17 research outputs found
Epidemiology of undiagnosed depression in people with diabetes mellitus: a comparative analysis of Ireland, England and the USA
Objectives Improving detection of depression in people with diabetes is recommended. However, little is known about how different health systems compare in depression
detection. We estimated and compared the (1) prevalence of depression detection in people with and without diabetes, and (2) association between diabetes and undiagnosed depression across three health systems. Design Cross-sectional analysis of three nationally representative studies: The Irish Longitudinal Study on Ageing, the English Longitudinal Study on Ageing and the Health and Retirement Study. Setting Community-dwelling adults in Ireland, England and the USA
GPs' perspectives on prescribing for older people in primary care: a qualitative study
AimsThe aim of this study was firstly to reveal the determinants of GP prescribing behaviour for older adults in primary care and secondly to elicit GPs' views on the potential role for broad intervention strategies involving pharmacists and/or information technology systems in general practice.MethodsSemi-structured qualitative interviews were carried out with a purposive sample of GPs. Three multidisciplinary researchers independently coded the interview data using a framework approach. Emerging themes were mapped to the Theoretical Domains Framework (TDF), a tool used to apply behaviour change theories.ResultsSixteen GPs participated in the study. The following domains in the TDF were identified as being important determinants of GP prescribing behaviour: 'Knowledge', 'Skills', 'Reinforcement', 'Memory Attention and Decision Process', 'Environmental Context and Resources', 'Social Influences', 'Social/Professional Role and Identity'. Participants reported that the challenges associated with prescribing for an increasingly older population will require them to become more knowledgeable in pharmacology and drug interactions and they called for extra training in these topics. GPs viewed strategies such as academic detailing sessions delivered by pharmacists or information technology systems as having a positive role to play in optimizing prescribing.ConclusionThis study highlights the complexities of behavioural determinants of prescribing for older people in primary care and the need for additional supports to optimize prescribing for this growing cohort of patients. Interventions that incorporate, but are not limited to interprofessional collaboration with pharmacists and information technology systems, were identified by GPs as being potentially useful for improving prescribing behaviour, and therefore require further exploration
The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: a systematic review
Objective: To evaluate studies of pharmacist-led interventions on potentially inappropriate prescribing among communitydwelling
older adults receiving primary care to identify the components of a successful intervention.
Data sources: An electronic search of the literature was conducted using the following databases from inception to
December 2015: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, MEDLINE (through Ovid),
Trip, Centre for Reviews and Dissemination databases, Cochrane Database of Systematic Reviews, ISI Web of Science,
ScienceDirect, ClinicalTrials.gov, metaRegister of Controlled Trials, ProQuest Dissertations & Theses Database (Theses in
Great Britain, Ireland and North America).
Review methods: Studies were included if they were randomised controlled trials or quasi-randomised studies involving a
pharmacist-led intervention compared to usual/routine care which aimed to reduce potentially inappropriate prescribing in
older adults in primary care. Methodological quality of the included studies was independently assessed.
Results: A comprehensive literature search was conducted which identified 2193 studies following removal of duplicates.
Five studies met the inclusion criteria. Four studies involved a pharmacist conducting a medication review and providing
feedback to patients or their family physician. One randomised controlled trial evaluated the effect of a computerised tool
that alerted pharmacists when elderly patients were newly prescribed potentially inappropriate medications. Four studies
were associated with an improvement in prescribing appropriateness.
Conclusion: Overall, this review demonstrates that pharmacist-led interventions may improve prescribing appropriateness
in community-dwelling older adults. However, the quality of evidence is low. The role of a pharmacist working as part of a
multidisciplinary primary care team requires further investigation to optimise prescribing in this group of patients
Influence of providing information to participants about development of trial outcomes on response rates and attitudes to questionnaire completion: Protocol for a study within a trial'
Background: Issues with questionnaire completion introduce bias
and limit examinations in trials. Improving communication with
participants about trial processes, such as outcome and questionnaire
development, may improve questionnaire completion and response
rates. Providing information about the involvement of stakeholders in
the development of core outcome sets (COS) measured in trials may
improve responding by tapping into subjective norms and behaviour
change mechanisms. The aim of this Study Within a Trial (SWAT) is to
examine if questionnaire response rates and participantsâ attitudes
towards questionnaire completion are impacted by
providing information about COS use in a trial of a complex
intervention.
Methods: This is a randomised, single-blinded, parallel group
intervention SWAT, embedded within a feasibility trial of an infant
feeding intervention to prevent childhood obesity. The SWAT
intervention consists of a brief written description and explanation
about the development and use of a COS of infant feeding outcomes
to prevent childhood obesity, used in the trial. Participants are parents
or caregivers of infants aged two months at questionnaire
completion. Participants will be randomly assigned to receive the
SWAT intervention prior to questionnaire completion (SWAT
Intervention), or not (SWAT Comparator). The primary outcome of
interest is response rates, which will be measured as proportion of
questionnaire completion and individual item response rates.
Participantsâ attitudes will also be assessed using closed-ended and an
open-ended question to evaluate participantsâ attitudes about questionnaire completion.
Discussion: We hypothesise that providing information about
development and use of a COS will increase questionnaire response
rates and attitudes toward questionnaire completion relative to the
control condition. Findings will indicate the potential usefulness of this
strategy for improving participant attitudes and response rates in
trials
Mean trajectories of HDL-c, Non-HDL-c and log triglycerides in females and males, by haplogroup.
99% confidence intervals for all haplogroups are displayed in grey. Detailed results with confidence intervals are provided in S16 & S17 Tables in S1 File. Note the different age range on the X axis for each outcome. HDL-c, high density lipoprotein cholesterol.</p
Mean trajectories of SBP, DBP and pulse in females and males, by haplogroup.
99% confidence intervals for all haplogroups are displayed in grey. Detailed results with confidence intervals are provided in S15 Table in S1 File. SBP, systolic blood pressure; DBP, diastolic blood pressure.</p
S1 File -
BackgroundMitochondria are organelles responsible for converting glucose into energy. Mitochondrial DNA is exclusively maternally inherited. The role of mitochondrial DNA haplogroups in the aetiology of cardiometabolic disease risk is not well understood.MethodsSex-specific associations between common European mitochondrial DNA haplogroups (H, U, J, T, K, V, W, I and X) and trajectories of cardiometabolic risk factors from birth to 18 years were examined in a prospective cohort. Cardiometabolic risk factors measured from birth/mid-childhood to 18 years included body mass index (BMI), fat and lean mass, systolic and diastolic blood pressure, pulse rate, high-density lipoprotein cholesterol (HDL-c), non-HDL-c and triglycerides. Fractional polynomial and linear spline multilevel models explored the sex-specific association between haplogroups and risk factor trajectories.ResultsAmong a total of 7,954 participants with 79,178 repeated measures per outcome, we found no evidence that haplogroups U, T, J, K and W were associated with cardiometabolic risk factors compared to haplogroup H. In females, haplogroup V was associated with 4.0% (99% CI: -7.5, -0.6) lower BMI at age one but associations did not persist at age 18. Haplogroup X was associated with 1.3kg (99% CI: -2.5, -0.2) lower lean mass at age 9 which persisted at 18. Haplogroup V and X were associated with 9.3% (99% CI: -0.4, 19.0) and 16.4% (99% CI: -0.5,33.3) lower fat mass at age 9, respectively, although confidence intervals spanned the null and associations did not persist at 18. In males, haplogroup I was associated with 2.4% (99% CI: -0.5, 5.3) higher BMI at age 7; widening to 5.1% (99% CI: -0.5, 10.6) at 18 with confidence intervals spanning the null.ConclusionsOur study demonstrated little evidence of sex-specific associations between mitochondrial DNA haplogroups and cardiometabolic risk factors.</div
Pharmacist-led academic detailing intervention in primary care: a mixed methods feasibility study
Background Academic detailing is a form of continuing medical education in which a trained health professional such as a physician or pharmacist visits prescribers in their practice to provide evidence-based information. While academic detailing has been adopted in other countries, this strategy is not routinely used in Ireland. Objective The aim of this study was to assess the feasibility and acceptability to General Practitioners (GPs) of a pharmacist-led academic detailing intervention in Ireland. Setting General Practice in County Cork, Ireland. Method A mixed methods feasibility study comprising a pharmacist-led academic detailing intervention on urinary incontinence in older people, quantitative data from patient medical records, and qualitative data from focus groups with GPs. The medical records for all patients agedââ„â65 years who were attending a participating GP with a diagnosis of urinary incontinence were analysed using a before-after approach. The measures of prescribing assessed before and after the intervention were: LUTS-FORTA criteria, Drug Burden Index, and the Anticholinergic Cognitive Burden scale. Focus groups were carried out with GPs who participated in the academic detailing intervention. Main outcome measure The quantitative prescribing patterns of the GPs and their qualitative responses from the focus groups. Results Twenty-three GPs participated in the academic detailing intervention from a selection of different types of general practice. The medical records of 154 patients were analysed. There was minimal or no change in any of the prescribing measures used. Fourteen GPs attended focus groups. GPs considered the topic of urinary incontinence as relevant to general practice. Participants appreciated the succinct nature of the information in the educational materials but expressed a preference for a more easily retrievable format, such as an online version rather than paper-based. Conclusion This study demonstrated that a pharmacist-led academic detailing intervention was acceptable to GPs in Ireland. Further research is needed in a larger population evaluating the impact and cost effectiveness of academic detailing to optimise patient care
Developing a core outcome set for childhood obesity prevention: a systematic review
Synthesis of effects of infant feeding interventions to prevent childhood obesity is limited by outcome measurement and reporting heterogeneity. Core outcome sets (COSs) represent standardised approaches to outcome selection and reporting. The aim of this review is to identify feeding outcomes used in infant feeding studies to inform an infant feeding COS for obesity prevention interventions. The databases EMBASE, Medline, CINAHL, CENTRAL, and PsycINFO searched from inception to February 2017. Studies eligible for inclusion must examine any infant feeding outcome in children â€1 year. Feeding outcomes include those measured using selfâreport and/or observational methods and include dietary intake, parentâchild interaction, and parental beliefs, among others. Data were extracted using a standardised data extraction form. Outcomes were assigned to outcome domains using an inductive, iterative process with a multidisciplinary team. We identified 82 unique outcomes, representing nine outcome domains. Outcome domains were âbreast and formula feeding,â âintroduction of solids,â âparent feeding practices and styles,â âparent knowledge and beliefs,â âpractical feeding,â âfood environment,â âdietary intake,â âperceptions of infant behaviour and preferences,â and âchild weight outcomes.â Heterogeneity in definition and frequency of outcomes was noted in reviewed studies. âIntroduction of solidsâ (59.5%) and âbreastfeeding durationâ (55.5%) were the most frequently reported outcomes. Infant feeding studies focus predominantly on consumption of milks and solids and infant weight. Less focus is given to modifiable parental and environmental factors. An infant feeding COS can minimise heterogeneity in selection and reporting of infant feeding outcomes for childhood obesity prevention interventions
Parental experiences and perceptions of infant complementary feeding: a qualitative evidence synthesis
Background
Interventions to prevent childhood obesity increasingly focus on infant feeding, but demonstrate inconsistent effects. A comprehensive qualitative evidence synthesis is essential to better understand feeding behaviours and inform intervention development. The aim of this study is to synthesize evidence on perceptions and experiences of infant feeding and complementary feeding recommendations.
Methods
Databases CINAHL, EMBASE, MEDLINE, PsycINFO, Academic Search Complete, SocIndex and Maternity and Infant Care were searched from inception to May 2017. Eligible studies examined parents' experiences of complementary feeding of children