Early intervention in psychosis (EIP) services improve outcomes for young people, but approximately 30% disengage.

To test whether a new motivational engagement intervention would prolong engagement and whether it was cost-effective.

We conducted a multicentre, single-blind, parallel-group, cluster randomised controlled trial involving 20 EIP teams at five UK National Health Service (NHS) sites. Teams were randomised using permuted blocks stratified by NHS trust. Participants were all young people (aged 14–35 years) presenting with a first episode of psychosis between May 2019 and July 2020 (N = 1027). We compared the novel Early Youth Engagement (EYE-2) intervention plus standardised EIP (sEIP) with sEIP alone. The primary outcome was time to disengagement over 12–26 months. Economic outcomes were mental health costs, societal costs and socio-occupational outcomes over 12 months. Assessors were masked to treatment allocation for primary disengagement and cost-effectiveness outcomes. Analysis followed intention-to-treat principles. The trial was registered at ISRCTN51629746.

Disengagement was low at 15.9% overall in standardised stand-alone services. The adjusted hazard ratio for EYE-2 + sEIP (n = 652) versus sEIP alone (n = 375) was 1.07 (95% CI 0.76–1.49; P = 0.713). The health economic evaluation indicated lower mental healthcare costs linked to reductions in unplanned mental healthcare with no compromise of clinical outcomes, as well as some evidence for lower societal costs and more days in education, training, employment and stable accommodation in the EYE-2 group.

We found no evidence that EYE-2 increased time to disengagement, but there was some evidence for its cost-effectiveness. This is the largest study to date reporting positive engagement, health and cost outcomes in a total EIP population sample. Limitations included high loss to follow-up for secondary outcomes and low completion of societal and socio-occupational data. COVID-19 affected fidelity and implementation. Future engagement research should target engagement to those in greatest need, including in-patients and those with socio-occupational goals.

Scalable, cost-effective interventions to support social health in dementia are required to address growing prevalence in the face of healthcare workforce shortfalls. Until now, very few high quality studies have addressed the effectiveness of assistive technologies for social health in dementia, and almost none have evaluated the cost-effectiveness. Effectiveness of the FindMyApps intervention was investigated and an economic evaluation was undertaken.

A single-centre, non-blinded, randomized controlled trial (RCT) was conducted, comparing the effectiveness of FindMyApps with a digital care as usual control intervention (normal tablet computer with general advice). Primary outcomes measured at baseline and three month follow-up were social participation and self-management of community-dwelling people with mild cognitive impairment (MCI) or early stage dementia (MMSE 18-25), and sense of competence of their informal caregiver. Healthcare usage data was collected using a modified version of the RUD-lite instrument. Incremental costs and effectiveness associated with FindMyApps compared to the control intervention were estimated.

Data collection was completed in November 2022. Of 150 dyads randomized, follow-up data wereavailable from 128 dyads (14.7% loss to follow-up). The dataset has been cleaned and analyses are ongoing. Alongside main effects on primary outcomes, both a cost-effectiveness analysis and a cost- utility analysis will be reported, from a societal and healthcare perspective. Cost and effect differences between FindMyApps and digital care as usual will be estimated with bivariate regression analyses and incremental cost-effectiveness ratios will be reported (the difference in the mean total costs between the groups divided by the difference in mean effect between the groups). Cost-effectiveness acceptability curves will demonstrate the probability that FindMyApps is cost-effective compared to digital care as usual.

The results of this study establish the extent to which FindMyApps is effective and cost-effective for supporting social health in dementia. Implications for healthcare professionals, researchers and policymakers with respect to further implementation of FindMyApps are highlighted, as well as remaining uncertainty and directions for future research. The results of this study demonstrate the feasibility of large-scale (cost-)effectiveness evaluations with assistive technology, which should be replicated as gold-standard evidence for other technologies and health priorities.

Most frequently felt needs in dementia concern maintaining self-management and participation in meaningful activities. E-health interventions may support these aspects of social health but few have undergone large-scale evaluations. The effectiveness of the FindMyApps intervention, an app selection tool and tablet training, designed to support people to find and use tablet apps that meet their needs and interests, was evaluated.

A non-blinded, single-centre, randomized controlled trial and process evaluation were conducted in the Netherlands between January 2020 and November 2022. Participants were community-dwelling people with mild dementia (MMSE <26 and >17) or mild cognitive impairment, and their informal caregivers. FindMyApps was compared with digital care as usual (normal tablet computer and general advice). Data regarding primary outcomes (self-management and social participation of the person with dementia, sense of competence of the caregiver) and secondary outcomes (including quality of life) were collected with standardized instruments at baseline and after a three months intervention period. ANCOVAs were conducted on post-test outcome measures, corrected for baseline scores, to investigate group differences.

Data collection was completed in November 2022 and analyses are underway. Of 150 dyads randomized, 128 completed the three-month follow-up (64 experimental, 64 control). Results of ANCOVAs investigating the effect and effect size of FindMyApps on the primary and secondary outcomes at three months, will be reported, as well as results of post-hoc analyses that explored the effect on outcomes of: previous tablet experience and education level of participants; observed use of the FindMyApps app; and reported adherence to recommended frequency of tablet use.

Results of this study will indicate whether FindMyApps is an effective intervention for supporting social health of people with mild dementia and MCI. Comparisons with previous studies of FindMyApps and other digital interventions for social health in dementia will be drawn and implications for professionals, concerning implementation of FindMyApps, and for researchers regarding further development, translation and evaluation of FindMyApps discussed. Finally, establishing feasibility and utility of randomized controlled trials in this field, the results of this study will set the bar for future evaluations of eHealth interventions in general.

INDUCT (Interdisciplinary Network for Dementia Using Current Technology), and DISTINCT (Dementia Inter-sectorial strategy for training and innovation network for current technology) are two Marie Sklodowska-Curie funded International Training Networks that aimed to develop a multi-disciplinary, inter-sectorial educational research framework for Europe to improve technology and care for people with dementia, and to provide the evidence to show how technology can improve the lives of people with dementia.

In INDUCT (2016-2020) 15 Early Stage Researchers worked on projects in the areas of Technology to support everyday life; technology to promote meaningful activities; and healthcare technology. In DISTINCT (2019-2023) 15 Early Stage Researchers worked on technology to promote Social health in three domains: fulfilling ones potential and obligations in society, managing one’s own life, and participation in social and other meaningful activities.

Both networks adopted three transversal objectives: 1) To determine practical, cognitive and social factors needed to make technology more useable for people with dementia; 2) To evaluate the effectiveness of specific contemporary technology; 3) To trace facilitators and barriers for implementation of technology in dementia care.

The main recommendations resulting from all research projects are integrated in a web-based digital Best Practice Guidance on Human Interaction with Technology in Dementia which was recently updated (Dec 2022 and June 2023) and will be presented at the congress. The recommendations are meant for different target groups, i.e. people in different stages of dementia, their (in)formal carers, policy makers, designers and researchers, who can easily find the recommendations relevant to them in the Best Practice Guidance by means of a digital selection tool.

The INDUCT/DISTINCT Best Practice Guidance informs on how to improve the development, usage, impact and implementation of technology for people with dementia in various technology areas. This Best Practice Guidance is the result of intensive collaborative partnership of INDUCT and DISTINCT with academic and non-academic partners as well as the involvement of representatives of the different target groups throughout the projects.

The pediatric medical device development (PMDD) process is highly complex, beset by a variety of financial, technical, medical, and regulatory barriers. Startup company innovators and academic investigators often struggle with accessing specialized knowledge relating to regulatory requirements, product development, research, and marketing strategies.

The West Coast Consortium for Technology & Innovation in Pediatrics (CTIP) conducted an educational needs assessment to understand knowledge gaps and inform our educational strategy.

We surveyed a total of 49 medical device startups and 52 academic investigators. Electronic surveys were developed for each group on Qualtrics and focused on manufacturing, regulatory, research, commercialization, and funding. Descriptive statistics were used.

A larger proportion of academic investigator respondents had a clinical background compared to the startup respondents (45% vs. 22%). The biggest barriers for academic investigators were understanding regulatory and safety requirements testing (52%) and finding and obtaining non-dilutive funding was the most difficult (54%). Among startups, understanding clinical research methods and requirements was the biggest barrier (79%).

Startup companies and academic investigators have similar, but not identical, educational needs to better understand the PMD development process. Investigators need more support in identifying funding sources, while startup companies identified an increased need for education on research regulatory topics. These findings can help guide curriculum development as well as opportunities for partnerships between academia and startups.

The use of clozapine demands regular monitoring of patients’ clozapine blood levels. Assays are usually performed in a central laboratory with results available only after several days. The South London and Maudsley NHS Trust wanted to implement a clozapine Point-of-Care (POC) capillary blood test that would provide the benefits of immediate results.

The MyCare Insite, a small (2.2 kg) tabletop analyser was used. The Insite can readily be connected to electronic health records. Insite device has been fully validated but to achieve the benefit of clozapine POC testing, other factors beyond the test validation needed to be considered. We developed tools, software, and processes to guide health professionals on why and when to measure clozapine blood levels, on what to do with test results, and systems for documentation and tracking of patients’ test results. In addition, the device supplier conducted staff training to ensure consistent and correct testing. Finally, users were certified as qualified based on demonstrated proficiency.

We have fully implemented POC capillary clozapine testing across four geographic sites.. Patients and staff preferred capillary finger stick testing over venous draws. Patients’ engagement with their results was better than with laboratory testing. Real-time testing for adherence was possible for patients admitted on clozapine. It was also possible to make rapid dose adjustments based on near immediate plasma level results. Patient safety was increased since toxic levels could be quickly detected. Clinical decision-making was expedited as results were available immediately (< 7 minutes). The utility of the testing meant that the length of hospital stays was reduced as discharges were not delayed pending a laboratory result.

Clozapine POC blood level testing was successfully implemented at our institution achieving the expected benefits of clozapine POC testing with near immediate results. The new process improves clozapine management, patient engagement and reduces inpatient bed stays.

Gathering honest feedback on experiences of clinical rotations is vital to allow improvement of training. However, our current local systems lack anonymity, which may lead to reduced confidence in providing honest views. Aim: To provide trainees with a method of giving honest and protected feedback to improve future training posts.

A Survey Monkey feedback form which was sent to core trainees across West Yorkshire in July 2022. This allowed feedback for up to 6 rotations, meaning those finishing CT3 could retrospectively review all their placements. The data were analysed by the project leads, grouped into themes, and anonymised.

We received responses for a total of 57 posts from 23 core trainees (total trainees July 2022 = 71), some of whom responded for multiple posts. Types of posts reviewed included: General Adult (40.4%), Older Adult (24.6%), Child and Adolescent Mental Health (8.8%), Forensics (7%), Learning Disability (5.3%) and Psychotherapy/Liaison (3.5%). 10.5% of responses did not specify the speciality.Overall, respondents strongly recommended 51.8% (n=29) and recommended 12.5% (n=7) of posts to other trainees. Respondents strongly did not recommend 5.3% (n=3) and did not recommend 1.8% (n=1) of posts to other trainees. Positive themes included having a range of experiences and a supportive team. Trainees valued having a range of cases with appropriate autonomy. They liked having a job that was busy enough to gain the required experience but not too busy to impede training and learning opportunities. An accessible and supportive supervisor who provided regular supervision with completion of work based placed assessments was also important.Negative themes included lack of regular supervision and heavy workload, which impacted a trainee's ability to attend teaching and participate in other aspects of professional development. Feedback for inpatient posts suggested that physical health obligations sometimes limited training opportunities.

Our results have shown that training needs are varied between trainees. It is therefore important that trainees have honest discussions with their supervisors about their needs and areas for development. Overall, trainees would recommend the majority (64.3%) of posts reviewed, however areas for improvement were highlighted. These may include extra training opportunities and increased physical health support. The main limitation of our evaluation was the low survey uptake (32.4%) in comparison to total trainee numbers. We hope that sharing our findings with both trainers and trainees will improve future responses.

The antipsychotic aripiprazole is often used in the treatment of first-episode psychosis. Measuring aripiprazole blood levels provides an objective measure of treatment adherence, but this currently involves taking a venous blood sample and sending to a laboratory for analysis.

To detail the development, validation and utility of a new point of care (POC) test for finger-stick capillary blood concentrations of aripiprazole.

Analytical performance (sensitivity, precision, recovery and linearity) of the assay were established using spiked whole blood and control samples of varying aripiprazole concentration. Assay validation was performed over a 14-month period starting in July 2021. Eligible patients were asked to provide a finger-stick capillary sample in addition to their usual venous blood sample. Capillary blood samples were tested by the MyCare™ Insite POC analyser, which provided measurement of aripiprazole concentration in 6 min, and the venous blood sample was tested by the standard laboratory method.

A total of 101 patients agreed to measurements by the two methods. Venous blood aripiprazole concentrations as assessed by the laboratory method ranged from 17 to 909 ng/mL, and from 1 to 791 ng/mL using POC testing. The correlation coefficient between the two methods (r) was 0.96 and there was minimal bias (slope 0.91, intercept 4 ng/ml).

The MyCare Insite POC analyser is sufficiently accurate and reliable for clinical use. The availability of this technology will improve the assessment of adherence to aripiprazole and the optimising of aripiprazole dosing.

The pandemic brought to the fore the importance of maritime transport as an essential sector for the continued delivery of critical supplies and global trade in times of crisis. Timely vaccination of seafarers secures their health and enables the chain of infection to be broken with the international propagation of the virus via maritime traffic. As part of the COVID-19 vaccination program, the Health Service Executive in conjunction with the Port of Cork company developed a unique pathway for seafarers to access COVID-19 vaccinations once they arrived in Cork.

An Excel template was developed by HSE and Port of Cork that would capture key information for seafarers to avail of vaccinations. Once data was captured by the ship's Captain, it was sent to the shipping agent and reviewed by the HSE South Emergency Management Office. Once the data was validated it was sent to the vaccination center so that the seafarer's details could be entered onto the system. Once confirmed, travel arrangements were made from the vessel to the vaccination clinic ensuring a safe staffing level remained on the vessel.

A total of 84 seafarers registered for the seafarer's vaccination program. 70 of these seafarers received one or more doses in Cork City Hall Vaccination Centre with the remainder having received one dose in pharmacies in Cork City.

This joint initiative developed by the HSE Emergency Management Office and the Port of Cork, the first seafarer's COVID-19 vaccination program in Ireland, ensured seafarers were allowed to avail of a COVID-19 vaccination when they arrived at the Port of Cork. This highlights the requirement for future vaccination programs to consider and incorporate the requirements of seafarers acknowledging the essential role they play in the global supply chain.

Every year many concerts, festivals, public meetings and major events take place in Ireland. Depending on the nature of the event such as: location, the number of attendees, and performers–these events present varying amounts of risk. The Health Service Executive is concerned with managing risks and advocates that event organizers put comprehensive event management plans in place. Healthcare arrangements for outdoor crowd events should be specified in the Event Medical Plan section of the event management plan by the event organizer. As part of the event notification process, event organizers engage with the HSE South Emergency Management Office which in turn liaises with the various care groups across the Cork Kerry region to inform them of events that may impact their service. Historically, event organizers have informed the Emergency Management office of events in a wide variety of formats and varying levels of information.

The HSE South Emergency Management Office engaged with Cork University Hospital (Major Trauma Center) to identify the information hospitals require from various events around the region. In addition, the Emergency Management Office liaised with a subject matter expert in Mass Gatherings from Australia to discuss key indicators/data points healthcare facilities could benefit from knowing in advance of mass gathering events.

A standardized Word document template was developed as a proof of concept that lists key data that healthcare facilities have identified as important for them to be made aware of as part of the notification process. This template now lends itself to be developed into an online editable form to enable event organizers to inform the relevant healthcare facilities of mass gathering events.

Health care facilities require timely and accurate information regarding mass gathering events to ensure appropriate plans and preparations are in place. A standardized notification template would assist in the preparation phase.

Distilling from the National Risk Assessment for Ireland, the Regional Working Group for Major Emergency Management Region South (Cork and Kerry) assessed threats in the region and 22 hazards were identified which were distributed over the natural, transportation, technological and civil categories. The hazards were plotted on an Interagency (Health, Police and Local Authority) Emergency Management Risk Matrix

A three-hour ‘Introduction to Emergency Management’ educational program was developed in May 2022 with the aim of introducing frontline members of the Principal Response Agencies (Health, Police and Local Authority) across the Cork and Kerry region to the concept of emergency management. As part of this educational session, participants (N = 55) were given an overview of the regional risks as identified through the risk assessment process by the Regional Working Group for Major Emergency Management. As part of a breakout session, course participants were asked to identify their perspective on ‘worst case scenario’ risks.

An analysis of the operational risks identified by members of the Principal Response Agencies (Police, Health and Local Authority) were categorized into the four risk sub-headings: natural, civil, technical and transport and compared with the strategic regional risk assessment. The differences identified based on the comparative analysis, detailed that those holding operational portfolios identified that concurrent risks, as evidenced during the Cyberattack on the Health Service Executive in May 2021 during a wave of the global pandemic in Ireland were a perceived 'greater' risk that those traditional risks identified in the regional risk assessment.

This study highlights the importance of engaging operational staff when developing regional emergency management risk assessments. The requirement to consider and incorporate concurrent emergency management risks is vital to ensure that the Cork and Kerry regions are prepared for future events.

The paper provides the perspective of emergency managers within a healthcare service, using a multi-agency framework to coordinate a regional response to COVID 19. While health services play a role in the planning, response and recovery to major emergencies they are rarely the lead in coordinating the response. The exploration of existing research through Pauchant and Mitroff Onion Theory is combined with the challenges and experiences faced by emergency managers during the COVID 19 response in Ireland. The research mirrors the experience of emergency managers that preparedness and relationship building are key to quickly establishing a response. However the experience of emergency managers was that although shared situational awareness is critical a flexible system framework is required, particularly in a prolonged pandemic situation. A hierarchical command and control system can negatively impact on strong local relationships and problem solving capability. The experience of emergency mangers concurs with research that the development of a learning organization is pivotal in information preparedness before and during the response and recovery phase. The challenges of implementing lessons learned across a national health service can be challenging especially during an extended response phase.

A deductive manifest analysis approach was adopted to carry out a qualitative thematic content analysis of exercise reports and emergency debrief reports.

Research Questions

Lessons learned in the five years prior to COVID 19 enhanced the response to the pandemic emergency–yes there are several examples of how lessons learned can improve response to seemingly unrelated emergencies.

The principals of the MEM Framework in Ireland are applicable to a pandemic emergency–yes but this is dependent on local arrangements and relationships to allow flexibility in the implementation of the framework.

Regular training and exercising as well as a debriefing of exercises and real emergencies enhances preparedness for emergencies.

According to the Climate Change Advisory Council, Ireland is woefully unprepared for future extreme weather events such as heatwaves, flooding, and coastal surges, which are going to be more extreme and frequent in the future. Met Éireann issued numerous red weather warnings since the inception of the severe weather forecasting system. Storms Ophelia (Ex. Hurricane) and Emma (Snow Storm) proved to be extremely challenging weather events for the Health Service across Ireland.

A comprehensive review of debriefs and lessons identified processes completed across the health system was conducted, in connection with lived experiences of emergency management staff, following Storm Ophelia and Storm Emma.

As part of the emergency management life cycle and an attempt to enhance severe weather preparations, this study lists over 50 actions (development of specific HR policies, creating 4X4 capacity, severe weather preparations sessions, development of service-specific red weather event action cards, development of severe weather care plans for community palliative care and renal dialysis patients, sharing critical health care facilities with Local Authorities for road salting and gritting etc.) that were taken across the Health Service Executive South (Cork and Kerry) to enhance the preparations for severe weather events,

The frequency and intensity of severe weather events will increase in Ireland over the coming years, as a result, it is essential that healthcare facilities and services have learned from previous severe weather events to ensure that the necessary plans and procedures are in place for future events, ensuring the delivery of safe and effective patient care and staff safety.