Статті в журналах з теми "Pilot guides – Ireland"

Background:In Ireland, approximately 65,000 people live with memory problems/dementia (PWMP). Most live in the community, supported by informal caregivers such as relatives. A comprehensive resilience-building psychosocial intervention (CREST) to strengthen intra- and interpersonal resources was piloted by PWMP and caregiver dyads, local GPs, and the community.Methodology:An advisory forum of PWMP, caregivers, and dementia advocacy representatives provided guidance on the intervention design and materials (e.g., interview guides), to ensure they addressed the needs of PWMP and caregivers. The 15-week CREST intervention comprised three components: cognitive stimulation therapy for PWMP (CST; 7 weeks), physical exercise for PWMP and partners from the community (8 weeks), and dementia education for key supporters of PWMP: caregivers (6 weeks), GPs, and the community (one-off events). Intervention processes (e.g., recruitment, data collection measures) were evaluated at each stage by PWMP and caregivers through qualitative (verbal feedback, interviews) and quantitative methods (ratings, questionnaires), to ensure they were feasible and acceptable.Findings:Nine PWMP/caregiver dyads were recruited and completed the CREST intervention; attendance was consistently high (90-95%) throughout. The dyads reported that the recruitment materials, phone calls, and letters from the research team were helpful and easy to understand. Feedback from PWMP, caregivers, event attendees, and programme facilitators confirmed that the intervention content and delivery were acceptable. Minor changes were recommended, and changes which facilitated participation by the PWMP during this pilot (e.g., giving verbal rather than written feedback, larger-print handouts) were implemented immediately. The PWMP enjoyed the CST activities (e.g., collages, tasting childhood sweets) and the “bit of fun” the group shared; some also perceived improvements in concentration and confidence. The PWMP enjoyed the group Exercise sessions, particularly the social aspects (e.g., “banter”, exercising with partners), and some reported improved fitness and feeling less breathless. Caregivers felt better informed about managing dementia and communicating with PWMP and enjoyed sharing experiences with other caregivers. Attendees at the community and GP education events reported improved knowledge of dementia.Conclusion:The involvement of the PWMP and caregivers was valuable to the iteration of the pilot CREST intervention. Consultations with both groups are ongoing to inform future research priorities.

AbstractObjectiveNo up-to-date data on the dietary intake of Irish adolescents are available. The aim of the present pilot study was to obtain and compare cross-sectional information on habitual adolescent beverage consumption between four distinct post-primary schools in the Republic of Ireland, in 2014–2015.DesignA cross-sectional observation study. A beverage consumption questionnaire was used to obtain data on beverage intake and influences on consumption.SettingFour post-primary mixed-sex schools in Ireland representing the following school classifications were selected for the study: urban fee-paying, urban disadvantaged, rural fee-paying and rural disadvantaged.SubjectsStudents (n 761) aged 12–18 years.ResultsData were analysed by Kruskal–Wallis (non-parametric) ANOVA to compare the distribution of beverage consumption across the schools. Water was the most highly consumed beverage among students from all four schools (median 1425 ml/d). Students from urban and rural disadvantaged schools reported a significantly higher volume of carbonated beverage intake than students from fee-paying schools. Students from an urban disadvantaged school also reported a significantly higher volume of carbonated beverage and energy drink intake compared with the other three schools. Students from an urban fee-paying school reported the highest consumption of water, while rural disadvantaged school students were the biggest consumers of tea and milk.ConclusionsSignificant differences in beverage consumption (ml/d) were reported by adolescents from four schools in Ireland. Surveillance on current beverage consumption trends among adolescents is vital to guide policies and interventions, and for appropriate targeting of resources.

Whole-school physical activity (PA) promotion programmes are recommended to increase youth PA. Evaluation of programmes is essential to ensure practice is guided by evidence. This paper evaluates the Active School Flag (ASF), a whole-school PA promotion programme in Ireland, using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. ASF was evaluated across three levels—(1) administration, (2) application, (3) outcomes—using a mixed-methods case study design. Existing data sources were reviewed, the programme coordinator was interviewed, and a pilot study was conducted to investigate impact on 3rd and 5th class students (3 schools, n = 126 students, age range 8–12 years). In-school Moderate to Vigorous Physical Activity (MVPA; by accelerometery), motivation for PA (BREQ), PA self-efficacy (PASES), school affect and peer social support (Kidscreen27) were measured pre-programme (0 months), post-programme (8 months), and at retention (12 months). Teacher perceptions of classroom behaviour (CBAST) were also measured pre- and post-programme. ASF has been successful in engaging 46% of primary schools nationally. Students’ in-school moderate–vigorous PA increased in all pilot-study schools from pre-programme to retention (η2 = 0.68–0.84). ASF programme design facilitates implementation fidelity, adoption and maintenance through buy in from schools and government stakeholders. ASF presents as an effective PA promotion programme in the short-to-medium term for primary schools. This RE-AIM evaluation provides evidence of ASF effectiveness, alongside valuable findings that could support programme improvement, and inform future similar programmes.

Abstract Background In Ireland,young people with Inflammatory Bowel Disease (IBD), diagnosed in a paediatric hospital transition to adult services at 16 years of age. Transition is an essential milestone for adolescents with IBD as critical functioning skills necessary for self-management are not fully developed and adolescents often find it difficult to engage with health care professionals about their disease. To date an ideal transition model has not been defined. The aim of this pilot study was to seek input from a transition group to aid the development of future transition and young person clinics. Methods During 2019, 8 patients transitioning into our adult IBD service were assigned to the pilot structured multidisciplinary (MDT) pathway for 12 months. This involved meeting with Consultant, CNS, psychologist and dietitian at each clinic appointment. Patient experience measures were given after each visit and on completion of the pathway participants rated their experience on Likert scales and free text responses. Findings would be useful to steer service development. Results At the end of 1 year excellent satisfaction rates were reported by those attending clinics with MDT input. Nonetheless 50% preferred consultant only clinics. 37.5% opted for full MDT review and 12.5% requested psychology input plus consultant at clinic. Conclusion The project highlights the importance of patient focused studies when designing young patient’s transition clinics. 50% of young IBD patients did not request full MDT on a regular basis. This study is being expanded to review patient experiences from a larger cohort aged 18–24 years and a Randomised Control Trial will be conducted to guide future a transition pathway

Introduction: Healthy Age Friendly Homes (HAFH) Phase 1 Pilot is a pilot programme aimed at creating a service to identify older people living at home and supporting them to age in place. It is a multi-stakeholder project, evaluated by Maynooth University and funded by Sláintecare, with the programme being delivered by Age Friendly Ireland hosted by Meath County Council. There were 768,900 persons living in Ireland aged 65 and over in April 2022, an increase of 139,100 older people since 2016. With an increasing population of older people; increased supports and services are required to adapt to this change. The aim of this programme was to take a multi-pronged approach encompassing health, housing, community and social supports, and technology, to support older people to remain independent at home, for as long as possible. Recruitment: A sample of convenience was sought across 9 counties. A National Manager and 9 Local Co-ordinators were appointed by Age Friendly Ireland, who conducted a series of awareness campaigns to encourage older people to self-refer into the programme. In addition, a multi stakeholder recruitment approach was utilised, working with services such as personnel in local government, health services, transport, community and voluntary groups, Gardaí, elected members and others, to identify those in communities who may benefit from the programme. Methods: Participants received a home visit from one of 9 Local Co-ordinators who conducted a personal assessment with each individual, covering the four key domains of health, housing, community/social and technology needs. Work orders were prepared based on individual needs assessments including referral to services such as befriending teams, health practitioners and assistance with completion of documentation relating to housing grants, and other opportunities available to older people such as rightsizing. Consenting research participants received two phone calls, at the beginning of the intervention and at 6 months post intervention. Data was collected on; Health Status (EQ-5D), Social Supports - The Oslo Social Support Scale (OSSS-3), Quality of Life - The CASP-12, Loneliness - The UCLA and on Self-Efficacy - The GSE scale. A randomised sample was chosen from each geographical region to undertake a qualitative interview, recording perceptions of the programme. The topic guide was created in line with the RE-AIM framework for intervention studies. Results: To date, 169 participants have taken part in the research evaluation presented. At baseline, 23% reported that their house does not meet their needs. Less than one quarter (24%) had previously applied for a housing adaptation grant. 21% of participants reported moderate problems with mobility, 25% reported moderate problems with pain/discomfort, and 16% reported slight problems with anxiety or depression. 18% of participants reported poor social support and a mean score of 27.24 was reported on the CASP-12. The programme was positively received by participants; one of the most positive aspects reported was the social interaction gained. Conclusion: The HAFH programme has been well received by participants and demonstrates how partnerships between local government, community and health services, can positively enhance the lives of older people living in the community.

This paper presents the results of the ‘Beyond the Peace Walls’ pilot project, which examined the role of urban parks in Belfast, a city marked by a history of sectarianism. It explores the interface of culture, inclusivity and belonging through the concept of ‘shared spaces’ following the rationale that has guided policy-making in Northern Ireland since the signing of the Good Friday Agreement in 1998. By examining the alternative narratives of the historical role of public parks, as spaces of community making, alongside recent efforts to overcome sectarianism, it investigates how the lived experience of parks articulated through the concept of ‘shared spaces’ is understood by policy-makers and local communities. The research draws on material collected in conversations with park goers framed by comparative analysis of research undertaken in other segregated cities to explore the extent to which urban design curbs or reinforces segregation. Findings reveal ongoing tensions between the neutralisation and the signification of space underlying place restructuring in Belfast rejecting the claim that parks are ‘neutral’ compared to other ‘interface’ locations. We argue that parks are not neutral spaces: people have very clear understandings of the demarcation of space within parks, even if the markers are not visible for all to see. Signifiers are perceived through gestures, language, names and activities, while shared spaces embody historically informed values and constraints. We also suggest that formal planning and management of shared spaces in Belfast need to be constantly evolving to meet the fluid needs and aspirations of the city’s population, while taking into account the historical and affective relevance of physical and ethno-political segregation.

Abstract Background As illustrated in a cross-sectional study at a Galway hospital, delirium is common with a 29% incidence in hospitalised older adults. This is associated with adverse clinical outcomes. Guidelines support specialised environments in the management of delirium to reduce morbidity and mortality. A delirium bay is a specialised unit with a standardised approach to comprehensive geriatric assessment for older adults with delirium. Methods We aimed to improve the care of the delirious older adult within our existing framework by creating a ‘Delirium Bay’ utilising the principles of quality improvement. An interdisciplinary team completed ‘Quality Improvement in Action’ training run by the Royal College of Physicians of Ireland from October 2018-March 2019. This involved defining our problem statement and ‘SMART’ aim (Specific, Measurable, Achievable, Realistic, Timely). Measures for improvement included the rate of adverse events, the duration of episodes, patient/family satisfaction, and the use of one-to-one supervision of patients. Results Stakeholder analysis included nursing, catering, multidisciplinary and healthcare assistance staff. We liaised with hospital management regarding restructuring staffing and maintenance regarding environmental changes. An educational programme on delirium was delivered.. We collected baseline data utilising the ‘Plan, Do, Study, Act’ Model and utilised this to guide our changes. A Standard Operating Procedures document was drafted. We opened our four-bedded delirium bay on 11th March 2019. Preliminary data indicates improved management of delirium with preserved continence, reduced risk of falls and high patient and family satisfaction levels. Interventions have been implemented with minimal funding and infrastructural changes. Staffing reconfiguration involved standardised planning replacing a pre-existing ad-hoc system. Conclusion Delirium in hospitalised older adults is common and associated with increased morbidity and mortality, yet amenable to interventions. We demonstrate that a delirium bay can be set up with a quality improvement approach. Pilot data suggests improved management of these patients within the framework of existing resources. Further collection of data on clinical outcomes is ongoing.

Aim/Purpose: The aim of this work is to explore which factors impact on the adoption of the flipped classroom in vocational education to pave the way for the schools which want to apply this model. Background: Although various experiences in the use of the flipped classroom have been reported in recent years in the literature, fewer efforts have been done on how to implement this model from a pedagogical standpoint. The factors that influence its adoption have not been studied in depth, at least not in a global way. These factors include the use of technology and teaching methodologies active in the classroom, the trend towards innovation of teachers and schools, and whether teachers have the necessary ICT training and infrastructures. Moreover, although the results of many experiences in Higher Education have been published, this is not so for other levels of education, such as vocational schools. Methodology: A quantitative research method was used by constructing a questionnaire. The questionnaire included open questions in order to obtain qualitative information, which enriched the results obtained. Descriptive and factor analysis was used to analyze data, within the framework of the project FlipIT!–Flipped Classroom in the European Vocational Education”, ERASMUS+ Strategic Partnership (2015-1-HU01-KA202-013555) funded by the European Union, with the participation of Hungary, the United Kingdom, Ireland, the Czech Republic, and Spain. The research sample includes 625 teachers (434 from Spain, 121 from Hungary and 61 from the Czech Republic) from schools participating or somehow associated to the project. Contribution: An empirically validated framework of the factors influencing the adoption of the flipped classroom approach in schools was obtained. This framework can guide the curriculum design of flipped classroom model courses for vocational education teachers. Findings: Empirically validated factors for the adoption of the flipped classroom in technical schools are presented. In addition, descriptive analysis results from a sample of 625 vocational education teachers confirmed that the countries involved in the survey fulfill the factors needed for the adoption of the flipped classroom in vocational education schools. Another important result is that, according to the surveyed teachers, the flipped classroom is a strongly practice-oriented method very suitable for vocational education. Recommendations for Practitioners: The framework here presented can guide the curriculum design of flipped classroom model courses for vocational and technical education teachers and allow schools to know the factors to review and improve in order to use the model. Recommendation for Researchers: This study is a first step toward determining the factors needed for the adoption of the flipped classroom model in vocational and technical schools. More studies using alternative data sources and methods are needed to obtain a definite model to support this adoption since FC has proved to be a very successful model for motivating students. We hope these results pave the way for schools who want to adopt the FC model and for focusing teaching training on the competences that this work detected. Impact on Society: Recently, we are witnessing an important debate about the future of education at every level. Different innovative methodologies have emerged in a search for more motivating and effective ways to learn, as well as to develop in our students the so-called 21st-century skills such as critical thinking, communication and collaboration, creativity, and information, media and technology skills. The flipped classroom approach can help to improve vocational education by changing traditional classes and teaching students other important soft skills, such as teamwork and collaboration, reflection, digital skills, and self-study. Future Research: The model is currently being implemented in schools in Spain, Hungary, and the Czech Republic using the results obtained here under the framework of the European project “FlipIT!–Flipped Classroom in the European Vocational Education”, ERASMUS+ Strategic Partnership (2015-1-HU01-KA202-013555). After checking the criteria obtained in the framework for each of the participating schools, as a first step, an online course has been created using the competences obtained in this framework, both pedagogical and ICT. Once the course is completed, the teachers will carry out a pilot project to use the model. We hope the framework is useful to other researchers in order to implement the model in other countries and extend it with other criteria to obtain a validated international framework. This study is a first step toward determining the factors needed for the adoption of the flipped classroom model in technical schools. More studies using alternative data sources and methods are needed to obtain a definite model to support this adoption since FC has proved to be a very successful model for motivating students. We hope these results pave the way for schools who want to adopt the FC model and for focusing teacher training on competences.

Abstract Background Older patients prescribed multiple medications commonly experience difficulties with adherence. High-quality evidence on interventions targeting older patients is lacking. Theory is rarely used to tailor adherence solutions. This study aimed to pilot test a novel intervention, developed using the Theoretical Domains Framework, which guides community pharmacists in identifying adherence barriers and delivering tailored solutions (behaviour change techniques). Key study procedures (e.g. recruitment, data collection) for a future randomised controlled trial (cRCT) were also assessed. Methods Using purposive sampling, this non-randomised pilot study aimed to recruit 12 community pharmacies (six in Northern Ireland; six in London, England). Pharmacists were trained to deliver the intervention to non-adherent older patients (maximum 10 per pharmacy; target n = 60-120) aged ≥ 65 years (reduced to 50 years due to recruitment challenges) and prescribed ≥ 4 regular medicines. The intervention, guided by an iPad web-application, was delivered over 3-4 face-to-face or telephone sessions, tailored to specific barriers to adherence. We assessed the feasibility of collecting adherence data (primary outcome: self-report and dispensing records), health-related quality of life (HRQOL) and unplanned hospitalisations (secondary outcomes) at baseline and 6-months. The final decision on progressing to a cRCT, using pre-defined ‘stop-amend-go’ criteria, is presented. Results Fifteen pharmacists from 12 pharmacies were recruited and trained. One pharmacy subsequently dropped out. Sixty patients were recruited (meeting the ‘Amend’ progression criteria), with 56 receiving the intervention. Adherence barriers were identified for 55 patients (98%) and a wide range of behaviour change solutions delivered (median: 5 per patient). Self-report and dispensing adherence data were available for 37 (61.7%) and 44 (73.3%) patients, respectively. HRQOL data were available for 35 (58.3%) patients. GP-reported and self-reported hospitalisations data were available for 47 (78.3%) and 23 (38.3%) patients, respectively. All progression concepts were met (nine ‘Go’ and three ‘Amend’ criteria). Conclusion This study demonstrates the feasibility of key study procedures (e.g. pharmacy recruitment) and delivery of a tailored adherence intervention in community pharmacies. However, modifications are required to enhance issues identified with patient recruitment, retention and missing data. A future definitive cRCT will explore the effectiveness of the intervention. Trial registration ISRCTN, ISRCTN73831533, Registered 12 January 2018.

Abstract Background The Health Service Executive in Ireland aims to facilitate the translation of research and innovation into policy and practice and increase dissemination of research. Previous HSE surveys showed that a high volume of research was undertaken but the impact on practice and policy was unclear. Researchers reported sharing their research in publications, conferences, and through education and training but identified problems in engaging with practice and policy stakeholders. Survey respondents requested help with dissemination and getting research into practice. An organisation-wide project to identify frameworks to support knowledge translation (KT), dissemination, and impact identified a recommended methodology, created guidance, and training for knowledge creators and users. Objectives Provide a series of six guides, tools and templates, to support knowledge creators and users across the organisation Provide online training to support translation and dissemination of research knowledge Underline the importance of planning KT and impact at research commencement and identify the planned outcomes Develop user-friendly training to explain the elements of KT and dissemination. Results Two pilot studies were undertaken to test the guidance which, although positively received, resulted in changes to the format, design, and language to increase useability. An explainer video and six online training modules were developed, based on the guidance and pilot feedback to be rolled out from July 2021. Learning was enhanced through transfer of complex information and models into short training modules to be accessed by researchers with a range of experience and understanding. Conclusions KT is a complex area and developing education and training for it requires understanding the different learning needs of knowledge creators and users. Education and training should focus on the need for KT and impact from the start of a project. Key messages Practical guidance to assist researchers in translation of their research findings into practice and improving dissemination enhances service user impact. Education and training should focus on the need to plan for KT from the start of a project.

Abstract Background Adhering to multiple medications as prescribed is challenging for older patients (aged ≥ 65 years) and a difficult behaviour to improve. Previous interventions designed to address this have been largely complex in nature but have shown limited effectiveness and have rarely used theory in their design. It has been recognised that theory (‘a systematic way of understanding events or situations’) can guide intervention development and help researchers better understand how complex adherence interventions work. This pilot study aims to test a novel community pharmacy-based intervention that has been systematically developed using the Theoretical Domains Framework (12-domain version) of behaviour change. Methods As part of a non-randomised pilot study, pharmacists in 12 community pharmacies across Northern Ireland (n = 6) and London, England (n = 6), will be trained to deliver the intervention to older patients who are prescribed ≥ 4 regular medicines and are non-adherent (self-reported). Ten patients will be recruited per pharmacy (n = 120) and offered up to four tailored one-to-one sessions, in the pharmacy or via telephone depending on their adherence, over a 3–4-month period. Guided by an electronic application (app) on iPads, the intervention content will be tailored to each patient’s underlying reasons for non-adherence and mapped to the most appropriate solutions using established behaviour change techniques. This study will assess the feasibility of collecting data on the primary outcome of medication adherence (self-report and dispensing data) and secondary outcomes (health-related quality of life and unplanned hospitalisations). An embedded process evaluation will assess training fidelity for pharmacy staff, intervention fidelity, acceptability to patients and pharmacists and the intervention’s mechanism of action. Process evaluation data will include audio-recordings of training workshops, intervention sessions, feedback interviews and patient surveys. Analysis will be largely descriptive. Discussion Using pre-defined progression criteria, the findings from this pilot study will guide the decision whether to proceed to a cluster randomised controlled trial to test the effectiveness of the S-MAP intervention in comparison to usual care in community pharmacies. The study will also explore how the intervention components may work to bring about change in older patients’ adherence behaviour and guide further refinement of the intervention and study procedures. Trial registration This study is registered at ISRCTN: 10.1186/ISRCTN73831533

Digital Drop-In is a pilot project that aims to provide an informal social environment where older adults can come together to enhance their digital skills through facilitated informal peer and intergenerational learning (IGL). This qualitative study explores the digital skills assistance provided by a small sample of secondary school students aged 15 to16 years to older adult participants in a series of pilot workshops in a secondary school in Ireland during Autumn 2023. Feedback solicited from participants following completion of the workshops yielded the following preliminary observations. First, from the perspectives of the students, all of whom had volunteered for the project, agreement that the learning experience was successful and that their motivation for volunteering was worthwhile. Second, from the perspective of the older adult participants, there was value in the personalised nature of the one-to-one learner-led exchanges by contrast with instructor-led offerings. Finally, from the perspective of the facilitator, guiding learner-led exchanges in informal social environments requires flexibility to meet the needs of individual learners. In Spring 2024, data are planned to be collected from both generations through an online survey instrument and generational focus groups.When complete, this study will contribute to the field of intergenerational research by exploring the perspectives of mid-teenagers involved in an intergenerational exchange to support the digital skills of older adult community members in Ireland. It has potential to offer a contribution to the field of informal peer learning by proposing the role of a facilitator to guide and support the digital skills knowledge exchange in informal social settings.

Breathlessness support services have demonstrated benefits for breathlessness mastery, quality of life and psychosocial outcomes for people living with breathlessness. However, these services have predominantly been implemented in hospital and home care contexts. This study aims to evaluate the adaptation and implementation of a hospice-based outpatient Multidisciplinary Breathlessness Support Service (MBSS) in Ireland. A sequential explanatory mixed methods design guided this study. People with chronic breathlessness participated in longitudinal questionnaires ( n = 10), medical record audit ( n = 14) and a post-discharge interview ( n = 8). Caregivers ( n = 1) and healthcare professionals involved in referral to ( n = 2) and delivery of ( n = 3) the MBSS participated in a cross-sectional interview. Quantitative and qualitative data were integrated deductively via the pillar integration process, guided by the RE-AIM framework. Integration of mixed methods data enhanced understanding of factors influencing the reach, adoption, implementation and maintenance of the MBSS, and the potential outcomes that were most meaningful for service users. Potential threats to the sustainability of the MBSS related to potential preconceptions of hospice care, the lack of standardized discharge pathways from the service and access to primary care services to sustain pharmacological interventions. This study suggests that an adapted multidisciplinary breathlessness support intervention is feasible and acceptable in a hospice context. However, to ensure optimal reach and maintenance of the intervention, activities are required to ensure that misconceptions about the setting do not influence willingness to accept referral to MBSS services and integration of services is needed to enable consistency in referral and discharge processes.

Background:Atrial fibrillation (AF), the most common cardiac arrhythmia, is a major risk factor for stroke. Atrial fibrillation is often asymptomatic making it difficult to diagnose. Globally, stroke is a leading cause of morbidity and mortality. Opportunistic atrial fibrillation screening has been recommended in clinical practice within Ireland and internationally, the optimal mode and location remains under investigation. Currently, there is no formal atrial fibrillation screening programme. Primary care has been proposed as a suitable setting.Aim:This study aimed to identify the facilitators and barriers to atrial fibrillation screening in primary care from the perspective of general practitioners (GPs).Design and setting:A qualitative descriptive study design was adopted. 54 GPs were invited from 25 practices insouthern Ireland to participate in individual interviews at their practices, rural and urban.MethodA topic guide was developed to guide the interview content towards identification of facilitators and barriers to atrial fibrillation screening. The interviews were conducted in-person, audio-recorded, transcribed verbatim and analysed using framework analysis.Results and conclusionEight GPs from five practices participated in an interview. Three GPs, two male and one female, were recruited from two rural practices and five GPs, two male and three female, were recruited from three urban practices. All eight GPs expressed a willingness to engage in atrial fibrillation screening. Time pressures and the need for additional staff to support were identified as barriers. Programme structure and patient awareness campaigns/education wereidentified as facilitators.The results have been integrated into a pilot primary care-based screening programme for atrial fibrillation.

Abstract Background While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MyComrade (MultimorbiditY Collaborative Medication Review And Decision Making) intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care. Aim The pilot study aimed to assess the feasibility of a definitive trial of the MyComrade intervention across two healthcare systems (Republic of Ireland (ROI) and Northern Ireland (NI)). Design A pilot cluster-randomised controlled trial was conducted (clustered at general practice level), using specific progression criteria and a process evaluation framework. Setting General practices in the ROI and NI. Participants Eligible practices were those in defined geographical areas who had GP’s and Practice Based Pharmacists (PBP’s) (in NI) willing to conduct medication reviews. Eligible patients were those aged 18 years and over, with multi morbidity and on ten or more medications. Intervention The MyComrade intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care, using a planned collaborative approach guided by an agreed checklist, within a specified timeframe. Outcome measures Feasibility outcomes, using pre-determined progression criteria, assessed practice and patient recruitment and retention and intervention acceptability and fidelity. Anonymised patient-related quantitative data, from practice medical records and patient questionnaires were collected at baseline, 4 and 8 months, to inform potential outcome measures for a definitive trial. These included (i) practice outcomes—completion of medication reviews; (ii) patient outcomes—treatment burden and quality of life; (iii) prescribing outcomes—number and changes of prescribed medications and incidents of potentially inappropriate prescribing; and (iv) economic cost analysis. The framework Decision-making after Pilot and feasibility Trials (ADePT) in conjunction with a priori progression criteria and process evaluation was used to guide the collection and analysis of quantitative and qualitative data. Results The recruitment of practices (n = 15) and patients (n = 121, mean age 73 years and 51% female), representing 94% and 38% of a priori targets respectively, was more complex and took longer than anticipated; impacted by the global COVID-19 pandemic. Retention rates of 100% of practices and 85% of patients were achieved. Both practice staff and patients found the intervention acceptable and reported strong fidelity to the My Comrade intervention components. Some practice staff highlighted concerns such as poor communication of the reviews to patients, dissatisfaction regarding incentivisation and in ROI the sustainability of two GPs collaboratively conducting the medication reviews. Assessing outcomes from the collected data was found feasible and appropriate for a definitive trial. Two progression criteria met the ‘Go’ criterion (practice and patient retention), two met the ‘Amend’ criterion (practice recruitment and intervention implementation) and one indicated a ‘Stop – unless changes possible’ (patient recruitment). Conclusion The MyComrade intervention was found to be feasible to conduct within two different healthcare systems. Recruitment of participants requires significant time and effort given the nature of this population and the pairing of GP and pharmacist may be more sustainable to implement in routine practice. Trial registration Registry: ISRCTN, ISRCTN80017020; date of confirmation 4/11/2019; retrospectively registered.

Abstract Background While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MultimorbiditY Collaborative Medication Review And Decision Making (MyComrade) intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care. Our aim in this pilot study is to evaluate the feasibility of a trial of the intervention with unique modifications accounting for contextual variations in two neighbouring health systems (Republic of Ireland (ROI) and Northern Ireland (NI)). Methods A pilot cluster randomised controlled trial will be conducted, using a mixed-methods process evaluation to investigate the feasibility of a trial of the MyComrade intervention based on pre-defined progression criteria. A total of 16 practices will be recruited (eight in ROI; eight in NI), and four practices in each jurisdiction will be randomly allocated to intervention or control. Twenty people living with multimorbidity and prescribed ≥ 10 repeat medications will be recruited from each practice prior to practice randomisation. In intervention practices, the MyComrade intervention will be delivered by pairs of general practitioners (GPs) in ROI, and a GP and practice-based pharmacist (PBP) in NI. The GPs/GP and PBP will schedule the time to review the medications together using a checklist. Usual care will proceed in practices in the control arm. Data will be collected via electronic health records and postal questionnaires at recruitment and 4 and 8 months after randomisation. Qualitative interviews to assess the feasibility and acceptability of the intervention and explore experiences related to multimorbidity management will be conducted with a purposive sample of GPs, PBPs, practice administration staff and patients in intervention and control practices. The feasibility of conducting a health economic evaluation as part of a future definitive trial will be assessed. Discussion The findings of this pilot study will assess the feasibility of a trial of the MyComrade intervention in two different health systems. Evaluation of the progression criteria will guide the decision to progress to a definitive trial and inform trial design. The findings will also contribute to the growing evidence-base related to intervention development and feasibility studies. Trial registration ISRCTN Registry, ISRCTN80017020. Date of confirmation is 4/11/2019.

This talk will present a progress report on the ‘PublishOA.ie’, project in Ireland (2022-24). The objective of PublishOA.ie is to conduct a feasibility study for an All-Ireland digital publishing platform for Diamond Open Access (OA) journals and books, designed to advance best practice and meet the needs of authors, readers, publishers and funders in Irish scholarly publishing.The project is unique in its mandate to report on the feasibility of a shared platform that will be ‘national’ in scope, but encompass academic publishing across two jurisdictions, which are now, post-Brexit, inside and outside the EU: the Republic of Ireland and Northern Ireland in the United Kingdom. The project is led by the Royal Irish Academy (RIA) and Trinity College Dublin (TCD) with 16 partners and affiliates from universities and organisations from the island of Ireland. It is supported by the National Open Research Forum of Ireland (NORF). Publishers and authors of books and journals are collaborating with international and national experts to conduct this feasibility study. First, a research exercise to map Irish academic publishing is being carried out for the first time, and a directory of all publishers in Ireland was published in June 2023.The feasibility study will be based on a review of publishing practices in the island of Ireland, with gap analysis on standards, technology, processes, copyright practices and funding models for Diamond OA, international benchmarking and requirements specification leading to the delivery of a pilot national publishing platform. A set of demonstrator journals and monographs will be published using the platform, which will be actively trialled by the partner publishers and authors.PublishOA.ie is guided by the experience and expertise from members of our international advisory group, including TSV (Finland), Openjournals.nl, DOAJ, SDG Academy, JSTOR, cOAlition S and DIAMAS. Consultation with these international organisations and institutions, all of which have demonstrable and significant experience in the field, are assisting us in analysing and discussing potential solutions to deploy, and where relevant, avail of existing developments. These discussions are proving especially valuable in the context of policy compliance (e.g. cOAlition S), technical advice (e.g. TSV’s use of Public Knowledge Project’s Open Journal Systems), and potential OA content provision.Diverse disciplinary perspectives e.g. from Irish Humanities Alliance, TCD Long Room Hub, Moore Institute (Arts and Humanities) at the University of Galway, Irish Open Access Publishers (IOAP) (multiple disciplines including Social Sciences and STEM), Dublin Institute of Advanced Studies (DIAS) (Physics, Irish language) and the RIA (multiple disciplines including STEM) will be integrated with international best practice. This will inform decisions on models and technical infrastructure tested and trialled ensuring their validity in the Irish context as well as their international validity.Bibliodiversity is at the heart of the PublishOA.ie project, as is long-term sustainability. Publishing in Ireland must always have regard to the considerably larger and better resourced publishing trade in the next-door United Kingdom, where Irish authors, writing as they do in English, have historically had strong representation.PublishOA.ie, aims to increase all-island connections and relationships within and between groups and individuals in scholarly publishing. The All-Ireland nature of the project strengthens the Shared Island initiative of the Government of Ireland.PublishOA.ie aims to deliver evidence-based understanding of Irish scholarly publishing and of the requirements of publishers to transition in whole or in part to Diamond OA. It will result in increased knowledge of the needs of publishers and authors in Ireland to move towards Diamond OA publishing. Critically, PublishOA.ie will aim to increase awareness and engagement by policymakers of the system-level risks, challenges and opportunities for a publicly owned, centralised platform for Diamond OA publication of journals and books in Ireland.

Abstract Background Self-management of type 1 diabetes (T1D) is complex and can be particularly challenging for young adults. This is reflected in the high blood glucose values and rates of clinic non-attendance in this group. There is a gap for a theory-based intervention informed by key stakeholder opinions to support and improve self-management in young adults with T1D. Purpose The aim of the work was to systematically co-develop an evidence-based and stakeholder-led intervention to support self-management and clinic engagement in young adults living with T1D in Ireland. Co-development was led by the Young Adult Panel. Methods The Behaviour Change Wheel was used to guide the development. Five evidence sources were used to inform the process. An iterative co-design process was used with the Young Adult Panel. Initial intervention components were refined and feasibility tested using qualitative methods. Results Environmental restructuring, education and training were selected as appropriate intervention functions. The co-design process, along with qualitative refinement and feasibility work, led to the final intervention content which consisted of 17 behaviour change techniques. The final D1 Now intervention consists of three components: a support worker, an agenda setting tool and an interactive messaging service. Conclusions The D1 Now intervention is now at pilot evaluation stage. Its transparent and systematic development will facilitate evaluation and future replications.

ObjectiveDespite progress in endonasal skull-base neurosurgery, cerebrospinal fluid (CSF) rhinorrhoea remains common and significant. The CRANIAL study sought to determine 1) the scope of skull-base repair methods used, and 2) corresponding rates of postoperative CSF rhinorrhoea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull-base tumors.MethodsA prospective observational cohort study of 30 centres performing endonasal skull-base neurosurgery in the UK and Ireland (representing 91% of adult units). Patients were identified for 6 months and followed up for 6 months. Data collection and analysis was guided by our published protocol and pilot studies. Descriptive statistics, univariate and multivariable logistic regression models were used for analysis.ResultsA total of 866 patients were included - 726 TSA (84%) and 140 EEA (16%). There was significant heterogeneity in repair protocols across centres. In TSA cases, nasal packing (519/726, 72%), tissue glues (474/726, 65%) and hemostatic agents (439/726, 61%) were the most common skull base repair techniques. Comparatively, pedicled flaps (90/140, 64%), CSF diversion (38/140, 27%), buttresses (17/140, 12%) and gasket sealing (11/140, 9%) were more commonly used in EEA cases. CSF rhinorrhoea (biochemically confirmed or requiring re-operation) occurred in 3.9% of TSA (28/726) and 7.1% of EEA (10/140) cases. A significant number of patients with CSF rhinorrhoea (15/38, 39%) occurred when no intraoperative CSF leak was reported. On multivariate analysis, there may be marginal benefits with using tissue glues in TSA (OR: 0.2, CI: 0.1-0.7, p<0.01), but no other technique reached significance. There was evidence that certain characteristics make CSF rhinorrhoea more likely – such as previous endonasal surgery and the presence of intraoperative CSF leak.ConclusionsThere is a wide range of skull base repair techniques used across centres. Overall, CSF rhinorrhoea rates across the UK and Ireland are lower than generally reported in the literature. A large proportion of postoperative leaks occurred in the context of occult intraoperative CSF leaks, and decisions for universal sellar repairs should consider the risks and cost-effectiveness of repair strategies. Future work could include longer-term, higher-volume studies, such as a registry; and high-quality interventional studies.

BackgroundIreland’s Model of Care for the Management of Overweight and Obesity outlines a plan for treating adolescent and child obesity (CO). However, engagement with key stakeholders is required to support its implementation and improve health services.AimThis study aims to map the perceived barriers and facilitators related to CO management across healthcare settings, professional disciplines, and regions in the Republic of Ireland (ROI).Materials and methodsAn online cross-sectional survey of registered healthcare professionals (HPs), designed to adhere to the Consolidated Framework for Implementation Research (CFIR), was co-developed by a project team consisting of researchers, healthcare professionals, and patient advocates. The survey was pilot tested with project stakeholders and distributed online to professional groups and via a social media campaign, between September 2021 and May 2022, using “SurveyMonkey.” Data were summarised using descriptive statistics and thematic analyses. Themes were mapped to the CFIR framework to identify the type of implementation gaps that exist for treating obesity within the current health and social care system.ResultsA total of 184 HPs completed the survey including nurses (18%), physicians (14%), health and social care professionals (60%), and other HPs (8%). The majority were female (91%), among which 54% reported conducting growth monitoring with a third (32.6%) giving a diagnosis of paediatric/adolescent obesity as part of their clinical practice. Nearly half (49%) of the HPs reported having the resources needed for clinical assessment. However, 31.5% of the HPs reported having enough “time,” and almost 10% of the HPs reported having no/limited access to suitable anthropometric measurement tools. Most HPs did not conduct obesity-related clinical assessments beyond growth assessment, and 61% reported having no paediatric obesity training. CFIR mapping identified several facilitators and barriers including time for clinical encounters, suitable materials and equipment, adequate training, perceived professional competency and self-efficacy, human equality and child-centredness, relative priorities, local attitudes, referral protocols, and long waiting times.ConclusionsThe findings provide actionable information to guide the implementation of the Model of Care for the Management of Overweight and Obesity in Ireland. Survey findings will now inform a qualitative study to explore implementation barriers and facilitators and prioritise actions to improve child and adolescent obesity management.

AbstractAimTo explore factors affecting participation in the pilot of the synchronous online national diabetes prevention programme (NDPP) in Ireland from the perspectives of those who attended and the educators who recruited for and delivered the programme.MethodsA qualitative study involving semi‐structured interviews and focus groups with NDPP attenders (attended the assessment and at least one session) and educators (dietitians) on the programme. The Framework Method using the Theoretical Domains Framework (TDF) guided the analysis.ResultsThirteen attenders took part in two online focus groups and five online or phone interviews. Eight educators took part. Four themes which cut across the TDF domains were identified as factors influencing participation; (i) lack of awareness of prediabetes and fear of diabetes, relating to attenders' fear of diabetes and lack of knowledge of prediabetes and diabetes prevention; (ii) perceived need for programme support to change health behaviour, concerning attenders' and educators' recognition of the need for the NDPP; (iii) trust in healthcare professionals (HCPs), relating to trust in HCPs to convey the seriousness of prediabetes and the value of diabetes prevention programmes (DPPs) and (iv) practical and personal ease of joining online, relating to the flexibility and accessibility of the synchronous online group format, the IT skills of attenders and educators and apprehension about group education.ConclusionsRaising awareness of prediabetes and the need for prevention programmes should be a priority for health services and HCPs. The synchronous online group format was seen as less daunting to join than a face‐to‐face programme and may be a useful option to encourage participation.

Abstract Background Venous Thrombo-Embolism (VTE) can be life-threatening. Risk assessment and mitigation is essential to reduce morbidity and mortality in all clinical settings. Northern Ireland Health and Social Care has a standardised, regional thromboprophylaxis risk assessment tool as part of paper-based drug charts in the acute, secondary care setting. Intermediate care setting drug charts incorporate this same tool. The 30-bedded pilot site cares for step-down patients from the acute hospital setting from surgical, orthopaedic and medical specialties, for those aged over 18 years requiring bed-based rehabilitation. Regularisation of reviews of risk assessments to address changes in VTE risk was identified as a need to avoid under-prescribing and over-prescribing. Methods Quality improvement methodology was used. Pre-phase, semi-structured interviews with stakeholders took place. An Ishikawa diagram analysed contributory factors to risks. A Sinek circle distilled intentions. A Clinical Value Compass map considered potential outcomes. A vision of “VTuEsdays” was co-designed. Global and specific aims informed driver diagrams. Plan, Do, Study, Act iterations were used in the implementation phase including a decision support tool to guide the appropriateness of deprescribing on the basis of rehabilitation trajectory and changing VTE risk. Results We collected baseline data and implemented education of staff working in the intermediate care centre, utilising the ‘PDSA’ Model to guide changes. A bright and easy to use flowchart was used with the title ‘VTuEsdays’. This encouraged the process of VTE risk assessment and weekly review on a Tuesday. There were improvements in: the completion rate of risk assessment tool; the accuracy of this assessment; the under-prescribing and over-prescribing of thromboprophylaxis. Conclusion The “VTuEsdays” themed day helped ameliorate under-prescribing and over-prescribing of thromboprophylaxis in an intermediate care bed-based rehabilitation setting. Quality improvement methodology enables a robust approach to risk mitigation. Similar themed days for regularisation of reassessment of clinical risk management in intermediate care settings could improve different aspects of care.

Abstract Patient-initiated follow-up (PIFU) is an alternative approach to a traditional appointment-based system, offering flexible review for patients, and has successfully been implemented across a range of specialty departments worldwide. In 2022, the Health Service Executive in Ireland announced reforms to introduce ‘patient-initiated review’ across the organization in its strategy to tackle long patient waiting lists. More recently, the British Association of Dermatologists developed guidelines to support dermatology departments within the National Health Service to introduce PIFU pathways successfully. We performed a single centre, prospective pilot study of patients offered PIFU over a 3-month period in 2021. Patients were identified through electronic reports for adult and paediatric dermatology clinics, and data were drawn from clinical records. Patients were offered ‘flexible’ review within 1 year of the original presentation pertaining to the same clinical condition. Patient demographics and clinical details were extracted and analysed, and patients followed for a 12-month period. Forty-seven patients were identified. Fifty-seven per cent (n = 27) were female and the median age was 23 years (range 0–83). Clinical diagnoses included acne (n = 13), eczema (n = 8), nonspecific rash (n = 4), infection (n = 5), nonmelanoma skin cancer (n = 3), urticaria (n = 2), hidradenitis suppurativa (n = 2), actinic keratosis (n = 2), guttate psoriasis (n = 2), vasculitis (n = 2) and other (n = 4). Thirty per cent (n = 14) of patients activated PIFU within a 12-month period. Median time until PIFU was 213 days (range 28–413). Fifty-seven per cent (n = 8/14) were paediatric patients. Forty-three per cent (n = 6/14) of patients had acne, 29% (n = 4/14) eczema, 14% (n = 2) actinic keratosis, 7% (n = 1), urticaria and 7% (n = 1) guttate psoriasis. The background rate of patients who ‘did not attend’ (DNA) in 2021 was 12% (n = 823/7093). This study demonstrates how PIFU has a useful role in reducing unnecessary attendance at outpatient clinics. Previous research has demonstrated its benefits in patients with chronic conditions who require lifelong management. Our findings support the view that PIFU has a role in dermatology for patients with conditions that display periods of quiescence, as seen in inflammatory dermatoses. Early review allows for the appropriate escalation of treatment to avoid potential complications. This study shows that PIFU can have a positive impact on DNA rates. In 2021, the departmental DNA rate was lower than the estimated annual national rate of 13%. The PIFU avoids unnecessary review of well patients, reducing the potential for nonattendance. Furthermore, 70% of patients were successfully discharged after 12 months. The PIFU may complement strategies such as nurse-led clinics and teledermatology in increasing outpatient capacity and reducing patient waiting lists. Further larger studies focusing on client and resource benefits of PIFU can guide specialty-specific policies for its use across institutions in the future.

Abstract Purpose For outdoor physical activity (PA), it is likely that the quality of the environment is a factor which determines adherence and compliance with PA at the population level. There is some evidence that a higher environmental quality contributes to the improvement of well-being and mental health, and increased in PA. The GoGreenRoutes intervention study will explore the relationship between outdoor environmental quality and PA adherence, and determine whether environmental exposure during PA indirectly influences health. Project description The project will be carried out in up to six cities, including Lahti (Finland), Limerick (Ireland), and Tallinn (Estonia) as part of the European Commission-funded project GoGreenRoutes. The participant population will comprise inactive adults of both sexes (aged 30-65y). The intervention will consist of an 8-week self-guided programme, where participants will perform PA in self-selected outdoor spaces (at least 3 times/week, 30min/session). This will be a two-group design, where the experimental group will be given advice and instructions in selecting a green route; while the control group, on the opposite, will be given advice and instructions in selecting an urban/road route. Both groups will receive information about the benefits of PA performed in outdoor spaces (control group) and green/nature spaces (experimental group). Environmental quality in each selected route will be assessed. Time spent in different movement behaviours will be measured at the baseline and week eight, using an activPAL accelerometer over a nine-day measurement period. Further, differences in anthropometric and physical fitness measurements, health perception and quality of life, sleep quality, and beliefs about green exercise will be investigated, as well as their associations with movement behaviours and environmental quality. Conclusion The intervention design has been guided by results from the pilot/feasibility study. It will contribute to the understanding of the relationship between environmental quality and PA adherence, and will provide data on the effects of self-selected outdoor route environmental quality on the daily PA undertaken in the sample population. Funding Source European Union’s Horizon 2020 research and innovation program, through the GoGreenRoutes research project under grant agreement No. 869764.

Abstract Background Despite widespread COVID-19 vaccination programs, there is an ongoing need for targeted disease prevention and control efforts in high-risk occupational settings. This study aimed to develop, pilot, and validate an instrument for surveying occupational COVID-19 infection prevention and control (IPC) measures available to workers in diverse geographic and occupational settings. Methods A 44-item online survey was developed in English and validated for face and content validity according to literature review, expert consultation, and pre-testing. The survey was translated and piloted with 890 workers from diverse industries in Canada, Ireland, Argentina, Poland, Nigeria, China, the US, and the UK. Odds ratios generated from univariable, and multivariable logistic regression assessed differences in ‘feeling protected at work’ according to gender, age, occupation, country of residence, professional role, and vaccination status. Exploratory factor analysis (EFA) was conducted, and internal consistency reliability verified with Cronbach’s alpha. Hypothesis testing using two-sample t-tests verified construct validity (i.e., discriminant validity, known-groups technique), and criterion validity. Results After adjustment for occupational sector, characteristics associated with feeling protected at work included being male (AOR = 1.88; 95% CI = 1.18,2.99), being over 55 (AOR = 2.17; 95% CI = 1.25,3.77) and working in a managerial position (AOR = 3.1; 95% CI = 1.99,4.83). EFA revealed nine key IPC domains relating to: environmental adjustments, testing and surveillance, education, costs incurred, restricted movements, physical distancing, masking, isolation strategies, and areas for improvement. Each domain showed sufficient internal consistency reliability (Cronbach’s alpha ≥0.60). Hypothesis testing revealed differences in survey responses by country and occupational sector, confirming construct validity (p < 0.001), criterion validity (p = 0.04), and discriminant validity (p < 0.001). Conclusions The online survey, developed in English to identify the COVID-19 protective measures used in diverse workplace settings, showed strong face validity, content validity, internal consistency, criterion validity, and construct validity. Translations in Chinese, Spanish, French, Polish, and Hindi demonstrated adaptability of the survey for use in international working environments. The multi-lingual tool can be used by decision makers in the distribution of IPC resources, and to guide occupational safety and health (OSH) recommendations for preventing COVID-19 and future infectious disease outbreaks.

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