Youth recommendations for early intervention responses by governments for future pandemics

Aims: During the pandemic, youth were particularly vulnerable to experiencing financial hardship, education and employment disruption, and mental health impacts. Ensuring governments and services are prepared to support youth during future outbreaks or novel pandemics should be a key priority. This work aimed to explore youth experiences during COVID-19 and gather youth opinions on government responses to inform planning, policy, and decision-making for future pandemics. Method(s): Youth (ages 15-25) from Ireland and two provinces in Canada (British Columbia and Ontario) were interviewed at three time points during the COVID-19 pandemic. A thematic analysis was conducted using an inductive approach. This research was primarily youth-led and developed. Result(s): Across all three time points, youth experienced mental health and service uptake challenges, with mixed views on pandemic response. Opportunities for personal and societal growth were identified, with desire for incorporating youth voices into governmental decision making processes. Youth offered recommendations for effectively communicating accurate information, prevention of misinformation, and expressed needs regarding service accessibility throughout the pandemic and beyond. Conclusion(s): This work provides insights into the opinions of young people on government and information sharing during the progression of the COVID-19 pandemic. Recommendations were developed to ensure youth are consulted and represented in future pandemics.

Pregnancy Outcomes in Women with Sickle Cell Disease in Ireland: A Retrospective Review

Background: Sickle cell disease (SCD) is one of the most common single gene disorders worldwide and is characterised by significant morbidity and early mortality.[1] Pregnancy in SCD is associated with an increased risk of maternal and foetal complications.[2,3] The 2011 RCOG and the 2021 BSH guidelines[5,6] on the management of pregnancy in SCD have provided the basis for best practice care in the UK over the past decade and is the guidance which we follow in Ireland. To date, there is no published data on outcomes for pregnant women with SCD in Ireland. The number of Irish patients with SCD has risen over the past 20 years. Without a national database, the exact prevalence is not known but currently there are at least 600 adults and children with SCD in Ireland, whose population is just over 5 million.[4] Aims: Our study assesses outcomes of pregnant patients with SCD from 2015 to 2022. Our aims were to: * Assess adherence to current guidelines * Assess pregnancy outcomes and maternal complications * Assess transfusion rates amongst our patient cohort. Method(s): This is a retrospective cohort study. We do not have a directly matched cohort, but have compared our findings to published data on Irish pregnancy outcomes from the Irish Maternity Indicator System National Report and have correlated our findings with studies of women with SCD who were managed in UK centres.[8,9,10] Results: We reviewed outcomes of 29 pregnancies in 19 women over a 7-year period. The median age was 29 (range 20-41) and the predominant maternal sickle genotype was HbSS (65.5%). Before conception, 55.2% of cases had pre-existing complications of SCD, including acute chest syndrome (ACS), pulmonary hypertension (PHTN) and prior stroke. In accordance with current guidelines, 100% of women (n=29) were prescribed folic acid, penicillin, and aspirin prophylaxis. 51.7% (n=15) of women had documented maternal complications during pregnancy, including ACS (34%), vaso-occlusive crisis (34%), gestational diabetes (10%), VTE (3%) and UTI (3%). Two women (7%) developed Covid-19 pneumonitis despite vaccination. There was one case of maternal bacteraemia (3%). 65.5% of cases (n=19) required blood transfusion during pregnancy. One woman was already on a blood transfusion programme for disease modification prior to pregnancy. In 6 cases (20.6%), a transfusion programme was commenced during pregnancy due to prior pregnancy complications or intrauterine growth restriction. During pregnancy, 27.6% (n=8) of women required emergency red cell exchange for ACS. Prior studies have suggested that between 30% and 70% of pregnant women with SCD require at least one blood transfusion during pregnancy.[8,9,10] By comparison, only 2.6% of the Irish general obstetric population required transfusion during pregnancy.[7] 20.6% (n=6) of births were preterm at <37 weeks' gestation. There was one live preterm birth (3%) at <34 weeks and one intrauterine death (3%) at 23 weeks' gestation. Similar to UK data[9], 31% of women required critical care stay (n=9) during pregnancy, in comparison with 1.44% nationwide in 2020.[7] Conclusion(s): It is well established that pregnancy in SCD is high risk, and despite adherence to current guidelines, we have shown very high rates of critical care admission, significant transfusion requirement and hospital admissions. Our findings are comparable to published UK outcomes and they further support the need for a comprehensive specialist care setting for this patient cohort.

From Shirts to Arpilleras – Derry's Textile Heritage Continues

The other contemporary textile programme closely linked to Derry city comes in the form of the International Conflict Textiles collection curated by Roberta Bacic. From Shirts to Arpilleras - Derry's Textile Heritage Continues Since then, Conflict Textiles has continued to use the process of I arpillera i workshops, seeding the creation of I arpilleras i and textiles exhibitions as a means of encouraging people to reflect on and process the difficult past in Northern Ireland and beyond. [Extracted from the article] Copyright of Textile: The Journal of Cloth & Culture is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

ID: 218414 Queen Mary University London Postgraduate Certification in Neuromodulation- Accreditation in Neuromodulation

Introduction: There is a distinct unmet need in structured, curriculum based, unbiased education in neuromodulation. Current teaching is through sporadic industry workshops, cadaver courses and peer proctorship. The COVID pandemic has created a unique opportunity where online platforms have enabled education to be delivered remotely in both synchronous and asynchronously. The William Harvey Research Institute, Queen Mary University, London, UK have initiated University based accreditation- Post Graduate Certificate in neuromodulation (PGCert) that provides candidate a qualification in one academic year through part-time study. Method(s): The program underwent rigorous staged university approval process (figure 1). To ensure market feasibility, two short proof of concept CPD programs "Executive Education in Neuromodulation (EEPIN)" were delivered in 2021. These courses attracted 87 candidates across Australia, Singapore, India, Germany, Poland, Czech Republic, Ireland, and UK. The faculty includes key opinion leaders that will deliver the program ensuring the candidates gain academic background and specialist skills to understand safe practice of neuromodulation. The PGCert advisory board has been established to ensure strict governance in terms of content and unbiased delivery confirming ACCME guidance. In order to obtain PGCert, candidates are required to complete 4 x 15 credit modules (60 credits). The four modules include Anatomy & Neurophysiology;Patient care and Procedurals skills;Devices and available technology;Intrathecal drug delivery for cancer and non-cancer pain. The modular nature of the program is designed to provide cumulative knowledge, from basic science to clinical application in line with the best available evidence. The modules comprise nine lectures, spreading over three consecutive days, followed by a written assignment with 40 direct contact hours in each module. The webpage can be accessed at Results: The anonymous data from EEPIN reported on Likert scale 1-5: Objectives defined 30.6% - 4 and 69.4% -5;Relevance of topics 10.2%- 4 and 89.8% -5;Content of presentations 22.4%- 4 and 77.6% -5;Organization 24.5% -4 and 69.4% -5;Candidate faculty interaction 14.3% -4 and 81.6% -5. 97% of the EEPIN candidates recommended the program to others whilst 81.8% expressed their strong interest to enroll for university-based post graduate qualification if offered. Conclusion(s): This PGcert Neuromodulation is a unique, university accredited program that provides qualification in neuromodulation with access to a flexible online e-learning platform to discuss and exchange ideas, share knowledge in candidate's own time. This will support the ongoing need for formal curriculum-based education in neuromodulation. Disclosure: Kavita Poply, PHD: None, Phillippe Rigoard: None, Jan Kallewaard, MD/PhD: None, FRANK J.P.M. HUYGEN, MD PhD: ABBOTT: Speakers Bureau:, Saluda: Consulting Fee:, Boston Scientific: Consulting Fee:, Grunenthal: Speakers Bureau:, Pfizer: Speakers Bureau:, Ashish Gulve, FRCA, FFPMRCA, FFPMCAI, DPMed, FCARCSI, MD, MBBS: None, Ganesan Baranidharan, FRCA: None, Sam ELDABE, MD, FRCA, FFPMRCA: Medtronic: Consulting Fee:, Medtronic: Contracted Research:, Mainstay Medical: Consulting Fee:, Saluda Medical: Consulting Fee:, Boston Scientific: Contracted Research:, Saluda Medical: Contracted Research:, James Fitzgerald, MA,PhD: St Jude Medical: Consultant: Self, Medtronic: Consulting Fee:, UCB: Contracted Research:, Merck: Contracted Research:, Serge Nikolic, MD: None, Stana Bojanic, BSc MBBS FRCS (SN): Abbott: Contracted Research:, Habib Ellamushi: None, Paresh Doshi, MS MCh: None, Preeti Doshi, MBBS, MD, FRCA: None, Babita Ghai, MBBS, MD, DNB: None, Marc Russo, MD: Presidio Medical: Ownership Interest:, Saluda Medical: Ownership Interest:, Boston Scientific: Contracted Research: Self, Mainstay Medical: Contracted Research: Self, Medtronic: Contracted Research: Self, Nevro: Contracted Research: Self, Saluda Medical: Contracted Research: Self, Presidio Medical: Contracted Research: Self, Freedom Ne ro: Ownership Interest - Own Stocks: Self, Lungpacer: Ownership Interest - Own Stocks: Self, SPR Therapeutics: Ownership Interest - Own Stocks: Self, Lawrence Poree, MD,MPH,PHD: Medtronic: Consulting Fee: Self, Saluda Medical: Contracted Research: Family, Nalu Medical: Contracted Research: Family, Gimer Medical: Consulting Fee: Self, Nalu Medical: Consulting Fee: Self, Saluda Medical: Consulting Fee: Self, Nalu: Ownership Interest:, Saluda Inc: Ownership Interest:, Alia Ahmad: None, Alaa Abd Sayed, MD: Medtronic, Abbott, SPR and StimWave: Consulting Fee:, Salim Hayek, MD,PhD: None, CHRISTOPHER GILLIGAN, MD MBA: Persica: Consulting Fee: Self, Saluda: Consulting Fee: Self, Mainstay Medical: Contracted Research: Self, Sollis Therapeutics: Contracted Research: Self, Iliad Lifesciences, LLC: Owner: individuals with legal ownership in a company:, Vivek Mehta: NoneCopyright © 2023

ICU without walls = ICU without Data? the Covid-19 deficit

Introduction: Northern Ireland (NI) has 5.5 ICU beds/100 000 population,1 amongst the lowest in Western Europe.2 Alongside ICU bed expansion the Covid-19 response required delivery of advanced Respiratory support (Continuous Positive Airway Pressure (CPAP) and High Flow Nasal Oxygen (HFNO)) outside ICU. ICNARC provides robust data for patients within ICU but this is unavailable for those receiving 'critical care' elsewhere. Objective(s): To evaluate delivery of CPAP/HFNO outside of ICU to Covid-19 patients - focusing on demographics and outcomes including ICU admission and mortality. Method(s): Ward-CPAP for acute hypoxaemic respiratory failure (AHRF) was not previously utilised.3 It was introduced for Covid-19 to Medical wards. Data was analysed using the NI Electronic Care Record, ward electronic note system (EDAMS) and ICU system (ICCA, Koninklijke Philips N.V.). Data was compared between Wave 1 (01/03/2020 - 12/12/2020) and Wave 2 (13/12/2020 - 01/04/2021). Result(s): 215 patients received CPAP/HFNO/Invasive Mechanical Ventilation (IMV) for Covid-19: 103 in Wave 1 and 112 in Wave 2. 75 Covid-19 patients were admitted to the ICU itself (comprising 44 of the study cohort, 11 direct from ED and 20 transferred from other Trusts). Table 1 shows demographics. Fewer patients were female as seen elsewhere,4 there were more young patients in Wave 2. The majority of patients would likely have been ICU candidates pre-pandemic,3 but a subset of 25% were deemed for a ward ceiling-of-care on admission by a Consultant and the proportion of elderly patients was higher than described by ICNARC.4 Comorbidities and obesity were common. Outcomes are shown in Table 2 and Figures 1-3. Close co-operation with ICU saw 61% of patients with a documented ICU review. Overall 20% of patients were admitted to ICU, and 15% received IMV. Mortality was 37%, but 22% if patients with an admission ward ceiling-of-care decision were excluded. Mortality correlated with frailty and age (fig 2&3). Outcomes were generally better in Wave 2. Conclusion(s): This Evaluation documents the huge contribution to the critical care Covid-19 response made by our Medical teams, not captured by ICNARC. Most patients avoided ICU admission and IMV and outcomes were likely at least comparable which undoubtedly freed up vital ICU beds. We thank the teams involved and believe it is vital to evaluate the outcome of all critically ill Covid-19 patients irrespective of their location.

Adapting Regulations Post-Brexit

The UK government is taking advantage of the new regulatory flexibility, afforded by Brexit, to boost the country's competitiveness in pharma On 1 Jan. 2021, the United Kingdom formally left the European Union to become a third country and no longer a member of the Union's single market and customs union. The UK has, for example, decided to draw up its own version of the EU chemicals legislation-called REACH (Registration, Evaluation, Authorization, and Restriction of Chemicals)-which sets technical standards for chemical ingredients for medicines (1). Because the UK is a separate legal entity-a third country-the UK's excipient producers and their raw material suppliers have started to be concerned about procedures like customs declarations and rules of origin. [...]by 18 Feb. 2021 the UK had vaccinated 26% of its population versus 8% in Denmark-the leading EU country for vaccines availability-6% in Germany, and 5% in France (6). NICE needs to change Industry believes that the National Institute for Health and Care Excellence (NICE), the government's health technology assessment (HTA) body, is being too restrictive with its evaluation of digitalization products, which ultimately sets the price paid by the government for them (9).

The introduction of novel bladder outlet therapies in a regional day-case unit in Northern Ireland

ContextNorthern Ireland has five health and social care trusts that provide a Urology service. COVID-19 resulted in the cessation of all but the most urgent elective urological cases. As a result there was an immediate need to enhance current facilities to improve care for our patients. Operations for bladder outlet obstruction, such as transurethral resection of the prostate (TURP), were largely on hold. Men with benign prostatic enlargement continued to suffer in terms of quality of life from symptoms and morbidity from their condition, with subsequent costly attendances through unscheduled care.Issue/ChallengeAs one trust, we had over 100 men active on a waiting list for TURP. We had over 100 patients awaiting a review to decide on surgical management. We had over 400 men awaiting routine assessment through our lower urinary tract symptom assessment clinic.Several surgical options now exist for bladder outlet obstruction. Until this project, TURP was the only option offered to men in Northern Ireland, which is out-with NICE guidance. A TURP has traditionally been an inpatient operation requiring a hospital stay of 2-3 days. During the pandemic and looking to the recovery of services, this was not a viable option.Assessment of issue and analysis of its causesA scoping exercise on where to best place any new service was performed. Key stakeholders included our clinical leaders, management colleagues in the trust and the Department of Health. With successful implementation of a traffic light system for COVID-19, a green pathway for elective surgery had been implemented with great success in our main inpatient Ulster Hospital site. Reflecting on what had been learned in this process, and with a clear need to advocate day-case as default for certain procedures, a regional centre out-with our main inpatient operating theatres was delivered – the Regional Day Procedure Centre (DPC), based at Lagan Valley Hospital.ImpactThe impact has been improved individual patient journeys and improved quality of life for men living with benign prostatic obstruction, with their treatment happening much more promptly, as well as increased staff satisfaction and a saving in theatre costs and bed days.InterventionWe learned and implemented novel bladder outlet techniques;namely Rezum steam ablation therapy to the prostate;green light laser treatment of the prostate (GLLP) and hoImium enucleation of the prostate (HoLEP). We arranged simulation-based training for our Consultant and Speciality Doctor team and mock theatre set up training with the theatre staff to include common pitfalls with equipment. We also arranged simulation-based training for postgraduate surgical trainees, enhancing training during the pandemic.Involvement of stakeholders, such as patients, carers or family members:We engaged and had the support of the clinical and managerial teams from the outset. We opened communication with the day-case unit pre-assessment and anaesthetic teams early. We introduced a new co-located outpatient prostate assessment clinic in conjunction with a nurse specialist.Key MessagesOver the last 6 months we have implemented an all options service for bladder outlet obstruction. We have performed more than 50 day-case Rezum cases, introduced day-case GLLP and inpatient HoLEP. All Rezum and GLLP cases have been day-case with the subsequent personal and institutional savings. We will report our clinical outcomes and reflect on lessons learned.Lessons learntThe introduction of novel bladder outlet therapies has led to improved quality of life for men living with bladder outlet obstruction. We have significantly reduced the waiting list and the waiting time for treatment. We have shown that service development and improvement for benign disease is possible even during a pandemic.Measurement of improvementWe are following up these men with validated symptoms and quality of life scores. We get objective measurement of improvement through repeat flow rate and measurement of post void residual urinary volumes. We have kept a database on key patien parameters and self-reported outcomes. Initial results are promising.Strategy for improvementAs an ongoing and ever evolving project, we use multiple PDSA cycles to improve our service. Weekly team briefs at the end of theatre lists allow feedback from all staff. In particular we have learned from our patients. We have introduced local anaesthetic treatment with Rezum in men unfit for other options. We have contacted other units to share their experience and there has been coverage of our work in our regional media.

Rehabilitation needs after critical illness: Referral outcomes from a ICU follow up clinic in Northern Ireland

Introduction: In 2019/20 a total of 171,900 people were admitted to adult general intensive care units (ICU) across England, Wales and Northern Ireland, with a survival rate of 79.6% at hospital discharge.1 Patients who survive critical illness and admission to ICU often experience ICU-related long-term physical and non-physical impairments and disability following hospital discharge.2 National guidance advocates multidisciplinary team (MDT) follow up to identify and manage the unmet health needs of this patient population.3-4 The UK has seen an increase in the number of follow up services available in the last 7 years.2 The Covid-19 pandemic further highlighted the need to provide this service, locally resulting in the establishment of the Belfast Health and Social Care Trust (BHSCT) ICU follow up clinic in July 2020. The follow up clinic is offered to patients aged = 18 years, an ICU length of stay of = 4 days, who have been discharged from an inpatient setting within the last 12 weeks and do not receive follow up from any other established care pathway. The clinic consists of an ICU Nurse, Doctor, Clinical Psychologist and Physiotherapist. Patients are offered either a virtual, face-to-face or telephone appointment. Objective(s): To identify unmet rehabilitation needs and onward referral requirements of patients presenting at an ICU follow-up clinic in Northern Ireland. Method(s): Data was gathered retrospectively using an excel database detailing patient demographics, appointment details and onward referrals generated from the clinic. Data was analysed for a set time period between the 01/12/2021 - 09/02/2022. The type of referral and the profession responsible were captured. Result(s): During the time period eight post ICU follow up clinics were completed. A total of 36 patient's attended (14 male and 22 female). Six appointments were attended virtually via MS Teams, 12 via telephone and 18 face-to-face. Twenty-three (64%) of the patients required at least one onward health referral. A total of 61 onward health referrals were generated from this population. Table 1 details the number of onwards referrals by speciality. Conclusion(s): Approximately 64% of patients who attended the post ICU follow up clinic, during a 10 week period, demonstrated unmet rehabilitation needs resulting in onward health referrals. This data supports the need for a post ICU follow up clinic at BHSCT to identify ongoing need, ensure transition of care to relevant services and optimise patient's physical and psychological outcomes. One limitation of this study is that not all recommended allied health professionals are commissioned for the clinic which may impact on the health needs identified. Future work should consider the impact of this and discussions regarding the need for a commissioned post ICU follow up clinic which is truly MDT for this patient population should be considered.

‘Cocooning' in prison during COVID-19: Findings from recent research in Ireland

The advent of COVID-19 prompted the enforced isolation of elderly and vulnerable populations around the world, for their own safety. For people in prison, these restrictions risked compounding the isolation and harm they experienced. At the same time, the pandemic created barriers to prison oversight when it was most needed to ensure that the state upheld the rights and wellbeing of those in custody. This article reports findings from a unique collaboration in Ireland between the Office of the Inspector of Prisons – a national prison oversight body – and academic criminologists. Early in the pandemic, they cooperated to hear the voices of people ‘cocooning' – isolated because of their advanced age or a medical vulnerability – in Irish prisons by providing journals to this cohort, analysing the data, and encouraging the Irish Prison Service to change practices accordingly. The findings indicated that ‘cocooners' were initially ambivalent about these new restrictions, both experiencing them as a punishment akin to solitary confinement, and understanding the goal of protection. As time passed, however, participants reported a drastic impact on their mental and physical health, and implications for their (already limited) agency and relationships with others, experienced more or less severely depending on staff and management practices. The paper also discusses the implications for prison practices during and following the pandemic, understanding isolation in the penological context, and collaboration between prison oversight bodies and academics.

Consolidating Ireland's Indigenous Social Enterprise Sector - A Policy Perspective

The National Social Enterprise Policy for Ireland (2019 - 2022) was a watershed moment for social enterprise in Ireland. Ireland has a rich, proud and diverse experience of social economy and social enterprise, yet the policy framework developed comparatively later than in some other EU member states. Since its launch in 2019, the Policy has helped to significantly shape the social enterprise sector in Ireland including through targeted measures and improved coherence across government policy. At the same time, the sector is still in a nascent phase and faces dramatic new challenges associated with the realities of focussing on social impact whilst trading in a competitive market economy traditionally focussed on export-potential, which have been exacerbated by the economic effects of the COVID-19 pandemic. As this foundational Policy comes to the end of its term, the Government, in partnership with the sector, now faces another significant juncture which will determine how successful social enterprise can be in moving from the margins to the mainstream and contributing to Ireland's economic, social and environmental progress. The current article seeks to clarify the features of Ireland's indigenous social enterprise sector, and offers perspectives on some of the prerequisites for an ambitious and impactful successor policy in 2023 to unlock the potential of the sector to grow in scale and impact.

A six year experience of a national leadership fellowship in Northern Ireland: achieve, develop, explore programme for trainees (ADEPT)

ContextThe Achieve, Develop, Explore Programme for Trainees (ADEPT) Clinical Leadership Fellowship Programme was established in response to growing recommendations to underpin healthcare reconfiguration in Northern Ireland (NI) with a collective leadership strategy. This is a Clinical Leadership Fellows programme available to specialist, general practice and dental trainees in NI as an out of programme experience year. It is recruited competitively through a scored application followed by a 3-part interview. The fellowship programme is coordinated with host organisations, who sponsor fellows to work with organisational leaders in an apprentice model and undertake a self-directed project. This leadership training was provided by the HSC Leadership Centre until 2020, which supported achievement of an Institute of Leadership and Management (ILM) level 7 Certificate. The current 2021-22 cohort have joined the Faculty of Medical Leadership and Management (FMLM) Fellow Scheme.Issue/ChallengeWith the ADEPT programme now in its sixth year and many of its graduates consultants or general practitioners (GPs), a need was identified to assess how the fellowship has shaped participant career performance, decision making and views on leadership training. This study aimed to determine the demographics of ADEPT Fellows and evaluate the impact of the fellowship as perceived by ADEPT alumni on career goals, choices, achievements, and development of leadership skills related to the NHS Healthcare Leadership Model.Assessment of issue and analysis of its causesDemographic data for all ADEPT fellows was held centrally through Northern Ireland Medical and Dental Training Agency (NIMDTA) and assessed anonymously. A mixed-methods questionnaire was composed using Smart Survey. Likert-scale questions were designed to determine the extent to which participants believed ADEPT supported their development of strong and exemplary elements of the nine dimensions of the NHS Healthcare Leadership Model. This questionnaire was split into 4 sections;demographics and project outline, self-assessment of leadership skills before and after ADEPT, career planning and progression and suggestions for programme improvement. The questionnaire was distributed electronically to all ADEPT alumni in November 2021 and remained open for 4 weeks.ImpactThis study validates the usefulness of the ADEPT clinical leadership programme both at an individual and organisational level.InterventionThere have been 46 ADEPT fellows to date (72% female;all fellows were white). ADEPT fellows were most commonly from Psychiatry (33%), Paediatrics (17%) and Obstetrics and Gynaecology (15%). There were 19 responses from the alumni cohort of 46 (41%). 75% of respondents reported that their project resulted in publication, presentation or award. Leadership skill development was identified as best in Evaluating Information and Engaging the Team, whereas skills in Sharing the Vision and Developing Capability saw less improvement. The majority felt that the fellowship had been useful in securing their position as a consultant or general practitioner and 50% went on to pursue senior leadership positions.Key MessagesThe ADEPT Clinical Leadership Fellowship delivers effective leadership training as measured by the nine domains of the NHS Healthcare Leadership Model. It provides value for host organisations through the projects undertaken and by developing doctors who are more likely to engage in future formal leadership roles. ADEPT alumni saw the value in their leadership experience and felt it should be embedded in standard postgraduate training schemes to reach a wider audience.Lessons learntA recurring theme in the healthcare sector is that doctors who have gone through years of formal training often fail to recognise the innate leadership skills they have acquired on their journey to become a consultant. This was evident within the ADEPT group as the majority did not identify themselves as leaders prior to undertaking the fellowship. Distinguishing, nurturing and reframing these skills or use outside of the clinical area are important considerations when developing leadership training in healthcare.Strategy for improvementThe programme will require ongoing review especially given the increasing demand placed on healthcare leadership from the sequelae of the COVID pandemic and an aging society with complex health needs. A ten year follow up to include opinions on the FMLM Fellow Scheme is suggested.

Joyce Lilian Dunlop

Joyce went to Trinity College Dublin to study medicine in 1954, where she enjoyed the Dublin University Biological Society and where she met the love of her life, Jim, a Scotsman, at the Dublin sailing school. After house jobs, Joyce spent some time in Northern Ireland, training in anaesthetics for obstetrics and gynaecology. Before coronavirus took hold, she was looking forward to a family holiday in Croatia in the summer with her three children, their spouses, and all her grandchildren, before her sudden death.

Are You with Us or Against Us?

When the COVID-19 pandemic hit, two contrasting images quickly became repre-sentative of the crisis. On the one hand, there were heroic doctors working day and night with the novel virus, risking their lives and making sacrifices to save others. On the other, there were 'anti-maskers' and 'anti-vaxxers': people doubting if the virus is real, questioning the ef-fectiveness of protective measures, suspicious that the crisis is nothing more than an elaborate plot, a scam aimed to redesign their world and to destroy the values they hold dear. Reflecting on research conducted in Ireland with people separated by the conspiratorial divide, this pa-per examines some methodological and analytical challenges of doing simultaneous research with opposing stakeholders. Analysing my own entanglements in the conflicts over vaccines and conspiracy theories in this paper I argue that the pandemic was not just a battle to secure the acceptability of specific medical technology (the COVID-19 vaccine) but was also about safeguarding respectability of science and maintaining the rule of experts. It was about pre-venting ontological turn, the end of the era of reason, a dawn of modernity.

Establishing an Intensive Care follow up clinic for patients in Belfast, Northern Ireland

Introduction: National guidance states that follow up should be offered to all patients who have spent more than four days in intensive care1 with specific guidance for the follow up of COVID patients released in May 2020.2 Prior to the pandemic, in the Belfast trust, there was no follow-up service provided for intensive care patients. The pandemic presented many new challenges to intensive care, with a high number of patients requiring follow up after discharge. It also presented a unique problem in that follow up clinics could not be delivered in the traditional face to face manner. Objective(s): To set up a follow up service that assessed patient recovery from COVID 19 and offered rehabilitation, in a manner that could be delivered safely during a national lockdown. Method(s): A database was collated of all the patients who had been treated in intensive care, during the first wave of the pandemic with a confirmed positive COVID-19 sample. A follow up pathway (Figure 1) was designed for the clinic based on the BTS and FICM guidelines.2-3 The multidisciplinary team used Microsoft Teams to complete clinic proformas for each patient, share files and perform virtual appointments. Patient questionnaires were collated using the forms app within MS Teams. Patients filled in various objective health questionnaires at both their 6 and 12 week appointments to allow the team to assess their rehabilitation. Once the appointments were completed the proformas were entered into their permanent medical record on the Northern Ireland Electronic Care Record (NIECR). Result(s): There were 42 patients treated in the pandemic's first wave, 40 were reviewed at 6 weeks and 39 at 12 weeks post hospital discharge. Anonymous feedback was gathered electronically from patients about their experience of the clinic. The feedback from the patients was overwhelmingly positive. To date the clinic has offered follow up to nearly 300 patients and is still in use. It has grown in size and has received input from the Belfast trust for further staffing and resources. The project recently received joint first prize in the innovation and transformation in care category for the Health and Social Care Quality Improvement (HSCQI) awards in the trust. Conclusion(s): This project highlights the essential requirement for follow-up after an intensive care admission with significant ongoing morbidity demonstrated in this patient cohort. It is currently still the only service with this breadth of MDT input in Northern Ireland. The initial use of MS Teams has allowed this service to run safely during a pandemic but it has since been adapted as the pandemic has evolved and is now offered to all Intensive care patients. Its collaborative platform allows for immediate communication throughout the whole team, and the ability for the team to be flexible. In essence, we have set up a unique and robust system that can be easily used to offer excellent follow up to Intensive care patients within the Belfast trust.

Development of digital mental health in Ireland

This paper provides an overview of the development and current status of digital mental health in Ireland. It will present the results of the work carried out on this topic as part of Interreg Europe's eMEN project. This charts the trajectory of digital mental health developments in Ireland across three phases: pre-, mid-, and post-COVID-19 pandemic. Before the pandemic hit, the field of digital mental health was gradually growing through a combination of bottom-up and top-down activities. The pandemic triggered a rapid shift to the online provision of mental health services, which often involved remote consultations via video platforms. As we come out of the pandemic, the focus has shifted to consolidating these pandemic-driven changes, as well as continuing to build on existing initiatives. This article outlines the key elements of each phase, as well discussing certain key issues that should be factored into healthcare policies and provision.These include quality assurance frameworks designed to cover a range of digital mental health applications, as well as new ontological frameworks to characterize the emerging ecosystem of technology-based care in the post-pandemic "new normal”. Copyright © 2023 John Libbey Eurotext. Téléchargé;Ce document présente un aperçu de l'évolution et du statut actuel de la santé mentale numérique en Irlande. Il présente les résultats du travail effectué par les auteurs dans le cadre du projet Interreg eMEN. Il décrit la trajectoire d'évolution de la santé mentale numérique en Irlande selon trois phases: avant, pendant et après la pandémie de Covid-19. Avant la pandémie, la santé mentale numérique évoluait progressivement grâce à une combinaison d'activités ascendantes et descendantes. La période de pandémie a déclenché une évolution rapide vers la fourniture en ligne de services de santé mentale, notamment les consultations à distance via des plateformes vidéo. Au sortir de la pandémie, l'accent est mis sur la consolidation des changements induits par la pandémie, ainsi que sur la poursuite du développement des initiatives déjà lancées auparavant. Cet article présente les éléments clés de chaque phase et examine certaines questions essentielles à prendre en compte dans les politiques et l'offre de soins. Il s'agit notamment des cadres d'assurance qualité destinés à couvrir les applications de santé mentale numérique, ainsi que de nouveaux cadres ontologiques pour caractériser l'écosystème émergent des soins basés sur la technologie dans la « nouvelle normalité» post-pandémique. Copyright © 2023 John Libbey Eurotext. Téléchargé;Este documento ofrece una panorámica de la evolución y el estado actual de la salud mental digital en Irlanda. Presenta los resultados del trabajo de los autores sobre este tema como parte del proyecto Interreg eMEN. Describe la trayectoria de evolución de la salud mental digital en Irlanda según tres fases: antes, durante y después de la pandemia de la COVID-19. Antes de la pandemia, la salud mental digital evolucionaba gradualmente mediante una combinación de actividades ascendentes y descendentes. El periodo pandémico desencadenó una rápida evolución hacia la prestación en línea de servicios de salud mental, en particular las consultas a distancia a través de plataformas de vídeo. Después de la pandemia, la atención se ha centrado en consolidar los cambios provocados por la pandemia, así como en seguir desarrollando las iniciativas ya puestas en marcha anteriormente. Este artículo presenta los elementos claves de cada fase y examina algunas de las cuestiones fundamentales que deben tenerse en cuenta en las políticas y la prestación de asistencia. Entre ellas se incluyen en primer lugar los marcos de garantía de calidad con el fin de cubrir las aplicaciones digitales de salud mental, así como los nuevos marcos ontológicos para caracterizar el ecosistema emergente de atención basada en la tecnología en la "nueva normalidad” pospandémica. Copyright © 2023 John Lib ey Eurotext. Téléchargé

Prone positioning for mechanically ventilated patients with coronavirus disease 2019: the experience of an Irish regional hospital intensive care unit.

BACKGROUND: The benefits of prone positioning in acute respiratory distress syndrome (ARDS) have been known for many years. While some controversy exists regarding whether coronavirus disease 2019 (COVID-19) pneumonia should be treated with the same therapeutic strategies as for non-COVID ARDS, the Surviving Sepsis Campaign still provide a weak recommendation to utilise prone positioning in this setting. AIMS: The aims of this study are to ascertain if prone positioning improves oxygenation significantly in mechanically ventilated patients with severe COVID-19 ARDS and to describe the feasibility of frequent prone positioning in an Irish regional hospital intensive care unit (ICU) with limited prior experience. METHODS: In this retrospective, observational cohort study, we investigate if the PaO2/FiO2 ratio and ventilatory ratio improve during and following prone positioning, and whether this improvement correlates with patient baseline characteristics or survival. RESULTS: Between March 2020 and 2021, 12 patients underwent prone positioning while mechanically ventilated for severe COVID ARDS. Sixty-six percent were male, mean age 60.9 (± 10.5), mean BMI 33.5 (± 6.74) and median APACHE II score on admission to ICU was 10.5 (7.25-16.3). Further, 83% were proned within 24 h of being intubated due to refractory hypoxaemia. PaO2/FiO2 ratio improved from 11.6 kPa (9.80-13.8) to 15.80 kPa (13.1-19.6) while prone, p < 0.0001. CONCLUSIONS: We found prone positioning to be a safe method of significantly improving oxygenation in mechanically ventilated patients with severe COVID-19 ARDS. We did not find a relationship between patient baseline characteristics nor illness severity and degree of PaO2/FiO2 ratio improvement, nor did we find a relationship between degree of PaO2/FiO2 ratio improvement and survival.

Cost-Effectiveness of the Use of Adjuvanted Quadrivalent Seasonal Influenza Vaccine in Older Adults in Ireland.

BACKGROUND: Enhanced vaccines (e.g., containing adjuvants) have shown increased immunogenicity and effectiveness in older adults, who often respond sub-optimally to conventional influenza vaccines. In this study, we evaluated the cost-effectiveness of an inactivated, seasonal, MF59-adjuvanted quadrivalent influenza vaccine (aQIV) for use in adults ≥ 65 years in Ireland. METHODS: A published dynamic influenza model incorporating social contact, population immunity, and epidemiological data was used to assess the cost-effectiveness of aQIV in adults ≥ 65 years of age compared with a non-adjuvanted QIV. Sensitivity analysis was performed for influenza incidence, relative vaccine effectiveness, excess mortality, and the impact on bed occupancy from co-circulating influenza and COVID-19. RESULTS: The use of aQIV resulted in discounted incremental cost-effectiveness ratios (ICERs) of EUR 2420/quality-adjusted life years (QALYs) and EUR 12,970/QALY from societal and payer perspectives, respectively, both of which are below the cost-effectiveness threshold of EUR 45,000/QALY. Sensitivity analysis showed that aQIV was effective in most scenarios, except when relative vaccine effectiveness compared to QIV was below 3%, and resulted in a modest reduction in excess bed occupancy. CONCLUSION: The use of aQIV for adults ≥ 65 years old in Ireland was shown to be highly cost-effective from both payer and societal perspectives.

Adaptations to a cohort study in response to the COVID-19 pandemic: insights from Growing Up in Ireland.

Growing Up in Ireland (GUI) is the national longitudinal study of children and young people in the Republic of Ireland and has followed two cohorts for over ten years to date: Cohort '98 who were recruited into the study at age nine years and Cohort '08, recruited at age nine months. The study aims to describe the lives of Irish children and young people in terms of their development, with a view to positively affecting policies and services available for them. Traditionally, data collection involved in-home visits from an interviewer who conducted face-to-face interviews, recorded physical measurements of study participants and administered cognitive assessments. However, with the onset of the COVID-19 pandemic and the associated restrictions, significant adaptations were required to these methods to ensure data collection for the pilot and main fieldwork for Cohort '08 at age 13 could continue to the expected timeline. Face-to-face interviews with participants were replaced with telephone and web-based modes, interviewer training was conducted online, online resources were made available for interviewers and participants and COVID-19 related items were added to questionnaires. In addition to the scheduled data collection, a special COVID-19 survey was also conducted on both GUI cohorts in December 2020 to explore the impact of the pandemic on participants' lives. This paper outlines the adaptations made to traditional data collection methods in GUI, highlighting the challenges that were met, but also the benefits of some changes that may be worth incorporating into future waves of GUI.

Establishing severe acute respiratory infection (SARI) surveillance in a sentinel hospital, Ireland, 2021 to 2022.

BackgroundIn 2020, due to the COVID-19 pandemic, the European Centre for Disease Prevention and Control (ECDC) accelerated development of European-level severe acute respiratory infection (SARI) surveillance.AimWe aimed to establish SARI surveillance in one Irish hospital as part of a European network E-SARI-NET.MethodsWe used routine emergency department records to identify cases in one adult acute hospital. The SARI case definition was adapted from the ECDC clinical criteria for a possible COVID-19 case. Clinical data were collected using an online questionnaire. Cases were tested for SARS-CoV-2, influenza and respiratory syncytial virus (RSV), including whole genome sequencing (WGS) on SARS-CoV-2 RNA-positive samples and viral characterisation/sequencing on influenza RNA-positive samples. Descriptive analysis was conducted for SARI cases hospitalised between July 2021 and April 2022.ResultsOverall, we identified 437 SARI cases, the incidence ranged from two to 28 cases per week (0.7-9.2/100,000 hospital catchment population). Of 431 cases tested for SARS-CoV-2 RNA, 226 (52%) were positive. Of 349 (80%) cases tested for influenza and RSV RNA, 15 (4.3%) were positive for influenza and eight (2.3%) for RSV. Using WGS, we identified Delta- and Omicron-dominant periods. The resource-intensive nature of manual clinical data collection, specimen management and laboratory supply shortages for influenza and RSV testing were challenging.ConclusionWe successfully established SARI surveillance as part of E-SARI-NET. Expansion to additional sentinel sites is planned following formal evaluation of the existing system. SARI surveillance requires multidisciplinary collaboration, automated data collection where possible, and dedicated personnel resources, including for specimen management.

Emerging venue considerations for event management: the case of Ireland

Event venues represent a focal point for infectious disease transmission among attendees and event stakeholders, creating lasting uncertainty within the industry post-COVID-19. There is now a need to investigate emerging venue considerations for the event industry as a result of the COVID-19 pandemic. Using Ireland as a case, a quantitative questionnaire was used on a sample of event managers. Event venue monitoring for COVID-19 is lacking, while risk mitigation procedures focus more on attendees already at the venue rather than avoiding infected persons entering the venue. Risk assessments now comprise COVID-19 risk;however, a lack of resources means regular health and safety has shown signs of weakening. Government and local authority resources and financial support are required. Pre-venue procedures of symptom screening and proof of vaccination, combined with venue procedures for disinfection of venue spaces, table service, and appropriate ventilation have proven to be effective COVID-19 risk mitigation procedures. Additionally, ICT (information and communications technology) could disseminate up-to-date health guidelines through customer-centric digital environments representing enhanced information sharing to avoid uncertainty and support pro-social intentions of event attendees and compliance with event venue COVID-19 risk mitigation procedures.