Application of action research in the field of healthcare: a scoping review protocol.

Background: Traditional research approaches are increasingly challenged in healthcare contexts as they produce abstract thinking rather than practical application. In this regard, action research is a growing area of popularity and interest, essentially because of its dual focus on theory and action. However, there is a need for action researchers not only to justify their research approach but also to demonstrate the quality of their empirical studies. Therefore, the authors set out to examine the current status of the quality of extant action research studies in healthcare to encourage improved scholarship in this area. The aim of this scoping review is to identify, explore and map the literature regarding the application of action research in either individual, group or organisational domains in any healthcare context. Methods: The systematic scoping review will search the literature within the databases of CINAHL, PubMed and ABI/Inform within the recent five-year period to investigate the scientific evidence of the quality of action research studies in healthcare contexts. The review will be guided by Arksey and O'Malley's five mandatory steps, which have been updated and published online by the Joanna Briggs Institute. The review will follow the PRISMA-ScR framework guidelines to ensure the standard of the methodological and reporting approaches are exemplary. Conclusion: This paper outlines the protocol for an exploratory scoping review to systematically and comprehensively map out the evidence as to whether action research studies demonstrate explicitly how the essential factors of a comprehensive framework of action research are upheld. The review will summarise the evidence on the quality of current action research studies in healthcare. It is anticipated that the findings will inform future action researchers in designing studies to ensure the quality of the studies is upheld.

Headache in the neurology clinic: a 2-year audit.

BACKGROUND: Headache is the most common reason for referral to neurology outpatient clinics in Ireland and represents approximately 30% of all new appointments. AIM: To evaluate diagnoses and outcomes of all patients newly referred with headache to a consultant neurologist at an Irish university teaching hospital over a 2-year period. DESIGN: A retrospective analysis and audit. METHODS: Data including patient demographics, red flags, investigations, diagnosis, and outcome were collected on consecutive patients newly referred with headache to a consultant neurologist's outpatient clinic over a 2-year period. RESULTS: Two hundred and seventy patients with headache were seen; 75% were women with mean age of 39 years. 89.26% (241/270) were diagnosed with a primary headache disorder alone; 4.44% (12/270) with a secondary headache disorder alone; 3.33% (9/270) with both a primary and secondary headache disorders; and 2.96% (8/270) with a painful cranial neuropathy. Migraine was the most common diagnosis, frequently associated with medication overuse. Non-attendance rates were high. Although imaging abnormalities were frequently found, on no occasion was it thought to be the cause of the headache. CONCLUSIONS: Most patients referred to a neurology outpatient clinic with headache have a primary headache disorder. Alternate pathways should be considered to reduce the burden on Ireland's limited neurology resources without compromising patient safety.

A scoping review protocol to map the evidence on the use of action research methodology by healthcare professionals and in healthcare team settings.

Background: Action research (AR) starts with an existing practical situation with which there is a concern or potential for improvement. It seeks transformative change through the simultaneous process of doing research and undertaking actions, both of which are linked together by a critical reflective process. It simultaneously allows one to systematically investigate a given social situation while promoting democratic change and collaborative participation. AR approaches have been used for many years in business management and education. More recently, AR has become an increasingly popular method of inquiry in healthcare, particularly in nursing, to investigate professional practice while simultaneously; introducing innovations; planning and undertaking action; and evaluating new ideas. The overall goal is to augment collaboration whilst improving the patient experience and outcomes. Methods: The Arksey and O'Malley methodology framework will be used to guide this scoping review process: stage 1 will identify the research questions; the eligibility criteria and search strategy will be defined in stage 2; studies will then be selected in stage 3; data will be extracted and charted from these included studies in stage 4; stage 5 involves aggregating and summarising these results along with criteria relevant for health professionals and policy-makers. An optional consultation (stage 6) exercise may potentially be included. Conclusion: This scoping review will comprehensively map the evidence on the use of AR methodology by healthcare professionals and in healthcare team settings. It is predicted that the findings will inform researchers in carrying out future AR and highlight gaps in the literature. An article reporting the results of the completed scoping review will be submitted for publication to a scientific journal and presented at relevant national and international conferences.

"Club-cutting" dystonic tremor: a case report.

BACKGROUND: Focal task-specific dystonic postures are well recognized. Often a tremor may be the main feature with little or no dystonia. These have been well reported in writers, musicians, and sportspeople. CASE REPORT: Herein we report a novel task-specific dystonic tremor in a 44-year-old Irish hairdresser due to club-cutting, a standard haircutting technique. DISCUSSION: Hairdresser's dystonia is a novel task-specific dystonia.

The ELISA-measured increase in cerebrospinal fluid tau that discriminates Alzheimer's disease from other neurodegenerative disorders is not attributable to differential recognition of tau assembly forms.

Elevated cerebrospinal fluid concentrations of tau discriminate Alzheimer's disease from other neurodegenerative conditions. The reasons for this are unclear. While commercial assay kits are widely used to determine total-tau concentrations, little is known about their ability to detect different aggregation states of tau. We demonstrate that the leading commercial enzyme-linked immunosorbent assay reliably detects aggregated and monomeric tau and evinces good recovery of both species when added into cerebrospinal fluid. Hence, the disparity between total-tau levels encountered in Alzheimer's disease and other neurodegenerative conditions is not due to differential recognition of tau assembly forms or the extent of degeneration.

Failure to attend out-patient clinics: is it in our DNA?

PURPOSE: This paper aims to determine the reasons why patients miss clinic appointments and to ascertain patients' views on the implementation of reminder systems and penalty fees to reduce the rates of did not attend (DNAs). Overall, the paper seeks to establish novel ways to run a more efficient out-patient department (OPD) service to improve waiting times and access for patients to limited neurology resources. DESIGN/METHODOLOGY/APPROACH: A questionnaire-based study was approved by the audit committee and was offered to 204 out-patients attending the neurology clinics over a three-month period (July to September 2009). The patients' demographic details and non-attendance records were reviewed. The paper aimed to ascertain, from the patients' perspective, why people failed to attend clinic appointments. Each participant was asked their views on how they felt their public hospital service might reduce the number of DNAs at their neurology OPD. FINDINGS: A total of 204 patients took part. Participants had a mean age of 31 years (range 25-75 years) with a modal peak in the 26 to 35 age bracket. Almost 10 per cent of those surveyed admitted to missing a hospital out-patient appointment in the past. The most common reason was that they simply "forgot" (28 per cent). DNA rates by age range were proportionally similar to the overall age profile of attenders. Over 55 per cent said they would like a pre-appointment reminder via a mobile telephone text message, 19 per cent preferred a pre-appointment telephone call, and 19 per cent an e-mail. Of those surveyed, 47 per cent said they would be willing to pay a fee on booking that could be refunded on attending for their appointment. The majority of these felt Euro 20 was the most appropriate amount (39 per cent). The rate of acceptance for various fee amounts was uniform across age ranges. Over half (52 per cent) said that they would agree to a "buddy" system whereby the appointment reminder was sent to the patient but also a nominated friend or relative. ORIGINALITY/VALUE: Non-attendance rates at the neurology clinics in our institution are high with almost 10 per cent of attendees admitting to missing an appointment. One of the main reasons why people did not attend was because they simply "forgot" that they had an appointment and the patients favoured a text messaging reminder system to help reduce non-attendance. Almost half of the respondents said that they would be willing to pay a refundable booking fee.