7786 research outputs found
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Climate change impacts and sustainability integration among breast international group members
No full textBackground: Integration of sustainability measures into clinical research would translate into less healthcare related climate impacts.Methods: We assessed climate change impacts, existing sustainability engagement, and challenges and facilitators to climate change mitigation strategies among Breast International Group (BIG) members. A 30 item web based survey assessing climate impacts, sustainability engagement, challenges to and facilitators of engagement, and sustainability integration in funding applications was developed, and circulated electronically between November 2023 and March 2024.Results: Thirty four members (research groups and data centres) and participating sites across 5 continents, and BIG headquarters responded. Twenty six responses were received from 21 organisations, 20 from 17 participating sites. No responses were obtained from 28 groups. Trial conduct at a third of member groups had been impacted by climate change impacts such as destroyed infrastructure. 78 % of groups agreed that sustainability should feature in future funding applications. Most respondents engaged in sustainability initiatives at a host institute and organisational level. However, 39 % of coordinating centres and 65 % of representative sites had none within clinical trials conducted by their organisation. The majority of respondents foresaw challenges to sustainability engagement including competing time pressure, staff attitudes and resource constraints. Of nine potential facilitators to engagement, funding, an evidence base for sustainable research practice and training were the leading themes.Conclusion: In the first global survey of its kind, a third of respondents reported that climate change had impacted trial conduct. Integration of sustainability measures was absent in a significant minority. Funding and dedicated resourcing would facilitate increased engagement in cancer clinical trials.</p
Transcutaneous versus open surgery for aortic valve replacement
No full textThe aortic valve is one of four heart valves and is located at the junction of the left ventricle and the aorta. Many pathologies are associated with the aortic valve, commonly aortic valve stenosis. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are options for surgical valve replacement in severe aortic stenosis (AS). SAVR is currently the gold standard treatment for AS. Access to the cardiac structures in SAVR is via sternotomy, whereas TAVI is a less invasive alternative commonly performed through the femoral artery. Despite advancements in TAVI and SAVR, clinical uncertainty about their long-term efficacy and safety persists. This review explores outcome differences, lifetime management, and current guidelines for TAVI and SAVR. Comparing TAVI and SAVR for severe AS highlights several key findings. TAVI demonstrates lower structural valve deterioration rates but higher pacemaker implantation and mild paravalvular regurgitation post procedure. SAVR shows lower rates of patient–prosthesis mismatch. Short-term quality of life and cost-effectiveness favour TAVI, especially via the transfemoral route. When it comes to younger patients who require several operations, future management – including valve-in-valve procedures – is critical. Choosing between TAVI and SAVR should involve multidisciplinary team assessment, individual patient factors and patient preference.</p
Virtual reality in surgical training: revolutionising education and bridging gaps in modern practice
No full textSurgical education has traditionally followed an apprenticeship model, but limitations in hands-on training and insufficient exposure to complex procedures have highlighted the need for innovation. Virtual reality (VR) offers a transformative solution, providing an immersive, risk-free environment where trainees can repeatedly practice procedures and refine technical skills before entering the operating room. Research demonstrates that VR enhances competency, reduces errors, and improves patient outcomes across multiple surgical specialties, including orthopaedics, ophthalmology, and general surgery. By allowing for repeated exposure to complex procedures, VR fosters confidence and mastery in trainees, which addresses gaps in traditional training. Beyond technical skill development, VR has the potential to bridge disparities in surgical education, particularly in resource-limited settings where access to expert mentorship and hands-on training is scarce. Early initiatives in global health have demonstrated VR’s effectiveness in expanding surgical training opportunities worldwide. Despite its promise, challenges remain, including cost, technological limitations, and the need for refinement in haptic feedback and anatomical accuracy. However, continued advancements and integration with traditional methods position VR as a key component of modern surgical education. By embracing VR, the medical field can ensure that the next generation of surgeons is better prepared, more confident, and ultimately safer for patients.</p
Beyond thyroid dysfunction: the systemic impact of iodine excess
No full textAs an essential micronutrient, iodine plays a crucial role in several physiological systems, particularly in the production of thyroid hormone. While deficiency is widely recognized, the consequences of iodine excess (IE) are less studied. IE, which may be caused by iodine-rich diets, supplements, iodinated contrast media and salt iodization, has been implicated in a range of adverse outcomes on thyroid and systemic health. Examples include autoimmune thyroid diseases like Graves’ disease and Hashimoto’s thyroiditis, driven by immune cell polarization and gut microbiota alterations. Furthermore, excessive iodine intake is associated with increased risks of cardiovascular diseases, including hypertension and atherosclerosis, due to oxidative stress, inflammation, and endothelial dysfunction. It contributes to the development of thyroid cancer, particularly papillary thyroid cancer, through genetic mutations such as BRAF mutations and enhanced cancer cell proliferation. Excess iodine intake has been implicated to have neurotoxic effects, significantly impairing learning and memory, negatively impacting neonatal brain development, and potentially contributing to the progression of neurodegenerative conditions. It also has a potential role in renal dysfunction in vulnerable populations, due to overload from povidone-iodine in sterile equipment. This mini-review aims to collate the adverse effects of IE, beyond its effect on thyroid health, through investigation of the cardiovascular, nervous, and renal systems. Through our consolidation of the current literature, we hope to raise awareness and contribute to the understanding of the multifaceted impact of excessive iodine intake.</p
Training Load and Injury Risk in Leinster Schoolboy Rugby Players
No full textRugby union is a popular sport with adolescent participation growing world-wide. The contact and evasive nature of the sport brings inherent risk of injury. Training accounts for up to 85% of load, which has shown to be associated with injury risk in adult team sport cohorts. The four studies within this thesis aimed to describe the training load undertaken by schoolboy rugby players, to complete injury surveillance and explore associations between training load and injury risk factors as a result of rugby participation.
The feasibility study (Chapter 3) informed the methodology for the larger main SCRUm cohort study by commencing training load data collection in four Leinster schools. The SCRUm study (Chapters 4 and 5) recruited 16 Leinster schools over a 20-week period during the 2019/20 season. Training load monitoring and injury surveillance was completed. Participant engagement in individual level training load data collection was low at 12%. The team level data revealed the varied training practices across all schools and senior schools level competitions. Injury surveillance identified similar injury patterns (by site, mechanism, position) as previously published research. The SCRUm study reported a match injury incidence of 19.9 injuries per 1000 match hours (95% CI 15.2 - 25.6) and training injury incidence of 0.7 injuries per 1000 training hours (95% CI 0.4-1.0). The tackle accounted for 49% (n=41) of all injuries.
The usability study (Chapter 6) found non-medical injury data collectors had low self-efficacy when reporting injury diagnoses using four levels of OSICS coding. The suggestion of a simplified coding system or use of two levels of OSICS coding is in line with guidelines for community rugby injury surveillance published during the course of this PhD. The usability study participants found the electronic injury surveillance system to be user friendly and would recommend its use to their peers.
The player focus group interviews (Chapter 7) identified the motivators to engage with training load data collection included the coaching staff ‘buy in’ and also the ability to view training load data on a weekly or monthly basis. The participants of the player focus groups preferred the electronic data collection tools over a paper and pen option and expressed interest in future research in this area.
The SCRUm study and the discrete studies are reported in full detail in the following chapters.</p
Incorporation of Pharmacy Technicians into the Medication Administration Process in a National Paediatric Cancer Inpatient Service; an Implementation Study
No full textBackground: Globally healthcare workforce shortages are becoming increasingly common along with future predictions that workforce requirements will substantially increase. This will require us to look at alternative combinations of workforce and skill mixes to meet this future demand. Extending the role of pharmacy technicians to include supporting nurses in the administration of medicines has the potential to address nursing workforce pressures. A pilot service introducing pharmacy technicians into the medication administration process in an Irish paediatric cancer inpatient ward was undertaken. The aims of this study were to conduct a narrative review critically appraising the published literature on advanced pharmacy technician roles outside the pharmacy domain and explore and evaluate the implementation of the service quantitatively and qualitatively. Qualitative analysis using CFIR constructs were used to determine the viability of the service for future expansion and it’s limitations.
Methods: Mixed methods study consisting of a descriptive study of the activity performed by the pharmacy technicians and qualitative interviews exploring the implementation of the service along with post analysis confirmatory anonymous surveys. Two pharmacy technicians were trained and participated in the study. The activity data was collected by conducting an observational study of patients receiving intravenous (IV) medicines in line with the new service for the first six months from competency sign off for the two pharmacy technicians along with pre and post implementation analysis of medication incident reporting. The observational study consisted of the pharmacy technicians completing data collection forms for each IV medication that they prepared/ second checked. The data collection forms included calculation completed by the pharmacy technicians and recorded time for each preparation.
Ten semi structured stakeholder interviews were conducted with two ward-based pharmacy technicians, six nurses and two members of pharmacy management. Interviews were transcribed verbatim and analysed using the framework approach, guided by CFIR. The survey was then designed to triangulate the data seen in interviews and allow the opinions of the wider nursing team in an anonymous forum.
Results: The pharmacy technicians assisted in the preparation and administration of 920 IV injections out of a possible 4447 (20%) of all IV injections prepared on the ward during the study period. The results indicated a one hour per day of nursing time released back to patient care and an increase in reporting of near misses and risk issues (NCC MERP category A and B).
Key themes identified from qualitative data included: adaptability of the service to an Irish setting and current work setting; training and education for service users; positive impacts of the service on work culture and medication safety; the importance of building interprofessional relationships and the current and future utilization of hospital pharmacy technicians.
Survey results verified the implementation issues and lessons identified in the interviews. Survey respondents were supportive of pharmacy technicians in this new service with 100% (n=22) agreeing that pharmacy technicians can perform in this new role and 95% (n=21) respondents believe that the addition of pharmacy technicians to the IV medication rounds is an improvement on the previous service.
Conclusion: This study demonstrates a safe and acceptable service that supports nurses to spend more time on patient facing tasks with additional benefits seen in medication safety culture on the study ward. The results of this study can be used to develop further expansion of advanced pharmacy technician roles outside the pharmacy domain. </div
Deregulated mRNA and microRNA expression patterns in the prefrontal cortex of the BTBR mouse model of autism
No full textAutism spectrum disorder (ASD) is a neurodevelopmental condition caused by both genetic and environmental factors. Since no single gene variant accounts for more than 1% of the cases, the converging actions of ASD-related genes and other factors, including microRNAs (miRNAs), may contribute to ASD pathogenesis. To date, few studies have simultaneously investigated the mRNA and miRNA profiles in an ASD-relevant model. The BTBR mouse strain displays a range of behaviors with ASD-like features but little is known about the protein-coding and noncoding gene expression landscape that may underlie the ASD-like phenotype. Here we performed parallel mRNA and miRNA profiling using the prefrontal cortex (PFC) of BTBR and C57BL/6 J (B6) mice. This identified 1063 differentially expressed genes and 48 differentially expressed miRNAs. Integration of mRNA and miRNA data identified a strong inverse relationship between upregulated (DEGs) and downregulated miRNAs, and vice versa. Pathway analysis, taking account of the inverse relationship between differentially expressed miRNAs and their target mRNAs highlighted significant shared enrichment in immune signaling, myelination, and neurodevelopmental processes. Notably, miRNA changes were predicted to affect synapse-related functions but we did not find enrichment of protein-coding genes linked to cellular components or biological processes related to synapses in the PFC of BTBR mice, indicating processes may evade miRNA control. In contrast, other miRNAs were predicted to have extensive relationships with DEGs suggesting their role as potential hub coordinators of gene expression. Profiling findings were confirmed via qRT-PCR for representative protein-coding transcripts and miRNAs. Our study underscores the complex interplay between gene expression and miRNA regulation within immune and inflammatory pathways in the BTBR model, offering insights into the neurodevelopmental mechanisms of ASD. These results support the value of the BTBR mouse model and identify strategies that could adjust molecular pathways for therapeutic applications in ASD research.</p
Digital for care 2030 empowering people: the future of digital transformation in the health service
No full textA paper presented at the 'Better health outcomes from digital health?’ National Healthcare Outcomes Conference, RCSI University of Medicine and Health Sciences, 8 April 2025.</p
Reflecting on cancer pain as constant acute pain, not chronic pain. 'Known knowns, known unknowns, unknown unknowns'
No full textPurpose of Review: to explore a paradigm shift in the definition of opioid-responsive cancer pain in this hypothesis-driven review. Opioid-responsive cancer pain may be misplaced within the definition of chronic pain, chronic pain takes three months to establish, early effective control is worthwhile to achieve.Recent: findings, from a bench-to-bed perspective, debates the interpretation of results supporting the hypothesis that opioid- responsive cancer pain could remain ‘constant acute pain’, with explanations, best solutions, for tolerance and/or addiction, in cancer patients compared to those with chronic pain from other conditions.Summary: Unraveling the unique apparent properties of opioid-responsive cancer pain empowers knowledge of the process by which acute pain may have the potential to remain acute in nature and not transition into chronic pain. Findings outlined defend the hypothesis of probable sustained acute nature of opioid-responsive cancer pain, importance of early, sustained pain control, opioid reduction and further exploration of this hypothesis in clinical practice.</p
Co-creating Wellby - a mobile app and wearable for student well-being management guided by a needs assessment and co-design
No full textBackground: Adolescents need additional well-being support, particularly in stressful periods such as during the final years of secondary school. These students are growing up in an increasingly digital world, however there is a lack of mobile applications specifically designed to support adolescent students' well-being. Because of this, there is a need for co-created digital tools that are built to promote thriving in this population. The aim of this study was to explore how digital tools, such as a mobile app and wearable, can be used to address Irish secondary school student well-being needs through a collaborative co-design process with students.Methods: Groups of students at four schools were sent a needs assessment to understand student's most pressing well-being needs. Co-design sessions were conducted with a group of students at each school, following the confirmation of stress and sleep as students' main well-being priorities and their interest in digital support tools.Results: Students' conversations and designs from these sessions helped to uncover important elements of a well-being toolkit that they named, Wellby. The Wellby toolkit is comprised of a bespoke mobile app and wearable device for use by individuals. Participating students identified requisite elements of Wellby support that included self-tracking tools, supports for stress, and customizable features.Discussion: These insights from Irish secondary school students helped to shape a student-centered well-being support tool and provide an example of co-created positive technology.</p