• Expanding access to rheumatology care: the rheumatology general practice toolbox.

      Conway, R; Kavanagh, R; Coughlan, R J; Carey, J J (Irish Medical Journal, 2015-02)
      Management guidelines for many rheumatic diseases are published in specialty rheumatology literature but rarely in general medical journals. Musculoskeletal disorders comprise 14% of all consultations in primary care. Formal post-graduate training in rheumatology is limited or absent for many primary care practitioners. Primary care practitioners can be trained to effectively treat complex diseases and have expressed a preference for interactive educational courses. The Rheumatology General Practice (GP) Toolbox is an intensive one day course designed to offer up to date information to primary care practitioners on the latest diagnostic and treatment guidelines for seven common rheumatic diseases. The course structure involves a short lecture on each topic and workshops on arthrocentesis, joint injection and DXA interpretation. Participants evaluated their knowledge and educational experience before, during and after the course. Thirty-two primary care practitioners attended, who had a median of 13 (IQR 6.5, 20) years experience in their specialty. The median number of educational symposia attended in the previous 5 years was 10 (IQR-5, 22.5), with a median of 0 (IQR 0, 1) in rheumatology. All respondents agreed that the course format was appropriate. Numerical improvements were demonstrated in participant's confidence in diagnosing and managing all seven common rheumatologic conditions, with statistically significant improvements (p < 0.05) in 11 of the 14 aspects assessed. The Rheumatology Toolbox is an effective educational method for disseminating current knowledge in rheumatology to primary care physicians and improved participant's self-assessed competence in diagnosis and management of common rheumatic diseases.
    • Fitness to drive in cognitive impairment – a quantitative study of GPs’ experience

      Doherty, Una; Hawke, Ana-Louise; Kearns, Jamie; Kelly, M (Irish Medical Journal, 2015-04)
      Assessing fitness to drive is part of the role of general practitioners. Cognitive impairment may affect an individualâ s ability to drive safely. The aims of our study were to question GPs about their experience of assessing patients with cognitive impairment for driving fitness and to explore their attitudes to this role. We carried out a quantitative cross-sectional anonymous postal survey of 200 GPs in counties Galway, Mayo and Roscommon. Ethical approval was obtained from the Irish College of General Practitioners. Data was analysed using Epi Info. The response rate was 62.5% (n=125). 86 (68.8%) GPs used guidelines when assessing fitness to drive in cognitive impairment. 83 (66.4%) respondents formally assess cognitive function. 52 (41.6%) GPs would certify someone as fit to drive with verbal restrictions. 102 (81.6 %) respondents feel confident in assessing fitness to drive. 98 (78.4%) GPs have referred patients for further assessment.
    • Parkinson’s disease – a brief practical approach

      Browne, Patrick; Daly, Lorna; Counihan, Timothy (Nursing in General Practice, 2014-09)
      arkinson’s disease (PD) is the second most common neurodegenerative disease after Alzheimer’s disease, and affects about 1% of the population over 65 year of age. Although the incidence of PD rises with advancing age, juvenile onset PD (onset under 40 years of age) is well recognised and is associated with identifiable genetic mutations in a significant proportion of cases. The cause of PD remains unknown. One possibility is that affected individuals may have inherited a predisposition to developing PD and that some environmental exposure may trigger the start of neuronal degeneration. The recent identification of a number of genetic mutations in families with several affected members, has enhanced our understanding of the pathogenesis of neuronal degeneration in PD. These gene mutations result in a number of possible abnormalities including abnormal protein folding/aggregation, defective protein clearance, defective cell resistance to oxidative stress, mitochondrial dysfunction – such abnormalities may contribute to pathogenesis.