HRB open research最新文献

Background: Despite the wealth of evidence demonstrating the health benefits of physical activity (PA), people with arthritis commonly do not meet recommended PA levels. Whilst various programmes support people with arthritis to become active, most individuals reduce their level of PA after completion of a structured exercise programme. This research aims to co-develop and feasibility test a PA maintenance intervention for those living with arthritis, after exit from a structured exercise programme.

Methods: Intervention development was guided by the INDEX framework for developing complex interventions.Phase 1, Evidence Synthesis: Bring together existing evidence, clinical guidelines and behavior change theories for PA maintenance in arthritis, to develop an intervention logic model.Phase 2, Observation and qualitative study: Conduct an observational analysis of a physiotherapy led structured exercise programme for those living with arthritis, to understand what behaviour change components are used and what might support PA maintenance. Followed by a qualitative exploration of PA maintenance barriers, facilitators and strategies for those who have participated in the classes, their family members/friends and the delivering physiotherapist.Phase 3, Finalise intervention prototype: Results from phases 1 and 2, will be triangulated to inform potential intervention options. Those living with arthritis/key stakeholders will be invited to participatory workshops to refine intervention content and delivery modes.Phase 4, Feasibility Study: The final phase is a pre-post, mixed methods feasibility evaluation of the newly developed multicomponent PA maintenance intervention for people living with arthritis, after completion of a physiotherapy led structured exercise programme.

Discussion: Intervention development will bring together PA maintenance theory and evidence with user input and other key contextual factors. User input will be achieved by collaboration with two embedded patient researchers and a wider Public Patient Involvement (PPI) panel to ensure diverse patient experiences and perspectives are heard and inform programme design.

Introduction: Gestational Diabetes Mellitus (GDM) is a hyperglycaemic condition diagnosed during pregnancy. GDM is strongly associated with future development of type 2 diabetes and cardiovascular disease. Lifestyle and pharmacological interventions can reduce the risk of developing type 2 diabetes. General practice is the recommended setting for long-term follow-up of women with a history of GDM. However, rates of follow-up are suboptimal. The evidence around long-term general practice healthcare for women with a history of GDM has not previously been reviewed.

Aims: The aim of this scoping review is to explore the current evidence base for the long-term care of women with a history of GDM in general practice.

Study design: The study described by this protocol is a scoping review. The study design was informed by Joanna Briggs Institute methodology.

Methods: Empirical qualitative and quantitative research studies published since 2014 will be identified from a search of the following databases: MEDLINE (Ovid), EMBASE (Elsevier), CINAHL, PsycINFO, Academic Search Complete and SocIndex. The review will identify key characteristics of the literature. Framework analysis will be used to map the findings against the Chronic Care Model, a primary care-based framework that sets out the core components for optimal long-term healthcare.

Results: A numerical descriptive summary (using frequencies) will describe the overall extent of literature, and the range and distribution of its component parts, including the geographical and economic settings, research methods, interventions, outcomes and findings. The qualitative analysis will map interventions and descriptions of care to components of the chronic care model. Research gaps will be reported, and research needs and priorities will be suggested.

Conclusion: The findings of this scoping review will have the potential to inform future research efforts in the area.

Registration: This protocol has been registered in Open Science Framework ( https://osf.io/bz2vh).

Background: Public and patient involvement (PPI) is important in stroke research to ensure that research conducted reflects the priorities and needs of people after stroke. Several factors have been found to affect PPI, including location of the research and time requirements for participation. The incidence of stroke is rising, and can result in symptoms including fatigue, depression, and physical/cognitive impairments.

Aims: 1) Describe the development of a PPI panelpanel and a healthcare professional panelpanel for stroke rehabilitation research and 2) to explore the perspectives of the members of the PPI groups on being involved in the research process.

Methods: A stakeholder panel consisting of up to 20 people with stroke, members of the public and healthcare professionals will be formed. A pragmatic purposive sampling technique using snowball sampling will be used to recruit members. The PPI panel will meet four times and will be supported by the guidelines developed from the INVOLVE framework. The PPI panel will be involved as co-researchers in the conceptualisation of future stroke rehabilitation research, the delivery of such studies, the analysis and dissemination of findings. Following the development of the panel, we will conduct a semi-structured focus groups to collect qualitative data, examining the perspectives of members. Data will be transcribed and analysed using Braun and Clarke's Reflexive Thematic Analysis. This will result in a set of themes and subthemes describing participants' opinions and experience of being on a PPI panel in stroke rehabilitation research.

Conclusions: PPI is an essential part of research in stroke. Stakeholders can provide key insights into the research processes. The results of this qualitative study will provide insight into the barriers and enablers of their participation in PPI in stroke rehabilitation research.

Background: It is increasingly suggested that clinical guidelines and practices be updated to permanently expand relaxation around access to opioid agonist treatment (OAT) take-home doses after COVID-19. Despite a risk of OAT drug diversion, flexibility in take-home doses is valued by patients and associated with improved quality of life and retention. However, few studies have examined the effects of changes to take-home dose policies on prescribing practices and patient outcomes, with mixed results.

Aims: This protocol relates to three inter-related studies. The first study will examine the impact of guidance issued on March 13th 2020 to all clinicians involved in the delivery of OAT to give the maximum number of take-home doses having given due consideration to the safety of the patient, on prescribing practices for take-home doses of methadone and buprenorphine in primary care. The second study will examine the association between increased take-home doses of OAT following March 13th 2020 guidance and treatment discontinuation in primary care. The third study will examine methadone-related deaths in Ireland before and after the guidance issue, and whether methadone-related deaths varied by whether the deceased was on OAT treatment at the time of death.

Methods: Retrospective observational studies will be carried out. The first study will use a time series design to examine changes in prescribing practices of take-home doses. The second study will use a retrospective cohort study design with proportional hazard Cox models to evaluate the association between increased take-home doses and treatment discontinuation. The third study will use a repeated cross-sectional study design with interrupted time series analysis, stratified by OAT treatment status, to assess changes in methadone-related deaths.

Discussion: It is anticipated that the studies will generate evidence with potential to inform both clinical and policy decision making with respect to take-home dosing of OAT.

Background: Diabetic foot ulcers (DFU)s pose significant challenges for individuals with diabetes, leading to severe consequences, such as lower extremity amputations (LEA)s, reduced quality of life, and increased mortality. Disorganized diabetic foot care services contribute to health inequities worldwide, highlighting the need for structured preventive measures, which require an understanding of organizational and systemic components of the implementation of foot screening programs or initiatives, including equity factors. Thus, the Consolidated Framework for Implementation Research (CFIR) is one of the most widely used frameworks for assessing these factors and contexts. This helps to reduce the risk of failure of implementation efforts in the real world and can help to support the scaling up of preventative measures. This review aims to analyze foot screening programs or initiatives for individuals at risk of DFUs and LEAs, define their key components and implementation determinants, identify barriers and facilitators, and describe effective implementation strategies in primary care with CFIR.

Methods: A rapid review will be conducted following the Canadian method by Dobbins (2017) and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. The research question is defined using the PICO framework. A systematic search will be conducted in MEDLINE, CINAHL, and EMBASE. Primary studies in English or French, including both primary study designs and knowledge syntheses, will be screened according to the defined eligibility criteria via Covidence. Study quality will be appraised using the Mixed Methods Appraisal Tool and data will be synthesized guided by the CFIR. Data synthesis will focus on implementation determinants, including barriers, facilitators, and implementation strategies.

Discussion: Findings will inform policy, practice and decision making regarding the implementation of screening programs. This can promote the development of screening programs for diabetic foot complications across Canada or in other countries.

Objective: The objective of this scoping review is to identify evidence of collaboration between healthcare and recreational sectors aimed at supporting community-based physical activity participation among young people with childhood-onset physical disability.

Introduction: Most young people with physical disabilities do insufficient physical activity, significantly impacting their future health. There have been long outstanding calls for collaboration between healthcare and recreational professionals to support physical activity participation for people with disabilities. Given the importance of physical activity and the roles of health and recreational professionals, there is a need to systematically identify evidence on collaborative strategies between sectors, describe the experiences of all individuals involved in delivering and receiving these collaborations and describe any outcomes measured as part of implementing these strategies.

Inclusion criteria: This review will include studies that involve healthcare professionals and recreational professionals working together to support community based physical activity. Specifically aimed young people aged 10 to 24 years with childhood-onset physical disabilities. Studies that report the experiences of individuals in delivering and receiving these collaborations will be included as well as studies that describe an evaluation of collaborative strategies.

Methods: This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology of scoping reviews. A comprehensive search strategy will be developed in consultation with an information specialist. The following databases will be searched: MEDLINE, CINAHL, Embase, Web of Science and Scopus. The review will consider studies of any design that address collaboration between health and recreation sectors including qualitative, quantitative and mixed-methods study designs. Two reviewers will independently screen each retrieved title and abstract and assess full-text articles against the inclusion criteria to determine eligibility. Data will be extracted and synthesized quantitively and qualitatively and mapped to a relevant framework.

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: Monitoring coronavirus disease (COVID-19) infection and vaccination during pregnancy is vital because of the increased susceptibility to severe disease. This article outlines the available data sources on COVID-19 infection and vaccination rates during pregnancy in Northern Ireland (NI) and the Republic of Ireland (ROI) and describes the processes, strengths, and weaknesses of available data.

Methods: Three data sources on COVID-19 vaccination and infection were identified in the ROI: the national computerized infectious disease reporting (CIDR) system used for reporting notifiable infectious diseases, the national dataset of all COVID-19 vaccinations for all residents (COVAX), and a regional Maternal and Newborn Clinical Management System (MN-CMS), which includes data on COVID-19 vaccination and infection. Four data sources were identified in NI: the NI maternity system (NIMATS) records maternity data, including COVID-19 infection and vaccination during pregnancy; datasets of COVID-19 antigen testing performed in hospitals (Pillar 1) and in the community (Pillar 2); and the NI Vaccine Management System dataset of COVID-19 Vaccinations.

Results: In the ROI, the CIDR database allows for the calculation of COVID-19 infection rates in women of reproductive age; however, pregnancy status remains largely unreported. The COVAX dataset includes pregnancy status, although the accuracy depends on whether the pregnancy is known at the time of vaccination. The MN-CMS tracks COVID-19 infection and vaccination during pregnancy. However, there are uncertainties regarding its reliability. In NI, COVID-19 data are available for all pregnant women using Health and Care numbers to link the NIMATS data to testing and vaccination databases.

Conclusions: Both countries track COVID-19 infection and vaccination rates, but the strength of the NI system is the use of unique identification numbers that allow linkage of maternal records to infection and vaccination databases. Both countries face delays in data access, underscoring the need for real-time systems to support future pandemic preparedness.

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.