Now showing 1 - 7 of 7
  • Publication
    Healthcare Assistants and Qualified Carers, A Trained, but Untapped Underutilised Resource: A population-based study in Ireland of skillset, career satisfaction, wellbeing and change across all sectors and care settings
    INTRODUCTION: This report addresses aspects of the function, wellbeing and satisfaction of healthcare assistants and qualified carers in Ireland. The study on which it is based was undertaken under the auspices of the Irish Healthcare Assistants and Carers Ireland Social Association. It set out to elicit the views of carers about their background, training, skillset, work environments and conditions, career satisfaction and aspirations and is based on responses from almost 2,000 healthcare assistants and carers. It is the first study of its kind in Ireland. The report provides a historical perspectives on the evolution of the caring role in Ireland and internationally with the development of hospitals and healthcare. In parallel with this there have been changes in the perception of the role and those who carry it out, the training required and in the value placed on it by society. METHODS: This is a quantitative, cross-sectional population-based study of Healthcare Assistants and Qualified Carers in Ireland. The population for this study were all members of HCA and Carers Ireland, the national association and support network for Healthcare Assistants and Qualified Carers in Ireland. Participants were employed in different areas of care during the study period, which lasted two weeks to allow for work schedules and shift work and to obtain as many responses. All data collected was anonymous and was collected using two published and validated research instruments, The General Well-being Schedule (GWBS) and The Minnesota Career Satisfaction Survey (MCSS). The instruments were incorporated into an accessible Google form for online distribution. Descriptive and comparative statistics were carried out to analyse the data collected. RESULTS: Skills acquired in training appear to be closely aligned with those needed in practice. Three quarters of respondents reported training in activities of daily living (ADL); almost half reported training in dementia care; 20% reported both training and use in practice of skills relating to medication administration. It is of note, however that 16% of respondents did not have a full formal qualification in caring. In terms of general satisfaction with their chosen career 11% of respondents reported with a high degree of satisfaction, while 87% of respondents reported an average level of satisfaction. Of note, 6% reported a high degree of Intrinsic satisfaction (i.e. satisfaction with occupational condition) while 91% reported average satisfaction. Responses to the General Wellbeing Schedule (GWS) demonstrated more than half (54%) reported positive (41%) or low positive (13%) wellbeing; 13% reported marginal wellbeing while 31% appear to be experiencing significant stress or distress. CONCLUSION: This study aimed to provide real, precise information for policy makers, institutions and companies to inform policy, legislation and change from the perspective of the population it affects. The study did find that there is still much room for improvement for the development of the role, legislation, policy and skillset of healthcare assistants and qualified carers. Regarding general wellbeing, there still remains issues regarding stress problems, which the population suspect is from their occupation; this was found to be statistically significant. In relation to career satisfaction, a majority of the study population are in a grey area regarding how satisfied they are with their occupation. There still remains many opportunities to entice people into the occupation which have not been availed of yet; but accreditisied professionalisation of the role is required to ensure that Ireland stay in line with international guidelines and continue to protect and ensure patient safety, worker mental health and betterment of public health.
  • Publication
    Community first responders for out-of-hospital cardiac arrest (Protocol)
    This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the impact of mobilizing community first responders (CFRs) to out-of-hospital cardiac arrest events in the community.
      198Scopus© Citations 26
  • Publication
    Community first responders for out-of-hospital cardiac arrest in adults and children
    Background: Mobilization of community first responders (CFRs) to the scene of an out-of-hospital cardiac arrest (OHCA) event has been proposed as a means of shortening the interval from occurrence of cardiac arrest to performance of cardiopulmonary resuscitation (CPR) and defibrillation, thereby increasing patient survival. Objectives: To assess the effect of mobilizing community first responders (CFRs) to out-of-hospital cardiac arrest events in adults and children older than four weeks of age, in terms of survival and neurological function. Search methods We searched the following databases for relevant trials in January 2019: CENTRAL, MEDLINE (Ovid SP), Embase (Ovid SP), and Web of Science. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and, and we scanned the abstracts of conference proceedings of the American Heart Association and the European Resuscitation Council. Selection criteria We included randomized and quasi-randomized trials (RCTs and q-RCTs) that compared routine emergency medical services (EMS) care versus EMS care plus mobilization of CFRs in instances of OHCA.Trials with randomization by cluster were eligible for inclusion, including cluster-design studies with intervention cross-over. In some communities, the statutory ambulance service/EMS is routinely provided by the local fire service. For the purposes of this review, this group represents the statutory ambulance service/EMS, as distinct from CFRs, and was not included as an eligible intervention. We did not include studies primarily focused on opportunistic bystanders. Individuals who were present at the scene of an OHCA event and who performed CPR according to telephone instruction provided by EMS call takers were not considered to be CFRs. Studies primarily assessing the impact of specific additional interventions such as administration of naloxone in narcotic overdose or adrenaline in anaphylaxis were also excluded. We included adults and children older than four weeks of age who had experienced an OHCA. Data collection and analysis Two review authors independently reviewed all titles and abstracts received to assess potential eligibility, using set inclusion criteria. We obtained and examined in detail full-text copies of all papers considered potentially eligible, and we approached authors of trials for additional information when necessary. We summarized the process of study selection in a PRISMA flowchart. Three review authors independently extracted relevant data using a standard data extraction form and assessed the validity of each included trial using the Cochrane ’Risk of bias’ tool. We resolved disagreements by discussion and consensus. We synthesized findings in narrative fashion due to the heterogeneity of the included studies. We used the principles of the GRADE system to assess the certainty of the body of evidence associated with specific outcomes and to construct a ’Summary of findings’ table. Main results: We found two completed studies involving a total of 1136 participants that ultimately met our inclusion criteria. We also found one ongoing study and one planned study. We noted significant heterogeneity in the characteristics of interventions and outcomes measured or reported across these studies, thus we could not pool study results. One completed study considered the dispatch of police and fire service CFRs equipped with automatic external defibrillators (AEDs) in an EMS system in Amsterdam and surrounding areas. This study was an RCT with allocation made by cluster according to non-overlapping geographical regions. It was conducted between 5 January 2000 and 5 January 2002. All participants were 18 years of age or older and had experienced witnessed OHCA. The study found no difference in survival at hospital discharge (odds ratio (OR) 1.3, 95% confidence interval (CI) 0.8 to 2.2; 1 RCT; 469 participants; low-certainty evidence), despite the observation that all 72 incidences of defibrillation performed before EMS arrival occurred in the intervention group (OR and 95% CI-not applicable; 1 RCT; 469 participants; moderate-certainty evidence). This study reported increased survival to hospital admission in the intervention group (OR 1.5, 95% CI 1.1 to 2.0; 1 RCT; 469 participants; moderate-certainty evidence). The second completed study considered the dispatch of nearby lay volunteers in Stockholm, Sweden, who were trained to perform cardiopulmonary resuscitation (CPR). This represented a supplementary CFR intervention in an EMS system where police and fire services were already routinely dispatched to OHCA in addition to EMS ambulances. This study, an RCT, included both witnessed and unwitnessed OHCA and was conducted between 1 April 2012 and 1 December 2013. Participants included adults and children eight years of age and older. Researchers found no difference in 30-day survival (OR 1.34, 95% CI 0.79 to 2.29; 1 RCT; 612 participants; low-certainty evidence), despite a significant increase in CPR performed before EMS arrival (OR 1.49, 95% CI 1.09 to 2.03; 1 RCT; 665 participants; moderate-certainty evidence). Neither of the included completed studies considered neurological function at hospital discharge or at 30 days, measured by cerebral performance category or by any other means. Neither of the included completed studies considered health-related quality of life. The overall certainty of evidence for the outcomes of included studies was low to moderate. Authors’ conclusions Moderate-certainty evidence shows that context-specific CFR interventions result in increased rates of CPR or defibrillation performed before EMS arrival. It remains uncertain whether this can translate to significantly increased rates of overall patient survival. When possible, further high-quality RCTs that are adequately powered to measure changes in survival should be conducted. The included studies did not consider survival with good neurological function. This outcome is likely to be important to patients and should be included routinely wherever survival is measured. We identified one ongoing study and one planned trial whose results once available may change the results of this review. As this review was limited to randomized and quasi-randomized trials, we may have missed some important data from other study types.
      241Scopus© Citations 4
  • Publication
    Numbers of close contacts of individuals infected with SARS-CoV-2 and their association with government intervention strategies
    Background: Contact tracing is conducted with the primary purpose of interrupting transmission from individuals who are likely to be infectious to others. Secondary analyses of data on the numbers of close contacts of confirmed cases could also: provide an early signal of increases in contact patterns that might precede larger than expected case numbers; evaluate the impact of government interventions on the number of contacts of confirmed cases; or provide data information on contact rates between age cohorts for the purpose of epidemiological modelling. We analysed data from 140,204 close contacts of 39,861 cases in Ireland from 1st May to 1st December 2020. Results: Negative binomial regression models highlighted greater numbers of contacts within specific population demographics, after correcting for temporal associations. Separate segmented regression models of the number of cases over time and the average number of contacts per case indicated that a breakpoint indicating a rapid decrease in the number of contacts per case in October 2020 preceded a breakpoint indicating a reduction in the number of cases by 11 days. Conclusions: We found that the number of contacts per infected case was overdispersed, the mean varied considerable over time and was temporally associated with government interventions. Analysis of the reported number of contacts per individual in contact tracing data may be a useful early indicator of changes in behaviour in response to, or indeed despite, government restrictions. This study provides useful information for triangulating assumptions regarding the contact mixing rates between different age cohorts for epidemiological modelling.
      218Scopus© Citations 7
  • Publication
    Elevated plasma CXCL12a is associated with a poorer prognosis in pulmonary arterial hypertension
    Recent work in preclinical models suggests that signalling via the pro-angiogenic and pro-inflammatory cytokine, CXCL12 (SDF-1), plays an important pathogenic role in pulmonary hypertension (PH). The objective of this study was to establish whether circulating concentrations of CXCL12a were elevated in patients with PAH and related to mortality. Plasma samples were collected from patients with idiopathic pulmonary arterial hypertension (IPAH) and PAH associated with connective tissue diseases (CTD-PAH) attending two pulmonary hypertension referral centres (n = 95) and from age and gender matched healthy controls (n = 44). Patients were subsequently monitored throughout a period of five years. CXCL12a concentrations were elevated in PAH groups compared to controls (P<0.05) and receiver-operating-characteristic analysis showed that plasma CXCL12a concentrations discriminated patients from healthy controls (AUC 0.80, 95% confidence interval 0.73-0.88). Kaplan Meier analysis indicated that elevated plasma CXCL12a concentration was associated with reduced survival (P<0.01). Multivariate Cox proportional hazards model showed that elevated CXCL12a independently predicted (P<0.05) earlier death in PAH with a hazard ratio (95% confidence interval) of 2.25 (1.01-5.00). In the largest subset by WHO functional class (Class 3, 65% of patients) elevated CXCL12a independently predicted (P<0.05) earlier death, hazard ratio 2.27 (1.05-4.89). Our data show that elevated concentrations of circulating CXCL12a in PAH predicted poorer survival. Furthermore, elevated circulating CXCL12a was an independent risk factor for death that could potentially be included in a prognostic model and guide therapy.
      394Scopus© Citations 25
  • Publication
    Estimation of the serial interval and proportion of pre-symptomatic transmission events of COVID-19 in Ireland using contact tracing data
    The serial interval is the period of time between the onset of symptoms in an infector and an infectee and is an important parameter which can impact on the estimation of the reproduction number. Whilst several parameters influencing infection transmission are expected to be consistent across populations, the serial interval can vary across and within populations over time. Therefore, local estimates are preferable for use in epidemiological models developed at a regional level. We used data collected as part of the national contact tracing process in Ireland to estimate the serial interval of SARS-CoV-2 infection in the Irish population, and to estimate the proportion of transmission events that occurred prior to the onset of symptoms. Results After data cleaning, the final dataset consisted of 471 infected close contacts from 471 primary cases. The median serial interval was 4 days, mean serial interval was 4.0 (95% confidence intervals 3.7, 4.3) days, whilst the 25th and 75th percentiles were 2 and 6 days respectively. We found that intervals were lower when the primary or secondary case were in the older age cohort (greater than 64 years). Simulating from an incubation period distribution from international literature, we estimated that 67% of transmission events had greater than 50% probability of occurring prior to the onset of symptoms in the infector. Conclusions Whilst our analysis was based on a large sample size, data were collected for the primary purpose of interrupting transmission chains. Similar to other studies estimating the serial interval, our analysis is restricted to transmission pairs where the infector is known with some degree of certainty. Such pairs may represent more intense contacts with infected individuals than might occur in the overall population. It is therefore possible that our analysis is biased towards shorter serial intervals than the overall population.
      166Scopus© Citations 8
  • Publication
    ‘Communication, that is the key’: a qualitative investigation of how essential workers with COVID-19 responded to public health information
    Objectives: To understand how essential workers with confirmed infections responded to information on COVID-19. Design: Qualitative analysis of semistructured interviews conducted in collaboration with the national contact tracing management programme in Ireland. Setting: Semistructured interviews conducted via telephone and Zoom Meetings. Participants: 18 people in Ireland with laboratory confirmed SARS-CoV-2 infections using real-time PCR testing of oropharyngeal and nasopharyngeal swabs. All individuals were identified as part of workplace outbreaks defined as ≥2 individuals with epidemiologically linked infections. Results: A total of four high-order themes were identified: (1) accessing essential information early, (2) responses to emerging ‘infodemic’, (3) barriers to ongoing engagement and (4) communication strategies. Thirteen lower order or subthemes were identified and agreed on by the researchers. Conclusions: Our findings provide insights into how people infected with COVID-19 sought and processed related health information throughout the pandemic. We describe strategies used to navigate excessive and incomplete information and how perceptions of information providers evolve overtime. These results can inform future communication strategies on COVID-19.
      85Scopus© Citations 1