College of Medicine and Health - Masters by Research Theses
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Item An exploration of joint working between intellectual disability and acute service providers when people with intellectual disabilities access acute care services: findings from a qualitative study(University College Cork, 2023) Kelleher, Eileen; Martin, Dr Anne-Marie; Caples, Dr Maria; Wills, Dr TeresaBackground: People with intellectual disabilities often avail of/use intellectual disability services within the community. However, they experience more health needs and are therefore twice as likely to access acute services compared to the general population. Several reports and enquiries have highlighted the sub-optimal care provided to this group while accessing care in acute services. Joint working between intellectual disability and acute services has repeatedly been identified as one measure to address the issues faced by people with intellectual disabilities in acute services. Aim: The research aimed to explore joint working between intellectual disability and acute service providers when adults and children with intellectual disabilities access acute care services. Method: A review protocol was first conducted which guided a mixed-method systematic review which explored current evidence of joint working compared to non-joint working. Data were analysed thematically. The findings of this review informed a qualitative descriptive study, which explored intellectual disability service providers experiences of joint working with acute service providers. Ten healthcare professionals took part in semi-structured interviews which were analysed using thematic analysis. Findings: When present, joint working was found to promote continuity of care. However, both studies found an absence of joint working between acute and intellectual disability services. Joint working was influenced by inter-service communication and both studies identified poor communication and information-sharing between services despite measures being in place to facilitate communication. Confusion regarding the role and responsibilities of service providers was found to negatively impact joint working, and the absence of specific intellectual disability policies and procedures contributed to this confusion. Healthcare professionals in acute services were found to have limited knowledge on the needs of those with intellectual disabilities and the supports available in intellectual disability services. Trust between services was considered important to ensure the future success of joint working. Conclusion: Benefits and challenges of joint working between both services were identified. Joint working creates better understanding between services and ensures continuity of care for those with intellectual disability. There is a need to strengthen joint working between services by improving communication between services providers to ensure better information-sharing. There is a need to establish the role and responsibilities of each service provider to improve joint working.Item The home life environment and organised extracurricular activities: associations with adolescent drug use in Ireland(University College Cork, 2023) Daly, Fionn Patrick; Barrett, Peter; Millar, Seán R.Introduction: Adolescent drug use is a major public health concern in many countries, including Ireland. Although drug use during adolescence may lead to a plethora of adverse sequelae, no study has examined how the home life environment, and involvement in extracurricular activities, can influence drug use among teenagers in Ireland. Aim: To identify the various home life environment factors and organised extracurricular activities that are associated with adolescent cannabis and stimulant (cocaine and/or ecstasy) use. Methods: The Planet Youth: Growing Up in the West 2020 survey was an anonymous, self-completed questionnaire among post-Junior cycle school-going adolescents in counties Galway, Mayo, and Roscommon. The study herein is compartmentalised into two data chapters: (1) cannabis and (2) stimulant (cocaine and/or ecstasy) use among study participants, and these comprised our outcomes. In relation to cannabis, outcomes were categorised as (i) cannabis use more than 12 months ago, (ii) cannabis use within the previous 12 months but not 30 days, (iii) cannabis use within the previous 30 days, and (iv) never used cannabis. For stimulants, the binary outcomes were lifetime use of (i) cocaine (yes/no) and/or (ii) ecstasy (yes/no). The same exposure variables of interest were examined for cannabis and stimulant use outcomes. These comprised of four home life environment factors (parental rule-setting, parental monitoring, intergenerational closure, and being outside after midnight in the previous week), and participation in four potential organised extracurricular activities (sports, arts, volunteering, and/or afterschool clubs). All adolescents who had complete data pertaining to age, gender, and drug use were included. For cannabis and stimulant use, multinomial and binomial logistic regression analyses, respectively, were undertaken to examine which exposure variables of interest were associated with our outcomes, controlling for potential confounders. Results: In total, 908 (18.5%) adolescents had previously used cannabis. Specifically, 182 (3.7%) had used cannabis more than a year ago, 361 (7.4%) had used cannabis within the last year but not within the previous 30 days, while 365 (7.5%) had used cannabis within the past 30 days. Furthermore, 167 (3.4%) and 136 (2.8%) had previously used cocaine and ecstasy, respectively. Being outside after midnight in the previous week, as well as a lack of parental monitoring, were associated with increased odds of cannabis use across all cannabis outcome categories. A lack of parental rule-setting was associated with cannabis use within the previous 30 days (AOR1.27, 95%CI1.14-1.41). A lack of intergenerational closure was associated with cannabis use within the previous year but not 30 days (AOR1.37, 95%CI1.24-1.52), and within the previous 30 days (AOR1.47, 95%CI1.33-1.63). Not regularly participating in sports was associated with cannabis use within the previous year but not 30 days (AOR1.28, 95%CI1.02-1.61), and within the previous 30 days (AOR1.49, 95%CI1.18-1.88). Not regularly volunteering was also associated with cannabis within the previous 12 months but not 30 days (AOR1.47, 95%CI1.10-1.95), and within the previous 30 days (AOR1.55, 95%CI1.15-2.08). Moreover, being outside after midnight during the previous week was associated with lifetime stimulant use (cocaine AOR5.63, 95%CI3.98-7.97; ecstasy AOR6.37, 95%CI4.36-9.30). A lack of parental rule-setting (cocaine AOR1.28, 95%CI1.10-1.50; ecstasy AOR1.39, 95%CI1.17-1.64), parental monitoring (cocaine AOR1.81, 95%CI1.58-2.06; ecstasy AOR2.15, 95%CI1.86-2.48), and intergenerational closure (cocaine AOR1.37, 95%CI1.18-1.58; ecstasy AOR1.57, 95%CI1.34-1.83) were associated with lifetime stimulant use. Regular participation in sports was linked with reduced odds of cocaine (AOR1.50, 95%CI1.06-2.11) and ecstasy (AOR1.54, 95%CI1.05-2.27) use. Conclusion: Cannabis and stimulants are relatively common among adolescents in Ireland by European standards, particularly cocaine. Users of cannabis and stimulants share several characteristics, primarily in relation to the home life environment. Involvement in certain organised extracurricular activities may reduce the likelihood of teenage drug use. These findings may inform the development of prevention interventions in the western region of Ireland.Item Profiling the meaningful reading habits of young people and adults with Down syndrome(University College Cork, 2023) Jolley, Mary; Frizelle, Pauline; O'Toole, Ciara; Hart; Hart, Nicola; University College CorkIntroduction: Given the technological advancements over the last 20 years, the impact of how we use written language in society and therefore the ability to read is particularly pertinent for people with Down syndrome. Adults with Down syndrome are now more than ever, accessing their communities, further education and employment. All of these facets of daily life can require aspects of reading, such as the ability to read street signs, text messages or work contracts. However, to date, no large scale, international study has profiled the reading habits of adults with Down syndrome in everyday contexts, or how they feel about reading. This information is invaluable as it can inform reading interventions which are functional to adults with Down syndrome; thus, having a meaningful impact on their quality of life. Aim: This study aimed to 1) Explore the reading habits of adults with Down syndrome, informed by the priorities of adults with Down syndrome themselves 2), Gather a large, international profile of meaningful reading for young people and adults with Down syndrome using a valid Meaningful Reading Measure (MRM) (Frizelle et al., 2023) and 3), Investigate whether age, education and place of residence influence meaningful reading for people with Down syndrome. Method: The research was carried out in two phases. Phase-1: Research questions for the study were prioritised and refined following a structured focus group of adults with Down syndrome (n=9). Phase-2: Using a combination of online survey and paper forms, data on the meaningful reading habits of people with Down syndrome were gathered using the MRM. The refined research questions were then addressed. Results: Phase-1 Results: The focus group members prioritised research questions such as whether people with Down syndrome liked reading, and what they felt was difficult or the ‘best thing’ about reading. They indicated an interest in those questions that referred to the impact of age and place of residence on meaningful reading. Phase-2 Results: Ninety-eight people with Down syndrome completed the survey. On average, the participants read 34 of the 46 items in the MRM. Scores ranged from 0-46. The most common item read by the sample was cards and food brands and the most common medium for reading was a tablet or computer (45.3%). The most common reason for reading was to pursue personal learning and interests. Many people with Down syndrome felt that reading novel or complex words was difficult and detailed the various challenges they faced with reading. No relationship between age and MRM score was observed. Younger individuals (aged 16-25) read significantly more new media items (p = .007) than older individuals (aged 26-37). Conclusion: Adults with Down syndrome read a variety of different items in everyday contexts, which are not dissimilar to typical populations. The participants in the study provided a unique insight into the challenges they face with reading; such as the accessibility of texts, complex words, and reading comprehension. In addition, it is evident that reading for both functional use and pleasure is focal in the lives of people with Down syndrome. This information can inform future reading interventions which are motivating, functional and meaningful for people with Down syndrome.Item The NEST study: NICOM vs ECHO in the screening of transient hypertrophic obstructive cardiomyopathy (HOCUM)(University College Cork, 2023) Finn, Bryan Padraig; Ó Tuathaigh, Colm; Dempsey, Eugene M.; University College CorkBackground: Gestational diabetes mellitus (GDM) is the most common metabolic disorder of pregnancy. An increasing number of infants are exposed to hyperglycaemia antenatally with the national prevalence estimated at 10.1-12.4%. Transient HOCUM (Hypertrophic Obstructive Cardiomyopathy) as well as interatrial/interventricular communications remain the most common cardiac sequelae for such infants. In particular, transient HOCUM has a broad estimated international incidence of 13-44%. The current standard of care for infants born to mothers with GDM (Gestational Diabetes Mellitus) is unchanged from routine care, consisting of a bedside newborn examination. A further echocardiogram is subsequently performed if clinically indicated as a key investigation for the detection of congenital heart disease. There has been a rising interest in NICOM (Non-invasive Cardiac Output Monitoring), a range of novel non-invasive measurements of cardiac output and left ventricular outflow using an array of techniques from electrical bioimpedance to transthoracic bioreactance. The appeal is that these investigations can be carried out at the patient’s bedside without a trained ECHO (Echocardiogram) technician. Aim: Our primary aim was to assess the ability of transthoracic bioreactance (a novel method of cardiac output measurement) in detecting left ventricular outflow tract obstruction in a high-risk group. Echocardiography at present is the most commonly used tool in the detection of such cases, whereby left ventricular outflow tract obstruction is secondary to transient hypertrophic obstructive cardiomyopathy (HOCUM) for infants born to mothers with GDM. We hoped to determine if bioreactance (a NICOM branch technology) could be used as a screening tool when compared with the best available standard of echocardiography. Methods: A single centre prospective observational cohort study was conducted. Our primary objective was to compare bioreactance using the NICOM TM device against the most commonly used method of obtaining LVO measurements: echocardiography in infants born to mothers with GDM. Our goal was to ascertain if NICOM could be used as a screening tool to detect those infants at risk of symptomatic transient HOCUM with LVOTO (left ventricular outflow tract obstruction). For the purposes of secondary objectives, maternal demographic characteristics including BMI (Body Mass Index), maternal age, maternal HbA1C (glycosylated haemoglobin) and method of diabetes control were collected from the electronic healthcare record. Infant demographic and clinical variables collected included infant gestation, anthropomorphic measurements, newborn clinical examination findings and if the infant was admitted to the neonatal unit (indication and treatment received). The data analysis strategy employed was primarily using Pearson’s correlation co-efficient to determine if bioreactance had comparable efficacy to echocardiography in the detection of reduced left ventricular outflow as expected in clinically significant transient HOCUM. Preliminary statistics revealed for Pearson’s correlation- a sample size of 29 patients was required to detect a large correlation (Cohen’s r = 0.5)). This was further assessed using a Bland Altman plot. Otherwise, univariate analysis of the transient HOCUM cohort was carried out using Chi Square tests for categorical variables and independent T-tests for continuous variables. Results: Fifty infants underwent echocardiography while 28/50 of these infants were paired with a NICOM assessment (four echocardiogram data sets lost due to HSE cyberattack). 4/46 patients (8.7%) were noted to have a z-score of >2 for both the interventricular septal wall thickness and left posterior ventricular wall in diastole (LVPWd) consistent with a diagnosis of transient HOCUM with LVOTO. 26 out of 46 infants born to mothers with diabetes had significant thickening (Z-score >2) of either the interventricular septum or the left posterior ventricular wall. Regarding congenital heart defects, VSDs (ventricular septal defects) were found in 8.7% (4/46) of the study population with one patient found to have a >3mm ASD secundum. The incidence of transient HOCUM was not associated with the degree of maternal glycaemic control, maternal BMI or the method of diabetes control (all P > 0.05). Bioreactance LVO measurements poorly correlated with ECHO LVO values (r(25)= 0.2, p=- 0.31) with an ambiguous agreement on Bland Altman analysis. Conclusion: The incidence of transient HOCUM in our cohort (8.7%) was lower than previous studies -13-44%. Transthoracic bioreactance does not appear to be an effective screening tool for transient HOCUM with LVOTO in this high-risk cohort of patients. This is on the basis of a poor Pearson correlation with ECHO derived LVO values and the wide limits of agreement found with the Bland Altman plot. Infants born to mothers with GDM would not benefit from routine echocardiography screening beyond the current standard of care. This is owing to our findings that all cases of clinically relevant congenital heart disease in our cohort would have been detected with the current standard of care- a newborn bedside examination followed by a targeted ECHO as clinically indicated.Item An exploration of how the wheelchair procurement system in Ireland compares to the needs and wants of the wheelchair users and clinicians, and how it influences everyday life(University College Cork, 2023) Murphy, Jack D.; Pennisi, Yvone; Boyle, Bryan; University College CorkIntroduction: For many people, wheelchairs are an essential part of daily life to enable participation and engagement in occupations. Despite being a vital personal mobility aid, the literature points to inefficient systems which procure and provide wheelchairs to the users. This places undue stress and pressure on both clinicians and service users alike. In Ireland, publicly funded wheelchair procurement occurs through the Health Service Executive [HSE] via use of a standardised national wheelchair contract. Prior to the introduction of the wheelchair contract, ownness for procuring wheelchairs fell to individual clinicians, and/or locally held contracts in some areas in Ireland. The aim of the new national wheelchair contract was to standardise the quality of wheelchairs provided by the HSE, reduce monetary waste, and reduce the workload on individual clinicians to procure wheelchairs. The experiences of those who use the wheelchair procurement system in Ireland everyday are yet to be investigated. This leads to questions regarding how the wheelchair procurement system is working from the perspectives of both the occupational therapists and service users. This project aims to review how the introduction of a national standardised wheelchair contract impacts time-savings, monetary savings, administration load and quality of life of the wheelchair users. Background: The background requires understanding two perspectives: how disability has been viewed historically and how this may have influenced daily life and policy engagement; and how the wheelchair procurement works here in Ireland, specifically using a wheelchair contract system to streamline the procurement process. Literature: The literature indicates that wheelchair provision is studied frequently, however wheelchair procurement is rarely studied. The procurement of wheelchairs is an integral aspect of provision and has the potential to impact its effectiveness. The literature indicates the importance of the meaning of the wheelchair to the user, and its impact on identity. This presents an opportunity for investigation to explore if this meaning is reflected in the wheelchair contract in Ireland. Additionally, the literature looks more broadly at how the wheelchair systems impact the user in terms of the status, regulatory frameworks and funding of these devices. Methodology: This project utilises a descriptive phenomenology methodology to explore the lived experiences of those whom the wheelchair contract directly impacts. Ethical approval was gained prior to commencement of data collection. This research was conducted in the midst of the COVID-19 global pandemic, which impacted the timeframes of the project. Five Occupational Therapists and four Manual Wheelchair Users were recruited for in-depth, semi-structured qualitative interviews, from gatekeepers including the Irish Wheelchair Association and the Association of Occupational Therapists Ireland. Findings: The project has three main findings. These included Personal Factors, which describe all of the factors identified by participants which impacted decisions with regards to wheelchair procurement. Next, the Impact of the System refers to the structures in place which must be navigated by participants to obtain their wheelchairs. Additionally, the final theme is a description of the ‘Business’ of Wheelchair Provision. This section describes the realities of working with Businesses and this is reflected in how the HSE is run like a Business. Discussion: The contract intended to streamline and standardise wheelchair provision and procurement for occupational therapists in Ireland. With wheelchair procurement being an important step in the overall process of wheelchair provision, the project uncovered interesting findings with regards to how it is used and its practical implementation. The wheelchair contract is used in different ways. The occupational therapist group use this directly, while the manual wheelchair user group use it indirectly. Conclusion: The wheelchair contract was noted to be dichotomous in nature. Participants were frustrated with the system inefficiencies which impact procurement and provision. However, participants felt the wheelchair contract was a step in the right direction despite some of its shortcomings.