Northern Ireland Research Articles

Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK.

Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting. 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey. 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD. We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting.

From Troubles to Triumph: The Role of Design Culture in Establishing a Design Policy in Northern Ireland

From Troubles to Triumph: The Role of Design Culture in Establishing a Design Policy in Northern Ireland

Comparing mental health and mental capacity law data across borders: Challenges and opportunities

The island of Ireland is partitioned into Northern Ireland and the Republic of Ireland. In both jurisdictions, there have been important developments in mental health and mental capacity law, and associated policies and services. This includes an emphasis on developing more comprehensive approaches to collecting data on outcomes and so there is an opportunity to align these processes to enable comparison and shared learning across the border. This article explores: legal and policy developments; international approaches to mental health outcomes; and the type of data that would be helpful to collect to better understand the use of mental health and mental capacity laws. It is argued that an inclusive strategy to developing a comprehensive, integrated and aligned approach to collecting and analysing data would benefit citizens, policy makers and professionals.

Reimagining Troubled Pasts and Sustainable Futures: Religion and Post-Brexit Northern Ireland

ABSTRACT: International, national and local peacebuilding documents suggest that islanders confront the legacy of the past as they articulate a vision of the future, and this article assesses the most useful frames, metaphors and terms for thinking about the troubled past and shared future of post-Brexit Ireland, North and South. It suggests that comparative history might help. Considering the history of religion and sustainability in the United States might allow participants to reframe the island's troubled past as a series of shared sustainability crises and to reimagine future-focused deliberations as collective efforts to repair socially and ecologically stressed niches. This approach addresses widespread concerns about the well-being of the next generation and uses terms that already have informed thinking about possible futures. It will not heal old wounds or end sectarian disputes, but, with new language to express shared hopes, this approach might make the post-Brexit transition a little less fraught.

Unionist Screws: Depictions of Northern Irish Unionists in British and Irish Cinema

This article explores the representation of Northern Irish unionists in British and Irish cinema by investigating a dominant way that the community has been portrayed in fiction films: as prison officers and orderlies. Specifically, Northern Irish unionists have been portrayed as prison officers and orderlies employed in the Maze and Armagh prisons during the period of republican unrest which culminated in hunger strikes in 1981, and a mass prison escape in 1983. The films that depict, to varying degrees, these characters as belonging to the Northern Irish unionist community include Some Mother’s Son (1996), H3 (2001), Silent Grace (2001), Hunger (2008) and Maze (2017). In these films, the typical representation of Northern Irish unionists reflects both the community’s general ‘othering’ in cinema and the film-makers’ primary interest in Irish nationalism when depicting Northern Ireland. Thus, unionist characters are usually depicted abjectly and feature only as adjuncts to narratives that are principally about Irish nationalists. This study aims to build upon a range of critical work in this area and to add to broader debates that have identified this cinematic deficit whereby Northern Irish unionists are depicted more critically and less frequently than Irish nationalists.

Ireland’s Foreign Relations in 2022

This review examines Ireland’s foreign relations in 2022. As Ireland emerged from the final period of Covid pandemic restrictions it faced an unstable world. Russia’s illegal escalation of its war in Ukraine would be the main focus of Ireland’s engagement with the world. The EU agenda was dominated by the response to the conflict and Ireland demonstrated solidarity with its partners. 2022 was also the second and final year of Ireland’s membership of the UN Security Council and saw Ireland take up the Presidency of the Council of Europe. Relations with the UK were strained by ongoing tensions over the Northern Ireland Protocol, not helped by political instability at Westminster. The review outlines how Ireland managed its foreign relations in this period and concludes by noting some significant deaths during the year.

Undertaking Studies Within A Trial to evaluate recruitment and retention strategies for randomised controlled trials: lessons learnt from the PROMETHEUS research programme.

Randomised controlled trials ('trials') are susceptible to poor participant recruitment and retention. Studies Within A Trial are the strongest methods for testing the effectiveness of strategies to improve recruitment and retention. However, relatively few of these have been conducted. PROMoting THE Use of Studies Within A Trial aimed to facilitate at least 25 Studies Within A Trial evaluating recruitment or retention strategies. We share our experience of delivering the PROMoting THE Use of Studies Within A Trial programme, and the lessons learnt for undertaking randomised Studies Within A Trial. A network of 10 Clinical Trials Units and 1 primary care research centre committed to conducting randomised controlled Studies Within A Trial of recruitment and/or retention strategies was established. Promising recruitment and retention strategies were identified from various sources including Cochrane systematic reviews, the Study Within A Trial Repository, and existing prioritisation exercises, which were reviewed by patient and public members to create an initial priority list of seven recruitment and eight retention interventions. Host trial teams could apply for funding and receive support from the PROMoting THE Use of Studies Within A Trial team to undertake Studies Within A Trial. We also tested the feasibility of undertaking co-ordinated Studies Within A Trial, across multiple host trials simultaneously. Clinical trials unit-based trials recruiting or following up participants in any setting in the United Kingdom were eligible. Clinical trials unit-based teams undertaking trials in any clinical context in the United Kingdom. Funding of up to £5000 and support from the PROMoting THE Use of Studies Within A Trial team to design, implement and report Studies Within A Trial. Number of host trials funded. Forty-two Studies Within A Trial were funded (31 host trials), across 12 Clinical Trials Units. The mean cost of a Study Within A Trial was £3535. Twelve Studies Within A Trial tested the same strategy across multiple host trials using a co-ordinated Study Within A Trial design, and four used a factorial design. Two recruitment and five retention strategies were evaluated in more than one host trial. PROMoting THE Use of Studies Within A Trial will add 18% more Studies Within A Trial to the Cochrane systematic review of recruitment strategies, and 79% more Studies Within A Trial to the Cochrane review of retention strategies. For retention, we found that pre-notifying participants by card, letter or e-mail before sending questionnaires was effective, as was the use of pens, and sending personalised text messages to improve questionnaire response. We highlight key lessons learnt to guide others planning Studies Within A Trial, including involving patient and public involvement partners; prioritising and selecting strategies to evaluate and elements to consider when designing a Study Within A Trial; obtaining governance approvals; implementing Studies Within A Trial, including individual and co-ordinated Studies Within A Trials; and reporting Study Within A Trials. The COVID-19 pandemic negatively impacted five Studies Within A Trial, being either delayed (n = 2) or prematurely terminated (n = 3). PROMoting THE Use of Studies Within A Trial significantly increased the evidence base for recruitment and retention strategies. When provided with both funding and practical support, host trial teams successfully implemented Studies Within A Trial. Future research should identify and target gaps in the evidence base, including widening Study Within A Trial uptake, undertaking more complex Studies Within A Trial and translating Study Within A Trial evidence into practice. All Studies Within A Trial in the PROMoting THE Use of Studies Within A Trial programme had to be registered with the Northern Ireland Network for Trials Methodology Research Study Within A Trial Repository. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 13/55/80) and is published in full in Health Technology Assessment; Vol. 28, No. 2. See the NIHR Funding and Awards website for further award information.

Véronique Altglas, Religion and Conflict in Northern Ireland. What Does Religion Do?

Véronique Altglas, Religion and Conflict in Northern Ireland. What Does Religion Do?

EXPLORING THE CONTEXTUAL COMPLEXITIES OF VIOLENCE ON DIGITAL PLATFORMS: INTERSECTIONS, IMPACTS, AND SOLUTIONS

As social media platforms face increasing complexity, severity, and pervasiveness of violent content, it is of utmost importance for researchers, educators, policymakers, and users alike to regard digital violence as an imminent threat. Indeed, violent content is widely acknowledged as an inseparable element of the continuum of violence, interlinked with various other types and embodiments of harm that transcend the archaic boundaries of online and offline realms. To adequately address the increasingly complex nature of violence on digital platforms, it is paramount to understand how digital platforms may modify and amplify violent behavior and content. The initial step in such efforts is to contextualize violence within its cultural and historical settings. Accordingly, this panel explores digital manifestations of violence as experienced and perceived within specific socio-cultural contexts. The papers presented delve into four case studies from diverse socio-cultural contexts (Colombia, Northern Ireland, Israel/Palestine, and Syria), and touch upon pressing contemporary issues such as the Israeli-Palestinian conflict, anti-religion protest in Iran, and the recent earthquakes in Syria. These case studies aim to explore the impact and reach of various forms of violence manifested on digital platforms. Panelists unpack ways of inciting, reproducing, expressing, and countering violence, enacted through a wide variety of media practices (such as memes, tweets and viral videos) across various platforms (including TikTok, Facebook, Twitter, and WhatsApp). In this panel we seek to build bridges and deepen our understanding of the complex and multifaceted dynamics of digital violence by exploring possible solutions for mitigating its detrimental impact.

Domestic and foreign Marxist tradition of the Northern Ireland conflict origins definition (1969–1998)

The article examines the perspectives of Soviet and foreign Marxist researchers in relation to the underlying causes of the beginning and escalation of Northern Irish conflict (The Troubles). The significance of this research lies in comprehending the lesser-explored Marxist heritage within the contemporary study of historical events in Great Britain and Ireland. The scientific novelty lies in addressing the scarcity of historiographical works dedicated to this issue, the depth of analysis they provide, and the absence of comprehensive comparative experiences. The research aims to investigate specific processes in the intellectual history of the USSR and other countries during the latter half of the XX century, focusing on instances of interaction or lack thereof between various Marxist schools of thought and trends. This is achieved by utilizing the Marxist historiography of the Northern Ireland conflict as an illustrative case. To fulfill this objective, the study undertakes a comparison of extensive sets of historiographical sources and internal subgroups of approaches present within Eastern and Western scholarly traditions that explore aspects of the Northern Ireland conflict within the context of Marxism. The primary theoretical framework draws upon the works of foreign and Russian Marxist scholars devoted to the issue of intercommunal conflict in Northern Ireland. The key finding of the research highlights the existence of evident similarities, encompassing logical, substantive, and linguistic-rhetorical aspects, between the works of Western and Eastern Marxists, despite the lack of direct citations between them. The research postulates several hypotheses concerning the origins of this phenomenon, including the potential impact of distinct methodologies on researchers’ perceptions of social processes and historical events, irrespective of the array of available source material. Furthermore, the research does not negate the possibility of implicit interactions between proponents of the English-language and the Russian-language Marxist academic traditions.

Breaking Silences: Women, Citizenship and Theatre In Northern Ireland

This essay seeks to weave together an analysis of women’s citizenship and its dependency on certain silences, and the exploration of this tension in two recent productions by Belfast- based Kabosh Theatre Company. Kabosh, and company Artistic Director Paula McFetridge, stage work that examines the realities of the region in the post-conflict era.  In constructing the theoretical frame for the analysis, the concept of “silence” and “silencing” draws from Kristie Dotson (2015), and from work on violence such as Gayatri Spivak’s concept of “epistemic violence” and a wide range of sources on the performance of violence in theatre. Chantal Mouffe’s concept of agonistic democracy shapes the discussion of the Northern Irish state, and Wendy Brown and Joane Butler are the key scholars for the consideration of citizenship and nation.   

Migrants, transcultural memory and World War I commemoration in post-conflict Northern Ireland

This article explores a community memory project on World War I led by first-generation migrants living in Northern Ireland. As a location recovering from 30 years of political violence, debates on commemoration are frequently reduced to the bi-partisan lens of Irish nationalism or British unionism. World War I is one episode often interpreted through this exclusivist framework. Recent immigration, however, raises questions as to how those who are neither nationalist nor unionist can partake in public memory debates. Drawing on the project’s experiences, I argue that incorporating migrants’ worldviews on the past can elucidate important transcultural analysis and positively aid in reframing simplistic ethno-national interpretations. Transcultural methods can illuminate cross-cultural themes and explicate differences and similarities across multiple groups rather than just two historically divided communities. Thus, transcultural approaches offer a novel means of generating holistic dialogue on memory which has transformative potential for a society transitioning from conflict to peace.

The importance and added value of patient involvement in person-centred medication reviews.

Background: The iSIMPATHY (implementing Stimulating Innovation in the Management of Polypharmacy and Adherence Through the Years) team is conducting person-centred medication reviews using a 7-step review tool focusing on ‘what matters to you’1.
 iSIMPATHY is an EU-funded partnership between Scotland, Ireland and Northern Ireland. One of the main drivers for change is the WHO 3rd global patient safety challenge, Medication Without Harm which aims to reduce severe avoidable medication-related harm by 50% globally in the next 5 years, with one of the key action areas being polypharmacy2. To date over 1400 person-centred medication reviews have been conducted with patients in Northern Ireland. These reviews aim to reduce inappropriate polypharmacy, promote adherence and health literacy and provide patient education.
 Personal and Public Involvement (PPI) feedback was sought prior to the project starting and patient engagement has continued throughout.
 Method: Structured, person-centred medication reviews were conducted in acute medical wards in a secondary care setting in Northern Ireland. Priority was given to those on 10 or more medicines or a high risk medicine, over 50 and resident in a care home or approaching end of life. Data were collected for a cohort of 66 patients who consented to an iSIMPATHY review. Data were analysed to determine the interventions made due to patient involvement in the review as compared with interventions which could be made by completing a kardex (medicine list) review only.
 Results: An average of 9.3 interventions were made per patient, significance was graded using the Eadon system, with 4.4% graded 3 (significant but does not lead to an improvement in patient care), 88.9% graded 4 (significant and results in an improvement in standard of care) and 6.7% graded 5 (very significant and prevents major organ failure or an adverse reaction of similar importance). Interventions included checking and requesting laboratory tests, omitted medicines started, adjustments made for allergy, frailty, renal or liver impairment and identification of adverse drug reactions.  Importantly, 88% (n=58) of patients had an intervention made because the medication review was discussed with them. This resulted in 38% additional interventions and included 22% of grade 5 interventions.
 The themes of additional interventions were: adherence and inhaler education (19%), identification of unmet/unknown health need and symptom control (15%), community support services (15%), lifestyle (12%), reduction and stopping unnecessary/inappropriate medicines (10%), identification of important additional information (10%), sick day rules (8%), self-care (7%) and referral to other services (5%).
 Conclusion: Patient involvement in their medication review leads to the identification of new and unmet needs, allows for the provision of counselling on medicines, adherence and lifestyle and prompts discussion and action on the deprescribing of inappropriate and unnecessary medicines. These additional interventions are clinically significant for the patient.
 Next steps: Medication reviews and data collection continues with the aim of scale and spread. For results and learning opportunities search https://www.isimpathy.eu/.
 
 https://www.isimpathy.eu/
 Medication Safety in Polypharmacy Technical Report, World Health Organisation 2019.
 
 https://www.who.int/initiatives/medication-without-harm
 
 Eadon, H. Assessing the quality of ward pharmacists’ interventions. Int. J. Pharm. Pract 1992, 1, 145–147
 
  

The introduction and impact of a National Frailty Education Programme

Background: Frailty is a dynamic functional state. Its onset and progression can be reduced and even reversed, if early intervention and correct management strategies are set in place. A number of reports suggest that healthcare professionals in general, have a poor understanding and view frailty as an inevitable part of ageing. In response the NCPOP developed The National Frailty Education Programme
 Aim: The programme aim is to provide healthcare professionals with an enhanced understanding of frailty and frailty assessments; thereby ensuring earlier recognition of frailty, improved healthcare management, and better outcomes for older adults living with frailty.
 Methods: A Test of Concept, using quality improvement (QI) methodology was employed. This allowed for small tests of change, which informed the development of the programme content and the programme delivery.
 Results: From 21st September 2017 to December 2019 n=3045 healthcare professionals completed the programme. A further 87 staff attended the programme during 2020. 
 97% of respondents rated the programme highly in relation to their level of enhanced understanding following participation in the study day.
 In early 2020, due to the outbreak of the COVID-19 the pandemic face to face education had to cease. The impact of COVID-19 on older adults and the increased prevalence of frailty on this cohort meant the development of and access to an eLearning programme became a priority and an eLearning programme was developed.  A blended programme is due to be launched in 2023.
 Impact: In 2018, the NFEP was awarded the Zenith Global Healthcare Award in recognition of its pioneer educational approach to the delivery of integrated interprofessional education. The programme has also been included in the European Union’s Joint Action on Frailty Prevention (Rodríguez-Laso et al., 2019), as a case study of good practice under Domain 7: Education and Training. Many other projects, publications and developments have arisen out of this programme including: the evolving Frailty Networks nationally, the inaugural meeting of the Irish Frailty Network of the Irish Gerontological Society in September 2019 , the first All-Ireland Frailty Network meeting in October 2021 , advisory inputs to the Northern Ireland Frailty Network in November 2021 towards developing a Frailty Education Programme for Northern Ireland, and many other initiatives and contributions to improve patient care. The programme has been cited internationally as an exemplar of an interprofessional approach to learning (Walsh, & Currid 2018, Adja, et al. 2020, Munro & Murphy, 2022, Romero-Ortuno, et al. 2022); in recognition, since 2022, Trinity College Dublin offers up to 5 annual scholarships to NFEP Facilitators for the online, standalone module in Assessment and Management of Frailty in Ageing Adults .

In search of Ukrainian Studies within Slavonic philology and other courses offered by Irish universities in the context of the Russian invasion of 24 February 2022

Abstract: The aim of this article is to examine the status of Ukrainian studies (predominantly literary studies, linguistic studies, cultural studies) within the teaching and research practices as regards Slavonic Studies and other academic fields in the Republic of Ireland and Northern Ireland. The questions posed concern what study programmes and academic activities that Irish universities can offer to develop Ukrainian Studies, within Slavonic Studies and other disciplines, following the Russian invasion on 24 February 2022. As the initial research on selected aspects of Slavonic Studies, with the focus on literary studies, was conducted in 2019, comparisons can be drawn as to the possible changes in the curricula, concerning the period before (2019) and after the Russian invasion (2023).

Changing Trends in Child Welfare Inequalities in Northern Ireland

Abstract Longitudinal research in England and Wales has identified increasing inequality in child welfare interventions, particularly with respect to children in the poorest areas coming into care. Although previous cross-sectional research has shown associations between area level deprivation and child welfare interventions to be weakest in Northern Ireland (NI), it remains unknown if this reflects wider trends over time. This study uses longitudinal administrative data to investigate the relationship between area level deprivation and the (1) referral, (2) investigation, (3) registration and (4) looked after stages of children’s contact with child and family social work from 2010 to 2017 (stages 1–3) and 2020 (stage 4). Both relative and absolute measures of inequality (Ratio of Inequality, Slope Index of Inequality and Relative Index of Inequality) were calculated to examine trends. The results highlight a clear and increasing social gradient in child welfare interventions in NI over time, particularly at the higher levels of intervention and those involving children aged 0–4 years. Routine analysis of children’s social care caseloads by deprivation is highlighted as a means of focusing attention on poverty and material inequality, prompting practitioners, managers and policy makers to consider the drivers of such inequality and how this might be addressed.

The workplace as a site of abortion surveillance

AbstractAnalysis of the experiences and resulting inequalities in reproductive health in the workplace has generated studies of pregnancy, miscarriage, menstruation, fertility and menopause. One issue that has remained outside of this literature is abortion. How abortion is talked about (or not talked about), experienced and perceived as a workplace issue were the central questions in our research undertaken in the Republic of Ireland and Northern Ireland in 2017. Our study comprised a survey (3180 respondents) followed by a series of online focus groups (61 participants) with trade union members from a broad range of workplaces, with the aim of investigating how abortion was positioned in workplaces within legally restrictive regimes. We conceptualize how self‐disciplining, silence and abortion stigma are reproduced in workplaces, drawing on a feminist Foucauldian framework to examine disciplinary power. We examine evidence of how, in conservative societies, abortion talk is suppressed, and we generate new theoretical knowledge on how disciplinary power undermines resistance to anti‐abortion norms and demonstrate the function of the normalizing gaze in the workplace. We conclude by offering avenues for future research on abortion stigma and disciplinary power, to extend further knowledge and conceptual framing of abortion as a workplace issue.

Making Representative Politics Work: Cross‐Segmental Parties in Consociations

AbstractCross‐segmental parties are outliers in consociations dominated by ethnic parties. While they often receive comparatively limited electoral support, they have the ability to make representative politics work. Cross‐segmental parties can successfully represent cross‐communal interests and encourage governments to focus on non‐segmental issues by bringing their ‘second policy dimension’ to the attention of segmental parties and encouraging ‘issue seepage’. To demonstrate this, we draw on evidence from these parties in cases including Northern Ireland, Belgium, Bosnia‐Herzegovina, Lebanon and South Tyrol, and argue that we need to look beyond election results to gauge their ‘success’. We identify three key areas – electoral dynamics, interactions in legislatures and contribution to government – where cross‐segmental, not segmental, parties can make representation work in consociations. This is true not only in liberal consociations that (can) explicitly accommodate cross‐segmental interests in legislative and executive arrangements but also in corporate consociations where formal accommodation does not exist.

Hate Crime in Northern Ireland: The Need for Legislation and a Bespoke Version of the Prevent Strategy

ABSTRACT Following the rise in hate crime in Northern Ireland, in 2019 the Northern Ireland Assembly appointed Judge Marrinan to conduct a review into hate crime. Publishing his findings in his review in December 2020, this article examines the key recommendations that should be included in a Hate Crime Bill. As the Assembly is currently suspended, the article examines the hate crime statistics recorded following the publication of the review to illustrate why it is imperative that when it reconvenes, the Assembly introduce a Hate Crime Bill at the earliest opportunity. The article also argues that a prevention programme is introduced alongside the Bill to safeguard and prevent young people being drawn towards paramilitary activity along with hate crime and non-paramilitary terrorist activity. Young people are the focus of introducing an initial programme with the demographics in the hate crime statistics revealing a high number of offenders are that category. Following an examination of current programmes in place and the threat posed by paramilitaries and extremists, including the far right and extreme far right (neo-Nazis), the article recommends the current WRAP programme is developed to help and safeguard young people drawn to the paramilitaries to include hate crime and extremist related terrorism.

Front and centre? Northern Irish electoral behaviour in the age of Brexit

ABSTRACT In post-conflict societies, traumatic experiences can have a profound effect on electoral behaviour. In Northern Ireland, Westminster elections between 2001 and 2017 were marked by the rise of hardline parties, but the 2019 election saw a significant shift towards the centre. The centre ground vote soared, resulting in the lowest level of political polarisation since the early 2000s. What are the factors underlying this transition to a moderate vote? Drawing on public opinion surveys and electoral data, we find that Brexit played a crucial role in incentivising voters to support parties prioritising non-sectarian constitutional interests. The findings suggest that voters employ party competition as a balancing mechanism. Our article contributes to the understanding of how individuals in post-conflict societies navigate the complex relationship between violence, politics, and peacebuilding.