Patient involvement in the implementation of infection prevention and control guidelines and associated interventions: a scoping review

Objective: To explore patient involvement in the implementation of infection prevention and control (IPC) guidelines and associated interventions.Design: Scoping review. Methods: A methodological framework was followed to identify recent publications on patient involvement in the implementation of IPC guidelines and interventions. Initially, relevant databases were searched to identify pertinent publications (published 2013–2018). Reflecting the scarcity of included studies from these databases, a bidirectional citation chasing approach was used as a second search step. The reference list and citations of all identified papers from databases were searched to generate a full list of relevant references. A grey literature search of Google Scholar was also conducted.Results: From an identified 2078 papers, 14 papers were included in this review. Our findings provide insights into the need for a fundamental change to IPC, from being solely the healthcare professionals (HCPs) responsibility to one that involves a collaborative relationship between HCPs and patients. This change should be underpinned by a clear understanding of patient roles, potential levels of patient involvement in IPC and strategies to overcome barriers to patient involvement focusing on the professional–patient relationship (eg, patient encouragement through multimodal educational strategies and efforts to disperse professional’s power).Conclusions: There is limited evidence regarding the best strategies to promote patient involvement in the implementation of IPC interventions and guidelines. The findings of this review endorse the need for targeted strategies to overcome the lack of role clarity of patients in IPC and the power imbalances between patients and HCPs

A Mathematical Model of Breast Tumor Progression Based on Immune Infiltration

Breast cancer is the most prominent type of cancer among women. Understanding the microenvironment of breast cancer and the interactions between cells and cytokines will lead to better treatment approaches for patients. In this study, we developed a data-driven mathematical model to investigate the dynamics of key cells and cytokines involved in breast cancer development. We used gene expression profiles of tumors to estimate the relative abundance of each immune cell and group patients based on their immune patterns. Dynamical results show the complex interplay between cells and molecules, and sensitivity analysis emphasizes the direct effects of macrophages and adipocytes on cancer cell growth. In addition, we observed the dual effect of IFN-γ role= presentation style= box-sizing: border-box; max-height: none; display: inline; line-height: normal; word-spacing: normal; overflow-wrap: normal; white-space: nowrap; float: none; direction: ltr; max-width: none; min-width: 0px; min-height: 0px; border: 0px; padding: 0px; margin: 0px; position: relative; \u3eγ on cancer proliferation, either through direct inhibition of cancer cells or by increasing the cytotoxicity of CD8+ T-cells

Clinical and economic systematic literature review to support the development of an integrated care programme for chronic disease prevention and management for the Irish health system

Report prepared for the Clinical Strategy and Programmes Division (CSPD) of the Health Service Executive to support the work of integrated clinical care programmes.Based on a clinical and economic systematic review of the international literature, this report presents the evidence on integrated care programmes and generic models of care designed for chronic disease prevention and management. This evidence will support the work of integrated clinical care programmes in Ireland through the Clinical Strategy and Programmes Division of the HSE

A systematic literature review on tackling delayed discharges in acute hospitals inclusive of hospital (Re) admission avoidance

The National Clinical Strategy and Programmes was established by the Health Service Executive (HSE) to improve and standardise patient care throughout the organisation by bringing together clinical disciplines and enabling them to share innovative solutions to deliver greater benefits to every user of HSE services. The directorate has established a number of National Clinical Programmes. The Programmes are based on three main objectives: To improve the quality of care delivered to all users of HSE services To improve access to all services To improve cost effectiveness. This desk-based research review was commissioned by The Health Service Executive to inform the integrated programme for patient flow with a particular focus on Delayed Discharges in the Acute Hospital system

Leadership perspective on the implementation of guidelines on healthcare-associated infections

Background Leadership is a key component for infection prevention and control and plays an important role in the implementation of guidelines on healthcareassociated infections. A body of literature exists on healthcare workers’ perspectives on implementing these types of guidelines; however, there is a paucity of data on the leadership perspectives on implementation. This study aims to contribute to the evidence base of leadership perspectives. Objective To explore the implementation of National Clinical Guidelines pertaining to methicillin-resistant Staphylococcus aureus and Clostridium difficile from the leadership angle. Setting Healthcare organisations. Participants Clinical and non-clinical leaders. Design This research used a mixed-methods approach comprising qualitative individual interviews (n=16) and quantitative surveys (n=51) underpinned by the integrated Promoting Action on Research Implementation in Health Services framework. Results Leaders recognise the value and innovation of guidelines to support clinical practice. However, they describe barriers to implementation that prevent the full uptake of guidelines, for example, guidelines may present an ideological approach to care which differs from the contextual reality of clinical practice where resources and time are not always available. Conclusion This research highlighted that guidelines are complex interventions in complex organisations, perhaps leadership could help overcome the challenges posed by this complexity. Leadership may allow a systematic approach to all aspects of implementation despite the variety of challenges faced at different stages of implementation and sustainability of uptake of guidelines over time