Background Palliative care integration in intensive care units (ICUs) is becoming increasingly important in terms of patient-centred care delivery. While both generalist (primary) palliative care provided at the ICU level and specialist palliative care (SPC) services support delivery, there is limited clarity regarding how such integration and care can be measured. Key performance indicators are generally identified as indicators of the quality of healthcare. However, relevant palliative care key performance indicators for the ICU are poorly defined and vary across policies, regulations and the literature. Aim To identify and map key performance indicators to inform a domain-based framework for evaluating palliative care delivery in ICUs. Methods This study will be conducted as a scoping review following the PRISMA-ScR guidelines. We will undertake a systematic search of peer-reviewed records, grey literature, national health system sources, regulatory bodies, and professional organisations. Once extracted, we will analyse the key performance indicators and group them into domains reflecting both generalist and specialist palliative care delivery. Conclusions This will result in a comprehensive synthesis of key performance indicators and inform the development of a structured framework to support the evaluation and implementation of palliative care delivery in the ICU.
Background Research has emphasised the value of a person-centred, interdisciplinary team (IDT) approach to structured goal setting in rehabilitation; yet these approaches are not consistently implemented in clinical practice, limiting the effect that goal setting can have on rehabilitation. The introduction of a new IDT, person-centred goal-setting process to Ireland’s National Rehabilitation Hospital (NRH) offers an opportunity to gain insight into barriers to implementing and normalising IDT goal setting in complex, specialist rehabilitation services. This process was developed prior to, and independently of, the current evaluation by the hospital’s quality improvement (QI) team; this protocol concerns the evaluation of its pilot implementation. Method The study was co-designed by embedded academic researchers and knowledge stakeholders, including the QI team responsible for introducing the new process and two former patients. A mixed-methods approach will capture patient and staff experiences and perspectives of the new process and, secondarily, pilot the feasibility of quantitative outcome measures ahead of a possible future hospital-wide evaluation. Data will be collected by embedded researchers using self-report measures and qualitative interviews with staff and patients. Measures include the Client-Centredness of Goal Setting scale (C-COGS), CollaboRATE, the Interprofessional Socialization and Valuing Scale (ISVS-9B), and the Normalization Measure Development questionnaire (NoMAD), capturing person-centredness of goals, shared decision-making, interprofessional socialisation and process normalisation. Quantitative data will be analysed using descriptive and, where appropriate, inferential statistics; qualitative interview data will be analysed using reflexive thematic analysis. Discussion & Conclusion The study aims to provide a holistic view of patient and staff experiences of the goal-setting process and to identify challenges and potential solutions to implementation within this context. Findings will inform further implementation within the hospital and contribute to rehabilitation practice around implementing IDT goal setting, adding an Irish perspective to the existing rehabilitation goal-setting literature.
Background Healthcare literature has proposed that “learning organisations” (LO) or “learning healthcare systems” (LHS) that continuously generate and apply evidence, innovation, quality, and value can provide better care. This is of value to non-acute healthcare settings such as rehabilitation, which are complex, multi-dimensional and multi-disciplinary in nature. Little is known about how these frameworks have been applied to rehabilitation settings. Objective and inclusion criteria The aim of this scoping review is to systematically summarise the literature conceptualising and operationalising LHS and LO in rehabilitation settings. Studies will be included which define a LO or LHS, describe an operating LHS/LO or include the translation of research evidence generated from LHS/LO data into healthcare improvement within a rehabilitation context. All study designs will be included. Methods The guidelines from the Joanna Briggs institute methodology for scoping reviews will be used for this review. The literature search will be performed using a three-step search strategy: an initial limited search of two databases has been performed to identify relevant key words and index terms. The developed search string will be adapted and applied across the following databases: OVID MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO and COCHRANE Database of Systematic Reviews. Reference lists of selected sources and relevant data-hubs will also be searched. A draft data extraction framework will be used and updated iteratively to extract data. Data will be extracted and described to address the research question of how LHS and LO have been conceptualised and operationalised in the context of rehabilitation. Discussion and Implications There is potential for rehabilitation focused LHSs to advance global rehabilitation services and facilitate best practice. Little is known about how rehabilitation focused LHSs have been constructed and sustained. This will be the first review to explore LHS application in rehabilitation, guiding future development and research.
Background Internationally, there is a growing emphasis on the importance and value of the patient’s “voice”, and the unique insights patients and their families have into healthcare system functioning. However, despite international policy shifts toward empowering patients to support patient safety, there remains a lack of knowledge regarding the full range of existing approaches for facilitating patient involvement in measuring and monitoring patient safety (MMS) in the hospital. This umbrella review will aim to identify existing approaches to involving adult inpatients (or family/partners/carers communicating on their behalf ) in MMS in hospital settings, along with evidence supporting their use. Methods The current review will adhere to the Joanna Briggs Institute guidance for umbrella reviews and the Preferred Reporting Items for Overviews of Reviews (PRIOR) checklist. Systematic searches will be conducted across five electronic databases (MEDLINE, CINAHL, PsycINFO, Scopus, and Academic Search Complete) to identify existing reviews that consider patient-involvement in MMS in hospital settings. Data will be extracted on the characteristics of approaches identified (e.g., surveys, interviews, incident reporting) any evidence of their feasibility, contextual appropriateness and psychometric properties, along with any reported barriers or facilitators relating to their implementation. Methodological quality will be appraised using the CASP checklist, and certainty of evidence will be assessed via a hybrid GRADE and GRADE-CERQual approach. Conclusions This umbrella review will deliver a comprehensive profile of each different approach to involving patients, families and carers in MMS in hospital settings. By evaluating the psychometric evidence and practical feasibility (APEASE criteria and reported barriers and facilitators to use) of these approaches, the findings will support the ascertainment of best practice to involving patients in MMS in hospital settings, ultimately reflecting the important shift in the historical framing of patients as passive recipients of care to active partners in safe and effective care delivery.
Background Cognitive Stimulation in Activities of Daily Living (CS-ADL) is an occupational therapist-led group cognitive stimulation program for people living with mild-to-moderate dementia that aims to enhance functioning of activities of daily living (ADLs). This study investigated the feasibility of CS-ADL and a randomised controlled design comparing the effect of CS-ADL to treatment-as-usual (TAU) on ADL outcomes. Methods This feasibility study used a pre-post-test design. Recruitment took place primarily within healthcare settings and supplemented via community outreach, media and voluntary organisations. Due to recruitment challenges, randomisation was not possible and between-group comparisons were not appropriate. ADL functioning, cognition, communication, quality of life (QOL) and neuropsychiatric symptoms (NPS) were assessed at baseline and follow-up. Data were analysed using descriptive statistics and analysis of pre-post intervention scores using mean differences and 95% confidence intervals. Results Sixteen participants were enrolled in the study, 12 of which completed follow-up assessments. Recruitment rates differed across intervention sites and affected the feasibility of study design. Thirteen participants were allocated to the intervention group (CS-ADL) and three were allocated to TAU. A reduction in caregiver distress from neuropsychiatric symptoms was observed in the intervention group at follow-up. No meaningful change at follow-up was identified in other secondary outcomes. Conclusions This is the first study to evaluate the feasibility of a trial comparing CS-ADL to TAU. Several challenges were identified in relation to recruitment, study design and outcome measures that require modification to enhance feasibility and rigour of future trials. Preliminary results indicate CS-ADL may reduce caregiver distress related to neuropsychiatric symptoms. Further research is necessary to confirm these findings.
Background Older adults living with frailty who are recently discharged from acute care settings are at increased risk of malnutrition and associated complications, including functional decline, hospital readmission, and reduced quality of life. Strengthening transitional nutrition care pathways is therefore important to ensure nutrition support is timely, coordinated, and responsive to patients’ needs. Incorporating the perspectives of older adults living with malnutrition and frailty, family members, and clinicians can help develop practical, effective, and sustainable care pathways and interventions. Objective To engage in a co-design process to identify the key components of an evidence-based and stakeholder-informed nutrition care pathway to support older adults living with frailty during the transition from hospital to home. Materials and Methods This study will use a longitudinal participatory co-design approach. Approximately 30 participants, including older adults, family carers, and hospital and community healthcare professionals, and representatives from voluntary and community services will take part in two co-design workshops facilitated by the primary researcher and research team. Workshops will be facilitating collaborative discussion and idea generation. Workshops will involve sharing experiences, identifying challenges, co-creating solutions, and refining a draft care pathway using interactive activities such as pathway mapping, visual prompts, and prioritisation exercises followed by structured consensus-building using the Nominal Group Technique to prioritise components of the nutritional care pathway. Data will be collected through field notes, audio recordings, and participant-generated materials, and analysed using an access to healthcare framework to identify key components and achieve consensus on the final model. Conclusion The co-design process is expected to identify key components of a stakeholder-informed nutritional care pathway to improve continuity of care, service integration, and tailored post-discharge nutrition support for older adults living with frailty and malnutrition.
Background National standards for health and social care services promote person-centred, evidence-based practice. Since HIQA’s National Standards for Residential Care Settings for Older People in Ireland were published in 2016, there have been significant changes in the sector, including a move towards larger residential services, the COVID-19 pandemic, and legislative reforms. It is therefore timely that HIQA considers whether these standards need to be updated to reflect the latest evidence in relation to best practice and to address changes in the sector. Despite widespread agreement on its value as an approach, person-centred care remains variably defined. An agreed definition would reduce confusion and support its implementation. To inform a potential update to the standards, this scoping review aims to identify and describe the definitions and characteristics of person-centred care in older persons’ residential services. This review will contribute to the academic literature by mapping and synthesising how person-centred care is defined and understood in this context. Methods This review will be conducted using the Joanna Briggs Institute framework for scoping reviews. The Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting. A search of electronic databases (Medline Complete, CINAHL Complete and PsycINFO via EBSCOhost) will be conducted to identify appropriate articles for inclusion. Data extraction will be completed using a template and guidance form adapted for this review, and a narrative summary will describe how the results relate to the review aims. Conclusion The review will provide an up-to-date understanding of how person-centred care in older persons’ residential services is defined and characterised in the peer-reviewed literature. This will inform whether an update to HIQA’s standards for older persons’ residential services is required, to ensure the standards are reflecting the latest evidence in relation to person-centred care.
Background In Ireland, an ageing population with increasingly complex medical needs and a reduced workforce capacity pose significant challenges for healthcare planning and resourcing. To support capacity building, many countries are seeking innovative workforce solutions to meet the growing demand for healthcare. Expanded nursing roles, such as advanced practice nurses, are being introduced to general practice in many countries. In Ireland, the Advanced Nurse Practitioner (ANP) role is predominant in acute hospitals and integrated care settings. However, an increasing number of nurses working in general practice are pursuing advanced nursing practice. This realist review protocol outlines a framework for evaluating evidence on the implementation of the ANP role in general practice. The review aims to gather robust evidence to generate theories about the implementation of the ANP role and, critically, to understand how the role is implemented, for whom, in what circumstances, in what respects, and how. Methods The protocol outlines five critical steps required to conduct a realist review: 1) defining the scope and developing initial theories, 2) developing the search strategy, 3) extracting data and reviewing evidence, 4) synthesising evidence and formulating conclusions and 5) refining theory and disseminating findings. Each stage outlines the specific expectations for that stage of the review. Conclusion The implementation of the ANP role in Irish general practice is a new phenomenon and requires further understanding and exploration. It is envisaged that this protocol will establish a robust framework for evaluating the ANP role in general practice. The insight generated by this realist review will, in turn, help determine if the advanced nurse practitioner role has a worthy place in the future of Irish general practice.
Background Augmentative and Alternative Communication (AAC) refers to a range of communication methods used by children or adults to enhance or replace oral communication. Studies show many children with communication needs who require AAC do not have access to appropriate supports, and that embedding AAC interventions in the classroom is challenging. This means many children who use AAC face barriers to meaningful participation, engagement, and independence. Understanding the experiences and perspectives of AAC users and those who support the use of AAC in the classroom can provide actionable knowledge to guide service improvement such that AAC users can be empowered to achieve and participate in school. Methods A comprehensive literature search of the following electronic databases will be completed: PubMed, CINAHL Complete, EMBASE, EBSCO and Scopus. A manual search of the grey literature will also be carried out. Qualitative studies and mixed-methods designs that include qualitative data on the perspectives and experiences of AAC users, their families, and educators and healthcare professionals who support AAC users in school settings for children 3–18 years will be analysed. Methodological quality of included papers will be appraised using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research by two independent reviewers. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) - Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach will be employed to assess how much confidence to place in the findings of the qualitative evidence synthesis. Qualitative content analysis will be undertaken using constructs from Normalisation Process Theory. Conclusion This qualitative evidence synthesis will summarise findings from the empirical international literature to provide a deeper understanding of the experiences of AAC use from a range of stakeholder perspectives. Findings will inform the development of pathways to support implementation of AAC for children with communication needs within schools. Prospero Registration No. CRD420251229480.
Background What, when, and how infants are fed in the first year of life can influence their growth and development. Establishing optimal infant feeding behaviours is therefore crucial. However, trials of infant feeding interventions for early childhood obesity prevention have shown inconsistent results, potentially related to heterogeneity in what and how outcomes are measured. This heterogeneity limits evidence synthesis and the evaluation of intervention effectiveness. A Core Outcome Set (COS) including 26 infant feeding outcomes was previously developed to address this issue. The next step is to establish a Core Outcome Measurement Set (COMS) that specifies how these outcomes can be best measured. Evidence from work to date has informed a draft COMS. The primary aim of this study is to finalise the COMS with key stakeholders to support standardised measurement across research, policy, and practice. The secondary aim is to develop implementation strategies to facilitate uptake of the COMS and identify areas for future research. Methods This multi-method study will involve parents/caregivers, healthcare practitioners, researchers, and policymakers. Guided by the Generative Co-Design Framework for Healthcare Innovation, it will include two distinct phases. Phase 1 will consist of online meetings to finalise the COMS including structured voting to reach agreement on measurement recommendations. Phase 2 will involve one online co-design workshop to develop implementation strategies and identify priorities for future research. Both phases will be recorded, transcribed, and analysed using inductive content analysis (Phase 1) and thematic analysis (Phase 2). Participant demographic data and voting results will be analysed descriptively. Findings from both phases will inform the finalised COMS and implementation recommendations. Discussion This study represents the final stage of the Standardised measurement for Childhood Obesity Prevention (SCOPE) Project (www.eiascope.com). Findings from this study will strengthen the design, conduct, and evaluation of interventions to promote optimal infant feeding and growth.
Background Adults with intellectual disability age differently, with differing comorbid conditions, prescribing patterns, and medication management considerations than the general population. The Optimising Pharmaco-Therapy and Improving Medication for Ageing with Intellectual Disability (OPTIMA-ID) tool is a newly described set of prescribing criteria developed by expert consensus designed specifically for medicines optimisation in older adults with intellectual disability. The Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA) is key source of observational evidence for medicines in this population. OPTIMA-ID must be tested in the population of older adults with intellectual disability to investigate applicability of the tool for medicines optimisation in clinical practice and to describe potentially inappropriate prescribing for the first time in Ireland. Methods To design a method for the application of OPTIMA-ID to IDS-TILDA data for the first time, the OPTIMA-ID tool was operationalised by translating the criteria into codable statements. These were used to develop bespoke functions in the programming language R for application to the health, behavioural and medicines data from the fifth Wave of IDS-TILDA data collection. Results For the Wave 5 IDS-TILDA dataset, 52 of 67 (78%) OPTIMA-ID criteria were applicable. They were translated into codable statements and built into functions in R for computerised application to the dataset. These functions produce an output of either True or False depending on whether the conditions for each OPTIMA-ID criteria are met, and identify the responsible medicine’s Anatomical Therapeutic Chemical code where relevant. Conclusion This protocol describes a method for the application of a novel medicines optimisation tool in a population of older adults with intellectual disability in Ireland, using accurate, computational methods to identify and describe potentially inappropriate prescribing in this population. This will be first study to use OPTIMA-ID to demonstrate its applicability in its intended target population.
Background Life-limiting conditions (LLCs) in children include conditions where curative treatment may be feasible but can fail or where there is no reasonable hope of cure. Children and young people with LLCs have been found to be resource-intense healthcare users, but evidence is limited to a small number of countries. Responding to this gap, this paper provides detailed information on inpatient hospital activity for children aged 0–19 with and without LLCs in Ireland to inform healthcare policy and provision, including paediatric palliative care. Methods Data: public acute hospital discharges aged 0–19, national Hospital In-Patient Enquiry. Discharges categorised as: with and without LLCs (recorded in any of 30 diagnostic fields). Descriptive analysis: number of discharges over time; inpatients only: principal diagnoses and procedures, resource use (length of stay, intensive care, complexity), deaths. Results Day and inpatient public acute hospital LLC discharges increased from 13.1% to 14.3% of total discharges aged 0–19 between 2009–2019. All discharges in this age group fell by 24.5% in 2020 (Covid-19 onset), increasing since then. Inpatient LLC discharges aged 0–19 accounted for <8% of total inpatient discharges aged 0–19 in Irish public acute hospitals in 2019 (pre-Covid-19), used almost 20% of total bed days, 23.3% of intensive care bed days. Conclusions Inpatient LLC discharges in Irish public acute hospitals were complex and resource-use intensive. The findings highlighted important lessons for healthcare policy and provision, palliative care training and education, hospital management, data collection and further analysis in this field.
Background Older adults undergoing surgery experience higher rates of postoperative morbidity, mortality, functional decline and institutionalisation compared with younger populations. Emerging evidence suggests that frailty screening and perioperative geriatric optimisation may improve postoperative outcomes. Comprehensive Geriatric Assessment (CGA) is the gold-standard approach for the identification and management of older adults living with frailty. Previous Cochrane reviews demonstrated that CGA improves outcomes for medically admitted older adults and hip fracture patients, although evidence remains limited for other surgical populations. This systematic review aims to update the 2018 review and synthesise current evidence regarding the effectiveness of CGA in older surgical patients. Methods and analysis This protocol follows PRISMA-P guidelines and is registered with PROSPERO (CRD420261322154). MEDLINE, Embase, CINAHL, PsycINFO and CENTRAL will be searched for randomised and quasi-randomised trials published from 2017 onwards involving adults aged ≥65 years undergoing surgical care. Eligible interventions must include multidimensional CGA delivered by a geriatric-trained healthcare professional. The primary outcome will be functional status. Secondary outcomes will include length of stay, mortality, days at home alive, readmission, cognitive outcomes, adverse events and postoperative complications. Two reviewers will independently screen studies, extract data and assess risk of bias using the Cochrane RoB 2 tool. Meta-analysis will be conducted where appropriate. Discussion This review will provide an updated synthesis of evidence regarding the effectiveness of CGA in older surgical patients and will inform clinicians, researchers and policymakers regarding the delivery of age-friendly perioperative care.
Introduction Organised population-based cancer screening invites identified populations to undergo a test, usually at regular intervals, to detect early-stage cancers or pre-cancerous lesions, to reduce cancer-specific mortality rates, and, in some cases, cancer-specific incidence. Emerging research highlights the role of cognitive processing, especially Defensive Information Processing (DIP), in influencing screening participation. This scoping review aims to 1) shed light on how Defensive Information Processing is defined and measured in cancer screening studies, 2) provide an overview of the use of theories and conceptual frameworks in such studies,3) describe defensive information processing profiles and outcomes, and 4) describe intervention strategies aimed at reducing defensiveness reactions to cancer screening. Methods This review will follow the Joanna Briggs Institute (JBI) guidelines and will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR). Inclusion/exclusion criteria and search strategy will be developed using the Population, Context, Concept (PCC) framework. Relevant studies will be retrieved via 6 databases (Scopus, Web of Science, EMBASE, Medline, CINAHL, PsychINFO and CENTRAL). Quantitative studies of cancer screening will be included if they report original research that defines, measures, and/or intervenes on any aspect of defensive information processing, consistent with the conceptualisations by McQueen et al (attention avoidance, blunting, suppression, and counterarguing). Two reviewers will independently screen published abstracts, full-text articles, and extract data from the final included studies using a standardised extraction form. Extracted data will be reported using narrative synthesis. Conclusion This scoping review will be the first to examine the range of literature on all or some domains of defensive information processing in cancer screening contexts since McQueen et al.’s conceptual model. By reviewing research beyond their work, it aims to provide an evidence base to inform future interventions addressing defensiveness in cancer screening.
Background Economic losses from extreme weather events (EWEs) are rising and are increasingly reported in settings with limited historical exposure to such hazards. Proactive disaster risk management is widely promoted to reduce impacts and improve value for investment, yet the economic evidence is dispersed across hazards, strategy types, and evaluation methods. As a result, decision-makers often struggle for a clear basis for comparing options across contexts. In addition, economic results are frequently reported without a structured synthesis of the barriers and facilitators that influence adoption and implementation. This review aims to synthesise and compare global evidence on proactive disaster risk management strategies for extreme weather events, alongside the barriers and facilitators associated with their adoption. Methods This protocol is registered in PROSPERO (CRD420251023343) and will be reported in accordance with PRISMA guidance. Peer-reviewed primary studies published from 2015 onwards will be eligible if they evaluate proactive strategies addressing extreme weather events and report at least one economic outcome. Eligible hazards must be extreme weather events. Interventions will be categorised as technology-based, infrastructure-based, community-based, nature-based, risk-financing, or hybrid strategies. Searches will be conducted in six electronic databases, with screening and data extraction managed in Covidence. Two reviewers will complete screening, extraction, and quality appraisal, with disagreements resolved through discussion or adjudication by a third reviewer. Data items will include study setting (Global North or South and World Bank income group), hazard type, intervention characteristics and scale, economic methods, and economic results. Economic outcomes will be collected. The study quality will be assessed using the Joanna Briggs Institute tools. Given anticipated heterogeneity, findings will be narratively synthesised alongside subgroup comparisons and a framework-based thematic synthesis of adoption barriers and facilitators.
Background Nearly 10% of the global population living with dementia resides in South Asia, a region of over two billion people with limited diagnostic and care resources. Clinicians require accessible, flexible, and contextually relevant training to improve dementia care in frontline settings. Aim To develop, pilot, and implement a multi-modal, interactive, hybrid training program to improve clinicians’ knowledge, skills, and practice in dementia diagnosis and care in South Asia. Methods/Design Using the ADDIE framework, a 5–6-month online dementia training course was developed through partnerships with the Neurology Academy (UK), the Global Brain Health Institute (Trinity College Dublin), regional academic and third-sector organisations, and international faculty. The course included pre-recorded lectures, live case-based discussions, quizzes, prescribed readings, online discussion forums, and a required Quality Improvement (QI) proposal. Content covered eight core themes delivered through 39 short lectures by multidisciplinary experts from ten countries, with country-specific material for Bangladesh, India, and Nepal. Evaluation was guided by the New World Kirkpatrick Four-Level Training Evaluation Model. Results Three course cohorts enrolled clinicians from Bangladesh, India, and Nepal (total n = 57). Level 1 evaluation showed high satisfaction with content and delivery; 14% reported the pace was too fast. Live case-based discussions were rated most valuable. Participation was strong, with 65% attending all live sessions and 80% engaging in online forums. Level 2 evaluation demonstrated significant improvements in dementia Knowledge, Attitudes, and Practice (KAP). At Level 3, most learners developed dementia-focused QI proposals, leading to initiatives such as caregiver training, patient awareness activities, and educational materials. Level 4 outcomes showed that several participants established or expanded local dementia services after course completion. Conclusion This training program improved dementia knowledge, skills, and clinical practice among clinicians in resource-limited South Asian settings, fostered professional networks, and contributed to strengthening dementia care capacity in the region. *ADDIE: Analyze, Design, Develop, Implement, Evaluate, Instructional Design Model (ADDIE)
Background Individuals with psychotic disorders face a 20-year mortality gap compared to the general population, largely driven by cardiovascular disease and metabolic syndrome. Antipsychotic medications, while essential, exacerbate this risk through rapid weight gain and metabolic dysregulation, particularly in the first three months of treatment. Resistance training improves body composition and metabolic health, particularly glucose regulation. Its effects on muscle strength and hypertrophy are enhanced by a caloric surplus that, in its absence, would otherwise lead to accumulation of adipose tissue. Its feasibility and efficacy in drug-naïve or minimally treated First-Episode Psychosis (FEP) patients has not been previously explored. Methods The START GAAIMS study is a multicentre, two-arm, crossover, randomised controlled feasibility trial. Forty adults (18–65 years) with FEP and < 4 weeks of antipsychotic exposure will be recruited from services in Dublin and Cork. Participants will be randomised (1:1) to an Intervention Group (12-week supervised RT programme + Treatment as Usual [TAU]) or a Control Group (TAU only). After 12 weeks, the control group will crossover to receive the intervention. Outcome Measures The primary outcome is the feasibility of the trial design (recruitment, retention, adherence) and a preliminary estimate of the effect size for change in body fat percentage at 12 weeks. Secondary outcomes include muscular power, metabolic biomarkers (glucose, lipids, inflammatory markers), and psychiatric symptoms (BPRS). Discussion This study will determine preliminary measures of the effects of resistance training on body composition in people with FEP starting antipsychotic medication, as well as its feasibility and acceptability in this cohort. Findings will inform the design of a definitive RCT to establish RT as a standard co-treatment for metabolic health in early psychosis.
Trauma is one of the major causes of morbidity, and it has to be handled with effective triage mechanisms. Trauma triage tools (TTTs) are constructed to standardize the practice of decision-making in emergency departments and the prehospital environment by making decisions based on physiological and injury-related criteria to direct the transport and escalation decisions. Although TTTs have been demonstrated to be clinically useful, their application in everyday practice is difficult to maintain. The review will use the World Health Organization epidemiological context and the current Irish reforms in the trauma system, guided by the Health Service Executive, to synthesize international evidence to support sustainable implementation of the national TTT in Ireland. The Arksey and O’Malley methodological framework will be used to carry out the review, and the findings will be reported in adherence to the PRISMA-ScR. Databases to be searched will include MEDLINE, Embase, CINAHL, Scopus, and Web of Science. Based on the updated Consolidated Framework of Implementation Research (CFIR 2.0), the determined determinants will be deductively mapped on five domains with inductive coding. Results will be synthesized in narrative and displayed in frequency tables. The review will match prioritized determinants with the implementation strategy of the ERIC framework. Finally, this research aims to fill the gap between TTT validation and practice and help planners and policymakers of the trauma system optimize the implementation of triage and patient outcomes. Institutional Details: Royal College of Surgeons in Ireland, Department of Health Psychology.
Background Aggression and hostility directed at pharmacists in healthcare settings and community pharmacies are increasingly recognised as significant occupational and public health concerns. Such behaviours may negatively impact pharmacists’ psychological well-being, job satisfaction, workforce retention, and the quality and safety of patient care. Despite growing reports internationally, evidence remains fragmented, with limited synthesis across practice settings. Objective To map the extent, nature, contributors, and consequences of aggression and hostility against pharmacists across practice settings. Methods and Analysis This scoping review will follow the Joanna Briggs Institute framework. Inclusion and exclusion criteria will follow the Population–Concept–Context approach. Electronic databases, along with a grey literature search, will be conducted. A data charting tool will be developed and applied through Covidence software. Qualitative and quantitative descriptive analyses will be undertaken. Conclusion Findings will inform policy, practice, and future research addressing pharmacist workplace safety.
Background Primary care datasets offer valuable longitudinal data for research and policy-making. However, Ireland’s primary care data infrastructure is limited, with inconsistent diagnostic coding raising concerns about research utility. While gaps in coding chronic conditions are well-documented, cancer diagnosis validation remains unaddressed. This study assesses the utility of Irish GP data by comparing cancer incidence rates from primary care records with the National Cancer Registry Ireland (NCRI). Methodology A retrospective cohort study used anonymised data from 43 GP practices in Ireland, covering the period from 1 January 2011 to 5 April 2018. Cancer cases were identified using ICPC-2 and ICD-10 diagnostic codes for the 20 most common reported cancers by NCRI. Age- and sex-adjusted cancer incidence was derived from NCRI data and compared with observed GP-recorded cases using standardised incidence ratios (SIRs). Chi-squared tests compared observed and expected frequencies. Inter-practice variation was assessed by comparing expected and observed case counts. Results The cohort comprised 41,782 patients aged ≥60 years, with mean follow-up of 5.3 years. Across 20 cancers examined, 15 were significantly under-recorded in GP data relative to NCRI estimates. No significant differences were observed for colorectal, leukaemia, thyroid, cervical cancers, or Hodgkin’s lymphoma. In contrast, marked under-recording was observed for melanoma, liver, pancreatic, brain, and ovarian cancers. Prostate (SIR 1.20), breast (SIR 1.53) and bladder cancer (SIR 2.14) were significantly over-recorded. Cancers lacking granular ICPC-2 diagnostic codes and relying on ICD-10 demonstrated the greatest under-ascertainment. Inter-practice variation was substantial with marked heterogeneity in coding and wide dispersion in practice-level SIRs. Conclusion Irish GP datasets substantially under-record cancer incidence versus NCRI estimates, primarily due to heterogeneity in coding practices and limitations of ICPC-2 diagnostic system. Standardisation of diagnostic coding, improved data linkage, and routine data validation are essential to enhance primary care data reliability for cancer surveillance, research and policy.
