COVID-19 Public Health Measures and Patient and Public Involvement in Health and Social Care Research: An Umbrella Review.

An umbrella review of previously published systematic reviews was conducted to determine the nature and extent of the patient and public involvement (PPI) in COVID-19 health and social care research and identify how PPI has been used to develop public health measures (PHM). In recent years, there has been a growing emphasis on PPI in research as it offers alternative perspectives and insight into the needs of healthcare users to improve the quality and relevance of research. In January 2022, nine databases were searched from 2020-2022, and records were filtered to identify peer-reviewed articles published in English. From a total of 1437 unique records, 54 full-text articles were initially evaluated, and six articles met the inclusion criteria. The included studies suggest that PHM should be attuned to communities within a sociocultural context. Based on the evidence included, it is evident that PPI in COVID-19-related research is varied. The existing evidence includes written feedback, conversations with stakeholders, and working groups/task forces. An inconsistent evidence base exists in the application and use of PPI in PHM. Successful mitigation efforts must be community specific while making PPI an integral component of shared decision-making.

A national audit of smoking cessation services in adult specialist cancer care hospitals in Ireland

BackgroundDespite the progress made in smoking reduction in Ireland, smoking remains a challenge, particularly in cancer patients where post-diagnosis smoking has detrimental impacts on treatment and survival. This audit was of existing hospital smoking cessation services (SCS) for all patients (including cancer) at the eight specialist adult cancer hospitals (tertiary referral university hospitals) and one specialist radiotherapy hospital.MethodsAn audit was conducted online, completed by smoking cessation (SC)/health promotion officers at each hospital in 2021, with questions based on literature review and the (first) consultative National Clinical Stop Smoking Guideline (published 2022).ResultsOne hospital did not participate due to unavailability of relevant staff. SCS were provided at 7 of 9 (77.8%) hospitals, predominantly to inpatients on admission or during hospital stay (5;55.5%) but also at lower rate at discharge (3;33.3%) and in outpatients (4;44.4%). SCS were provided in the main by medical, nursing and hospital SC officers (6;66.6%);just 44.4%% noted alignment with community SC (for ongoing support). SCS provided included brief intervention and or ongoing support (6;66.6%), intensive support (4;44.4%), follow up phone support (2;22.2%). SCS were delivered mainly (pre-COVID) as individual face-to-face (5;55.5%) but phone (4;44.4%), online (3;33.3%) and group work (1;11.1%%) were also utilised. Nicotine Replacement Therapy was the first-choice in 2021 which almost all provided (7;77.8%), with fewer offering varenicline (5;55.5%) or bupropion (2;22.2%). SCS was promoted on the hospital website in 55.5% despite hospital campuses being smoke-free, however, SC information was provided in appointment letters. Most hospitals (6;66.6%) provide/promote SC training;and 4 (44.4%) have staff trained to deliver intensive stop-smoking advice.Six (66.6%) of 9 hospitals provided SCS to cancer patients attending outpatient clinics, day units, inpatients or other departments (e.g., radiology, emergency). However, many hospitals noted low referral rates for cancer patients. While 6 hospitals recorded data on overall SCS uptake, one recorded it specifically for cancer patients. Cancer patients who smoke are automatically referred to SCS (at diagnosis/when starting systemic anti-cancer therapy/radiotherapy) and routinely prescribed SC medications at one hospital. Few oncology staff had received SC intervention training.ConclusionA hospital visit/admission provides a cue to action for smokers and is an important opportunity for brief intervention by healthcare professionals to promote SC. This first National Clinical Guideline should assist necessary strengthening of hospital SCS and promote smoking cessation support, particularly among cancer patients.

Understanding and Tackling the Complex Challenges of Homelessness and Health.

Homelessness is a complex global public health challenge [...].

Irish Public Health Nursing Services and Home Support Services: governance of older persons' home care.

OBJECTIVE: To describe experiences of nurses in the Irish Public Health Nursing service working with Home Support Services (HSS) when providing home care for older people. DESIGN: Qualitative design. Two of twenty-four focus groups undertaken in 2018 are examined to report specific experiences of registered nurses. SAMPLE: The first group comprised three Public Health Nurses (PHNs) and two community Registered General Nurses (cRGNs) and the second comprised three PHNs and one cRGN. In total nine nurses participated. MEASUREMENTS: Focus group interviews were used to collect data, discussions lasted 60-90 minutes and were audio-recorded, professionally transcribed verbatim, and anonymised. RESULTS AND CONCLUSIONS: Gaps in lines of authority and accountability in day-to-day care exist, posing risks to safety. Establishing an enhanced home care model for complex cases and levels of accountability and supervision is critical. Investigating ways of adopting digital solutions to share commissioned home care plans with primary care teams (PCTs) would clarify responsibility and roles and reduce the risks of care left undone. Formally defining the role of commissioned home care agencies in primary care and that which they are expected to play during times of crisis, such as during COVID-19 pandemic will enhance integrated care and governance.

A rapid systematic review of measures to protect older people in long-term care facilities from COVID-19.

OBJECTIVES: The global COVID-19 pandemic produced large-scale health and economic complications. Older people and those with comorbidities are particularly vulnerable to this virus, with nursing homes and long term care facilities (LTCF) experiencing significant morbidity and mortality associated with COVID-19 outbreaks. The aim of this rapid systematic review was to investigate measures implemented in LTCF to reduce transmission of COVID-19 and their effect on morbidity and mortality of residents, staff and visitors. SETTING: Long-term care facilities. PARTICIPANTS: Residents, staff and visitors of facilities. PRIMARY AND SECONDARY OUTCOME MEASURES: Databases (PubMed, EMBASE, CINAHL, Cochrane Databases and repositories and MedRXiv prepublished database) were systematically searched from inception to 27 July 2020 to identify studies reporting assessment of interventions to reduce transmission of COVID-19 in nursing homes among residents, staff or visitors. Outcome measures include facility characteristics, morbidity data, case fatalities and transmission rates. Due to study quality and heterogeneity, no meta-analysis was conducted. RESULTS: The search yielded 1414 articles, with 38 studies included. Reported interventions include mass testing, use of personal protective equipment, symptom screening, visitor restrictions, hand hygiene and droplet/contact precautions, and resident cohorting. Prevalence rates ranged from 1.2% to 85.4% in residents and 0.6% to 62.6% in staff. Mortality rates ranged from 5.3% to 55.3% in residents. CONCLUSIONS: Novel evidence in this review details the impact of facility size, availability of staff and practices of operating between multiple facilities, and for-profit status of facilities as factors contributing to the size and number of COVID-19 outbreaks. No causative relationships can be determined; however, this review provides evidence of interventions that reduce transmission of COVID-19 in LTCF. PROSPERO REGISTRATION NUMBER: CRD42020191569.

Work environment challenging Irish public health nurses' care quality: First postnatal visit.

OBJECTIVES: Exploring views and experiences of public health nurses of their work environment and measurement of care practices at first postnatal visits. DESIGN: An exploratory qualitative design. Data collected using four focus groups and analyzed using thematic analysis. SAMPLE: Nineteen public health nurses from four health service regions in Ireland participated. RESULTS: Two themes emerged. Theme one identified "challenges of providing a quality service." Public health nurses identified workload demands and that the working environment can detract from the ability to provide a quality service. Challenges within the home, language barriers, and lack of support from management were key issues. Theme two identified "challenges of measuring quality of public health nursing practice." While Measuring practice through quantitative outcomes such as key performance indicators were viewed as inadequate to measure the quality of care provided, positive views of using quality process indicators to measure the quality of their practice emerged. CONCLUSIONS: Key issues concern the working environment of public health nurses and challenges of providing and measuring care practices. Absence of appropriate supports and resources means public health nurses work hard to provide quality care. Public health nurses were confident they would score high on quality process measurements of their practice.