College of Medicine and Health - Masters by Research Theses
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- ItemProficiency-based progression (PBP) training- the future model for dental operative skills training? A systematic review and meta-analysis of existing literature(University College Cork, 2023-01) Kehily, Elaine; Roberts, Anthony; Allen, Finbarr; Gallagher, Anthony G.; Health Research BoardObjective: To evaluate the effectiveness of proficiency-based progression (PBP) operative training using validated performance metrics, by comparing this to standard, conventional training methods. Data: This systematic review was conducted in accordance with the PRISMA guidelines for the Transparent Reporting of Systematic Reviews and Meta-Analyses. Study quality was assessed using the MERSQI tool and the Cochrane Risk of Bias tool. Results were pooled using biased corrected standardized mean difference and ratio-of-means (ROM). Summary effects were evaluated using a series of fixed and random effects models. The primary outcome was the number of procedural errors performed comparing PBP and non-PBP-based training pathways. In quantitative synthesis testing for procedural errors, a pooled meta-analysis on 87 trainees was conducted using random-effects models. In a ROM analysis, PBP was estimated to reduce the mean rate of errors by 62%, when compared to standard training (ROM 0.38, 95% CI: 0.25; 0.58; p < 0.001) Sources: The electronic databases of PubMed, Embase, Web of Science, MEDLINE and Cochrane library’s CENTRAL were searched from inception to 8/11/2021. Filters activated were Randomized Controlled trials, clinical trial. Study selection: 13 studies were included for review with 11 included in the quantitative synthesis from 174 potentially relevant publications identified by the search strategy. Main inclusion criteria were studies comparing standard surgical/operative training with proficiency-based simulation training using validated metrics based on expert performance. Conclusions: Our meta-analysis found that PBP training improved trainees' performances, by decreasing procedural errors. There is sufficient evidence to explore PBP training for use in dental skills training.
- ItemThe influence of gender on paternal involvement in the treatment process of a child or adolescent with an eating disorder(University College Cork, 2022-06-29) O'Sullivan, Hazel; O'Donovan, Áine; Goodwin, JohnAim: To identify factors that influence paternal engagement in the treatment process of a child or adolescent with an eating disorder. Background: Eating disorders are complex mental health issues and are exacerbated by a high mortality rate. Adolescence is the period of development when an eating disorder typically commences. International and national guidelines recommend the involvement of the family in the treatment process. However, barriers can exist on both an organisational and on an individual level. The family is an important source of support, yet there is a lack of research pertaining to the factors that facilitate or prevent fathers from participating in the treatment process. Method: A scoping review of the literature was undertaken to identify what key information existed within the current literature and research pertaining to the topic under examination. Thirteen studies were identified as pertinent to the research question posed. Following analysis, these studies identified the importance of parental involvement in the treatment process but pointed to fathers assuming a more peripheral role. Thus, to further understand the processes that contributed to paternal engagement this research sought to further examine the paternal role within the treatment process. It was determined that a qualitative descriptive approach would best suit the research aim. Data were obtained by conducting focus groups with a total of seven fathers agreeing to participate in two focus groups. Both focus groups were guided by a semi-structured interview guide. A qualitative content analysis approach was used to analyse the data regarding paternal experiences of engagement in the treatment process. Findings: Four themes were generated from the data. These were; fathers didn’t see this coming, no one place for one person to go alone, we are not as in touch with our children and the eating disorder as a mental illness. Conclusion: Fathers described themselves as on the periphery of the family, they identified themselves as experiencing things differently to mothers with a belief their role was to provide support to their wives and children within the treatment process. Impact: Healthcare providers need to be aware of the contribution of gendered roles within the family system, and the need to consider this when working with families within the treatment process.
- ItemThe evaluation of estradiol and indomethacin for incorporation into microneedle formulations(University College Cork, 2022) Lalchandani, Akash Parsram; Crean, Abina; Faisal, Waleed; Enterprise IrelandThe objective of this thesis is the technical evaluation of the suitability of drug substances, estradiol and indomethacin, for incorporation into a patented dissolvable microneedle (DMN) platform technology for intradermal drug delivery. Estradiol and indomethacin were chosen based on their physicochemical properties (melting point, glass transition temperature, amorphous solid state after melt-cooling) which were favourable for manufacturing microneedles using the melt DMN technology. Oral dosage forms of both drugs, and transdermal patches of estradiol are available in the market. Currently no indomethacin transdermal patch formulation is available. This project aims to assess the feasibility of developing dosage forms of both drugs for microneedle-assisted, intradermal delivery. The research presented, initially provides a background to the drivers and challenges related to the development of microneedle (MN) drug combination products for inclusion in the mainstream pharmaceutical and medical device market. The thesis then focuses on the experimental studies evaluating the feasibility of developing DMN from the drug substances of interest, estradiol and indomethacin. Melt-cooled samples of both drugs were also prepared to simulate the processing stress of the DMN manufacturing process. Melt-cooled samples were evaluated for solid-state form by differential scanning calorimetry (DSC) and powder X-ray diffraction (PXRD), and chemical composition by high performance liquid chromatography. Microneedle formulations of both drugs were produced using a previously developed manufacturing process and their mechanical strength and ability to penetrate pig skin analysed. A stability study was conducted to evaluate chemical and solid-state stability of the melt-cooled samples at 3 storage conditions: condition A (25°C/60% RH), condition B (40°C/ 75% RH), and condition C (2°C to 8°C in nitrogen filled vials) over a 3 month time period. The melt-cooled solid form of both drugs post melting was found to be chemically stable over the period of 3 months when stored at all 3 storage conditions studied. The amorphous melt-cooled samples of both drugs showed greatest stability at 2°C to 8°C in nitrogen. However, DSC and PXRD results identified crystallisation of the melt-cooled estradiol and indomethacin samples to when stored at 25°C/60% RH and 40°C/ 75% RH over 3 months. This loss in amorphous form was paramount for indomethacin when stored at 40°C/ 75% RH. These results indicated the need for storage and packaging precautions for MN of both drugs to prevent solid-state alterations upon storage which could impact on MN mechanical strength and dissolution in the skin. The MNs formed from both drugs, using the melt dissolvable microneedle technology, were found to be physically strong and capable of penetrating ex-vivo pig ear skin. The research presented illustrated that estradiol and indomethacin DMN can be manufactured using a melt DMN technology, but packaging and storage precautions are required to stabilise the drug solid-state form.
- ItemSchool connectedness: a qualitative case study through an occupational lens(University College Cork, 2022) O'Leary, Jennifer; Boyle, Bryan; Lynch, HelenBackground: School connectedness is an under researched concept in all professions. While the term “belonging” has been used within occupational science, “connectedness” is not a term frequently used. To date, there is one study based on school connectedness and occupation and there is no study in an Irish context. The relationship, if any, between occupation and school connectedness is not understood. Given the strong position of belonging in occupational science, this concept must be understood in a school context. Since the passing of Ann Wilcock (1940-2019), there has been a call for research which continues to build on her Occupational Perspective of Health (doing, being, becoming, belonging). This study aims to do so within a school context. Aim/ Objectives: This research study had three aims; 1) To better understand students and their school’s personnel perceptions of school connectedness 2) To further understand what determines a student’s sense of connectedness to the school environment according to the students and the school personnel 3) To explore the relationship between student’s school-based occupations and their sense of school connectedness. Study Design: This research study is a qualitative single instrumental case study. This study commenced by an entire sixth class group completing a creative exercise to elicit data. Ten students engaged in a focus group and individual semi-structured interviews. This study also had four school personnel engage in individual semi-structured interviews. Thematic data analysis was conducted. Findings: Four themes emerged from the findings; 1) The Importance of the Student’s Social Context on School Connectedness 2) Occupational Influence on School Connectedness 3) Co-constructing an Environment for School Connectedness 4) How Community Connectedness is Reflected in the School. Conclusions: This study established a new perspective of school connectedness through an occupational lens. School connectedness is necessary for enhancing every student’s school occupational performance. Findings outline that due to the impact school connectedness has on occupational participation, occupational therapists should promote school connectedness through a whole school approach. Findings enhance the need to consider the value of interdependence as an outcome to practice.
- ItemExamining fathers’ feeding practices with their children(University College Cork, 2021-12-21) O'Connor, Simone; Mulcahy, Helen; Leahy-Warren, PatriciaBackground: The prevalence of obesity is increasing globally at a rapid rate resulting in a significant threat to public health. Only thirty-seven percent of the Irish population have a normal Body Mass Index (BMI), while 25% of children in Ireland are overweight or obese (Department of Health 2016). Gregory (2015) identified that fathers wish to be more involved in the care of their children than what they currently are. Fathers remain underrepresented in the literature relating to their children’s health outcomes. Aim: The aim of this research is to examine fathers’ feeding practices with their children. Methods: A cross-sectional quantitative research design was utilized. A convenience sample of fathers (n=129) in Ireland who had children 18 years or younger prior to the commencement of the study were recruited through various online platforms. Data were collected using a demographic questionnaire and the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub 2007). A cross-sectional quantitative research design was utilized. A convenience sample of fathers (n=129) in Ireland who had children 18 years or younger prior to the commencement of the study were recruited through various online platforms. Data were collected using a demographic questionnaire and the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub 2007). Once data collection was completed the data were coded using the guidelines from Musher-Eizenman & Holub (2007). The response options utilized a 5-point response scale. A Microsoft Excel Sheet was prepared, and data were entered into it. SPSS version 25 was used for analysis. The mean and standard deviation per subscale of the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub 2007) were calculated, Spearman's rank correlation coefficient (p value) was used to examine the relationship between age of child and each subscale of the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub 2007) and the Mann–Whitney U test was used to exam the relationship between child gender and each subscale of the Comprehensive Feeding Practices Questionnaire. Results: Of 129 respondents, almost half were in the 35-44 age range, only 5.4% were between the ages of 18-25 years. The majority identified as white and had achieved third level qualifications. Most responses were based on children ages 2 to 10 years old, and forty-five percent answered in relation to male children. Ninety-three percent of respondents were not concerned about their child’s weight, while 89% categorised their child’s weight as ‘average’. The feeding practices used most frequently by respondents were Encourage Balance and Variety (M 4.66(SD 0.5)), Modelling (M 4.3(SD 0.8)) and Monitoring (M 4.01(SD 0.91)). Fathers’ feeding practices were found to be the similar regardless of gender. Conclusion: Fathers have become more involved in the routine tasks of childcare which were once seen as the mother’s role (Taylor et al., 2013). Despite this the Mixed Methods Systematic Review (MMSR) showed that fathers were underrepresented in the literature. The MMSR found that fathers did have concerns regarding their children maintaining a healthy weight. In the current study most respondents were not concerned about their child’s weight. Fathers’ feeding practices were found to be similar regardless of gender, while they varied with child age. The majority of respondents (93.8%) were not concerned about their child’s weight. Fathers’ feeding practices were found to be similar across both genders. Findings of this study should be used to inform healthcare professionals’ interventions with fathers with regard to their feeding practices and ensure that they are included in all parenting interventions. Based on these findings it is recommended that future studies using the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub 2007) with a larger probability sample would further inform the application of appropriate clinical and parenting interventions. Implications for clinical practice: Healthcare Professionals should provide education to both fathers and mothers involved in relation to their children’s health. If both parents attend their child’s healthcare visits, healthcare professionals should focus advice, information, and questions equally towards both parents.