Evaluation of the impact and implementation of a national clinical programme for the management of self-harm in hospital emergency departments: study protocol for a natural experiment

Background A National Clinical Programme for the Management of Hospital-Presenting Self-Harm (NCP-SH) was introduced in Ireland in 2014. This involved the development of a model of care to standardise the management of self-harm in emergency departments, to be delivered by dedicated clinical nurse specialists. The core components of the programme were to: ensure an empathic and timely response, conduct a biopsychosocial assessment, involve family members in assessment and discharge planning, and provide a bridge to next care. The overall aim of the programme was to reduce the rate of repeat self-harm. This multistage study will evaluate the impact of the NCP-SH on hospital-presenting self-harm and to identify determinants influencing its implementation. Methods Employing a sequential mixed methods design, the first stage will use data from the National Self-Harm Registry Ireland to examine the impact of the NCP-SH on self-harm repetition, along with other aspects of care, including provision of psychosocial assessments and changes in admissions and postdischarge referrals. A cost-effectiveness analysis will assess the cost per repeat self-harm attendance avoided as a result of the NCP-SH. The second stage will identify the influences of implementation fidelity—adherence to the programme’s core components—using a combination of document analysis and semistructured interviews with staff of the programme, guided by the Consolidated Framework for Implementation Research. Ethics and dissemination This study has received full ethical approval and will run until August 2023. This study is novel in that it will identify important factors influencing successful implementation of complex programmes. It is expected that the findings will provide important learnings for the integration of mental health services in general hospital settings and will be disseminated via peer-review publications along with reports for clinicians and policy-makers

An exploration of men's experiences of undergoing active surveillance for favourable-risk prostate cancer: A mixed methods study protocol

BACKGROUND: Prostate cancer is one of the most common male cancers worldwide. Active Surveillance (AS) has been developed to allow men with lower risk disease to postpone or avoid the adverse side effects associated with curative treatments until the disease progresses. Despite the medical benefits of AS, it is reported that living with untreated cancer can create a significant emotional burden for patients. METHODS/DESIGN: The aim of this study is to gain insight into the experiences of men eligible to undergo AS for favourable-risk PCa. This study has a mixed-methods sequential explanatory design consisting of two phases: quantitative followed by qualitative. Phase 1 has a multiple point, prospective, longitudinal exploratory design. Ninety men diagnosed with favourable-risk prostate cancer will be assessed immediately post-diagnosis (baseline) and followed over a period of 12 months, in intervals of 3 month. Ninety age-matched men with no cancer diagnosis will also be recruited using peer nomination and followed up in the same 3 month intervals. Following completion of Phase 1, 10-15 AS participants who have reported both the best and worst psychological functioning will be invited to participate in semi-structured qualitative interviews. Phase 2 will facilitate further exploration of the quantitative results and obtain a richer understanding of participants' personal interpretations of their illness and psychological wellbeing. DISCUSSION: To our knowledge, this is the first study to utilise early baseline measures; include a healthy comparison group; calculate sample size through power calculations; and use a mixed methods approach to gain a deeper more holistic insight into the experiences of men diagnosed with favourable-risk prostate cancer

Treatment of dairy soiled water using an aerobic woodchip filter and a sand filter

The milking process produces dairy soiled water (DSW) that contains variable concentrations of nutrients. The most common method of disposal is by application to land. However, this practice can result in the pollution of nearby receiving water bodies. It is proposed that aerobic woodchip filters would decrease contaminant concentrations of nutrients in DSW. A laboratory-based experiment investigated woodchip as a filter medium to treat DSW. Subsequently, farm-scale filters investigated the system under normal farm conditions. The effectiveness of two types of sand filters (SFs), single-layer and stratified, were compared to treat effluent from the farm-scale woodchip filters. 0.5, 1, and 1.5 m-deep laboratory filters (n=3) containing Sitka Spruce (Picea sitchensis (Bong.) Carr.) treated DSW at two loading rates: 280 g suspended solids (SS) m-2 d-1 (S1) and 840 g SS m-2 d-1 (S2). Average chemical oxygen demand (COD), SS and total nitrogen (TN) decreases of 95, 99 and 88 %, respectively, were achieved and the effect of depth was negligible. Based on these findings, three replicated farm-scale 1 m-deep filters, each with a surface area of 100 m2, were constructed and loaded at 30 L m-2 d-1 for 11 months. Average decreases of 65, 84 and 60 % for COD, SS and TN, respectively, were achieved. Three replicated single-layer SFs and stratified SFs were operated for 82 days and loaded at 20 L m-2 d-1 with the effluent from the farm-scale filters. Average influent COD, SS and TN concentrations were decreased by an average of 39, 52 and 36 % for the single-layer SFs and 56, 62 and 57 % for the stratified SFs, respectively. These results demonstrate the potential use of woodchip as a filter medium for treating DSW to produce an effluent for re-use in washing yards, or for application to land as an organic fertiliser. This would reduce water usage and the environmental risks associated with land spreading. Woodchip filters are a low cost, minimal maintenance treatment system, using a renewable resource, which can be easily integrated into existing farm infrastructure

Economic evaluation of a range of options for the management of soiled water/dilute slurry on Irish dairy farms

Dairy soiled water (DSW) is water collected from concreted areas, hard stand areas and holding areas for livestock that has become contaminated by livestock faeces or urine, and parlour washings and must be managed in compliance to the Nitrates Directive S.I.610.2010. The objectives of this study were to evaluate the economic outcomes from a range of options for the management of DSW on Irish grass based dairy production systems. The management options evaluated were DSW stored separately for 10 days, DSW recycled using a woodchip and a sand filter, and DSW mixed together with slurry. The different options investigated centred around contrasting methods of DSW storage and application. The overall mean net costs for storage, treatment and application were €242, €1536 and €849 respectively . The mean savings were €15 per cow across management options, consisting of savings from fertiliser, water, increased herbage DM production. The management option of storing DSW with slurry had higher savings compared to MO1 and MO2, which were attained from extending the grazing season length, using low cost storage and application methods combined with strategic application during the growing season for optimum NFRV and DM response