St. Finbarr's Hospitalhttp://hdl.handle.net/10147/2348312024-03-29T11:54:26Z2024-03-29T11:54:26ZEvaluating the national multisite implementation of dialectical behaviour therapy in a community setting: a mixed methods approach.Flynn, DanielJoyce, MaryGillespie, ConallKells, MarySwales, MichaelaSpillane, AilbheHurley, JustinaHayes, AoifeGallagher, EdelArensman, EllaWeihrauch, Mareikehttp://hdl.handle.net/10147/6347222022-11-30T01:49:22Z2020-05-14T00:00:00ZEvaluating the national multisite implementation of dialectical behaviour therapy in a community setting: a mixed methods approach.
Flynn, Daniel; Joyce, Mary; Gillespie, Conall; Kells, Mary; Swales, Michaela; Spillane, Ailbhe; Hurley, Justina; Hayes, Aoife; Gallagher, Edel; Arensman, Ella; Weihrauch, Mareike
Background: The implementation of evidence-based interventions for borderline personality disorder in community settings is important given that individuals with this diagnosis are often extensive users of both inpatient and outpatient mental health services. Although work in this area is limited, previous studies have identified facilitators and barriers to successful DBT implementation. This study seeks to expand on previous work by evaluating a coordinated implementation of DBT in community settings at a national level. The Consolidated Framework for Implementation Research (CFIR) (Damschroder et al., Implementation Sci. 4:50, 2009) provided structural guidance for this national level coordinated implementation.
Methods: A mixed methods approach was utilised to explore the national multisite implementation of DBT from the perspective of team leaders and therapists who participated in the coordinated training and subsequent implementation of DBT. Qualitative interviews with DBT team leaders (n = 8) explored their experiences of implementing DBT in their local service and was analysed using content analysis. Quantitative surveys from DBT therapists (n = 74) examined their experience of multiple aspects of the implementation process including orienting the system, and preparations and support for implementation. Frequencies of responses were calculated. Written qualitative feedback was analysed using content analysis.
Results: Five themes were identified from the interview data: team formation, implementation preparation, client selection, service level challenges and team leader role. Participants identified team size and support for the team leader as key points for consideration in DBT implementation. Key challenges encountered were the lack of system support to facilitate phone coaching and a lack of allocated time to focus on DBT. Implementation facilitators included having dedicated team members and support from management.
Conclusions: The barriers and facilitators identified in this study are broadly similar to those reported in previous research. Barriers and facilitators were identified across several domains of the CFIR and are consistent with a recently published DBT implementation Framework (Toms et al., Borderline Personal Disord Emot Dysregul. 6: 2, 2019). Future research should pay particular attention to the domain of characteristics of individuals involved in DBT implementation. The results highlight the importance of a mandated service plan for the coordinated implementation of an evidence-based treatment in a public health service.
2020-05-14T00:00:00ZDialectical behaviour therapy: Implementation of an evidence-based intervention for borderline personality disorder in public health systems.Flynn, DanielKells, MaryJoyce, Maryhttp://hdl.handle.net/10147/6345812022-10-29T01:45:08Z2021-01-07T00:00:00ZDialectical behaviour therapy: Implementation of an evidence-based intervention for borderline personality disorder in public health systems.
Flynn, Daniel; Kells, Mary; Joyce, Mary
Dialectical behaviour therapy (DBT) is an intervention with demonstrated efficacy and effectiveness for individuals with borderline personality disorder. In recent years, research has shifted focus to the evaluation of DBT implementation in routine clinical settings. In this article, we consider the empirical evidence that guides clinicians and managers in health services with local implementation of DBT in community settings. Research on this topic has most recently advanced to the evaluation of coordinated implementation efforts. Although coordinated implementation has merit, it does not mitigate all implementation challenges. Consideration of implementation facilitators and barriers in DBT can also be applied to other evidence-based interventions for BPD and for adaptations for individuals with early-stage symptomatology. Ongoing research and evaluation in these areas is recommended.
2021-01-07T00:00:00ZAn investigation into the rates of transmission of SARS-CoV-2 during the first 6 weeks of the 2020-2021 academic year in primary and post-primary schools in Cork and Kerry, Ireland.White, PhilippaO'Sullivan, Margaret BernadetteMurphy, NicolaStapleton, JaneDillon, AnnetteBrennan, AlineDeasy, BenvonCarlton, LouiseBermingham, ÁineO'Mahony, Mary TeresaMurray, DeirdreNolan, Cliodhna FoleySheahan, Annehttp://hdl.handle.net/10147/6311092022-01-26T01:57:15Z2021-04-01T00:00:00ZAn investigation into the rates of transmission of SARS-CoV-2 during the first 6 weeks of the 2020-2021 academic year in primary and post-primary schools in Cork and Kerry, Ireland.
White, Philippa; O'Sullivan, Margaret Bernadette; Murphy, Nicola; Stapleton, Jane; Dillon, Annette; Brennan, Aline; Deasy, Benvon; Carlton, Louise; Bermingham, Áine; O'Mahony, Mary Teresa; Murray, Deirdre; Nolan, Cliodhna Foley; Sheahan, Anne
Background: Schools in Ireland closed in March 2020 as part of a national strategy to contain the spread of severe acute respiratory syndrome (SARS-CoV-2). The extent to which schools contribute to the overall propagation of SARS-CoV-2 was continuing to evolve internationally.
Aims: To examine regional data on SARS-CoV-2 transmission in primary, post-primary and special schools in Cork and Kerry, two counties in southwest Ireland, during the first 6 weeks of the 2020-2021 academic year and determine the rate of in-school transmission.
Methods: Data were obtained from the Computerised Infectious Disease Reporting (CIDR) system and supplemented with digital records from the regional Department of Public Health (Dept PH) and from the Health Service Executive (HSE) Covid Care Tracker application. The positivity rate among school close contacts was calculated to determine the rate of in-school SARS-CoV-2 transmission.
Results: The overall rate of in-school transmission of SARS-CoV-2 was low at 4.1%. Positivity rates among students and staff who were close contacts were similarly low (3.1% vs. 6.9%, p = 0.07). One secondary case of coronavirus disease 2019 (COVID-19) emerged, on average, for every 7.6 infectious days spent by an index case in school. Schools accounted for 2.2% of all notified cases of COVID-19 in the region during the observation period.
Conclusions: During the first 6 weeks of the academic year, the rate of in-school SARS-CoV-2 transmission in the region was low, and schools did not contribute substantially to the overall burden of COVID-19.
2021-04-01T00:00:00ZCorrection to: Dialectical behaviour therapy for treating adults and adolescents with emotional and behavioural dysregulation: study protocol of a coordinated implementation in a publicly funded health service.Flynn, DanielKells, MaryJoyce, MarySuarez, CatalinaGillespie, Conallhttp://hdl.handle.net/10147/6230292019-08-30T12:45:40Z2018-05-07T00:00:00ZCorrection to: Dialectical behaviour therapy for treating adults and adolescents with emotional and behavioural dysregulation: study protocol of a coordinated implementation in a publicly funded health service.
Flynn, Daniel; Kells, Mary; Joyce, Mary; Suarez, Catalina; Gillespie, Conall
Upon publication of the original article (1) it was highlighted by the authors that there was just one error in the manuscript in the 'Sample size' subsection of the Methods/Design.
Upon publication of the original article [1] it was highlighted by the authors that there was just one error in the manuscript in the ‘Sample size’ subsection of the Methods/Design. The current text reads:
“It is anticipated that there will be a total of 442 participants across 16 sites in this research study over a four year period. Of the 312, it is estimated that 120 will be adults with a primary diagnosis of BPD attending Adult Mental Health Services across eight study sites.......”
2018-05-07T00:00:00ZBetter palliative care for people with a dementia: summary of interdisciplinary workshop highlighting current gaps and recommendations for future research.Fox, SiobhánFitzGerald, CarolHarrison Dening, KarenIrving, KateKernohan, W GeorgeTreloar, AdrianOliver, DavidGuerin, SuzanneTimmons, Suzannehttp://hdl.handle.net/10147/6214962019-08-30T12:06:00Z2017-07-14T00:00:00ZBetter palliative care for people with a dementia: summary of interdisciplinary workshop highlighting current gaps and recommendations for future research.
Fox, Siobhán; FitzGerald, Carol; Harrison Dening, Karen; Irving, Kate; Kernohan, W George; Treloar, Adrian; Oliver, David; Guerin, Suzanne; Timmons, Suzanne
Dementia is the most common neurological disorder worldwide and is a life-limiting condition, but very often is not recognised as such. People with dementia, and their carers, have been shown to have palliative care needs equal in extent to those of cancer patients. However, many people with advanced dementia are not routinely being assessed to determine their palliative care needs, and it is not clear why this is so.; An interdisciplinary workshop on "Palliative Care in Neurodegeneration, with a focus on Dementia", was held in Cork, Ireland, in May 2016. The key aim of this workshop was to discuss the evidence base for palliative care for people with dementia, to identify 'gaps' for clinical research, and to make recommendations for interdisciplinary research practice. To lead the discussion throughout the day a multidisciplinary panel of expert speakers were brought together, including both researchers and clinicians from across Ireland and the UK. Targeted invitations were sent to attendees ensuring all key stakeholders were present to contribute to discussions. In total, 49 experts representing 17 different academic and practice settings, attended. Key topics for discussion were pre-selected based on previously identified research priorities (e.g. James Lind Alliance) and stakeholder input. Key discussion topics included: i. Advance Care Planning for people with Dementia; ii. Personhood in End-of-life Dementia care; iii. Topics in the care of advanced dementia at home. These topics were used as a starting point, and the ethos of the workshop was that the attendees could stimulate discussion and debate in any relevant area, not just the key topics, summarised under iv. Other priorities.; The care experienced by people with dementia and their families has the potential to be improved; palliative care frameworks may have much to offer in this endeavour. However, a solid evidence base is required to translate palliative care into practice in the context of dementia. This paper presents suggested research priorities as a starting point to build this evidence base. An interdisciplinary approach to research and priority setting is essential to develop actionable knowledge in this area.
: Dementia is the most common neurological disorder worldwide and is a life-limiting condition, but
very often is not recognised as such. People with dementia, and their carers, have been shown to have palliative
care needs equal in extent to those of cancer patients. However, many people with advanced dementia are not
routinely being assessed to determine their palliative care needs, and it is not clear why this is so
2017-07-14T00:00:00ZRisk Factors for Macro- and Microvascular Complications among Older Adults with Diagnosed Type 2 Diabetes: Findings from The Irish Longitudinal Study on Ageing.Tracey, Marsha LMcHugh, Sheena MFitzgerald, Anthony PBuckley, Claire MCanavan, Ronan JKearney, Patricia Mhttp://hdl.handle.net/10147/6214312019-08-30T11:58:23Z2016-01-01T00:00:00ZRisk Factors for Macro- and Microvascular Complications among Older Adults with Diagnosed Type 2 Diabetes: Findings from The Irish Longitudinal Study on Ageing.
Tracey, Marsha L; McHugh, Sheena M; Fitzgerald, Anthony P; Buckley, Claire M; Canavan, Ronan J; Kearney, Patricia M
Objective. To explore risk factors for macro- and microvascular complications in a nationally representative sample of adults aged 50 years and over with type 2 diabetes in Ireland. Methods. Data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) (2009-2011) was used in cross-sectional analysis. The presence of doctor diagnosis of diabetes, risk factors, and macro- and microvascular complications were determined by self-report. Gender-specific differences in risk factor prevalence were assessed with the chi-squared test. Binomial regression analysis was conducted to explore independent associations between established risk factors and diabetes-related complications. Results. Among 8175 respondents, 655 were classified as having type 2 diabetes. Older age, being male, a history of smoking, a lower level of physical activity, and a diagnosis of high cholesterol were independent predictors of macrovascular complications. Diabetes diagnosis of 10 or more years, a history of smoking, and a diagnosis of hypertension were associated with an increased risk of microvascular complications. Older age, third-level education, and a high level of physical activity were protective factors (p < 0.05). Conclusions. Early intervention to target modifiable risk factors is urgently needed to reduce diabetes-related morbidity in the older population in Ireland.
To explore risk factors for macro- and microvascular complications in a nationally representative sample of adults aged 50 years and over with type 2 diabetes in Ireland. Methods. Data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) (2009–2011) was used in cross-sectional analysis. The presence of doctor diagnosis of diabetes, risk factors, and macro- and microvascular complications were determined by self-report. Gender-specific differences in risk factor prevalence were assessed with the chi-squared test
2016-01-01T00:00:00ZAcute hospital dementia care: results from a national auditTimmons, SuzanneO’Shea, EmmaO’Neill, DesmondGallagher, Paulde Siún, AnnaMcArdle, DeniseGibbons, PatriciaKennelly, Seanhttp://hdl.handle.net/10147/6214122020-03-03T12:15:41Z2017-06-01T00:00:00ZAcute hospital dementia care: results from a national audit
Timmons, Suzanne; O’Shea, Emma; O’Neill, Desmond; Gallagher, Paul; de Siún, Anna; McArdle, Denise; Gibbons, Patricia; Kennelly, Sean
Admission to an acute hospital can be distressing and disorientating for a person with dementia, and
is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of
dementia care in acute hospitals in the Republic of Ireland
2017-06-01T00:00:00ZWhich part of the Quick mild cognitive impairment screen (Qmci) discriminates between normal cognition, mild cognitive impairment and dementia?O'Caoimh, RónánGao, YangGallagher, Paul FrancisEustace, JoesphMcGlade, CiaraMolloy, D Williamhttp://hdl.handle.net/10147/6201442019-08-30T12:49:10Z2013-05-01T00:00:00ZWhich part of the Quick mild cognitive impairment screen (Qmci) discriminates between normal cognition, mild cognitive impairment and dementia?
O'Caoimh, Rónán; Gao, Yang; Gallagher, Paul Francis; Eustace, Joesph; McGlade, Ciara; Molloy, D William
the Qmci is a sensitive and specific test to differentiate between normal cognition (NC), mild cognitive impairment (MCI) and dementia. We compared the sensitivity and specificity of the subtests of the Qmci to determine which best discriminated NC, MCI and dementia.; the objective was to determine the contribution each subtest of the Qmci makes, to its sensitivity and specificity in differentiating MCI from NC and dementia, to refine and shorten the instrument.; existing data from our previous study of 965 subjects, testing the Qmci, was analysed to compare the sensitivity and specificity of the Qmci subtests.; all the subtests of the Qmci differentiated MCI from NC. Logical memory (LM) performed the best (area under the receiver operating curve of 0.80), registration the worst, (0.56). LM and verbal fluency had the largest median differences (expressed as percentage of total score) between MCI and NC, 20 and 25%, respectively. Other subtests did not have clinically useful differences. LM was best at differentiating MCI from NC, irrespective of age or educational status.; the Qmci incorporates several important cognitive domains making it useful across the spectrum of cognitive impairment. LM is the best performing subtest for differentiating MCI from NC.
the Qmci is a sensitive and specific test to differentiate between normal cognition (NC), mild cognitive impairment
(MCI) and dementia. We compared the sensitivity and specificity of the subtests of the Qmci to determine which
best discriminated NC, MCI and dementia
2013-05-01T00:00:00ZComparison of the quick mild cognitive impairment (Qmci) screen and the SMMSE in screening for mild cognitive impairment.O'Caoimh, RónánGao, YangMcGlade, CiaraHealy, LiamGallagher, PaulTimmons, SuzanneMolloy, D Williamhttp://hdl.handle.net/10147/6201582019-08-30T12:49:10Z2012-09-01T00:00:00ZComparison of the quick mild cognitive impairment (Qmci) screen and the SMMSE in screening for mild cognitive impairment.
O'Caoimh, Rónán; Gao, Yang; McGlade, Ciara; Healy, Liam; Gallagher, Paul; Timmons, Suzanne; Molloy, D William
differentiating mild cognitive impairment (MCI) from normal cognition (NC) is difficult. The AB Cognitive Screen (ABCS) 135, sensitive in differentiating MCI from dementia, was modified to improve sensitivity and specificity, producing the quick mild cognitive impairment (Qmci) screen.; this study compared the sensitivity and specificity of the Qmci with the Standardised MMSE and ABCS 135, to differentiate NC, MCI and dementia.; weightings and subtests of the ABCS 135 were changed and a new section 'logical memory' added, creating the Qmci. From four memory clinics in Ontario, Canada, 335 subjects (154 with MCI, 181 with dementia) were recruited and underwent comprehensive assessment. Caregivers, attending with the subjects, without cognitive symptoms, were recruited as controls (n = 630).; the Qmci was more sensitive than the SMMSE and ABCS 135, in differentiating MCI from NC, with an area under the curve (AUC) of 0.86 compared with 0.67 and 0.83, respectively, and in differentiating MCI from mild dementia, AUC of 0.92 versus 0.91 and 0.91. The ability of the Qmci to identify MCI was better for those over 75 years.; the Qmci is more sensitive than the SMMSE in differentiating MCI and NC, making it a useful test, for MCI in clinical practice, especially for older adults.
differentiating mild cognitive impairment (MCI) from normal cognition (NC) is difficult. The AB Cognitive Screen (ABCS) 135, sensitive in differentiating MCI from dementia, was modified to improve sensitivity and specificity, producing the quick mild cognitive impairment (Qmci) screen.
2012-09-01T00:00:00ZEconomic (gross cost) analysis of systematically implementing a programme of advance care planning in three Irish nursing homesO’Sullivan, RonanMurphy, AileenO’Caoimh, RónánCornally, NicolaSvendrovski, AntonDaly, BrianFizgerald, CarolTwomey, CillianMcGlade, CiaraMolloy, D. Williamhttp://hdl.handle.net/10147/6084762019-08-30T13:01:47Z2016-04-26T00:00:00ZEconomic (gross cost) analysis of systematically implementing a programme of advance care planning in three Irish nursing homes
O’Sullivan, Ronan; Murphy, Aileen; O’Caoimh, Rónán; Cornally, Nicola; Svendrovski, Anton; Daly, Brian; Fizgerald, Carol; Twomey, Cillian; McGlade, Ciara; Molloy, D. William
Although advance care planning (ACP) and the use of advanced care directives (ACD) and end-of-life
care plans are associated with a reduction in inappropriate hospitalisation, there is little evidence supporting the
economic benefits of such programmes. We assessed the economic impact (gross savings) of the Let Me Decide
(LMD) ACP programme in Ireland, specifically the impact on hospitalisations, bed days and location of resident deaths,
before and after systematic implementation of the LMD-ACP combined with a palliative care education programme.
2016-04-26T00:00:00Z