Barbara Whelan

Background Evidence-informed policymaking promotes the use of the best available evidence in a systematic and transparent manner to guide policy decisions. It aims to ensure that policies are grounded in credible and relevant evidence while also considering factors such as feasibility, sustainability, equity, and stakeholder input. The Global Evidence Commission has emphasised the necessity for stronger national evidence infrastructures and recommended that governments evaluate their evidence-support systems, focusing on the demand for evidence from policymakers, the supply of timely and relevant evidence, and the coordination between the two. To assist countries in reviewing their evidence-support systems, the Global Commission on Evidence to Address Societal Challenges developed the Rapid Evidence Support System Assessment (RESSA). Here, we outline the protocol for a RESSA of health policymaking being conducted in Ireland. Methods This study will adopt a flexible, mixed-methods design with four key stages: (1) a high-level website review, (2) an in-depth document review, (3) semi-structured interviews with key stakeholders, and (4) seeking feedback. For the document review, the data analysis and synthesis process will follow the READ approach, allowing for a systematic way to organise, interpret, and synthesise the information extracted from the selected documents. Interview data will be analysed using a thematic approach. Findings from both sources will be triangulated to ensure robust conclusions about the strengths and challenges of the evidence-support system for health policymaking. Conclusions This protocol outlines the methods for assessing Ireland’s evidence support system for health policymaking. By documenting our approach in detail, we aim to enhance transparency and replicability, providing a foundation for easier comparison and contrast with similar assessments conducted by other groups. While this study focuses on health, the methodology and findings may also inform evidence-support systems in other sectors, such as climate and education.

Introduction: The coronavirus pandemic placed significant stress on healthcare services globally, requiring rapid transformation to cope with critically ill patients. In many countries, including Ireland, staff redeployment to intensive care units was a core response. Objectives: To understand the experiences of nurses redeployed to intensive care units during the coronavirus pandemic and identify effective strategies for training and supporting nurses during future pandemics. Methods: A qualitative descriptive study using semistructured interviews with 19 nurses recruited from two hospitals in the west of Ireland. The sample consisted of senior nurses/clinical facilitators in intensive care units (n = 4), nurses previously in intensive care units and redeployed back (n = 2), and nurses redeployed from other clinical areas (n = 13). Data were collected between January 2023 and February 2024 and analyzed using thematic analysis. Results: Five main themes were identified: redeployment of staff to intensive care units; training; emotional impact; effective communication and valuing nurses; and planning for the next pandemic. Many nurses experienced significant stress and anxiety initially but felt more confident with support and training. Clear communication, effective training and strong support systems were important. Clinical facilitators provided just-in-time, hands-on training and reassurance, helping to make the experience of working in intensive care units less daunting. Training for those new to intensive care units focused pragmatically on what was “good-to-know” versus “essential-to-know.” Key findings highlight the importance of rapid, effective training, clear communication, and strong support systems, including psychological support. Conclusion: Redeployment to intensive care units during the coronavirus pandemic had a significant professional and emotional impact on nurses. Despite challenges, nurses demonstrated resilience and strong commitment to patient care. The findings emphasize the need for pandemic preparedness planning, including regular skills maintenance, effective communication strategies, and robust professional and psychological support during a health emergency. Recognizing and valuing nurses’ contributions is essential for fostering resilience, maintaining high quality clinical care and ensuring preparedness for future crises.

A dementia diagnosis can lead to a decline in cognitive, social, and physical health, but people with dementia can live meaningful lives and participate actively in society with psychosocial support. This single-arm, non-randomised feasibility study explored the feasibility and acceptability of a Comprehensive REsilience-building psychoSocial intervenTion (CREST) for people with dementia, their caregivers, General Practitioners (GPs), and the public. Nine people with dementia and their primary caregivers living in the community (n = 9 dyads) completed the CREST intervention which had three components (cognitive stimulation therapy [CST], physical exercise, and dementia education). Quantitative secondary outcomes were assessed at baseline and following the 15-week intervention; qualitative interviews were conducted during and post-intervention. All study components were assessed against pre-defined criteria, to determine the feasibility of conducting a future definitive trial. Recruitment of people with dementia and their caregiver was a significant challenge and led to considerable delays to the onset and conduct of the intervention. Only 13% of eligible GP practices agreed to assist in recruitment and achieved a 6% enrolment rate; a community-based recruitment strategy proved more effective, yielding a 29% enrolment rate. However, once recruited, participants maintained high attendance and adherence to the content of each component with average adherence rates of 98% for CST, exercise sessions and caregiver education. Adherence to secondary exercise measures was lower, with home exercise diary completion at 37% and Fitbit wear adherence at 80% during the day and 67% at night. The people with dementia felt their concentration and fitness had improved over the 15-week intervention and particularly enjoyed the social aspects (e.g. group classes, exercising with partners from the community). Caregivers felt they had better knowledge and understanding following their education component and reported that the social aspects (interacting and sharing experiences with each other) were important. Overall, participants reported that the three components of the intervention were feasible and acceptable. In addition, the quantitative measures and health economic tools employed were feasible. However, the secondary elements of the exercise component (recording home exercise diaries and Fitbit use) were not considered feasible. Overall, pre-defined criteria for progression to a definitive intervention were fulfilled in terms of acceptability, retention and fidelity but not recruitment. While overall, the CREST intervention was feasible and acceptable to participants, significant difficulties with recruitment of people with dementia and their caregiver through GP practices impacted the viability of delivering the intervention. Recruitment through community-based groups proved a more feasible option and further work is needed to overcome barriers to recruiting this cohort before a larger-scale trial can be conducted. ISRCTN25294519.

A novel Complex REsilience-building psychoSocial intervenTion (CREST) targeted at people with dementia, their informal carers, general practitioners and the wider community with the aim of increasing resilience and strengthening the personal attributes or external assets of people with dementia living at home, in the community, was developed. It included three components: cognitive stimulation therapy (CST), physical exercise and dementia education. A non-randomised feasibility study was conducted of the CREST intervention, the aim of which was to inform the design of a future randomised controlled trial. This article presents the findings from the qualitative component of the CREST intervention feasibility study, describing the experience of the people with dementia and their caregivers who participated and the volunteer older adults who supported the intervention. A descriptive qualitative research approach using semi-structured interviews was undertaken. Key stakeholders (people with dementia (n = 9), their caregivers (n = 9) and the volunteer older adults from the physical exercise component (n = 9)) were interviewed about the intervention and the perceived impact of their participation. The social aspect of the CREST intervention proved to be important for all three groups. Attendance remained high throughout the intervention. The people with dementia spoke positively about their participation in the CST and exercise components of the CREST intervention. The caregivers liked receiving coping strategies focused on how to communicate better with the person they cared for and how to better manage their own self-care and they liked the group element of the programme. The volunteer older adults supported the people with dementia in taking part in the exercise component, motivating them to do the exercises and helping with social interaction within the group. The volunteers gained exposure to the illness and as a result understood more about dementia and felt better equipped to communicate and deal with people with dementia. Participation in the CREST intervention produced a positive impact on all three groups. The social element of the intervention was noted by everybody and was regarded as being beneficial. Qualitative insights emphasised the value of embedding qualitative research within feasibility studies to inform future intervention design. Further research should focus on conducting a full-scale randomised controlled trial to evaluate CREST’s effectiveness and explore its application to individuals with more advanced dementia. ISRCTN25294519.

Clinical scenario A 65 year‐old male presented with a 12 hour history of deteriorating rash. Two weeks previously, he had completed a course of neo‐adjuvant chemotherapy for ductal carcinoma of the breast. On examination, there were bullae, widespread atypical targetoid lesions and 15% epidermal detachment. There was no mucosal involvement on presentation but, subsequently, it did evolve. Skin biopsy showed sub‐epidermal blistering with epidermal necrosis. This confirmed our clinical diagnosis of overlap SJS‐TEN. On transfer to ICU, he was anxious and fearful. What are the psychological impacts of SJS/TEN on this man’s life?. Background SJS and TEN have devastating outcomes for those affected. Objectives To conduct a critically appraised topic (CAT) to (1) analyse existing research related to the psychological impact of SJS and TEN and (2) apply the results to the clinical scenario. Methods Seven electronic databases were searched for publications focusing on the psychological impact of SJS TEN on adults over 18 years of age. Results Six studies met inclusion criteria. Health care practitioners’ (HCPs) lack of information around the disorder was highlighted. Patients experienced undue stress and fear. Some patients had symptoms aligned to post‐traumatic stress disorder (PTSD), anxiety and depression. Discussion and recommendation for clinical case The evidence suggests that SJS and TEN impact psychologically on patients’ lives. Education of HCPs, to address their lack of awareness and information on SJS/TEN, should facilitate their capacity to provide information and support to patients, thereby reducing patient anxiety. On discharge, a follow up appointment with relevant HCPs to reduce the possibility of PTSD occurring should be considered.

Alongside a randomized controlled trial testing the effectiveness of offering a cash transfer scheme (shopping vouchers) to mothers in areas with low breastfeeding rates, qualitative interviews were conducted with health care professionals delivering the scheme to explore their experiences. Health care professionals (n = 34; mainly midwives and health visitors) were interviewed in depth. Transcripts from recorded interviews were analyzed using a Framework Analysis approach. There was widespread acceptance of the scheme by health care professionals, with prior concerns regarding bribery and coercion being quickly allayed. Health care professionals reported that the scheme fitted in well with their routine ways of promoting and endorsing breastfeeding. They described their experiences of women’s positive reaction toward the scheme and how the scheme encouraged breastfeeding and gave breastfeeding higher value. Health care professionals reported that the incentives helped them engage women and promote and support breastfeeding in areas with low breastfeeding rates.

Breastfeeding is associated with a positive effect on an infant’s life chances, survival, development, and health, including protection against childhood infections, obesity, and diabetes; nursing women are also protected against breast cancer.^1,2 The importance of breastfeeding in promoting health and development is reflected in national and international policy recommendations and guidance.^3,4 However, there are considerable long-standing social and cultural barriers to breastfeeding in many settings. Breastfeeding in many countries is sexualized in public discourse and the media, resulting in a powerful disincentive to breastfeed mediated through embarrassment and fear.⁵ Breastfeeding prevalence has been low in many low-income communities in high-income countries for generations. Over the past 25 years, breastfeeding rates in such communities have not risen in response to a range of policy developments,^6,7 and no trials of support interventions have been effective in increasing breastfeeding prevalence.⁸

A cluster randomised controlled trial of a financial incentive for breastfeeding conducted in areas with low breastfeeding rates in the UK reported a statistically significant increase in breastfeeding at 6–8 weeks. In this paper we report an analysis of interviews with women eligible for the scheme, exploring their experiences and perceptions of the scheme and its impact on breastfeeding to support the interpretation of the results of the trial. Semi-structured interviews were carried out with 35 women eligible for the scheme during the feasibility and trial stages. All interviews were recorded and verbatim transcripts analysed using a Framework Analysis approach. Women reported that their decisions about infant feeding were influenced by the behaviours and beliefs of their family and friends, socio-cultural norms and by health and practical considerations. They were generally positive about the scheme, and felt valued for the effort involved in breastfeeding. The vouchers were frequently described as a reward, a bonus and something to look forward to, and helping women keep going with their breastfeeding. They were often perceived as compensation for the difficulties women encountered during breastfeeding. The scheme was not thought to make a difference to mothers who were strongly against breastfeeding. However, women did believe the scheme would help normalise breastfeeding, influence those who were undecided and help women to keep going with breastfeeding and reach key milestones e.g. 6 weeks or 3 months. The scheme was acceptable to women, who perceived it as rewarding and valuing them for breastfeeding. Women reported that the scheme could raise awareness of breastfeeding and encourage its normalisation. This provides a possible mechanism of action to explain the results of the trial. The trial is registered with the ISRCTN registry, number 44898617 , https://www.isrctn.com

Women aged less than 20 years are less likely to initiate and sustain breastfeeding until their baby is 6 weeks and older compared with older mothers, according to the Infant Feeding Survey ( McAndrew et al, 2010 ). The ‘vouchers for breastfeeding’ scheme, which was trialled in 2015–2016 with more than 10 000 women in parts of Yorkshire and Derbyshire, offered mothers shopping vouchers worth up to £200 if they provided breast milk to their baby up to the age of 6 months. Over the period of this large-scale scheme, a parallel small-scale intervention was commissioned and offered by a family nurse partnership (FNP) to first-time young mothers in an adjacent area. This article reports on the evaluation of the initiative within the local FNP service. The results indicate that the scheme was acceptable and deliverable within this setting.