various definitions; feasibility outcomes were reached in all. Common outcomes examined include lower body function and quality of life. Adverse events were uncommon and minor were reported. Qualitative studies identified cost- and time-savings, healthcare professional support, and technology features that encourage engagement as facilitators. CONCLUSION Remote exercise interventions using technology appear to be feasible and acceptable in OACA. IMPLICATIONS FOR CANCER SURVIVORS Some remote exercise interventions may be a viable way to increase PA for OACA.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, 108-4400 4th Ave, Regina, SK, S4T 0H6, Canada.
| | - E Papadopoulos
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
| | - G V H Smith
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - K R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - F Kobekyaa
- Faculty of Applied Science, School of Nursing, University of British Columbia, T201-2211, Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - I Tejero
- Department of Geriatric Medicine, Parc de Salut Mar, Pg. Marítim de la Barceloneta, 25, 29, 08003, Barcelona, Spain
| | - C Bradley
- Library, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - M B Nadler
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
- Division of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
| | - K L Campbell
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 - 2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - D Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada
| | - S M H Alibhai
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave, Toronto, ON, M5G 2C4, Canada
- Department of Medicine, University of Toronto, Toronto, 6 Queen's Park Crescent West, 3/F, Toronto, ON, M5S 3H2, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Ste. 425, Toronto, ON, M5T 3M6, Canada
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Elgammal A, Ryan J, Bradley C, Crean A, Bermingham M. The impact of drug palatability on prescribing and dispensing of antibiotic formulations for paediatric patients: a cross-sectional survey of general practitioners and pharmacists. Fam Pract 2023:cmad071. [PMID: 37410016 DOI: 10.1093/fampra/cmad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Palatability is a key element of paediatric acceptability for medicines. Many patient and drug factors are considered when choosing an antibiotic for a child. Pharmacists report that they receive questions about the palatability of oral liquid antibiotics for children. This study aimed to explore the experiences of GPs and pharmacists concerning palatability of oral liquid antibiotics for children. METHODS A questionnaire about the impact of palatability on the choice of antibiotic formulation for children was emailed to all community pharmacists in Ireland and to GPs and trainee GPs in the Cork region and posted on social media. Survey items were not compulsory; therefore, percentage responses were calculated based on the number of responses to that item. GP and pharmacist responses were analysed independently. RESULTS Responses were received from 244 participants (59 GPs, 185 pharmacists). Clinical guidelines and availability of supply were the most important factors considered when choosing an oral liquid antibiotic formulation for children by GP (79.7%) and pharmacist (66.5%) respondents respectively. Forty GP respondents (76.9%) reported ensuring adherence was the most common palatability-related reason leading to deviation from guidelines. Pharmacist respondents (52%) reported advising a parent/caregiver to manipulate the required antibiotic dose to improve acceptability. The least palatable oral liquid antibiotics reported were flucloxacillin (16% GPs, 18% pharmacists) and clarithromycin (17% of each profession). CONCLUSION This study identified palatability issues associated with oral liquid antibiotics for children reported by GPs and pharmacists. Pharmaceutical approaches to adapting oral liquid antibiotic formulations must be developed to improve palatability and thus paediatric acceptability.
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Affiliation(s)
- Ayat Elgammal
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
- SSPC Pharmaceutical Research Centre, School of Pharmacy, University College Cork, Cork, Ireland
| | - Joseph Ryan
- Department of General Practice, School of Medicine, University College Cork, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, School of Medicine, University College Cork, Cork, Ireland
| | - Abina Crean
- SSPC Pharmaceutical Research Centre, School of Pharmacy, University College Cork, Cork, Ireland
| | - Margaret Bermingham
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Hause AM, Marquez P, Zhang B, Moro PL, Myers TR, Bradley C, Bazel S, Panchanathan SS, Shimabukuro TT, Shay DK. Safety Monitoring of mRNA COVID-19 Vaccine Third Doses Among Children Aged 6 Months-5 Years - United States, June 17, 2022-May 7, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:621-626. [PMID: 37289661 DOI: 10.15585/mmwr.mm7223a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
As of May 7, 2023, CDC's Advisory Committee on Immunization Practices (ACIP) recommends that all children aged 6 months-5 years receive at least 1 age-appropriate bivalent mRNA COVID-19 vaccine dose. Depending on their COVID-19 vaccination history and history of immunocompromise, these children might also need additional doses* (1-3). Initial vaccine safety findings after primary series vaccination among children aged 6 months-5 years showed that transient local and systemic reactions were common whereas series adverse events were rare (4). To characterize the safety of a third mRNA COVID-19 vaccine dose among children aged 6 months-5 years, CDC reviewed adverse events and health surveys reported to v-safe, a voluntary smartphone-based U.S. safety surveillance system established by CDC to monitor health after COVID-19 vaccination (https://vsafe.cdc.gov/en/) and the Vaccine Adverse Event Reporting System (VAERS), a U.S. passive vaccine safety surveillance system co-managed by CDC and the Food and Drug Administration (FDA) (https://vaers.hhs.gov/) (5). During June 17, 2022-May 7, 2023, approximately 495,576 children aged 6 months-4 years received a third dose (monovalent or bivalent) of Pfizer-BioNTech vaccine and 63,919 children aged 6 months-5 years received a third dose of Moderna vaccine.† A third mRNA COVID-19 vaccination was recorded for 2,969 children in v-safe; approximately 37.7% had no reported reactions, and among those for whom reactions were reported, most reactions were mild and transient. VAERS received 536 reports after a third dose of mRNA COVID-19 vaccine for children in these age groups; 98.5% of reports were nonserious and most (78.4%) were classified as a vaccination error.§ No new safety concerns were identified. Preliminary safety findings after a third dose of COVID-19 vaccine for children aged 6 months-5 years are similar to those after other doses. Health care providers can counsel parents and guardians of young children that most reactions reported after vaccination with Pfizer-BioNTech or Moderna vaccine were mild and transient and that serious adverse events are rare.
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Bradley C, Snaith B. The radiation dose, clinical and anatomical implications of erect lumbar spine radiography: A single centre pre-post implementation evaluation. Radiography (Lond) 2023; 29:690-696. [PMID: 37187066 DOI: 10.1016/j.radi.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/04/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Lumbar radiographs remain a common imaging examination despite strategies to reduce their use. Many authors have demonstrated benefits in changing from traditional supine and recumbent lateral projections to a prone and/or erect orientation. Despite evidence of clinical and radiation dose optimisation, widespread adoption of these strategies has stalled. This article describes the single-centre implementation and evaluation of erect PA and lateral projections. METHOD This was an observational study pre- and post-implementation of an erect imaging protocol. Patient BMI, image field size, source image and source object distances and DAP were collected together with assessment of radiographic spinal alignment and disc space demonstration. Effective dose was calculated with organ specific doses. RESULTS 76 (53.5%) patients were imaged in the supine AP and recumbent lateral position, 66 (46.5%) had erect PA and lateral radiographs. Despite the larger BMI of the erect cohort and similar field sizes, effective dose was lower in the PA position by an average of 20% (p < 0.05), however, no significant difference in lateral dose. Anatomical improvements were evident with greater visualisation of intervertebral disc spaces in the PA erect (t = -9.03; p < .001) and lateral (t = -10.298; p < .001) orientations. Erect PA radiographs demonstrated a leg length discrepancy in 47.0% (0.3-4.7 cm) and a scoliosis in 21.2% of cases, with a significant link between these findings (r (64) = 0.44; p < .001). CONCLUSION Erect lumbar spine radiography provides information on clinical outcomes not available with recumbent projections. The improvements in anatomical visualisation and radiation dose reduction supports the local change in practice. IMPLICATIONS FOR PRACTICE - Erect imaging can reduce effective dose with an optimised acquisition protocol - additional pathological information can be revealed by the erect posture. - postural awareness is critical to interpret images accurately.
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Affiliation(s)
- C Bradley
- Radiology, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK.
| | - B Snaith
- Radiology, Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK; Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK
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Blease C, Kharko A, Bernstein M, Bradley C, Houston M, Walsh I, D Mandl K. Computerization of the Work of General Practitioners: Mixed Methods Survey of Final-Year Medical Students in Ireland. JMIR Med Educ 2023; 9:e42639. [PMID: 36939809 PMCID: PMC10131917 DOI: 10.2196/42639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/14/2022] [Accepted: 01/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The potential for digital health technologies, including machine learning (ML)-enabled tools, to disrupt the medical profession is the subject of ongoing debate within biomedical informatics. OBJECTIVE We aimed to describe the opinions of final-year medical students in Ireland regarding the potential of future technology to replace or work alongside general practitioners (GPs) in performing key tasks. METHODS Between March 2019 and April 2020, using a convenience sample, we conducted a mixed methods paper-based survey of final-year medical students. The survey was administered at 4 out of 7 medical schools in Ireland across each of the 4 provinces in the country. Quantitative data were analyzed using descriptive statistics and nonparametric tests. We used thematic content analysis to investigate free-text responses. RESULTS In total, 43.1% (252/585) of the final-year students at 3 medical schools responded, and data collection at 1 medical school was terminated due to disruptions associated with the COVID-19 pandemic. With regard to forecasting the potential impact of artificial intelligence (AI)/ML on primary care 25 years from now, around half (127/246, 51.6%) of all surveyed students believed the work of GPs will change minimally or not at all. Notably, students who did not intend to enter primary care predicted that AI/ML will have a great impact on the work of GPs. CONCLUSIONS We caution that without a firm curricular foundation on advances in AI/ML, students may rely on extreme perspectives involving self-preserving optimism biases that demote the impact of advances in technology on primary care on the one hand and technohype on the other. Ultimately, these biases may lead to negative consequences in health care. Improvements in medical education could help prepare tomorrow's doctors to optimize and lead the ethical and evidence-based implementation of AI/ML-enabled tools in medicine for enhancing the care of tomorrow's patients.
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Affiliation(s)
- Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Anna Kharko
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- School of Psychology, University of Plymouth, Plymouth, United Kingdom
| | - Michael Bernstein
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
- Department of Diagnostic Imaging, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Colin Bradley
- School of Medicine, University College Cork, Cork, Ireland
| | - Muiris Houston
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ian Walsh
- Dentistry and Biomedical Sciences, School of Medicine, Queen's University, Belfast, Ireland
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA, United States
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8
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Kelly M, Fullen B, Martin D, Bradley C, O'Mahony B, McVeigh JG. Design and development of an eHealth intervention to support self-Management in people with musculoskeletal Disorders - ‘eHealth: It’s TIME’: a study protocol. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13611.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Musculoskeletal disorders (MSDs) are a leading cause of global morbidity, with the burden expected to increase in the near future. Self-management, with the support of healthcare professionals, is recommended for many MSDs. However, frequent clinical contact is not feasible. Previous research has highlighted the need for a co-designed eHealth-mediated self-management follow-up support intervention which integrates remote monitoring and behavioural change. Thus, the current study aims to develop and design a user-centred, eHealth-mediated self-management support prototype for people with MSDs. Methods: A three-step, iterative system development cycle will be utilised to develop and design the “eHealth: It’s TIME prototype”. The three-step process will include creating website features and content using two sequential focus groups with people with MSDs (n = 6 – 8); heuristic testing using the 10 heuristic principles of Nielsen (n = 5); and usability testing through in-person 60-minute interviews with people with MSDs (n = 3 – 5) and musculoskeletal physiotherapists (n = 3 – 5). Conclusion: The eHealth: It’s TIME prototype will be a systematically developed, follow-up self-management support intervention guided by behavioural change theory and the preferences of end users.
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McMahon EM, Greiner BA, Corcoran P, Larkin C, Leitao S, McCarthy J, Cassidy E, Bradley C, McAuliffe C, Griffin E, Williamson E, Foster T, Gallagher J, Perry IJ, Kapur N, Arensman E. Psychosocial and psychiatric factors preceding death by suicide: A case-control psychological autopsy study involving multiple data sources. Suicide Life Threat Behav 2022; 52:1037-1047. [PMID: 35815892 PMCID: PMC9796414 DOI: 10.1111/sltb.12900] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/09/2022] [Accepted: 06/21/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND A range of factors including mental disorders and adverse life events can increase the risk of suicide. The objectives of this study were to examine psychosocial and psychiatric factors and service engagement among suicide decedents compared with living controls. METHODS A case-control study using multiple sources was conducted. Information on 132 consecutive cases of suicide was drawn from coronial files, and interviews were carried out with 35 family informants and 53 living controls. GPs completed questionnaires for 60 suicide cases and 27 controls. RESULTS The majority (83.3%) of suicide decedents had contacted a GP in the year prior to death, while 23.3% had 10 or more consultations during the year prior to death. Half of suicide decedents had a history of self-harm. Suicide cases were significantly more likely than controls to have a psychiatric diagnosis (60% vs. 18.5%) and a depressive illness (36.7% vs. 14.8%). Over one-quarter of suicide decedents had been treated as a psychiatric inpatient. DISCUSSION Primary care providers should be supported to deliver multidisciplinary interventions to engage, assess, and treat patients at risk of suicide, targeting those who present very frequently, those with a history of self-harm or substance misuse, and those with psychological presentations.
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Affiliation(s)
- Elaine M. McMahon
- National Suicide Research FoundationCorkIreland,School of Public HealthUniversity College CorkCorkIreland
| | | | - Paul Corcoran
- National Suicide Research FoundationCorkIreland,School of Public HealthUniversity College CorkCorkIreland,National Perinatal Epidemiology CentreUniversity College CorkCorkIreland
| | - Celine Larkin
- Department of Emergency MedicineUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Sara Leitao
- National Perinatal Epidemiology CentreUniversity College CorkCorkIreland
| | | | - Eugene Cassidy
- Department of Psychiatry and Neuro‐behavioural ScienceUniversity College CorkCorkIreland
| | - Colin Bradley
- Department of General PracticeUniversity College CorkCorkIreland
| | | | - Eve Griffin
- National Suicide Research FoundationCorkIreland,School of Public HealthUniversity College CorkCorkIreland
| | | | - Tom Foster
- Southern Health and Social Care TrustNorthern IrelandUK
| | - John Gallagher
- School of Public HealthUniversity College CorkCorkIreland
| | - Ivan J. Perry
- School of Public HealthUniversity College CorkCorkIreland
| | - Nav Kapur
- Centre for Mental Health and SafetyUniversity of ManchesterManchesterUK,Greater Manchester Mental Health NHS Foundation TrustManchesterUK,NIHR Greater Manchester Patient Safety Translational Research CentreUniversity of ManchesterManchesterUK
| | - Ella Arensman
- National Suicide Research FoundationCorkIreland,School of Public HealthUniversity College CorkCorkIreland,Australian Institute for Suicide Research and PreventionSchool of Applied Psychology, Griffith UniversityBrisbaneQueenslandAustralia
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10
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Alyousef M, Naughton C, Bradley C, Savage E. Primary healthcare reform for chronic conditions in countries with high or very high human development index: A systematic review. Chronic Illn 2022; 18:469-487. [PMID: 34841923 PMCID: PMC9397395 DOI: 10.1177/17423953211059143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To address the growing burden of chronic disease globally, many countries have developed a national policy for primary healthcare reform. In some countries with high and very high human development index, evaluations of the implementation of these reforms have been published. To date, there has been no systematic review of these evaluations. The objectives of this review are to identify: (a) the vision for primary healthcare; (b) the features of primary healthcare reforms; and (c) evaluation findings of primary healthcare reforms. METHODS A systematic literature review was conducted guided by the PRISMA statement. We searched for academic articles and grey literature from 1 March 2008 to 1 September 2020. Screening and data extraction were conducted by two authors. Descriptive analysis and narrative synthesis were applied. RESULTS A vision for integrated primary healthcare shifting chronic disease management from specialist hospital services to primary care was found to require new organization and funding models such as collaborative primary healthcare networks and commissioning along with shared governance across health sectors. The need for general practitioner leadership and engagement to support primary healthcare reform was identified. Although there was evidence of barriers in progressing primary healthcare reform, evaluation results showed some positive outcomes, most notably shifts in services towards increased primary care access and utilization. DISCUSSION A challenge in undertaking the review was the heterogeneity of articles with little consistency in how primary healthcare reform was evaluated and reported on across countries. Evaluation of national health reforms involves complex system-wide projects and is an area that needs further exploration and discussion to determine the most appropriate methodologies for collecting and analysing large-scale data with consideration for service and health outcomes.
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Affiliation(s)
- Mohammed Alyousef
- School of Nursing and Midwifery, 8795University College Cork, Cork, Ireland.,Department of Health Services Administration and Hospitals, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Corina Naughton
- School of Nursing and Midwifery, 8795University College Cork, Cork, Ireland
| | - Colin Bradley
- The Department of General Practice, 8795University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, 8795University College Cork, Cork, Ireland
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Lynch T, Ryan C, Bradley C, Foster D, Huff C, Hutchinson S, Lamberson N, Lynch L, Cadogan C. Supporting safe and gradual reduction of long‐term benzodiazepine receptor agonist use: Development of the SAFEGUARDING‐BZRAs toolkit using a codesign approach. Health Expect 2022; 25:1904-1918. [PMID: 35672924 PMCID: PMC9327818 DOI: 10.1111/hex.13547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/02/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Long‐term benzodiazepine receptor agonist (BZRA) use persists in healthcare settings worldwide and poses risks of patient harm. Objective This study aimed to develop an intervention to support discontinuation of long‐term BZRA use among willing individuals. Methods The intervention development process aligned with the UK Medical Research Council's complex intervention framework. This involved a previous systematic review of brief interventions targeting long‐term BZRA use in primary care and qualitative interviews based on the Theoretical Domains Framework that explored barriers and facilitators to discontinuing long‐term BZRA use. A codesign approach was used involving an active partnership between experts by experience, researchers and clinicians. Intervention content was specified in terms of behaviour change techniques (BCTs). Results The SAFEGUARDING‐BZRAs (Supporting sAFE and GradUAl ReDuctIon of loNG‐term BenZodiazepine Receptor Agonist uSe) toolkit comprises 24 BCTs and includes recommendations targeted at primary care‐based clinicians for operationalizing each BCT to support individuals with BZRA discontinuation. Conclusion The SAFEGUARDING‐BZRAs toolkit has been developed using a systematic and theory‐based approach that addresses identified limitations of previous research. Further research is needed to assess its usability and acceptability by service users and clinicians, as well as its potential to effectively support safe and gradual reduction of long‐term BZRA use. Patient or Public Contribution The qualitative interview phase included patients as participants. The codesign process included ‘experts by experience’ with either current or previous experience of long‐term BZRA use as collaborators.
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Affiliation(s)
- Tom Lynch
- School of Pharmacy and Biomolecular Sciences Royal College of Surgeons in Ireland Dublin Ireland
| | - Cristín Ryan
- School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin Dublin Ireland
| | - Colin Bradley
- Department of General Practice University College Cork Cork Ireland
| | - D. Foster
- Benzodiazepine Action Work Group Colorado Consortium for Prescription Drug Abuse Prevention Aurora Colorado USA
| | - Christy Huff
- Benzodiazepine Information Coalition Midvale Utah USA
| | | | | | | | - Cathal Cadogan
- School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin Dublin Ireland
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12
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Knott E, Zlevor A, Hinshaw L, Laeseke P, Longhurst C, Frank J, Bradley C, Couillard A, Xu Z, Lee F, Ziemlewicz T. Abstract No. 170 Histotripsy vs. microwave ablation in the liver: a comparison study in a porcine model. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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13
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Lynch T, Ryan C, Bradley C, Foster D, Huff C, Hutchinson S, Lamberson N, Lynch L, Cadogan C. Supporting sAFE and GradUAl ReDuctIon of loNG-term BenzodiaZepine Receptor Agonist uSe: development of the SAFEGUARDING-BZRAs toolkit using a co-design approach. International Journal of Pharmacy Practice 2022. [DOI: 10.1093/ijpp/riac021.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Long-term benzodiazepine receptor agonist (BZRA) use (>3 months) persists worldwide and poses risks of harm. Effective interventions are needed to address this issue.
Aim
To develop an intervention to support discontinuation of long-term benzodiazepine receptor agonist (BZRA) use.
Methods
The intervention development process built on previous qualitative work that used the Theoretical Domains Framework (TDF) to explore perceived barriers and facilitators to discontinuing long-term BZRA use (1). A co-design approach was used whereby lay individuals and professionals worked as equals during the research process based on principles of authentic participation and collaboration (2). The co-design team included five ‘experts by lived experience’ with experience of long-term BZRA use who previously provided input on other related work as patient and public involvement representatives or responded to an expression of interest call on social media. Two online co-design team meetings were held. During the first meeting, a summary of previous findings was presented together with a long-list of behaviour change techniques (BCTs) generated using established mapping matrices in which BCTs were reliably allocated to the TDF. Each team member independently documented their decision as to whether each BCT should be included in a short-list for potential inclusion in the final intervention using online polling software. The a priori decision rule was that 70% of team members had to agree regarding the inclusion/exclusion of a BCT. All other BCTs were then discussed at a follow-up meeting. A finalised list of BCTs for inclusion in the intervention was agreed at the second meeting using a consensus-based approach involving the same decision rule. Potential ways in which BCTs could be operationalised were then discussed.
Results
Thirty BCTs were discussed and six BCTs were excluded. For example, team members recommended avoiding ‘Social comparison’ as individual circumstances and experiences of discontinuation and associated withdrawal symptoms are unique and not directly comparable. Given the number of included BCTs, the co-design team recommended presenting them as a toolkit. The SAFEGUARDING-BZRAs (Supporting sAFE and GradUAl ReDuctIon of loNG-term BenzodiaZepine Receptor Agonist uSe) toolkit comprises 24 BCTs: ‘Goal setting (behaviour)’, ‘Review behaviour goal(s)’, ‘Review outcome goal(s)’, ‘Feedback on behaviour’, ‘Self-monitoring of behaviour’, ‘Social support (practical)’, ‘Social support (emotional)’, ‘Information about health consequences’, ‘Monitoring of emotional consequences’, ‘Information about emotional consequences’, ‘Prompts/cues’, ‘Habit reversal’, ‘Graded tasks’, ‘Pros and cons’, ‘Comparative imagining of future outcomes’, ‘Social reward’, ‘Self-reward’, ‘Reduce negative emotions’, ‘Distraction’, ‘Adding objects to the environment’, ‘Body changes’, ‘Verbal persuasion about capability’, ‘Focus on past success’ and ‘Credible source’. The toolkit includes recommendations targeted at primary care-based clinicians for operationalising each BCT to support BZRA discontinuation.
Conclusion
The SAFEGUARDING-BZRAs toolkit has been developed using a systematic, theory-based approach that addresses identified limitations of previous research (e.g. lack of detailed intervention description). In terms of limitations, it is possible that a different group of individuals may have developed a different type of intervention. To overcome this, a priori decision rules were used for decision making. Further research is needed to assess the toolkit’s usability and acceptability by service users and clinicians.
References
(1) Lynch et al. Health Expect. [in press] DOI: 10.1111/hex.13392.
(2) O’Donnell et al. BMC Health Serv Res. 2019;19(1):797
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Affiliation(s)
- T Lynch
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - C Ryan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
| | - C Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - D Foster
- Benzodiazepine Action Work Group, Colorado Consortium for Prescription Drug Abuse Prevention, Aurora, Colorado, USA
| | - C Huff
- Benzodiazepine Information Coalition, Midvale, Utah, USA
| | | | | | | | - C Cadogan
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, Ireland
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14
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Hynes L, Murphy AW, Hart N, Kirwan C, Mulligan S, Leathem C, McQuillan L, Maxwell M, Carr E, Walkin S, McCarthy C, Bradley C, Byrne M, Smith SM, Hughes C, Corry M, Kearney PM, McCarthy G, Cupples M, Gillespie P, Newell J, Glynn L, Alvarez-Iglesias A, Sinnott C. The MultimorbiditY COllaborative Medication Review And DEcision Making (MyComrade) study: a protocol for a cross-border pilot cluster randomised controlled trial. Pilot Feasibility Stud 2022; 8:73. [PMID: 35346380 PMCID: PMC8958932 DOI: 10.1186/s40814-022-01018-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MultimorbiditY Collaborative Medication Review And Decision Making (MyComrade) intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care. Our aim in this pilot study is to evaluate the feasibility of a trial of the intervention with unique modifications accounting for contextual variations in two neighbouring health systems (Republic of Ireland (ROI) and Northern Ireland (NI)). Methods A pilot cluster randomised controlled trial will be conducted, using a mixed-methods process evaluation to investigate the feasibility of a trial of the MyComrade intervention based on pre-defined progression criteria. A total of 16 practices will be recruited (eight in ROI; eight in NI), and four practices in each jurisdiction will be randomly allocated to intervention or control. Twenty people living with multimorbidity and prescribed ≥ 10 repeat medications will be recruited from each practice prior to practice randomisation. In intervention practices, the MyComrade intervention will be delivered by pairs of general practitioners (GPs) in ROI, and a GP and practice-based pharmacist (PBP) in NI. The GPs/GP and PBP will schedule the time to review the medications together using a checklist. Usual care will proceed in practices in the control arm. Data will be collected via electronic health records and postal questionnaires at recruitment and 4 and 8 months after randomisation. Qualitative interviews to assess the feasibility and acceptability of the intervention and explore experiences related to multimorbidity management will be conducted with a purposive sample of GPs, PBPs, practice administration staff and patients in intervention and control practices. The feasibility of conducting a health economic evaluation as part of a future definitive trial will be assessed. Discussion The findings of this pilot study will assess the feasibility of a trial of the MyComrade intervention in two different health systems. Evaluation of the progression criteria will guide the decision to progress to a definitive trial and inform trial design. The findings will also contribute to the growing evidence-base related to intervention development and feasibility studies. Trial registration ISRCTN Registry, ISRCTN80017020. Date of confirmation is 4/11/2019. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01018-y.
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Affiliation(s)
- Lisa Hynes
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland.
| | - Andrew W Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland
| | - Nigel Hart
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Collette Kirwan
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland
| | - Sarah Mulligan
- Sligo Medical Academy, National University of Ireland, Galway, Ireland
| | - Claire Leathem
- Northern Ireland Clinical Research Network (Primary Care), Belfast, Northern Ireland
| | - Laura McQuillan
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Marina Maxwell
- Northern Ireland Clinical Research Network (Primary Care), Belfast, Northern Ireland
| | - Emma Carr
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland
| | - Scott Walkin
- Sligo Medical Academy, National University of Ireland, Galway, Ireland
| | - Caroline McCarthy
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carmel Hughes
- School of Pharmacy, Queen's University, Belfast, Northern Ireland
| | - Maura Corry
- General Practice Federation, Belfast, Northern Ireland
| | | | | | - Margaret Cupples
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Paddy Gillespie
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
| | - John Newell
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Carol Sinnott
- THIS Institute, University of Cambridge, Cambridge, UK
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15
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Blease C, Kharko A, Bernstein M, Bradley C, Houston M, Walsh I, Hägglund M, DesRoches C, Mandl KD. Machine learning in medical education: a survey of the experiences and opinions of medical students in Ireland. BMJ Health Care Inform 2022; 29:bmjhci-2021-100480. [PMID: 35105606 PMCID: PMC8808371 DOI: 10.1136/bmjhci-2021-100480] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Charlotte Blease
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anna Kharko
- Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Michael Bernstein
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Colin Bradley
- School of Medicine, University College Cork, Cork, Ireland
| | - Muiris Houston
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ian Walsh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Belfast, Northern Ireland, UK
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Catherine DesRoches
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth D Mandl
- Harvard Medical School, Boston, Massachusetts, USA.,Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
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16
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Geraghty A, Castro PD, Reynolds C, McBean L, Browne S, Clyne B, Bury G, Bradley C, Finnigan K, Clarke S, McCullagh L, Perrotta C, Murrin C, Gibney E, Kennelly S, Corish C. Evaluation of an online malnutrition management education module for general practitioners: the onspres project. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Browne S, Kelly L, Geraghty A, Reynolds C, McCallum K, McBean L, Clyne B, Bury G, Bradley C, McCullagh L, Finnigan K, Bardon L, Murrin C, Perrotta C, Gibney E, Kennelly S, Castro PD, Corish C. Healthcare professionals’ perceptions of malnutrition management and oral nutritional supplement prescription in the community: a qualitative study. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Bradley C, Aggarwal A, Goatman K, Jones G, Berry C, Good R. Patients presenting with acute coronary syndromes have unreported coronary artery calcium on historical CT imaging. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Ischaemic heart disease (IHD) remains the leading cause of mortality globally1. The presence and extent of coronary artery calcification (CAC) is a strong predictor of cardiovascular events, and CAC scoring has been shown to be more predictive of cardiovascular events than other traditional risk assessment scores2.
Incidental coronary calcification can be detected and quantified on non-gated CT chest scans covering the heart in the field of view3. This finding is typically not reported4 and hence an opportunity to optimise cardiovascular risk assessment and treatment is missed.
Purpose
We sought to investigate whether patients presenting to our centre with an acute coronary syndrome (ACS) event had historical CT imaging demonstrating coronary artery calcification.
Methods
We retrospectively reviewed case records for all patients referred to our centre for an invasive coronary angiogram following their first known admission with an ACS event. ACS were defined according to contemporary guidelines from the European Society of Cardiology. We reviewed a 3 month period prior to the COVID-19 pandemic (01/01/2019–31/03/2019). The national imaging database was interrogated to identify previous CT imaging that includes the heart in the field of view. The presence of coronary calcification was confirmed and quantified using an ordinal scoring method previously described3. The clinical radiology reports for the scans were reviewed to determine the frequency of CAC being reported.
Demographic information was collected from our electronic patient record including the presence of risk factors for IHD. Prescribed medication prior to admission was also recorded using the on-admission medicines reconciliation documented in the electronic patient record.
Results
385 patients with first presentation of ACS were identified. 75 (19%) had a prior non-gated CT chest imaging. The most common indication for CT was for investigation of possible malignancy. The mean interval from CT imaging to ACS admission was 36 months.
CAC was present on 67 (89%) scans. The mean ordinal score was 4.04, corresponding to moderate CAC. The distribution of CAC by coronary artery revealed the majority of disease to involve the left anterior descending artery (Table 1). Only 12/67 (18%) of clinical radiology reports mentioned coronary calcification (Figure 1).
Patients with CAC frequently had additional risk factors for IHD. Despite this only 42% were prescribed antiplatelet therapy, and only 45% prescribed a statin.
Conclusions
A significant proportion of ACS admissions have evidence of CAC on historical CT scans. This finding is often not reported and the majority of patients with demonstrated coronary artery disease are not prescribed appropriate preventative therapies. Systematic reporting of this finding may have a significant impact on the prevention of acute cardiovascular events.
Funding Acknowledgement
Type of funding sources: None. Table 1
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Affiliation(s)
- C Bradley
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - A Aggarwal
- University of Glasgow, Glasgow, United Kingdom
| | - K Goatman
- Canon Medical Europe, Edinburgh, United Kingdom
| | - G Jones
- Swansea University, Swansea, United Kingdom
| | - C Berry
- University of Glasgow, Glasgow, United Kingdom
| | - R Good
- Golden Jubilee National Hospital, Glasgow, United Kingdom
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19
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Riordan F, Murphy K, Bradley C, Kearney PM, Smith SM, McHugh SM. Acceptability and feasibility of conducting a pilot trial in Irish primary care: lessons from the IDEAs study. HRB Open Res 2021; 4:73. [PMID: 35136854 PMCID: PMC8804907 DOI: 10.12688/hrbopenres.13306.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Understanding primary care practices’ ‘readiness’ to engage in trials and their experience is important to inform trial procedures and supports. Few studies report on the feasibility of study procedures though this is a central part of pilot trials. We explored the acceptability and feasibility of study procedures of a cluster randomised pilot trial of an intervention in primary care to improve uptake of Ireland’s national diabetic retinopathy programme. Methods As part of the embedded mixed-methods process evaluation, quantitative and qualitative data were gathered across four general practices participating in the intervention. Interviews were conducted with a purposive sample of staff. Research logs on time spent on intervention delivery, staff assignment, resources, problems/changes, and reasons for drop-outs, were maintained over the course of intervention rollout, and practice audit data were analysed. Quantitative outcomes included recruitment, retention, completion, and data quality and completeness. Qualitative data on perceptions and experience of the pilot trial procedures were analysed using the Framework Method. Findings Nine staff (3 GPs, 4 nurses, 2 administrators) were interviewed. An interest in the topic area or in research motivated practices to take part in the trial. Reimbursement meant they could ‘afford’ to participate. Staff valued the researcher briefing at the start of the trial, to avoid ‘going in slightly blind’. While staff varied in audit skills and confidence, and some found this aspect of data collection challenging, a ‘step-by-step’ audit manual and regular researcher contact, helped them stay on track and troubleshoot during data collection. Audit quality was acceptable overall, however there were some issues, incorrect assignment of patient status being most common. Conclusion The IDEAs trial procedures were acceptable and feasible for primary care staff, however, challenges with conducting the audit may reflect staff skills gaps and the need for greater guidance and support from researchers.
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Affiliation(s)
- Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
| | - Katie Murphy
- Department of General Practice, University College Cork, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | | | - Susan M. Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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20
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Sattar S, Haase KR, Bradley C, Papadopoulos E, Kuster S, Santa Mina D, Tippe M, Kaur A, Campbell D, Joshua AM, Rediger C, Souied O, Alibhai S. Barriers and facilitators related to undertaking physical activities among men with prostate cancer: a scoping review. Prostate Cancer Prostatic Dis 2021; 24:1007-1027. [PMID: 34108646 DOI: 10.1038/s41391-021-00399-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/30/2021] [Accepted: 05/19/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Prostate cancer (PC) and its treatments lead to significant acute, chronic, or latent adverse effects that result in declines in patients' physical functions, quality of life and reduced sense of masculinities. Robust evidence shows that physical activity (PA) can improve many health outcomes in men with PC; however, less is known about the facilitators, preferences, and barriers to PA engagement in this population. The purpose of this scoping review is to document the nature and extent of literature related to these aspects of PA participation among men with PC. METHODS We conducted a scoping review of PA among men with PC. Databases searched included Medline, CINAHL, Embase, Rehabilitation & Sports Medicine Source, and SportDiscus from inception to June 30, 2020. Multiple reviewers were used in all screening and data abstractions. RESULTS The search yielded 2788 individual citations after duplicates were removed. Following title and abstract screening, 129 underwent full-text review, and 46 articles were included. Quantitative data related to our research question showed that structured group exercise was the most commonly reported facilitator/preference among men with PC, whereas treatment-related effects and lack of time are the most common barriers. In terms of qualitative data, the most prominent theme noted related to masculinities and gender-specific needs within the context of having PC. CONCLUSION Men with PC have unique facilitators and barriers concerning PA. More work is needed from the research and clinical practice perspectives to enable this population to engage and remain in regular PA.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, Regina, SK, Canada.
| | - K R Haase
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - C Bradley
- Library, University of Regina, Regina, SK, Canada
| | - E Papadopoulos
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - S Kuster
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
| | - D Santa Mina
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - M Tippe
- Patient consultant, Toronto, ON, Canada
| | - A Kaur
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - D Campbell
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - A M Joshua
- Department of Medical Oncology, Kinghorn Cancer Centre; Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - C Rediger
- Saskatchewan Health Authority, Regina, SK, Canada
| | - O Souied
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - S Alibhai
- University Health Network, Toronto, ON, Canada.,Department of Medicine, Institute of Health Policy, Management, and Evaluation, Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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21
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Khamis K, Bradley C, Gunter HJ, Basevi G, Stevens R, Hannah DM. Calibration of an in-situ fluorescence-based sensor platform for reliable BOD 5 measurement in wastewater. Water Sci Technol 2021; 83:3075-3091. [PMID: 34185701 DOI: 10.2166/wst.2021.197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Reliance on biochemical oxygen demand (BOD5) as an indicator of wastewater quality has hindered the development of efficient process control due to the associated uncertainty and lag-times. Surrogate measurements have been proposed, with fluorescence spectroscopy a promising technique. Yet, assessment of in-situ fluorescence sensors across multiple wastewater treatment plants (WwTPs), and at different treatment stages, is limited. In this study a multi-parameter sonde (two fluorescence peaks, turbidity, temperature and electrical conductivity) was used to provide a BOD5 surrogate measurement. The sonde was deployed at three WwTPs, on post primary settlement tanks (PST) and final effluent (FE). Triplicate laboratory measurements of BOD5, from independent laboratories were used to calibrate the sensor, with high variability apparent for FE samples. Site and process specific sensor calibrations yielded the best results (R2cv = 0.76-0.86; 10-fold cross-validation) and mean BOD5 of the three laboratory measurements improved FE calibration. When combining PST sites a reasonable calibration was still achieved (R2cv = 0.67) suggesting transfer of sensors between WwTPs may be possible. This study highlights the potential to use online optical sensors as robust BOD5 surrogates in WwTPs. However, careful calibration (i.e. replicated BOD5 measurements) is required for FE as laboratory measurements can be associated with high uncertainty.
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Affiliation(s)
- K Khamis
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK E-mail:
| | - C Bradley
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK E-mail:
| | - H J Gunter
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK E-mail: ; RS Hydro Ltd, Leask House, Hanbury Road, Stoke Prior, Worcestershire B60 4JZ, UK
| | - G Basevi
- RS Hydro Ltd, Leask House, Hanbury Road, Stoke Prior, Worcestershire B60 4JZ, UK
| | - R Stevens
- RS Hydro Ltd, Leask House, Hanbury Road, Stoke Prior, Worcestershire B60 4JZ, UK
| | - D M Hannah
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK E-mail:
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22
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Uberoi A, Bartow-McKenney C, Zheng Q, Flowers L, Campbell A, Knight S, Chan N, Wei M, Lovins V, Bugayev J, Horwinski J, Bradley C, Meyer J, Crumrine D, Sutter C, Elias P, Mauldin E, Sutter T, Grice E. 190 Commensal microbiota regulates skin barrier function and repair via signaling through the aryl hydrocarbon receptor. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Miklin D, Bradley C, Salimbangon A, Wolfson A, Vaidya A, Depasquale E. Outcomes of Septuagenarians Undergoing Heart Transplant after the UNOS Allocation Policy Change. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Dharmaprani D, Jenkins E, Quah J, Lahiri A, Tiver K, Mitchell L, Bradley C, Hayward M, Paterson D, Taggart P, Clayton R, Nash M, Ganesan A. A Governing Equation for Human Ventricular Fibrillation. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Brooke J, Safavi S, Prayle A, Ng C, Alappadan J, Bradley C, Cooper A, Munidasa S, Zanette B, Santyr G, Barr H, Major G, Smyth A, Gowland P, Francis S, Hall I. P109 Regional assessment of lung function using non-contrast MRI in people with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Reynolds C, Dominguez Castro P, Bardon L, Kennelly S, Clyne B, Bury G, Bradley C, Finnigan K, McCullagh L, Barry M, Murrin C, Perrotta C, Gibney E, Corish C. It Takes A Village: Patient Perspectives On The Management Of Malnutrition In The Community. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Castro PD, Reynolds C, Kennelly S, Clyne B, Bury G, Bradley C, Finnigan K, McCullagh L, Barry M, Murrin C, Perrotta C, Gibney E, Corish C. “Don’t Go Near The Word Malnutrition”; A qualitative study of community healthcare professionals and patients views on the term malnutrition. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dominguez Castro P, Reynolds C, Bizzaro G, Kennelly S, Clyne B, Bury G, Bradley C, Finnigan K, McCullagh L, Barry M, Murrin C, Perrotta C, Gibney E, Corish C. Large number of prescribed central nervous system drugs and younger age predict the use of more oral nutritional supplements units. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Reynolds C, Dominguez Castro P, Kennelly S, Clyne B, Bury G, Bradley C, Finnigan K, McCullagh L, Barry M, Murrin C, Perrotta C, Gibney E. Healthcare professionals’ preferences for the delivery, content and structure of a malnutrition education programme: An exploratory qualitative Study. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McCarthy S, Fitzgerald C, Sahm L, Bradley C, Walsh EK. Patient-held health IT adoption across the primary-secondary care interface: a Normalisation Process Theory perspective. Health Syst (Basingstoke) 2020; 11:17-29. [DOI: 10.1080/20476965.2020.1822146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Stephen McCarthy
- Business Information Systems, University College Cork, Cork, Ireland
| | - Ciara Fitzgerald
- Business Information Systems, University College Cork, Cork, Ireland
| | - Laura Sahm
- Business Information Systems, University College Cork, Cork, Ireland
| | - Colin Bradley
- Business Information Systems, University College Cork, Cork, Ireland
| | - Elaine K Walsh
- Business Information Systems, University College Cork, Cork, Ireland
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Bury G, Smith S, Kelly M, Bradley C, Howard W, Egan M. COVID-19 community assessment hubs in Ireland-the experience of clinicians. Ir J Med Sci 2020; 190:475-480. [PMID: 32980973 PMCID: PMC7519851 DOI: 10.1007/s11845-020-02381-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022]
Abstract
Background COVID-19 required rapid innovation in health systems, in the context of an infection which placed healthcare professionals at high risk; general practice has been a key component of that innovative response. In Ireland, GPs were asked to work in a network of community assessment hubs. A focused training programme in infection control procedures/clinical use of personal protective equipment (PPE) was rapidly developed in advance. University departments of general practice were asked to develop and deliver that training. Aim The aim of this article is to describe infection control procedure training in Ireland, the uptake by GPs and the initial experience of GPs working in this unusual environment. Design and setting Two anonymous cross-sectional online surveys are sent to participants in training courses. Method Survey 1 followed completion of training; survey 2 followed establishment of the hubs. Results Six hundred seventy-five participants (including 439 GPs, 156 GP registrars) took part in the training. Two hundred thirty-nine (50.3%) out of four hundred seventy-five responded to Survey 1—over 95% reported an increase in confidence in the use of PPE. Two hundred ten (44.2%) out of four hundred seventy-five participants responded to Survey 2; 195 had completed hub shifts. Younger, female GPs predominated. Very high levels of infection control procedures were reported. Participants commented positively on teamworking, environment and systems. However, ‘real-time’ ambulance service data suggest the peak of the surge may have passed by the time the hubs were established. Conclusion Academic departments, GPs and the Irish health system collaborated effectively to respond to the need for community assessment of COVID-19 patients.
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Affiliation(s)
- Gerard Bury
- Academic General Practice, School of Medicine, UCD, Dublin, Ireland.
| | - Susan Smith
- Department of Family Medicine & Primary Care, RCSI, Dublin, Ireland
| | - Maureen Kelly
- Discipline of General Practice, NUIG, Galway, Ireland
| | | | | | - Mairead Egan
- Academic General Practice, School of Medicine, UCD, Dublin, Ireland
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Murphy A, Brosnan S, McCarthy S, O'Raghallaigh P, Bradley C, Kirby A. World Café approach: exploring the future vision of oral anticoagulants for patients with atrial fibrillation (AF) in Ireland. BMJ Open 2020; 10:e036493. [PMID: 32973054 PMCID: PMC7517561 DOI: 10.1136/bmjopen-2019-036493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/08/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To explore and reflect on the current anticoagulation therapy offered to patients with atrial fibrillation (AF), potential challenges and the future vision for oral anticoagulants for patients with AF and healthcare professionals in Ireland. DESIGN A multistakeholder focus group using a World Café approach. PARTICIPANTS Nine participants from academic, clinical and health backgrounds attended the focus group together with a facilitator. RESULTS Enhanced patient empowerment; more effective use of technology and developing system-based medical care pathways would provide improved supports for AF management. The challenges in providing these include cost and access issues, the doctor-patient relationship and the provision of education. While consensus for developing evidence-based pathways to maximise efficiency and effectiveness of AF treatment was evident, it would require a shared vision between stakeholders of integrated care. The benefits of embracing technological advances for clinicians and patients were evident; however, clinicians indicate this can increase pressure on already stretched resources; coupled with institutional barriers (including scarce resources) arising from the complex nature of anticoagulation for patients with AF, which emerged strongly. Including the unpredictable nature of warfarin, hidden costs associated with monitoring, adverse clinical effects, different patient cohorts (including those prescribed anticoagulant for the first time vs those switching from warfarin to a new oral anticoagulant (NOAC)), non-adherence concerns and undesirable impacts on patients' daily lives. CONCLUSIONS While anticoagulation therapy for patients with AF using NOACs has been widely adopted and is diffusing into routine practice, significant operationalisation issues and barriers to effective treatment/management persist. The reflections reported in this study are a catalyst for future discussion and research.
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Affiliation(s)
- Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Stephen Brosnan
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Stephen McCarthy
- Department of Business Information Systems, Cork University Business School, University College Cork, Cork, Ireland
| | - Paidi O'Raghallaigh
- INFANT Research Centre, University College Cork, Cork, Ireland
- Cork University Business School, University College London, London, UK
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Ann Kirby
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
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Riordan F, Racine E, Phillip ET, Bradley C, Lorencatto F, Murphy M, Murphy A, Browne J, Smith SM, Kearney PM, McHugh SM. Correction to: Development of an intervention to facilitate implementation and uptake of diabetic retinopathy screening. Implement Sci 2020; 15:61. [PMID: 32731882 PMCID: PMC7393863 DOI: 10.1186/s13012-020-01026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Fiona Riordan
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland.
| | - Emmy Racine
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Eunice T Phillip
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | | | - Mark Murphy
- Department of General Practice, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - John Browne
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Susan M Smith
- Department of General Practice, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
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Sattar S, Haase K, Kuster S, Puts M, Spoelstra S, Bradley C, Wildes TM, Alibhai S. Falls in older adults with cancer: an updated systematic review of prevalence, injurious falls, and impact on cancer treatment. Support Care Cancer 2020; 29:21-33. [PMID: 32671565 DOI: 10.1007/s00520-020-05619-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/07/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE This update of our 2016 systematic review answers the following questions: (1) How often do older adults with cancer fall? (2) What are the predictors for falls? (3) What are the rates and predictors of injurious falls? (4) What are the circumstances and outcomes of falls? (5) How do falls in older patients affect subsequent cancer treatment? and a new research question, (6) Which fall reduction interventions are efficacious in this population? METHODS MEDLINE, PubMed, CINAHL, and Embase were searched (September 2015-January 25, 2019). Eligible studies included clinical trials and cohort, case-control, and cross-sectional studies published in English in which the sample (or subgroup) included adults aged ≥ 60, with cancer, in whom falls were examined as an outcome. RESULTS A total of 2521 titles were reviewed, 67 full-text articles were screened for eligibility, and 30 new studies were identified. The majority involved the outpatient setting (n = 19) utilizing cross-sectional method (n = 18). Sample size ranged from 21 to 17,958. Fall rates ranged from 1.52 to 3.41% per 1000 patient days (inpatient setting) and from 39%/24 months to 64%/12 months (outpatient setting). One out of the 6 research questions contributed to a new finding: one study reported that 1 in 20 older patients experienced impact on cancer treatment due to falls. No consistent predictors for falls/fall injuries and no studies on fall reduction interventions in the geriatric oncology setting were identified. CONCLUSION This updated review highlights a new gap in knowledge pertaining to interventions to prevent falls. Additionally, new knowledge also emerged in terms of impact of falls on cancer treatment; however, further research may increase generalizability. Falls and fall-related injuries are common in older adults with cancer and may affect subsequent cancer treatment. Further studies on predictors of falls, subsequent impacts, and fall reduction in the oncology setting are warranted.
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Affiliation(s)
- S Sattar
- College of Nursing, University of Saskatchewan, 4400 4th Avenue, Room 108, Regina, Saskatchewan, S4T 0H8, Canada.
| | - K Haase
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - S Kuster
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, Canada
| | - M Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - S Spoelstra
- Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, MI, USA
| | - C Bradley
- Library, University of Regina, Regina, Canada
| | - T M Wildes
- Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA
| | - S Alibhai
- Department of Medicine, Institute of Health Policy, Management, and Evaluations, University of Toronto, Toronto, Canada.,University Health Network, Toronto, Canada
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Bradley C, McKeown C, Rutherford C, Downey D, Addy C, Caskey S. P149 A review of the clinical trajectory of adults with cystic fibrosis prescribed nebulised Aztreonam Lysine (Cayston™). J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bradley C, Rutherford C, McParland C, Addy C, Downey D, McKeown C, Caskey S. WS03.3 A review of ursodeoxycholic acid prescribing in an adult cystic fibrosis population. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rutherford C, Bradley C, McKeown C, Caskey S, Downey D, Addy C. P197 The effect of ivacaftor on clinical trajectory of adults with cystic fibrosis carrying a R117H mutation. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Riordan F, Racine E, Phillip ET, Bradley C, Lorencatto F, Murphy M, Murphy A, Browne J, Smith SM, Kearney PM, McHugh SM. Development of an intervention to facilitate implementation and uptake of diabetic retinopathy screening. Implement Sci 2020; 15:34. [PMID: 32429983 PMCID: PMC7236930 DOI: 10.1186/s13012-020-00982-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/12/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND 'Implementation interventions' refer to methods used to enhance the adoption and implementation of clinical interventions such as diabetic retinopathy screening (DRS). DRS is effective, yet uptake is often suboptimal. Despite most routine management taking place in primary care and the central role of health care professionals (HCP) in referring to DRS, few interventions have been developed for primary care. We aimed to develop a multifaceted intervention targeting both professionals and patients to improve DRS uptake as an example of a systematic development process combining theory, stakeholder involvement, and evidence. METHODS First, we identified target behaviours through an audit in primary care of screening attendance. Second, we interviewed patients (n = 47) and HCP (n = 30), to identify determinants of uptake using the Theoretical Domains Framework, mapping these to behaviour change techniques (BCTs) to develop intervention content. Thirdly, we conducted semi-structured consensus groups with stakeholders, specifically users of the intervention, i.e. patients (n = 15) and HCPs (n = 16), regarding the feasibility, acceptability, and local relevance of selected BCTs and potential delivery modes. We consulted representatives from the national DRS programme to check intervention 'fit' with existing processes. We applied the APEASE criteria (affordability, practicability, effectiveness, acceptability, side effects, and equity) to select the final intervention components, drawing on findings from the previous steps, and a rapid evidence review of operationalised BCT effectiveness. RESULTS We identified potentially modifiable target behaviours at the patient (consent, attendance) and professional (registration) level. Patient barriers to consent/attendance included confusion between screening and routine eye checks, and fear of a negative result. Enablers included a recommendation from friends/family or professionals and recognising screening importance. Professional barriers to registration included the time to register patients and a lack of readily available information on uptake in their local area/practice. Most operationalised BCTs were acceptable to patients and HCPs while the response to feasibility varied. After considering APEASE, the core intervention, incorporating a range of BCTs, involved audit/feedback, electronic prompts targeting professionals, HCP-endorsed reminders (face-to-face, by phone and letter), and an information leaflet for patients. CONCLUSIONS Using the example of an intervention to improve DRS uptake, this study illustrates an approach to integrate theory with user involvement. This process highlighted tensions between theory-informed and stakeholder suggestions, and the need to apply the Theoretical Domains Framework (TDF)/BCT structure flexibly. The final intervention draws on the trusted professional-patient relationship, leveraging existing services to enhance implementation of the DRS programme. Intervention feasibility in primary care will be evaluated in a randomised cluster pilot trial.
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Affiliation(s)
- Fiona Riordan
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland.
| | - Emmy Racine
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Eunice T Phillip
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | | | - Mark Murphy
- Department of General Practice, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - John Browne
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Susan M Smith
- Department of General Practice, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Sheena M McHugh
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
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Nazeri K, Ahmed F, Ahsani V, Joe HE, Bradley C, Toyserkani E, Jun MBG. Hollow-Core Photonic Crystal Fiber Mach-Zehnder Interferometer for Gas Sensing. Sensors (Basel) 2020; 20:E2807. [PMID: 32429091 PMCID: PMC7284782 DOI: 10.3390/s20102807] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/08/2020] [Accepted: 05/13/2020] [Indexed: 01/24/2023]
Abstract
A novel and compact interferometric refractive index (RI) point sensor is developed using hollow-core photonic crystal fiber (HC-PCF) and experimentally demonstrated for high sensitivity detection and measurement of pure gases. To construct the device, the sensing element fiber (HC-PCF) was placed between two single-mode fibers with airgaps at each side. Great measurement repeatability was shown in the cyclic test for the detection of various gases. The RI sensitivity of 4629 nm/RIU was demonstrated in the RI range of 1.0000347-1.000436 for the sensor with an HC-PCF length of 3.3 mm. The sensitivity of the proposed Mach-Zehnder interferometer (MZI) sensor increases when the length of the sensing element decreases. It is shown that response and recovery times of the proposed sensor inversely change with the length of HC-PCF. Besides, spatial frequency analysis for a wide range of air-gaps revealed information on the number and power distribution of modes. It is shown that the power is mainly carried by two dominant modes in the proposed structure. The proposed sensors have the potential to improve current technology's ability to detect and quantify pure gases.
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Affiliation(s)
- Kaveh Nazeri
- Department of Mechanical Engineering, University of Victoria, Victoria, BC V8W 2Y2, Canada; (K.N.); (V.A.); (C.B.)
| | - Farid Ahmed
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Vahid Ahsani
- Department of Mechanical Engineering, University of Victoria, Victoria, BC V8W 2Y2, Canada; (K.N.); (V.A.); (C.B.)
| | - Hang-Eun Joe
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA; (H.-E.J.); (M.B.G.J.)
| | - Colin Bradley
- Department of Mechanical Engineering, University of Victoria, Victoria, BC V8W 2Y2, Canada; (K.N.); (V.A.); (C.B.)
| | - Ehsan Toyserkani
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Martin B. G. Jun
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA; (H.-E.J.); (M.B.G.J.)
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Riordan F, Racine E, Smith SM, Murphy A, Browne J, Kearney PM, Bradley C, James M, Murphy M, McHugh SM. Feasibility of an implementation intervention to increase attendance at diabetic retinopathy screening: protocol for a cluster randomised pilot trial. Pilot Feasibility Stud 2020; 6:64. [PMID: 32426158 PMCID: PMC7216495 DOI: 10.1186/s40814-020-00608-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diabetic retinopathy screening (DRS) leads to the earlier detection of retinopathy and treatment that can prevent or delay the development of diabetes-related blindness. However, uptake continues to be sub-optimal in many countries, including Ireland. Routine management of type 2 diabetes largely takes place in primary care. As such, there may be an opportunity in primary care to introduce interventions to improve DRS uptake. However, few studies test the feasibility of interventions to enhance DRS uptake in this context. Our aim is to investigate the feasibility of an implementation intervention (IDEAs (Improving Diabetes Eye screening Attendance)) delivered in general practice to improve the uptake of the national DRS programme, RetinaScreen. METHODS The IDEAs study is a cluster randomised pilot trial with an embedded process evaluation and economic evaluation. Following stratification by practice size, eight general practices (clusters) will be randomly allocated to intervention (n = 4) or wait-list control groups (n = 4). The intervention will be delivered for 6 months, after which, it will be administered to wait-list control practices. The intervention is multi-faceted and comprises provider-level components (training, audit and feedback, health care professional prompt, reimbursement) and patient-level components (GP-endorsed reminder with information leaflet delivered opportunistically face-to-face, and systematically by phone and letter). Patient inclusion criteria are type 1 or type 2 diabetes and DRS programme non-attendance. A multi-method approach will be used to determine screening uptake, evaluate the trial and study procedures and examine the acceptability and feasibility of the intervention from staff and patient perspectives. Quantitative and qualitative data will be collected on intervention uptake and delivery, research processes and outcomes. Data will be collected at the practice, health professional and patient level. A partial economic evaluation will be conducted to estimate the cost of delivering the implementation intervention in general practice. Formal continuation criteria will be used to determine whether IDEAs should progress to a definitive trial. DISCUSSION Findings will determine whether IDEAsis feasible and acceptable and will be used to refine the intervention and study procedures. A definitive trial will determine whether IDEAs is a cost-effective intervention to improve DRS uptake and reduce diabetes-related blindness. TRIAL REGISTRATION ClinicalTrials.gov NCT03901898. Registered 3rd April 2019.
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Affiliation(s)
- Fiona Riordan
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Emmy Racine
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Susan M. Smith
- Department of General Practice, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - John Browne
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Patricia M. Kearney
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Mark James
- Medical Education Unit, University College Cork, Cork, Ireland
| | - Mark Murphy
- Department of General Practice, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Sheena M. McHugh
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
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Khamis K, Bradley C, Hannah DM. High frequency fluorescence monitoring reveals new insights into organic matter dynamics of an urban river, Birmingham, UK. Sci Total Environ 2020; 710:135668. [PMID: 31785904 DOI: 10.1016/j.scitotenv.2019.135668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
Natural organic matter (NOM) is fundamental to many biogeochemical processes in river ecosystems. Currently, however, we have limited knowledge of NOM dynamics across the spectrum of flow conditions as previous studies have focused largely on storm events. Field deployable fluorescence technology offers new opportunities to explore both stochastic and predictable diel NOM dynamics at finer time-steps and for longer periods than was hitherto possible, thus yielding new insight into NOM sources, processing, and pathways. Hourly fluorescence data (humic-like fluorescence [Peak C] and tryptophan-like fluorescence [Peak T]) and a suite of hydro-climatological variables were collected from an urban river (Birmingham, UK). We explored monthly concentration-discharge (C-Q) patterns using segmented regression and assessed hysteretic and flushing behaviour for Peak C, T and turbidity to infer source zone activation. Diel patterns were assessed during low flow periods. Wavelet analysis identified strong diurnal variations in Peak C with early morning peaks while no diel dynamics were apparent for Peak T. Using generalised linear modelling relationships between Peak C periodicity and both solar radiation and time since previous storm/scouring event were identified. Breakpoints and positive slopes for C-Q relationship highlighted chemodynamic behaviour for NOM over most of the monitoring period, with Peak T mobilised more relative to Peak C during high Q. Hysteresis patterns were highly variable but flushing behaviour of Peak T and C suggested exhaustion of humic compounds during long duration events and following successive rainfall events. Peak T flushing was correlated with Q magnitude highlighting the potential for combined sewer overflows to act as important NOM sources despite significant dilution potential. This research highlights the potential of real-time, field deployable fluorescence spectroscopy as a viable method for providing insight into diel and transport driven NOM dynamics.
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Affiliation(s)
- K Khamis
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK.
| | - C Bradley
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK
| | - D M Hannah
- School of Geography Earth and Environmental Science, University of Birmingham, Birmingham B15 2TT, UK
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Lu H, Yan H, Masey O’Neill H, Bradley C, Bedford M, Wilcock P, Nakatsu C, Adeola O, Ajuwon K. Effect of timing of postweaning xylanase supplementation on growth performance, nutrient digestibility, and fecal microbial composition in weanling pigs. Can J Anim Sci 2020. [DOI: 10.1139/cjas-2019-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Effect of timing of xylanase supplementation to weanling pigs and its effect on growth performance, nutrient digestibility, and fecal microbiota was investigated. A total of 128 weanling pigs [(Hampshire × Duroc) × (Yorkshire × Landrace); 6.2 ± 0.6 kg body weight (BW); weaning age: 21 d] were assigned to four treatments, with eight replicate pens and four pigs per pen. Treatments were a combination of two dietary treatments (without or with xylanase) in two periods; (period 1, days 0–14) and period 2 (days 14–42): xylanase–xylanase, xylanase–control, control–xylanase, and control–control. Fecal microbiota diversity and apparent total tract digestibility (ATTD) were determined. From days 0–14, pigs had lower (P < 0.01) BW, average daily gain (ADG), and feed efficiency when xylanase was included in the diets. The final BW (P < 0.05) and overall ADG (P < 0.02) at day 42 were greater when xylanase was supplemented from day 14 compared with supplementation from day 0. The apparent ileal digestibility and ATTD of dry matter, gross energy, nitrogen, and phosphorus were increased (P < 0.05) by xylanase. Xylanase significantly decreased (P < 0.05) the relative abundance of Veillonella spp. and tended (P = 0.08) to decrease the relative abundance of Megasphaera spp. in period 2 compared with the non-supplemented group.
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Affiliation(s)
- H. Lu
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - H. Yan
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, USA
| | | | - C. Bradley
- AB Vista Feed Ingredients, Marlborough, Wiltshire SN8 4AN, UK
| | - M.R. Bedford
- AB Vista Feed Ingredients, Marlborough, Wiltshire SN8 4AN, UK
| | - P. Wilcock
- AB Vista Feed Ingredients, Marlborough, Wiltshire SN8 4AN, UK
| | - C.H. Nakatsu
- Department of Agronomy, Purdue University, West Lafayette, IN 47907, USA
| | - O. Adeola
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - K.M. Ajuwon
- Department of Animal Sciences, Purdue University, West Lafayette, IN 47907, USA
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Murphy A, Kirby A, Bradley C. Monitoring of atrial fibrillation in primary care patients prescribed direct oral anticoagulants for stroke prevention. Ir J Med Sci 2020; 189:961-966. [PMID: 31900842 DOI: 10.1007/s11845-019-02150-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 11/20/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Direct oral anticoagulants (DOACs) are widely marketed as medicines that do not require routine laboratory monitoring. However, they do have complex pharmacological properties and side effects; hence prescribing and monitoring guidelines, such as the European Heart Rhythm Association (EHRA) guidelines, have emerged. These advocate monitoring for renal and hepatic impairment; bleeding episodes; liver function; co-medication; circulation, and occurrence of side effects. Though 3 to 6 month follow-up is advocated, this is currently not routine, and its implementation creates a potential obligation for general practitioners (GPs) managing atrial fibrillation (AF) patients in the community. AIMS This study investigates the frequency, the type of follow-up, and the factors that influenced follow-up among Irish GPs, who prescribed DOACs to patients with AF, to prevent strokes in 2015. METHODS The frequency and type of follow-up care is estimated, and a count model regression analysis is applied to determine the GP and practice characteristics that are associated with the implementation of follow-up. RESULTS The EHRA guidelines most frequently followed were those pertaining to renal function (82%), bleeding episodes (71%), liver function (69%), circulation (54%), and side effects (55%). The regression analysis revealed that female GPs (P = 0.05) and GPs who follow all seven guidelines (P = 0.06) practice more frequent follow-up while those in training practices (P = 0.09) provide less frequent follow-up. CONCLUSIONS Results show that there was incomplete adherence to the 2013 EHRA prescribing guidelines with only 24% adhering to all seven guidelines, and patient follow-up was less frequent than has been suggested.
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Affiliation(s)
- Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Aras na Laoi, Western Rd., Cork, Ireland.
| | - Ann Kirby
- Department of Economics, Cork University Business School, University College Cork, Aras na Laoi, Western Rd., Cork, Ireland
| | - Colin Bradley
- Department of General Practice, School of Medicine, Western Gateway Building, University College Cork, Cork, Ireland
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Wiffen L, Lodge D, Fox L, Bradley C, Ibrahim W, Bentley K, Cook C, Nutkins K, Brown T, Rupani H, Chauhan A, Bishop L, Hicks A. Patient experience of telephone consultations in the lung cancer pathway. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sattar S, Puts M, Spoelstra S, Yokom D, Haase K, Kuster S, Bradley C, Fazalzad R, Wildes T, Alibhai S. FALLS IN OLDER ADULTS WITH CANCER: PRELIMINARY ANALYSIS OF AN UPDATED SYSTEMATIC REVIEW OF PREVALENCE, INJURIOUS FALLS, AND IMPACT ON CANCER TREATMENT. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31283-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sattar S, Haase K, Bradley C, Papadopoulos E, Kuster S, Mina D, Joshua A, Souied O, Rediger C, Alibhai S. PERCEPTION OF STRUCTURED EXERCISE PROGRAMS AND FACTORS ASSOCIATED WITH PARTICIPATION AND ADHERENCE AMONG MEN WITH PROSTATE CANCER: A SCOPING REVIEW. J Geriatr Oncol 2019. [DOI: 10.1016/s1879-4068(19)31282-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Arensman E, Larkin C, McCarthy J, Leitao S, Corcoran P, Williamson E, McAuliffe C, Perry IJ, Griffin E, Cassidy EM, Bradley C, Kapur N, Kinahan J, Cleary A, Foster T, Gallagher J, Malone K, Ramos Costa AP, Greiner BA. Psychosocial, psychiatric and work-related risk factors associated with suicide in Ireland: optimised methodological approach of a case-control psychological autopsy study. BMC Psychiatry 2019; 19:275. [PMID: 31492119 PMCID: PMC6728991 DOI: 10.1186/s12888-019-2249-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 08/20/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Suicide has profound effects on families and communities, but is a statistically rare event. Psychological autopsies using a case-control design allow researchers to examine risk factors for suicide, using a variety of sources to detail the psychological and social characteristics of decedents and to compare them to controls. The Suicide Support and Information System Case Control study (SSIS-ACE) aimed to compare psychosocial, psychiatric and work-related risk factors across three groups of subjects: suicide decedents, patients presenting to hospital with a high-risk self-harm episode, and general practice controls. METHODS The study design includes two inter-related studies; one main case-control study: comparing suicide cases to general practice (GP) controls, and one comparative study: comparing suicide cases to patients presenting with high-risk self-harm. Consecutive cases of suicide and probable suicide are identified through coroners' registration of deaths in the defined region (Cork City and County, Ireland) and are frequency-matched for age group and gender with GP patient controls recruited from the same GP practice as the deceased. Data sources for suicide cases include coroners' records, interviews with health care professionals and proxy informants; data sources for GP controls and for high-risk self-harm controls include interviews with control, with proxy informants and with health care professionals. Interviews are semi-structured and consist of quantitative and qualitative parts. The quantitative parts include a range of validated questionnaires addressing psychiatric, psychosocial and occupational factors. The study adopts several methodological innovations, including accessing multiple data sources for suicide cases and controls simultaneously, recruiting proxy informants to examine consistency across sources. CONCLUSIONS The study allows for the investigation of consistency across different data sources and contributes to the methodological advancement of psychological autopsy research. The study will also inform clinical and public health practice. The comparison between suicide cases and controls will allow investigation of risk and protective factors for suicide more generally, while the comparison with high-risk self-harm patients will help to identify the factors associated specifically with a fatal outcome to a self-harm episode. A further enhancement is the particular focus on specific work-related risk factors for suicide.
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Affiliation(s)
- E. Arensman
- 0000000123318773grid.7872.aNational Suicide Research Foundation and School of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - C. Larkin
- 0000 0001 0742 0364grid.168645.8Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, 01655 USA
| | | | - S. Leitao
- 0000 0004 0617 6269grid.411916.aSchool of Public Health, College of Medicine and Health and National Perinatal Epidemiology Centre, Department of Obstetrics and Gynaecology, Cork University Hospital Maternity Hospital, Wilton, Cork, Ireland
| | - P. Corcoran
- 0000000123318773grid.7872.aNational Suicide Research Foundation and School of Public Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. Williamson
- 0000000123318773grid.7872.aNational Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - C. McAuliffe
- St. Patrick’s Mental Health Services, Cork, Ireland
| | - I. J. Perry
- 0000000123318773grid.7872.aSchool of Public Health, College of Medicine and Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. Griffin
- 0000000123318773grid.7872.aNational Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - E. M. Cassidy
- Department of Psychiatry and Neurobehavioural Science, University College Cork, Liaison Psychiatry Service, Cork University Hospital, Cork, Ireland
| | - C. Bradley
- 0000000123318773grid.7872.aDepartment of General Practice, University College Cork, Western Gateway Building, Cork, Ireland
| | - N. Kapur
- 0000 0004 0430 6955grid.450837.dCentre for Mental Health and Safety, University of Manchester and Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - J. Kinahan
- 0000 0004 0575 9497grid.411785.eNorth Lee Psychiatric Services, Mercy University Hospital, Cork, Ireland
| | - A. Cleary
- 0000 0001 0768 2743grid.7886.1Geary Institute for Public Policy, University College Dublin, Dublin, Ireland
| | - T. Foster
- Consultant Psychiatrist, Omagh and Fermanagh, Northern Ireland
| | - J. Gallagher
- 0000000123318773grid.7872.aSchool of Public Health, University College Cork, Cork, Ireland
| | - K. Malone
- 0000 0001 0768 2743grid.7886.1School of Medicine, University College Dublin, Dublin, Ireland
| | - A. P. Ramos Costa
- 0000000123318773grid.7872.aSchool of Public Health and National Suicide Research Foundation, University College Cork, Cork, Ireland
| | - B. A. Greiner
- 0000000123318773grid.7872.aSchool of Public Health, College of Medicine and Health, University College Cork, Cork, Ireland
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Sinnott C, Foley T, Horgan L, McLoughlin K, Sheehan C, Bradley C. Shifting gears versus sudden stops: qualitative study of consultations about driving in patients with cognitive impairment. BMJ Open 2019; 9:e024452. [PMID: 31439594 PMCID: PMC6707695 DOI: 10.1136/bmjopen-2018-024452] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE General practitioners (GPs) report finding consultations on fitness to drive (FtD) in people with cognitive impairment difficult and potentially damaging to the physician-patient relationship. We aimed to explore GP and patient experiences to understand how the negative impacts associated with FtD consultations may be mitigated. METHODS Individual qualitative interviews were conducted with GPs (n=12) and patients/carers (n=6) in Ireland. We recruited a maximum variation sample of GPs using criteria of length of time qualified, practice location and practice size. Patients with cognitive impairment were recruited via driving assessment services and participating general practices. Interviews were audio-recorded, transcribed and analysed thematically by the multidisciplinary research team using an approach informed by the framework method. RESULTS The issue of FtD arose in consultations in two ways: introduced by GPs to proactively prepare patients for future driving cessation or by patients who urgently needed a medical report for an expiring driving license. The former strategy, implementable by GPs who had strong relational continuity with their patients, helped prevent crisis consultations from arising. The latter scenario became acrimonious if cognition had not been openly discussed with patients previously and was now potentially impacting on their right to drive. Patients called for greater clarity and empathy for the threat of driving cessation from their GPs. CONCLUSION GPs used their longitudinal relationship with cognitively impaired patients to reduce the potential for conflict in consultations on FtD. These efforts could be augmented by explicit discussion of cognitive impairment at an earlier stage for all affected patients. Patients would benefit from greater input into planning driving cessation and acknowledgement from their GPs of the impact this may have on their quality of life.
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Affiliation(s)
- Carol Sinnott
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Linda Horgan
- Department of Occupational Therapy, University College Cork, Cork, Ireland
| | | | - Cormac Sheehan
- Department of General Practice, University College Cork, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
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Geraci AA, Bradley C, Gao D, Weinstein J, Derevianko A. Searching for Ultralight Dark Matter with Optical Cavities. Phys Rev Lett 2019; 123:031304. [PMID: 31386466 DOI: 10.1103/physrevlett.123.031304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 02/16/2019] [Indexed: 06/10/2023]
Abstract
We discuss the use of optical cavities as tools to search for dark matter (DM) composed of virialized ultralight fields (VULFs). Such fields could lead to oscillating fundamental constants, resulting in oscillations of the length of rigid bodies. We propose searching for these effects via differential strain measurement of rigid and suspended-mirror cavities. We estimate that more than 2 orders of magnitude of unexplored phase space for VULF DM couplings can be probed at VULF Compton frequencies in the audible range of 0.1-10 kHz.
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Affiliation(s)
- Andrew A Geraci
- Department of Physics and Astronomy, Northwestern University, Evanston, Illinois 60208, USA
| | - Colin Bradley
- Department of Physics, University of Nevada, Reno, Nevada 89557, USA
| | - Dongfeng Gao
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan 430071, China
| | | | - Andrei Derevianko
- Department of Physics, University of Nevada, Reno, Nevada 89557, USA
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Ahsani V, Ahmed F, Jun MBG, Bradley C. Tapered Fiber-Optic Mach-Zehnder Interferometer for Ultra-High Sensitivity Measurement of Refractive Index. Sensors (Basel) 2019; 19:s19071652. [PMID: 30959916 PMCID: PMC6480093 DOI: 10.3390/s19071652] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/31/2019] [Accepted: 04/03/2019] [Indexed: 12/13/2022]
Abstract
A Mach-Zehnder interferometer (MZI) based fiberoptic refractive index (RI) sensor is constructed by uniformly tapering standard single mode fiber (SMF) for RI measurement. A custom flame-based tapering machine is used to fabricate microfiber MZI sensors directly from SMFs. The fabricated MZI device does not require any splicing of fibers and shows excellent RI sensitivity. The sensor with a cladding diameter of 35.5 µm and length of 20 mm exhibits RI sensitivity of 415 nm/RIU for RI range of 1.332 to 1.384, 1103 nm/RIU for RI range of 1.384 to 1.4204 and 4234 nm/RIU for RI range of 1.4204 to 1.4408, respectively. The sensor reveals a temperature sensitivity of 0.0097 nm/°C, which is relatively low in comparison to its ultra-high RI sensitivity. The proposed inexpensive and highly sensitive optical fiber RI sensors have numerous applications in chemical and biochemical sensing fields.
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Affiliation(s)
- Vahid Ahsani
- Department of Mechanical Engineering, University of Victoria, Victoria, BC V8W 2Y2, Canada.
| | - Farid Ahmed
- Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
| | - Martin B G Jun
- Department of Mechanical Engineering, University of Victoria, Victoria, BC V8W 2Y2, Canada.
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47907, USA.
| | - Colin Bradley
- Department of Mechanical Engineering, University of Victoria, Victoria, BC V8W 2Y2, Canada.
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