Rose Galvin

Background/Objectives Secondary prevention is essential to improve outcomes after stroke, with lifestyle modification shown to reduce cardiovascular risk factors. However, access to structured lifestyle supports post-stroke remains limited. This paper describes the systematic adaptation of The Improving Health and Lifestyle Programme (iHeLP), a co-designed, theory- and evidence-informed secondary prevention intervention, for implementation within an Irish stroke support organisation. Methods The ADAPT guidance was followed to systematically adapt iHeLP for implementation within the Irish Heart Foundation. Four stages were undertaken: i) assessment of the intervention-context fit; ii) planning and undertaking adaptations; iii) piloting and evaluation; iv) implementation planning. The process involved collaboration with organisational stakeholders, a panel of people with lived experience of stroke and caregivers, and a member of the original intervention development team. The Model for Adaptation Design and Impact (MADI) was used to support transparent reporting. Results iHeLP demonstrated strong alignment with existing Irish Heart Foundation services. Key implementation considerations related to workforce capacity, resource availability, and service delivery models. Planned adaptations focused on intervention format, delivery, and implementation while maintaining core intervention functions. Pilot testing further informed reactive adaptations to enhance intervention feasibility, acceptability, and sustainability. Conclusions This article offers insights into the systematic adaptation of a lifestyle modification intervention for delivery within a stroke support organisation. This work represents an important step toward expanding access to secondary prevention supports for stroke survivors in Ireland. The paper provides a structured template and practical insights into adapting evidence-informed interventions for community-based, resource-constrained settings, that can be replicated for other populations, services and behaviour change interventions.

Older adults account for one of the largest users of Emergency Medical Services (EMS) and require specialised care and tailored interventions during this time. The experiences of older adults and those important to them is crucial to ensure an age-friendly EMS. This review aims to systematically identify and synthesise qualitative literature regarding older adults and their families and informal caregivers’ experiences of access and use of EMS. The review will employ a seven-step meta-ethnographic approach (Noblit & Hare, 1988) of qualitative evidence synthesis. Five databases will be searched: Medline, CINAHL, PsycInfo, Academic Search Complete and Embase. The search strategy will be supplemented with citation-chasing. Study selection will be informed by a two-step purposive sampling technique that will be used to determine the richness of studies alongside the relevance of their scope and objectives. The CASP-checklist will be used to critically assess the quality of the included studies. A Public Patient Involvement panel of older adults and family carers has shaped the conceptualisation of the research question and will engage in the synthesis and dissemination of findings. The confidence of findings will further be assessed using the GRADE-CERQual framework. The findings of this meta-ethnography will generate new conceptual understanding of how older adults and those important to them experience pre-hospital emergency care offering an in-depth richness and understanding and informing the design and implementation of an age-attuned EMS.

Background Prostate cancer is the most common solid tumour amongst men in Ireland with a median age at diagnosis of 67 years. The incidence of frailty amongst cancer patients is high. Among patients undergoing systemic anti-cancer therapy, frailty increases the risk of treatment related toxicity, hospitalisation, and death and is associated with a poorer quality of life. The prevalence of frailty amongst men and its impact on function, quality of life and patient outcomes has not previously been described. Aims This study aims to describe the demographic, clinical, socioeconomic and frailty characteristics of men living with prostate in the Mid-West of Ireland. This study will also assess the predictive accuracy of three frailty screening tools used in Irish clinical practice for predicting adverse outcomes at 6 and 12 months. Methods Patients with a diagnosis of prostate cancer and aged >65 years attending the Mid-Western Cancer Centre will have three screening tools (G8, CFS, PRISMA 7) performed by face-to-face interview with a research nurse (RN) during their index visit. The RN will complete a baseline demographic questionnaire, baseline functional status and record baseline comorbidities. A telephone follow up will occur at six and twelve months and will capture healthcare utilisation as well as outcome data including treatment toxicity, unscheduled attendance to the hospital, hospital/hospice admission and death. Longitudinal changes in functional status, quality of life, and healthcare utilisation over the 12-month follow-up period will be assessed using appropriate statistical tests. Associations between frailty status and adverse clinical outcomes will be explored using univariable and multivariable regression analyses. Implications The findings of this study will provide important real-world insights into frailty, treatment practices, and patient-centred outcomes in prostate cancer, and may help inform future screening strategies and intervention studies.

BackgroundOlder adults account for a substantial proportion of Emergency Department (ED) attendances and experience high rates of adverse outcomes following an ED visit. A growing range of ED-based and ED-initiated interventions have been developed for this population, but synthesis of effectiveness has been limited by heterogeneity in outcomes assessed. This review aimed to identify and categorise outcomes, outcome measurement instruments (OMIs), and assessment timepoints reported in experimental studies involving older adults in the ED, as the first stage of a core outcome set (COS) development process.MethodsA scoping review was conducted in accordance with Joanna Briggs Institute guidance and reported using PRISMA-ScR. MEDLINE, CINAHL, CENTRAL, and ClinicalTrials.gov were searched from 2003 to October 2025. Published and registered longitudinal experimental studies of ED-delivered or ED-initiated interventions involving older adults were included. Outcomes were extracted verbatim, harmonised, and mapped to the Dodd outcome taxonomy. OMIs and assessment timepoints were summarised descriptively.ResultsA total of 103 studies (86 published papers; 17 trial registrations) involving 159,728 older adults or ED presentations were included. Overall, 552 verbatim outcome labels were harmonised into 179 outcome domains. The Dodd taxonomy core areas of life impact (n=233) and resource use (n=197) were most frequently assessed. The domains most frequently assessed within these core areas were hospital (n=168) and delivery of care (n=98) outcomes. Routine healthcare data were the most common measurement source (n=72). Outcomes were assessed using 106 unique OMIs, most commonly the Barthel Index family (n=12) and EQ-5D family (n=9). Thirty-day follow-up was the most frequently reported assessment timepoint.ConclusionsThe wide range and variability of outcomes and time points underscore the need for a COS in this area. The review also highlighted limited attention to patient-reported outcomes and experiences.

Background Older adults living with frailty who are recently discharged from acute care settings are at increased risk of malnutrition and associated complications, including functional decline, hospital readmission, and reduced quality of life. Strengthening transitional nutrition care pathways is therefore important to ensure nutrition support is timely, coordinated, and responsive to patients’ needs. Incorporating the perspectives of older adults living with malnutrition and frailty, family members, and clinicians can help develop practical, effective, and sustainable care pathways and interventions. Objective To engage in a co-design process to identify the key components of an evidence-based and stakeholder-informed nutrition care pathway to support older adults living with frailty during the transition from hospital to home. Materials and Methods This study will use a longitudinal participatory co-design approach. Approximately 30 participants, including older adults, family carers, and hospital and community healthcare professionals, and representatives from voluntary and community services will take part in two co-design workshops facilitated by the primary researcher and research team. Workshops will be facilitating collaborative discussion and idea generation. Workshops will involve sharing experiences, identifying challenges, co-creating solutions, and refining a draft care pathway using interactive activities such as pathway mapping, visual prompts, and prioritisation exercises followed by structured consensus-building using the Nominal Group Technique to prioritise components of the nutritional care pathway. Data will be collected through field notes, audio recordings, and participant-generated materials, and analysed using an access to healthcare framework to identify key components and achieve consensus on the final model. Conclusion The co-design process is expected to identify key components of a stakeholder-informed nutritional care pathway to improve continuity of care, service integration, and tailored post-discharge nutrition support for older adults living with frailty and malnutrition.

Background Augmentative and Alternative Communication (AAC) refers to a range of communication methods used by children or adults to enhance or replace oral communication. Studies show many children with communication needs who require AAC do not have access to appropriate supports, and that embedding AAC interventions in the classroom is challenging. This means many children who use AAC face barriers to meaningful participation, engagement, and independence. Understanding the experiences and perspectives of AAC users and those who support the use of AAC in the classroom can provide actionable knowledge to guide service improvement such that AAC users can be empowered to achieve and participate in school. Methods A comprehensive literature search of the following electronic databases will be completed: PubMed, CINAHL Complete, EMBASE, EBSCO and Scopus. A manual search of the grey literature will also be carried out. Qualitative studies and mixed-methods designs that include qualitative data on the perspectives and experiences of AAC users, their families, and educators and healthcare professionals who support AAC users in education settings for children 3–18 years will be analysed. Methodological quality of included papers will be appraised using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research by two independent reviewers. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) - Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach will be employed to assess how much confidence to place in the findings of the qualitative evidence synthesis. Qualitative content analysis will be undertaken using constructs from Normalisation Process Theory. Conclusion This qualitative evidence synthesis will summarise findings from the empirical international literature to provide a deeper understanding of the experiences of AAC use from a range of stakeholder perspectives. Findings will inform the development of pathways to support implementation of AAC for children with communication needs within schools. Prospero Registration No. CRD420251229480.

Background Current treatments for haematological cancers are associated with improved survival rates; however, they are also associated with significant toxicity and long periods of hospitalization, which may negatively affect patients’ quality of life and physical performance. Haematological stem cell transplant (HSCT) is a potentially curative treatment option however remains a high-toxicity treatment with a high risk of severe complications. It is unclear what rehabilitation is needed by patients undergoing HSCT. The primary objective of this study is to investigate the impact of allogeneic HSCT on subjective and objective measures of physical performance. Methods and Analysis REACT is a prospective, longitudinal cohort study. Participants will be recruited from the National Adult Allogeneic Transplant Programme in Ireland. Five assessments will be completed at two timepoints prior to transplant and three timepoints following transplant (3, 6 and 12 months). Assessments will include both an objective measure of physical function (Short Physical Performance Battery) and a subjective measure (WHODAS 2.0). Additional data collected will include patient-reported outcomes, anthropometric measurements, measures of healthcare-utilization and sociodemographic, clinical and social environment characteristics. An embedded qualitative study will examine patients’ experiences of the impact of allogeneic transplantation on physical function and activity levels within a subgroup of participants. Discussion This prospective cohort study will provide important insights into the physical performance trajectory of patients undergoing allogeneic HSCT. By combining objective and subjective assessments across multiple timepoints, the REACT study will clarify the extent and pattern of functional decline and recovery following transplant. The inclusion of patient-reported outcomes, healthcare utilisation data, and qualitative feedback will offer a comprehensive understanding of the multidimensional rehabilitation needs and priorities of this population. Ultimately, the findings will help inform the development of targeted, evidence-based rehabilitation pathways to support recovery, enhance quality of life, and optimise long-term outcomes for individuals undergoing allogeneic HSCT.

Background: Comprehensive geriatric assessment (CGA) can be resource-intensive as its delivery involves multidisciplinary personnel, multidimensional assessment, care planning and follow-up. The aim of this systematic review is to appraise and synthesise evidence on the cost-effectiveness of CGA across settings. Methods: Full economic evaluation studies examining CGA were searched across five databases. We included studies involving adults aged ≥65 years who were identified as living with frailty or at risk of adverse outcomes. Two independent reviewers screened studies against eligibility criteria and extracted data using a pretested extraction form. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards framework. We reported the results through narrative summaries, tables and figures. Results: A total of 4864 studies were identified, of which 17 were included across 7 settings (11 community, 6 hospital). Of 13 cost-utility analysis studies, incremental quality-adjusted life years ranged from −0.06 to 0.54 and incremental costs ranged from €−12 744 to €29 785. The probability CGA was cost-effective ranged from 0% to 98.9% across stated willingness-to-pay thresholds (cost-effective in 5/13, not cost-effective in 7/13, 50% chance in 1/13). Two studies showed that cost-effectiveness can vary by frailty severity and residential status. The resource intensity of CGA varied, ranging from 25% (case management protocol) to 81% (comprehensive assessment). Only five studies accounted for informal caregiver costs. The reporting quality ranged from 38% to 90%. Conclusion: The cost-effectiveness of CGA remains uncertain. Variations in resource intensity of CGA, frailty severity, residential status of older adults and setting may explain this heterogeneity. PROSPERO registration no: CRD42023492586.

Background Older adults undergoing surgery experience higher rates of postoperative morbidity, mortality, functional decline and institutionalisation compared with younger populations. Emerging evidence suggests that frailty screening and perioperative geriatric optimisation may improve postoperative outcomes. Comprehensive Geriatric Assessment (CGA) is the gold-standard approach for the identification and management of older adults living with frailty. Previous Cochrane reviews demonstrated that CGA improves outcomes for medically admitted older adults and hip fracture patients, although evidence remains limited for other surgical populations. This systematic review aims to update the 2018 review and synthesise current evidence regarding the effectiveness of CGA in older surgical patients. Methods and analysis This protocol follows PRISMA-P guidelines and is registered with PROSPERO (CRD420261322154). MEDLINE, Embase, CINAHL, PsycINFO and CENTRAL will be searched for randomised and quasi-randomised trials published from 2017 onwards involving adults aged ≥65 years undergoing surgical care. Eligible interventions must include multidimensional CGA delivered by a geriatric-trained healthcare professional. The primary outcome will be functional status. Secondary outcomes will include length of stay, mortality, days at home alive, readmission, cognitive outcomes, adverse events and postoperative complications. Two reviewers will independently screen studies, extract data and assess risk of bias using the Cochrane RoB 2 tool. Meta-analysis will be conducted where appropriate. Discussion This review will provide an updated synthesis of evidence regarding the effectiveness of CGA in older surgical patients and will inform clinicians, researchers and policymakers regarding the delivery of age-friendly perioperative care.