HRB open research最新文献

Introduction: Dental operative procedures, by their interventive nature, impede the opportunity for peri-intervention verbal communication between patients and clinicians. This can impair trust, consent, and shared decision making with the potential of adversely affecting patient dignity, and potentially resulting in suboptimal clinical outcomes.This scoping review aims to interrogate the literature concerning non-verbal communication methods used in dental and medical practices during peri-interventive procedures, in aiding communication between clinician and patient. We will also ascertain how these align with the Limited Capacity Model of Motivated Mediated Message Processing (LC4MP) communication theory.

Methods: The framework proposed by the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews, will be used to guide this scoping review and reporting methodology. Selected electronic databases (Medline, Embase, Cochrane Library and Scopus), PsychInfo, CINAHL and grey literature sources will be searched.Inclusion criteria are: articles written in the English language, publications between 2000 and 2025, peer-reviewed empirical studies, with either qualitative or quantitative data, mixed methods, reviews, book chapters and grey literature with a principal focus on non-verbal communication in the healthcare setting.A narrative synthesis will be conducted, with results reported according to elements of LCM4P theory: cognitive load, motivated messaging, message processing and memory.

Conclusion: This scoping review will contribute to our methodological and theoretical understanding of the use of non-verbal communication strategies in clinical settings.

Introduction: Advances in therapeutics and healthcare have led to a growing population of individuals living with multimorbidity and polypharmacy making prescribing more challenging. Most prescribing occurs in primary care and General Practitioners (GPs) have expressed interest in comparative feedback on their prescribing performance. Clinical decision support systems (CDSS) and audit and feedback interventions have shown some impact, but changes are often short-lived. Interactive dashboards, a novel approach integrating CDSS and audit and feedback elements, offer longitudinal updated data outside clinical encounters. This systematic review aims to explore the effectiveness of interactive dashboards on prescribing-related outcomes in primary care and examine the characteristics of these dashboards.

Methods: This protocol was prospectively registered on PROSPERO (CRD42023481475) and reported in line with PRISMA-P guidelines. Searches of PubMed, EMBASE, Medline, PsychINFO, CINAHL, Scopus, the Cochrane Library, and grey literature, including trial registries were performed to identify interventional studies (randomised and non-randomised) that assess the effectiveness of interactive dashboards on prescribing related outcomes. The search will be supplemented by searching references of retrieved articles with the use of an automated citation chaser. Identified records will be screened independently by two reviewers and data from eligible studies extracted using a purposely developed data extraction tool. We will narratively summarise the intervention types and those associated with improvements in prescribing outcomes. A quantitative synthesis will be carried out if a sufficient number of homogenous studies are identified. Methodological quality will be assessed by two reviewers using the Cochrane Effective Practice and Organisation of Care risk assessment tool.

Discussion: This systematic review will explore the effect of interactive dashboards on prescribing related outcome measures in primary care and describe the characteristics of interactive dashboards. This research may inform future intervention development and shape policymaking particularly in the context of ongoing and planned developments in e-prescribing infrastructure.

Background: Delirium is an acute, neuropsychiatric syndrome, characterized by an altered mental state. It often affects hospital in-patients and is associated with an increased risk of mortality, dementia, and functional decline. Delirium can be detected through the use of validated assessment tools, administered by nurses, and early detection is associated with improved outcomes for patients. However, validated tools are infrequently utilised and cases of delirium are frequently missed. A greater understanding of nurses' use of validated delirium assessment tools is needed in order to reduce the number of missed cases.

Objectives: The aim of this scoping review is to identify how validated assessment tools are used by nurses in general acute care settings to assess for delirium and identify the barriers and enablers for said tools' use.

Methods: This scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. The databases CINAHL, PubMed, Web of Science, and Scopus will be searched using a search strategy. Grey literature will also be searched using Google Scholar and BASE. Results will be uploaded to Covidence where the sources will be screened for relevance. Data from relevant sources will be extracted using a data extraction tool.

Results: The PRISMA-ScR flow diagram will present the results of the search. Results will be mapped descriptively and presented as both tabulated results and a narrative summary.

Conclusion: This protocol outlines the structure of a scoping review that will analyse the existing literature surrounding nurses use of validated delirium assessment tools. This review aims to map the evidence of delirium assessment tool utilisation by nurses and identify any barriers to usage. This will support future researchers and policy makers in the improvement of delirium assessment in acute care settings.

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: In areas of social disadvantage up to 40-50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system.

Method: The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children's receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated.

Discussion: This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the 'real world' in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage.

Trial registration: clinicaltrials.gov NCT06460090.

Trial management: There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.

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.