HRB open research最新文献

Background: Neurocognitive disorders (NCDs), including delirium, cognitive impairment, or dementia are prevalent in up to 39% of older adults in acute care, particularly older trauma patients. Undiagnosed NCDs result in poor outcomes, such as increased incidence of depressive symptoms, longer length of stay, and mortality.

Objective: This study aims to identify the diagnostic test accuracy of screening tools for the detection of NCDs in older trauma patients in acute settings.

Design: Systematic review protocol.

Literature search: Electronic databases (MEDLINE, Embase, CINAHL, PsycInfo, Cochrane Library) will be searched for journal articles. Search terms related to NCDs, delirium and cognitive screening tools, and diagnostic accuracy will be included.

Study selection criteria: Cross-sectional, prospective, or retrospective cohort studies of adults aged ≥60 post-trauma, in an acute setting, will be included where the study aimed to validate a screening tool for detection of 1) delirium or 2) cognitive impairment, or dementia against a reference standard of a clinical decision, based on standardised diagnostic criteria or a validated tool.

Data synthesis: Two review authors will conduct study selection, data extraction, and appraisal. Data will be extracted based on the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) checklist. Studies will be assessed for methodological quality by two independent review authors using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Narrative summaries will be generated describing risk of bias and concerns regarding applicability. Quantitative synthesis of study findings will be conducted.

Conclusion: This systematic review will aim to identify screening tools with the best diagnostic accuracy for detection of 1) delirium and 2) cognitive impairment or dementia in adults aged ≥60 post-trauma in acute care settings. Results will inform clinical practice to enhance the probability of patients with NCDs receiving appropriate care and management.

Registration: PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024518730 (11/03/2024).

Background: Following Spinal Cord Injury (SCI), 53% of people develop neuropathic pain (NP). NP can be more debilitating than other consequences of SCI, and a persistent health issue. Pharmacotherapies are commonly recommended for NP management in SCI, although severe pain often remains refractory to these treatments in many sufferers. Furthermore, poor medication adherence exists, stemming from unacceptable side-effects and fear of dependency.Sensorimotor stimulation using active walking with robotic assistance has not been well studied in NP after SCI, despite convincing locomotor-based pre-clinical studies, identifying prevention and reversal of NP.Our primary aim is to assess the impact of exoskeleton-based walking on NP intensity and interference after SCI and examine feasibility outcomes for progression to a definitive trial.

Methods: This is a phase 2 single-blinded, randomised feasibility study. It will test the feasibility and acceptability of exoskeleton-based walking 3 times per week for 12 weeks (intervention), as a mechanistic-based intervention for NP after SCI. The comparator will be an equally dosed, blended relaxation programme devoid of motor imagery prompts. 40 participants with moderate-to-severe NP post SCI will be recruited and randomised to intervention and comparator groups.The primary outcomes are feasibility outcomes for progression to definitive trial which include recruitment and retention rates, adverse events and acceptability of the intervention.Secondary outcomes explore changes in NP intensity and interference as measured by the International Spinal Cord Injury Pain Basic Data Set 3.0 (ISCIPBDS) at baseline, post-intervention (week 13) and at 6-month follow-up.

Conclusions: There is a need to explore non-pharmacological management of NP after SCI. The findings of this feasibility trial will inform the development of a future multicentre, international RCT.

Trial registration: NCT06463418, 08/07/2024, https://clinicaltrials.gov/study/NCT06463418.

Introduction: Internationally, the prevalence of diabetes is increasing, and with this comes an increase in diabetes related complications. Diabetic foot disease is the most common lower extremity complication in people with diabetes causing 2% of the global disease burden. It, is associated with major morbidity, mortality, and costs to health services. Despite this burden, the incidence and prevalence of diabetic foot disease is unknown in Ireland. This paper presents a protocol for a systematic review to examine the incidence and prevalence of diabetic foot disease in the Irish population.

Methods: A systematic review will be performed using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Pubmed, EMBASE, and Lenus, the Irish Health Research repository, will be searched for publications in any language and without restrictions to date. Title, abstract, and full text screening will be carried out independently by two investigators. Publications reporting on the incidence or prevalence of peripheral neuropathy, peripheral artery disease, ulceration, or amputation in people with diabetes in Ireland, from a defined geographical catchment area of Ireland, will be included. Joanna Briggs Institute (JBI) Critical Appraisal tool will be used to assess included studies methodological quality. Results will be reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.

Conclusion: The results of this systematic review can be used to inform appropriate stakeholders on the incidence and prevalence of diabetic foot disease in Irish populations, enabling decision making around appropriate use of resources to help prevent, and improve management of this disease.

Systematic review registration: CRD42023472904.

Background: This study aims to understand and explain the influence of contextual factors on the implementation of Intentional Rounding in acute hospitals using the realist synthesis methodology.Falls of hospital admitted patients are one of the most frequent concerns for patient safety in the acute hospital environment. The reasons why people fall are complex. International guidelines recommend a multifactorial assessment and effective prevention and management of identified risk factors in order to reduce the number of falls. Intentional Rounding (IR) is one approach for delivering this. IR is an umbrella term, understood as a structured process whereby nurses or care staff carry out regular checks with individual patients using a standardised protocol to address such issues as positioning, pain, personal needs and placement of possessions.

Methods: This study will use realist synthesis to understand what works, for whom, in what circumstances, and in what settings. Realist synthesis is a theory driven interpretive approach to evidence synthesis. It is our intention to analyse IR as an intervention, which aims to enhance patient care and safety in hospital settings. The synthesis forms part of a larger implementation study examining interventions that reduce the number of falls that occur in hospitals. Search terms will include intentional rounding, purposeful rounding, comfort rounding and hourly rounding and will encompass search terms beyond IR and falls rates to avoid limiting the synthesis. This synthesis will conform to the RAMESES (realist and meta-narrative evidence synthesis group) publication and reporting quality standards.

Conclusions: The findings will inform the next phase of an implementation study on IR in acute hospital settings, to address evidence informed enablers and barriers to IR. The results will be disseminated in a peer-reviewed journal and through presentations.

Young people with physical disability experience challenges to being physically active. To attain the health benefits of physical activity (PA) and sustain engagement, it is essential that participation is meaningful and enjoyable. This study aims to describe current participation in PA by adolescents with physical disability in Ireland, and to establish consensus on their priorities for enhancing physical activity participation. A parallel convergent mixed methods study will be undertaken, comprising a national cross-sectional quantitative assessment of PA participation ("Participation Snapshot") and Delphi consensus study ("Delphi"). Adolescents (n=100) aged 13-17 years with a physical disability will be invited to take part. The Participation Snapshot primary outcome is the Children's Assessment of Participation and Enjoyment (CAPE). Contextual factors including underlying medical diagnosis, demographics, mobility (Functional Mobility Scale), hand function (Manual Ability Classification System) and health related quality of life (Child Health Utility 9D) will also be collected. The Delphi will comprise two to four survey rounds, until consensus is reached. Round 1 consists of a bespoke survey, designed and piloted with a public and patient involvement (PPI) panel, with open-ended questions and Likert scales inviting contributions from adolescents on their prior experience and ideas to enhance participation. Responses will be analysed using inductive thematic analysis to construct items and themes, which will then be deductively mapped to the "F-words" and the family of Participation-Related Constructs frameworks. These items will be presented back to participants in subsequent rounds for selection and ranking, until consensus is achieved on the "top 10 priorities" for enhancing PA participation. The project team and PPI panel will then co-design dissemination material and identify targets for dissemination to relevant stakeholder or policy groups. The findings will provide a basis for developing interventions aiming to enhance future PA participation for adolescents with physical disability.

Background: Mallet finger injuries are a frequent cause of hospital attendance, being the fifth most common injury in the body. They are therefore a frequent cause of hospital visits. To date, these injuries have primarily been managed using generic splints. As a generic splint provides a generic fit, patients who receive these are not provided with a custom splint experience. As the size and fit of these splints are not bespoke to the patient's anatomy, patients may not always find the fit comfortable and may find complying with these splints difficult at times. However, an opportunity is developing within healthcare where custom splinting can be obtained for some using Three-D (3D) printing. The rationale for this review is to gain an understanding of the research that has been conducted on 3D printing of mallet injury splints.

Objective: The objective of this scoping review is to map the current literature on 3D printing associated with mallet finger injury.

Methods: The Joanna Briggs Institute (JBI) methodology for scoping reviews will be used throughout along with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Two researchers will search the databases that will include CINAHL, Embase, Cochrane, EbscoHost, Medline/Pubmed, Science Direct, Web of Science, and Google Scholar. The search will include a hand search of sources falling outside the chosen databases. Screen titles, abstracts, and full-text articles will be reviewed by two researchers independently using Rayaan software. The data extracted from the literature will first be presented in a tabulated chart followed by a narrative synthesis.

Registration: The protocol was registered on 6 ^th September 2023, with the Open Science Framework. Registration DOI: https://doi.org/10.17605/OSF.IO/FSJPK.

Background: Global healthcare faces challenges such as rising costs, budget constraints, aging populations, chronic diseases, and increasing patient expectations. Healthcare organisations are deploying continuous improvement methodologies to address these challenges. Lean, derived from the Toyota Production System, focuses on eliminating non-value-adding activity and enhancing efficiency, making it a prominent quality improvement approach in healthcare. Effective implementation of Lean requires robust leadership to sustain improvements and foster a culture of continuous improvement. However, the attributes, values, principles, and behaviours of effective Lean leaders in healthcare remain underexplored.

Methods: This realist review protocol details methods to research how leaders' and managers' attributes, values, principles, and behaviours contribute to the sustainable implementation of Lean in healthcare. Following the RAMESES guidelines, a five-stage structured methodology will be used: defining the scope of the review and developing initial theories, developing the search strategy, reviewing primary studies and extracting data, synthesising evidence and developing conclusions, refining theory iteratively, and disseminating findings. An Expert Panel and reference groups of healthcare managers and leaders will refine candidate programme theories (CPTs) into initial programme theories (IPTs), guiding detailed evidence searches and data extraction.

Conclusion: This realist review will deepen our understanding of the specific mechanisms by which leadership impacts Lean implementation outcomes in the context of acute hospitals. By exploring how leadership attributes, values, principles and behaviours shape outcomes for diverse stakeholders, the review aims to provide critical insights into the dynamics driving the success of Lean in healthcare. The findings will inform policy and practice, enhancing leadership strategies to improve patient and staff experiences, patient outcomes, and organizational performance.

Background: Antimicrobial stewardship programmes (ASP) are essential in promoting responsible antimicrobial use, reducing antimicrobial resistance (AMR) and health care-associated infections. In 2009 the Strategy for the Control of Antimicrobial Resistance in Ireland (SARI), Hospital Antimicrobial Stewardship Working Group published guidance on antimicrobial stewardship (AMS) in hospitals. This paper presents a protocol for a scoping review which aims to examine the current literature to evaluate progress related to the implementation of the SARI (2009) guidance on antimicrobial stewardship in hospitals in Ireland.

Methods: This scoping review will be conducted in line with the five-stage methodological framework by Arksey & O'Mally 2005. We will search the following databases (PubMed, CINAHL, Embase, Web of Science) and targeted websites for articles and reports for possible inclusion in our review. Studies pertaining to AMS undertaken or related to the Republic of Ireland from January 2010 until December 2021 will be included. We will include all study designs. We will map all selected publications to the recommendations of the SARI (2009) guidance document. The protocol follows the guidance of Peters et al., 2022. Two reviewers will independently screen studies and reports to assess eligibility with any discrepancies resolved by consensus discussion with a third reviewer.

Results: These will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR)and this checklist will be included when the scoping review is published.

Conclusion: This scoping review will map studies and reports to evaluate AMS in relation to national guidelines without restriction on study design or outcomes in the Republic of Ireland. This information has the potential to provide a valuable resource for the implementation of future AMS research and interventions.

Background: In paediatric palliative and bereavement care, providing comprehensive support that extends beyond medical treatment to address the emotional and psychosocial needs of children and their families is essential. Memory-making interventions play a critical role in capturing cherished moments and fostering emotional resilience. However, widespread consensus on the foundation and scope of memory-making interventions for children and young people remains sparse. This review aims to identify, appraise, and synthesise the evidence on memory-making interventions for children and young people with life-limiting or life-threatening conditions and their family members receiving palliative or bereavement care.

Methods: This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A systematic search will be undertaken from January 1, 1985, to February 27, 2024, across the following databases: PubMed, EMBASE, CINAHL (EBSCO), PsycINFO (EBSCO), Web of Science, the Cochrane Library, and Scopus. Studies across diverse research designs that examine children (0-19 years) with life-limiting or life-threatening conditions undergoing memory-making interventions with psychosocial or other outcomes will be included. Screening, data extraction, and quality appraisal will be performed by two independent reviewers, with a third reviewer resolving discrepancies. Joanna Briggs Institute guidelines for conducting mixed methods systematic reviews will be used to inform the data analysis and synthesis process.

Conclusions: This review will provide critical insights into the existing evidence base on memory-making interventions in paediatric palliative and bereavement care, highlighting psychosocial and other impacts, implementation factors, and evidence quality. By identifying best practices and gaps in knowledge, this evidence review may inform future research and intervention design, or adaptation, and contribute to the enhancement of healthcare for children and young people with life-limiting and life-threatening conditions and their families as well as families in bereavement.

Registration: This review was registered in PROSPERO, the International Prospective Register of Systematic Reviews (CRD42024521388; 18/03/2024).