An infodemiology study on exploring the quality and reliability of colorectal cancer immunotherapy information

Background: Immunotherapy is a new treatment modality which promises hope for advanced colorectal cancer patients. To our knowledge, no previous studies have evaluated the quality of patient information available on this topic online.Objective: This study will explore the quality and reliability of colorectal cancer immunotherapy information using the Journal of the American Medical Association (JAMA) and DISCERN tools.Methods: Design thinking methodology was integrated with systematic scoping reviews framework to inform our descriptive observational media analysis study. Google Chrome was used to run four searches using prespecified search terms selected according to the top patient concerns about immunotherapy. The first 20 relevant results were identified (n=80) and then duplicates were removed. Descriptive narrative univariate and bivariate analysis was done for the relevant variables.Results: The total of included websites was 17. Most websites score Conclusion: Assessing the reliability of information about cancer treatments online remains a challenge. Further research is required to understand the patient perceptions and use of online information and whether it has an impact on their behavioural health outcomes.</p

Long term antidepressant use in a cohort of older people

Objectives: Depression is the most common mental health problem in older adults and untreated is associated with significant burden of illness for patients. This study aimed to examine longitudinal patterns of antidepressant use in older adults and determine which factors were associated with changes in use. Methods: Adults aged 50 and over, from the Irish Longitudinal Study on Ageing, who participated at any one of the four TILDA waves (n = 8,175) were included in the analysis. Repeated measures latent class analysis (RMLCA) is the model-based approach we used to identify underlying subgroups in a population. Results: We found antidepressant use ranged from 6% to 10%, over a 6-year period. RMLCA identified three distinct classes of anti-depressant use. Notably, 6% of older adults were categorised in a ‘long-term antidepressant use’ class, with consistent use across all four waves, and 6% were categorised in an ‘Intermittent/ Developing Use’ class. We found long-term antidepressant use to be a characteristic of older adults with chronic conditions at baseline of study and striking low uptake of psychological and psychiatric services. Conclusions: These findings provide evidence of the complex presentations of depression with comorbidities in long-term antidepressant users. While prolonged use of antidepressants in an older cohort is often rationalised due to recurrent depression and comorbidities, this study suggests little deprescribing of antidepressants and a need for greater access and provision of psychological services tailored to later life seem necessary improve management of this condition

Toxicities and outcomes of neoadjuvant treatment in elderly patients with locally advanced rectal cancer: a scoping review protocol

Introduction Colorectal cancer remains the second  leading cause of cancer-related death in 60–79 years  old and the third leading cause of death in patients aged  80 and above. Rectal cancer accounts for approximately  a third of colorectal cancer diagnoses. The current  standard of care for managing locally advanced rectal  cancer involves a multimodal combined approach with  neoadjuvant treatment, surgery with total mesorectal  excision and adjuvant chemotherapy. Neoadjuvant  treatment can be in the form of short-course radiotherapy,  long-course concurrent radiotherapy with chemotherapy  or total neoadjuvant chemotherapy with concurrent  chemoradiotherapy followed by chemotherapy. This  scoping aims to assess the toxicity and outcome of the  different neoadjuvant treatment modalities in elderly  patients. Methods and analysis We will use Arksey and  O'Malley’s five scoping review methodology framework  stages. Searches will be conducted in Ovid Medline,  Embase, Cochrane database and CINAHL. In addition,  the researcher will hand search for all registered trials,  using a combination of terms such as “locally advanced  rectal cancer”, “neoadjuvant treatment”, and “elderly  patients.” Two independent reviewers will screen titles and  abstracts and then full text based on predefined inclusion  and exclusion criteria. Publications will be extracted  using a customised data extraction tool to include study  characteristics, research topics, exposures and outcomes. Ethics and dissemination Ethics approval is not required  as the data will be collected from the existing literature.  The findings of this study will help with future clinical  research on the topic. We will publish the findings of this  review in a peer-reviewed journal and present them at  academic conferences targeting geriatric oncology service  providers </p

An integrative review protocol on interventions to improve users’ ability to identify trustworthy online health information

Background The epidemiological transition phenomena drive the attention to focus the scope on health literacy as it has an impact on patients’ health outcomes and quality of life. Aim This paper aims to explore the implemented interventions for improving users’ ability to identify trustworthy online health information. Methodology A comprehensive search of the literature will be conducted on the following electronic biblio?graphic databases: Ovid Medline, Embase, Cochrane database, Academic search complete and APA psycinfo. Further, manual search of eligible studies reference lists will be carried out to identify other eligible studies. The search strategy will include a combination of three key blocks of terms, namely: (adult OR adults) Or (patient OR patients) OR (layperson OR laypersons) OR (caregiver OR caregivers), (Intervention OR Interventions) OR Educa?tional programs OR (health literacy And curriculum) OR Community outreach OR Interactive workshops OR (Online portal OR Patient Portals), and information seeking behavior OR consumer health information OR online information OR social media OR access to information. The results of these categories will then be combined using the AND connector. Two independent reviewers will screen and assess data quality. Disagreements will be resolved by consensus. Due to the anticipated methodological pluralism of the potentially eligible studies, a narrative synthesis of the findings on interventions aimed at improving users’ ability to identify trustworthy online information will be provided according to the pre-identified thematic areas. Furthermore, a narrative synthesis of the reported barriers and facilitators for applying these interventions by end users. Expected results and impact Given that the focus of our review findings is on understanding the breadth and depth of the global research into interventions to improve users’ ability to identify trustworthy online health information. The findings will be of great value to inform future innovative approaches to promote identification of trustable online sources for young people worldwide.</p

Mapping health, social and health system issues and applying a social accountability inventory to a problem based learning medical curriculum

Social accountability is a powerful concept. It is applied to medical education to encourage future doctors to take action to address health inequalities and overlooked health needs of disadvantaged populations. Problem-based learning (PBL) provides an ideal setting to teach medical students about these topics. The objective of this study is to explore how well the components of social accountability are covered in a pre-clinical PBL medical curriculum and to determine the usefulness of an adapted validated social accountability framework. We identified Irish health needs and social issues through a literature review. The retrieved documents were aligned to four values (relevance, equity, cost effectiveness and quality) from a validated social accountability inventory, to generate a map of social accountability values present in the Irish health system and population. We then used the adapted validated social accountability inventory to evaluate the content of the PBL medical curriculum at an Irish medical school. We identified 45 documents, which upon analysis lead to the identification of health and social issues related to social accountability. 66 pre-clinical PBL cases included demographic, health and psychosocial issues similar to the local population. Analysing along the four social accountability values, the PBL cases demonstrated room for improvement in the equity and relevance domains. Topics for expansion are Traveller health, LGBTI health, alcohol use, climate change and more. Medical educators can use the paper as an example of how to apply this methodology to evaluate PBL cases. Adapting and applying a validated framework is a useful pedagogical exercise to understand established societal values related to social accountability to inform a medical curriculum. We identified opportunities to improve the PBL cases to depict emerging global and social issu

Introducing Advanced Paramedics into the rural general practice team in Ireland – general practitioners attitudes

Introduction: As Ireland’s population increases and chronic disease becomes more prevalent, demand on limited  general practice services will increase. Nursing roles within general practice are now considered to be standard, yet  alternative allied health professional roles are under explored within an Irish context. Allied health personnel such as  Advanced Paramedics (APs) may have the capability to provide support to general practice. Aim: To explore General Practitioners’ (GPs) attitudes and opinions of integrating Advanced Paramedics (APs) into  rural general practice in Ireland. Methods: A sequential explanatory mixed methodology was adopted. A questionnaire was designed and distributed to a purposeful sample of GPs attending a rural conference followed by semi-structured interviews. Data was  recorded and transcribed verbatim and thematically analysed. Results: In total n=27 GPs responded to the survey and n=13 GPs were interviewed. The majority of GPs were  familiar with APs and were receptive to the concept of closely collaborating with APs within a variety of settings  including out-of-hours services, home visits, nursing homes and even roles within the general practice surgery. Conclusion: General Practitioner and Advanced Paramedic clinical practice dovetail within many facets of primary  care and emergency care. GPs recognise that current rural models are unsustainable and realise the potential of integrating APs into the general practice team to help support and sustain the future of rural general practice services in  Ireland. These interviews provided an exclusive, detailed insight into the world of general practice in Ireland that has  not been previously documented in this way. </p

Antidepressant medication prescribing patterns in Irish General Practice from 2016 to 2020 to assess for long term use

Background/aims The aim of this study was to identify the trends in antidepressant (AD) medication use in two Irish general practices over a 5-year period, 2016 to 2020. The rationale for this study is attributed to the growing prevalence of depression amongst the Irish general public as well as concerns surrounding long-term AD medication use. Methods The research was undertaken in 2021 examining AD prescription rates from 2016 to 2020. The medications of interest were selective serotonin and norepinephrine reuptake inhibitors (SSRI and SNRIs): sertraline, escitalopram, fuoxetine and venlafaxine. The number of medical card holders (MCH) and prescription dispensing rates were analysed for observable trends. Results AD medication use is rising amongst the Irish MCH population. The number of MCH prescribed AD grew from 9.42 to 12.3 per 100 MCH between the years 2016 and 2020, respectively. The year 2020 represented the largest proportion of MCH prescriptions, 6.32 AD prescriptions per 1000 MCH prescriptions. The years 2019 to 2020 represented the largest annual increase in prescription dispensing with a growth of 0.45 per 1000 MCH prescriptions. Annual fgures show a continual increase in AD dispensing refll rates from 4.14 to 5.67 per 1000 MCH prescriptions in 2016 and 2020, respectively. Conclusion This study illustrates a steady rise in AD medication within the general practice setting, with an observed rise in prescription dispensing rates. The high proportion of refll prescriptions demonstrates the long-term use of AD medications. This may be indicative of chronic depression or may highlight a lack of appropriate medication cessation strategies

The need for standardised methods of data collection, sharing of data and agency coordination in humanitarian settings

Humanitarian crises and emergencies are prevalent all over the world. With a surge in crises in the last decade, humanitarian agencies have increased their presence in these areas. Initiatives such as the Sphere Project and the Minimum Initial Service Package known as MISP were formed to set standards and priorities for humanitarian assistance agencies. MISP was initiated to coordinate and standardise data and collection methods and involve locals for programme sustainability. Developing policies and programmes based on available data in humanitarian crises is necessary to make evidence-based decisions.Data sharing between humanitarian agencies increases the effectiveness of rapid responses and limits duplication of services and research. In addition, standardising data collection methods helps alleviate the risk of inaccurate information and allows for comparison and estimates among different settings. Big data is a new collection method that can help assemble timely data if resources are available and turn the data into information. Further research on setting priority indicators for humanitarian situations can help guide agencies to collect quality data.</p

HIPPP: health information portal for patients and public

Cancer misinformation is becoming an increasingly complex issue. When a person or a loved one receives a diagnosis of possible cancer, that person, family and friends will try to better inform themselves in this area of healthcare. Like most people, they will turn to their clinician for guidance and the internet to better verse themselves on the topic. But can they trust the information provided online? Are there ways to provide a quick evaluation of such information in order to prevent low-quality information and potentially dangerous consequences of trusting it? In the context of the UL Cancer Research Network (ULCan), this interdisciplinary project aims to develop the Health Information Portal for Patients and Public (HIPPP), a web-based application co-designed with healthcare domain experts that helps to improve people navigate the health information space online. HIPPP will be used by patients and the general public to evaluate user-provided web-based health information (WBHI) sources with respect to the QUEST framework and return a quality score for the information sources. As a web application, HIPPP is developed with modern extreme model-driven development (XMDD) technologies in order to make it easily adaptable and evolvable. To facilitate the automated evaluation of WBHI, HIPPP embeds an artificial intelligence (AI) pipeline developed following model-driven engineering principles. Through co-design with health domain experts and following model-driven engineering principles, we have extended the Domain Integrated Modelling Environment (DIME) to include a graphical domain-specific language (GDSL) for developing websites for evaluating WBHI. This GDSL allows for greater participation from stakeholders in the development process of both the user-facing website and the AI-driven evaluation pipeline through encoding concepts familiar to those stakeholders within the modelling language. The time efficiency study conducted as part of this research found that the HIPPP evaluation pipeline evaluates a sample of WBHI with respect to the QUEST framework up to 98.79% faster when compared to the time taken by a human expert evaluator.</p

Management of psychotropic medications in adults with intellectual disability: a scoping review

Background/objective(s): Psychotropic medications are commonly prescribed among adults with intellectual disability, often in the absence of a psychiatric diagnosis. The aim of this scop?ing review is to provide an overview of the extent, range, and nature of the available research on medication use and practices and medication management in people with intellectual disability taking psychotropic medications for behaviours that challenge. Materials and methods: A scoping review of research studies (qualitative, quantitative, and mixed design) and Grey Literature (English) was carried out. Databases included: Ovid MEDLINE, Embase, CINAHL, JBI Evidence Synthesis, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, and Scopus. A three-step search strategy was followed, with results screened by two independent reviewers. Data was extracted inde?pendently by two reviewers using a data extraction tool with results mapped and presented using a narrative form supported by tables and diagrams to the research questions. Results: Following the removal of duplicates, records were screened, full texts assessed, and 49 studies were included. Medication outcomes included reduced repetitive, stereotypic, and/or aggressive behaviours. High dosing/prescribing in the setting of an absent/unclear clinical indi?cation was associated with worsening of symptoms for which psychotropics were prescribed. While psychotropics had a role in managing behaviours that challenge, reducing or discontinu?ing psychotropics is sometimes warranted. Study designs were frequently pragmatic resulting in small sample sizes and heterogeneous cohorts receiving different doses and combinations of medications. Access to multidisciplinary teams, guidelines, medication reviews, staff training, and enhanced roles for carers in decision-making were warranted to optimize psychotropic use. Conclusions: These findings can inform prescribing interventions and highlight the need for timely and comprehensive patient outcome data, especially on long-term use of high doses of psychotropics and what happens when reduce or stop prescribing these doses. </p