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Fowler K, Mayock P, Byrne E, Bennett K, Sexton E. "Coming home was a disaster, I didn't know what was going to happen": a qualitative study of survivors' and family members' experiences of navigating care post-stroke. Disabil Rehabil 2024:1-13. [PMID: 38265039 DOI: 10.1080/09638288.2024.2303368] [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: 07/01/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Understanding navigational barriers and facilitators has the potential to advance equitable stroke care delivery. The aim of this study was to explore, using a qualitative study, the experiences of stroke survivors and their families as they journey through the stroke care system, both before and during the COVID-19 pandemic. METHODS In-depth semi-structured interviews were conducted with 18 stroke survivors and 12 family members during 2021 and 2022. Participants were recruited through voluntary organisations, social media, and stroke support groups. Data analysis followed a systematic process guided by the framework method with steps including familiarisation, coding, framework development, and charting and interpretation. RESULTS The experiences of navigating stroke care were particularly challenging following discharge from hospital into the community. Barriers to stroke care continuity included insufficient appropriate services and information, unsatisfactory relationships with healthcare professionals and distressed mental health. There were particular navigational challenges for survivors with aphasia. Facilitators to effective navigation included having prior knowledge of the health system, harnessing support for care co-ordination, and being persistent. CONCLUSION Greater support for patient navigation, and person-centred referral pathways, particularly during times of increased pressure on the system, have the potential to improve access to services and wellbeing among stroke survivors.
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Affiliation(s)
- Karen Fowler
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paula Mayock
- School of Social Work and Social Policy, Trinity College Dublin, Ireland
| | - Elaine Byrne
- Centre for Positive Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eithne Sexton
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Sexton E, Fowler K, Hickey A, Williams DJ, Horgan F, Byrne E, Macey C, Cuffe P, Timmons S, Bennett K. Priorities for developing stroke care in Ireland from the perspectives of stroke survivors, family carers and professionals involved in stroke care: A mixed methods study. PLoS One 2024; 19:e0297072. [PMID: 38241235 PMCID: PMC10798447 DOI: 10.1371/journal.pone.0297072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/26/2023] [Indexed: 01/21/2024] Open
Abstract
INTRODUCTION Increasing numbers of people are living with stroke, due to population ageing and improved survival, leading to a need for evidence to inform future policy decision-making. This study aimed to engage with stakeholders in Ireland to identify priorities for stroke services development. METHODS A sequential mixed methods design was used. Phase 1 (qualitative) was exploratory, involving initial priority gathering via an online qualitative survey and interviews, with stroke survivors, family/main carers, and professionals working in stroke care. Framework analysis was used to generate a long-list of improvements to stroke services. Phase 2 involved a quantitative survey, where stakeholders selected five priority improvements from the long-list. Results were discussed in a stakeholder meeting. RESULTS In-depth interviews were completed with 18 survivors, 13 carers and 8 professionals, while 80 professionals took part in a qualitative survey (phase 1). Priority areas of care were identified and a long-list of 45 priority improvements was generated. In phase 2, 34 survivors, 19 family carers and 42 professionals completed a survey. The highest priority improvements (selected by >20% of respondents) were access to specialist neuro-rehabilitation, ongoing support for life after stroke, recruitment/retention of specialist staff, improved information and support for health system navigation, and access to specialist acute care. Stroke survivors/carers prioritised exploring ways to improve access for strokes with atypical presentation, while professionals prioritised specialist inpatient rehabilitation and early supported discharge. Neither group prioritised stroke prevention. Based on discussions in the stakeholder meeting (n = 12), it was decided that support for mental health should also be included as a priority. DISCUSSION The development of stroke services benefits from exploring the priorities of those receiving and delivering stroke care. Findings emphasise the need for equitable access to high quality adequately-staffed services, particularly post-discharge, that are easy to navigate, with good communication, and effective information provision.
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Affiliation(s)
- Eithne Sexton
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Karen Fowler
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anne Hickey
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - David J. Williams
- Department of Geriatric and Stroke Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Elaine Byrne
- Centre for Positive Health Science, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Padraic Cuffe
- Irish Heart Foundation, Dublin, Ireland
- Patient Collaborator, Sligo, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Byrne E, Heywood A. Use of routine health information systems data in developing and monitoring district and facility health plans: a scoping review. BMC Health Serv Res 2023; 23:1049. [PMID: 37784166 PMCID: PMC10544391 DOI: 10.1186/s12913-023-09914-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Routine Health Information Systems data should be used in a systematic and institutionalised manner to support the making of plans, the monitoring of plans and in supportive supervision. To explore to what extent there is discussion about the linkage between planning, monitoring and supervision of sub-national programs using routine data we conducted a scoping review. The review question was: How are routine health information systems used in developing and monitoring health plans at district and facility level? METHODS From a search of Ovid Medline (all), EMBASE and Web of Science along with a review of grey literature and involving a number of key stakeholders in identifying any missing resources a total of over 2200 documents were reviewed and data from 13 documents were extracted. RESULTS Overall, there are many descriptions of how to implement and strengthen systems, ways to assess and improve data availability and quality, tools to improve the data use context, training in data use and mechanisms to involve stakeholders and strengthen infrastructure. However, there are gaps in examples of routine health data being used in the development, monitoring and supervision of plans at district and facility level. CONCLUSIONS There appears to be no institutionalised obligation of planners to monitor plans, very little guidance on how to practically monitor programs and minimal discussion about how to use the routinely available data to supportively supervise the implementation of the plans. To overcome these shortcomings, we recommend that practical procedures to ensure linkage of existing district plans to regular monitoring of priority programs are institutionalised, that mechanisms for making managers institutionally accountable for monitoring and supervising these plans are put in place, and that practical guidelines for linking plans with routine health information system data and regular monitoring and supportive supervision are developed.
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Ferris France N, Byrne E, Nyamwanza O, Munatsi V, Willis N, Conroy R, Vumbunu S, Chinembiri M, Maedziso S, Katsande MA, Dongo TA, Crehan E, Mavhu W. Wakakosha "You are Worth it": reported impact of a community-based, peer-led HIV self-stigma intervention to improve self-worth and wellbeing among young people living with HIV in Zimbabwe. Front Public Health 2023; 11:1235150. [PMID: 37575105 PMCID: PMC10422020 DOI: 10.3389/fpubh.2023.1235150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction Self-stigma-negative self-judgements or core beliefs-can result in feelings of shame, worthlessness and self-blame, and impacts social interaction, mental health and health service utilization among people living with HIV (PLHIV). Few interventions target self-stigma among PLHIV and, to our knowledge, none until now for adolescents and young people LHIV (AYPLHIV) in sub-Saharan Africa. We present qualitative findings on the perceived impact of a self-stigma intervention (Wakakosha, "You are Worth it"). Methods The Wakakosha intervention adopted inquiry-based stress reduction (IBSR) at its core-a unique way of identifying and questioning deeply rooted self-stigma, combined with mindfulness, meditation and creativity. The intervention consisted of 16 × 3 hour group sessions. Supporting the intervention was a 156-page activity journal. We utilized a qualitative enquiry to explore the perceived impact of the intervention at various time points between November 2021 and November 2022, with 62 participants (n = 32 female). Discussions explored experiences of being involved in the intervention and any reports on changes in relation to self-stigma and shame. Additionally, we reviewed intervention documentation and creative elements. A thematic analysis guided generation of themes across all data sources. Results Both intervention participants and coaches described the transformative effect of the intervention, detailing their experiences before and after. Main themes that emerged were positive changes around: self-confidence, self-agency, sense of purpose/meaning, body positivity, improved communication and personal/family relationships and, forgiveness. The intervention also transferred a set of practical skills on self-inquiry, mindfulness, meditation and creativity that continued to be used in participants' daily lives. Conclusion The Wakakosha intervention, using IBSR supported by music, creativity, writing and mindfulness techniques, showed potential for reducing self-stigma and improving self-worth among AYPLHIV. It also transferred practical skills to intervention participants and peer coaches, building their capacity to support others and deal with life challenges beyond HIV. The next phase is to continue supporting the young people to ensure fidelity as the peer coaches deliver the intervention to others. Study results indicate that culturally and practically, interventions to reduce self-stigma and/or improve self-worth operate at various levels and need to be designed and assessed at each level.
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Affiliation(s)
- Nadine Ferris France
- Beyond Stigma, Dublin, Ireland
- University College Cork School of Medicine, Department of Public Health & Epidemiology, Cork, Ireland
| | - Elaine Byrne
- Centre for Positive Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Owen Nyamwanza
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
| | | | | | - Ronan Conroy
- Department of Epidemiology and Public Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Moud Chinembiri
- Community of the Work in Zimbabwe, Harare, Zimbabwe
- The Work Under the Tree Trust, Harare, Zimbabwe
| | | | | | | | | | - Webster Mavhu
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Flocks Monaghan C, Pittalis C, Byrne E, Hussein I, Chilunjika T, Nandi B, Borgstein E, Gajewski J. The status of pediatric surgery in Malawi: a narrative mini-review. Front Pediatr 2023; 11:1195691. [PMID: 37484773 PMCID: PMC10357470 DOI: 10.3389/fped.2023.1195691] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Pediatric surgery is essential to a well-functioning health system. Unmet surgical needs contribute to 6.7% of pediatric deaths in Malawi. Understanding the current state of pediatric surgical care in Malawi is necessary to recognize gaps and opportunities in service delivery and to develop evidence-based national planning and solutions. Methods This narrative mini review synthesized the literature on the state of pediatric surgery in Malawi through the pillars of the World Health Organization's Health System Building Blocks. A search of PubMed, Embase, and Scopus databases was executed to identify relevant studies and a thematic analysis was performed. Further, to ensure contextual accuracy, pediatric surgeons from Malawi were consulted and involved in this review. Results Twenty-six papers were identified. In Malawi's central hospitals, there are six specialist pediatric surgeons for a pediatric population of more than 8 million. There is limited pediatric surgical capacity at the district hospitals. There is little to no written evidence of the national governing and finance structures in place for pediatric surgical services. Discussion In countries like Malawi, where a significant portion of the population comprises children, it is crucial to recognize that pediatric services are currently inadequate and fall short of the required standards. It is crucial to prioritize the enhancement of services specifically designed for this age group. This review aims to shed light on the existing gaps within pediatric surgical services in Malawi, providing valuable insights that can inform the development of comprehensive national surgical planning strategies.
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Affiliation(s)
- Celina Flocks Monaghan
- Institute of Global Surgery, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Chiara Pittalis
- Institute of Global Surgery, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elaine Byrne
- Centre for Positive Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Israa Hussein
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tiyamike Chilunjika
- Department of Surgery, University of Malawi College of Medicine, Zomba, Malawi
| | - Bip Nandi
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
- Michael E. Debakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Eric Borgstein
- Department of Surgery, University of Malawi College of Medicine, Zomba, Malawi
| | - Jakub Gajewski
- Institute of Global Surgery, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Global Surgery, University of Stellenbosch, Cape Town, South Africa
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Cronin Á, Noctor E, O' Doherty D, Bowers S, Byrne E, Cremona A. Facilitators and barriers to attending postpartum screening in women with a recent pregnancy complicated by gestational diabetes mellitus: a qualitative study. Public Health 2023; 220:99-107. [PMID: 37290175 DOI: 10.1016/j.puhe.2023.04.022] [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: 10/05/2022] [Revised: 04/06/2023] [Accepted: 04/25/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Pregnant women with gestational diabetes mellitus (GDM) are 50% more likely to develop type II diabetes (T2D) within 6 months to 2 years after giving birth. Therefore, international guidelines recommend it is best practice for women diagnosed with GDM to attend screening for T2D 6-12 weeks postpartum and every 1-3 years thereafter for life. However, uptake of postpartum screening is suboptimal. This study will explore the facilitators of and barriers to attending postpartum screening for T2D that women experience. STUDY DESIGN This was a prospective qualitative cohort study using thematic analysis. METHODS A total of 27 in-depth, semistructured interviews were conducted over the telephone with women who had recent GDM. Interviews were recorded and transcribed, and data were analysed using thematic analysis. RESULTS Facilitators of and barriers to attending postpartum screening were identified at three different levels: personal, intervention, and healthcare systems level. The most common facilitators identified were concern for their own health and having the importance of screening explained to them by a health professional. The most common barriers identified were confusion over the test and COVID-19. CONCLUSION This study identified several facilitators of and barriers to attending postpartum screening. These findings will help to inform research and interventions for improving rates of attendance at postpartum screening to reduce the subsequent risk of developing T2D.
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Affiliation(s)
- Á Cronin
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - E Noctor
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Ireland; Division of Endocrinology, UL Hospital Group, Limerick, Ireland; Health Science Academy, University Hospital Limerick, Limerick, Ireland
| | - D O' Doherty
- School of Medicine, University of Limerick, Ireland
| | - S Bowers
- Department of Clinical Nutrition and Dietetics, UL Hospital Group, Limerick, Ireland; Health Science Academy, University Hospital Limerick, Limerick, Ireland
| | - E Byrne
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Ireland
| | - A Cremona
- Discipline of Dietetics, School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland; Health Science Academy, University Hospital Limerick, Limerick, Ireland.
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7
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Callahan R, Byrne E. Don’t forget about the gut. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00380-4] [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: 01/28/2023]
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8
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Callahan R, Wee S, Byrne E. What is entrustment? Development of an objective approach to assessing an Entrustable Professional Activity. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00330-0] [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: 01/28/2023]
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Russek LN, Block NP, Byrne E, Chalela S, Chan C, Comerford M, Frost N, Hennessey S, McCarthy A, Nicholson LL, Parry J, Simmonds J, Stott PJ, Thomas L, Treleaven J, Wagner W, Hakim A. Presentation and physical therapy management of upper cervical instability in patients with symptomatic generalized joint hypermobility: International expert consensus recommendations. Front Med (Lausanne) 2023; 9:1072764. [PMID: 36743665 PMCID: PMC9893781 DOI: 10.3389/fmed.2022.1072764] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/29/2022] [Indexed: 01/19/2023] Open
Abstract
Experts in symptomatic generalized joint hypermobility (S-GJH) agree that upper cervical instability (UCI) needs to be better recognized in S-GJH, which commonly presents in the clinic as generalized hypermobility spectrum disorder and hypermobile Ehlers-Danlos syndrome. While mild UCI may be common, it can still be impactful; though considerably less common, severe UCI can potentially be debilitating. UCI includes both atlanto-occipital and atlantoaxial instability. In the absence of research or published literature describing validated tests or prediction rules, it is not clear what signs and symptoms are most important for diagnosis of UCI. Similarly, healthcare providers lack agreed-upon ways to screen and classify different types or severity of UCI and how to manage UCI in this population. Consequently, recognition and management of UCI in this population has likely been inconsistent and not based on the knowledge and skills of the most experienced clinicians. The current work represents efforts of an international team of physical/physiotherapy clinicians and a S-GJH expert rheumatologist to develop expert consensus recommendations for screening, assessing, and managing patients with UCI associated with S-GJH. Hopefully these recommendations can improve overall recognition and care for this population by combining expertise from physical/physiotherapy clinicians and researchers spanning three continents. These recommendations may also stimulate more research into recognition and conservative care for this complex condition.
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Affiliation(s)
- Leslie N. Russek
- Department of Physical Therapy, Clarkson University, Potsdam, NY, United States,St. Lawrence Health System, Potsdam, NY, United States,*Correspondence: Leslie N. Russek,
| | - Nancy P. Block
- Advanced Therapy Programs PT, San Jose, CA, United States
| | - Elaine Byrne
- Central Health Physiotherapy, London, United Kingdom
| | - Susan Chalela
- The Chalela Physical Therapy Institute for EDS/CCI, Charleston, SC, United States
| | - Cliffton Chan
- Department of Health Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Mark Comerford
- Performance Rehab, Brisbane, QLD, Australia,Comera Movement Science, Bristol, United Kingdom
| | | | | | - Ann McCarthy
- Central Health Physiotherapy, London, United Kingdom
| | - Leslie L. Nicholson
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jason Parry
- Central Health Physiotherapy, London, United Kingdom,University College London Hospital Trust, London, United Kingdom
| | - Jane Simmonds
- Central Health Physiotherapy, London, United Kingdom,Faculty of Population Health Sciences, University College London, London, United Kingdom
| | | | - Lucy Thomas
- Neck and Head Research Unit, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Julia Treleaven
- Performance Rehab, Brisbane, QLD, Australia,Neck and Head Research Unit, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | | | - Alan Hakim
- University College London Hospital Trust, London, United Kingdom,The Ehlers-Danlos Society, London, United Kingdom
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Sexton E, Fowler K, Byrne E, Bennett K. 125 STROKE SURVIVOR AND CARER EXPERIENCES OF NAVIGATION OF STROKE SERVICES AND INFORMATION IN IRELAND: AN EXPLORATORY QUALITATIVE INTERVIEW STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.104] [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: 11/12/2022] Open
Abstract
Abstract
Background
Patient navigation of stroke services is challenging, as survivors have diverse and complex needs, and clear care pathways are often lacking, particularly in the post-acute phase. Exploring the views of stroke survivors and main carers is critical to understanding these navigational challenges.
Methods
In-depth semi-structured interviews were conducted online or by phone with stroke survivors (n=16) and main carers (n=13) recruited through voluntary organisations and social media. Participants with communication or cognitive difficulties were included, and provided with accessible information materials. Interviews were audio-recorded and transcribed. Framework analysis was used, involving data familiarisation, coding, development of an analytic framework, charting and interpretation. Ryvicker’s (2018) behavioral-ecological conceptual framework for patient navigation was used to inform the analytic framework.
Results
Barriers to successful patient navigation at the healthcare system level included complex and unclear eligibility criteria for services and entitlements, including arbitrary age limits; geographical variation; and waiting times for services, particularly rehabilitation. Having a skilled or knowledgeable advocate, such as a family member with experience of the healthcare system, was a key enabling factor. Survivors and carers had to be pro-active and “push” or “battle” for needed services and information. Navigation often involved a substantial administrative burden, which survivors and caregivers had to manage in addition to the demands of the stroke itself, the recovery process, and in many cases other co-morbidities. Healthcare provider factors that supported navigation included clear communication with survivors/carers about services and the stroke itself. Staff who specifically supported care co-ordination were helpful, but this tended to be ad-hoc and limited in availability.
Conclusion
Dedicated staff to support patient navigation across the care continuum could make a significant difference to stroke survivor access to services and consequently outcomes. Clearer, standardised and more person-centred referrals pathways, that are widely publicised and understood, would also improve access.
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Affiliation(s)
- E Sexton
- RCSI University of Medicine and Health Sciences , Dublin, Ireland
| | - K Fowler
- RCSI University of Medicine and Health Sciences , Dublin, Ireland
| | - E Byrne
- RCSI University of Medicine and Health Sciences , Dublin, Ireland
| | - K Bennett
- RCSI University of Medicine and Health Sciences , Dublin, Ireland
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Moran CN, Jeffares I, Merriman NA, McCormack J, Harbison J, Sexton E, Williams D, Kelly PJ, Horgan F, Collins R, Bhreacáin MN, Byrne E, Thornton J, Tully C, Hickey A. 119 ENHANCING THE QUALITY OF STROKE CARE IN IRELAND - DEVELOPMENT OF AN IRISH NATIONAL STROKE AUDIT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.098] [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] Open
Abstract
Abstract
Background
Population ageing, stroke treatment advances, changing models of care, and between-hospital heterogeneity in stroke outcomes demonstrate the necessity of continual audit of stroke care to support quality improvement at local and national levels, and to enhance patient recovery and wellbeing. This project aims to identify the core minimum datasets for acute and non-acute stroke care, and Patient-Reported Outcome Measures (PROMs), for integration in to the newly-developed Irish National Audit of Stroke (INAS), in addition to identifying resourcing needs and implementation procedures.
Methods
In Phase 1, a minimum dataset for acute stroke care was identified based on a scoping review of international practice and available guidelines. Phase 2 (ongoing) involves identifying datasets for non-acute rehabilitative and follow-up care based on a scoping review of international practice, iterative cycles of qualitative stakeholder engagement, and systematic review of PROMs. In Phase 3, a review of resourcing and data collection procedures used in stroke audits internationally will be used to produce an implementation strategy for data collection, contextualised to the Irish healthcare system.
Results
Twenty-one eligible international stroke registries were identified from the scoping review. Within Phase 1, core clinical and thrombectomy items in the Irish registry were benchmarked against internationally-collected items to identify common items and to generate an inventory of items that other registries collect that Ireland does not. Based on consensus agreement on the most frequently-occurring international items, as reviewed by key stakeholders, a core minimum dataset for audit of acute stroke care was delivered.
Conclusion
These minimum datasets shall act as the “gold standard” for evaluating stroke care in Ireland, by not only incorporating structure, process, and care quality outcome indicators, but also PROMs. The resultant datasets may inform policy and quality improvement initiatives, and shape health service delivery across the trajectory of stroke care, from hyper-acute care, to rehabilitation, and return to the community.
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Affiliation(s)
- CN Moran
- RCSI Dept. of Health Psychology, , Dublin, Ireland
| | - I Jeffares
- RCSI Dept. of Health Psychology, , Dublin, Ireland
| | - NA Merriman
- RCSI Dept. of Health Psychology, , Dublin, Ireland
| | - J McCormack
- National Office of Clinical Audit , Dublin, Ireland
| | - J Harbison
- National Office of Clinical Audit , Dublin, Ireland
| | - E Sexton
- RCSI Dept. of Health Psychology, , Dublin, Ireland
| | - D Williams
- Beaumont Hospital Dept. of Geriatric and Stroke Medicine, , Dublin, Ireland
- RCSI Dept. of Geriatric and Stroke Medicine, , Dublin, Ireland
| | - PJ Kelly
- Mater Misericordiae University Hospital Dept. of Neurology, , Dublin, Ireland
- University College Dublin Neurovascular Clinical Science Unit, , Dublin, Ireland
| | - F Horgan
- School of Physiotherapy, RCSI , Dublin, Ireland
| | - R Collins
- Tallaght University Hospital Dept. of Geriatric and Stroke Medicine, , Dublin, Ireland
| | | | - E Byrne
- Institute of Leadership, RCSI , Dublin, Ireland
| | - J Thornton
- Beaumont Hospital Dept. of Radiology, , Dublin, Ireland
| | - C Tully
- National Office of Clinical Audit , Dublin, Ireland
| | - A Hickey
- RCSI Dept. of Health Psychology, , Dublin, Ireland
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12
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Byrne E, Sæbø JI. Routine use of DHIS2 data: a scoping review. BMC Health Serv Res 2022; 22:1234. [PMID: 36203141 PMCID: PMC9535952 DOI: 10.1186/s12913-022-08598-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 08/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background In regard to health service planning and delivery, the use of information at different levels in the health system is vital, ranging from the influencing of policy to the programming of action to the ensuring of evidence-informed practices. However, neither ownership of, nor access to, good quality data guarantees actual use of these data. For information to be used, relevant data need to be collected, processed and analysed in an accessible format. This problem of underused data, and indeed the absence of data use entirely, is widespread and has been evident for decades. The DHIS2 software platform supports routine health management for an estimated 2.4 billion people, in over 70 countries worldwide. It is by far the largest and most widespread software for this purpose and adopts a holistic, socio-technical approach to development and implementation. Given this approach, and the rapid and extensive scaling of DHIS2, we questioned whether or not there has been a parallel increase in the scaling of improved information use. To date, there has been no rigorous review of the documentation on how exactly DHIS2 data is routinely being used for decision-making and subsequent programming of action. This scoping review addresses this review gap. Methods The five-stage approach of Arksey and O’Malley progressed by Levac et al. and Peters was followed. Three databases (PubMed, Web of Science and Embase) were searched, along with relevant conference proceedings and postgraduate theses. In total, over 500 documents were reviewed and data from 19 documents were extracted. Results Overall, DHIS2 data are being used but there are few detailed descriptions of this usage in peer reviewed or grey literature. We find that, commonly, there exists a centralised versus decentralised pattern of use in terms of access to data and the reporting of data ‘up’ in the system. We also find that the different conceptualisations of data use and how data use is conceptualised are not made explicit. Conclusions We conclude with some suggestions for a way forward, namely: i) the need to document in more detail and share how data are being used, ii) the need to investigate how data were created and who uses such data, iii) the need to design systems based on work practices, and in tandem develop and promote forums in which ‘conversations’ around data can take place. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08598-8.
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Affiliation(s)
- Elaine Byrne
- HISP Centre and Department of Informatics, University of Oslo, Gaustadalléen 30, N-0373, Oslo, Norway.
| | - Johan Ivar Sæbø
- HISP Centre and Department of Informatics, University of Oslo, Gaustadalléen 30, N-0373, Oslo, Norway
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Skelly F, McCaffrey N, Byrne E, Kennelly S. 54 EXWELL: OUTCOMES FROM A SIX-WEEK COMMUNITY EXERCISE REHABILITATION PROGRAM FOR PEOPLE LIVING WITH CHRONIC ILLNESS. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.54] [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: 02/25/2023] Open
Abstract
Abstract
Background
Chronic diseases (CD) are long-term conditions, which often require ongoing medical treatment and have the potential to limit the quality of life of the people who live with them. Exercise rehabilitation has been shown to improve physical functioning and health related quality of life (HRQoL) in this cohort.
ExWell is a community-based exercise rehabilitation (CBER) program that offers group exercise rehabilitation classes to individuals with a range of CD. The purpose of this study was to investigate the impact of 6 weeks of participation in the ExWell Medical program on physical functioning and HRQoL in a diverse CD population.
Methods
Participants with a range of CD were referred by healthcare practitioners to the HSE-funded ExWell Medical program based in a community setting. Outcome variables included measurements of body composition, functional capacity and health related quality of life. Assessments were taken at baseline and 6 weeks. Participants were encouraged to attend ExWell Medical classes twice weekly for the duration of the study. Each forty-five minute class included a warm up, aerobic, resistance, core and balance exercises and a cool-down.
Results
Three hundred and ten people (mean age 70.7 ± 7.7 years, 48.3% Female) participated. Statistically and clinically significant improvements were found in cardiorespiratory fitness, lower body strength, balance, co-ordination, body composition and health related quality of life. The greatest improvements were observed in those with the lowest levels of fitness at baseline, and the oldest participants. Improvements in cardiorespiratory fitness and lower body strength matched the recognized clinically meaningful differences in the entire group sample and greatly exceeded them in those in the lowest tertile of fitness at baseline.
Conclusion
The ExWell mixed CD CBER program is an effective approach to rehabilitation delivery in clinical practice. Clinically meaningful improvements can be achieved within 6 weeks of participation, and older and frail participants show greatest improvements overall.
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Affiliation(s)
- F Skelly
- ExWell Medical , Dublin, Ireland
| | | | - E Byrne
- ExWell Medical , Dublin, Ireland
| | - S Kennelly
- Tallaght University Hospital , Dublin, Ireland
- Department of Medical Gerontology, Trinity College Dublin , Dublin, Ireland
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Sexton E, Hickey A, Williams DJ, Horgan F, Byrne E, Macey C, Cuffe P, Timmons S, Collins R, Bennett K. Identifying priority interventions for stroke in Ireland through stakeholder engagement to inform population-based modelling: a mixed methods protocol. HRB Open Res 2021; 4:109. [PMID: 38567097 PMCID: PMC10985459 DOI: 10.12688/hrbopenres.13413.1] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 04/04/2024] Open
Abstract
Introduction Improvements in stroke survival have resulted in increasing numbers of people living with stroke, and with a rapidly evolving evidence-base for stroke prevention and management, there is a need for robust data and evidence to inform future policy decision-making. Population-based modelling and economic evaluation of alternative policy options is a useful tool to support decision making. However, this process must be aligned to key stakeholder priorities. The aim of the proposed research is to engage with stakeholders in Ireland to identify their priorities for the development of stroke prevention and management strategies and policies. Methods The design is iterative, based on mixed methods. Phase 1 involves a qualitative approach for initial priority gathering, based on an open-ended online survey (target sample: 100-120) and interviews (target sample: 34-40). Stakeholders will include: 1) stroke survivors and family member/main carers, 2) healthcare professionals (HCPs) providing stroke care and 3) people working in stroke research, policy and advocacy. These data will be analysed qualitatively, with the aim of identifying a long-list of specific interventions. Phase 2 involves an interim priority-setting exercise, based on a quantitative online survey. Participants will be asked to rank the interventions on the initial long-list. These rankings will be used to inform a final priority-setting workshop (Phase 3), where a small stakeholder group will decide on the final set of priorities. Discussion The rich and detailed quantitative and qualitative data, based on the views of diverse stakeholders, will be directly relevant to policy makers and service planners involved in developing and improving stroke care in Ireland. The information provided will also be essential to inform the Scenario and Intervention Modelling in Ireland for Stroke (SIMI-Stroke) project, a population-based economic and epidemiological modelling study aimed at identifying cost-effective interventions for stroke across the prevention, acute and post-acute care continuum.
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Affiliation(s)
- Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J. Williams
- Department of Geriatric and Stroke Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - F. Horgan
- School of Physiotherapy, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Elaine Byrne
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Padraic Cuffe
- Irish Heart Foundation, Dublin, Ireland
- Patient collaborator, Sligo, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, University College Cork, Cork, Ireland
- National Dementia Office, Health Service Executive, Tullamore, Co Offaly, Ireland
| | - Rónán Collins
- National Clinical Programme for Stroke, Health Service Executive, Dublin, Ireland
- Age-Related Health Care and Stroke Service, Tallaght University Hospital, Dublin, Ireland
| | - K. Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Bruen C, Merriman NA, Murphy PJ, McCormack J, Sexton E, Harbison J, Williams D, Kelly PJ, Horgan F, Collins R, Ní Bhreacáin M, Byrne E, Thornton J, Tully C, Hickey A. Development of a national stroke audit in Ireland: scoping review protocol. HRB Open Res 2021; 4:31. [PMID: 36330536 PMCID: PMC9607932 DOI: 10.12688/hrbopenres.13244.1] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction
Recent advances in stroke management and care have resulted in improved survival and outcomes. However, providing equitable access to acute care, rehabilitation and longer-term stroke care is challenging. Recent Irish evidence indicates variation in stroke outcomes across hospitals, and a need for continuous audit of stroke care to support quality improvement. The aim of this project is to develop a core minimum dataset for use in the new Irish National Audit of Stroke (INAS), which aims to improve the standard of stroke care in Ireland. This paper outlines the protocol for conducting a scoping review of international practice and guidelines in auditing acute and non-acute stroke care.
Objective
Identify data items that are currently collected by stroke audits internationally, and identify audit guidelines that exist for recommending inclusion of content in stroke audit datasets.
Methods and analysis
This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR). We will search the following databases: Medline Ovid; Embase; CINAHL EBSCOHost. Grey literature will also be searched for relevant materials, as will relevant websites. Study selection and review will be carried out independently by two researchers, with discrepancies resolved by a third. Data charting and synthesis will involve sub-dividing relevant sources of evidence, and synthesising data into three categories: i) acute stroke care; ii) non-acute stroke care; and iii) audit data collection procedures and resourcing. Data will be charted using a standardised form specific to each category. Consultation with knowledge users will be conducted at all stages of the scoping review.
Discussion
This scoping review will contribute to a larger project aimed at developing an internationally benchmarked stroke audit tool that will be used prospectively to collect data on all stroke admissions in Ireland, encompassing both acute and non-acute data items.
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Affiliation(s)
- Carlos Bruen
- Dept of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A. Merriman
- Dept of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul J. Murphy
- Library Services, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Eithne Sexton
- Dept of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joseph Harbison
- National Office of Clinical Audit, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Dept of Geriatric and Stroke Medicine, St. James' Hospital, Dublin, Ireland
| | - David Williams
- Dept of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
- Dept of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter J. Kelly
- Dept of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland
- Neurovascular Clinical Science Unit, University College Dublin, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rónán Collins
- Dept of Geriatric and Stroke Medicine, Tallaght University Hospital, Dublin, Ireland
| | | | - Elaine Byrne
- Institute of Leadership, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - John Thornton
- Dept. of Radiology, Beaumont Hospital, Dublin, Ireland
| | | | - Anne Hickey
- Dept of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Matthews A, Walsh A, Brugha R, Manda-Taylor L, Mwale D, Phiri T, Mwapasa V, Byrne E. The Demand and Supply Side Determinants of Access to Maternal, Newborn and Child Health Services in Malawi. Matern Child Health J 2020; 23:1556-1563. [PMID: 31240427 DOI: 10.1007/s10995-019-02791-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives In order to improve maternal and neonatal outcomes, it is important to understand how to maximise the utilisation of MNCH services. The supply side (service-driven) factors affecting access to MNCH services are more commonly studied and are better understood than the demand side (community led) factors. The aim of this study was to identify demand and supply determinants of access to MNCH services in Malawi. Methods Research was conducted in two districts of the Central Region of Malawi (Nkhotakota & Mchinji). Qualitative interviews (n = 85) and focus group discussions (n = 20) were conducted with a range of community members, leaders and health workers. Data were managed in NVivo (v10) and analysed using framework analysis, using Levesque et al. (2013) access framework. Results Community members clearly recognise their need for and seek out MNCH care from the formal health system. Women experience difficulties reaching health services and when reached find them limited, characterised by many indirect costs. There are many technical and interpersonal deficits, which results in poor satisfaction and reportedly poor outcomes for women. Conclusions for practice Women are seeking and utilising MNCH services which they find under-resourced and unwelcoming. Utilising the Levesque et al. (2013) framework, a granular analysis of demand and supply factors has identified the many challenges that remain to achieving equitable access to MNCH services in Malawi. Community members experience lack of availability, acceptability and appropriateness of these essential services.
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Affiliation(s)
- Anne Matthews
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland.
| | - Aisling Walsh
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ruairi Brugha
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Daniel Mwale
- College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Victor Mwapasa
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Elaine Byrne
- Royal College of Surgeons in Ireland, Dublin, Ireland
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17
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Huber J, Ferris France N, Nguyen VA, Nguyen HH, Thi Hai Oanh K, Byrne E. Exploring beliefs and experiences underlying self-stigma among sex workers in Hanoi, Vietnam. Cult Health Sex 2019; 21:1425-1438. [PMID: 30794065 DOI: 10.1080/13691058.2019.1566572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 01/03/2019] [Indexed: 06/09/2023]
Abstract
Sex workers are among the most stigmatised people globally, with sex workers in Vietnam being no exception. Self-stigma affects sex workers adversely, harming psychological health and acting as a barrier to seeking health care. To inform programmes and interventions to improve well-being, identifying unhelpful or negative core beliefs may provide the basis from which individuals can be supported. With this in mind, this study aimed to gain the perspective of sex workers in Vietnam on the contexts of their working lives. Data were collected in Hanoi. Fourteen semi-structured interviews were conducted with Vietnamese sex workers over the age of 18 who were working or formerly worked in Vietnam. Data were analysed manually, informed by theoretical models of self-stigma using inductive thematic analysis. The analysis identified negative/unhelpful core beliefs (disclosure, self-stigma and shame, sexuality, sexual pleasure relationships, health care); contextual life circumstances (sex work, violence, traditional education); and coping mechanisms (problem-focused coping, emotion-focused coping). Findings identify the importance of core beliefs in understanding self-stigma, paving the way for programmes and interventions to address self-stigma among sex workers.
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Affiliation(s)
- Jasmine Huber
- Centre for Global Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Van Anh Nguyen
- The Center for Supporting Community Development Activities (SCDI), Hanoi, Vietnam
| | - Hoai Huong Nguyen
- The Center for Supporting Community Development Activities (SCDI), Hanoi, Vietnam
| | - Khuat Thi Hai Oanh
- The Center for Supporting Community Development Activities (SCDI), Hanoi, Vietnam
| | - Elaine Byrne
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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18
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Merriman NA, Bruen C, Gorman A, Horgan F, Williams DJ, Pender N, Byrne E, Hickey A. "I'm just not a Sudoku person": analysis of stroke survivor, carer, and healthcare professional perspectives for the design of a cognitive rehabilitation intervention. Disabil Rehabil 2019; 42:3359-3369. [PMID: 30971135 DOI: 10.1080/09638288.2019.1594400] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Exploring the views of those impacted by stroke is key to the design of an effective and appropriate cognitive rehabilitation intervention for post-stroke cognitive impairment. This qualitative study examined the perspectives and preferences of stroke survivors, carers, and healthcare professionals to inform the design of a cognitive rehabilitation intervention.Design and methods: The research employed a qualitative study design and thematic analysis of data. In-depth semi-structured interviews were conducted with stroke survivors (n = 14), carers (n = 11), and healthcare professionals involved in providing stroke care (n = 19). Interviews were audio-recorded and transcribed. Coding was conducted and themes were developed both inductively and deductively.Results: Themes address five broad areas relevant for the design and implementation of the intervention: (i) activities to include; (ii) when it takes place; (iii) location; (vi) format; (v) who the intervention should include.Conclusions: Qualitative work with stroke survivors, carers and healthcare professionals provided vital information for the intervention design. Issues identified by participants as being key to intervention development included: (i) implications of post-stroke cognitive impairment survivors' confidence; (ii) their individual capacity in terms of fatigue and metacognition; and (iii) practical issues such as intervention location. The inclusion of psychoeducation regarding consequences of stroke was recommended.Implications for rehabilitationStroke survivors, carers, and rehabilitation professionals who provide stroke care can provide valuable insights and ideas to inform the development of a cognitive rehabilitation intervention.A cognitive rehabilitation intervention should be tailored to patient-specified goals, incorporating both group and individualized activities.Information, education, and communication are required to help stroke survivors and carers understand the cognitive, emotional, and behavioral consequences of stroke.Intervention content should be considerate of stroke survivors' capacity in terms of cognitive impairment and fatigue levels.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carlos Bruen
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ashleigh Gorman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - Elaine Byrne
- Institute of Leadership, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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19
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Russell V, Clarke M, Loo CE, Bharathy A, Vasudevan U, Byrne E, Smith SM. Medical Student Perceptions of the Value of Learning Psychiatry in Primary Care Settings in Penang, Malaysia. Acad Psychiatry 2019; 43:157-166. [PMID: 30069698 DOI: 10.1007/s40596-018-0960-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The study's objective was to determine the educational value of participation in a consultation/liaison psychiatry service to primary care clinics, from the perspective of Malaysian medical undergraduates. METHODS A mixed method design was used. Fourth-year medical students participated in a consultation/liaison psychiatry service to two government-operated primary care clinics. Each student attended two half-day consultations to the clinics during the psychiatry clinical clerkship. Students joined in discussions with primary care clinicians, performed supervised clinical assessments, and administered a depression screening instrument. The learning experience was evaluated through four focus groups, each with 9-10 participants, held throughout the academic year. An end-of-year, anonymous, online questionnaire survey was administered to the entire class. Thematic analysis of focus group transcripts was performed and quantitative statistics were calculated (Stata version 13). RESULTS Focus group themes included the following: (a) active learning opportunities in primary care psychiatry consultation had perceived added educational value, (b) students benefited from contact with patients with previously undiagnosed common mental disorders, and (c) students' primary care experience raised their awareness of societal and professional responsibilities. Of the class of 113 students, 93 (82%) responded to the questionnaire. The survey responses reflected the qualitative themes, with 79 respondents (85%) stating that the learning experience met or exceeded their expectations. CONCLUSIONS Academic psychiatry has been criticized for its overreliance on secondary care settings in undergraduate clinical teaching. Our findings suggest that supervised clinical placements in primary care are feasible and provide added educational value as a routine component of the undergraduate psychiatry clinical clerkship.
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Affiliation(s)
| | - Mary Clarke
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ching Ee Loo
- Clinical Research Centre, Ministry of Health Malaysia, Seberang Jaya Hospital, Penang, Malaysia
| | | | | | - Elaine Byrne
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Susan M Smith
- Royal College of Surgeons in Ireland, Dublin, Ireland
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20
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O'Donovan MA, McCallion P, McCarron M, Lynch L, Mannan H, Byrne E. A narrative synthesis scoping review of life course domains within health service utilisation frameworks. HRB Open Res 2019; 2:6. [PMID: 32296746 PMCID: PMC7140772 DOI: 10.12688/hrbopenres.12900.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Accepted: 03/13/2019] [Indexed: 11/20/2022] Open
Abstract
Background: Current thinking in health recognises the influence of early life experiences (health and otherwise) on later life outcomes. The life course approach has been embedded in the work of the World Health Organisation since the Ageing and Health programme was established in 1995. Yet there has been limited debate on the relevancy of a life course lens to understanding health service utilisation. Aim: The aim of the review was twofold. Firstly, identify existing healthcare utilisation frameworks other than the dominant Andersen's behavioural model currently in use. Secondly, to identify if current frameworks incorporate the advocated life course perspective in understanding health service utilisation. Methods: A scoping review of PubMed, Cinahl Plus, Emerald, PsycINFO, Web of Knowledge and Scopus was conducted. Data extraction used a framework approach with meta-synthesis guided by the four domains of the life course proposed by Elder (1979): human agency, location, temporality and relationships, and interdependencies. Results: A total of 551 papers were identified, with 70 unique frameworks (other than Andersen's Behavioural Model) meeting the inclusion criteria and included in the review. Conclusion: To date there has been limited explicit discussion of health service utilisation from a life course perspective. The current review highlights a range of frameworks that draw on aspects of the life course, but have been used with this perspective in mind. The life course approach highlights important gaps in understanding and assessing health service utilisation (HSU), such as utilisation over time. HSU is a complex phenomenon and applying a structured framework from a life course perspective would be of benefit to researchers, practitioners and policy makers.
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Affiliation(s)
- Mary-Ann O'Donovan
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Phillip McCallion
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mary McCarron
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Louise Lynch
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Hasheem Mannan
- School of Nursing and Midwifery, University College Dublin, Dublin, Ireland
| | - Elaine Byrne
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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21
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Byrne E, Brugha R, McGarvey A. 'A melting pot of cultures' -challenges in social adaptation and interactions amongst international medical students. BMC Med Educ 2019; 19:86. [PMID: 30885174 PMCID: PMC6423840 DOI: 10.1186/s12909-019-1514-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 03/07/2019] [Indexed: 05/21/2023]
Abstract
BACKGROUND The internationalisation of higher level education and the profiles - nationalities, ethnicities and cultural identities - of students who migrate to undertake higher level education programmes in a different country are increasingly complex. This article explores the way in which cultural backgrounds impact the student's experiences of an international medical school, and how these experiences have the potential to inform the development and design of student support services for those students who are not coping well with the transition. METHODS Thirty one first year students were interviewed by sixteen second year students who were trained and supervised by an experienced researcher. Three focus group discussions were also held. RESULTS While many international students had lived in more than one country and region and spoke several languages, most reported difficulties in forming intercultural friendships, especially interactions outside of the academic setting. Some of the challenges faced were similar to what has been reported in the literature, such as difficulties with language and loss of established friendship networks. Other challenges to emerge in this study were the complex interrelatedness of the daily life challenges facing international students regarding the forming and importance of intercultural relations, which is impacted by gender, the presence of alcohol, languages spoken (in addition to English, which was the language used for medical education), and the dominance of the regional grouping the student belongs to. CONCLUSION The challenges of adaptation and intercultural relations are increasing in complexity and it is important for higher level institutions who enrol international students to understand the nature of the pressures these students experience, outside as well as within the academic environment, and to support them in managing these transitions.
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Affiliation(s)
- E. Byrne
- Institute of Leadership, Royal College of Surgeons in Ireland, Ballymoss Road, Sandyford Industrial Est, Dublin, 18 Ireland
| | - R. Brugha
- Division of Population and Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin, 2 Ireland
| | - A. McGarvey
- Anatomy Department, Royal College of Surgeons in Ireland, 123 St Stephen’s Green, Dublin, 2 Ireland
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22
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Ferris France N, Macdonald SHF, Conroy RR, Chiroro P, Ni Cheallaigh D, Nyamucheta M, Mapanda B, Shumba G, Mudede D, Byrne E. 'We are the change' - An innovative community-based response to address self-stigma: A pilot study focusing on people living with HIV in Zimbabwe. PLoS One 2019; 14:e0210152. [PMID: 30759114 PMCID: PMC6373928 DOI: 10.1371/journal.pone.0210152] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 12/17/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction Self-stigma–negative self-judgements resulting in shame, worthlessness and self-blame–may play a crucial role in emotional reactions and cause emotional distress among many people living with HIV and other chronic illnesses. Furthermore, self-stigma negatively impacts on self-agency, quality of life, adherence to treatment, and access to services. High levels of self-stigma have been reported across many countries, however few programmes or interventions exist to specifically tackle this phenomenon. This paper reports the findings of a pilot study carried out in Zimbabwe using a programme incorporating “Inquiry-Based Stress Reduction (IBSR): The Work of Byron Katie”–a guided form of self-inquiry which helps users to overcome negative thoughts and beliefs. Objectives The primary objective of this uncontrolled pilot study was to examine the potential role of the IBSR intervention in helping people living with HIV to overcome self-stigma and associated states. Methods 23 people living with HIV (17 Female, 6 male, average age 41 years) were recruited from a local HIV support network, via open call for volunteers. All participants received the intervention, consisting of a 12-week facilitated programme using techniques derived from IBSR: The Work of Byron Katie. Qualitative and quantitative data were collected and analysed pre- and post-programme. Results After taking part in the intervention, participants reported significant improvements in factors including self-stigma (1-month follow-up vs baseline Z = 2.1, p = 0.039; 3-month follow-up vs baseline Z = 3.0, p = 0.003, n = 23, Wilcoxon Matched Pairs Signed Rank Test) and depression (1mo vs baseline Z = 3.7, p = <0.001; 3mo vs baseline Z = 3.3, p = 0.001). Qualitatively, participants reported improvements including lessened fears around disclosure of their HIV status, reduced feelings of life limitations due to HIV, and greater positive mentality. Improvements persisted at three-month follow-up. Conclusion With further development and larger comparative studies to confirm effects, the IBSR programme could become a novel tool to enable people living with HIV to support themselves in overcoming self-stigma.
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Affiliation(s)
- Nadine Ferris France
- The Work for Change / Irish Forum for Global Health, c/o Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Stephen H.-F. Macdonald
- The Work for Change / Irish Forum for Global Health, c/o Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- * E-mail:
| | - Ronan R. Conroy
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Masimba Nyamucheta
- Zimbabwe National Network of People Living with HIV (ZNNP+), Harare, Zimbabwe
| | | | - Godsway Shumba
- Independent Consultant to Trócaire, Maynooth, Co. Kildare, Ireland
| | - Dennis Mudede
- Connect Zimbabwe Institute of Systemic Therapy (ZIST), Harare, Zimbabwe
| | - Elaine Byrne
- RCSI Institute of Leadership, Royal College of Surgeons in Ireland, Dublin, Ireland
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Walsh A, Matthews A, Manda-Taylor L, Brugha R, Mwale D, Phiri T, Byrne E. The role of the traditional leader in implementing maternal, newborn and child health policy in Malawi. Health Policy Plan 2018; 33:879-887. [PMID: 30084938 DOI: 10.1093/heapol/czy059] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2018] [Indexed: 01/12/2023] Open
Abstract
Traditional leaders play a prominent role at the community level in Malawi, yet limited research has been undertaken on their role in relation to policy implementation. This article seeks to analyse the role of traditional leaders in implementing national maternal, newborn and child health (MNCH) policy and programmes at the community level. We consider whether the role of the chief embodies a top-down (utilitarian) or bottom-up (empowerment) approach to MNCH policy implementation. Primary data were collected in 2014/15, through 85 in-depth interviews and 20 focus group discussions in two districts in Malawi. We discovered that traditional leaders play a pivotal role in supporting MNCH service utilization, through mobilization for MNCH campaigns, and encouraging women to give birth at the health facility rather than at home or in the community setting. Women and their families responded to bylaws to deliver in the facility out of respect for the traditional leader, which is ingrained in Malawian culture. Fines were imposed on women for delivering at home, in the form of goats, chickens and money. Fear and coercion were often used by traditional leaders to ensure that women delivered at the health facility. Chiefs who failed to enforce these bylaws were also fined. Although the role of the traditional leader was often positive and encouraging in relation to MNCH service utilization, this was sometimes carried out in a coercive manner. Results show evidence of a utilitarian top-down model of policy implementation, where the goal of health service utilization justified the means, through encouragement, fear, punishment or coercion. Although the bottom-up approach would be associated with a more empowerment approach, it is unlikely that this would have been successful in Malawi, given the hierarchical nature of society. Further research on policy implementation in the context of community participation is needed.
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Affiliation(s)
- Aisling Walsh
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Lower Mercer Street, Dublin, Ireland
| | - Anne Matthews
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | | | - Ruairi Brugha
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Beaux Lane House, Lower Mercer Street, Dublin, Ireland
| | - Daniel Mwale
- College of Medicine, University of Malawi, Malawi
| | - Tamara Phiri
- Department of Nursing and Midwifery, Mzuzu University, Malawi
| | - Elaine Byrne
- Institute of Leadership, Royal College of Surgeons in Ireland, Dublin, Ireland
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O'Donovan MA, Mannan H, McVeigh J, Mc Carron M, McCallion P, Byrne E. Core Human Rights Concepts in Irish Health and Housing Policy Documents: In Search of Equity for People With ID. Journal of Policy and Practice in Intellectual Disabilities 2018. [DOI: 10.1111/jppi.12274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | | | - Philip McCallion
- College of Public Health; Temple University; Philadelphia PA USA
| | - Elaine Byrne
- Royal College of Surgeons in Ireland; Dublin Ireland
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Maguire F, Murphy ME, Rourke M, Morgan F, Brady G, Byrne E, O’Callaghan ME. A Cross-Sectional Study of Antibiotic Prescribing for Childhood Upper Respiratory Tract Infections in Irish General Practice. Ir Med J 2018; 111:835. [PMID: 30558408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction This study aimed to analyse antibiotic prescribing in cases of upper respiratory tract infection (URTI) in children under 6 years attending Irish daytime and out-of-hours General Practice (GP) services. There have been large scale changes in entitlements for free GP care for this group in recent years. Methods A cross-sectional study of children under 6 years with URTI presentations was performed, over a two-week period for three years from 2015 to 2017. Factors associated with antibiotic prescription and preferred antibiotic compliance were examined using multivariate logistic regression. Results 1,007 Under-6 patients presented with an URTI in our sample over the study period. Following introduction of free GP care, patients were 50% less likely to receive an antibiotic prescription. Overall antibiotic prescribing fell from 70% to 50% in daytime services and from 72% to 60% in the out-of-hours setting. Patients presenting to out-of-hours services were more likely to receive an antibiotic (OR: 1.42) and less likely to receive a deferred antibiotic (OR: 0.53). One quarter to one third of all prescriptions were for deferred antibiotics. Year-on-year trends showed a 13% decrease in prescriptions and 13% increase in preferred antibiotic use. Conclusion The introduction of free GP care led to significant reductions in antibiotic prescribing, which may be due to changes in health seeking behaviour by parents or other reasons. Antibiotic prescribing was more commonplace in the out-of-hours setting, and rates remains high by international standards. This study underlines the importance of ongoing work around GP antimicrobial stewardship, particularly in the out-of-hours setting.
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Affiliation(s)
- F Maguire
- School of Medicine, Trinity College Dublin, The University of Dublin, Ireland
| | - M E Murphy
- HRB Centre for Primary Care Research, Royal College of Surgeons Ireland, Dublin 2, Ireland
| | - M Rourke
- Trinity College Dublin/Health Service Executive (TCD/HSE) GP training scheme, Floor 6, The Russell Centre, Tallaght Cross West, Tallaght, Dublin 24
| | - F Morgan
- Trinity College Dublin/Health Service Executive (TCD/HSE) GP training scheme, Floor 6, The Russell Centre, Tallaght Cross West, Tallaght, Dublin 24
| | - G Brady
- Trinity College Dublin/Health Service Executive (TCD/HSE) GP training scheme, Floor 6, The Russell Centre, Tallaght Cross West, Tallaght, Dublin 24
| | - E Byrne
- Trinity College Dublin/Health Service Executive (TCD/HSE) GP training scheme, Floor 6, The Russell Centre, Tallaght Cross West, Tallaght, Dublin 24
| | - M E O’Callaghan
- Trinity College Dublin/Health Service Executive (TCD/HSE) GP training scheme, Floor 6, The Russell Centre, Tallaght Cross West, Tallaght, Dublin 24
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Abstract
Background We propose that arts based methodologies can be of value in the production and exchange of evidence in supporting public health related policy. This article reports on a collaborative piece of work resulting from two projects which took place in a former coal mining town in South Wales. Methods We used a participatory framework whereby researchers, community members and artists co-produced 'evidence' through the creative arts to inform public policy. We collected a range of data using a number of different techniques, including interviews, focus groups and observation, but also included an extensive range of creative activities. Results The data provided a diverse range of perspectives on how people of different ages live their lives. The People's Platform was a performance-based debate which was the culmination of the collaboration. The show involved a series of short performances with time for facilitated discussion in-between. It was felt that the show facilitated knowledge exchange on health and wellbeing issues that are usually difficult to express and understand through traditional forms of evidence. Conclusion Whilst arts-based approaches are not free from risk, they offer an alternative form of knowledge as a necessary complement to the range of data available to policy makers.
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Affiliation(s)
- E Byrne
- Cardiff University, Cardiff CF10 3BG, UK
| | - E Elliott
- Cardiff University, Cardiff CF10 3BG, UK
| | - R Saltus
- University of South Wales, Pontypridd CF37 1DL, UK
| | - J Angharad
- POSSIB, Canolfan Soar, Merthyr Tydfil CF47 8UB, UK
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Elmusharaf K, Byrne E, AbuAgla A, AbdelRahim A, Manandhar M, Sondorp E, O'Donovan D. Patterns and determinants of pathways to reach comprehensive emergency obstetric and neonatal care (CEmONC) in South Sudan: qualitative diagrammatic pathway analysis. BMC Pregnancy Childbirth 2017; 17:278. [PMID: 28851308 PMCID: PMC5576292 DOI: 10.1186/s12884-017-1463-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [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: 04/04/2016] [Accepted: 08/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background Maternity referral systems have been under-documented, under-researched, and under-theorised. Responsive emergency referral systems and appropriate transportation are cornerstones in the continuum of care and central to the complex health system. The pathways that women follow to reach Emergency Obstetric and Neonatal Care (EmONC) once a decision has been made to seek care have received relatively little attention. The aim of this research was to identify patterns and determinants of the pathways pregnant women follow from the onset of labour or complications until they reach an appropriate health facility. Methods This study was conducted in Renk County in South Sudan between 2010 and 2012. Data was collected using Critical Incident Technique (CIT) and stakeholder interviews. CIT systematically identified pathways to healthcare during labour, and factors associated with an event of maternal mortality or near miss through a series of in-depth interviews with witnesses or those involved. Face-to-face stakeholder interviews were conducted with 28 purposively identified key informants. Diagrammatic pathway and thematic analysis were conducted using NVIVO 10 software. Results Once the decision is made to seek emergency obstetric care, the pregnant woman may face a series of complex steps before she reaches an appropriate health facility. Four pathway patterns to CEmONC were identified of which three were associated with high rates of maternal death: late referral, zigzagging referral, and multiple referrals. Women who bypassed nonfunctional Basic EmONC facilities and went directly to CEmONC facilities (the fourth pathway pattern) were most likely to survive. Overall, the competencies of the providers and the functionality of the first point of service determine the pathway to further care. Conclusions Our findings indicate that outcomes are better where there is no facility available than when the woman accesses a non-functioning facility, and the absence of a healthcare provider is better than the presence of a non-competent provider. Visiting non-functioning or partially functioning healthcare facilities on the way to competent providers places the woman at greater risk of dying. Non-functioning facilities and non-competent providers are likely to contribute to the deaths of women. Electronic supplementary material The online version of this article (10.1186/s12884-017-1463-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Khalifa Elmusharaf
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland. .,Reproductive & Child Health Research Unit (RCRU), University of Medical Sciences & Technology, Khartoum, Sudan.
| | - Elaine Byrne
- Institute of Leadership, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ayat AbuAgla
- Reproductive & Child Health Research Unit (RCRU), University of Medical Sciences & Technology, Khartoum, Sudan
| | - Amal AbdelRahim
- Reproductive & Child Health Research Unit (RCRU), University of Medical Sciences & Technology, Khartoum, Sudan
| | - Mary Manandhar
- Family, Women's and Children's Cluster, WHO, Geneva, Switzerland
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Elmusharaf K, Byrne E, Manandhar M, Hemmings J, O’Donovan D. Participatory Ethnographic Evaluation and Research: Reflections on the Research Approach Used to Understand the Complexity of Maternal Health Issues in South Sudan. Qual Health Res 2017; 27:1345-1358. [PMID: 27811290 PMCID: PMC5476190 DOI: 10.1177/1049732316673975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many methodological approaches have been used to understand cultural dimensions to maternal health issues. Although a well-designed quantitative survey with a representative sample can provide essential information on trends in behavior, it does not necessarily establish a contextualized understanding of the complexity in which different behaviors occur. This article addresses how contextualized data can be collected in a short time and under conditions in which participants in conflict-affected zones might not have established, or time to establish, trust with the researchers. The solution, the Participatory Ethnographic Evaluation and Research (PEER) approach, is illustrated through a study whereby South Sudanese marginalized women were trained to design research instruments, and collect and analyze qualitative data. PEER overcomes the problem that many ethnographic or participatory approaches face-the extensive time and resources required to develop trusting relationships with the community to understand the local context and the social networks they form.
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Affiliation(s)
- Khalifa Elmusharaf
- Graduate Entry Medical School (GEMS), University of Limerick, Limerick, Ireland
- Reproductive and Child Health Research Unit (RCRU), University of Medical Sciences and Technology, Khartoum, Sudan
| | - Elaine Byrne
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Manandhar
- Renewing Efforts Against Child Hunger (REACH), United Nations, Yangon, Myanmar
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O'Donovan MA, Byrne E, McCallion P, McCarron M. Measuring choice for adults with an intellectual disability - a factor analysis of the adapted daily choice inventory scale. J Intellect Disabil Res 2017; 61:471-487. [PMID: 28281320 DOI: 10.1111/jir.12364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 12/14/2016] [Accepted: 01/18/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND For most people, choice making is an everyday occurrence, but for adults with an intellectual disability (ID), such opportunities are often limited, if not, absent. Defining choice, and related opportunity capacity and supports continue to feature prominently in academic, practice and policy discourse within the field of ID as reflected in the range of measures available. This paper examines the factor analytic properties of an adapted 14-item choice inventory scale. METHOD Presence and type of choice were recorded in wave 1 of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing using a choice inventory scale adapted for the Irish context for 753 participants with ID over age 40 years. Analysis included both an exploratory and confirmatory factor analysis. Descriptive statistics on choice by type of living arrangement, type of interview (proxy, self or supported) and level of ID are presented. RESULTS Exploratory factor analysis indicates good model fit when using both a 3-item and 4-item response with the 4-item version suggesting a two-factor model. Further exploration of this two-factor model through confirmatory factor analysis highlighted an improved fit for the 4-item model. Further improvement in model fit is found when four item pairs are co-varied within the model. CONCLUSION Two broad types of choice were found to exist for adults with ID - everyday decisions and key life decisions. In addition, the factor analysis support for the inclusion of a 'no choice' response may help reduce the potential for missing data.
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Affiliation(s)
- M-A O'Donovan
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - E Byrne
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Ireland
| | - P McCallion
- School of Social Welfare, University of Albany, Ireland
| | - M McCarron
- Faculty of Health Sciences, Trinity College Dublin, Ireland
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O Flynn D, O Flynn E, Deneke A, Yohannan P, da Costa AA, O Boyle C, Byrne E. Training Surgeons as Medical Educators in Africa. J Surg Educ 2017; 74:539-542. [PMID: 27843097 DOI: 10.1016/j.jsurg.2016.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Dermot O Flynn
- Institute of Leadership, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Eric O Flynn
- RCSI/COSECSA Collaboration Programme, RCSI Surgical Affairs, Dublin, Ireland
| | - Andualem Deneke
- College of Surgeons of East, Central and Southern Africa (COSECSA), Addis Ababa, Ethiopia
| | - Prem Yohannan
- College of Surgeons of East, Central and Southern Africa (COSECSA), Maputo, Mozambique
| | - Antonio Assis da Costa
- College of Surgeons of East, Central and Southern Africa (COSECSA), Addis Ababa, Ethiopia
| | - Ciaran O Boyle
- Institute of Leadership, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Elaine Byrne
- Institute of Leadership, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.
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Walsh A, Brugha R, Byrne E. "The way the country has been carved up by researchers": ethics and power in north-south public health research. Int J Equity Health 2016; 15:204. [PMID: 27955670 PMCID: PMC5153695 DOI: 10.1186/s12939-016-0488-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/28/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the recognition of power as being central to health research collaborations between high income countries and low and middle income countries, there has been insufficient detailed analysis of power within these partnerships. The politics of research in the global south is often considered outside of the remit of research ethics. This article reports on an analysis of power in north-south public health research, using Zambia as a case study. METHODS Primary data were collected in 2011/2012, through 53 in-depth interviews with: Zambian researchers (n = 20), Zambian national stakeholders (n = 8) and northern researchers who had been involved in public health research collaborations involving Zambia and the global north (n = 25). Thematic analysis, utilising a situated ethics perspective, was undertaken using Nvivo 10. RESULTS Most interviewees perceived roles and relationships to be inequitable with power remaining with the north. Concepts from Bourdieu's theory of Power and Practice highlight new aspects of research ethics: Northern and southern researchers perceive that different habituses exist, north and south - habituses of domination (northern) and subordination (Zambian) in relation to researcher relationships. Bourdieu's hysteresis effect provides a possible explanation for why power differentials continue to exist. In some cases, new opportunities have arisen for Zambian researchers; however, they may not immediately recognise and grasp them. Bourdieu's concept of Capitals offers an explanation of how diverse resources are used to explain these power imbalances, where northern researchers are often in possession of more economic, symbolic and social capital; while Zambian researchers possess more cultural capital. CONCLUSIONS Inequities and power imbalances need to be recognised and addressed in research partnerships. A situated ethics approach is central in understanding this relationship in north-south public health research.
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Affiliation(s)
- Aisling Walsh
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Ruairi Brugha
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Elaine Byrne
- Institute of Leadership, Royal College of Surgeons in Ireland, Dublin, Ireland
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Elmusharaf K, Tahir H, O' Donovan D, Brugha R, Homeida M, Abbas AMO, Byrne E. From local to global: a qualitative review of the multi-leveled impact of a multi-country health research capacity development partnership on maternal health in Sudan. Global Health 2016; 12:20. [PMID: 27184907 PMCID: PMC4869333 DOI: 10.1186/s12992-016-0153-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 05/07/2015] [Accepted: 04/21/2016] [Indexed: 11/25/2022] Open
Abstract
Background There is a substantial body of literature on the principles of good partnerships and the rationale for such partnerships in research capacity strengthening. This paper illustrates the long term effects of a multi-country (8 countries) global partnership for health systems research capacity development (Connecting health Research in Africa and Ireland Consortium - ChRAIC) in relation to its contribution to capacity strengthening, public advocacy and policy influence at different levels and its practical achievements in Sudan in addressing access to maternal health services. Methods The authors (all members of the global partnership) reflect on the project in one of its’ partner countries, Sudan, over its’ five year duration. This reflection is supported by specific project data collected over the period of the project (2008–2014). The data collected included: (i) 6 monthly and annual donor reports; (ii) a mid-term internal and end of project independent evaluation of the entire project, and; (ii) a Ph.D study conducted by a member of the Sudanese research team. Results The ChRAIC project in Sudan achieved the deliverables set out at the beginning of the project. These included a national knowledge synthesis report on Sudan’s health system; identification of country level health systems research priorities; research capacity assessment and skills training, and; the training and graduation of a Sudanese team member with a Ph.D. Mechanisms established in Sudan to facilitate these achievements included the adoption of culturally sensitive and locally specific research and capacity strengthening methods at district level; the signing of a Memorandum of Understanding at country level between the Ministry of Health, research and academic institutions in Sudan, and; the establishment of country level initiatives and a research unit. The latter being recognized globally through awards and membership in global health forums. Conclusion We surmise that the ‘network of action’ approach adopted to partnership formation facilitated the benefits gained, but that adopting such an approach is not sufficient. More local and contextual factors influenced the extent of the benefits and the sustainability of the network.
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Affiliation(s)
- Khalifa Elmusharaf
- University of Medical Sciences and Technology, Khartoum, Sudan.,University of Limerick, Limerick, Ireland
| | - Hanan Tahir
- University of Medical Sciences and Technology, Khartoum, Sudan
| | | | - Ruairi Brugha
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mamoun Homeida
- University of Medical Sciences and Technology, Khartoum, Sudan
| | - Amal M O Abbas
- University of Medical Sciences and Technology, Khartoum, Sudan
| | - Elaine Byrne
- Royal College of Surgeons in Ireland, Dublin, Ireland.
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Byrne E, Mulvaney S, Abela N. S-KETAMINE SEDATION IN A TERTIARY PAEDIATRIC EMERGENCY DEPARTMENT. Arch Emerg Med 2015. [DOI: 10.1136/emermed-2015-205372.59] [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: 11/04/2022]
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Byrne E, Brugha R, Clarke E, Lavelle A, McGarvey A. Peer interviewing in medical education research: experiences and perceptions of student interviewers and interviewees. BMC Res Notes 2015; 8:513. [PMID: 26423420 PMCID: PMC4588247 DOI: 10.1186/s13104-015-1484-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 09/21/2015] [Indexed: 11/15/2022] Open
Abstract
Background Interviewing is one of the main methods used for data collection in qualitative research. This paper explores the use of semi-structured interviews that were conducted by students with other students in a research study looking at cultural diversity in an international medical school. Specifically this paper documents and gives ‘voice’ to the opinions and experiences of interviewees and interviewers (the peers and the communities) on the value of peer interviewing in the study and outlines (1) the preparation made to address some of the foreseen challenges, (2) the challenges still faced, and (3) the benefits of using peer interviews with respect to the research study, the individual and the institution. Methods Peer interviewing was used as part of a two-year phased-study, 2012–2013, which explored and then measured the impact of cultural diversity on undergraduate students in a medical higher education institution in Ireland. In phase one 16 peer interviewers were recruited to conduct 29 semi-structured interviews with fellow students. In order to evaluate the peer interviewing process two focus group discussions were he
ld and an online survey conducted. Results Key findings were that substantial preparations in relation to training, informed consent processes and addressing positionality are needed if peer-interviewing is to be used. Challenges still faced included were related to power, familiarity, trust and practical problems. However many benefits accrued to the research, the individual interviewer and to the university. Conclusions A more nuanced approach to peer interviewing, that recognises commonalities and differences across a range of attributes, is needed. While peer interviewing has many benefits and can help reduce power differentials it does not eliminate all challenges. As part of a larger research project and as a way in which to get ‘buy-in’ from the student body and improve a collaborative research partnership peer interviewing was extremely useful.
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Affiliation(s)
- Elaine Byrne
- Division of Population and Health Sciences, Royal College of Surgeons in Ireland, Beaux Lane House, Lr Mercer Street, Dublin 2, Ireland.
| | - Ruairi Brugha
- Division of Population and Health Sciences, Royal College of Surgeons in Ireland, Beaux Lane House, Lr Mercer Street, Dublin 2, Ireland.
| | - Eric Clarke
- Health Professions Education Centre, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
| | - Aisling Lavelle
- Faculty of Medicine and Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
| | - Alice McGarvey
- Anatomy Department, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland.
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Elmusharaf K, Byrne E, O'Donovan D. Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed. BMC Public Health 2015; 15:870. [PMID: 26350731 PMCID: PMC4562346 DOI: 10.1186/s12889-015-2222-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 03/23/2015] [Accepted: 09/04/2015] [Indexed: 11/13/2022] Open
Abstract
Background Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective. Discussion Common demand side strategies can be grouped into three categories:(i) Financial incentives/subsidies; (ii) Enhancing patient transfer, and; (iii) Community involvement. The main challenges in assessing the effectiveness or efficacy of these interventions or strategies are the lack of quality evidence on their outcome and impact and interventions not integrated into existing health or community systems. However, what is highlighted in this review and overlooked in most of the published literature on this topic is the lack of knowledge about the context in which these strategies are to be implemented. Summary We suggest three challenges that need to be addressed to create a supportive environment in which these demand-side strategies can effectively improve access to maternal health services. These include: addressing decision-making norms, engaging in intergenerational dialogue, and designing contextually appropriate communication strategies.
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Affiliation(s)
- Khalifa Elmusharaf
- Reproductive & Child Health Research Unit (RCRU), University of Medical Sciences & Technology, Khartoum, Sudan. .,Royal College of Surgeons in Ireland, Manama, Bahrain. .,National University of Ireland, Galway, Ireland.
| | - Elaine Byrne
- Royal College of Surgeons in Ireland, Dublin, Ireland.
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Tomlinson JE, Byrne E, Pusterla N, Magdesian KG, Hilton HG, McGorum B, Davis E, Schoster A, Arroyo L, Dunkel B, Carslake H, Boston RC, Johnson AL. The Use of Recombinant Tissue Plasminogen Activator (rTPA) in The Treatment of Fibrinous Pleuropneumonia in Horses: 25 Cases (2007-2012). J Vet Intern Med 2015; 29:1403-9. [PMID: 26256909 PMCID: PMC4858032 DOI: 10.1111/jvim.13594] [Citation(s) in RCA: 16] [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] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 05/06/2015] [Accepted: 07/08/2015] [Indexed: 11/29/2022] Open
Abstract
Background Information about treatment protocols, adverse effects and outcomes with intrapleural recombinant tissue plasminogen activator (rTPA) use in horses with fibrinous pleuropneumonia is limited. Hypothesis/Objectives Describe factors that contribute to clinical response and survival of horses treated with rTPA intrapleurally. Animals Horses with bacterial pneumonia and fibrinous pleural effusion diagnosed by ultrasonography, that were treated with rTPA intrapleurally. Methods Retrospective multicenter case series from 2007–2012. Signalment, history, clinical and laboratory evaluation, treatment, and outcome obtained from medical records. Regression analysis used to identify associations between treatments and outcomes. Results Thirty three hemithoraces were treated in 25 horses, with 55 separate treatments. Recombinant tissue plasminogen activator (375–20,000 μg/hemithorax) was administered 1–4 times. Sonographically visible reduction in fibrin mat thickness, loculations, fluid depth, or some combination of these was seen in 32/49 (65%) treatments. Response to at least 1 treatment was seen in 17/20 (85%) horses with sonographic follow‐up evaluation after every treatment. Earlier onset of rTPA treatment associated with increased survival odds. No association was found between cumulative rTPA dose or number of rTPA doses and survival, development of complications, duration of hospitalization or total charges. Clinical evidence of hypocoagulability or bleeding was not observed. Eighteen horses (72%) survived to discharge. Conclusions and clinical importance Treatment with rTPA appeared safe and resulted in variable changes in fibrin quantity and organization within the pleural space. Recombinant tissue plasminogen activator could be a useful adjunct to standard treatment of fibrinous pleuropneumonia, but optimal case selection and dosing regimen remain to be elucidated.
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Affiliation(s)
- J E Tomlinson
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
| | - E Byrne
- Alamo Pintado Equine Medical Center, Los Olivos, CA
| | - N Pusterla
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
| | - K Gary Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, CA
| | - H G Hilton
- Departments of Structural Biology and Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA
| | - B McGorum
- Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, UK
| | - E Davis
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - A Schoster
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - L Arroyo
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Canada
| | - B Dunkel
- Department of Clinical Science and Services, The Royal Veterinary College, North Mymms, Herts, UK
| | - H Carslake
- Philip Leverhulme Equine Hospital, University of Liverpool, Wirral, UK
| | - R C Boston
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
| | - A L Johnson
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
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McGarvey A, Brugha R, Conroy RM, Clarke E, Byrne E. International students' experience of a western medical school: a mixed methods study exploring the early years in the context of cultural and social adjustment compared to students from the host country. BMC Med Educ 2015; 15:111. [PMID: 26134823 PMCID: PMC4488065 DOI: 10.1186/s12909-015-0394-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 06/12/2015] [Indexed: 05/10/2023]
Abstract
BACKGROUND Few studies have addressed the challenges associated with international students as they adapt to studying medicine in a new host country. Higher level institutions have increasing numbers of international students commencing programmes. This paper explores the experiences of a cohort of students in the early years of medical school in Ireland, where a considerable cohort are from an international background. METHODS A mixed exploratory sequential study design was carried out with medical students in the preclinical component of a five year undergraduate programme. Data for the qualitative phase was collected through 29 semi-structured interviews using the peer interview method. Thematic analysis from this phase was incorporated to develop an online questionnaire combined with components of the Student Adaptation to College Questionnaire and Student Integration Questionnaire. First year students were anonymously surveyed online. The Mokken Scaling procedure was used to investigate the students' experiences, both positive and negative. RESULTS Three main themes are identified; social adjustment, social alienation and cultural alienation. The response rate for the survey was 49% (467 Respondents). The Mokken Scaling method identified the following scales (i) Positive experience of student life; (ii) Social alienation, which comprised of negative items about feeling lonely, not fitting in, being homesick and (iii) Cultural alienation, which included the items of being uncomfortable around cultural norms of dress and contact between the sexes. With the threshold set to H = 0.4. Subscales of the positive experiences of student life scale are explored further. CONCLUSIONS Overall student adjustment to a western third level college was good. Students from regions where cultural distance is greatest reported more difficulties in adjusting. Students from these regions also demonstrate very good adaptation. Some students from the host country and more similar cultural backgrounds were also struggling. Acculturation is more complex than being associated with cultural distance and worthy of further exploration.
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Affiliation(s)
- A McGarvey
- Anatomy Department, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - R Brugha
- Division of Population and Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - R M Conroy
- Division of Population and Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - E Clarke
- Health Professions Education Centre, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
| | - E Byrne
- Division of Population and Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland.
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France NF, Mcdonald SH, Conroy RR, Byrne E, Mallouris C, Hodgson I, Larkan FN. "An unspoken world of unspoken things": a study identifying and exploring core beliefs underlying self-stigma among people living with HIV and AIDS in Ireland. Swiss Med Wkly 2015; 145:w14113. [PMID: 25768695 DOI: 10.4414/smw.2015.14113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PRINCIPLES Human immunodeficiency virus (HIV) related self-stigma--negative self-judgements resulting in shame, worthlessness and self-blame - negatively influences access to care and treatment, and overall quality of life for people living with HIV (PLHIV). Despite evidence that high levels of self-stigma exist among PLHIV, and is experienced to a far greater extent than stigma received from the broader community, there is a paucity of research aimed at understanding causes and functions of self-stigma, and an absence of interventions to mitigate its harmful effects. Understanding the core beliefs underlying self-stigma is therefore essential. METHODS This pilot study used a qualitative approach to analyse interviews and written statements to uncover core beliefs underlying self-stigma, the functions thereof, and strategies used to overcome it, among a heterogeneous group of PLHIV in Ireland. RESULTS Core beliefs underlying HIV-related self-stigma were uncovered and grouped into four categories: disclosure; sexuality and sexual pleasure; self-perception; and body, illness and death. Reported functions of self-stigma included contributing to maintaining a "victim" status; providing protection against stigma received from others; and justifying non-disclosure of HIV status. To cope with self-stigma, participants highlighted: community involvement and professional development; personal development; and connection to others and sense of belonging. Findings were also used to create a conceptual framework. CONCLUSIONS This study helps fill identified gaps in knowledge about self-stigma as experienced by PLHIV. By understanding the core beliefs driving self-stigma, it will be possible to create targeted interventions to challenge and overcome such beliefs, supporting PLHIV to achieve improved wellbeing and lead productive lives free of self-limitation and self-judgement.
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Affiliation(s)
| | | | | | - Elaine Byrne
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | - Fiona N Larkan
- Irish Forum for Global Health/Trinity College, Dublin, Ireland
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Amin N, Byrne E, Johnson J, Chenevix-Trench G, Walter S, Nolte IM, Vink JM, Rawal R, Mangino M, Teumer A, Keers JC, Verwoert G, Baumeister S, Biffar R, Petersmann A, Dahmen N, Doering A, Isaacs A, Broer L, Wray NR, Montgomery GW, Levy D, Psaty BM, Gudnason V, Chakravarti A, Sulem P, Gudbjartsson DF, Kiemeney LA, Thorsteinsdottir U, Stefansson K, van Rooij FJA, Aulchenko YS, Hottenga JJ, Rivadeneira FR, Hofman A, Uitterlinden AG, Hammond CJ, Shin SY, Ikram A, Witteman JCM, Janssens ACJW, Snieder H, Tiemeier H, Wolfenbuttel BHR, Oostra BA, Heath AC, Wichmann E, Spector TD, Grabe HJ, Boomsma DI, Martin NG, van Duijn CM. Genome-wide association analysis of coffee drinking suggests association with CYP1A1/CYP1A2 and NRCAM. Mol Psychiatry 2012; 17:1116-29. [PMID: 21876539 PMCID: PMC3482684 DOI: 10.1038/mp.2011.101] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [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: 12/18/2022]
Abstract
Coffee consumption is a model for addictive behavior. We performed a meta-analysis of genome-wide association studies (GWASs) on coffee intake from 8 Caucasian cohorts (N=18 176) and sought replication of our top findings in a further 7929 individuals. We also performed a gene expression analysis treating different cell lines with caffeine. Genome-wide significant association was observed for two single-nucleotide polymorphisms (SNPs) in the 15q24 region. The two SNPs rs2470893 and rs2472297 (P-values=1.6 × 10(-11) and 2.7 × 10(-11)), which were also in strong linkage disequilibrium (r(2)=0.7) with each other, lie in the 23-kb long commonly shared 5' flanking region between CYP1A1 and CYP1A2 genes. CYP1A1 was found to be downregulated in lymphoblastoid cell lines treated with caffeine. CYP1A1 is known to metabolize polycyclic aromatic hydrocarbons, which are important constituents of coffee, whereas CYP1A2 is involved in the primary metabolism of caffeine. Significant evidence of association was also detected at rs382140 (P-value=3.9 × 10(-09)) near NRCAM-a gene implicated in vulnerability to addiction, and at another independent hit rs6495122 (P-value=7.1 × 10(-09))-an SNP associated with blood pressure-in the 15q24 region near the gene ULK3, in the meta-analysis of discovery and replication cohorts. Our results from GWASs and expression analysis also strongly implicate CAB39L in coffee drinking. Pathway analysis of differentially expressed genes revealed significantly enriched ubiquitin proteasome (P-value=2.2 × 10(-05)) and Parkinson's disease pathways (P-value=3.6 × 10(-05)).
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Affiliation(s)
- N Amin
- Unit of Genetic Epidemiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E Byrne
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - J Johnson
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - G Chenevix-Trench
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - S Walter
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands,Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - I M Nolte
- Unit of Genetic Epidemiology and Bioinformatics, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - J M Vink
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - R Rawal
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - M Mangino
- Department of Twin Research and Genetic Epidemiology, St Thomas' Hospital Campus, King's College London, London, UK
| | - A Teumer
- Interfaculty Institute for Genetics and Functional Genomics, Department of Functional Genomics, University of Greifswald, Greifswald, Germany
| | - J C Keers
- LifeLines Cohort Study and Biobank, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G Verwoert
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S Baumeister
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - R Biffar
- Department of Prosthodontics, Gerodontology and Dental Materials, Center of Oral Health, University of Greifswald, Greifswald, Germany
| | - A Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University of Greifswald, Greifswald, Germany
| | - N Dahmen
- Department of Psychiatry, University of Mainz, Mainz, Germany
| | - A Doering
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
| | - A Isaacs
- Unit of Genetic Epidemiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L Broer
- Unit of Genetic Epidemiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N R Wray
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - G W Montgomery
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - D Levy
- National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA, USA,Center for Population Studies, NHLBI, Bethesda, MD, USA
| | - B M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA, USA,Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland,University of Iceland, Reykjavik, Iceland
| | - A Chakravarti
- McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, MD, USA,Department of Epidemiology and Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - P Sulem
- deCODE Genetics, Reykjavik, Iceland
| | | | - L A Kiemeney
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands,Department of Endocrinology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands,Comprehensive Cancer Center East, BG Nijmegen, The Netherlands
| | - U Thorsteinsdottir
- deCODE Genetics, Reykjavik, Iceland,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - K Stefansson
- deCODE Genetics, Reykjavik, Iceland,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - F J A van Rooij
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Y S Aulchenko
- Unit of Genetic Epidemiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J J Hottenga
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - F R Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C J Hammond
- Human Genetics, Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - S-Y Shin
- Human Genetics, Wellcome Trust Sanger Institute, Genome Campus, Hinxton, UK
| | - A Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J C M Witteman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A C J W Janssens
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Snieder
- Unit of Genetic Epidemiology and Bioinformatics, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,LifeLines Cohort Study and Biobank, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H Tiemeier
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands,Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B H R Wolfenbuttel
- LifeLines Cohort Study and Biobank, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands,Department of Endocrinology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B A Oostra
- Unit of Genetic Epidemiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands,Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A C Heath
- Department of Psychiatry, Washington University, St Louis, MI, USA
| | - E Wichmann
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany,Institute of Medical Informatics, Biometry and Epidemiology, Chair of Epidemiology, Ludwig-Maximilians-Universität, Munich, Germany
| | - T D Spector
- Department of Twin Research and Genetic Epidemiology, St Thomas' Hospital Campus, King's College London, London, UK
| | - H J Grabe
- Department of Psychiatry and Psychotherapy, University of Greifswald, Stralsund, Germany
| | - D I Boomsma
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - N G Martin
- Department of Genetics, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - C M van Duijn
- Unit of Genetic Epidemiology, Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands,Centre of Medical Systems Biology, Netherlands Consortium on Healthy Aging, Leiden and National Genomics Initiative, The Hague, The Netherlands,Department of Epidemiology, Erasmus Medical Center Rotterdam, Dr Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands. E-mail:
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O'Brien TJ, Pasaliaris B, D'Apice A, Byrne E. Anti-Yo positive paraneoplastic cerebellar degeneration: a report of three cases and review of the literature. J Clin Neurosci 2012; 2:316-20. [PMID: 18638835 DOI: 10.1016/0967-5868(95)90052-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Anti-Yo is an anti-Purkiney cell cytoplasmic antibody found in approximately 50% of patients with parancoplastic cerebellar degeneration (PCD). We report three patients with anti-Yo positive PCD (one ovarian carcinoma and two poorly differentiated adenocarcinomas consistent with breast origin). Two were treated with chemotherapy and plasmapheresis but died within months of the diagnosis from progressive neurological disease. The other was given gamma-globulin and has remained table at 6 months follow up. Anti-Yo antibodies are highly specific with almost all patients having breast or gynaecological malignanies. Commonly the tumour is of small volume and asymptomatic. Attempts at treatment are usually unsuccessful but there are a number of reports of stabilisation or improvement when treatment is begun before the development of severe neurological disability. The detection of anti-Yo antibodies is very useful for the diagnosis of PCD allowing early tumour detection and prompt institution of treatment.
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Affiliation(s)
- T J O'Brien
- Department of Clinical Neuroscience, St Vincent's Hospital, Melbourne, Australia
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Holt NG, Johnson J, Wilton S, Byrne E, Piechocka-Trocha A, Walker BD, Kwon D. γδ T-cells in HIV infection. Retrovirology 2012. [PMCID: PMC3441376 DOI: 10.1186/1742-4690-9-s2-p200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chakravarty PD, McLaughlin E, Whittaker D, Byrne E, Cowan E, Xu K, Bruce DM, Ford JA. Comparison of laparoscopic adjustable gastric banding (LAGB) with other bariatric procedures; a systematic review of the randomised controlled trials. Surgeon 2012; 10:172-82. [PMID: 22405735 DOI: 10.1016/j.surge.2012.02.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 02/07/2012] [Accepted: 02/07/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Bariatric surgery can provide efficient weight loss and improvement in obesity-related co-morbidities in adults. Laparoscopic adjustable gastric banding (LAGB) comprised 30.3% of all bariatric procedures between 2009 and 2010 in the UK. This review evaluates the level 1 evidence for change in co-morbidities, quality of life (QoL) and weight provided by LAGB compared with other bariatric procedures. METHOD Systematic literature search of MEDLINE, EMBASE and CENTRAL (1988 to May 2011) was performed. Only randomised controlled trials (RCTs) were included. Studies with non-surgical comparators, open gastric banding procedures or adolescent participants were excluded. Primary outcome was change in co-morbidities. Secondary outcomes included QoL, weight loss, complications, operation time and length of stay. RESULTS Five RCTs met the inclusion criteria. Vertical banded gastroplasty, sleeve gastrectomy and gastric bypass were compared to LAGB. Co-morbidities were reported in two studies and QoL in one. LAGB was comparable to other procedures for both of these outcomes. All five trials showed LABG to be effective in weight loss, however all comparative procedures resulted in greater weight loss. Operative time and length of hospital stay were significantly shorter with LAGB. Short-term complications were found to be consistently lower in the LAGB group. Evidence was divided with respect to long-term complications. CONCLUSION Co-morbidities and QoL are poorly reported and showed no difference between LAGB and other bariatric procedures. Evidence suggests that LAGB is not the most effective surgical procedure to reduce weight. LAGB is associated with lower early complications and shorter operative time and length of stay, and therefore may be preferable to patients.
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Affiliation(s)
- P D Chakravarty
- University of Aberdeen, Section of Population Health, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK
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Catak M, Bas N, Cronin K, O'Brien S, Byrne E. Mathematical modelling of a solid particle motion in a re-circulatory fluidised bed unit. CAN J CHEM ENG 2010. [DOI: 10.1002/cjce.20390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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O’Kelly RA, Brady JJ, Byrne E, Hooley K, Mulligan C, Mulready K, O’Gorman P, O’Shea P, Boran G. A survey of point of care testing in Irish hospitals: room for improvement. Ir J Med Sci 2010; 180:237-40. [DOI: 10.1007/s11845-010-0535-x] [Citation(s) in RCA: 4] [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] [Received: 01/31/2010] [Accepted: 07/12/2010] [Indexed: 10/19/2022]
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King RD, Rowland J, Oliver SG, Young M, Aubrey W, Byrne E, Liakata M, Markham M, Pir P, Soldatova LN, Sparkes A, Whelan KE, Clare A. Make Way for Robot Scientists. Science 2009; 325:945. [DOI: 10.1126/science.325_945a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abstract
BACKGROUND Many diverse pathogenic mitochondrial DNA (mtDNA) mutations have been described since 1988. The Melbourne Neuromuscular Research Institute (MNRI) has undertaken diagnostic detection of selected mtDNA mutations since 1990. MtDNA mutations screened have included point mutations associated with Leber's hereditary optic neuropathy (LHON; G3460A, G11778A and T14484C), mitochondrial encephalopathy lactic acidosis and stroke-like episodes (MELAS; A3243G), myoclonus epilepsy and ragged red fibres (MERRF; A8344G) and Leigh's syndrome/neuropathy ataxia retinitis pigmentosa (LS/NARP; T8993C/G). Samples have also been screened for deletions/ rearrangements associated with Kearns-Sayre syndrome (KSS) and chronic progressive external ophthalmoplegia (CPEO). AIMS To present an audit of the MNRI mtDNA diagnostic service between 1990 and 2001, encompassing 1725 referred patients. METHODS The detection techniques carried out included polymerase chain reaction amplification of mtDNA combined with restriction fragment length polymorphism analysis for mtDNA point mutation detection, supplemented with selected sequence analysis and Southern blots for the detection of deletions/ rearrangements. Tissues tested included blood, hair and skeletal muscle. RESULTS Of the 1184 patients screened for MELAS A3243G, 6.17% were positive for the mutation, whereas for MERRF A8344G, 2.21% carried the mutation and for LS/NARP T8993C/G, 0.32% carried the mutation. The outcomes for the LHON mutations were G11778A, 6.60%, T14484C, 5.76% and G3460A, 0.29%. Of the patients referred for KSS and CPEO, 17.72% had deletions/rearrangements. CONCLUSIONS Overall, the detection rate of mtDNA point mutations was low. The protean clinical features of mitochondrial disorders and the frequency of partial phenotypes lead to requests for tests in many patients with a relatively low likelihood of mtDNA mutations. An improved algorithm could involve mutation screening appropriate to the phenotype using sequencing of selected mtDNA regions in patients with a high likelihood of mtDNA disease. Features increasing the likelihood of mtDNA mutations include the following: (i) a typical phenotype, (ii) a maternal inheritance pattern and (iii) histochemical evidence of mitochondrial abnormality in the muscle biopsy. Efficient laboratory diagnosis of mtDNA disease involves good communication between the physician and laboratory scientists, coupled with screening of the appropriate tissue.
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Affiliation(s)
- R Marotta
- Mitochondrial DNA Diagnostic Laboratory, Melbourne Neuromuscular Research Institute, St Vincent's Hospital, Melbourne University, 41 Victoria Parade, Fitzroy, Victoria 3065, Australia.
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