7786 research outputs found
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Human rights of residents in the nursing home sector: developing practical evidence-based guidance for implementation
No full textThis study responds to the growing need for practical and implementable nursing home care models that prioritise resident dignity, autonomy, and inclusion. Aim: The study aimed to develop evidence-based guidance to support the implementation of a Human Rights-Based Approach (HRBA) in nursing home care in Ireland. The study was initiated and commissioned by Nursing Homes Ireland and led by the Faculty of Nursing and Midwifery at Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences. Methods: The research study comprised a three-phase methodology: 1) a rapid review of international literature; 2) stakeholder consultations through focus groups; and 3) development of guidance information for nursing homes in Ireland. This paper reports on the third stage of the project, focusing on using a co-design process and best-practice approaches to develop and implement evidence-based guidance tailored for practical use in the Irish nursing home care context. Findings: Findings revealed that while legal and regulatory frameworks exist to protect resident rights, there are significant barriers to their practical implementation. These barriers include institutional routines, staff shortages, inadequate training, and limited resident voice in decision-making. Stakeholders emphasised the importance of moving beyond technocratic compliance with care quality requirements to foster a ‘homeliness culture’ of respect, fairness, and person-led care. Guidance information in the form of accessible information, methods, tools and resources, as well as signposting resources, training and support, was developed drawing on best practice in implementation to facilitate a HRBA in nursing home care settings. Implications for practice: Overall, the guidance information that has been developed aligns with legal and statutory requirements and offers a roadmap for transforming care environments into spaces where human rights are actively protected and promoted. The paper concludes with a call for further research and systemic change to ensure that nursing home care in Ireland fully reflects the values and standards of a human rights-based model.</p
Co-designing accessible and inclusive patient information resources for gastrointestinal endoscopy using patient and public involvement (PPI) and Universal Design for Learning (UDL) principles
No full textIntroduction: Patients undergoing GI endoscopy can experience anxiety before their procedure, for numerous different reasons, including ineffective patient education resources received beforehand. Paper-based information leaflets are insufficient to accommodate for the diverse way in which people access, consume and process information. Public and patient involvement (PPI) and Universal Design for Learning (UDL) are two well-described pedagogical principles that strive to optimise patient-centred care and inclusivity.Objectives: Our aim was to apply these principles to design more effective and accessible patient education materials, improving the health literacy of our patients. Working with patient partners, we identified the need to develop high-quality and trustable video resources for patients, that would be available on our hospital website. These videos were co-designed by patients and other key stakeholders.Results: We used techniques such as storyboard development, the UDL educational principles of representation, engagement and expression, as well as the individual expertise of our stakeholder panel members to achieve appropriate and accessible information for our patient cohort. The development phase was an iterative process, with feedback and input from patient partners and other stakeholders playing a crucial role in prompting necessary adjustments for accuracy and patient understanding. Our project is the first guide in combining both PPI and UDL principles in the development of patient information and education materials.Conclusion: By involving patients and other key stakeholders as partners, we improved the relevance and quality of our patient information content. Identification of patient partners and appropriate other stakeholders is an important initial step when co-designing patient information resources. The use of UDL in the co-design process allows for a structured approach to creating accessible content, highlighting important steps that otherwise may be overlooked by team members. Formal assessment of the impact of these co-designed videos, through quantitative and qualitative methods, will be assessed as part of a larger study.</p
The support of early-career researchers in health professions education - an expert position statement
No full textIntroduction: The development of health professions education (HPE) as an academic discipline requires well-qualified educational researchers, equipped with the competence to advance the field. There is, therefore, a need to establish and support pathways in which early-career researchers (ECRs) can develop the necessary competence to pursue a career in this field.Approach: A group of 19 international experts in HPE from various professions, conducted a 2.5-day Scoping Workshop in Hannover, Germany, in November 2024. The main output of the workshop is a joint position statement on the support of ECRs in HPE, using appreciative inquiry and collaborative writing.Position: The Scoping Workshop led to a dynamic and productive exchange of ideas and experiences resulting in a common vision and five positions: (1) identify, establish, and recognize distinct career paths, (2) develop and implement a robust funding strategy, (3) create a nurturing and diverse intellectual culture, (4) connect research to practice and address real-world problems, (5) invest in leadership, advocacy, and coaching. There was strong agreement that these areas were not well developed and required urgent attention.Outlook: There is a need to foster interprofessional and interdisciplinary collaboration and provision of sustainable support structures so that ECRs can advance HPE. Only when these areas are addressed can these educational researchers contribute to the development of effective learning which prepares the healthcare workforce to meet today's challenges. Researchers, educators, decision-makers and stakeholders in academia, education, and health and social care contexts share a responsibility for shaping the way forward.</p
Liquid biopsy in lung cancer
No full textLung cancer is the leading cause of cancer-related mortality worldwide, with nonsmall cell lung cancer (NSCLC) accounting for the majority of cases. Despite advancements in therapeutics, outcomes remain poor due to late-stage diagnoses and the molecular complexity of the disease. Liquid biopsy, a minimally invasive diagnostic approach, has emerged as a potentially transformative tool in lung cancer. The detection of tumour-derived biomarkers, such as circulating-tumour DNA, circulating tumour cells and exosomes, can be analysed for molecular profiling, early detection and monitoring of disease progression. There have been significant advancements of liquid biopsy technologies, such as next-generation sequencing and droplet digital PCR, that identify actionable mutations, detect resistance mechanisms and improve therapeutic outcomes. While there are still challenges like detecting early-stage disease and the risk of false positives, the combination of multi-omics data and artificial intelligence has the potential for more personalised and precise cancer treatments. Liquid biopsy represents a paradigm shift in the early detection and personalised treatment of lung cancer, offering significant potential to improve patient outcomes.</p
The role of placental and cardiotocography analysis in the assessment of fetal risk for neonatal hypoxic ischaemic encephalopathy and their relationship to perinatal brain injury
No full textIntroduction: Hypoxic ischaemic encephalopathy (HIE) of the newborn relates to neurological dysfunction caused by perinatal asphyxia. HIE is associated with a high risk for mortality and long-term adverse neurodevelopment. Newborns with HIE are often born to women who have had a seemingly uneventful pregnancy, and up to two-thirds have no obvious antecedent intrapartum sentinel event. Recent research provides evidence that deficiencies within the maternal-placental-fetal (MPF) triad contributes to the pathogenesis of HIE.Aim and Hypothesis: This study aimed to determine the role of the MPF triad in the pathogenesis of HIE through analyses of the placenta and intrapartum fetal heart rate characteristics (cardiotocography, CTG) in near-term and term-born infants with moderate or severe HIE compared with healthy newborn infants. These findings were then related to brain injury assessed by neonatal neuroimaging as a surrogate outcome measure of disease severity. This study hypothesised that the MPF triad has a role in the pathogenesis of HIE and the severity of associated brain injury as assessed by neonatal neuroimaging.Methods: Retrospective observational case-control study of newborn infants with moderate or severe HIE (cases, n=140) and healthy newborn infants (controls, n=98) with placental and intrapartum CTG analyses. A retrospective observational cohort sub-study comprising the same newborn infants with moderate or severe HIE was conducted to evaluate the relationships between the placenta, intrapartum CTG and severity of brain injury assessed on neonatal neuroimaging. Placental pathology, intrapartum CTG and neonatal neuroimaging were reviewed using up-to-date guidelines for reporting and/or validated scoring systems, with all reviewers blinded to the clinical history of participants.Results: Associations were found between the presence of 1) placental pathology and 2) CTG abnormality and HIE. There was an association between placental pathology and duration of CTG abnormalities. Placental pathology and abnormal CTG had limited impact on the location/severity of brain injury.Conclusion: This study adds important information to the unanswered research question of what is the cause of HIE in the absence of an intrapartum sentinel event (ISE). This research study demonstrates the importance of placental pathology and prolonged, consecutive durations of CTG abnormality contributing to the development of HIE.</p
Health outcomes and psychosocial determinants in young carers: a systematic review
No full textEvidence suggests that young carers (age <25 years) can have worse health outcomes than their peers, yet the long-term effects of caregiving remain unclear. While psychosocial factors influence adult carers' health, their role in young carers' health is understudied. The aim of our Review is to synthesise longitudinal evidence examining young carers' physical and mental health and summarise psychosocial determinants. Databases were searched for eligible studies (eg, longitudinal and health-focused studies, those that included a non-carer comparison group, and studies of carers age <25 years) until Dec 31, 2024. After screening 4362 records, 18 studies met the inclusion criteria with 17 retained for narrative synthesis. All studies were conducted in high-income countries. 17 studies contributed 26 associations between caregiving and health, with 20 for mental health and six for physical health. Three studies identified links between psychosocial factors and mental health. Despite some notable inconsistencies, our findings suggest a small-to-moderate risk of poorer mental health among young carers, with stronger effects for subgroups (eg, high-intensity carers). Evidence on physical health was inconclusive. Social connections appear to play a key part in young carers' mental health. Further large-scale longitudinal studies are needed to clarify inconsistent findings. Unequal conditions of care relating to individual and situational factors could affect health in young carers.</p
An update on health literacy dimensions: an umbrella review
No full textAwareness of the value of health literacy has grown significantly in recent years, with the concept increasingly integrated within public health policy, research and practice, and notably, more commonly being explored in a systems approach to health promotion. The concept does however appear to be constantly evolving, with various iterations of definitions being used. As such, there is a need to review and update understanding of health literacy’s core components. This umbrella review aims to provide a contemporary understanding of health literacy and its dimensions. Searches were conducted between July and August 2023 across three databases, and 784 studies were identified and screened, with nine systematic reviews identified for extraction. All included systematic review articles aimed to conceptualise or define health literacy. Following a quality assessment, using the AMSTAR-2, inductive analysis was carried out to map specific health literacy dimensions identified in each included study to previously identified health literacy clusters. The findings of this umbrella review highlight the ever-evolving nature of the concept of health literacy; the responsibility placed on the individual to develop and maintain adequate health literacy. Despite the relatively poor reporting quality of many of the review articles included, the findings from this umbrella review point to the difficulty in developing tools to comprehensively measure health literacy, and critically, how to effectively improve health literacy at both an individual and populational level.</p
Pilot study of on-treatment platelet reactivity at low shear stress and platelet activation status on aspirin or clopidogrel monotherapy in patients with TIA or ischaemic stroke
No full textBackground: Simultaneously-collected data regarding platelet reactivity and activation in ischaemic cerebrovascular disease (CVD) patients starting antiplatelet agents are limited.Methods: This prospective observational pilot study assessed platelet reactivity and activation in TIA/ischaemic stroke patients before (baseline; N = 73), 14 ± 7 days (14d; N = 59) and ≥ 90 days (90d; N = 38) after commencing aspirin or clopidogrel monotherapy. Platelet reactivity at low shear-stress (Multiplate® Aspirin/ADP assays) and platelet activation status (% expression of CD62P, CD63, and leucocyte-platelet complexes by flow cytometry) were quantified in whole blood. Prevalence of high on-treatment platelet reactivity (HTPR) was determined on Multiplate with 'case-control definitions' (Aspirin-HTPR:>40 U; Clopidogrel-HTPR:>46 U), and innovative 'longitudinal-HTPR definitions' (failure to reduce aggregation compared with the patient's baseline by more than twice the co-efficient of variation of the relevant assay).Results: Prevalence of case-control aspirin-HTPR was 23.8 % at 14d and 30.8 % at 90d, and of longitudinal aspirin-HTPR was 4.8 % at 14d and 0 % at 90d. Prevalence of clopidogrel-HTPR was significantly higher with case-control than longitudinal definitions at 14d (60.5 % vs. 21 %) and 90d (52 % vs. 24 %) (P ≤ 0.03). % Neutrophil-platelet complexes (P = 0.04) and lymphocyte-platelet complexes (P = 0.002) were higher in patients with vs. without case-control clopidogrel-HTPR at 14d. Median % lymphocyte-platelet complexes significantly decreased between baseline and 14d (P = 0.019), and monocyte-platelet complexes decreased between baseline and 90d (P = 0.017) only in the clopidogrel-patient subgroup whose platelets were adequately inhibited by clopidogrel.Conclusions: Antiplatelet-HTPR prevalence is higher in CVD patients with case-control than longitudinal definitions on the Multiplate analyser. Quantifying leucocyte-platelet complexes improves our understanding of cellular mechanisms contributing to case-control clopidogrel-HTPR.</p
Employed but unpaid, volunteers or paradoxical surplus? Sierra Leone's unsalaried health workforce
No full textBackground: In 2016, 36.5% of Sierra Leone's health workforce consisted of unsalaried clinical staff whose payroll inclusion was deferred. The Ministry of Health introduced policies to reduce this percentage, renewing pledges to introduce health workforce planning. This paper focuses on how many unsalaried clinical staff currently work in public health facilities, based on a survey among Sierra Leone's District Health Management Teams. The study also draws on qualitative responses from unsalaried health workers regarding their coping strategies.Methods: A mixed methods approach was used, and this paper reports primarily on the survey conducted among all 16 district health authorities in 2023 and 2024. Findings from qualitative data collected among health workers, salaried and unsalaried, is also reported on.Findings: 10 out of 16 districts shared staffing data, representing 55% of the population. Just over half of all Peripheral Health Unit clinical staff was unsalaried, and in 7 out of 10 districts those who were unsalaried outnumbered salaried staff. Only the capital Freetown had a large cohort of salaried clinical health workers, 58% in total. The coping strategy information from unsalaried health workers confirmed their financial hardship and formal, and sometimes informal, income generating activities.Discussion/conclusion: Unsalaried clinical health worker numbers have increased in PHUs since 2016; an estimated 4000-5000 unsalaried clinical staff is in precarious employment, awaiting payroll inclusion. The majority of this 'paradoxical surplus' of health workers is trained to auxiliary cadre, meaning their eventual payroll inclusion will not increase the country's skilled-health-worker-to-population ratio, or improve Universal Health Coverage rates.</p
A discourse on skin tone assessment: the how, the why, and the path toward equitable pressure ulcer prevention
No full textPressure ulcers (PUs) are a significant and costly healthcare challenge, affecting individuals with limited mobility across various healthcare settings [1]. The pathophysiology of PU development has highlighted the importance of the early detection of PUs [2], which has become an important focus of research in recent years [3,4]. The challenge however, is that the detection of PUs is influenced by multiple factors, including skin tone, yet this area remains largely underexplored [5,6]. Current research often focuses on broad assessment strategies such as risk assessment scales and visual skin assessment, but there is limited understanding of how skin tone influences the development and progression of PUs [7,8]. This knowledge gap presents a clear opportunity to improve healthcare equity by addressing how skin tone variability impacts the tissue response to pressure and shear, and the risk of developing a PU.</p