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Ojo A, Rizun N, Walsh GS, Przychodzen W, Mashinchi MI, Foley C, Rohde D. Building confidence and trust in Ireland's National Maternity Services Workforce -What matters most and how? Health Policy 2023; 138:104947. [PMID: 37992566 DOI: 10.1016/j.healthpol.2023.104947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/04/2023] [Accepted: 11/16/2023] [Indexed: 11/24/2023]
Abstract
National surveys on care experiences are increasingly adopted as regulatory mechanisms for improving care quality and increasing public trust in healthcare services. Based on data collected as part of Ireland's 2020 National Maternity Experience Survey, this study investigates care-related factors that contribute most to confidence and trust in the professional workforce (or carers) within Irish maternity services. The survey covered the full spectrum of maternity care and received 3,206 responses which were analysed using structural equation modelling. Results show that trust in carers may be enhanced through greater attention to the quality of interpersonal aspects of maternity care in a few core areas. We found that factors related to dignity and respect (β=0.270), involvement in decision-making (β=0.186), pain management (β=0.172), and communication (β=0.151) are core determinants of confidence and trust in the professional workforce of maternity services. Perceived quality of care in these four aspects increased on average, with the women's age. Women under 29 rated their experiences in these areas as significantly lower than the average. Women with a disability also rated their experiences significantly lower than average in three core areas. Our results suggest that trustworthy, equitable, and high-quality maternity care requires ongoing development of interpersonal skills within the maternity services professional workforce particularly in caring for younger women (under 29 years) and those with a disability.
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Affiliation(s)
- Adegboyega Ojo
- School of Public Policy and Administration, Carleton University, Ottawa, ON, Canada.
| | - Nina Rizun
- Gdansk University of Technology, Gdansk, Poland
| | - Grace S Walsh
- CONNECT, the Science Foundation Ireland Research Centre for Future Networks and Communications, Maynooth; School of Business, Maynooth University, Kildare, Ireland
| | | | | | - Conor Foley
- National Care Experience Programme, Health Information and Quality Authority, Cork, Ireland
| | - Daniela Rohde
- National Care Experience Programme, Health Information and Quality Authority, Cork, Ireland
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Drummond L, Guiney S, Connolly D, Foley C, O'Connor L, O'Carroll T, Flynn R, Rohde D. Experiences of shared decision making in acute hospitals: A mixed methods secondary analysis of the Irish National Inpatient Experience Survey. Patient Educ Couns 2023; 113:107755. [PMID: 37099839 DOI: 10.1016/j.pec.2023.107755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/04/2023] [Accepted: 04/12/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION This study explored patient experiences of shared decision making (SDM) in public acute hospitals in Ireland. METHODS Quantitative and qualitative data from three years of the Irish National Inpatient Experience Survey were analysed. Survey questions were mapped to definitions of SDM and subjected to principal components analysis. Three SDM subscales (care on the ward; treatments; discharge) and one overall SDM scale were created. Differences in experiences of SDM by aspects of care and patient group were assessed. Thematic analysis of qualitative responses was undertaken. RESULTS 39,453 patients participated in the survey. The mean SDM experience score was 7.60 ± 2.43. Experience scores were highest on the treatments sub-scale, and lowest during discharge. Patients who had a non-emergency admission, those aged 51-80 years and men had more positive experiences than other groups. Patient comments highlighted that opportunities to clarify information and facilitation of families/caregivers in SDM were found to be lacking. CONCLUSION There were differences in experiences of SDM by aspects of care and patient group. PRACTICE IMPLICATIONS Efforts to improve SDM in acute hospitals are required, particularly at the time of discharge. SDM may be improved by facilitation of more time for discussion between clinicians and patients and/or their families/caregivers.
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Affiliation(s)
- Linda Drummond
- Health Information and Quality Authority, Dublin, Ireland.
| | | | | | - Conor Foley
- Health Information and Quality Authority, Dublin, Ireland
| | - Laura O'Connor
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Rachel Flynn
- Health Information and Quality Authority, Dublin, Ireland
| | - Daniela Rohde
- Health Information and Quality Authority, Dublin, Ireland
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Ó Coimín D, Rohde D, Foley C, O’Carroll T, Murphy R. Dying, death and bereavement: developing a national survey of bereaved relatives. BMC Palliat Care 2023; 22:14. [PMID: 36823584 PMCID: PMC9947439 DOI: 10.1186/s12904-023-01135-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Assessing and measuring the experience and quality of care provided is central to the improvement of care delivery of all healthcare systems. This paper reports on the development of a survey instrument to capture the experiences of care at end of life from the perspective of bereaved relatives in the Republic of Ireland. METHODS A multi-method, multi-stakeholder, sequential approach was adopted for this study. Items for inclusion in the survey instrument bank were identified through (1) a feasibility study and scoping literature review, (2) expert panel programme board review, (3) focus groups and (4) gap analysis. The following steps were undertaken to prioritise the items for inclusion in the final survey instrument: (1) a Delphi study (2) technical expert panel review (3) cognitive interviews with bereaved relatives and an (4) expert panel programme board review. RESULTS Following an iterative process with key stakeholders, a survey instrument was developed with sections focusing on the provision of care at home, in the last nursing home / residential care facility, hospice and hospital, as well as care experience in the last 2 days of life, the relative's experiences of care and support, the circumstances of care surrounding death and demographic information. In total, a bank of 123 questions were prioritised to be included in the National End of Life Survey instrument. CONCLUSION The survey will provide a standardised national approach to capturing the experience of care of those who have died, from the perspective of bereaved relatives in the Republic of Ireland. This will allow health service providers, policy makers and regulators to gather important insights into the experiences of care at end of life and will help fulfil the requirement of healthcare services to ensure they are providing high-quality care.
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Affiliation(s)
- Diarmuid Ó Coimín
- Hospice Friendly Hospitals Programme, Quality and Patient Safety Directorate, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Daniela Rohde
- National Care Experience Programme, Health Information and Quality Authority, George’s Court, George’s Lane, Smithfield, Dublin 7, D07 E98Y Ireland
| | - Conor Foley
- National Care Experience Programme, Health Information and Quality Authority, George’s Court, George’s Lane, Smithfield, Dublin 7, D07 E98Y Ireland
| | - Tracy O’Carroll
- National Care Experience Programme, Health Information and Quality Authority, George’s Court, George’s Lane, Smithfield, Dublin 7, D07 E98Y Ireland
| | - Róisín Murphy
- National Care Experience Programme, Health Information and Quality Authority, George’s Court, George’s Lane, Smithfield, Dublin 7, D07 E98Y Ireland
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Pérez S, Rohde D. The Relationship Between Religious/Spiritual Beliefs and Subjective Well-Being: A Case-Based Comparative Cross-National Study. J Relig Health 2022; 61:4585-4607. [PMID: 35434763 PMCID: PMC9569290 DOI: 10.1007/s10943-022-01550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
The most unique aspect of religiosity/spirituality (R/S), supernatural beliefs, and their relationship with SWB has hardly been examined. This study explores the relationship between six R/S supernatural beliefs and SWB, in a case-based comparative cross-national design including two religious and two secular nations. Data were obtained from the International Social Survey Programme (ISSP) Religion IV module from the religious countries of the USA (n = 1060) and Turkey (n = 1353) and the secular countries of Denmark (n = 1281) and Czech Republic (n = 1112). SWB was measured as happiness and self-rated health. Statistical analyses were performed using binary logistic regression models replicated across countries. Results indicated that the American sample showed no evidence of relationships between R/S and SWB outcomes capable of improving the model over demographic and service attendance covariates. In Turkey, some R/S beliefs were found to be statistically significantly related to SWB, with positive and negative associations with happiness. No associations were found in the secular countries. Findings were discussed in the light of previous research and interpreted from a terror management theory perspective.
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Affiliation(s)
- Sergio Pérez
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Republic of Ireland.
- Department of Medical Gerontology, TILDA, School of Medicine, Trinity College Dublin, Dublin, Republic of Ireland.
| | - Daniela Rohde
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Republic of Ireland
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Rohde D, Foley C, Murphy R, Kelly M, Drummond L. Patient experiences of hospital care during the COVID-19 pandemic in Ireland. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
The COVID-19 pandemic has greatly impacted healthcare service delivery. This study explored patient experiences of hospital care during the COVID-19 pandemic in Ireland, using National Inpatient Experience Survey (NIES) 2021 data.
Methods
NIES is a repeat cross-sectional survey of inpatient experiences in all public acute hospitals in Ireland. Patients who spent 24+ hours in hospital and were discharged in September 2021 were eligible to participate. 7 questions addressed experiences specific to the pandemic. Comparisons between 2019 and 2021 were conducted using t-tests. Effect sizes (d) are reported. Qualitative data were thematically analysed.
Results
10,743 patients participated (42% response rate). While 68% did not feel at risk of catching COVID-19, 9% felt at risk. 35% reported that staff always helped them to keep in touch with family. There were small, statistically significant differences between 2019 and 2021 ratings, with questions on opportunity for family to talk to a doctor (d=-.328), provision of information to family (d=-.136), and being able to find staff to talk to about worries and fears (d=-.167) recording the biggest decreases. Scores for cleanliness of wards (d = 0.063) and bathrooms (d=.075), and privacy during examination or treatment in the ED (d = 0.085) improved significantly. Patients commented on their appreciation of staff, but missed having visitors, with restrictions posing challenges for those with sensory or physical impairments.
Conclusions
Given the unique challenges experienced by acute healthcare services during the COVID-19 pandemic, comparisons with pre-pandemic patient experiences should be interpreted with caution. Continuing to gather patient feedback during a pandemic presents a unique opportunity to understand the resilience of healthcare systems as they continue to operate under unprecedented pressure, with the potential to inform responses and delivery of care during future pandemics or other emergencies.
Key messages
• Visiting restrictions posed many challenges for patients and affected communication both between patients and their family members, as well as between healthcare staff and patients’ family.
• Gathering patient feedback during a pandemic presents a unique opportunity to inform responses and delivery of care during future pandemics or other emergencies.
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Affiliation(s)
- D Rohde
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
| | - C Foley
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
| | - R Murphy
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
| | - M Kelly
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
| | - L Drummond
- National Care Experience Programme, Health Information and Quality Authority , Dublin, Ireland
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Rohde D, Isazad Mashinchi M, Rizun N, Gruda D, Foley C, Flynn R, Ojo A. Generating actionable insights from free-text care experience survey data using qualitative and computational text analysis: A study protocol. HRB Open Res 2022; 5:60. [PMID: 37994330 PMCID: PMC10663659 DOI: 10.12688/hrbopenres.13606.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/24/2023] Open
Abstract
Introduction:The National Care Experience Programme (NCEP) conducts national surveys that ask people about their experiences of care in order to improve the quality of health and social care services in Ireland. Each survey contains open-ended questions, which allow respondents to comment on their experiences. While these comments provide important and valuable information about what matters most to service users, there is to date no unified approach to the analysis and integration of this detailed feedback. The objectives of this study are to analyse qualitative responses to NCEP surveys to determine the key care activities, resources and contextual factors related to positive and negative experiences; to identify key areas for improvement, policy development, healthcare regulation and monitoring; and to provide a tool to access the results of qualitative analyses on an ongoing basis to provide actionable insights and drive targeted improvements. Methods:Computational text analytics methods will be used to analyse 93,135 comments received in response to the National Inpatient Experience Survey and National Maternity Experience Survey. A comprehensive analytical framework grounded in both service management literature and the NCEP data will be employed as a coding framework to underpin automated analyses of the data using text analytics and deep learning techniques. Scenario-based designs will be adopted to determine effective ways of presenting insights to knowledge users to address their key information and decision-making needs. Conclusion:This study aims to use the qualitative data collected as part of routine care experience surveys to their full potential, making this information easier to access and use by those involved in developing quality improvement initiatives. The study will include the development of a tool to facilitate more efficient and standardised analysis of care experience data on an ongoing basis, enhancing and accelerating the translation of patient experience data into quality improvement initiatives.
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Affiliation(s)
- Daniela Rohde
- National Care Experience Programme, Health Information and Quality Authority, Dublin, Ireland
| | - Mona Isazad Mashinchi
- Maynooth University School of Business, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Nina Rizun
- Maynooth University School of Business, Maynooth University, Maynooth, Co Kildare, Ireland
- Department of Informatics in Management, Gdansk University of Technology, Gdansk, Poland
| | - Dritjon Gruda
- Maynooth University School of Business, Maynooth University, Maynooth, Co Kildare, Ireland
| | - Conor Foley
- National Care Experience Programme, Health Information and Quality Authority, Dublin, Ireland
| | - Rachel Flynn
- National Care Experience Programme, Health Information and Quality Authority, Dublin, Ireland
| | - Adegboyega Ojo
- Maynooth University School of Business, Maynooth University, Maynooth, Co Kildare, Ireland
- School of Public Policy and Administration (SPPA), Carleton University, Ottawa, K1S 5B6, Canada
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Jeffares I, Rohde D, Doyle F, Horgan F, Hickey A. The impact of stroke, cognitive function and post-stroke cognitive impairment (PSCI) on healthcare utilisation in Ireland: a cross-sectional nationally representative study. BMC Health Serv Res 2022; 22:414. [PMID: 35351125 PMCID: PMC8962254 DOI: 10.1186/s12913-022-07837-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cognitive impairment after stroke is associated with poorer health outcomes and increased need for long-term care. The aim of this study was to determine the impact of stroke, cognitive function and post-stroke cognitive impairment (PSCI) on healthcare utilisation in older adults in Ireland.
Methods
This cross-sectional study involved secondary data analysis of 8,175 community-dwelling adults (50 + years), from wave 1 of The Irish Longitudinal Study on Ageing (TILDA). Participants who had been diagnosed with stroke by a doctor were identified through self-report in wave 1. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA). The main outcome of the study was healthcare utilisation, including General Practitioner (GP) visits, emergency department visits, outpatient clinic visits, number of nights admitted to hospital, and use of rehabilitation services. The data were analysed using multivariate adjusted negative binomial regression and logistic regression. Incidence-rate ratios (IRR), odds ratios (OR) and 95% confidence intervals (CI) are presented.
Results
The adjusted regression analyses were based on 5,859 participants who completed a cognitive assessment. After adjusting for demographic and clinical covariates, stroke was independently associated with an increase in GP visits [IRR (95% CI): 1.27 (1.07, 1.50)], and outpatient service utilisation [IRR: 1.49 (1.05, 2.12)]. Although participants with poor cognitive function also visited the GP more frequently than participants with normal cognitive function [IRR: 1.07 (1.04, 1.09)], utilisation of outpatient services was lower in this population [IRR: 0.92 (0.88, 0.97)]. PSCI was also associated with a significant decrease in outpatient service utilisation [IRR: 0.75 (0.57, 0.99)].
Conclusions
Stroke was associated with higher utilisation of GP and outpatient services. While poor cognitive function was also associated with more frequent GP visits, outpatient service utilisation was lower in participants with poor cognitive function, indicating that cognitive impairment may be a barrier to outpatient care. In Ireland, the lack of appropriate neurological or cognitive rehabilitation services appears to result in significant unaddressed need among individuals with cognitive impairment, regardless of stroke status.
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Casey M, O'Connor L, Rohde D, Twomey L, Cullen W, Carroll Á. Role dimensions of practice nurses and interest in introducing advanced nurse practitioners in general practice in Ireland. Health Sci Rep 2022; 5:e555. [PMID: 35284651 PMCID: PMC8905424 DOI: 10.1002/hsr2.555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/01/2022] [Accepted: 02/14/2022] [Indexed: 11/11/2022] Open
Abstract
Background Internationally many countries have implemented strategies to enhance primary care, to strengthen their health systems to cope with an aging population, the rise of chronic conditions, and increased costs. Primary care has the potential to address these challenges, however, general practitioners are increasingly struggling to meet patient demand resulting from a growing and aging population. Expanding the role of general practice nurses to advanced nurse practitioner (ANP) level has worked internationally and could equally be a solution to the Irish context. However, their current role must first be established as well as their level of interest in becoming an ANP. Aim To explore the role of general practice nurses and their interest in becoming an ANP. Design A survey design. Method A purposeful sample of general practice nurses (n = 40) was undertaken between April and June 2019. Data were analyzed using the Statistical Package for Social Science (SPSS V 25.0; IBM). Results General practice nurses appear to have an agenda in relation to activities associated with wound care, immunizations, respiratory and cardiovascular issues. Just over half of the respondents were not interested in becoming an ANP. Their perceived challenges associated with the implementation of the role include a lack of support from general practitioners, a lack of resources, insurance issues, and a lack of understanding of the role. Challenges were associated with undertaking further training and their experience of having more work transferred to general practice without concomitant reallocation of resources. Conclusion General practice nurses have extensive clinical experience to deliver major improvements in primary care. Educational opportunities need to be provided for upskilling existing general practice nurses to advanced practice level. Greater understanding of the role and the potential contribution of the role in general practice is required among medical colleagues and the public.
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Affiliation(s)
- Mary Casey
- UCD School of Nursing, Midwifery and Health SystemsDublinIreland
| | | | - Daniela Rohde
- UCD School of Nursing, Midwifery and Health SystemsDublinIreland
| | - Liam Twomey
- UCD School of Medicine and Medical ScienceCollege of Health and Agricultural SciencesDublinIreland
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Mwakilasa MT, Foley C, O'Carroll T, Flynn R, Rohde D. Care Experiences of Older People in the Emergency Department: A Concurrent Mixed-Methods Study. J Patient Exp 2021; 8:23743735211065267. [PMID: 34917753 PMCID: PMC8669876 DOI: 10.1177/23743735211065267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The growing population of older people has increased demand to meet their complex healthcare needs, including in emergency departments (EDs). This study explored the experiences of people aged 65+ in Irish EDs, involving secondary analysis of quantitative and qualitative data from the 2019 National Inpatient Experience Survey (NIES). Experiences in the ED and overall hospital experiences were dichotomized as poor to fair or good to very good. Logistic regression was used to model quantitative data. Free text comments relating to EDs were thematically analyzed. Of 12,343 survey participants, 4,442 (39.9%) were aged 65+ years and used the ED. Longer waiting times, completion of the questionnaire by another person either with or on behalf of the patient, and having both a medical card and private health insurance were predictors of poor to fair ED experiences. Patients aged 85+ years were more likely to report good to very good ED experiences. Poor experiences in the ED were associated with poorer overall hospital experiences (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.76 to 2.73, p < .001). Thematic analysis revealed that long waiting times and unpleasant waiting conditions, including lack of communication, privacy, and personal care were important challenges encountered in the ED, with some older patients noting their preference for separate ED services. There is a need to reduce waiting times and integrate user perspectives in the planning, organization, and delivery of ED care to improve experiences and quality of care for a growing older population.
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Affiliation(s)
- Magreth Thadei Mwakilasa
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
- Muhimbili University of Health and Allied Sciences, Ilala, Tanzania
| | - Conor Foley
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Rachel Flynn
- Health Information and Quality Authority, Dublin, Ireland
| | - Daniela Rohde
- School of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
- Health Information and Quality Authority, Dublin, Ireland
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10
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Abstract
Abstract
Background
While breastfeeding may be among the most effective ways to ensure child health and survival, breastfeeding rates in Ireland are consistently low. This study aimed to explore women's experiences of infant feeding in Ireland.
Methods
Thematic analysis of feeding-related free-text comments from the National Maternity Experience Survey 2020 was undertaken. The survey collected data on the experiences of women who were 16 years or older and gave birth in one of Ireland's 19 maternity hospitals or units or had a home birth.
Results
3,204 women participated in the survey (50% response rate). In the first few days after birth, 41.9% of women breastfed exclusively, 29.0% used formula and breast milk, and 29.1% bottle fed only. 824 comments related to feeding were received. A number of themes were identified, including support and encouragement from healthcare professionals, information and education regarding feeding, and pressure and respect for personal preferences. Women highlighted that while breastfeeding was encouraged in antenatal care, this was not always the case in the postnatal ward, where formula was readily available, with an apparent lack of resources for breastfeeding women. Some women described feeling pressured to use a feeding method that was not their first preference, with some feeling pushed to breastfeed when this may not have been their wish, while women who wished to breastfeed felt pressured to supplement with formula. Staffing shortages on postnatal wards, a lack of lactation consultants and contradictory advice from healthcare professionals exacerbated difficulties with both feeding methods.
Conclusions
Some women experience a lack of practical support with infant feeding, regardless of feeding method, and clear and concise information on feeding practices is needed. The addition of lactation consultants, home supports and further education and training could benefit mothers on their breastfeeding journey.
Key messages
Barriers to breastfeeding included a lack of support from healthcare professionals and conflicting information. It is important to support women regardless of their chosen feeding method.
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Affiliation(s)
- R Murphy
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - D Rohde
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - C Foley
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - T O'Carroll
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
| | - R Flynn
- National Care Experience Programme, Health Information and Quality Authority, Mahon Cork, Ireland
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Rohde D, Ahern S, Clyne B, Comber L, Spillane S, Walsh KA, Carty PG, Drummond L, Boland T, Smith SM, Connolly MA, Harrington P, Ryan M, O'Neill M. Effectiveness of face masks worn in community settings at reducing the transmission of SARS-CoV-2: A rapid review. HRB Open Res 2020. [DOI: 10.12688/hrbopenres.13161.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: The use of face masks is part of a suite of infection prevention and control measures intended to limit the transmission of respiratory viral diseases. The use of face masks by the general public has been subject to ongoing debate, with limited direct evidence on the effectiveness of face masks in the community during the COVID-19 pandemic. The aim of this review was to synthesise direct evidence on the effectiveness of wearing face masks at reducing the transmission of SARS-CoV-2 in community settings. Methods: A rapid review was conducted. PubMed, Embase, NHS Evidence and Europe PMC were searched systematically from 1 January to 27 August 2020. Clinical trials, cohort, case control, and cross-sectional studies were included if they reported on the effectiveness of face masks in community settings at reducing the transmission of SARS-CoV-2. Studies were critically appraised and synthesised narratively. Results: Seven observational studies were identified, including one study set in households and six in community settings, that reported on the effectiveness of wearing face masks compared with not wearing face masks at reducing the transmission of SARS-CoV-2. Results suggested that face masks reduce the risk of SARS-CoV-2 infection; however, all studies were at high risk of bias and the quality of the evidence was low. Conclusions: This is to date the most comprehensive review of direct evidence on the effectiveness of wearing face masks in the community during the COVID-19 pandemic. There is limited, low certainty direct evidence that wearing face masks reduces the risk of transmission of SARS-CoV-2 in community settings. Further high quality studies are required to confirm these findings.
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Walsh KA, Jordan K, Clyne B, Rohde D, Drummond L, Byrne P, Ahern S, Carty PG, O'Brien KK, O'Murchu E, O'Neill M, Smith SM, Ryan M, Harrington P. SARS-CoV-2 detection, viral load and infectivity over the course of an infection. J Infect 2020; 81:357-371. [PMID: 32615199 PMCID: PMC7323671 DOI: 10.1016/j.jinf.2020.06.067] [Citation(s) in RCA: 444] [Impact Index Per Article: 111.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To summarise the evidence on the detection pattern and viral load of SARS-CoV-2 over the course of an infection (including any asymptomatic or pre-symptomatic phase), and the duration of infectivity. METHODS A systematic literature search was undertaken in PubMed, Europe PubMed Central and EMBASE from 30 December 2019 to 12 May 2020. RESULTS We identified 113 studies conducted in 17 countries. The evidence from upper respiratory tract samples suggests that the viral load of SARS-CoV-2 peaks around symptom onset or a few days thereafter, and becomes undetectable about two weeks after symptom onset; however, viral loads from sputum samples may be higher, peak later and persist for longer. There is evidence of prolonged virus detection in stool samples, with unclear clinical significance. No study was found that definitively measured the duration of infectivity; however, patients may not be infectious for the entire duration of virus detection, as the presence of viral ribonucleic acid may not represent transmissible live virus. CONCLUSION There is a relatively consistent trajectory of SARS-CoV-2 viral load over the course of COVID-19 from respiratory tract samples, however the duration of infectivity remains uncertain.
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Affiliation(s)
- Kieran A Walsh
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland.
| | - Karen Jordan
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland
| | - Barbara Clyne
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland; Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
| | - Daniela Rohde
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland
| | - Linda Drummond
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland
| | - Paula Byrne
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland
| | - Susan Ahern
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland
| | - Paul G Carty
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland
| | - Kirsty K O'Brien
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland
| | - Eamon O'Murchu
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland
| | - Michelle O'Neill
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland
| | - Susan M Smith
- Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland
| | - Máirín Ryan
- Health Information and Quality Authority, Smithfield, Dublin 7, Ireland; Department of Pharmacology & Therapeutics, Trinity College Dublin, Trinity Health Sciences, James Street, Dublin 8, Ireland
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Shumba J, McLoughlin A, Browne L, Schmid A, Wren MA, Hickey A, Kelly P, Bennett K, Rohde D, Sexton E. Systematic review and meta-analysis of the effect of cognitive impairment on the risk of admission to long-term care after stroke. HRB Open Res 2020. [DOI: 10.12688/hrbopenres.13055.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Admission to long-term care (LTC) post-stroke can be a significant source of costs. Studies evaluating the effect of cognitive impairment (CI) and dementia on risk of LTC admission post-stroke have not been systematically reviewed. The aim of this paper was to conduct a systematic review and meta-analysis of studies of the association between post-stroke CI/dementia and admission to LTC. Patients and methods: PubMed, PsycInfo and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched for peer-review articles in English published January 2000-June 2018. Included studies were population-based or hospital-based studies assessing the relationship between CI or dementia, and admission to LTC post-stroke. Abstracts were screened, followed by full-text review of potentially relevant articles. Relevant data was extracted using a standard form and the Crowe Critical Appraisal Tool was used for quality appraisal. Results were pooled using random-effects meta-analysis and heterogeneity was assessed using the I² statistic. Results: 18 articles were included in the review and 12 in a meta-analysis. 14/18 studies adjusted for covariates including functional impairment. Increased odds of admission to LTC was associated with post-stroke CI [Odds Ratio (CI 95%): 2.36 (1.18, 4.71), I²=77%] and post-stroke dementia [Odds Ratio (CI 95%): 2.58 (1.38 to 4.82), I²=60%]. Discussion and conclusion: Post-stroke CI and dementia increase odds of admission to LTC post-stroke, independent of functional impairment. This indicates the potential for interventions that reduce post-stroke CI and dementia to also reduce risk of admission to LTC post-stroke, and ultimately costs.
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Abstract
Since its inception in Ireland in 2007, the Nurse Prescribing Programme has prepared registered nurses and midwives to prescribe from a limited formulary in their area of clinical speciality. However, registration numbers have declined in recent years, prompting changes to the registration processes. This article present the findings of a study conducted on the prescribing behaviours, practices and confidence of registered nurse/midwife prescribers following these changes, reporting the findings from the qualitative arm of a larger mixed-method study. Interviews with participants (n=6) explored their prescribing behaviours, practices and confidence. The findings suggest that organisational and professional factors influence prescribing. Scope of practice and expert decision-making is seen to influence engagement with treatment. Interprofessional cooperation continues to develop in making prescribing decisions. There is a clear need for interprofessional education to increase cooperation between health professionals in making prescribing decisions and including national competencies for all prescribers.
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Affiliation(s)
- Áine McHugh
- Lecturer in Mental Health Nursing, Department of Nursing, Midwifery and Early Years, Dundalk Institute of Technology, Dundalk, Ireland
| | - Mary Hughes
- Associate Professor in Children’s Nursing, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Agnes Higgins
- Professor in Mental Health, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Tom Buckley
- Associate Professor Faculty of Nursing and Midwifery, Sydney Nursing Schoo, University of Sydney, NSW, Australia
| | - Andrew Cashin
- Professor of Autism and Intellectual Disability, School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Mary Casey
- Associate Professor in Nursing, UCD School of Nursing, Midwifery and Health Systems, University College Dublin
| | - Daniela Rohde
- Research Assistant, UCD School of Nursing, Midwifery and Health Systems University College Dublin
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Casey M, Rohde D, Higgins A, Buckley T, Cashin A, Fong J, Hughes M, McHugh A. “Providing a complete episode of care”: A survey of registered nurse and registered midwife prescribing behaviours and practices. J Clin Nurs 2019; 29:152-162. [DOI: 10.1111/jocn.15073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/07/2019] [Accepted: 09/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Mary Casey
- UCD School of Nursing, Midwifery and Health Systems Health Sciences Centre University College Dublin Dublin Ireland
| | - Daniela Rohde
- UCD School of Nursing, Midwifery and Health Systems Health Sciences Centre University College Dublin Dublin Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery Trinity College The University of Dublin Dublin Ireland
| | - Tom Buckley
- Faculty of Nursing and Midwifery (Sydney Nursing School) The University of Sydney Sydney NSW Australia
| | - Andrew Cashin
- School of Health and Human Sciences Southern Cross University Lismore NSW Australia
| | - Jacqueline Fong
- Faculty of Medicine and Health Susan Wakil School of Nursing and Midwifery Sydney Nursing School The University of Sydney Camperdown NSW Australia
| | - Mary Hughes
- School of Nursing and Midwifery Trinity College The University of Dublin Dublin Ireland
| | - Aine McHugh
- Department of Nursing, Midwifery & Health Studies Dundalk Institute of Technology Dundalk Ireland
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Rohde D, Gaynor E, Large M, Mellon L, Bennett K, Williams DJ, Brewer L, Hall P, Callaly E, Dolan E, Hickey A. Cognitive impairment and medication adherence post-stroke: A five-year follow-up of the ASPIRE-S cohort. PLoS One 2019; 14:e0223997. [PMID: 31622438 PMCID: PMC6797135 DOI: 10.1371/journal.pone.0223997] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/02/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Control of vascular risk factors is essential for secondary stroke prevention. However, adherence to secondary prevention medications is often suboptimal, and may be affected by cognitive impairment. Few studies to date have examined associations between cognitive impairment and medication adherence post-stroke, and none have considered whether adherence to secondary prevention medications might affect subsequent cognitive function. The aim of this study was to explore prospective associations between cognitive impairment and medication non-adherence post-stroke. METHODS A five-year follow-up of 108 stroke survivors from the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) prospective observational cohort study. Cognitive function was assessed using the Montreal Cognitive Assessment at 6 months, and a neuropsychological test battery at 5 years. Adherence to antihypertensive, antithrombotic and lipid-lowering medications was assessed using prescription refill data. RESULTS The prevalence of cognitive impairment at five years was 35.6%. The prevalence of non-adherence ranged from 15.1% for lipid-lowering agents to 30.2% for antithrombotics. There were no statistically significant associations between medication non-adherence in the first year post-stroke and cognitive impairment at 5 years, nor between cognitive impairment at 6 months and non-adherence at 5 years. Stroke survivors with cognitive impairment were significantly more likely to report receiving help with taking medications [OR (95% CI): 4.84 (1.17, 20.07)]. CONCLUSIONS This is the first study to explore the potential impact of non-adherence to secondary prevention medications on cognitive impairment in stroke survivors. Findings highlight the role of family members and caregivers in assisting stroke survivors with medication administration, particularly in the context of deficits in cognitive function. Involving family members and caregivers may be a legitimate and cost-effective strategy to improve medication adherence in stroke survivors.
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Affiliation(s)
- Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- * E-mail:
| | - Eva Gaynor
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Margaret Large
- Clinical Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Lisa Mellon
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J. Williams
- Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Linda Brewer
- Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Patricia Hall
- Clinical Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Elizabeth Callaly
- Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Eamon Dolan
- Geriatric Medicine, Connolly Hospital, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Rohde D, Gaynor E, Large M, Mellon L, Hall P, Brewer L, Bennett K, Williams D, Dolan E, Callaly E, Hickey A. The Impact of Cognitive Impairment on Poststroke Outcomes: A 5-Year Follow-Up. J Geriatr Psychiatry Neurol 2019; 32:275-281. [PMID: 31167593 DOI: 10.1177/0891988719853044] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM To explore the impact of cognitive impairment poststroke on outcomes at 5 years. METHODS Five-year follow-up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) prospective cohort. Two hundred twenty-six ischemic stroke survivors completed Montreal Cognitive Assessments at 6 months poststroke. Outcomes at 5 years included independence in activities of daily living, receipt of informal care, quality of life, and depressive symptoms. Data were analyzed using logistic and linear regression models. Adjusted odds ratios (ORs; 95% confidence interval [CI]) and β coefficients (95% CI) are reported. RESULTS One hundred one stroke survivors were followed up at 5 years. Cognitive impairment at 6 months was independently associated with worse quality of life (B [95% CI]: -0.595 [-0.943 to -0.248]), lower levels of independence (B [95% CI]: -3.605 [-5.705 to -1.505]), increased likelihood of receiving informal care (OR [95% CI]: 6.41 [1.50-27.32]), and increased likelihood of depressive symptoms (OR [95% CI]: 4.60 [1.22-17.40]). Conclusion: Cognitive impairment poststroke is associated with a range of worse outcomes. More effective interventions are needed to improve outcomes for this vulnerable group of patients.
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Affiliation(s)
| | - Eva Gaynor
- 2 Department of Medicine, RCSI, Dublin, Ireland
| | - Margaret Large
- 3 Clinical Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Lisa Mellon
- 1 Population Health Sciences, RCSI, Dublin, Ireland
| | - Patricia Hall
- 3 Clinical Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Linda Brewer
- 4 Geriatric and Stroke Medicine, RCSI and Beaumont Hospital, Dublin, Ireland
| | | | - David Williams
- 4 Geriatric and Stroke Medicine, RCSI and Beaumont Hospital, Dublin, Ireland
| | - Eamon Dolan
- 5 Geriatric Medicine, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Elizabeth Callaly
- 6 Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Anne Hickey
- 1 Population Health Sciences, RCSI, Dublin, Ireland
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Jeffares I, Merriman NA, Rohde D, McLoughlin A, Scally B, Doyle F, Horgan F, Hickey A. A systematic review and meta-analysis of the effects of cardiac rehabilitation interventions on cognitive impairment following stroke. Disabil Rehabil 2019; 43:773-788. [PMID: 31339368 DOI: 10.1080/09638288.2019.1641850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE The cardiac rehabilitation model has potential as an approach to providing rehabilitation following stroke. This review aims to identify evidence for the participation of stroke patients in cardiac/cardiovascular rehabilitation programs internationally, whether or not such programs offer a cognitive intervention as part of treatment, and the impact of rehabilitation on post-stroke cognitive function. METHOD Five electronic databases were searched from inception to 1 May 2019, namely: MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Central Register of Controlled Trials, and the Web of Science. Eligible studies included both randomized and non-randomized studies of cardiac rehabilitation-type interventions which measured cognitive function in patients with transient ischemic attack (TIA) or stroke. RESULTS Of 14,153 records reviewed, nine studies which delivered cardiac rehabilitation-type interventions to stroke patients were finally included. Only three of these studies delivered cognitive rehabilitation as part of the intervention. Cardiac rehabilitation had no statistically significant effect on cognitive function in five randomized controlled trials (standardized mean difference= 0.28, 95% CI= -0.16 to 0.73) or in three one group pre-post studies (standardized mean difference= 0.15, 95% CI= -0.03 to 0.33). CONCLUSIONS This review highlights that there are very few studies of delivery of cardiac rehabilitation to stroke patients and that the inclusion of cognitive interventions is even less common, despite the high prevalence of post-stroke cognitive impairment.IMPLICATIONS FOR REHABILITATIONThe cardiac rehabilitation model has the potential to be expanded to include patients post-stroke given the commonality of secondary prevention needs, thereby becoming a cardiovascular rehabilitation model.Up to half of patients experience cognitive impairment after stroke; suggesting that a post-stroke cardiovascular rehabilitation model should incorporate specific cognitive strategies for patients.This systematic review identified three cardiovascular rehabilitation programmes which delivered cognitive rehabilitation as part of treatment; however, evidence for efficacy is weak.
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Affiliation(s)
- Isabelle Jeffares
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A Merriman
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Affraic McLoughlin
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brendan Scally
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Casey M, Rohde D, Brady AM, Fealy G, Hegarty J, Kennedy C, McNamara M, Nicholson E, O'Connell R, O'Connor L, O'Leary D, O'Reilly P, Stokes D. Developing a new health-related policy analysis tool: An action research cooperative inquiry approach. J Nurs Manag 2019; 27:1233-1241. [PMID: 31169959 DOI: 10.1111/jonm.12804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/05/2019] [Accepted: 05/25/2019] [Indexed: 11/29/2022]
Abstract
AIM To develop a tool for the analysis of nursing, midwifery and health-related policy and professional guidance documents. BACKGROUND Analysis tools can aid both policy evaluation and policy development. However, no framework for analysing the content of professional regulation and guidance documents among health care professionals currently exists. METHOD This study used an action research, cooperative inquiry design. Data were generated from two integrative literature reviews and discussions held during the cooperative inquiry meetings. RESULTS A set of key themes to be considered in the development or evaluation of health policy or professional regulation and guidance documents were identified. These themes formed the basis of the six domains considered by the Health-related Policy Analysis Tool (HrPAT): Context, Process, Content, Stakeholder Consultation, Implementation and Evaluation. CONCLUSION Use of the HrPAT can assist in policy development, evaluation and implementation, as well as providing some retrospective analytical insights into existing health policies. IMPLICATION FOR NURSING MANAGEMENT Professional regulation documents, guidelines and policy reports should be capable of being scrutinized for their content, quality and developmental process. The HrPAT can assist relevant stakeholders in the development, analysis and evaluation of such documents, including local, service-level policies and guidelines.
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Affiliation(s)
- Mary Casey
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Daniela Rohde
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Anne-Marie Brady
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Gerard Fealy
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Josephine Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Catriona Kennedy
- Department of Nursing and Midwifery, University of Limerick, Dublin, Ireland
| | - Martin McNamara
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Emma Nicholson
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Rhona O'Connell
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Laserina O'Connor
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Denise O'Leary
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Pauline O'Reilly
- Department of Nursing and Midwifery, University of Limerick, Dublin, Ireland
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Rohde D, Gaynor E, Large M, Conway O, Bennett K, Williams DJ, Callaly E, Dolan E, Hickey A. Stroke survivor cognitive decline and psychological wellbeing of family caregivers five years post-stroke: a cross-sectional analysis. Top Stroke Rehabil 2019; 26:180-186. [PMID: 30907273 DOI: 10.1080/10749357.2019.1590972] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Family members frequently provide long-term care for stroke survivors, which can lead to psychological strain, particularly in the presence of cognitive decline. OBJECTIVES To profile anxious and depressive symptoms of family caregivers at 5 years post-stroke, and to explore associations with stroke survivor cognitive decline. METHODS As part of a 5-year follow-up of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) cohort of stroke survivors, family members completed a self-report questionnaire. Symptoms of anxiety and depression were assessed using the HADS-A and CES-D. Cognitive decline in stroke survivors was assessed from the caregiver's perspective using the IQCODE, with cognitive performance assessed by the MoCA. Data were analyzed using logistic regression models. RESULTS 78 family members participated; 25.5% exhibited depressive symptoms, 19.4% had symptoms of anxiety. Eleven stroke survivors (16.7%) had evidence of cognitive decline according to both the IQCODE and MoCA. Family members of stroke survivors with cognitive decline were significantly more likely to report symptoms of depression [age-adjusted OR (95% CI): 5.94 (1.14, 30.89)] or anxiety [age-adjusted OR (95% CI): 5.64 (1.24, 25.54)] than family members of stroke survivors without cognitive decline. CONCLUSIONS One-fifth of family caregivers exhibited symptoms of anxiety and one-quarter symptoms of depression at 5 years post-stroke. Stroke survivor cognitive decline was significantly associated with both depressive and anxious symptoms of family caregivers. Family members play a key role in the care and rehabilitation of stroke patients; enhancing their psychological wellbeing and identifying unmet needs are essential to improving outcomes for stroke survivors and families.
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Affiliation(s)
- Daniela Rohde
- a Population Health Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Eva Gaynor
- b Department of Medicine , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Margaret Large
- c Clinical Research Centre , Royal College of Surgeons in Ireland, Beaumont Hospital , Dublin , Ireland
| | - Orla Conway
- a Population Health Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - Kathleen Bennett
- a Population Health Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland
| | - David J Williams
- d Geriatric and Stroke Medicine , Royal College of Surgeons in Ireland, Beaumont Hospital , Dublin , Ireland
| | - Elizabeth Callaly
- e Geriatric Medicine , Mater Misercordiae University Hospital , Dublin , Ireland
| | - Eamon Dolan
- f Geriatric Medicine , Connolly Hospital , Dublin , Ireland
| | - Anne Hickey
- a Population Health Sciences , Royal College of Surgeons in Ireland , Dublin , Ireland
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Merriman NA, Sexton E, McCabe G, Walsh ME, Rohde D, Gorman A, Jeffares I, Donnelly NA, Pender N, Williams DJ, Horgan F, Doyle F, Wren MA, Bennett KE, Hickey A. Addressing cognitive impairment following stroke: systematic review and meta-analysis of non-randomised controlled studies of psychological interventions. BMJ Open 2019; 9:e024429. [PMID: 30819706 PMCID: PMC6398645 DOI: 10.1136/bmjopen-2018-024429] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Cognitive impairment is a pervasive outcome of stroke, reported in over half of patients 6 months post-stroke and is associated with increased disability and a poorer quality of life. Despite the prevalence of post-stroke cognitive impairment, the efficacy of existing psychological interventions for the rehabilitation of cognitive impairment following stroke has yet to be established. The aim of this study is to identify psychological interventions from non-randomised studies that intended to improve post-stroke cognitive function and establish their efficacy. DESIGN Systematic review and meta-analysis of non-randomised studies of psychological interventions addressing post-stroke cognitive impairment. DATA SOURCES Electronic searches were performed in the Pubmed, EMBASE and PsycINFO databases, the search dating from inception to February 2017. ELIGIBILITY CRITERIA All non-randomised controlled studies and quasi-randomised controlled trials examining psychological interventions to improve cognitive function following stroke were included, such as feasibility studies, pilot studies, experimental studies, and quasi-experimental studies. The primary outcome was cognitive function. The prespecified secondary outcomes were functional abilities in daily life and quality of life. METHODS The current meta-analyses combined the findings of seven controlled studies, examining the efficacy of psychological interventions compared with treatment-as-usual controls or active controls, and 13 one-group pre-post studies. RESULTS Results indicated an overall small effect on cognition across the controlled studies (Hedges' g=0.38, 95% CI=0.06 to 0.7) and a moderate effect on cognition across the one-group pre-post studies (Hedges' g=0.51, 95% CI=0.3 to 0.73). Specific cognitive domains, such as memory and attention also demonstrated a benefit of psychological interventions. CONCLUSIONS This review provides support for the potential of psychological interventions to improve overall cognitive function post-stroke. Limitations of the study, in terms of risk of bias and quality of included studies, and future research directions are explored. PROSPERO REGISTRATION NUMBER CRD42017069714.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grainne McCabe
- Library, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary E Walsh
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ashleigh Gorman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Isabelle Jeffares
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora-Ann Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Sexton E, McLoughlin A, Williams DJ, Merriman NA, Donnelly N, Rohde D, Hickey A, Wren MA, Bennett K. Systematic review and meta-analysis of the prevalence of cognitive impairment no dementia in the first year post-stroke. Eur Stroke J 2019; 4:160-171. [PMID: 31259264 DOI: 10.1177/2396987318825484] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 12/20/2018] [Indexed: 01/14/2023] Open
Abstract
Introduction Increasing attention is being paid to interventions for cognitive impairment (CI) post-stroke, including for CI that does not meet dementia criteria. The aim of this paper was to conduct a systematic review and meta-analysis of the prevalence of cognitive impairment no dementia (CIND) within one year post-stroke. Patients and methods Pubmed, EMBASE and PsychInfo were searched for papers published in English in 1995-2017. Included studies were population or hospital-based cohort studies for first-ever/recurrent stroke, assessing CIND using standardised criteria at 1-12 months post-stroke. Abstracts were screened, followed by full text review of potentially relevant articles. Data were extracted using a standard form, and study quality was appraised using the Crowe Critical Appraisal Tool. A pooled prevalence of CIND with 95% confidence intervals (CI) was estimated using random-effects meta-analysis. Heterogeneity was measured using the I2 statistic. Results A total of 7000 abstracts were screened, followed by 1028 full text articles. Twenty-three articles were included in the systematic review, and 21 in the meta-analysis. The pooled CIND prevalence was 38% [95% CI = 32-43%] (I2=92.5%, p < 0.01). Study quality emerged as one source of heterogeneity. The five studies with the highest quality scores had no heterogeneity (I2=0%, p = 0.99), with a similar pooled prevalence (39%, 95%CI = 35-42%). Other sources of heterogeneity were stroke type, inclusion of pre-stroke CI, and age at assessment time.Discussion and conclusion: Meta-analysis of available studies indicates that in the first year post-stroke, 4 in 10 patients display a level of cognitive impairment that does not meet the criteria for dementia.
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Affiliation(s)
- Eithne Sexton
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Affraic McLoughlin
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A Merriman
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nora Donnelly
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Daniela Rohde
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maev-Ann Wren
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Sexton E, Merriman N, McLoughlin A, Donnelly N, Rohde D, Williams D, Hickey A, Bennett K. 167Prevalence of Cognitive Impairment no Dementia (CIND) Post-Stroke: Systematic Review and Meta-analysis. Age Ageing 2018. [DOI: 10.1093/ageing/afy140.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eithne Sexton
- Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | | | | | - Nora Donnelly
- Economic and Social Research Institute, Dublin 2, Ireland
| | - Daniela Rohde
- Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | | | - Anne Hickey
- Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Rohde D, Gaynor E, Large M, Conwat O, Williams D, Bennett K, Callaly E, Dolan E, Hickey A. 100Cognitive Impairment in Stroke Patients Five Years Post-Stroke is Associated with Anxious and Depressive Symptoms in Family Members. Age Ageing 2018. [DOI: 10.1093/ageing/afy140.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Eva Gaynor
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Orla Conwat
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - Eamon Dolan
- James Connolly Memorial University Hospital, Blanchardstown, Dublin 15, Ireland
| | - Anne Hickey
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Merriman NA, Sexton E, Donnelly NA, McCabe G, Walsh ME, Rohde D, Gorman A, Jeffares I, Pender N, Williams D, Horgan F, Doyle F, Wren MA, Bennett KE, Hickey A. Managing cognitive impairment following stroke: protocol for a systematic review of non-randomised controlled studies of psychological interventions. BMJ Open 2018; 8:e019001. [PMID: 29326188 PMCID: PMC5781105 DOI: 10.1136/bmjopen-2017-019001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Stroke is one of the primary causes of death and disability worldwide, leaving a considerable proportion of survivors with persistent cognitive and functional deficits. Despite the prevalence of poststroke cognitive impairment, there is no established treatment aimed at improving cognitive function following a stroke. Therefore, the aims of this systematic review are to identify psychological interventions intended to improve poststroke cognitive function and establish their efficacy. METHODS AND ANALYSIS A systematic review of non-randomised controlled studies that investigated the efficacy of psychological interventions aimed at improving cognitive function in stroke survivors will be conducted. Electronic searches will be performed in the PubMed, Embase and PsycINFO databases, the search dating from the beginning of the index to February 2017. Reference lists of all identified relevant articles will be reviewed to identify additional studies not previously identified by the electronic search. Potential grey literature will be reviewed using Google Scholar. Titles and abstracts will be assessed for eligibility by one reviewer, with a random sample of 50% independently double-screened by second reviewers. Any discrepancies will be resolved through discussion, with referral to a third reviewer where necessary. Risk of bias will be assessed with the Risk of Bias in Non-randomized Studies of Interventions tool. Meta-analyses will be performed if studies are sufficiently homogeneous. This review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The quality of the evidence regarding cognitive function will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation. ETHICS AND DISSEMINATION This systematic review will collect secondary data only and as such ethical approval is not required. Findings will be disseminated through presentations and peer-reviewed publication. This review will provide information on the effectiveness of psychological interventions for poststroke cognitive impairment, identifying which psychological interventions are effective for improving poststroke cognitive function. PROSPERO REGISTRATION NUMBER CRD42017069714.
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Affiliation(s)
- Niamh A Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eithne Sexton
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Grainne McCabe
- Royal College of Surgeons in Ireland Library, Dublin, Ireland
| | - Mary E Walsh
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ashleigh Gorman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Isabelle Jeffares
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland
| | - Frances Horgan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maev-Ann Wren
- Economic and Social Research Institute, Dublin, Ireland
| | - Kathleen E Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Burns A, Webb M, Stynes G, O'Brien T, Rohde D, Strawbridge J, Clancy L, Doyle F. Implementation of a Quit Smoking Programme in Community Adult Mental Health Services-A Qualitative Study. Front Psychiatry 2018; 9:670. [PMID: 30622485 PMCID: PMC6308392 DOI: 10.3389/fpsyt.2018.00670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/20/2018] [Indexed: 01/01/2023] Open
Abstract
Little is known about the experiences of people with severe mental health difficulties in smoking cessation interventions. This study aimed to review the implementation of a smoking cessation programme across 16 community mental health day services. The aim was to establish the experience from both service user and facilitator perspectives and refine implementation for future groups. In-depth interviews were conducted with 20 service users and four focus groups held with 17 facilitators. Thematic analysis was used to analyse the data for emergent themes in relation to key enablers and barriers to implementation. Data from service users and facilitators revealed that implementation was enabled by an open and engaged recruitment approach; the resourcefulness of facilitators; programme materials and group-based format; combining the cessation programme with other and broader health initiatives; and participants' motivations, including health and money. Barriers included the structure of the service; the lack of a joined-up approach across the health services; literacy issues and the serial/logical process assumed by the programme. Barriers perceived as more specific to those with mental health difficulties included the use of smoking as a coping mechanism, lack of alternative activities/structure and lack of consistent determination. The tobacco free policy, implemented shortly before the programme, interestingly emerged as both a barrier and an enabler. In conclusion, although this group-based cessation programme in community mental health settings was well-received overall, a number of key barriers persist. A joined-up approach which addresses the culture of smoking in mental health settings, inconsistencies in smoking policies, and provides consistent cessation support, is needed. Care needs to be taken with the timing as overall it may not be helpful to introduce a new smoking cessation programme at the same time as a tobacco free policy.
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Affiliation(s)
- Annette Burns
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Greg Stynes
- EVE, Health Service Executive, Dublin, Ireland
| | - Tom O'Brien
- EVE, Health Service Executive, Dublin, Ireland
| | - Daniela Rohde
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Luke Clancy
- TobaccoFree Research Institute, Dublin Institute of Technology, Dublin, Ireland
| | - Frank Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Rohde D, Merriman NA, Doyle F, Bennett K, Williams D, Hickey A. Does cognitive impairment impact adherence? A systematic review and meta-analysis of the association between cognitive impairment and medication non-adherence in stroke. PLoS One 2017; 12:e0189339. [PMID: 29220386 PMCID: PMC5722379 DOI: 10.1371/journal.pone.0189339] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/22/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND While medication adherence is essential for the secondary prevention of stroke, it is often sub-optimal, and can be compromised by cognitive impairment. This study aimed to systematically review and meta-analyse the association between cognitive impairment and medication non-adherence in stroke. METHODS A systematic literature search of longitudinal and cross-sectional studies of adults with any stroke type, which reported on the association between any measure of non-adherence and cognitive impairment, was carried out according to PRISMA guidelines. Odds ratios and 95% confidence intervals were the primary measure of effect. Risk of bias was assessed using the Cochrane Bias Methods Group's Tool to Assess Risk of Bias in Cohort Studies, with evidence quality assessed according to the GRADE approach. We conducted sensitivity analyses according to measure of cognitive impairment, measure of medication adherence, population, risk of bias and adjustment for covariates. The protocol was registered with PROSPERO. RESULTS From 1,760 titles and abstracts, we identified 9 studies for inclusion. Measures of cognitive impairment varied from dementia diagnosis to standardised cognitive assessments. Medication adherence was assessed through self-report or administrative databases. The majority of studies were of medium risk of bias (n = 6); two studies had low risk of bias. Findings were mixed; when all studies were pooled, there was no evidence of an association between cognitive impairment and medication non-adherence post-stroke [OR (95% CI): 0.85 (0.66, 1.03)]. However, heterogeneity was substantial [I2 = 90.9%, p < .001], and the overall evidence quality was low. CONCLUSIONS Few studies have explored associations between cognitive impairment and medication adherence post-stroke, with substantial heterogeneity in study populations, and definitions and assessments of non-adherence and cognitive impairment. Further research using clear, standardised and objective assessments is needed to clarify the association between cognitive impairment and medication non-adherence in stroke.
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Affiliation(s)
- Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh A. Merriman
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Beaumont Hospital and Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Rohde D, Hickey A, Williams D, Bennett K. Cognitive impairment and cardiovascular medication use: Results from wave 1 of The Irish Longitudinal Study on Ageing. Cardiovasc Ther 2017; 35. [PMID: 28836733 DOI: 10.1111/1755-5922.12300] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 07/24/2017] [Accepted: 08/20/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Daniela Rohde
- Division of Population Health Sciences; Royal College of Surgeons in Ireland; Dublin Ireland
| | - Anne Hickey
- Division of Population Health Sciences; Royal College of Surgeons in Ireland; Dublin Ireland
| | - David Williams
- Geriatric and Stroke Medicine; Royal College of Surgeons in Ireland and Beaumont Hospital; Dublin Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences; Royal College of Surgeons in Ireland; Dublin Ireland
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Abstract
Purpose
Physical activity is associated with both physical and mental health benefits for people with psychosis. However, mental health services have been criticised for failing to adequately promote physical activities. Occupational Therapy, with its focus on meaningful everyday occupations, is well placed to incorporate physical activity interventions. The purpose of this study was to explore the experiences of men with psychosis participating in an Irish community-based football programme.
Design/methodology/approach
Six men with psychosis participated in qualitative interviews. The interviews were audio-recorded and transcribed verbatim. Interview data were analysed thematically.
Findings
Participants identified many benefits of engaging in the programme. Football became a valued part of weekly routines and fostered re-engagement with previously valued roles. Participants identified improvements in social confidence and motor and process skills, as well as a positive impact on their mental and physical health.
Originality/value
This study highlights the value and meaning of participation in football for men with psychosis, as well as demonstrating the longer-term feasibility of football as a therapeutic medium in Occupational Therapy mental health service provision. Findings could help to promote the routine use of sports interventions to mental health services.
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Rohde D, Williams D, Gaynor E, Bennett K, Dolan E, Callaly E, Large M, Hickey A. Secondary prevention and cognitive function after stroke: a study protocol for a 5-year follow-up of the ASPIRE-S cohort. BMJ Open 2017; 7:e014819. [PMID: 28348196 PMCID: PMC5372058 DOI: 10.1136/bmjopen-2016-014819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/22/2016] [Accepted: 01/06/2017] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Cognitive impairment is common following stroke and can increase disability and levels of dependency of patients, potentially leading to greater burden on carers and the healthcare system. Effective cardiovascular risk factor control through secondary preventive medications may reduce the risk of cognitive decline. However, adherence to medications is often poor and can be adversely affected by cognitive deficits. Suboptimal medication adherence negatively impacts secondary prevention targets, increasing the risk of recurrent stroke and further cognitive decline. The aim of this study is to profile cognitive function and secondary prevention, including adherence to secondary preventive medications and healthcare usage, 5 years post-stroke. The prospective associations between cognition, cardiovascular risk factors, adherence to secondary preventive medications, and rates of recurrent stroke or other cardiovascular events will also be explored. METHODS AND ANALYSIS This is a 5-year follow-up of a prospective study of the Action on Secondary Prevention Interventions and Rehabilitation in Stroke (ASPIRE-S) cohort of patients with stroke. This cohort will have a detailed assessment of cognitive function, adherence to secondary preventive medications and cardiovascular risk factor control. ETHICS AND DISSEMINATION Ethical approval for this study was granted by the Research Ethics Committees at Beaumont Hospital, Dublin and Connolly Hospital, Dublin, Mater Misericordiae University Hospital, Dublin, and the Royal College of Surgeons in Ireland. Findings will be disseminated through presentations and peer-reviewed publications.
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Affiliation(s)
- Daniela Rohde
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland
| | - Eva Gaynor
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eamon Dolan
- Department of Geriatric Medicine, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Elizabeth Callaly
- Department of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Margaret Large
- Clinical Research Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Anne Hickey
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Clos D, Skaugen G, Mazetti M, Rohde D. Wet Expansion Steam Cycles for Offshore Industry. Int J CMEM 2017. [DOI: 10.2495/cmem-v5-n1-76-86] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Fealy GM, Rohde D, Casey M, Brady AM, Hegarty J, Kennedy C, McNamara M, O'Reilly P, Prizeman G. Facilitators and barriers in expanding scope of practice: findings from a national survey of Irish nurses and midwives. J Clin Nurs 2015; 24:3615-26. [PMID: 26373786 DOI: 10.1111/jocn.12980] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2015] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES The aim was to examine current scope of practice among nurses and midwives in Ireland. The objectives were to describe practitioners' self-reported facilitators and barriers to expanding scope of practice and to develop a scope of practice barriers scale. BACKGROUND Regulatory authorities permit practice expansion, so long as it falls within accepted parameters of scope of practice. Enduring difficulties in relation to scope of practice include the difficulty of balancing practice restriction with practice expansion. DESIGN A postal survey design was used to examine registered nurses' and midwives' current scope of practice, including their experiences of facilitators and barriers to expanding practice. METHODS A stratified random sample of registered nurses and midwives in Ireland was surveyed using the Scope-QB, a 19-item self-report scope of practice barriers scale. RESULTS Based on a sample of 1010 respondents, the self-reported perceived barriers to practice expansion included fear of legal consequences, time restrictions and lack of remuneration. Professional satisfaction, patients' needs, organisational support and having access to continuing professional education were perceived as facilitators of practice expansion. Older nurses and midwives as well as nurses and midwives holding more senior promotional grades, such as clinical nurse manager grades, perceived fewer barriers than their younger and more junior counterparts. CONCLUSIONS Nurses and midwives continue to experience difficulties in relation to expanding their practice. Practitioners can operate to optimal scope of practice when practitioner-centred and workplace-based circumstances are optimal. The optimal circumstances for practice expansion exist when the facilitators of practice expansion outweigh the barriers. RELEVANCE TO CLINICAL PRACTICE Given the critical role that nurses and midwives play in modern health services, it is important that they are empowered and enabled to expand their practice and to work to full scope of practice when patient needs and service requirements warrant it.
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Affiliation(s)
- Gerard M Fealy
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Daniela Rohde
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Mary Casey
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Anne-Marie Brady
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland
| | - Catriona Kennedy
- School of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Martin McNamara
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | | | - Geraldine Prizeman
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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Ho SY, Alnashri N, Rohde D, Murphy P, Doyle F. Systematic review and meta-analysis of the impact of depression on subsequent smoking cessation in patients with chronic respiratory conditions. Gen Hosp Psychiatry 2015; 37:399-407. [PMID: 26022383 DOI: 10.1016/j.genhosppsych.2015.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 05/03/2015] [Accepted: 05/04/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To systematically review the impact of depression on subsequent smoking cessation in prospective studies of chronic respiratory patients. METHOD A systematic search of electronic databases (MEDLINE, PsycINFO, CINAHL) was conducted to identify prospective studies of chronic respiratory patients that measured depression at baseline and smoking status at follow-up, dating from 1st January 1990 to 21st February 2014. The standardized mean difference (SMD) and 95% confidence interval (CI) for the association between baseline depressive symptoms and subsequent smoking cessation was estimated from available data using random effects meta-analysis. RESULTS A total of 1314 citations were retrieved and 197 articles were further evaluated by two reviewers. Seven articles provided sufficient data to estimate the association between depressive symptoms and subsequent smoking cessation. Those with elevated depressive symptoms were significantly less likely to quit smoking at follow-up than those not reporting elevated depressive symptoms (SMD=-.31, 95% CI -.43 to -.19; I(2)=0%, P=.506). CONCLUSIONS The association between depression and subsequent smoking was poorly reported or omitted in most studies. However, the available evidence suggests that depression decreases the likelihood that patients with chronic respiratory conditions will quit smoking. Future research is needed to determine how best to manage depression and smoking cessation in this population.
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Affiliation(s)
- Shu Ying Ho
- Royal College of Surgeons in Ireland, Dublin 2, Ireland.
| | - Nora Alnashri
- Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Daniela Rohde
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland
| | - Paul Murphy
- Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Frank Doyle
- Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Dublin 2, Ireland
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Brady AM, Fealy G, Casey M, Hegarty J, Kennedy C, McNamara M, O'Reilly P, Prizeman G, Rohde D. Am I covered?': an analysis of a national enquiry database on scope of practice. J Adv Nurs 2015; 71:2402-12. [DOI: 10.1111/jan.12711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 01/04/2023]
Affiliation(s)
| | - Gerard Fealy
- School of Nursing, Midwifery & Health Systems; University College Dublin; Ireland
| | - Mary Casey
- School of Nursing, Midwifery & Health Systems; University College Dublin; Ireland
| | | | - Catriona Kennedy
- School of Nursing and Midwifery; University of Limerick; Ireland
| | - Martin McNamara
- School of Nursing, Midwifery & Health Systems; University College Dublin; Ireland
| | - Pauline O'Reilly
- Department of Nursing and Midwifery; University of Limerick; Ireland
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Fealy G, Casey M, Rohde D, Brady AM, Hegarty J, Kennedy C, McNamara M, O'Reilly P, Prizeman G. Scope of practice decision making: findings from a national survey of Irish nurses and midwives. J Clin Nurs 2015; 24:2871-80. [PMID: 26095297 DOI: 10.1111/jocn.12896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The aim was to examine and describe aspects of the current scope of practice among nurses and midwives in Ireland. The objective was to describe practitioners' decision making associated with the scope of practice. BACKGROUND Regulatory frameworks on the scope of practice describe the roles and activities an individual registrant is permitted to undertake in the course of professional practice. Research into the scope of practice has examined practitioners' perspectives on particular frameworks or their experiences of practice expansion, and suggests that frameworks are helpful in guiding practitioners; however, local circumstances and practitioner competence often determine scope of practice. DESIGN A national postal survey of registered nurses and midwives was conducted to elicit self-reports of current scope of practice. METHODS A stratified random sample of 2354 registered nurses and midwives in Ireland were surveyed using the Scope-Q, a 64-item self-report questionnaire. RESULTS While over half of the respondents consulted others when making scope of practice decisions, the majority relied on their own professional judgement, acted only when they believed that they were competent to act, and recognised the limitations of their own competence. Although a small number of statistically significant associations were observed between respondents' age and self-reported scope of practice, respondents' current scope of practice was independent of either grade or gender. CONCLUSIONS When making a decision about scope of practice, practitioners may consult other resources, including published frameworks, professional colleagues and line managers; however, most particularly, older, more experienced practitioners, rely on their own professional judgement when making scope of practice decisions. RELEVANCE TO CLINICAL PRACTICE While published scope of practice frameworks guide practitioners on how they may act in circumstances of uncertainty, regulatory authorities should continue to emphasise individual accountability and self-reliance in everyday decision making, so that practitioners' actions are grounded in local circumstances and self-assessed practitioner competence.
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Affiliation(s)
- Gerard Fealy
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin
| | - Mary Casey
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin
| | | | | | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork
| | - Catriona Kennedy
- School of Nursing and Midwifery, University of Limerick, Limerick
| | - Martin McNamara
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin
| | - Pauline O'Reilly
- Department of Nursing and Midwifery, University of Limerick, Limerick
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Kennedy C, O'Reilly P, Fealy G, Casey M, Brady AM, McNamara M, Prizeman G, Rohde D, Hegarty J. Comparative analysis of nursing and midwifery regulatory and professional bodies' scope of practice and associated decision-making frameworks: a discussion paper. J Adv Nurs 2015; 71:1797-811. [DOI: 10.1111/jan.12660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Catriona Kennedy
- Department of Nursing and Midwifery; University of Limerick; Ireland
| | - Pauline O'Reilly
- Department of Nursing and Midwifery; University of Limerick; Ireland
| | - Gerard Fealy
- UCD School of Nursing; Midwifery & Health Systems; University College Dublin; Ireland
| | - Mary Casey
- UCD School of Nursing; Midwifery & Health Systems; University College Dublin; Ireland
| | | | - Martin McNamara
- UCD School of Nursing; Midwifery & Health Systems; University College Dublin; Ireland
| | - Geraldine Prizeman
- UCD School of Nursing; Midwifery & Health Systems; University College Dublin; Ireland
| | - Daniela Rohde
- UCD School of Nursing; Midwifery & Health Systems; University College Dublin; Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery; Brookfield Health Sciences Complex; University College Cork; Ireland
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Mellon L, Doyle F, Rohde D, Williams D, Hickey A. Stroke warning campaigns: delivering better patient outcomes? A systematic review. Patient Relat Outcome Meas 2015; 6:61-73. [PMID: 25750550 PMCID: PMC4348144 DOI: 10.2147/prom.s54087] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Patient delay in presenting to hospital with stroke symptoms remains one of the major barriers to thrombolysis treatment, leading to its suboptimal use internationally. Educational interventions such as mass media campaigns and community initiatives aim to reduce patient delays by promoting the signs and symptoms of a stroke, but no consistent evidence exists to show that such interventions result in appropriate behavioral responses to stroke symptoms. Methods A systematic literature search and narrative synthesis were conducted to examine whether public educational interventions were successful in the reduction of patient delay to hospital presentation with stroke symptoms. Three databases, MEDLINE, CINAHL, and PsycINFO, were searched to identify quantitative studies with measurable behavioral end points, including time to hospital presentation, thrombolysis rates, ambulance use, and emergency department (ED) presentations with stroke. Results Fifteen studies met the inclusion criteria: one randomized controlled trial, two time series analyses, three controlled before and after studies, five uncontrolled before and after studies, two retrospective observational studies, and two prospective observational studies. Studies were heterogeneous in quality; thus, meta-analysis was not feasible. Thirteen studies examined prehospital delay, with ten studies reporting a significant reduction in delay times, with a varied magnitude of effect. Eight studies examined thrombolysis rates, with only three studies reporting a statistically significant increase in thrombolysis administration. Five studies examined ambulance usage, and four reported a statistically significant increase in ambulance transports following the intervention. Three studies examining ED presentations reported significantly increased ED presentations following intervention. Public educational interventions varied widely on type, duration, and content, with description of intervention development largely absent from studies, limiting the potential replication of successful interventions. Conclusions Positive intervention effects were reported in the majority of studies; however, methodological weaknesses evident in a number of studies limited the generalizability of the observed effects. Reporting of specific intervention design was suboptimal and impeded the identification of key intervention components for reducing patient delay. The parallel delivery of public and professional interventions further limited the identification of successful intervention components. A lack of studies of sound methodological quality using, at a minimum, a controlled before and after design was identified in this review, and thus studies incorporating a rigorous study design are required to strengthen the evidence for public interventions to reduce patient delay in stroke. The potential clinical benefits of public interventions are far-reaching, and the challenge remains in translating knowledge improvements and correct behavioral intentions to appropriate behavior when stroke occurs.
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Affiliation(s)
- Lisa Mellon
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniela Rohde
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anne Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
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Casey M, Fealy G, Kennedy C, Hegarty J, Prizeman G, McNamara M, O'Reilly P, Brady AM, Rohde D. Nurses’, midwives’ and key stakeholders’ experiences and perceptions of a scope of nursing and midwifery practice framework. J Adv Nurs 2015; 71:1227-37. [DOI: 10.1111/jan.12603] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Mary Casey
- UCD School of Nursing; Midwifery & Health Systems; University College Dublin; Belfield Ireland
| | - Gerard Fealy
- UCD School of Nursing; Midwifery & Health Systems; University College Dublin; Belfield Ireland
| | - Catriona Kennedy
- School of Nursing and Midwifery; University of Limerick; Ireland
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery; University College Cork; Ireland
| | | | - Martin McNamara
- UCD School of Nursing; Midwifery & Health Systems; University College Dublin; Belfield Ireland
| | - Pauline O'Reilly
- Department of Nursing and Midwifery; University of Limerick; Ireland
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Meyer FJ, Borst MM, Buschmann HC, Ewert R, Friedmann-Bette B, Ochmann U, Petermann W, Preisser AM, Rohde D, Rühle KH, Sorichter S, Stähler G, Westhoff M, Worth H. [Exercise testing in respiratory medicine]. Pneumologie 2013; 67:16-34. [PMID: 23325729 DOI: 10.1055/s-0032-1325901] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This document replaces the DGP recommendations published in 1998. Based on recent studies and a consensus conference, the indications, choice and performance of the adequate exercise testing method in its necessary technical and staffing setting are discussed. Detailed recommendations are provided: for arterial blood gas analysis and right heart catherterization during exercise, 6-minute walk test, spiroergometry, and stress echocardiography. The correct use of different exercise tests is discussed for specific situations in respiratory medicine: exercise induced asthma, monitoring of physical training or therapeutical interventions, preoperative risk stratification, and evaluation in occupational medicine.
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Affiliation(s)
- F J Meyer
- Klinik für Pneumologie, Gastroenterologie, Internistische Intensiv- und Beatmungsmedizin, Städtisches Klinikum Harlaching, München.
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Rohde D, Goertz M, Hayn H, Cremer U, Jakse G. Interferon-alpha and gemcitabine (2',2'-difluorodeoxycytidine) in adult and pediatric renal tumors. Int J Oncol 2012; 11:623-7. [PMID: 21528256 DOI: 10.3892/ijo.11.3.623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
2',2'-difluorodeoxycytidine (dFdC) is an active anticancer drug in different human malignancies. The present study aimed to evaluate if the activity of dFdC in renal tumors could be improved by interferon-alpha (IFN-alpha). The influence of IFN-alpha (4 h) on the cytotoxicity of dFdC was analyzed in vitro by a colorimetric assay. in vivo, nude mice with xenografts from human nephroblastoma (AC-KLxe-12) and renal cell cancer (ACHN, SN12C) were treated by dFdC +/- IFN-alpha. IFN-alpha alone resulted in no growth inhibition in vitro, but pretreatment with IFN-alpha sensitized SN12C and ACHN cells against dFdC. The additional treatment with IFN-alpha increased the CR rate of ACHN- and SN12C-mice (40%; 7%) compared to dFdC alone (20%; 0%). Xenografts from AC-KLxe-12 did all progress. In conclusion, IFN-alpha increased cytotoxicity of dFdC in vitro and tumor responses of renal cell cancer (RCC) in xenografts. Since therapy lacked activity in nephroblastoma, further studies should focus on RCC to compare the efficacy of dFdC and interferons with other types of biochemotherapy.
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Affiliation(s)
- D Rohde
- UNIV AACHEN,DEPT LEGAL MED,FAC MED,D-52057 AACHEN,GERMANY
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41
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Tong T, Rohde D, Peter S. Progress in the management of advanced renal cell carcinoma (RCC). Aktuelle Urol 2010; 41 Suppl 1:S57-60. [PMID: 20094957 DOI: 10.1055/s-0030-1247237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A more profound understanding in the pathophysiological mechanism of renal cell cancer has led to a shift in the treatment approach. Traditionally, cytokines were the frontline drugs, but recently this has transitioned to drugs interacting vascular endothelial growth factor (VEGF) related pathway. Sorafenib, sunitinib, bevacizumab, temsirolimus and everolimus have demonstrated clinical improvements in randomized trials. The purpose of this review is to summarise the current management of advanced RCC.
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Affiliation(s)
- A Haferkamp
- Klinik fur Urologie, Universitatsklinikum Im Neuenheimer Feld 110, 69120 Heidelberg.
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Machemer H, Rohde D. [Elevated PSA--what to do?]. MMW Fortschr Med 2008; 150:38-39. [PMID: 19024490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- H Machemer
- Urologische Klinik, Klinikum Darmstadt, Darmstadt
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Schmitz-Dräger B, Rohde D, Peschkes C, Ebert T, Ackermann R. Monoklonale Antikörper gegen Harnblasenkarzinome-ein Beitrag zur Verbesserung der Diagnostik? Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1061365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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45
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Krege S, Rohde D. [Off-label use: update and relevance for urology]. Aktuelle Urol 2007; 38:301-4. [PMID: 17647167 DOI: 10.1055/s-2007-980077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The use of pharmaceuticals beyond the approved indication and conditions (off-label use) is of increasing public interest in times of necessary financial constraints in public health together with the high requirements for drug safety to protect the patient. Remarkably, more than half of the therapies in oncology are performed as off-label use. The discussion on off-label use is controversial and based on different points of interests. Evaluation of therapeutic agents by the pharmaceutical industry is predominantly driven by marketing and business requirements. As a consequence, treatment of rare diseases is often only possible by off-label use, creating more or less an off-label need. Reimbursement by health-care insurance is based on the approval of a pharmaceutical substance for a particular situation, because only the rigorous licensing process assures that the verified efficacy is higher than the, often severe, adverse side effects. It is a well known fact that the sometimes adverse events, which occur on administration of substances in an off-label fashion, are not included in the information on the regular use of a given drug. Finally, physicians request a controlled off-label use, which only allows experienced colleagues and (sub)-specialized oncologists to use pharmaceuticals in an off-label fashion. Up to date no legal documents exist that provide regulations for such an off-label usage.
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Affiliation(s)
- S Krege
- Urologische Universitätsklinik Essen, Germany.
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Hahn C, Haussen RHV, Löhr M, Patsialas C, Rohde D. [Natural and artificial erections in spite of radical, non-nerve-sparing retropubic prostatectomy]. Aktuelle Urol 2007; 38:305-12. [PMID: 17647168 DOI: 10.1055/s-2006-944305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to evaluate sexual functions (SF) of patients after retropubic, non-nerve-sparing radical prostatectomy (NNS-RP). MATERIALS AND METHODS A self-assessment survey on 213 selected patients (multiple choice questionnaire, 18 questions and 80 choices with regard to pre- and postoperative SF and course of tumor disease) was performed. The analysed parameters were demographics, sexual desire, capacities for erections and intercourses, orgasm, use of potency-supporting drugs and devices, attending physicians, life quality (LQ), and S100 immunohistochemical staining on neurovasculare bundles (NVB). RESULTS The general response rate of the survey was 61.5 %. 123 data files were evaluable. 87 % of the patients reported on pre-operative erections (n = 107). Of these 12.1 % (n = 13) noticed residual nocturnal erections after NNS-RP. One patient had additional arbitrary full-erections that enabeled him to practice intercourse (< 50 % of attempts sufficient). Bilateral resections of NVB were confirmed on all histopathological specimens from erectile patients. Although 59.2 % of the patients reported on sexual desires (71/120) that persisted postoperatively, only 53.3 % (38/71) tested drugs or devices to induce or improve erections. 18 of these 38 patients (47.4 %) were finally capable of intercourses. 9 of 123 patients were sildenafil-responders, eight of them without any spontaneous erections. 23.8 % of the patients reported on a severe decrease in quality of life due to complete or partial loss of SF. However, only 62.6 % patients (77/123) asked for professional support regarding SF. For this purpose 88.3 % (68/77) consulted an urologist. CONCLUSIONS The existence of residual spontaneous erectile activities and responses on sildenafil after NNS-RP indicate some kind of functional accessory routes for innervations besides the NVB (or submaximal resections). However, the prevalence and quality of the observed erections were clinically insignificant.
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Affiliation(s)
- C Hahn
- Urologische Klinik, Klinikum Darmstadt, Germany
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Rohde D, Mihelcic V. [Does plasmatic dilution influence the validity of PSA-tests?]. Aktuelle Urol 2007; 38:137-43. [PMID: 17390276 DOI: 10.1055/s-2006-944308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study is to improve the validity of PSA-based tests by considerations of the dilutions caused by the individual plasmatic blood volume (or other relevant body fluids). MATERIALS AND METHODS Retrospective analyses of patients who underwent adenomectomy (n = 32) or radical prostatectomy (pT1 - 4 N0 M0; n = 60) were carried out. We calculated the PSA density (PSAD) and two new PSA-based parameters (mPSA (Vp), mPSAD (Vp)) that converted t-PSA concentration and PSAD with regard to individual Vp (according to Sprenger's modified Retzlaff formula). Comparative statistics of receiver operating characteristics (ROC-) curves, AUC, sensitivity, specificity, positive and negative predictive values for t-PSA, mPSA (Vp), PSAD and mPSAD (Vp) were performed. RESULTS PSA was positively correlated with local tumour stage. With regard to the whole range of t-PSA (n = 92; 0.1 - 88.4 microg/L) the diagnostic selection between prostate carcinoma (CaP) and benign disease (BPH) was significantly improved by PSAD (AUC = 0.803) and mPSAD (Vp) (AUC = 0.806) (p < or = 0.003) compared to t-PSA und mPSA (Vp) (AUC = 0.531). Within the range of 4.0 - 10.0 microg/L PSA, the areas under the ROC curves were much better for t-PSA (AUC = 0.663), mPSA (Vp) (0.694) and PSAD (0.931) in gereral; mPSAD (Vp) provided the best AUC (0.947). However, although considering Vp does demonstrate better AUCs, this tendency does not reach the level of significance (yet). CONCLUSIONS The most conclusive way to improve PSA test validity is to adjust PSA to different "volumes". Therefore, elaborated devices for a better preoperative investigation of the whole volume of the prostate gland and its distinct partial volumes (such as carcinoma or benign tissues), as well as applied knowledge on the distribution and kinetics of PSA in body fluids, might substantially help to optimise the detection of curable patients with unknown carcinoma of the prostate.
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Affiliation(s)
- D Rohde
- Urologische Klinik, Klinikum Darmstadt.
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Rüter A, Rohde D. Urologinnen in Deutschland – Geschichte und Gegenwart. Aktuelle Urol 2006. [DOI: 10.1055/s-2006-947539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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49
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Meyer F, Rohde D. Erhebung zu „Standard“-Chemotherapien urologischer Malignome. Aktuelle Urol 2006. [DOI: 10.1055/s-2006-947404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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Steiner T, Roigas J, Kirchner H, Doehn C, Heynemann H, Siebels M, Loening S, Jocham D, Fornara P, Rohde D, Stieff CG. Clinical course of patients with metastatic papillary renal cell carcinoma. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.14591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
14591 Background: For a long time it has been discussed, whether patients (pts.) with metastatic papillary renal cell carcinoma (mRCC pap) demonstrate different behaviour compared to those with clear cell mRCC. Methods: Clinical data of 61 pts. with mRCC pap were retrospectively assessed at 8 treatment centres. Results: Median follow-up was 20 (1–114) months, median age at time of diagnosis was 62 (24–85) years. Men were affected predominantly (50/61 pts.; 82%). 21 pts. (34%) showed metastases at time of diagnosis. The remaining 40 pts. had metachroneous metastatic disease. Mean time to metastases development was 30.4 (3–143; median 16.5) months. Metastatic sites were: lung (37; 61%), bone (24; 38%), liver (20; 33%), lymph nodes (24; 38%). Local recurrences occurred in 17 pts. (28%). Others sites of metastatic disease were brain in 6 pts. (10%), peritoneal carcinosis in 5 pts. (8%) and others. A surgical approach was performed primarily in 11 pts. (18%): lung 2; local recurrence and lymphomas 7; liver 1; brain 1. 26/61 pts. with metastatic disease received an immuno- (interferon-a ± interleukin-2) or immunochemotherapy (in combination with vinblastine or 5-fluorouracile) as first line treatment. In total, 42/61 pts. (69%) received an interferon- or interleukin-based immunotherapy. No treatment at all was performed in 12 pts. (20%) because of poor performance status. 5/42 pts. (11.4%) achieved an objective response to immuno(chemo)therapy. In the Kaplan-Meier-analysis, median overall survival after diagnosis of metastatic disease was estimated to be 13 ± 1.5 (95% CI 9.9–16) months for the entire study group and 12 ± 2.5 (95% CI 7.1–16.3) from the beginning of systemic treatment. Conclusions: Clinical data of a large population of pts. with mRCC pap have been assessed in this retrospective analysis for the first time. Compared to pts. with clear cell mRCC, these patients are characterized by: I) more frequent local recurrences; II) lower remission rates to immuno(chemo)therapeutic approaches; III) poorer prognosis with regard to overall survival. These findings should be taken into account when planning future studies. No significant financial relationships to disclose.
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Affiliation(s)
- T. Steiner
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - J. Roigas
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - H. Kirchner
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - C. Doehn
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - H. Heynemann
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - M. Siebels
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - S. Loening
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - D. Jocham
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - P. Fornara
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - D. Rohde
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
| | - C. G. Stieff
- Friedrich Schiller University, Jena, Germany; Humboldt-University Berlin, Berlin, Germany; Hospital Siloah, Hannover, Germany; University of Schleswig-Holstein, Luebeck, Germany; Martin-Luther-University Halle/Wittenberg, Halle/Saale, Germany; Ludwig-Maximilians-University Munich, Munich, Germany; Hospital, Darmstadt, Germany
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