BACKGROUND AND HYPOTHESIS:As many as half of all psychotic disorders diagnosed by age 28 in the population emerge in individuals who attended child and adolescent psychiatry services, highlighting important opportunities for psychosis prediction and prevention. An important next step is to identify prognostic factors for later psychotic disorders within this clinical population. We assessed a large number of potential prognostic factors for adult-onset psychosis within adolescent psychiatry services. STUDY DESIGN:Linked population-wide register data for all individuals born in Finland 1987-1992. Using survival analyses, we assessed a range of clinical, service use, and sociodemographic characteristics in adolescent psychiatry patients (ie, individuals who were diagnosed with a mental disorder in specialist-level services in adolescence [ages 13-17 years]) as prognostic factors for adult-onset psychotic disorders (ages 18-30 years; individuals diagnosed with psychosis before age 18 [n = 2276] were excluded). STUDY RESULTS:Among adolescent psychiatry patients (n = 27 626), cumulative risk of psychosis between ages 18 and 30 was 8.5%. Within-service significant prognostic factors for psychosis included: total number of mental disorder diagnoses received in adolescence, young maternal age, premature birth, older age at first adolescent psychiatry contact, history of child psychiatry contact, psychiatric inpatient admission in adolescence, parental history of psychosis, and parental history of inpatient psychiatric admission. CONCLUSIONS:Our findings demonstrate that a number of clinical, service use, and sociodemographic factors have prognostic significance for the development of adulthood psychosis among adolescent psychiatry patients.

BACKGROUND:Reducing the duration of untreated psychosis (DUP) is a key aim of early intervention in psychosis (EIP) services. While DUP accounts for a proportion of the time individuals experience psychotic symptoms, the duration of active psychosis (DAP) concept provides a broader scope by including the duration of psychosis both before and after treatment initiation. This study aimed to describe DAP in a large naturalistic cohort of people with first-episode psychosis (FEP), and explore the relationship between DAP and early psychosis outcomes. METHODS:This study involved secondary analyses of an existing dataset of consecutive cases of FEP in young people aged 15 to 24 from an EIP service in Melbourne. The duration of active psychosis after treatment initiation (DAT), limited to the first year of care, was estimated using the short form Scale for the Assessment of Positive Symptoms measured repeatedly at regular intervals. This was combined with DUP to calculate DAP. DAP was divided into four groups according to quartiles and regression analysis was used to explore the relationship between DAP and outcomes at discharge. RESULTS:DAP was estimated for 749 individuals with FEP. The group with the longest DAP (>58 weeks) presented at a younger age (mean 18.6 vs mean 19.7) and had a higher proportion of females (49.7% vs 38.9%). Adjusted linear regression models demonstrated that longer DAP (>58 weeks) was a significant predictor of worse overall functioning (β = -7.07, p = .005) and negative symptom severity (β = 1.10, p = .006) at discharge from the EIP service. CONCLUSIONS:Time spent in active psychosis is an important consideration beyond the initial untreated period and further research is indicated to establish the relationship between DAP and outcomes in FEP.

OBJECTIVES:Psychological outcome measures guide research and clinical decision-making, yet many widely used tools were developed with limited psychometric rigour. Although advanced methods (e.g., item response theory, structural equation modelling) are now widely available, their added value in applied research remains uncertain and applied researcher perspective regarding such are unexplored. We aimed to address this gap in knowledge by examining key stakeholder perspective. METHOD:To explore how these methods are perceived, we conducted semi-structured interviews with 21 stakeholders spanning psychometrics, clinical practice, applied research, statistics and academia. Data were analysed using reflexive thematic analysis. RESULTS:Analysis identified three overarching themes: (1) growing recognition that heterogeneity in latent traits challenges assumptions underlying many measures, (2) the enduring use of entrenched but psychometrically weak tools and (3) nuanced views on when advanced methods meaningfully influence research findings. Participants acknowledged gaps in psychometric literacy and emphasised the need for more training and collaboration with psychometricians. CONCLUSION:These findings highlighted persistent limitations in measurement practice, clarify contexts where psychometric methods add genuine value, and point to opportunities for strengthening outcome measurement in psychology and psychiatry research.

Introduction Venous thromboembolism (VTE) risk assessment (VTERA) tools can be used to guide clinical decisions on postpartum thromboprophylaxis. However, the appropriateness of these decisions depends on the accuracy of the data input into VTERA tools. Objectives The primary objective was to assess whether the accuracy of postpartum VTE risk assessments differed between the study years (2019–2025), across nine predefined risk factors. The secondary objectives included evaluating the accuracy of all risk factors, and thromboprophylaxis recommendations, in a 2025 sample. Methods In this retrospective observational study, the accuracy of data entered into a postpartum VTERA tool was assessed, through comparison to electronic health record (EHR) data. Differences in accuracy across study years (2019–2025), for nine structured risk factors, were evaluated using Poisson regression.For the primary analysis, all deliveries and bookings, with a matched VTE risk assessment between January 2019 and August 2025 were included. For the secondary analysis, 283 patients from 2025 were manually reviewed, to assess all 23 risk factors and thromboprophylaxis recommendations. Results Primary analysis included 47 489 deliveries and bookings, with a matched risk assessment. BMI was the risk factor with the lowest accuracy overall (94.3%), and remained the lowest across each year. Compared with 2019, postpartum VTE risk factor recording was significantly more accurate in 2020, 2021, 2022, 2023, 2024 and 2025.Secondary analysis showed that 6.0% of risk assessments produced inaccurate thromboprophylaxis recommendations, regarding indication and duration, and 4.9% yielded inaccurate dose recommendations. Conclusions Future research must focus on enhancing the accuracy of VTE risk assessments. This may involve auto-population of VTERA tools using EHR data.

Background Antipsychotic trials in schizophrenia quantify treatment efficacy using clinician-rated scales such as the Positive and Negative Syndrome Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS). If these scales include redundant or weakly informative items, measurement noise can blur drug-comparator differences that may dilute real effect sizes. Modern psychometric methods can refine and re-weight symptom scores that may improve precision and potentially increase detectable treatment effects, although it is unclear which approaches might be best. Aims To 1) determine best psychometric models for the PANSS and BPRS, and 2) test whether psychometrically-informed scoring of PANSS/BPRS alters estimated antipsychotic effect sizes compared with conventional total-score analyses, and 3) to explore whether any changes differ across symptom domains and by sex. Method We will conduct secondary analyses of anonymised individual participant data from randomized Phase II–IV schizophrenia trials accessed via secure data-sharing platforms (YODA Project and Vivli). Item-level PANSS/BPRS data will be harmonised at baseline and outcome. Psychometric models will be derived using confirmatory factor analysis, item response theory, and network analysis. Stability and invariance analyses will be conducted, examining covariates such as age and sex. Antipsychotic efficacy will be estimated using mixed-effects participant-level models, expressed as Cohen’s d standardised mean differences (SMDs) for both conventional and psychometrically-informed outcomes. The primary outcome will be the difference in SMDs between conventional and psychometrically-informed effect sizes, summarised across trials. Conclusions This study will determine whether best practice psychometric refinement of existing measures meaningfully changes antipsychotic effect size estimates, informing outcome measurement choices and interpretation of trial results.

ABSTRACT Purpose In deprescribing studies, a prescription-free gap is typically used to determine if patients discontinued their treatment. An appropriate gap depends on the typical time between prescriptions during continued use. This work aims to characterise the interval between prescriptions of chronic drugs using different methods for a cohort of older people in primary care in Ireland. Methods The empirical prescription interval was analysed for 38,154 patients for the twenty most common drug classes and the association between covariates and the interval was analysed using a multi-level model. Estimates were also compared to those obtained from the parametric waiting time distribution (pWTD) approach. Results Available covariates had consistent relationships with prescription intervals across drug classes. For example, each additional prescription issue was associated with an increase in the interval by 5.0 (NSAIDs) to 19.7 days (“Other antidepressants”). Full public health cover was associated with a -29.0 day (inhaled adrenergics) to -11.0 day (opioids) change relative to partial cover, while other/private cover had a -17.9 day (benzodiazepines and associated drugs) to -7.1 day (SSRI and SNRIs) change relative to partial cover. The pWTD also produced consistent estimates of the population interval for most drugs. Conclusions The interval varied substantially within drug classes, due to a mixture of patient, practice and unmodelled factors. Variation between practices was effectively explained, with residual variation between patients and within patients. The pWTD approach is useful for describing complex distributions of intervals, and may be more appropriate for inferring a gap than summarising truncated data. Plain language summary The time between one drug prescription and the next was calculated for the 20 most commonly prescribed drug classes in a database of older people attending primary care in Ireland. The timing varied drastically among drugs, due to differences in patients and practices. We analysed these variables using two approaches. The first looked at how factors such as age, sex, and healthcare cover relate to the time between prescriptions. The second described the overall pattern of prescription intervals as a combination of simpler underlying patterns. Key points Prescription intervals are highly focussed around intervals of typical prescribed quantities, as expected, with modes of approximately 30, 60, and 90 days for all drug classes. Heterogeneity in the prescription interval for specific drug classes was found to be mainly at the within-patient level. This may be due to prescription renewal behaviour changing over time for individuals. Patient-specific covariates, such as age, sex and healthcare scheme cover had a similar effect on the prescription interval across the most frequent drug classes prescribed. The parametric waiting time distribution, using a finite mixture model to account for unmodelled variation, was able to robustly explain the population average distribution of empirical intervals using a penalised likelihood procedure.

PURPOSE:Simulation studies are used in pharmacoepidemiology for evaluating statistical methods in a controlled setting, whereby a known data-generating mechanism allows evaluation of the performance of different approaches and assumptions. This study aimed to review simulation studies performed in pharmacoepidemiology. METHODS:We conducted a review of all papers published in the journal of Pharmacoepidemiology and Drug Safety (PDS) over the period 2017-2024. We extracted data on study characteristics and key simulation choices such as the type of data-generating mechanism used, inferential methods tested and simulation size. RESULTS:Among 42 simulation studies included, 34 (81%) were informing comparative effectiveness/safety studies. Twenty-two studies (52%) used simulation in the context of a clinical condition, and 36 (86%) used Monte-Carlo simulation. Inputs not derived from empirical data alone (n = 22, 52%) or in combination with real-world data sources (n = 19, 45%) were most often used for data generation. The complexity of simulations was often relatively low: although 31 studies (74%) generated data based on other covariates, time-dependent covariates (n = 3) and effects (n = 4) were rarely implemented. Bias was the most often used performance measure (n = 26, 62%), although notably 18 studies (43%) did not report uncertainty in the method. CONCLUSION:Simulations contributed a relatively small number of articles (3.2% of 1320) to PDS over 2017-2024. Greater focus on evaluating methods and inferential approaches, using simulation studies that are appropriately complex given clinical realities, may be beneficial to the pharmacoepidemiology field.

Background Antipsychotic trials in schizophrenia quantify treatment efficacy using clinician-rated scales such as the Positive and Negative Syndrome Scale (PANSS) and Brief Psychiatric Rating Scale (BPRS). If these scales include redundant or weakly informative items, measurement noise can blur drug-comparator differences that may dilute real effect sizes. Modern psychometric methods can refine and re-weight symptom scores that may improve precision and potentially increase detectable treatment effects, although it is unclear which approaches might be best. Aims To 1) determine best psychometric models for the PANSS and BPRS, and 2) test whether psychometrically-informed scoring of PANSS/BPRS alters estimated antipsychotic effect sizes compared with conventional total-score analyses, and 3) to explore whether any changes differ across symptom domains and by sex. Method We will conduct secondary analyses of anonymised individual participant data from randomized Phase II–IV schizophrenia trials accessed via secure data-sharing platforms (YODA Project and Vivli). Item-level PANSS/BPRS data will be harmonised at baseline and outcome. Psychometric models will be derived using confirmatory factor analysis, item response theory, and network analysis. Stability and invariance analyses will be conducted, examining covariates such as age and sex. Antipsychotic efficacy will be estimated using mixed-effects participant-level models, expressed as Cohen’s d standardised mean differences (SMDs) for both conventional and psychometrically-informed outcomes. The primary outcome will be the difference in SMDs between conventional and psychometrically-informed effect sizes, summarised across trials. Conclusions This study will determine whether best practice psychometric refinement of existing measures meaningfully changes antipsychotic effect size estimates, informing outcome measurement choices and interpretation of trial results.

AIM:The aim of this study was to evaluate the impact of pressure ulcer prevention education for health care assistants on their knowledge, skills, and attitudes towards PU prevention. MATERIALS AND METHODS:A quasi-experimental, one group, pre-test, post-test design was employed. The participants were health care assistants (HCAs) caring for older adults at risk of pressure ulcer development residing in long term care settings. Following ethical approval, the Shanley pressure ulcer prevention programme (SPUPP) (Shanley et al., 2022 May). and the pressure ulcer classification education tool (PUCLAS) (Beeckman, 2017) was delivered to consenting participants. Knowledge was assessed using the knowledge of pressure ulcer prevention tool (KPUP) (Shanley et al., 2020), skills were assessed using images depicting pressure ulcers as per the European Pressure Ulcer Advisory Panel (2019) classification tool, and attitudes were assessed using the Moore and Price attitude tool (APUP) (Moore & Price 2004). Outcomes were assessed at baseline, immediately following the education intervention and again at 4 months. Data were analysed using descriptive and inferential statistics, as appropriate. RESULTS:A total of 129 HCAs completed the education intervention and completed the questionnaires pre (K1) and post intervention (K2), while 52% (n = 67) completed the 4 month (K3) follow up questionnaires. In total, 19% (n = 24) were male and 81% (n = 105) were female, with a mean age of 49 years (SD: 7 years; min 29 years, max 60 years). The average duration of employment was 2.4 (SD:1) years and 33% (n = 42) had received previous education in PU prevention. There was a statistically significant increase in average knowledge scores at K2 compared to K1 (MD: 3.40; 95% CI: 3.10 to 3.70) and K3 compared to K1 (MD: 3.04; 95% CI: 2.65 to 3.42) with large effects (Cohen's d = 1.74 at K2; d = 1.55 at K3), and a decrease in average scores from K2 to K3, but this was not statistically significant (MD: -0.36, 95% CI: -0.75 to 0.02). Similarly, there was a statistically significant increase in average skill scores at S2 compared to S1 (MD: 2.13; 95% CI: 1.95 to 2.30; p < 0.001) and S3 compared to S1 (MD: 1.53; 95% CI: 1.31 to 1.75; p < 0.001) with large effects (Cohen's d = 2.72 at S2; d = 1.95 at S3). Conversely, there was a statistically significant decrease in mean skill scores from S2 to S3 (MD: -0.60; 95% CI: -0.82 to 0.38; p < 0.001). Furthermore, there was a statistically significant MD in attitude scores from A1TS to A2TS and from A1TS to A3TS (MD: 1.81, 95% CI: 1.08 to 2.55, p < 0.001; MD: 2.83, 95% CI: 1.89 to 3.76, p < 0.001, respectively) with a moderate effect at A2TS (Cohen's d = 0.47) and a moderate-to-large effect at A3TS (d = 0.73). There was also a statistically significant difference in attitude scores from A2TS to A3TS (MD: 1.00, 95% CI: 0.77 to 1.95, p = 0.035). CONCLUSIONS:HCAs are an integral component of the health care workforce, and play a very important role in providing direct care to patients within the LTC setting. As such, HCAs need the right knowledge, skills and attitudes to ensure that care delivered is timely and appropriate. Outcomes of this study showed that knowledge, skill and attitude scores improved from baseline and remained higher than baseline at the 4 month follow up. It is evident therefore, that HCAs are a group of health care workers that can be positively impacted by investment in education. Findings also reiterate the need for reinforcement of education at regular intervals, due to the risk of knowledge and skill scores dropping over time.

Abstract Background Prescribing cascades, where one medication is used to treat/prevent the adverse effects of another, have been the subject of increased research focus. However, few studies have confirmed potential prescribing cascades identified via administrative or dispensed medicines records with general practice patient record data. This study examined the incidence of ThinkCascades, a list of nine prescribing cascades of clinical relevance in older adults developed via international expert consensus, using general practice data in The Netherlands. Methods A retrospective cohort study examined prescribing records for adults aged ≥ 65 years captured within the FaMe-Net general practice database in The Netherlands for the period 2011–2021. The primary exposures were incident use of Drug A within each ThinkCascades dyad, with the primary outcomes defined as incident use of the corresponding Drug B within 365 days. Independent clinical review of identified potential prescribing cascades was conducted by a general practitioner and pharmacist using an approach consistent with methods applied in earlier prescribing cascade research. Results The eligible cohort comprised 710 incident users of any ThinkCascades Drug A. Their mean age was 75.8 (SD = 6.1) years; 53.5% (n = 380) were female. Overall, 21 ThinkCascades dyads were identified in 18 participants, representing a one-year incidence proportion of 2.5% (N = 710). Only six of nine ThinkCascades were identified amongst study participants, most commonly the calcium channel blocker to diuretic prescribing cascade. Just over one-quarter of identified potential prescribing cascades (6/21; 28.6%) were supported as true prescribing cascades based on independent clinical record review. True cascade likelihood was indeterminable for three cases. Conclusions Prescribing cascades, defined by ThinkCascades, were relatively uncommon over the eight-year study of older people attending Dutch general practice. Three of nine ThinkCascades were not identified. Only one in four identified prescribing cascades had evidence supporting a true prescribing cascade following independent clinical record review. Further research to characterise the prevalence of confirmed prescribing cascades is required. Recent research recommends expanding the number of prescribing cascade dyads which may impact identification rates. Tools to support prescribing cascade awareness, identification and deprescribing need to incorporate shared decision-making with patients and demonstrate clinical utility in supporting medication reviews in primary care.

This paper presents independent associations between complex multimorbidity and health-related quality of life using the EQ-5D-5L instruments. Identifying the decrements in utility associated with complex multimorbidity is of value for economic evaluation and health technology assessment. Data from the population normative dataset from the Irish EQ-5D-5L study were combined with baseline data from the SPPiRE (Supporting Prescribing in Older Adults with Multimorbidity in Irish Primary Care) randomised controlled trial. The trial included an Irish cohort aged 65+ with complex multimorbidity. For the analysis, the estimation sample consisted of 364 individuals from the SPPiRE complex multimorbidity sample, along with 116 individuals aged 65+ from the general population who did not report having any serious illness. A multivariate ordered probit regression model was used to estimate the independent associations between complex multimorbidity and the five EQ-5D-5L dimensions. Complex multimorbidity was independently associated with a lower probability of reporting no problems for all five EQ-5D-5L dimensions, and a higher probability of reporting the most extreme response for all five dimensions. The loss in health utility associated with complex multimorbidity was estimated to be − 0.506 (95

Evidence for After Action Reviews (AAR), a non-hierarchical debriefing approach, is limited. We explored AAR implementation and measured safety culture and second victim experience and support, before and after introduction of AAR at an Irish hospital. A mixed-methods study which coincided with the COVID-19 pandemic and a health system cyber-attack was conducted. Hospital selected staff were trained as AAR facilitators using a simulation-based programme (July-Sept 2021). The intervention was the hospital introduction of AAR over 12-months (Sept 2021–Aug 2022). Before training, the Hospital Survey on Patient Safety 2.0 (HSOPS 2.0) and Second Victim Experience and Support Tool (SVEST) were distributed to all staff (N = 586), and repeated at 12-months with additional questions on AAR awareness, frequency and duration. At 6-months, focus groups with trained facilitators explored implementation enablers and barriers. Costs were estimated. Quantitative analysis used chi-squared, Fisher’s exact and t-tests to compare pre-/post- responses. Qualitative data was analysed using the Capability, Opportunity, Motivation – Behaviour (COM-B) model. Findings were integrated via triangulation, and the level of implementation was categorised using Roger’s theory of the diffusion of innovations. Nine per cent (n = 50) of staff were trained as AAR facilitators. Survey response rates were 33

BACKGROUND:Venous thromboembolism (VTE) is the leading cause of maternal death. Current VTE risk assessment (VTERA) tools often require manual data entry, which can reduce accuracy and affect thromboprophylaxis decisions. Building on 'Thrombocalc', an established postpartum manual VTERA tool, we developed a semi-automated VTERA application ('app') using SMART on FHIR. This app integrates with the electronic health record (EHR) to automatically extract 11 risk factors. OBJECTIVES:The primary objective was to evaluate the accuracy of a semi-automated VTERA app. The secondary objectives were to evaluate efficiency and usability. PATIENTS/METHODS:A randomised crossover study was conducted at a tertiary maternity hospital. Healthcare professionals (HCPs) completed ten simulated patient assessments using both manual and semi-automated VTERA tools. Accuracy was evaluated based on the inclusion of appropriate risk factors, accuracy of risk scores, and appropriateness of thromboprophylaxis recommendations. These recommendations pertained to thromboprophylaxis indication, duration, and dosage. Mouse clicks, keystrokes, and completion times were logged to assess efficiency. Usability of the semi-automated tool was evaluated using the System Usability Scale (SUS). Linear and logistic mixed-effects models were used to analyse accuracy and efficiency outcomes. RESULTS:Thirty-one HCPs participated. The proportion of accurate risk scores increased from 63% with the manual tool, to 87% with the semi-automated tool. Accurate thromboprophylaxis recommendations increased from 79% to 91%. Mixed-effects models demonstrated higher odds of producing accurate risk scores (OR 6.99, 95% CI 3.31-14.67) and recommendations (OR 3.59, 95% CI 1.64-7.88) with the semi-automated tool. Task completion time decreased by 49 s (95% CI 32.8-65). Mouse clicks were reduced by 12 clicks (95% CI 9.01-15.37), and keystrokes by 94% (95% CI 93.4-94.2%). The semi-automated tool achieved a mean SUS score of 89.8, indicating excellent usability. CONCLUSION:Automation can enhance postpartum VTE risk assessment. However, optimal performance requires reliable data and HCP oversight.

AIM:This meta-review examined the incidence and prevalence rates of pressure ulcers in paediatric populations, to place in context the scope of the problem in this cohort of patients. The findings provide a foundation for future research on early factors contributing to paediatric pressure ulcers, aiming to improve understanding and prevention. METHOD:A protocol for this study was registered with the International Prospective Register of Systematic Reviews. This meta-review followed the recommendations from the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A comprehensive electronic literature search was undertaken of seven databases in February 2025. Search terms and keywords were identified to try and identify as many relevant articles as possible. Inclusion and exclusion criteria were applied, and articles which were identified were critically appraised using the Joanna Briggs Institute checklist for systematic reviews. Individual studies were extracted from the systematic reviews, duplicates were removed manually. From these individual studies, data points were identified for extraction and inclusion in this meta-review. Reported incidence and prevalence rates were broken into categories based on the type of pressure ulcer: hospital-acquired, medical device-related and tracheostomy-related pressure ulcers. RESULTS:Five systematic reviews met the inclusion criteria and were included in this review. Three types of pressure ulcers were discussed in the included studies: hospital-acquired pressure ulcers, medical device-related pressure ulcers, and tracheostomy-related pressure ulcers. Pooled incidence and prevalence rates were calculated using the STATA application and the Metaprop command. The pooled incidence rate for hospital-acquired pressure ulcers was 8 % (95 % Confidence Interval [CI]: 4 %-13 %), and for medical device-related pressure ulcers was 9 % (95 % CI: 2 %-19 %). The pooled prevalence rate for hospital-acquired pressure ulcers was 8 % (95 % CI: 5 %-12 %), and for medical device-related pressure ulcers was 10 % (95 % CI: 1 %-26 %). Studies related to tracheostomy-related pressure ulcers showed a pooled risk ratio of 0.35 (95 % CI 0.26-0.49). CONCLUSION:Pressure ulcers are a concern in paediatric populations, with comparable incidence and prevalence rates between hospital-acquired and medical device-related pressure ulcers. Children with tracheostomies face a significantly higher risk of developing pressure ulcers, highlighting the need for tailored preventive interventions. The findings here point to the need for vigilant preventive measures and tailored interventions to safeguard the well-being of young patients against pressure ulcers.

ObjectivesTo describe the prevalence of sub-optimal monitoring for selected higher-risk medicines in older community-dwelling adults and to evaluate patient characteristics and outcomes associated with sub-optimal monitoring.Study designRetrospective observational study (2011–2015) using historical general practice-based cohort data and linked dispensing data from a national pharmacy claims database.SettingIrish primary care.Participants625 community-dwelling adults aged ≥70 years and prescribed at least one higher-risk medicine during the 5-year study period.Primary and secondary outcome measuresThe primary outcome was the prevalence of sub-optimal laboratory monitoring using a composite measure of published medication monitoring indicators, with a focus on commonly prescribed higher-risk medicines such as diuretics and anticoagulants. Poisson regression was used to assess the patient characteristics associated with sub-optimal monitoring and explanatory variables included the number of medicines, age, sex, deprivation and anxiety/depression symptoms. Logistic regression was used to explore the association between baseline sub-optimal monitoring and the odds of adverse health outcomes (unplanned healthcare utilisation, adverse drug reactions and mortality).ResultsOf 625 participants, the mean age was 77.7 years, 53% were female, the mean number of drugs was 7.3 (SD 3.3) and 499 (79.8%) had ≥1 unmonitored dispensing over 5 years. The number of drugs, deprivation and anxiety/depression symptoms were significantly associated with sub-optimal monitoring, with the strongest association seen for anxiety/depression symptoms (incidence rate ratio: 1.33, 95% CI 1.05 to 1.68). There was a small but significant association between baseline sub-optimal monitoring and emergency department visits at follow-up, but no evidence of an association with unplanned hospital admissions, mortality or adverse drug reactions.ConclusionThe prevalence of sub-optimal medication monitoring was high, and number of drugs, deprivation and anxiety/depression symptoms were significantly associated with sub-optimal monitoring. However, the public health impact of these findings remains uncertain, as there was no clear evidence of an association between sub-optimal monitoring and adverse health outcomes. Further research is needed to evaluate the effect of improved monitoring strategies and the optimal timing for drug monitoring of higher risk medications.

Background:Nicotine product use (NPU; including combustible tobacco products and/or e-cigarettes) is changing rapidly worldwide. Aiming to inform an agile policy response, this study examined NPU trends, and associations with intentions and attempts to quit tobacco. Methods:Survey-weighted prevalences of NPU (tobacco and/or e-cigarette), tobacco, e-cigarette, and dual (tobacco and e-cigarette) use were estimated from 2015 to 2023 (excluding 2020 and 2021) using seven waves of the nationally representative Healthy Ireland survey (combined N = 52,167). Associations between sociodemographic factors and NPU, as well as between NPU and quit intentions and attempts, were examined using survey-weighted regression in the 2015 and 2023 waves. Findings:Between 2015 and 2023, decreases in NPU were non-significant (24·6% (1846/7502) to 22·9% (1688/7356), ptrend = 0·120), while tobacco use decreased (22·8% (1713/7502) to 17·7% (1303/7356), ptrend = 0·012), e-cigarette use increased (3·1% (230/7502) to 8·4% (614/7356), ptrend = 0·001) and dual use increased (1·3% (97/7502) to 3·1% (230/7356), ptrend = 0·006). Among those aged 15-24, NPU increased from 19·6% (214/1095) in 2015 to 30·0% (345/1149) in 2023. In 2015, dual use was strongly associated with higher odds of quit intentions and attempts to quit tobacco, compared to tobacco-only, but this was no longer the case in 2023. Interpretation:E-cigarette and dual use have more than doubled in Ireland, while tobacco declines have slowed. The most substantial changes occurred among 15-24-year-olds. Concurrently, the link between dual use and quit intentions and attempts attenuated. These findings underscore the need for stronger e-cigarette regulation and renewed policy efforts to achieve tobacco endgame in Ireland. Funding:None.

Background Care following major trauma requires multi-specialty, multi-agency responses and many early-phase critical decisions, requiring synergy to ensure best patient outcomes. The National Ambulance Service (NAS) collects pre-hospital trauma care data, while the Major Trauma Audit (MTA) records data on hospital admission, but no single database encompasses the entire patient journey. The HRB-funded TRAUMA study has merged these databases, but a single research project is insufficient for ongoing, informed decision-making for optimal major trauma care nationally. Therefore, we explored whether stakeholder collective intelligence (CI) engagement techniques could inform best-practice mechanisms for ongoing combining of NAS and MTA datasets in the future. Methods An integrated CI methodology was adopted. 29 stakeholders, representing a variety of organisations and expertise, provided advance input to a trigger question on ongoing challenges to data merging, and solutions for same, then participated in a one-day workshop. During the workshop, user needs were generated using scenario-based design and user-story methods, which were later categorised using the paired-comparison method. Results Stakeholders generated a total of 102 challenges, divided into 12 categories, i.e. governance, legal, resourcing, leadership, professional roles, IT/software issues, interoperability standards and infrastructure, data issues (unique identifier), consent/rights, operational and outcome challenges. Stakeholders generated 82 Information, Operational, and Infrastructure needs (10 categories), and 84 Communication, Collaboration, and Teamwork needs (13 categories). Core elements informed the upgrading of the MTA database after a cyberattack. Conclusions Stakeholder CI has provided a clear roadmap, identifying challenges and user needs which need to be addressed in any comprehensive plan for ongoing database combination for optimal major trauma care nationally. Certain core elements have already been implemented and can inform other audit and registry updating.

Introduction Medication-related problems at transitions of care are common and can lead to patient harm. Comparing results of studies that look at medication reconciliation and medication safety at transitions of care can be difficult as the outcomes reported in these studies are heterogeneous. Moreover, the outcomes measured often lack the patient’s perspective. A core outcome set (COS) is a list of outcomes which should be measured and reported in studies in order to avoid heterogeneity between trials, measure outcomes relevant to stakeholders and ensure all trials report usable information. This study aims to develop a COS for medicines safety at transitions of care, through updating an existing systematic review and evaluating the perspectives of patients, carers and healthcare professionals.Methods This study is registered with the Core Outcome Measures in Effective Trials (COMET) initiative and the project will be conducted following the COS-STAR (Core Outcome Set-Standards for Reporting) guidelines for the design and reporting of COSs. A four-step process will be followed: (1) updating an existing systematic literature review; (2) semistructured interviews with patients and their caregivers; (3) Delphi survey preparation involving a project steering group to compile a list of potential outcomes; (4) a three-round Delphi consensus exercise involving patients, clinicians and policymakers to refine the final core list of outcomes.Analysis This will be the first COS for medicines safety at transitions of care and will address an unmet need in providing an essential measurement approach that incorporates patients’, carers’ and healthcare professionals’ views. The findings apply to both quality improvement and research, ensuring the relevance and translation of future research findings.Ethics and dissemination Ethical approval for the qualitative surveys and Delphi technique has been granted by the Irish College of General Practitioners Research Ethics Committee (Record ID: 2182). The findings of this project will be disseminated through peer-reviewed publications, conference presentations and registration with the COMET Initiative. Members of the Delphi panel will receive summaries of the outputs, and findings will also be shared with the patient and public involvement groups involved in the study through lay summaries. Engagement with professional societies, healthcare organisations and patient groups will ensure that the COS is widely accessible and adopted into future practice.