• Doctor-Patient Communication in an Outpatient Setting

      Mulligan, K; Egan, S; Brennan, D; Irish Society of Gynaecological oncology Public and patient involvement group members; O’Meara, Y; O’Toole, S (Irish Medical Journal, 2019-05)
      It is widely recognised that effective doctor-patient communication plays a vital role in patient care. Doctors must aim to develop rapport and build a trusting relationship with the patient. With a focus on explanation and patient-inclusive planning as per the Calgary Cambridge Guide to the Medical Interview, doctors can ensure optimal communication with their patients. Effective communication leads to greater adherence with treatment, greater satisfaction with care and it has also been shown to improve health outcomes. We can see this reflected in gynaecological malignancy where effective physician communication skills have been shown to result in improved patient outcomes following a diagnosis
    • Immunotherapy- A double Edged Sword; A case of Fatal Myocarditis and Complete Response

      Peters, N; Greally, M; Breen, K; Fabre, A; Blazkova, S (Irish Medical Journal, 2019-05)
    • Quantitative examination of the bone health status of older adults with intellectual and developmental disability in Ireland: a cross-sectional nationwide study.

      Burke, Éilish; Carroll, Rachael; O'Dwyer, Máire; Walsh, James Bernard; McCallion, Philip; McCarron, Mary (BMJ Open, 2019-04-15)
    • What matters to people with COPD: outputs from Working Together for Change.

      Early, Frances; Lettis, Matthew; Winders, Sarah-Jane; Fuld, Jonathan (npj Primary Care Respiratory Medicine, 2019-04-12)
    • Consequential differences in perspectives and practices concerning children with developmental language disorders: an integrative review.

      Gallagher, Aoife L; Murphy, Carol-Anne; Conway, Paul; Perry, Alison (International Journal of Language & Communication Disorders, 2019-04-04)
    • Slow release oral morphine versus methadone for the treatment of opioid use disorder.

      Klimas, Jan; Gorfinkel, Lauren; Giacomuzzi, Salvatore M; Ruckes, Christian; Socías, M Eugenia; Fairbairn, Nadia; Wood, Evan (2019-04-02)
      Two independent reviewers extracted data and assessed risk of bias. Data were pooled using the random-effects model and expressed as risk ratios (RRs) or mean differences with 95% CIs. Heterogeneity was assessed (χ2 statistic) and quantified (I2 statistic) and a sensitivity analysis was undertaken to assess the impact of particular high-risk trials.
    • Excellent reliability and validity of the Addiction Medicine Training Need Assessment Scale across four countries.

      Pinxten, W J Lucas; Fitriana, Efi; De Jong, Cor; Klimas, Jan; Tobin, Helen; Barry, Tomas; Cullen, Walter; Jokubonis, Darius; Mazaliauskiene, Ramune; Iskandar, Shelly; et al. (2019-04-01)
      Addiction is a context specific but common and devastating condition. Though several evidence-based treatments are available, many of them remain under-utilized, among others due to the lack of adequate training in addiction medicine (AM). AM Training needs may differ across countries because of difference in discipline and level of prior AM training or contextual factors like epidemiology and availability of treatment. For appropriate testing of training needs, reliability and validity are key issues. The aim of this study was to evaluate the psychometric properties of the AM-TNA Scale: an instrument specifically designed to develop the competence-based curriculum of the Indonesian AM course. In a cross-sectional study in Indonesia, Ireland, Lithuania and the Netherlands the AM-TNA was distributed among a convenience sample of health professionals working in addiction care in The Netherlands, Lithuania, Indonesia and General Practitioners in-training in Ireland. 428 respondents completed the AM-TNA scale. To assess the factor structure, we used explorative factor analysis. Reliability was tested using Cronbach's Alpha, ANOVA determined the discriminative validity. Validity: factor analysis revealed a two-factor structure: One on providing direct patient treatment and care (Factor 1: clinical) and one factor on facilitating/supporting direct patient treatment and care (Factor 2: non-clinical) AM competencies and a cumulative 76% explained variance. Reliability: Factor 1 α = 0.983 and Factor 2: α = 0.956, while overall reliability was (α = 0.986). The AM-TNA was able to differentiate training needs across groups of AM professionals on all 30 addiction medicine competencies (P = .001). In our study the AM-TNA scale had a strong two-factor structure and proofed to be a reliable and valid instrument. The next step should be the testing external validity, strengthening discriminant validity and assessing the re-test effect and measuring changes over time.
    • Predicting admission to long-term care and mortality among community-based, dependent older people in Ireland.

      Aspell, Niamh; O'Sullivan, Maria; O'Shea, Eamon; Irving, Kate; Duffy, Chloe; Gorman, Rebecca; Warters, Austin (International Journal of Geriatric Psychiatry, 2019-03-22)
    • Association between caesarean section delivery and obesity in childhood: a longitudinal cohort study in Ireland.

      Masukume, Gwinyai; McCarthy, Fergus P; Baker, Philip N; Kenny, Louise C; Morton, Susan Mb; Murray, Deirdre M; Hourihane, Jonathan O'B; Khashan, Ali S (BMJ Open, 2019-03-15)
      To investigate the association between caesarean section (CS) birth and body fat percentage (BF%), body mass index (BMI) and being overweight or obese in early childhood. Prospective longitudinal cohort study. Babies After Screening for Pregnancy Endpoints: Evaluating the Longitudinal Impact on Neurological and Nutritional Endpoints cohort. Infants born to mothers recruited from the Screening for Pregnancy Endpoints study, Cork University Maternity Hospital between November 2007 and February 2011.
    • Development of a suite of metrics and indicators for children's nursing using consensus methodology.

      Brenner, Maria; Browne, Catherine; Gallen, Anne; Byrne, Susanna; White, Ciara; Nolan, Mary (Journal of Clinical Nursing, 2019-03-04)
    • Perspectives of people with aphasia poststroke towards personal recovery and living successfully: A systematic review and thematic synthesis

      Manning, Molly; MacFarlane, Anne; Hickey, Anne; Franklin, Sue; School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick (Plos One, 2019-03)
    • A comparative analysis of prophylactic antimicrobial use in long-term care facilities in Ireland, 2013 and 2016

      Tandan, Meera; O'Connor, Rory; Burns, Karen; Murphy, Helen; Hennessy, Sarah; Roche, Fiona; Donlon, Sheila; Cormican, Martin; Vellinga, Akke (Eurosurveillance, 2019-03)
    • Codeine Usage in Ireland- A Timely Discussion on an Imminent Epidemic

      McDonnell, E; Graduate Entry Medical School, University of Limerick (Irish Medical Journal, 2019-03)
    • The Profile of Women Attending the National Maternity Hospital Emergency Out Of Hours Service – Two Decades On. A Retrospective Review

      O’Brien, O.F; Lee, S.; Baby, A.; McAuliffe, F.M; Higgins, M.F (Irish Medical Journal, 2019-03)
    • Polypharmacy Rates among Patients over 45 years

      Tatum, T; Curry, P; Dunne, B; Walsh, K; Bennett, K; UCD Geary Institute for Public Policy, University College Dublin (Irish Medical Journal, 2019-03)
    • Medical management of acute upper respiratory infections in an urban primary care out-of-hours facility: cross-sectional study of patient presentations and expectations.

      O'Connor, Raymond; O'Doherty, Jane; O'Regan, Andrew; O'Neill, Aoife; McMahon, Claire; Dunne, Colum P (BMJ Open, 2019-02-15)
      The purpose of this study was to examine the expectations of patients attending an urban primary care out-of-hours (OOH) facility with acute upper respiratory tract infection (acute URTI) regarding clinical examination, symptom management, information on their condition, reassurance, antibiotic treatment and other possible options including referral. Cross-sectional design. One urban primary care OOH facility located in the midwest of Ireland. 457 patients filled out a questionnaire while waiting in the OOH facility; 22 surveys were excluded as the patients did not present with symptoms of acute URTI resulting in 435 patients' data being included in this study. There were 59.5% female participants and 40.5% male participants.
    • Over prescribing of antibiotics for acute respiratory tract infections; a qualitative study to explore Irish general practitioners' perspectives.

      O'Doherty, Jane; Leader, Leonard F W; O'Regan, Andrew; Dunne, Colum; Puthoopparambil, Soorej Jose; O'Connor, Raymond (BMC Family Practice, 2019-02-14)
      Anti-microbial resistance (AMR) is a global threat to public health and antibiotics are often unnecessarily prescribed for acute respiratory tract infections (ARTIs) in general practice. We aimed to investigate why general practitioners (GPs) continue to prescribe antibiotics for ARTIs despite increasing knowledge of their poor efficacy and worsening antimicrobial resistance. We used an explorative qualitative study design. Thirteen GPs were recruited through purposive sampling to represent urban and rural settings and years of experience. They were based in general practices within the Mid-West of Ireland. GPs took part in semi-structured interviews that were digitally audio recorded and transcribed. Three main themes and three subthemes were identified. Themes include (1) non-comprehensive guidelines; how guideline adherence can be difficult, (2) GPs under pressure; pressures to prescribe from patients and perceived patient expectations and (3) Unnecessary prescribing; how to address it and the potential of public interventions to reduce it. GPs acknowledge their failure to implement guidelines because they feel they are less usable in clinical situations. GPs felt pressurised to prescribe, especially for fee-paying patients and in out of hours settings (OOH), suggesting the need for interventions that target the public's perceptions of antibiotics. GPs behaviours surrounding prescribing antibiotics need to change in order to reduce AMR and change patients' expectations.
    • Comparing Canadian and United States opioid agonist therapy policies.

      Priest, Kelsey C; Gorfinkel, Lauren; Klimas, Jan; Jones, Andrea A; Fairbairn, Nadia; McCarty, Dennis (2019-02-11)
      Canada and the United States (U.S.) face an opioid use disorder (OUD) and opioid overdose epidemic. The most effective OUD treatment is opioid agonist therapy (OAT)-buprenorphine (with and without naloxone) and methadone. Although federal approval for OAT occurred decades ago, in both countries, access to and use of OAT is low. Restrictive policies and complex regulations contribute to limited OAT access. Through a non-systematic literature scan and a review of publicly available policy documents, we examined and compared OAT policies and practice at the federal (Canada vs. U.S.) and local levels (British Columbia [B.C.] vs. Oregon). Differences and similarities were noted between federal and local OAT policies, and subsequently OAT access. In Canada, OAT policy control has shifted from federal to provincial authorities. Conversely, in the U.S., federal authorities maintain primary control of OAT regulations. Local OAT health insurance coverage policies were substantively different between B.C. and Oregon. In B.C., five OAT options were available, while in Oregon, only two OAT options were available with administrative limitations. The differences in local OAT access and coverage policies between B.C. and Oregon, may be explained, in part, to the differences in Canadian and U.S. federal OAT policies, specifically, the relaxation of special federal OAT regulatory controls in Canada. The analysis also highlights the complicating contributions, and likely policy solutions, that exist within other drug policy sub-domains (e.g., the prescription regime, and drug control regime) and broader policy domains (e.g., constitutional rights). U.S. policymakers and health officials could consider adopting Canada's regulatory policy approach to expand OAT access to mitigate the harms of the ongoing opioid overdose epidemic.
    • Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy.

      McEachern, Jasmine; Adye-White, Lauren; Priest, Kelsey C; Moss, Eloise; Gorfinkel, Lauren; Wood, Evan; Cullen, Walter; Klimas, Jan (2019-02-01)
      Opioid agonist therapy (OAT) is a first-line treatment for opioid use disorder (OUD); however, the efficacy and role of urine drug screening (UDS) in OAT has received little research attention. Prior evidence suggests that UDS frequency reflects philosophy and practice context rather than differences in patient characteristics or clinical need. Therefore, we reviewed the literature on the effect of and recommendations for the frequency of UDS on health outcomes for persons with OUD who receive OAT. We searched Medline and EMBASE for articles published from 1995-2017. Search results underwent double, independent review with discrepancies resolved through discussion with a third reviewer, when necessary. Additional articles were identified through snowball searching, hand searching (Google Scholar), and expert consultation. The Cochrane tool was used to assess risk of bias. Of the 60 potentially eligible articles reviewed, only one three-arm randomized open-label trial, comparing weekly and monthly UDS testing with take-home OAT doses, met our inclusion criteria. Our review identified an urgent gap in research evidence underpinning an area of clinical importance and that is routinely reported by patients as an area of concern.