University College Dublinhttp://hdl.handle.net/10147/6272542024-03-26T23:28:06Z2024-03-26T23:28:06ZEligibility for heroin-assisted treatment (HAT) among people who inject opioids and are living with HIV in a Canadian setting.Klimas, JanDong, HuiruFairbairn, NadiaSocías, EugeniaBarrios, RolandoWood, EvanKerr, ThomasMontaner, JulioMilloy, M-Jhttp://hdl.handle.net/10147/6408372024-02-21T02:02:56Z2018-02-07T00:00:00ZEligibility for heroin-assisted treatment (HAT) among people who inject opioids and are living with HIV in a Canadian setting.
Klimas, Jan; Dong, Huiru; Fairbairn, Nadia; Socías, Eugenia; Barrios, Rolando; Wood, Evan; Kerr, Thomas; Montaner, Julio; Milloy, M-J
Objectives: A growing body of evidence supports the effectiveness of injectable diacetylmorphine (i.e., heroin) for individuals with treatment-refractory opioid use disorder. Despite this evidence, and the increasing toll of opioid-associated morbidity and mortality, it remains controversial in some settings. To investigate the possible contribution of heroin-assisted treatment (HAT) to HIV treatment-related outcomes, we sought to estimate the proportion and characteristics of HIV-positive people who inject opioids that might be eligible for HAT in Vancouver, Canada.
Methods: We used data from a prospective cohort of people living with HIV who use illicit drugs in Vancouver, Canada. Using generalized estimating equations (GEE), we assessed the longitudinal relationships between eligibility for HAT, using criteria from previous clinical trials and guidelines, with behavioural, social, and clinical characteristics.
Results: Between 2005 and 2014, 478 participants were included in these analyses, contributing 1927 person-years of observation. Of those, 94 (19.7%) met eligibility for HAT at least once during the study period. In a multivariable GEE model, after adjusting for clinical characteristics, being eligible for HAT was positively associated with homelessness, female gender, high-intensity illicit drug use, drug dealing and higher CD4 count.
Conclusions: In our study of HIV-positive people with a history of injection drug use, approximately 20% of participants were eligible for HAT at ≥ 1 follow-up period. Eligibility was linked to risk factors for sub-optimal HIV/AIDS treatment outcomes, such as homelessness and involvement in the local illicit drug trade, suggesting that scaling-up access to HAT might contribute to achieving optimal HIV treatment in this setting.
2018-02-07T00:00:00ZThe impact of steerable sheath visualization during catheter ablation for atrial fibrillation.Keaney, JohnFitzpatrick, NoelMittal, AshishKeelan, EdwardO'Brien, JimJauvert, GaelSzeplaki, GaborGalvin, JosephGalvin, Josephhttp://hdl.handle.net/10147/6403062024-01-09T02:44:32Z2023-03-09T00:00:00ZThe impact of steerable sheath visualization during catheter ablation for atrial fibrillation.
Keaney, John; Fitzpatrick, Noel; Mittal, Ashish; Keelan, Edward; O'Brien, Jim; Jauvert, Gael; Szeplaki, Gabor; Galvin, Joseph; Galvin, Joseph
Aims: Incorporating a steerable sheath that can be visualized using an electroanatomical mapping (EAM) system may allow for more efficient mapping and catheter placement, while reducing radiation exposure, during ablation procedures for atrial fibrillation (AF). This study evaluated fluoroscopy usage and procedure times when a visualizable steerable sheath was used compared with a non-visualizable steerable sheath for catheter ablation for AF.
Methods and results: In this retrospective, observational, single-centre study, patients underwent catheter ablation for AF using a steerable sheath that is visualizable using the CARTO EAM (VIZIGO; n = 57) or a non-visualizable steerable sheath (n = 34). The acute procedural success rate was 100%, with no acute complications in either group. Use of the visualizable sheath vs. the non-visualizable sheath was associated with a significantly shorter fluoroscopy time [median (first quartile, third quartile), 3.4 (2.1, 5.4) vs. 5.8 (3.8, 8.6) min; P = 0.003], significantly lower fluoroscopy dose [10.0 (5.0, 20.0) vs. 18.5 (12.3, 34.0) mGy; P = 0.015], and significantly lower dose area product [93.0 (48.0, 197.9) vs. 182.2 (124.5, 355.0) μGy·m2; P = 0.017] but with a significantly longer mapping time [12.0 (9.0, 15.0) vs. 9.0 (7.0, 11.0) min; P = 0.004]. There was no significant difference between the visualizable and non-visualizable sheaths in skin-to-skin time [72.0 (60.0, 82.0) vs. 72.0 (55.5, 80.8) min; P = 0.623].
Conclusion: In this retrospective study, use of a visualizable steerable sheath for catheter ablation of AF significantly reduced radiation exposure vs. a non-visualizable steerable sheath. Although mapping time was longer with the visualizable sheath, the overall procedure time was not increased.
2023-03-09T00:00:00ZInterval cancer audit and disclosure in breast screening programmes: An international survey.Fitzpatrick, PatriciaByrne, HelenFlanagan, FidelmaO'Doherty, AnnConnors, AlissaLarke, AideenO'Laoide, RisteardWilliams, YvonneMooney, Theresehttp://hdl.handle.net/10147/6379632023-10-03T02:22:42Z2022-09-07T00:00:00ZInterval cancer audit and disclosure in breast screening programmes: An international survey.
Fitzpatrick, Patricia; Byrne, Helen; Flanagan, Fidelma; O'Doherty, Ann; Connors, Alissa; Larke, Aideen; O'Laoide, Risteard; Williams, Yvonne; Mooney, Therese
Objective and setting: Accurate monitoring of interval cancers is important both for quality improvement and education and is a key parameter of breast screening quality assurance. Issues in relation to communication regarding interval cervical cancer in the Irish cervical screening programme were found, prompting interval cancer process review in all cancer screening programmes. An international survey to examine international consensus on interval breast cancer audit processes was conducted to inform Irish processes.
Methods: A survey of 24 international population-based breast screening programmes was done to determine which undertook audit of interval breast cancer; if yes, they were asked (1) how they undertake audit, (2) if they obtain individual consent for audit and inform women of audit results, and (3) if disclosure of audit results occurs.
Results: Response was 71% (17/24). Of these, 71% (12/17) have a programmatic audit process to calculate the interval cancer rate (ICR). Of these, ten also carry out radiological reviews, three using a blinded review. Two inform patients that audit is taking place; two provide choice to be in the audit; nine state that routine screening consent covers audit. For two of the five that have an open disclosure policy for medical incidents, this policy applies to screening interval cancers. One other country/region has an open disclosure policy for category 3 interval cancers only. Five have legal protection for interval cancers arising in the screened population.
Conclusion: While consistency in providing aggregate programmatic audits exists, there is no consistent approach to individual interval cancer reviews or results disclosure.
2022-09-07T00:00:00ZDoes the sun hold the key to improving the lives and well-being of a growing older population in rural Africa?http://hdl.handle.net/10197/114872023-08-31T08:15:31ZDoes the sun hold the key to improving the lives and well-being of a growing older population in rural Africa?
Globally the number of older people is rising. In Africa the number of people over 60 years is expected to increase from just under 50 million to nearly 200 million by 2050 1. Generally the number of older persons is growing faster in urban areas than in rural areas 1 however, a large share of the elderly reside in rural areas, where support and services are more difficult to find 2. Many older people across sub-Saharan Africa (SSA) live in chronic and profound poverty. Increasingly, older people also live alone or are disconnected from their families who may have moved into the cities or even abroad 3. Despite the changing demographics of Africa, the older population has largely remained invisible in international development initiatives and related health policy discourses. As a result, SSA is lagging in investment and development of infrastructure and support programs to meet the needs of their ageing citizens. Preparing for an ageing population is vital to achieving the goals of poverty eradication, good health, gender equality, economic growth and decent work, reduction of inequalities and creation of sustainable cities as set out in Agenda 2030 for sustainable development 4.; non-peer-reviewed; Other
What characterizes 'the usual' preoperative education in clinical contexts?http://hdl.handle.net/10197/41302023-09-01T02:35:25ZWhat characterizes 'the usual' preoperative education in clinical contexts?
The literature on preoperative education is dominated by studies that employ experimental designs to measure the effects of structured programs on patient outcomes. These studies predominantly compare structured preoperative educational interventions with the usual care that patients receive. However, the notion of what the “usual” care comprises is largely elusive and unexplored. This study aimed to understand how the usual preoperative education is practiced in a number of surgical clinical units at one particular hospital in Ireland. Twelve experienced surgical nurses were interviewed in depth. A qualitative strategy resembling grounded theory was employed to analyze the data. The findings indicated that the content and quality of the preoperative education that patients received depended largely upon the individual nurse caring for the patient. Although there was a generic content of preoperative education that all participants identified as important, this related to physical and technical issues, and to the transmission of administrative or procedural information. Perspectives on the process of delivering preoperative education were diverse. The vast majority did not relate to the formal language of the discourses of teaching and learning; nonetheless, their descriptions of engaging in their work indicated the application of some elements of educational theory. The data suggested that the use of teaching tools was inconsistent, depending on their availability and the practices of individual nurses. On the whole, the usual care as described by participants in our study may be characterized as uneven, variable, and mutable. We conclude by raising some methodological issues relating to the use of the usual care in control groups in experimental studies on preoperative education.; non-peer-reviewed; Other
Addressing Health and Wellbeing Challenges for Homeless Children and Families Living in Temporary and Emergency Accommodationhttp://hdl.handle.net/10197/114452023-09-01T02:35:19ZAddressing Health and Wellbeing Challenges for Homeless Children and Families Living in Temporary and Emergency Accommodation
Data from homeless charities and service organisations suggest that the number of homeless families with young children has been increasing in Ireland, and particularly in Dublin, in recent years. In October 2019 in Ireland, 1700 families including almost 1000 single parents and 3826 children were in this situation. In Dublin this accounted for 1270 families, 700 single parents and 2795 children.; non-peer-reviewed; Other
Using Lean Six Sigma to Improve Controlled Drug Processes and Release Nursing Timehttp://hdl.handle.net/10197/109182023-08-31T08:15:27ZUsing Lean Six Sigma to Improve Controlled Drug Processes and Release Nursing Time; Improving controlled drug processes
BACKGROUND: Hospital controlled drug processes are established to adhere to legislation, with little consideration of efficiency of processes. LOCAL PROBLEM: A controlled drug process existed, where nurses requested a porter to collect a hand-written order; however, only 19% of drug orders were processed this way. Instead, an unscheduled, ad hoc process led to an average of 17 nurse journeys to pharmacy daily. We aimed to reduce nurse journeys to the pharmacy by 25% to release nursing time. METHODS: A pre-/postintervention design was used with Lean Six Sigma methods. INTERVENTIONS: A multifaceted intervention involved process redesign, increasing the frequency of a porter-led delivery service, amending delivery times to reflect times of greatest need, and streamlining checking requirements. RESULTS: Following implementation, there was a statistically significant 44% decrease in nurse journeys to pharmacy for drug collections, which was maintained after 18 months. CONCLUSIONS: Interprofessional collaboration improving hospital-wide processes can have significant benefits for the release of nursing time.; non-peer-reviewed; Other
A systematic review and narrative synthesis of the experiences of caring for older people living with dementia in sub-Saharan Africahttp://hdl.handle.net/10197/114942023-08-31T08:15:26ZA systematic review and narrative synthesis of the experiences of caring for older people living with dementia in sub-Saharan Africa
The broad review question will be: What are the experiences of caring for older people with dementia in sub-Saharan Africa (SSA)?; non-peer-reviewed; Other
Incidencia de niños, niñas y adolescentes como ciudadanos/as activos/as en Nicaraguahttp://hdl.handle.net/10197/120632023-09-01T02:35:12ZIncidencia de niños, niñas y adolescentes como ciudadanos/as activos/as en Nicaragua
En este documento presentamos los resultados de un proyecto de investigación realizado en sociedad por el Centro de Servicios Educativos en Salud y Medio Ambiente, CESESMA, y la Universidad del Norte de Nicaragua, UNN, en el marco del programa "Ciudadanía Activa en Centro América", con el fin de encontrar respuestas a las siguientes cuatro preguntas claves: 1. ¿Cuáles son las condiciones que favorecen la incidencia política de niños, niñas y adolescentes? 2. ¿Cuáles son los espacios o modalidades de organización y participación que propician la incidencia de niños, niñas y adolescentes como ciudadanos/as activos/as? 3. ¿Cuáles son las estrategias de intervención y las metodologías de facilitación que nos conducen al éxito en la promoción de incidencia política de niños, niñas y adolescentes? 4. ¿Cuáles son los obstáculos que tenemos que enfrentar y cómo los han superado?; non-peer-reviewed; Other
The medicalisation of childbearing norms: encounters between unmarried pregnant women and medical personnel in an Irish contexthttp://hdl.handle.net/10197/42112023-09-01T02:35:04ZThe medicalisation of childbearing norms: encounters between unmarried pregnant women and medical personnel in an Irish context
non-peer-reviewed; Other