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

On-farm treatment of dairy soiled water using aerobic woodchip filters

Dairy soiled water (DSW) is produced on dairy farms through the washing-down of milking parlours and holding areas, and is generally applied to land. However, there is a risk of nutrient loss to surface and ground waters from land application. The aim of this study was to use aerobic woodchip filters to remove organic matter, suspended solids (SS) and nutrients from DSW. This novel treatment method would allow the re-use of the final effluent from the woodchip filters to wash down yards, thereby reducing water usage and environmental risks associated with land spreading. Three replicate 100 m(2) farm-scale woodchip filters, each 1 m deep, were constructed and operated to treat DSW from 300 cows over an 11-month study duration. The filters were loaded at a hydraulic loading rate of 30 L m(-2) d(-1), applied in four doses through a network of pipes on the filter surface. Average influent concentrations of chemical oxygen demand (COD), SS and total nitrogen (TN) of 5750 +/- 1441 mg L-1, 602 +/- 303 mg L-1 and 357 +/- 100 mg L-1, respectively, were reduced by 66, 86 and 57% in the filters. Effluent nutrient concentrations remained relatively stable over the study period, indicating the effectiveness of the filter despite increasing and/or fluctuating influent concentrations. Woodchip filters are a low cost, minimal maintenance treatment system, using a renewable resource that can be easily integrated into existing farm infrastructure. (C) 2011 Elsevier Ltd. All rights reserved.peer-reviewe

Comparison of a stratified and a single-layer laboratory sand filter to treat dairy soiled water from a farm-scale woodchip filter

Journal articleWashing-down parlours and standing areas, following milking on dairy farms, produces dairy soiled water (DSW) that contains variable concentrations of nutrients. Aerobic woodchip filters can remove organic matter, nutrients and suspended solids (SS) in DSW, but the effluent exiting the filters may have to be further treated before it is suitable for re-use for washing yard areas. The performance of a single-layer sand filter (SF) and a stratified SF, loaded at a 20 L m-2 d-1, to polish effluent from a woodchip filter was investigated over 82 days. Average influent unfiltered chemical oxygen demand (CODT), total nitrogen (TN), ammonium-N (NH4-N), ortho-phosphorus (PO4-P) and SS concentrations of 1991±296, 163±40, 42.3±16.9, 27.2±6.9 and 84±30 mg L-1 were recorded. The single-layer SF decreased the influent concentration of CODT, TN, NH4-N, PO4-P and SS by 39, 36, 34, 58 and 52%, respectively. Influent concentrations of CODT, TNT, NH4-N, PO4-P and SS were decreased by 56, 57, 41, 74 and 62% in the stratified SF. The single-layer SF and the stratified SF were capable of reducing the influent concentration of total coliforms by 96 and 95%, respectively. Although a limited amount of biomass accumulated in the upper-most layers of both SFs, organic and particulate matter deposition within both filters affected rates of nitrification.  Both types of SFs produced final water quality in excess of the standards for re-use in the washing of milking parlours.Teagas