Supplemental material, sj-pdf-1-hpq-10.1177_13591053211064985 for Assessing medical mistrust in o... more Supplemental material, sj-pdf-1-hpq-10.1177_13591053211064985 for Assessing medical mistrust in organ donation across countries using item response theory by Arunangshu Ghoshal, Ronan E O'Carroll, Eamonn Ferguson, Lee Shepherd, Sally Doherty, Mary Mathew, Karen Morgan and Frank Doyle in Journal of Health Psychology
Although medical mistrust (MM) may be an impediment to public health interventions, no MM scale h... more Although medical mistrust (MM) may be an impediment to public health interventions, no MM scale has been validated across countries and the assessment of MM has not been explored using item response theory, which allows generalisation beyond the sampled data. We aimed to determine the dimensionality of a brief MM measure across four countries through Mokken analysis and Graded Response Modelling. Analysis of 1468 participants from UK ( n = 1179), Ireland ( n = 191), India ( n = 49) and Malaysia (n = 49) demonstrated that MM items formed a hierarchical, unidimensional measure, which is very informative about high levels of MM. Possible item reduction and scoring changes were also demonstrated. This study demonstrates that this brief MM measure is suitable for international studies as it is unidimensional across countries, cross cultural, and shows that minor adjustments will not impact on the assessment of MM when using these items.
Background: There are few published examples of studies which have taken a systematic approach to... more Background: There are few published examples of studies which have taken a systematic approach to developing implementation interventions. We present the development of the CHARMS [Cardiac Health and Relationship Management Study] intervention to improve provision of sexual assessment and counselling in hospital cardiac rehabilitation. Methods: Sixty general practitioners, 61 cardiac rehabilitation staff and 382 cardiac patients were surveyed about provision of sexual counselling in health services. We conducted one-to-one and focus group interviews with key stakeholders [cardiac rehabilitation staff (n=14), patients/service users (n=13) and general practitioners (n=9)] to model intervention components. Findings: Staff reported lacking awareness, knowledge and confidence in addressing sexual issues and wanted more training and specific guidelines. Patients reported that they would like more opportunity to discuss sexual issues with health professionals, but were reluctant to initiat...
Healthcare professional students should be engaged in best practice regarding communication with ... more Healthcare professional students should be engaged in best practice regarding communication with patients, including awareness of the relationship between patient health literacy and use of patient information leaflets (PILs). Such PILs should have good readability, use health psychology theory content to maximise motivation and provide practical assistance for behaviour change, and provide good quality, unbiased information for patients. We describe a compulsory first semester flexible learning student project that requires identification, quantification and application of these indices to enhance PIL design, comparing findings across 2 international sites, and undergraduate and graduate student cohorts. After ethical approval was provided, a cross-sectional survey of first semester students across two RCSI sites (Dublin [undergraduate and graduate entry programmes], Malaysia) investigated readability (Flesch score), quality ratings (DISCERN) and health psychology theory content in...
ObjectivesTo measure levels of occupational stress, burn-out, work–life balance, presenteeism, wo... more ObjectivesTo measure levels of occupational stress, burn-out, work–life balance, presenteeism, work ability (balance between work and personal resources) and desire to practise in trainee and consultant hospital doctors in Ireland.DesignNational cross-sectional study of randomised sample of hospital doctors. Participants provided sociodemographic data (age, sex), work grade (consultant, higher/basic specialist trainee), specialty, work hours and completed workplace well-being questionnaires (Effort–Reward Imbalance (ERI) Scale, overcommitment, Maslach Burnout Inventory) and single item measures of work ability, presenteeism, work–life balance and desire to practise.SettingIrish publicly funded hospitals and residential institutions.Participants1749 doctors (response rate of 55%). All hospital specialties were represented except radiology.Results29% of respondents had insufficient work ability and there was no sex, age or grade difference. 70.6% reported strong or very strong desire ...
Healthcare professional students should be engaged in best practice regarding communication with ... more Healthcare professional students should be engaged in best practice regarding communication with patients, including using good quality patient information leaflets (PILs) on health behaviours. A cross-sectional survey of 337 junior medical and physiotherapy students investigated the readability, health psychology theory content, and quality and reliability ratings of nine international PILs on smoking. Estimates of readability, theory content and quality/reliability ratings varied considerably across PILs. Importantly, additional theory-based content, as proposed by students, had no detrimental effect on readability scores. Results are discussed with regard to their potential for improving interactions between future healthcare providers and service users.
The CHARMS Study : Predictors of sexual dysfunction among patients post hospitalcardiac rehabilit... more The CHARMS Study : Predictors of sexual dysfunction among patients post hospitalcardiac rehabilitation
Objectives: Including or excluding certain questions about organ donation may influence peoples' ... more Objectives: Including or excluding certain questions about organ donation may influence peoples' intention to donate. We investigated the effect of omitting certain affective attitudinal items on potential donors' intention and behavior for donation. Design: A cross-sectional survey with a subgroup nested randomized trial. Methods: A total of 578 members of the public in four shopping centers were surveyed on their attitudes to organ donation. Non-donors (n = 349) were randomly assigned to one of three groups: Group 1 completed items on affective and cognitive attitudes, anticipated regret, intention, subjective norm and perceived behavioral control. Group 2 completed all items above but excluded affective attitudes. Group 3 completed all items but omitted negatively worded affective attitudes. The primary outcome was intention to donate, taking a donor card after the interview was a secondary behavioral outcome, and both were predicted using linear and logistic regression with group 1 as the reference. Results: Mean (SD) 1-7 intention scores for groups 1, 2 and 3 were, respectively: 4.43 (SD 1.89), 4.95 (SD 1.64) and 4.88 (SD 1.81), with group 2 significantly higher than group 1 (β = 0.518, 95% confidence interval [CI] 0.18 to 0.86).At the end of the interview, people in group 2 (66.7%; OR = 1.40, 95% CI 0.94 to 2.07, p = 0.096) but not those in group 3 (61.7%; OR = 1.10, 95% CI 0.69 to 1.75, p = 0.685), were marginally more likely to accept a donor card from the interviewer than people in group 1 (59.7%). Conclusion: Omitting affective attitudinal items results in higher intention to donate organs and marginally higher rates of acceptance of donor cards, which has important implications for future organ donation public health campaigns.
Background: While a healthy sexual life is regarded as an important aspect of quality of life, se... more Background: While a healthy sexual life is regarded as an important aspect of quality of life, sexual counselling from healthcare providers for cardiac patients has received little attention in the literature. Aim: To document current practice and assess the needs of cardiac rehabilitation service providers in Ireland with regard to sexual assessment and management for patients. Methods: Cardiac rehabilitation staff in all relevant centres in Ireland responded to a postal questionnaire. Sexual health management was assessed by a series of questions on current practice, staff attitudes, beliefs and perceived barriers to discussing sexual problems. Results: Staff (N = 60; 61% response rate) reported a lack of assessment and counselling protocols for addressing sexual health problems, with little or no onward referral system available. Results also suggest staff believe that patients do not expect them to ask about their sexual concerns. Barriers reported included an overall lack of confidence (45%), knowledge (58%) and training (85%). Conclusion: Development of guidelines, assessment protocols and training for cardiac rehabilitation staff are essential in the area of sexual health problems in order to improve the quality of services for patients with coronary heart disease.
Many people living with cardiovascular disease (CVD) are affected by sexual problems associated w... more Many people living with cardiovascular disease (CVD) are affected by sexual problems associated with the condition. International guidelines recommend all patients with CVD should receive sexual counselling, yet this is rarely provided by health professionals. The current study piloted the Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention, a complex multi-level intervention designed to increase the implementation of sexual counselling guidelines in hospital-based cardiac rehabilitation (CR) in Ireland. The CHARMS intervention, consisting of awareness training and skills development for staff, and education and support for patients, was implemented in two CR centres. Following a repeated measures design, quantitative and qualitative feasibility, fidelity, cost, and outcome data were collected from staff and patients at baseline (T1, pre-intervention), at 3 months post-baseline (T2, post-intervention), and at 6 months post-baseline (T3, post-intervention)....
The Journal of cardiovascular nursing, Jan 17, 2018
International guidelines recommend sexual assessment and counseling be offered to all patients wi... more International guidelines recommend sexual assessment and counseling be offered to all patients with cardiovascular disease during cardiac rehabilitation. However, sexual problems are infrequently addressed. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention is a complex, multilevel intervention designed to increase the provision of sexual counseling in cardiac rehabilitation. It was piloted in 2 cardiac rehabilitation centers to assess the acceptability and feasibility of the intervention and to inform and refine a definitive cluster randomized controlled trial protocol. The aim of this study was to explore the experiences, perceptions, and opinions of patients, partners, and cardiac rehabilitation staff who participated in the CHARMS staff-led patient education class. A qualitative, descriptive study using semistructured interviews to collect the data. Cardiac rehabilitation staff (n = 8) were interviewed when the intervention commenced in their cent...
To measure levels of psychological distress, psychological wellbeing and self-stigma in hospital ... more To measure levels of psychological distress, psychological wellbeing and self-stigma in hospital doctors in Ireland. National cross-sectional study of randomised sample of hospital doctors. Participants provided sociodemographic data (age, sex, marital status), work grade (consultant, higher/basic specialist trainee), specialty and work hours and completed well-being questionnaires (the Depression Anxiety Stress Scale, WHO Well-being Index, General Health Questionnaire) and single-item scales on self-rated health and self-stigma. Irish publicly funded hospitals and residential institutions. 1749 doctors (response rate of 55%). All hospital specialties were represented except radiology. Half of participants were men (50.5%). Mean hours worked per week were 57 hours. Over half (52%) rated their health as very good/excellent, while 50.5% reported positive subjective well-being (WHO-5). Over a third (35%) experienced psychological distress (General Health Questionnaire 12). Severe/extre...
Given that general practitioners are perfectly placed to detect eating disorders this summer rese... more Given that general practitioners are perfectly placed to detect eating disorders this summer research study aimed to examine general practitioners' knowledge, skills and attitudes towards eating disorders. The study aimed to compile a national picture of the diagnosis, referral practices, and management of eating disorders in primary care in Ireland. Methods An online survey consisting of 20 questions previously used in an American study was emailed to Irish general practitioners (GPs) of which 226 emails were read. The study remained open over a three week period. The email addresses were obtained via the Irish Medical Directory and through phone calls to surgeries. Ethical approval was granted by RCSI.
Relationship satisfaction is generally positively correlated with sexual satisfaction, but this r... more Relationship satisfaction is generally positively correlated with sexual satisfaction, but this relation has been poorly examined in people with cardiovascular disease who are at increased risk of sexual problems compared with the general population. To document reported changes to sex after a diagnosis of cardiac disease and determine whether there is an association between sexual function and relationship satisfaction. Semistructured telephone interviews focused on relationship satisfaction and sexual problems were conducted with 201 people with cardiovascular disease who were currently in a sexual relationship with one main partner and were recruited from six hospital cardiac rehabilitation centers in Ireland. Comparisons between groups were conducted using t-tests and multivariate analysis of variance for continuous variables and χ(2) tests for categorical variables. Predictors of relationship satisfaction were assessed using multiple linear regression analysis. Data were gather...
Sexual problems are common with cardiovascular disease, and can negatively impact quality of life... more Sexual problems are common with cardiovascular disease, and can negatively impact quality of life. To address sexual problems, guidelines have identified the importance of sexual counselling during cardiac rehabilitation, yet this is rarely provided. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention aims to improve the provision of sexual counselling in cardiac rehabilitation in Ireland. This is a multicentre pilot study for the CHARMS intervention, a complex, multilevel intervention delivered within hospital-based cardiac rehabilitation programmes. The intervention includes (1) training in sexual counselling for staff, (2) a staff-led patient education and support intervention embedded within the cardiac rehabilitation programme, (3) a patient information booklet and (4) an awareness raising poster. The intervention will be delivered in two randomly selected cardiac rehabilitation centres. In each centre 30 patients will be recruited, and partners w...
Inguinal hernias are a significant cause of morbidity. The purpose of this systematic review and ... more Inguinal hernias are a significant cause of morbidity. The purpose of this systematic review and meta-analysis is to determine the totality of evidence regarding the effectiveness of local anaesthesia when compared to spinal anaesthesia in individuals undergoing open inguinal hernia repair. A systematic literature search was conducted. Inclusion criteria were randomised controlled trials (RCTs) comparing spinal and local anaesthesia on clinical and self-reported outcomes, in patients undergoing open inguinal hernia repairs. The methodological quality was assessed using the Cochrane risk of bias tool. The mode of analysis used was the difference in outcomes between the groups post-surgery and at follow-up time points. Statistical heterogeneity was assessed using the I(2) statistic. Ten original RCTs were included, with a total of 1379 patients. There was no significant difference in operative time between the groups [Random Effects Model, MD -0.70 min (95% CI, -5.80 to 4.40 min), p = 0.79, I(2) = 84%]. Patients in the local anaesthetic group experienced significantly less pain than those in the spinal group [Fixed Effects Model, SMD -0.63 (95% CI, -0.81 to -0.46), p < 0.01, I(2) = 49%], lower rates of urinary retention [FEM, RR 0.03 (95% CI 0.01-0.08), p < 0.01, I(2) = 0%], decreased rates of anaesthetic failure [FEM, OR 0.17 (95% CI 0.06-0.45), p < 0.01, I(2) = 0%], and increased satisfaction with the anaesthetic [FEM, OR 3.40 (95% CI 2.09-5.52), p < 0.01, I(2) = 0%]. The methodological quality of studies was variable. Our findings support the use of local anaesthetic in adult patients undergoing open repair for a primary inguinal hernia.
Ž. Ž. Brain-derived neurotrophic factor BDNF , a member of the neurotrophin family, and ciliary n... more Ž. Ž. Brain-derived neurotrophic factor BDNF , a member of the neurotrophin family, and ciliary neurotrophic factor CNTF , a member of the neurocytokine family, are known to have synergistic effects on motoneurons, but such synergistic effect has not been studied in detail especially in the brain. In the present study, we examined the synergistic effects of BDNF and CNTF on the survival of basal forebrain Ž. cholinergic neurons cultured from postnatal 2-week-old P2w rats. Although BDNF is well-known to promote the survival of basal Ž. forebrain cholinergic neurons in P2w culture, CNTF had little effect on the survival of choline acetyltransferase ChAT-positive neurons and did not increase ChAT activity in the culture. However, CNTF enhanced BDNF-mediated promotion of cell survival of cholinergic neurons when added concomitantly. BDNF alone induced only a threefold increase in ChAT activity in control cultures, but the concomitant addition of CNTF resulted in an eight-fold increase. CNTF did not enhance BDNF-mediated cell survival of total neurons from the basal forebrain, hippocampus or cerebellum, suggesting that the synergistic effects of CNTF on the BDNF-mediated increase of viability might be strong in basal forebrain cholinergic neurons. CNTF also enhanced the neurotrophin-4r5-mediated increase of ChAT Ž. activity, but not the nerve growth factor NGF-mediated one. Furthermore, the BDNF-mediated increase was also enhanced by leukemia inhibitory factor but not by interleukin-6. Similar synergistic pattern between neurotrophins and cytokines were also observed in the induction of ChAT activity in embryonic basal forebrain culture. These results suggest that TrkB, a functional high-affinity receptor of BDNF and NT-4r5, and LIFR b, a receptor component contained in CNTF and LIF receptor complex, might be involved in the observed synergistic effects.
Background Heart failure is a condition associated with significant morbidity. It is caused by st... more Background Heart failure is a condition associated with significant morbidity. It is caused by structural or functional abnormalities of the heart. Many of these abnormalities if detected and managed early would prevent the onset of heart failure. Aims The aim of this study was to to determine the usefulness of echocardiography as a means of predicting readmission rates. A secondary aim was to profile patients with echocardiography abnormalities. Methods This was a prospective cohort study that followed patients over 36 months. Data were abstracted from the medical records of 76 cardiology patients in a large urban teaching hospital between 1.6.11 and 31.8.14. The outcome of interest was the number of readmissions occurring up to 48 months after discharge. We also aimed to profile these patients in terms of their co-morbidities and their medication history. Results Of those patients who had echocardiography (n = 447), 76 were considered to have a cardiac disorder (HHD, VHD, or LVSD) (n = 29). The mean readmission rate for HHD was 0.82, LVSD 0.62, and HHD 0.98. Patients with HHD were associated with a higher readmission rate of 1.8980 and for LVSD-1.24 times more likely. Those with a cardiac disorder were 13 % more likely to have a readmission within the next 36 months than those without a cardiac disorder. Conclusions A significant proportion of patients were found to have a cardiac disorder related to HF. Echocardiographic abnormalities were shown to be an independent risk factor for readmission.
Supplemental material, sj-pdf-1-hpq-10.1177_13591053211064985 for Assessing medical mistrust in o... more Supplemental material, sj-pdf-1-hpq-10.1177_13591053211064985 for Assessing medical mistrust in organ donation across countries using item response theory by Arunangshu Ghoshal, Ronan E O'Carroll, Eamonn Ferguson, Lee Shepherd, Sally Doherty, Mary Mathew, Karen Morgan and Frank Doyle in Journal of Health Psychology
Although medical mistrust (MM) may be an impediment to public health interventions, no MM scale h... more Although medical mistrust (MM) may be an impediment to public health interventions, no MM scale has been validated across countries and the assessment of MM has not been explored using item response theory, which allows generalisation beyond the sampled data. We aimed to determine the dimensionality of a brief MM measure across four countries through Mokken analysis and Graded Response Modelling. Analysis of 1468 participants from UK ( n = 1179), Ireland ( n = 191), India ( n = 49) and Malaysia (n = 49) demonstrated that MM items formed a hierarchical, unidimensional measure, which is very informative about high levels of MM. Possible item reduction and scoring changes were also demonstrated. This study demonstrates that this brief MM measure is suitable for international studies as it is unidimensional across countries, cross cultural, and shows that minor adjustments will not impact on the assessment of MM when using these items.
Background: There are few published examples of studies which have taken a systematic approach to... more Background: There are few published examples of studies which have taken a systematic approach to developing implementation interventions. We present the development of the CHARMS [Cardiac Health and Relationship Management Study] intervention to improve provision of sexual assessment and counselling in hospital cardiac rehabilitation. Methods: Sixty general practitioners, 61 cardiac rehabilitation staff and 382 cardiac patients were surveyed about provision of sexual counselling in health services. We conducted one-to-one and focus group interviews with key stakeholders [cardiac rehabilitation staff (n=14), patients/service users (n=13) and general practitioners (n=9)] to model intervention components. Findings: Staff reported lacking awareness, knowledge and confidence in addressing sexual issues and wanted more training and specific guidelines. Patients reported that they would like more opportunity to discuss sexual issues with health professionals, but were reluctant to initiat...
Healthcare professional students should be engaged in best practice regarding communication with ... more Healthcare professional students should be engaged in best practice regarding communication with patients, including awareness of the relationship between patient health literacy and use of patient information leaflets (PILs). Such PILs should have good readability, use health psychology theory content to maximise motivation and provide practical assistance for behaviour change, and provide good quality, unbiased information for patients. We describe a compulsory first semester flexible learning student project that requires identification, quantification and application of these indices to enhance PIL design, comparing findings across 2 international sites, and undergraduate and graduate student cohorts. After ethical approval was provided, a cross-sectional survey of first semester students across two RCSI sites (Dublin [undergraduate and graduate entry programmes], Malaysia) investigated readability (Flesch score), quality ratings (DISCERN) and health psychology theory content in...
ObjectivesTo measure levels of occupational stress, burn-out, work–life balance, presenteeism, wo... more ObjectivesTo measure levels of occupational stress, burn-out, work–life balance, presenteeism, work ability (balance between work and personal resources) and desire to practise in trainee and consultant hospital doctors in Ireland.DesignNational cross-sectional study of randomised sample of hospital doctors. Participants provided sociodemographic data (age, sex), work grade (consultant, higher/basic specialist trainee), specialty, work hours and completed workplace well-being questionnaires (Effort–Reward Imbalance (ERI) Scale, overcommitment, Maslach Burnout Inventory) and single item measures of work ability, presenteeism, work–life balance and desire to practise.SettingIrish publicly funded hospitals and residential institutions.Participants1749 doctors (response rate of 55%). All hospital specialties were represented except radiology.Results29% of respondents had insufficient work ability and there was no sex, age or grade difference. 70.6% reported strong or very strong desire ...
Healthcare professional students should be engaged in best practice regarding communication with ... more Healthcare professional students should be engaged in best practice regarding communication with patients, including using good quality patient information leaflets (PILs) on health behaviours. A cross-sectional survey of 337 junior medical and physiotherapy students investigated the readability, health psychology theory content, and quality and reliability ratings of nine international PILs on smoking. Estimates of readability, theory content and quality/reliability ratings varied considerably across PILs. Importantly, additional theory-based content, as proposed by students, had no detrimental effect on readability scores. Results are discussed with regard to their potential for improving interactions between future healthcare providers and service users.
The CHARMS Study : Predictors of sexual dysfunction among patients post hospitalcardiac rehabilit... more The CHARMS Study : Predictors of sexual dysfunction among patients post hospitalcardiac rehabilitation
Objectives: Including or excluding certain questions about organ donation may influence peoples' ... more Objectives: Including or excluding certain questions about organ donation may influence peoples' intention to donate. We investigated the effect of omitting certain affective attitudinal items on potential donors' intention and behavior for donation. Design: A cross-sectional survey with a subgroup nested randomized trial. Methods: A total of 578 members of the public in four shopping centers were surveyed on their attitudes to organ donation. Non-donors (n = 349) were randomly assigned to one of three groups: Group 1 completed items on affective and cognitive attitudes, anticipated regret, intention, subjective norm and perceived behavioral control. Group 2 completed all items above but excluded affective attitudes. Group 3 completed all items but omitted negatively worded affective attitudes. The primary outcome was intention to donate, taking a donor card after the interview was a secondary behavioral outcome, and both were predicted using linear and logistic regression with group 1 as the reference. Results: Mean (SD) 1-7 intention scores for groups 1, 2 and 3 were, respectively: 4.43 (SD 1.89), 4.95 (SD 1.64) and 4.88 (SD 1.81), with group 2 significantly higher than group 1 (β = 0.518, 95% confidence interval [CI] 0.18 to 0.86).At the end of the interview, people in group 2 (66.7%; OR = 1.40, 95% CI 0.94 to 2.07, p = 0.096) but not those in group 3 (61.7%; OR = 1.10, 95% CI 0.69 to 1.75, p = 0.685), were marginally more likely to accept a donor card from the interviewer than people in group 1 (59.7%). Conclusion: Omitting affective attitudinal items results in higher intention to donate organs and marginally higher rates of acceptance of donor cards, which has important implications for future organ donation public health campaigns.
Background: While a healthy sexual life is regarded as an important aspect of quality of life, se... more Background: While a healthy sexual life is regarded as an important aspect of quality of life, sexual counselling from healthcare providers for cardiac patients has received little attention in the literature. Aim: To document current practice and assess the needs of cardiac rehabilitation service providers in Ireland with regard to sexual assessment and management for patients. Methods: Cardiac rehabilitation staff in all relevant centres in Ireland responded to a postal questionnaire. Sexual health management was assessed by a series of questions on current practice, staff attitudes, beliefs and perceived barriers to discussing sexual problems. Results: Staff (N = 60; 61% response rate) reported a lack of assessment and counselling protocols for addressing sexual health problems, with little or no onward referral system available. Results also suggest staff believe that patients do not expect them to ask about their sexual concerns. Barriers reported included an overall lack of confidence (45%), knowledge (58%) and training (85%). Conclusion: Development of guidelines, assessment protocols and training for cardiac rehabilitation staff are essential in the area of sexual health problems in order to improve the quality of services for patients with coronary heart disease.
Many people living with cardiovascular disease (CVD) are affected by sexual problems associated w... more Many people living with cardiovascular disease (CVD) are affected by sexual problems associated with the condition. International guidelines recommend all patients with CVD should receive sexual counselling, yet this is rarely provided by health professionals. The current study piloted the Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention, a complex multi-level intervention designed to increase the implementation of sexual counselling guidelines in hospital-based cardiac rehabilitation (CR) in Ireland. The CHARMS intervention, consisting of awareness training and skills development for staff, and education and support for patients, was implemented in two CR centres. Following a repeated measures design, quantitative and qualitative feasibility, fidelity, cost, and outcome data were collected from staff and patients at baseline (T1, pre-intervention), at 3 months post-baseline (T2, post-intervention), and at 6 months post-baseline (T3, post-intervention)....
The Journal of cardiovascular nursing, Jan 17, 2018
International guidelines recommend sexual assessment and counseling be offered to all patients wi... more International guidelines recommend sexual assessment and counseling be offered to all patients with cardiovascular disease during cardiac rehabilitation. However, sexual problems are infrequently addressed. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention is a complex, multilevel intervention designed to increase the provision of sexual counseling in cardiac rehabilitation. It was piloted in 2 cardiac rehabilitation centers to assess the acceptability and feasibility of the intervention and to inform and refine a definitive cluster randomized controlled trial protocol. The aim of this study was to explore the experiences, perceptions, and opinions of patients, partners, and cardiac rehabilitation staff who participated in the CHARMS staff-led patient education class. A qualitative, descriptive study using semistructured interviews to collect the data. Cardiac rehabilitation staff (n = 8) were interviewed when the intervention commenced in their cent...
To measure levels of psychological distress, psychological wellbeing and self-stigma in hospital ... more To measure levels of psychological distress, psychological wellbeing and self-stigma in hospital doctors in Ireland. National cross-sectional study of randomised sample of hospital doctors. Participants provided sociodemographic data (age, sex, marital status), work grade (consultant, higher/basic specialist trainee), specialty and work hours and completed well-being questionnaires (the Depression Anxiety Stress Scale, WHO Well-being Index, General Health Questionnaire) and single-item scales on self-rated health and self-stigma. Irish publicly funded hospitals and residential institutions. 1749 doctors (response rate of 55%). All hospital specialties were represented except radiology. Half of participants were men (50.5%). Mean hours worked per week were 57 hours. Over half (52%) rated their health as very good/excellent, while 50.5% reported positive subjective well-being (WHO-5). Over a third (35%) experienced psychological distress (General Health Questionnaire 12). Severe/extre...
Given that general practitioners are perfectly placed to detect eating disorders this summer rese... more Given that general practitioners are perfectly placed to detect eating disorders this summer research study aimed to examine general practitioners' knowledge, skills and attitudes towards eating disorders. The study aimed to compile a national picture of the diagnosis, referral practices, and management of eating disorders in primary care in Ireland. Methods An online survey consisting of 20 questions previously used in an American study was emailed to Irish general practitioners (GPs) of which 226 emails were read. The study remained open over a three week period. The email addresses were obtained via the Irish Medical Directory and through phone calls to surgeries. Ethical approval was granted by RCSI.
Relationship satisfaction is generally positively correlated with sexual satisfaction, but this r... more Relationship satisfaction is generally positively correlated with sexual satisfaction, but this relation has been poorly examined in people with cardiovascular disease who are at increased risk of sexual problems compared with the general population. To document reported changes to sex after a diagnosis of cardiac disease and determine whether there is an association between sexual function and relationship satisfaction. Semistructured telephone interviews focused on relationship satisfaction and sexual problems were conducted with 201 people with cardiovascular disease who were currently in a sexual relationship with one main partner and were recruited from six hospital cardiac rehabilitation centers in Ireland. Comparisons between groups were conducted using t-tests and multivariate analysis of variance for continuous variables and χ(2) tests for categorical variables. Predictors of relationship satisfaction were assessed using multiple linear regression analysis. Data were gather...
Sexual problems are common with cardiovascular disease, and can negatively impact quality of life... more Sexual problems are common with cardiovascular disease, and can negatively impact quality of life. To address sexual problems, guidelines have identified the importance of sexual counselling during cardiac rehabilitation, yet this is rarely provided. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention aims to improve the provision of sexual counselling in cardiac rehabilitation in Ireland. This is a multicentre pilot study for the CHARMS intervention, a complex, multilevel intervention delivered within hospital-based cardiac rehabilitation programmes. The intervention includes (1) training in sexual counselling for staff, (2) a staff-led patient education and support intervention embedded within the cardiac rehabilitation programme, (3) a patient information booklet and (4) an awareness raising poster. The intervention will be delivered in two randomly selected cardiac rehabilitation centres. In each centre 30 patients will be recruited, and partners w...
Inguinal hernias are a significant cause of morbidity. The purpose of this systematic review and ... more Inguinal hernias are a significant cause of morbidity. The purpose of this systematic review and meta-analysis is to determine the totality of evidence regarding the effectiveness of local anaesthesia when compared to spinal anaesthesia in individuals undergoing open inguinal hernia repair. A systematic literature search was conducted. Inclusion criteria were randomised controlled trials (RCTs) comparing spinal and local anaesthesia on clinical and self-reported outcomes, in patients undergoing open inguinal hernia repairs. The methodological quality was assessed using the Cochrane risk of bias tool. The mode of analysis used was the difference in outcomes between the groups post-surgery and at follow-up time points. Statistical heterogeneity was assessed using the I(2) statistic. Ten original RCTs were included, with a total of 1379 patients. There was no significant difference in operative time between the groups [Random Effects Model, MD -0.70 min (95% CI, -5.80 to 4.40 min), p = 0.79, I(2) = 84%]. Patients in the local anaesthetic group experienced significantly less pain than those in the spinal group [Fixed Effects Model, SMD -0.63 (95% CI, -0.81 to -0.46), p < 0.01, I(2) = 49%], lower rates of urinary retention [FEM, RR 0.03 (95% CI 0.01-0.08), p < 0.01, I(2) = 0%], decreased rates of anaesthetic failure [FEM, OR 0.17 (95% CI 0.06-0.45), p < 0.01, I(2) = 0%], and increased satisfaction with the anaesthetic [FEM, OR 3.40 (95% CI 2.09-5.52), p < 0.01, I(2) = 0%]. The methodological quality of studies was variable. Our findings support the use of local anaesthetic in adult patients undergoing open repair for a primary inguinal hernia.
Ž. Ž. Brain-derived neurotrophic factor BDNF , a member of the neurotrophin family, and ciliary n... more Ž. Ž. Brain-derived neurotrophic factor BDNF , a member of the neurotrophin family, and ciliary neurotrophic factor CNTF , a member of the neurocytokine family, are known to have synergistic effects on motoneurons, but such synergistic effect has not been studied in detail especially in the brain. In the present study, we examined the synergistic effects of BDNF and CNTF on the survival of basal forebrain Ž. cholinergic neurons cultured from postnatal 2-week-old P2w rats. Although BDNF is well-known to promote the survival of basal Ž. forebrain cholinergic neurons in P2w culture, CNTF had little effect on the survival of choline acetyltransferase ChAT-positive neurons and did not increase ChAT activity in the culture. However, CNTF enhanced BDNF-mediated promotion of cell survival of cholinergic neurons when added concomitantly. BDNF alone induced only a threefold increase in ChAT activity in control cultures, but the concomitant addition of CNTF resulted in an eight-fold increase. CNTF did not enhance BDNF-mediated cell survival of total neurons from the basal forebrain, hippocampus or cerebellum, suggesting that the synergistic effects of CNTF on the BDNF-mediated increase of viability might be strong in basal forebrain cholinergic neurons. CNTF also enhanced the neurotrophin-4r5-mediated increase of ChAT Ž. activity, but not the nerve growth factor NGF-mediated one. Furthermore, the BDNF-mediated increase was also enhanced by leukemia inhibitory factor but not by interleukin-6. Similar synergistic pattern between neurotrophins and cytokines were also observed in the induction of ChAT activity in embryonic basal forebrain culture. These results suggest that TrkB, a functional high-affinity receptor of BDNF and NT-4r5, and LIFR b, a receptor component contained in CNTF and LIF receptor complex, might be involved in the observed synergistic effects.
Background Heart failure is a condition associated with significant morbidity. It is caused by st... more Background Heart failure is a condition associated with significant morbidity. It is caused by structural or functional abnormalities of the heart. Many of these abnormalities if detected and managed early would prevent the onset of heart failure. Aims The aim of this study was to to determine the usefulness of echocardiography as a means of predicting readmission rates. A secondary aim was to profile patients with echocardiography abnormalities. Methods This was a prospective cohort study that followed patients over 36 months. Data were abstracted from the medical records of 76 cardiology patients in a large urban teaching hospital between 1.6.11 and 31.8.14. The outcome of interest was the number of readmissions occurring up to 48 months after discharge. We also aimed to profile these patients in terms of their co-morbidities and their medication history. Results Of those patients who had echocardiography (n = 447), 76 were considered to have a cardiac disorder (HHD, VHD, or LVSD) (n = 29). The mean readmission rate for HHD was 0.82, LVSD 0.62, and HHD 0.98. Patients with HHD were associated with a higher readmission rate of 1.8980 and for LVSD-1.24 times more likely. Those with a cardiac disorder were 13 % more likely to have a readmission within the next 36 months than those without a cardiac disorder. Conclusions A significant proportion of patients were found to have a cardiac disorder related to HF. Echocardiographic abnormalities were shown to be an independent risk factor for readmission.
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Papers by Sally Doherty