Latent inhibition, aberrant salience, and schizotypy traits in cannabis users

Aberrant salience processing may underlie the link between cannabis and psychosis, as posited in individuals with schizophrenia or high schizotypy. We investigated the relative effects of cannabis use, schizotypy status, and self-reported aberrant salience experiences on salience processing, measured using a latent inhibition (LI) task (Granger et al., 2016), in a non-clinical population. A university sample of 346 participants completed the Schizotypal Personality Questionnaire (SPQ), Aberrant Salience Inventory (ASI) the modified Cannabis Experience Questionnaire (CEQmv) and the LI task. Regression models and parallel (Bayesian and frequentist) t-tests or ANOVA (or non-parametric equivalents) examined differences in LI based on lifetime or current cannabis use (frequent use during previous year), as well as frequency of use. Mann-Whitney U tests assessed differences in SPQ and ASI scores based on current cannabis use. Neither lifetime nor current cannabis use was associated with significant change in LI scores. Current cannabis use was associated with both higher ‘Disorganised’ and ‘Cognitive-perceptual’ SPQ dimension scores and higher total and sub-scale ASI scores. No association was observed between LI score and SPQ total and dimension scores. Higher scores on ‘Senses sharpening’ and the ‘Heightened cognition’ ASI subscales predicted decreased LI scores. These data support previous findings of no association between cannabis use and abnormality in other associative learning tasks in young non-clinical populations, and elaborate the previously demonstrated association between self-reported cannabis use, schizotypy and aberrant salience. The association between dimensions of ASI and LI performance suggests this task may have potential as an experimental measure of aberrant salience.</p

Structural alterations in brainstem, basal ganglia and thalamus associated with parkinsonism in schizophrenia spectrum disorders

The relative roles of brainstem, thalamus and striatum in parkinsonism in schizophrenia spectrum disorder (SSD) patients are largely unknown. To determine whether topographical alterations of the brainstem, thalamus and striatum contribute to parkinsonism in SSD patients, we conducted structural magnetic resonance imaging (MRI) of SSD patients with (SSD-P, n = 35) and without (SSD-nonP, n = 64) parkinsonism, as defined by a Simpson and Angus Scale (SAS) total score of ≥ 4 and </p

Exploring safety culture in the ICU of a large acute teaching hospital through triangulating different data sources

Safety Culture (SC) has become a key priority for safety improvement in healthcare. Studies have identified links between positive SC and improved patient outcomes. Mixed-method measurements of SC are needed to account for diverse social, cultural, and subcultural contexts within different healthcare settings. The aim of the study was to triangulate data on SC from three sources in an Intensive Care Unit (ICU) in a large acute teaching hospital. A mixed-methods approach was used, including analysing the Hospital Survey for Patient Safety Culture results, retrospective chart reviews using the Global Trigger Tool (GTT) for the ICU, and staff reporting of adverse events (AE). There was a 47% (101/216) response rate for the survey. Further, 98% of respondents stated a positive patient safety rating. The GTT identified 16 AEs and 11 AEs that were reported in the same timeframe. The triangulation of the data demonstrates the complexity of understanding components of SC in particular: learning, reporting, and just culture.</p

Exploring the role of pain as an early indicator for individuals at risk of pressure ulcer development: a systematic review

Background: Pressure ulcer (PU) development begins with an inflammatory response, arising due to pressure and shear forces causing changes to the cytoskeletal structure of cells. Thus, pain, synonymous with inflammation, may be an indicator of PU development. Aim: To explore the role of pain as an indicator of PU development and to determine how this pain was measured. Method: We searched PUBMED, CINAHL, SCOPUS, Cochrane, and EMBASE databases. A total of 879 records were returned, with eight satisfying the inclusion criteria. Narrative data synthesis was undertaken. The quality of studies was assessed using the evidence-based librarianship (EBL) checklist. Results: The studies were conducted between 2000 and 2019, and 75% (n = 6) employed a cross-sectional design. The mean sample size was 760 participants (SD = 703). Of the included studies, 87.5% (n = 7) identified that pain was associated with PU development. The most frequent pain assessment tool was the numeric rating scale (37.5%; n = 3). Using the EBL checklist, 62.5% (n = 5) of the studies scored ≥75%, reflecting validity. Linking evidence to action: Pain is associated with PU development; however, further research is required to validate these findings and assess the characteristics associated with pain as a symptom preceding PU development.</p

Prescribing differences among older adults with differing health cover and socioeconomic status: a cohort study

Introduction: As health reforms move Ireland from a mixed public-private system toward universal healthcare, it is important to understand variations in prescribing practice for patients with differing health cover and socioeconomic status. This study aims to determine how prescribing patterns for patients aged ≥ 65 years in primary care in Ireland differ between patients with public and private health cover. Methods: This was an observational study using anonymised data collected as part of a larger study from 44 general practices in Ireland (2011-2018). Data were extracted from electronic records relating to demographics and prescribing for patients aged ≥ 65 years. The cohort was divided between those with public health cover (via the General Medical Services (GMS) scheme) and those without. Standardised rates of prescribing were calculated for pre-specified drug classes. We also analysed the number of medications, polypharmacy, and trends over time between groups, using multilevel linear regression adjusting for age and sex, and hospitalisations. Results: Overall, 42,456 individuals were included (56% female). Most were covered by the GMS scheme (62%, n = 26,490). The rate of prescribing in all drug classes was higher for GMS patients compared to non-GMS patients, with the greatest difference in benzodiazepine anxiolytics. The mean number of unique medications prescribed to GMS patients was 10.9 (SD 5.9), and 8.1 (SD 5.8) for non-GMS patients. The number of unique medications prescribed to both GMS and non-GMS cohorts increased over time. The increase was steeper in the GMS group where the mean number of medications prescribed increased by 0.67 medications/year. The rate of increase was 0.13 (95%CI 0.13, 0.14) medications/year lower for non-GMS patients, a statistically significant difference. Conclusion: Our study found a significantly larger number of medications were prescribed to patients with public health cover, compared to those without. Increasing medication burden and polypharmacy among older adults may be accelerated for those of lower socioeconomic status. These findings may inform planning for moves towards universal health care, and this would provide an opportunity to evaluate the effect of expanding entitlement on prescribing and medications use.</p

Communication and contextual factors in robotic-assisted surgical teams: protocol for developing a taxonomy

Background: Robotic-assisted surgery (RAS) has been rapidly integrated into surgical practice in the past few decades. The setup in the operating theater for RAS differs from that for open or laparoscopic surgery such that the operating surgeon sits at a console separate from the rest of the surgical team and the patient. Communication and team dynamics are altered due to this physical separation and visual barriers imposed by the robotic equipment. However, the factors that might comprise effective communication among members of RAS teams and the contextual factors that facilitate or inhibit effective communication in RAS remain unknown. Objective: We aim to develop a taxonomy of communication behaviors and contextual factors that influence communication in RAS teams. We also aim to examine the patterns of communication behaviors based on gender. Methods: We will first perform a scoping review on communication in RAS to develop a preliminary taxonomy of communication based on the existing literature. We will then conduct semistructured interviews with RAS team members, including the surgeon, assisting surgeon or trainee, bedside or first assistant, nurses, and anesthetists. Participants will represent different disciplines, including urology, general surgery, and gynecology, and have a range of experiences in RAS. We will use a reflexive thematic analysis to analyze the data and further refine the taxonomy. We will also observe live robotic surgeries at Royal College of Surgeons in Ireland (RCSI)-affiliated hospitals. We will observe varying lengths and conditions of RAS procedures to a capture a wide range of communication behaviors and contextual factors to help finalize the taxonomy. Although we anticipate conducting 30 interviews and 30 observations, we will collect data until we achieve data sufficiency. We will conduct data collection in parallel with data analysis such that if we identify a new behavior in an interview, we will follow up with questions related to that behavior in additional interviews and/or observations. Results: The taxonomy from this project will include a list of actionable communication behaviors, contextual factors, their descriptions, and examples. As of May 2024, this project has been approved by the RCSI Research and Ethics Committee. Data collection started in June 2024 and will continue throughout the year. We plan to publish the findings as meaningful results emerge in our data analysis in 2024 and 2025. Conclusions: The results from this project will be used to observe and train surgical teams in a simulated environment to effectively communicate with each other and prevent communication breakdowns. The developed taxonomy will also add to the knowledge base on the role of gender in communication in RAS and produce recommendations that can be incorporated into training. Overall, this project will contribute to the improvement of communication skills of surgical teams and the quality and safety of patient care.</p

The impact of clinical result acquisition and interpretation on task performance during a simulated pediatric cardiac arrest: a multicentre observational study

Purpose: The acquisition and interpretation of clinical results during resuscitations is common; however, this can delay critical clinical tasks, resulting in increased morbidity and mortality. This study aims to determine the impact of clinical result acquisition and interpretation by the team leader on critical task completion during simulated pediatric cardiac arrest before and after team training. Methods: This is a secondary data analysis of video-recorded simulated resuscitation scenarios conducted during Teams4Kids (T4K) study (June 2011-January 2015); scenarios included cardiac arrest before and after team training. The scenario included either a scripted paper or a phone call delivery of results concurrently with a clinical transition to pulseless ventricular tachycardia. Descriptive statistics and non-parametric tests were used to compare team performance before and after training. Results: Performance from 40 teams was analyzed. Although the time taken to initiate CPR and defibrillation varied depending on the type of interruption and whether the scenario was before or after team training, these findings were not significantly associated with the leader's behaviour [Kruskal-Wallis test (p > 0.05)]. An exact McNemar's test determined no statistically significant difference in the proportion of leaders involved or not in interpreting results between and after the training (exact p value = 0.096). Conclusions: Team training was successful in reducing time to perform key clinical tasks. Although team training modified the way leaders behaved toward the results, this behaviour change did not impact the time taken to start CPR or defibrillate. Further understanding the elements that influence time to critical clinical tasks provides guidance in designing future simulated educational activities, subsequently improving clinical team performance and patient outcomes.</div

The impact of hospital presentation time on stroke outcomes: a nationally representative Irish cohort study

Objectives: There is conflicting evidence regarding the outcomes of acute stroke patients who present to hospital within normal working hours ('in-hours') compared with the 'out-of-hours' period. This study aimed to assess the effect of time of stroke presentation on outcomes within the Irish context, to inform national stroke service delivery. Materials and methods: A secondary analysis of data from the Irish National Audit of Stroke (INAS) from Jan 2016 to Dec 2019 was carried out. Patient and process outcomes were assessed for patients presenting 'in-hours' (8:00-17:00 Monday-Friday) compared with 'out-of-hours' (all other times). Results: Data on arrival time were available for 13,996 patients (male 56.2%; mean age 72.5 years), of which 55.7% presented 'out-of-hours'. In hospital mortality was significantly lower among those admitted 'in-hours' (11.3%, n = 534) compared with 'out-of-hours' (12.8%, n = 749); (adjusted Odds Ratio (OR) 0.82; 95% Confidence Interval CI [95% CI] 0.72-0.89). Poor functional outcome at discharge (Modified Rankin Scale ≥ 3) was also significantly lower in those presenting 'in-hours' (adjusted OR 0.79; 95% CI 0.68-0.91). In patients receiving thrombolysis, mean door to needle time was shorter for 'in-hours' presentation at 55.8 mins (n = 562; SD 35.43 mins), compared with 'out-of-hours' presentation at 80.5 mins (n = 736; SD 38.55 mins, p Conclusion: More than half of stroke patients in Ireland present 'out-of-hours' and these presentations are associated with a higher mortality and a lower odds of functional independence at discharge. It is imperative that stroke pathways consider the 24 hour period to ensure the delivery of effective stroke care, and modification of 'out-of-hours' stroke care is required to improve overall outcomes.</p

Drug-drug interactions and their association with adverse health outcomes in the older community-dwelling population: a prospective cohort study

Background: Evidence on associations between drug-drug interactions (DDIs) and health outcomes in the older community-dwelling population is limited. Objective: We estimate potentially clinically important DDI prevalence and examine the association between DDIs and (1) adverse drug events (ADEs), (2) emergency hospital attendance and (3) health-related quality of life (HRQoL) in an older community-dwelling population in Ireland. Methods: This is a prospective cohort study of community-dwelling older adults (N = 904) aged ≥ 70 years from 15 general practices in Ireland recruited in 2010 (wave-1) and followed-up over 2 years (wave-2; 2012-2013), with linked national pharmacy claims data. Individuals dispensed two or more drugs (wave-1: N = 842; wave-2: N = 763) were included. DDI prevalence at baseline, follow-up and 6 months prior to each health outcome was estimated. Multi-level regression was used to model the association between DDI-exposure and health outcomes at follow-up. DDI prevalence, adjusted incidence-rate ratios (aIRR), adjusted odds ratios (aOR), β coefficients and robust standard error (RSE) from multi-level regression analyses, and 95% confidence intervals (CIs) are reported. Results: At wave-1, n = 196 (23.3% [95% CI 20.5-26.3]), individuals were potentially exposed to ≥ 1 DDI, increasing to n = 345 (45.2% [41.7-48.9]) at wave-2. At 2-year follow-up, the median number of ADEs was 3 (interquartile range [IQR 2-5]); 229 (30.1%) had ≥ 1 emergency hospital attendance, and the mean EQ-5D was 0.74 (± 0.23). Evidence for the association between DDI-exposure and emergency hospital attendance at follow-up was lacking (aOR = 1.38 [0.42-4.53]). DDI-exposure was associated with an increasing number of ADEs (aIRR = 1.26 [1.03-1.55]), and decreasing EQ-5D utility (β = - 0.07, [-0.11 to -0.04], RSE = 0.02). Aspirin-warfarin, clarithromycin-prednisolone, amiodarone-furosemide, clarithromycin-salbutamol, rosuvastatin-warfarin, amiodarone-bisoprolol, and aspirin-nicorandil were common DDIs 6 months preceding these health outcomes. Conclusions: We found a two-fold increase in DDI prevalence between wave 1 and 2. DDI exposure was associated with increasing ADEs and declining HRQoL at 2-year follow-up. Common DDIs involved anticoagulants, cardiovascular and antimicrobial drugs, which should be targeted for medicine optimisation.</p

Medicines Optimisation in Older Adults with Cancer

Background: The global burden of cancer is rapidly increasing, driven to a large extent by advancing population age. The care of an older adult with cancer is complex, and often involves the prescription of multiple medications for co-existing illnesses, alongside medications for the treatment of cancer. The aim of this thesis is to examine medicines optimisation in older adults with cancer.  Methods: This thesis comprises four studies: (1) a systematic scoping review of interventions to optimise medication prescribing and adherence in older adults with cancer; (2) the development of criteria for identifying potentially inappropriate prescribing (PIP) in older adults with cancer receiving palliative care via a Delphi consensus approach; (3) a retrospective observational study to determine PIP in older adults with cancer receiving specialist palliative care; (4) a qualitative interview study to explore the views and experiences of older adults with cancer and carers regarding medication prescribing and use.  Results: The scoping review highlighted a lack of robust evaluations of interventions aimed at optimising prescribing and adherence in older adults with cancer. A consensus-agreed set of prescribing criteria were developed for identifying PIP of medications for symptomatic relief in older adults with cancer who are receiving palliative care and limited life expectancy. The retrospective analysis study found that the number of medications prescribed to older adults with cancer increased as time to death approached, and the prevalence of PIP ranged from 12.8% to 30%. The interview study provided a rich and detailed description of the healthcare experiences of older adults with cancer and their carers, particularly regarding medication prescribing and use.  Conclusion: This thesis adds to the existing literature by providing an overview of interventions that have targeted medication optimisation in older adults with cancer. It also demonstrates that PIP is prevalent in this patient cohort, in the last week of life. The PIP-CPC criteria were developed to reduce PIP, although further research is needed to examine the applicability and acceptability of the tool in clinical practice. The interview study provides valuable insights into the views opinions of older adults with cancer and their carers, which should be taken into account when considering ways of optimising medications in this cohort. </p