HRB open research最新文献

Background: Antimicrobial resistance is a significant global health challenge, exacerbated by inappropriate antibiotic prescribing, particularly in primary care where up to 50% of antibiotic prescriptions prescribed by general practitioners (GPs) and dispensed by community pharmacists (CPs) are deemed inappropriate. Respiratory tract infections (RTIs) are among the most common conditions leading to GP consultations and subsequent antibiotic prescribing, much of which is inappropriate as most RTIs are viral in nature or self-limiting bacterial infections. Point-of-care tests (POCTs) have emerged as tools to improve the diagnosis and appropriate treatment of RTIs.

Objective: This study aims to develop and test an intervention to improve the use of POCTs in managing RTIs involving GPs and CPs in Irish primary care, following the UK's Medical Research Council's (MRC) framework for complex intervention development, involving five work-packages (WPs).

Methods: WP1 involves creating best practice guidance for using POCT in managing RTIs, informed by a scoping review and validated with an expert Delphi panel. This guidance will be used to define target behaviour(s) for GPs and CPs related to POCT use. WP2 explores GP and CP perceived barriers and facilitators to these behaviours using the Theoretical Domains Framework, mapping influential domains to Behaviour Change Techniques to develop draft interventions. WP3 gathers patients' perspectives on using POCTs for RTIs. In WP4, a task group will review and finalise the intervention(s). They will consider patients' perspectives from WP3 and assess feasibility of the intervention(s). WP5 involves a proof-of-concept study to test the feasibility of the newly developed intervention(s).

Conclusion: A theoretically informed intervention(s) for using POCT(s) in the management of RTIs in primary care in Ireland will be developed and tested in a proof-of-concept study, following MRC guidance. Further refinement and larger studies will be needed to determine its effectiveness before widespread implementation.

Background: Equality, diversity and inclusion (EDI) has gained discursive momentum across multiple arenas, including in maternal health research. As a preliminary exploration for future discussion and development, we undertook a scoping review to identify the types, frequency, and extent of EDI characteristics that were measured and reported in randomised controlled trials (RCTs) of intrapartum interventions specifically.

Methods: Joanna Briggs Institute methodological guidance for scoping reviews guided the conduct of the review. The population were women of any parity and risk category who were enrolled in intrapartum RCTs in any birth setting or geographical location. The concept was measured and reported EDI characteristics. CINAHL, MEDLINE, PsycINFO, EMBASE, and CENTRAL were searched from January 2019 to March 2024. Data were extracted using a pre-designed form. The findings were summarised and narratively reported supported by illustrative tables and graphs.

Results: Two-hundred and forty-seven RCTs from 49 countries were included. Eleven EDI characteristics were measured or reported in at least one RCT, although frequency varied. Religion, for example, featured in three RCTs only, whereas Age featured in 222 RCTs. How the EDI characteristics featured also varied. Race/Ethnicity, for example, was described in 21 different ways in 25 RCTs. Similarly, Education was reported in 62 different ways across 96 RCTs. Ninety RCTs limited inclusion to nulliparous participants only, six RCTs required participants to have a minimum educational level, 127 RCTs had inclusion age cut-offs although 23 different variations of this were noted and 15 RCTs excluded participants on the grounds of disability.

Conclusions: This scoping review highlights EDI characteristic measurement and reporting deficits in intrapartum RCTs. There is a critical need for improvements in designing, conducting, and reporting RCTs to incorporate EDI. By adopting more extensive EDI practices a greater understanding of healthcare treatments and innovations leading to enhanced maternal health equity could be achieved.

Background: Diabetes prevention programmes (DPPs) are being implemented around the world to tackle the rise in type 2 diabetes. In 2021/22, the Health Service Executive(HSE) in Ireland piloted a fully online national diabetes prevention programme(NDPP). Characteristics and factors affecting participation may be different among people attending online DPPs compared to face-to-face programmes. The aim of this study was to describe the demographic, psychosocial and health characteristics of participants in the pilot of the online NDPP in Ireland.

Methods: A survey from the evaluation of the English NDPP was adapted for the Irish context with Patient and Public Involvement (PPI) input. The survey was sent (between April and June 2022) to all individuals who attended the initial assessment of the pilot NDPP (n=73). It contained questions on health status, co-morbidities, motivation to improve health, quality of life, self-efficacy, beliefs about the risk of diabetes, participation(e.g. recollection and understanding of invite, number of sessions attended), as well as demographic information.

Results: Response rate was 30.5% (n=22). Mean age of responders was 62 years (range 36-82 years) and over half were men (57.1%, n=12). The majority (81%, n=17) had attended 6 or more of the 14 sessions. Most (90.5% n=19) reported having family members or acquaintances with diabetes, had positive views of their current health status and high quality of life scores (71.4%, n= 15). Mental health scores were slightly higher than the national average. Over half (57.2%, n=12) were confident or very confident about participating in an online DPP. Almost all (95.2%, n=20) believed it was important to manage their risk of type 2 diabetes.

Conclusions: Participants in the online pilot NDPP had positive views of their general health and positive psychosocial characteristics affecting their decision to participate. These beliefs may be modifiable intervention targets to encourage participation among non-attenders in future programmes.

Public health research presents compelling evidence that health is socially determined. To address structural inequalities and inequities in health, public policies require intersectoral development and implementation. Health Impact Assessment (HIA) is an established approach for analysing potentially detrimental health impacts of policies, programmes, and projects, as well as potentially positive impacts and opportunities. National public health policy, Healthy Ireland (2013-2025), endorses an intersectoral whole-of-system approach to ensure that health is a central part of all relevant policy areas. HIA is endorsed in this policy as one way to drive this agenda. Synergising with this policy commitment for HIA, the all-island Institute of Public Health Ireland produced revised HIA guidance in 2021. Two HIAs will be carried out as part of this project, including one at a local policy level, addressing the Cork City Development Plan (2022-2028), and the second HIA at a national policy level, addressing the Irish Government's Climate Action Plan (2024). The updated HIA guidance will be used in the conduct of these HIAs. This research project involves a co-creation of a Health Impact Assessment Implementation Model by employing an action research approach with implementation science frameworks to the conduct of the two HIAs. Therefore, the process of doing the HIAs will form the basis for the research study. In order to enhance meaningful community involvement in HIA in Ireland, the project will co-create a Community Engagement Toolkit for HIA. This Model will strengthen researcher, policy actor, practitioner, community, and voluntary sector capacity to collaboratively develop and implement intersectoral and equitable policy responses to major population health issues.

Background: Digital health interventions (DHIs) are increasingly used for the secondary prevention of cardiovascular disease (CVD). The aim of this study is to determine the feasibility of "INTERCEPT", a co-designed DHI developed to improve secondary prevention in hospitalised coronary heart disease patients (CHD).

Methods: This non-randomised, pilot feasibility study with embedded process evaluation will be conducted with a sample of 40 patients in an acute hospital setting. Informed by behaviour change theory, INTERCEPT integrates a smartphone interface, health care professional portal, a fitness wearable and a blood pressure monitor. INTERCEPT is designed to support and motivate patients to set goals, self-monitor lifestyle and medical risk factors, and manage their medications, with the health care professional portal enabling monitoring and communication with patients. Using consecutive sampling, eligible patients will be recruited in two phases, a pre-implementation phase and an implementation phase. Commencing with pre-implementation (1 month duration), participants will not immediately receive INTERCEPT, however, they will be invited to receive INTERCEPT at 3 months follow-up. This will enable early learning about the processes of recruitment and conducting the assessment prior to full scale deployment of INTERCEPT in the next step implementation phase. During the implementation phase (2 months duration), participants will be invited to download INTERCEPT to their smartphone prior to hospital discharge. Qualitative interviews will be conducted among a subset of patients and health care professionals to gain a greater insight into their experience of using INTERCEPT. Primary outcomes will be assessed at baseline and 3-month follow-up. Using pre-defined feasibility criteria, including recruitment, retention and engagement rates, together with data on intervention acceptability, will determine the appropriateness of progressing to a definitive trial.

Discussion: This study will provide important insights to help inform the feasibility of conducting a definitive trial of "INTERCEPT" among coronary heart disease patients in a critical health care setting.

Background: Poor transition from child- to adult-oriented healthcare may lead to negative outcomes and dissatisfaction with services in adulthood. The aim of the study was to examine how transition is provided to and experienced by young people with cerebral palsy in Ireland. This report provides integrated quantitative and qualitative findings and implications based on the totality of knowledge generated.

Methods: A convergent parallel mixed-methods study was conducted. Data were collected from people with cerebral palsy aged 16-22 years, parents, and health professionals using surveys and semi-structured interviews, which were both informed by a framework of nine key transition practices. Quantitative finding from the surveys and qualitative findings from interviews were integrated at the interpretation stage of the research using integration through joint displays. Implications were developed through discussions with health professionals, young people, and parents.

Results: Surveys were completed by 75 young people/parents and 108 health professionals. Interviews were conducted with 13 young people, 14 parents, and 27 health professionals. There was complementarity between quantitative and qualitative findings indicating lack of a named worker, limited information provision, insufficient self-management support, no opportunity to meet the adult team, limited contact with the general practitioner, and no opportunity for attending formal life skills training. There was dissonance between quantitative and qualitative findings regarding appropriate level of parental involvement. Quantitative findings identified limited promotion of health self-efficacy and a lack of senior managers responsible for transition. These practices were not described in the qualitative findings.

Conclusion: Implications of integrated findings include the need for a standardised transition pathway, intentional actions to enable parents and young people to adapt to changing roles, provision of information in a collaborative and phased approach, a common understanding of self-management between young people, parents and health professionals, and the need to involve general practitioners in transition.

Background: Puberty has been historically considered as a time of risk and vulnerability for young people. It is associated with rapid development in the hypothalamus, which is central in the production of both stress and sex steroids. While patterns of stress reactivity are calibrated in early life, this time of rapid development may provide a means for these patterns to change. This purpose of this study was to examine whether patterns of cortisol reactivity remained stable across one year of pubertal development, and whether variations in pubertal development impacted on this stability.

Methods: This study used a secondary dataset comprised of 102 adolescent-aged children and adolescents. Children and adolescents took part in the Trier Social Stress Test to elicit a physiological stress response. Cortisol reactivity was measured as the increase in salivary cortisol concentration taken at five time points throughout the session. Pubertal stage was measured by nurse report where possible, and parent/self-report otherwise and was used to calculate pubertal timing and tempo relative to peers. Measures of anxiety, BMI, and socio-economic status were taken and included in analysis.

Results: Results of a linear mixed-effect model found there to be a significant difference in cortisol reactivity over time, indicating that cortisol stress reactivity did not remain stable during this time (Estimate= 3.39, t=3.67, p<.001, CI[1.56, 5.22]). Additionally, results show children and adolescents who developed slower/quicker than peers displayed decreased stress reactivity (Estimate= -3.59, t=-2.13. p=.03, CI[-6.92, -0.25]).

Conclusions: This research contributes to a relatively small but consistent body of research noting pattern of increased cortisol reactivity during pubertal development. While a significant effect was found for pubertal tempo, this finding should not be considered indicative of any true effect.

Background: The Knowledge Translation and Exercise for Degenerative Meniscal Pathology and Early Knee Osteoarthritis (KNEE-DEeP) intervention was designed to promote greater uptake of evidence-based non-surgical treatments for knee pain attributed to degenerative meniscal pathology and early knee osteoarthritis (OA) in primary care, by tackling barriers at a service, clinician and patient level. Evidence indicates that patients frequently do not access first-line treatments, namely exercise and patient education, prior to specialist referral. The KNEE-DEeP intervention supports general practitioners (GPs) and physiotherapists to enhance their skills and confidence in managing patients with this type of knee pain through professional development workshops. In turn, patients will receive an 'enhanced consultation' from their GP and be referred to an early 'best practice' physiotherapy session. Physiotherapists will work with patients to develop a collaborative action plan focussing on self-management and exercise.

Methods: This protocol outlines a single arm non-randomised feasibility study with a mixed method process evaluation. The study intends to recruit 15 GPs, five physiotherapists and 36 patients from general practices in the South-West of Ireland. Eligible patients, will be aged between 35 years and 69 years inclusive, and attend their GP with an episode of non-traumatic knee pain attributed to a degenerative meniscal tear (DMT) or early OA. Physiotherapists and GPs will be trained in intervention delivery. Within two weeks of receiving an 'enhanced consultation' from their participating GP, patients will attend the one-hour 'best practice' physiotherapy session. Patient data will be collected via online questionnaires at baseline, 12 weeks and 6 months. Qualitative interviews to assess the feasibility and acceptability of the intervention will be conducted with a purposive sample of GPs, physiotherapists and their enrolled patients.

Ethics and dissemination: Approved by Clinical Research Ethics Committee of the Cork Teaching Hospitals. Results will be presented in peer-reviewed journals and at international conferences.

Registration: clinicaltrials.gov ( NCT06576557).

Background: Delirium and cognitive impairment are common in hip fracture populations and are associated with significant adverse patient outcomes. National hip fracture registries facilitate improvements in patient outcomes and care quality, such as reduced mortality and the development of specialist multidisciplinary services. However, there is substantial variation in the data collected and reported in relation to delirium and cognition, which impedes international comparison and may reduce quality of care.

Objective: This scoping review aims to identify delirium and cognition data items currently collected by hip fracture registries internationally, to identify associated registry guidance that exists for the administration of delirium and cognitive screening tools, and report outcomes of these data items across the most recently published annual reports of identified hip fracture registries.

Methods: This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR). We will search the following databases: Medline Ovid; Embase; CINAHL EBSCOHost. Relevant websites such as the Fragility Fracture Network (FFN) will also be searched. Study selection and review will be carried out independently by two research team members, with discrepancies resolved by a third member of the research team. Data extraction and synthesis will be conducted by one reviewer and checked for accuracy and omissions by another. The scoping review findings will be informed and validated through engagement with the FFN Hip Fracture Audit Special Interest Group, who will share their knowledge, expertise, and research to achieve consensus over core aspects of the scoping review findings.

Conclusion: By identifying existing heterogeneity in delirium and cognitive screening tool use and administration, it is hoped that administration and specific screening tool use will become standardised to optimise comparability across countries and ensure that high quality and reliable data are included across international registry reports.

Introduction: Active mobility, such as walking, wheeling, and cycling, is a low-carbon transport mode and a source of physical activity. Cycling, as a form of active mobility, is associated with physical and mental health benefits, transport cost savings, and improved air quality. During the transition to sustainable mobility, equitable outcomes depend on opportunities for active mobility reaching across our societies. This review will chart what is currently known about cycling among people experiencing socioeconomic disadvantage.

Objective: To conduct a scoping review to understand the extent and type of evidence reporting utility cycling (i.e., cycling for transport) among people experiencing socioeconomic disadvantage.

Inclusion criteria: This review will include studies involving adult participants who are described as experiencing socioeconomic disadvantage. Studies will be included if the focus/objective relates to utility cycling and the study reports cycling experiences, purposes, barriers, enablers, frequencies, perceptions, correlates, determinants, impacts, and/or interventions. Primary research using a qualitative, quantitative, or mixed-method design will be considered. Relevant peer-reviewed articles, conference proceedings, dissertations/theses, and preprints will be included.

Methods: The review will be conducted in accordance with the Joanna Briggs Institute's guidance for scoping reviews. A search strategy that includes key terms and subject headings was developed and translated for use across the following databases: PsycINFO (via EBSCOhost), SPORTDiscus (via EBSCOhost), CINAHL (via EBSCOhost), Embase, PubMed, Scopus, ProQuest Dissertations and Theses (via Web of Science), Europe PMC (preprints), and OpenAlex (preprints). Database search results will be collated in Zotero and uploaded to Covidence for study selection. Titles, abstracts, and subsequent full texts will be independently screened by two reviewers. Data will be extracted from the included studies using a data-extraction tool. Data will be synthesized in two stages: (1) charting the data and (2) descriptive qualitative content analysis.