ICGP PUBLICATIONS
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ICGP Library: Health Horizon Monthly, July 2020
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ICGP PUBLICATIONS
Forum July/August [login required to access] https://www.icgp.ie/go/library/forum?spid=ED08091E-5A82-47E5-A8B3CEB3322F85A5
ICGP Quick Reference Guide: Clinical Support for Termination of Pregnancy in
General Practice from the ICGP Quality and Safety in Practice Committee (July 12th) https://www.icgp.ie/go/library/catalogue/item/1B42F529-1633-45CC-82369491D13B5417
REPORTS
HRB ‘Alcohol treatment in Ireland 2014 to 2020’ (13th July)
https://www.hrb.ie/publications/publication/alcohol-treatment-in-ireland-2014-to-
2020/returnPage/1/
This is the annually updated bulletin from the National Drug Treatment Reporting System
(NDTRS) on cases of treated problem alcohol use in Ireland. It covers the period 2014 to
2020. In this seven-year period, 51,205 cases were treated for alcohol as a main problem
drug.
HRB ‘Drug treatment data in Ireland 2014 to 2020’ (20th July)
https://www.hrb.ie/publications/publication/drug-treatment-data-in-ireland-2014-to-
2020/returnPage/1/
This is the annually updated bulletin from the National Drug Treatment Reporting System
(NDTRS) on cases of treated problem drug use (excluding alcohol) in Ireland. It covers the
period 2014 to 2020. In this seven-year period, 68,571 cases were treated for drug use as a
main problem.
ICGP Library: Health Horizon Monthly, July 2020
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ESRI Research Bulletin ‘Medical card non-take-up: estimates and financial implications’
(7th July)
https://www.esri.ie/publications/medical-card-non-take-up-estimates-and-financial-
implications
This research estimates the proportion of eligible families who do not take up a Medical
Card, possible reasons for non-take-up and potential financial consequences. They estimate
that 31 per cent of eligible individuals do not take up a Medical Card. Families not taking up
the card are significantly more likely to report having an unmet health need due to financial
reasons and they spend more on healthcare and private health insurance per annum.
Medical Cards are means tested and aimed at those on lower incomes or with long-term
health conditions. They confer free, and often prioritised, primary, community and hospital
care, and prescription medication with a small fee. Medical cardholders also receive benefits
such as a reduced rate of the Universal Social Charge, exemptions from school transport
charges and state exam fees. A variety of reasons may explain lack of uptake: the
administrative burden of filling in the application form; perceptions of how much benefit the
card gives; stigma, as the card is aimed at those on lower incomes; or confusion about
eligibility. As well as estimating non-take-up, they investigate the characteristics of the
relevant families, the link between Medical Cards and private health insurance (PHI) and
differences in out-of-pocket healthcare expenditure across take-up and non-takeup groups.
Department of Health ‘Medical Cannabis Access Programme’ (19th July)
https://www.gov.ie/en/press-release/78f48-minister-for-health-announces-developments-to-
medical-cannabis-access-programme-increasing-availability-and-benefiting-eligible-patients-
around-ireland/
The Medical Cannabis Access Programme (MCAP) is now open for medical consultants to
make an application for themselves and their patients to be registered for the programme.
Registration by consultants and their patients on the Cannabis for Medical Use Register, to be
operated by the HSE, is required for the prescribing of cannabis-based products under the
MCAP.
The MCAP is a five-year pilot programme and subject to review. It is designed for patients
who suffer from three specific medical indications:
spasticity associated with multiple sclerosis
intractable nausea and vomiting associated with chemotherapy
severe, refractory (treatment-resistant) epilepsy
Oireachtas Library & Research Service, 2021, ‘L&RS Bill Digest: CervicalCheck Tribunal
(Amendment) Bill 2021’ (20th July)
https://data.oireachtas.ie/ie/oireachtas/libraryResearch/2021/2021-07-20_bill-digest-
cervicalcheck-tribunal-amendment-bill-2021_en.pdf
The CervicalCheck Tribunal (Amendment) Bill 2021 is a short technical Bill which will
extend the time limit in which a claim for compensation to the CervicalCheck Tribunal can
be made.
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Sub-Committee on Mental Health ‘Interim Report on Covid-19 and its effect on Mental
Health Services in the Community’ (28th July) https://data.oireachtas.ie/ie/oireachtas/committee/dail/33/joint_sub_committee_on_mental_health/reports/2021/2021-07-28_interim-report-on-covid-19-and-its-effect-on-mental-health-services-in-the-community_en.pdf
The Sub-Committee on Mental Health has launched its Interim Report on Covid-19 and its
effect on Mental Health Services in the Community. The Sub-Committee report calls on the
Department of Health to introduce emergency measures to meet the current surge in need for
mental health supports and services including a fit for purpose suicide prevention 24-hour
support team. The report also calls for a retrospective review of the mental health impact of
Covid-19 restrictions on palliative care, end-of-life supports and funerals, as evidence
emerges of the suffering and longer-term effects on mental health that arise as a result of not
being able to grieve properly. The calls are among the ten recommendations made in the
Interim report to respond to the pandemic linked increase in mental health service demand.
Other recommendations made in the report include the need to ensure the following:
State services develop a plan that ensures availability of and access to critical mental
health services as a matter of priority.
An increase in State funding supports, management and multidisciplinary planning for
mental health services to ensure that timely, appropriate and accessible services are
provided for the population
An increase in resources for specialist mental health services for youth services,
international protection applicants and Travellers.
A national health campaign highlighting addiction is implemented in addition to the
development of a comprehensive dual diagnosis service that includes joint care plans
between addiction services and mental health services
State services focus on connectedness, to support community actions that strengthen
social cohesion and reduce loneliness.
State agencies need to effectively engage with and respect the work of organised
community groups.
ESRI ‘Projections of Expenditure for Primary, Community and Long-Term Care in
Ireland, 2019–2035, based on the Hippocrates Model’ (July 28th) https://www.esri.ie/publications/projections-of-expenditure-for-primary-community-and-long-term-care-in-ireland-2019
New research from the ESRI funded by the Department of Health projects expenditure for
most primary, community, and long-term health and social care services in Ireland for the
years 2019–2035. The findings provide an evidence base for workforce and capacity planning
and for the implementation of important Sláintecare proposals. Identifying approaches to
address the projected increases in the cost of care delivery should be an important
consideration for policymakers.
Main findings
The cost of delivering care, particularly pay-related costs, is the main driver of
expenditure growth for health and social care services.
Of the services considered, the largest increases in expenditure are projected to be for
high-tech medicines dispensed in the community, long-term residential care and home
support services.
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We project nominal expenditure requirements for:
o public and private general practice of between €1.6bn and €2bn in 2035. This
implies a 2.9 per cent - 4.5 per cent average annual expenditure increase.
Increases in the cost of providing care is the largest driver of projected
expenditure growth.
o high-tech medicines of between €2.3bn and €4.4bn in 2035. This implies a 6.1
per cent - 10.5 per cent average annual increase and reflects a continuation of
high recent growth in demand for high-tech medicines.
o public and private long-term residential care of between €3.8bn and €5.7bn in
2035. This implies a 4.3 per cent - 6.9 per cent average annual expenditure
increase. Population ageing is the key driver of projected expenditure
increases for this service.
o public and private home support of between €1.2bn and €3.0bn in 2035. This
implies a 4.4 per cent - 10.4 per cent average annual increase. Likely increases
in demand following the establishment of a statutory home support scheme is
the key driver of projected expenditure growth.
More information: Irish Times - Billions needed to fund health services into next decade,
ESRI says (28th July 2021)
https://www.irishtimes.com/news/health/billions-needed-to-fund-health-services-into-next-
decade-esri-says-1.4632056
Government of Ireland ‘Impact of Demographic Change on Health Expenditure 2022-
2025’ (30th July) https://www.gov.ie/en/collection/8930f-spending-review-2021/#health
Building on previous IGEES work, this paper provides updated estimates of the funding
required to maintain ‘Existing Levels of Service’ out to 2025 when considering only
demographic change. The cost of maintaining the existing range of health services for the
State’s ageing population is forecast to increase by almost twice as much previously thought,
with an extra €324 million expected to be needed next year. Figures in the review suggest
that extra provision may have to be made in the budget to cope with the demographic change. The forecast of €324 million extra being required to treat Ireland’s growing cohort of older
people next year is almost double an estimate of €175 million included in a similar review
carried out in 2019. The paper says the cost will increase to €385 million in 2025,
significantly above the previous estimate of €186 million for the years 2023 to 2026.
Findings
• Using a base year of 2019, the paper estimates that an increase in expenditure of €324m is
required in 2022 to maintain ELS when considering only demographic change, increasing to
€385m in 2025. This compares with an estimate of €175m for 2022 by IGEES (2019),
increasing to an average annual cost of €186m between 2023-2026. The main reason for the
increase in estimates in this analysis is due to the use of more age specific data and expanding
the scope of service areas modelled.
More information: Irish Times - Health services to need extra €324m next year to cater for
ageing population (30th July)
https://www.irishtimes.com/news/health/health-services-to-need-extra-324m-next-year-to-
cater-for-ageing-population-1.4634291
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WEBINARS Health Protection Surveillance Centre (HPSC) ‘COVID-19 guidance updates for
healthcare staff undertaking home visits and community outpatient services’ (20th July) https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/infectionpreventionandcontrolguidance/webinarresourcesforipc/
This webinar is part of the AMRIC Education Centre series on COVID-19 Infection
Prevention and Control.
NMIC (NATIONAL MEDICINES INFORMATION CENTRE)
NMIC Therapeutics Today, July 2021 https://nmiccomms.newsweaver.com/1khv9z6at3/1ni3pal582h1slv5k9x0oo?email=true&lang=en&a=6&p=4232853&t=745893
Persistence with oral bisphosphonates and denosumab among older adults in primary
care in Ireland
NMIC useful medicines information resources webpage
Poisoning related to medication errors with low-dose methotrexate
Potentially inappropriate prescribing in people in the community with chronic kidney
disease
Useful information and resources on COVID-19 vaccines
NMIC Bulletin, Vol. 27, No. 3, 2021 –Questions and Answers on Biosimilars https://nmiccomms.newsweaver.com/icfiles/12/87651/255025/372779/fccc0349a3b66ed92797559f/final%20biosimilars.pdf
Biological medicines are well established in clinical practice; they were introduced for
autoimmune conditions and cancer but now provide therapeutic options for a wide range of
conditions. While biological medicines play a vital role in the treatment of many diseases,
they are responsible for a significant proportion of the total drug expenditure. In Europe it is
estimated that 30% of all drug expenditure is on biological medicines. In Ireland, biological
medicines feature in the “Top 10 medicines” of expenditure reports under the Community
Drug Schemes and in secondary care. The biosimilars market will continue to grow in the
coming years as more medicines lose patent exclusivity and additional biosimilars are
approved. This bulletin updates a previous bulletin on biosimilars (2015).
Biosimilars are biological medicines that are highly similar in all essential aspects to
an already approved (reference) biological medicine and have gone through a robust
authorisation process to demonstrate therapeutic equivalence.
Under the supervision of a physician, biosimilars can be used interchangeably with
the reference medicine or with other biosimilars of that reference medicine.
All biological medicines must be prescribed by brand name rather than by
International Nonproprietary Name (INN) for traceability and to avoid inadvertent
substitution.
There are an increasing number of patients being prescribed a biosimilar e.g. the best-
value biological medicines for adalimumab and etanercept. This trend is likely to
continue in the coming years.
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NICE NEWS NICE Guideline [NG197]: Shared Decision-making (17th June) https://www.nice.org.uk/guidance/ng197
This guideline covers how to make shared decision making part of everyday care in all
healthcare settings. It promotes ways for healthcare professionals and people using services
to work together to make decisions about treatment and care. It includes recommendations on
training, communicating risks, benefits and consequences, using decision aids, and how to
embed shared decision making in organisational culture and practices.
NICE Guideline [NG198]: Acne vulgaris: management (25th June) https://www.nice.org.uk/guidance/ng198
This guideline covers management of acne vulgaris in primary and specialist care. The new
guideline is the first by NICE to address acne vulgaris, and offers recommendations on
pharmacological and photodynamic therapies, which will help the majority of people with the
condition. It includes advice on topical and oral treatments (including antibiotics and
retinoids), treatment using physical modalities, and the impact of acne vulgaris on mental
health and wellbeing. Recommendations also emphasise the importance of supporting the
mental health of individuals who are experiencing significant psychological distress as a
result. The guideline advises clinicians to consider referral to mental health services where
appropriate, especially for those with a current or past history of severe depression or anxiety,
body dysmorphic disorder, suicidal ideation and self-harm.
NICE Technology Appraisal Guidance [TA715]: Adalimumab, etanercept, infliximab
and abatacept for treating moderate rheumatoid arthritis after conventional DMARDs
have failed (14th July) https://www.nice.org.uk/guidance/ta715
This guideline recommends several treatment options for around 25,000 people with
moderate rheumatoid arthritis that have not responded to conventional therapies.
Adalimumab, etanercept and infliximab, taken with methotrexate have been recommended
for use within the NHS. Adalimumab and etanercept can also be used as monotherapy when
methotrexate is contraindicated or not tolerated. NICE has previously recommended
biological treatments only for severe rheumatoid arthritis [TA375]. This guidance was
reviewed because biosimilars have become available, meaning that these treatments are now
available to the NHS at a lower price. A biosimilar medicine is a medicine that is developed
to be similar to an existing biological medicine.
NICE Guideline [NG200]: COVID-19 rapid guideline: vaccine-induced immune
thrombocytopenia and thrombosis (VITT) (29th July)
https://www.nice.org.uk/guidance/NG200
This guideline covers vaccine-induced immune thrombocytopenia and thrombosis (VITT), a
syndrome which has been reported in rare cases after COVID-19 vaccination. VITT may also
be called vaccine-induced prothrombotic immune thrombocytopenia (VIPIT) or thrombotic
thrombocytopenic syndrome (TTS). Because VITT is a new condition, there is limited
evidence available to inform clinical management, identification and management of the
condition is evolving quickly as the case definition becomes clearer. This guideline was
produced to support clinicians to diagnose and manage this newly recognised syndrome.
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ARTICLES
Barry T, Headon M, Quinn M, Egan M, Masterson S, Deasy C, Bury G.
General practice and cardiac arrest community first response in Ireland.
Resusc Plus. 2021 May 5;6:100127. doi: 10.1016/j.resplu.2021.100127.
PMID: 34223384; PMCID: PMC8244493. Full-Text Available Online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8244493/
Abstract
Background: In Ireland, the MERIT 3 scheme enables doctors to volunteer as cardiac arrest
community first responders and receive text message alerts from emergency medical services
(EMS) to facilitate early care.
Aim: To establish the sustainability, systems and clinical outcomes of a novel, general
practice based, cardiac arrest first response initiative over a four-year period.
Methods: Data on alerts, responses, incidents and outcomes were gathered prospectively
using EMS control data, incident data reported by responders and corroborative data from the
national Out-of-Hospital Cardiac Arrest Registry.
Results: Over the period 2016-2019, 196 doctors joined MERIT 3 and 163 (83.2%) were
alerted on one or more occasions; 61.3% of those alerted responded to at least one alert.
Volunteer doctors attended 300 patients of which 184 (61.3%) had suffered OHCA and had a
resuscitation attempt. Responders arrived to OHCA before EMS on 75 occasions (40.8%),
initiated chest compressions on seven occasions (3.8%), and brought the first defibrillator on
42 occasions (22.8%). Information on the first monitored rhythm was available for 149/184
(81.0%) patients and was shockable in 30/149 (20.1%); in 9/30 cases, shocks were
administered by responders. The overall survival rate was 11.0% (national survival rate
7.3%). Doctors also provided advanced life support and were closely involved in decision
making on ceasing resuscitation.
Conclusion: The MERIT 3 initiative in Ireland has been sustained over a four-year period
and has demonstrated the ability of volunteer doctors to provide early care for OHCA patients
as well as more complex interventions including end-of-life care. Further development of this
strategy is warranted.
Keywords: Emergency responders; General practice; Out-of-hospital cardiac arrest; Primary
healthcare.
MacFarlane A, Dowrick C, Gravenhorst K, O'Reilly-de Brún M, de Brún
T, van den Muijsenbergh M, van Weel Baumgarten E, Lionis C,
Papadakaki M. Involving migrants in the adaptation of primary care
services in a 'newly' diverse urban area in Ireland: The tension between
agency and structure. Health Place. 2021 Jun 29;70:102556. doi:
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10.1016/j.healthplace.2021.102556. Epub ahead of print. PMID: 34214893. Article available via Inter-Library Loan, contact the ICGP Library.
Abstract
In line with World Health Organization policy (WHO, 2016; 2019), primary care services
need to be adapted to effectively meet the needs of diverse patient populations. Drawing from
a European participatory implementation study, we present an Irish case study. In a hybrid
participatory space, migrants, general practice staff and service planners (n = 11) engaged in
a project to implement the use of trained interpreters in primary care over 17 months. We
used Normalisation Process Theory to analyse data from 15 Participatory Learning and
Action research focus groups and related sources. While stakeholders' agency and expertise
produced relevant positive results for the introduction of changes in a general practice setting,
structural factors limited the range and scope for sustained changes in day-to-day practice.
Keywords: Implementation theory; Ireland; Migrant health; Participatory research; Primary
care; Public participation.
Liss DT, Uchida T, Wilkes CL, Radakrishnan A, Linder JA. General
Health Checks in Adult Primary Care: A Review. JAMA. 2021 Jun
8;325(22):2294-2306. doi: 10.1001/jama.2021.6524. PMID: 34100866. Article available via Inter-Library Loan, contact the ICGP Library.
Abstract
Importance: General health checks, also known as general medical examinations, periodic
health evaluations, checkups, routine visits, or wellness visits, are commonly performed in
adult primary care to identify and prevent disease. Although general health checks are often
expected and advocated by patients, clinicians, insurers, and health systems, others question
their value.
Observations: Randomized trials and observational studies with control groups reported in
prior systematic reviews and an updated literature review through March 2021 were included.
Among 19 randomized trials (906 to 59 616 participants; follow-up, 1 to 30 years), 5
evaluated a single general health check, 7 evaluated annual health checks, 1 evaluated
biannual checks, and 6 evaluated health checks delivered at other frequencies. Twelve of 13
observational studies (240 to 471 415 participants; follow-up, cross-sectional to 5 years)
evaluated a single general health check. General health checks were generally not associated
with decreased mortality, cardiovascular events, or cardiovascular disease incidence. For
example, in the South-East London Screening Study (n = 7229), adults aged 40 to 64 years
who were invited to 2 health checks over 2 years, compared with adults not invited to
screening, experienced no 8-year mortality benefit (6% vs 5%). General health checks were
associated with increased detection of chronic diseases, such as depression and hypertension;
moderate improvements in controlling risk factors, such as blood pressure and cholesterol;
increased clinical preventive service uptake, such as colorectal and cervical cancer screening;
and improvements in patient-reported outcomes, such as quality of life and self-rated health.
In the Danish Check-In Study (n = 1104), more patients randomized to receive to a single
health check, compared with those randomized to receive usual care, received a new
antidepressant prescription over 1 year (5% vs 2%; P = .007). In a propensity score-matched
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analysis (n = 8917), a higher percentage of patients who attended a Medicare Annual
Wellness Visit, compared with those who did not, underwent colorectal cancer screening
(69% vs 60%; P < .01). General health checks were sometimes associated with modest
improvements in health behaviors such as physical activity and diet. In the OXCHECK trial
(n = 4121), fewer patients randomized to receive annual health checks, compared with those
not randomized to receive health checks, exercised less than once per month (68% vs 71%;
difference, 3.3% [95% CI, 0.5%-6.1%]). Potential adverse effects in individual studies
included an increased risk of stroke and increased mortality attributed to increased
completion of advance directives.
Conclusions and relevance: General health checks were not associated with reduced
mortality or cardiovascular events, but were associated with increased chronic disease
recognition and treatment, risk factor control, preventive service uptake, and improved
patient-reported outcomes. Primary care teams may reasonably offer general health checks,
especially for groups at high risk of overdue preventive services, uncontrolled risk factors,
low self-rated health, or poor connection or inadequate access to primary care.
Cunningham C, O'Sullivan R. Healthcare Professionals Promotion of
Physical Activity with Older Adults: A Survey of Knowledge and Routine
Practice. Int J Environ Res Public Health. 2021 Jun 4;18(11):6064. doi:
10.3390/ijerph18116064. PMID: 34199893; PMCID: PMC8200063. Full-Text Available Online: https://www.mdpi.com/1660-4601/18/11/6064
Abstract
Healthcare professionals have a key role in promoting physical activity, particularly among
populations at greatest risk of poor health due to physical inactivity. This research aimed to
develop our understanding of healthcare professionals knowledge, decision making and
routine practice of physical activity promotion with older adults. A cross-sectional survey
was conducted with practicing healthcare professionals in general practice, physiotherapy,
occupational therapy and nursing in Ireland and Northern Ireland. We received 347 eligible
responses, with 70.3% of all respondents agreeing that discussing physical activity is their job
and 30.0% agreeing that they have received suitable training to initiate conversations with
patients about physical activity. Awareness of the content and objectives of national
guidelines for physical activity varied considerably across the health professions surveyed.
Less than a third of respondents had a clear plan on how to initiate discussions about physical
activity in routine practice with older adults. Assessment of physical activity was not routine,
neither was signposting to physical activity supports. Considering the COVID-19 pandemic
and its implications, 81.6% of all respondents agreed that healthcare professionals can play
an increased role in promoting physical activity to older adults as part of routine practice.
Appropriate education, training and access to resources are essential for supporting healthcare
professionals promotion of physical activity in routine practice. Effective physical activity
promotion in healthcare settings has the potential for health benefits at a population level,
particularly in older adult populations.
Keywords: behaviour change; healthcare professionals; older adults; physical activity;
policy; theoretical domains framework.
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Piumatti G, Guttormsen S, Zurbuchen B, Abbiati M, Gerbase MW,
Baroffio A. Trajectories of learning approaches during a full medical
curriculum: impact on clinical learning outcomes. BMC Med Educ. 2021
Jul 7;21(1):370. doi: 10.1186/s12909-021-02809-2. PMID: 34233677;
PMCID: PMC8262035.
Full-Text Available Online: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-021-02809-2
Abstract
Background: No consensus exists on whether medical students develop towards more deep
(DA) or surface learning approaches (SA) during medical training and how this impacts
learning outcomes. We investigated whether subgroups with different trajectories of learning
approaches in a medical students' population show different long-term learning outcomes.
Methods: Person-oriented growth curve analyses on a prospective cohort of 269 medical
students (Mage=21years, 59 % females) traced subgroups according to their longitudinal
DA/SA profile across academic years 1, 2, 3 and 5. Post-hoc analyses tested differences in
academic performance between subgroups throughout the 6-year curriculum until the national
high-stakes licensing exam certifying the undergraduate medical training.
Results: Two longitudinal trajectories emerged: surface-oriented (n = 157; 58 %), with
higher and increasing levels of SA and lower and decreasing levels of DA; and deep-oriented
(n = 112; 42 %), with lower and stable levels of SA and higher but slightly decreasing levels
of DA. Post hoc analyses showed that from the beginning of clinical training, deep-oriented
students diverged towards better learning outcomes in comparison with surface-oriented
students.
Conclusions: Medical students follow different trajectories of learning approaches during a
6-year medical curriculum. Deep-oriented students are likely to achieve better clinical
learning outcomes than surface-oriented students.
Keywords: Approaches to learning; Growth curve modeling; Learning outcome; Student
performance.
Soukoulis V, Martindale J, Bray MJ, Bradley E, Gusic ME. The use of
EPA assessments in decision-making: Do supervision ratings correlate with
other measures of clinical performance? Med Teach. 2021 Jul 9:1-7. doi:
10.1080/0142159X.2021.1947480. Epub ahead of print. PMID: 34242113.
Full-Text Available Online: [via ICGP Journals – login required to access] https://www-tandfonline-
com.icgplibrary.idm.oclc.org/doi/full/10.1080/0142159X.2021.1947480
Abstract
Background: Entrustable professional activities (EPAs) have been introduced as a
framework for teaching and assessment in competency-based educational programs. With
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growing use, has come a call to examine the validity of EPA assessments. We sought to
explore the correlation of EPA assessments with other clinical performance measures to
support use of supervision ratings in decisions about medical students' curricular progression.
Methods: Spearman rank coefficients were used to determine correlation of supervision
ratings from EPA assessments with scores on clerkship evaluations and performance on an
end-of-clerkship-year Objective Structured Clinical Examination (CPX).
Results: Both overall clinical evaluation items score (rho 0.40; n = 166) and CPX patient
encounter domain score (rho 0.31; n = 149) showed significant correlation with students'
overall mean EPA supervision rating during the clerkship year. There was significant
correlation between mean supervision rating for EPA assessments of history, exam, note, and
oral presentation skills with scores for these skills on clerkship evaluations; less so on the
CPX.
Conclusions: Correlation of EPA supervision ratings with commonly used clinical
performance measures offers support for their use in undergraduate medical education. Data
supporting the validity of EPA assessments promotes stakeholders' acceptance of their use in
summative decisions about students' readiness for increased patient care responsibility.
Keywords: Clinical; clinical skills; medicine; undergraduate.
Richardson D, Kinnear B, Hauer K.E., Turner T.L., Warm E.J., et al. &
On behalf of the ICBME Collaborators (2021) Growth mindset in
competency-based medical education, Med
Teach., DOI: 10.1080/0142159X.2021.1928036
Full-Text Available Online: [via ICGP Journals – login required to access] https://www-tandfonline-
com.icgplibrary.idm.oclc.org/doi/full/10.1080/0142159X.2021.1928036
Abstract
The ongoing adoption of competency-based medical education (CBME) across health
professions training draws focus to learner-centred educational design and the importance of
fostering a growth mindset in learners, teachers, and educational programs. An emerging
body of literature addresses the instructional practices and features of learning environments
that foster the skills and strategies necessary for trainees to be partners in their own learning
and progression to competence and to develop skills for lifelong learning. Aligned with this
emerging area is an interest in Dweck’s self theory and the concept of the growth mindset.
The growth mindset is an implicit belief held by an individual that intelligence and abilities
are changeable, rather than fixed and immutable. In this paper, we present an overview of the
growth mindset and how it aligns with the goals of CBME. We describe the challenges
associated with shifting away from the fixed mindset of most traditional medical education
assumptions and practices and discuss potential solutions and strategies at the individual,
relational, and systems levels. Finally, we present future directions for research to better
understand the growth mindset in the context of CBME.
Keywords: Clinical; teaching and learning; work-based management; role of teacher;
learning outcomes; general assessment.
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McGlacken-Byrne SM, O'Rahelly M, Cantillon P, Allen NM. Journal club:
old tricks and fresh approaches. Arch Dis Child Educ Pract Ed. 2020
Aug;105(4):236-241. doi: 10.1136/archdischild-2019-317374. Epub 2019
Aug 29. PMID: 31467064.
Full-Text Available Online: https://ep.bmj.com/content/105/4/236.long
Abstract
Journal club is a long-standing pedagogy within clinical practice and education. While
journal clubs throughout the world traditionally follow an established format, new approaches
have emerged in recent times, including learner-centred and digital approaches. Key factors
to journal club success include an awareness of the learning goals of the target audience,
judicious article selection and emphasis on promoting the engagement of participant learners.
This article reviews the role that journal club plays in modern clinical education and
considers how to optimise its benefit for contemporary learners.
Keywords: critical appraisal; evidence-based medicine; journal club; learner-centred; twitter
journal club.
Fenton F, Stokes S, Eagleton M. A cross-section observational study on the
seroprevalence of antibodies to COVID-19 in patients receiving opiate
agonist treatment. Ir J Med Sci. 2021 Jul 9:1–6. doi: 10.1007/s11845-021-
02660-w. Epub ahead of print. PMID: 34241774; PMCID: PMC8267507.
Full-Text Available Online:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267507/
Abstract
Introduction: The HSE National Drug Treatment Centre is an inner city drug treatment
centre in Dublin which provides opiate agonist treatment (OAT) to approximately 565
patients, many of whom have complex care needs.
Objective: This study was conducted to determine seropositivity to the COVID-19 virus in
patients attending NDTC, and to establish if patients tested had any clinical symptoms of this
disease since March 2020.
Method: All patients attending for OAT were invited to participate and 103/565 patients
agreed. The patients were tested for the presence of serum antibodies to COVID-19 in a
single sample collected over a 4-month period (July-October 2020). A questionnaire was
administered at the same time as sample taking.
Results: Results showed that the majority of patient samples (100; 97%) tested were negative
for the presence of antibodies to COVID-19. There were only two confirmed positive results
(1.9%) and one equivocal result (1%). None of the approximately 565 attendees at the HSE
NDTC presented with serious illness indicative of COVID-19 throughout the three waves of
the pandemic, nor were any deaths due to COVID-19 reported.
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Conclusion: These findings indicate (a) possible low level of exposure to COVID-19 among
this patient cohort or (b) that those patients who have been exposed have not developed or
maintained detectable antibody levels, nor developed symptoms of the disease. Public health
measures could explain the low level of COVID-19 in this cohort. The findings are also
consistent with the possibility of a protective effect of OAT medications on development of
the disease.
Keywords: Buprenorphine; COVID-19; Methadone; OST; Opiate substitution treatment;
Protective; SARS-CoV-2; Seroprevalence.
Sopcak N, Fernandes C, O'Brien MA, Ofosu D, Wong M, Wong T, Kebbe
M, Manca D. What is a prevention visit? A qualitative study of a
structured approach to prevention and screening - the BETTER WISE
project. BMC Fam Pract. 2021 Jul 19;22(1):153. doi: 10.1186/s12875-021-
01503-y. PMID: 34275453.
Full-Text Available Online: https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-021-01503-y
Abstract
Background: This qualitative study is a sub-component of BETTER WISE, a comprehensive
and structured approach that proactively addresses chronic disease prevention, screening, and
cancer survivorship, including screening for poverty and addressing lifestyle risks for patients
aged 40 to 65. Patients (n = 527) from 13 primary care clinics (urban, rural, and remote) in
Alberta, Ontario, and Newfoundland & Labrador, Canada agreed to participate in the study
and were invited to a one-hour prevention visit delivered by a Prevention Practitioner (PP) as
part of BETTER WISE. We identified the key components of a BETTER WISE prevention
visit based on patients' and primary care providers' perspectives.
Methods: Primary care providers (PPs, physicians and their staff) participated in 14 focus
groups and 19 key informant interviews to share their perspectives on the BETTER WISE
project. Of 527 patients who agreed to participate in the study and were invited for a
BETTER WISE prevention visit with a PP, we received 356 patient feedback forms. We also
collected field notes and memos and employed thematic analysis using a constant
comparative method focusing on the BETTER WISE prevention visit.
Results: We identified four key themes related to a BETTER WISE prevention visit: 1)
Creating a safe environment and building trust with patients: PPs provided sufficient time and
a safe space for patients to share what was important to them, including their concerns related
to poverty, alcohol consumption, and mental health, topics that were often not shared with
physicians; 2) Providing personalized health education: PPs used the BETTER WISE tools to
provide patients with a personalized overview of their health status and eligible screening; 3)
Non-judgmental empowering of patients: Instead of directing patients on what to do, PPs
evoked patients' preferences and helped them to set goals (if desired); and 4) Integrating care
for patients: PPs clarified information from patients' charts and surveys with physicians and
helped patients to navigate resources within and outside of the primary care team.
Conclusions: The results of this study underscore the importance of personalized, trusting,
non-judgmental, and integrated relationships between primary care providers and patients to
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effectively address chronic disease prevention, screening, and cancer survivorship as
demonstrated by the BETTER WISE prevention visits.
Trial registration: This qualitative study is a sub-component of the BETTER WISE
pragmatic, cRCT, trial registration ISRCTN21333761 (date of registration 19/12/2016).
Keywords: Chronic Disease; Patient Care Team; Primary Care; Primary Prevention;
Qualitative Research.
Lambe K, Lydon S, McSharry J, Byrne M, Squires J, Power M, Domegan
C, O'Connor P. Identifying interventions to improve hand hygiene
compliance in the intensive care unit through co-design with stakeholders.
HRB Open Res. 2021 Jul 16;4:64. doi: 10.12688/hrbopenres.13296.2. PMID:
34250439; PMCID: PMC8243226. Full-Text Available Online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8243226/
Abstract
Background: Despite the effectiveness of hand hygiene (HH) for infection control, there is a
lack of robust scientific data to guide how HH can be improved in intensive care units
(ICUs). The aim of this study is to use the literature, researcher, and stakeholder opinion to
explicate potential interventions for improving HH compliance in the ICU, and provide an
indication of the suitability of these interventions. Methods: A four-phase co-design study
was designed. First, data from a previously completed systematic literature review was used
in order to identify unique components of existing interventions to improve HH in ICUs.
Second, a workshop was held with a panel of 10 experts to identify additional intervention
components. Third, the 91 intervention components resulting from the literature review and
workshop were synthesised into a final list of 21 hand hygiene interventions. Finally, the
affordability, practicability, effectiveness, acceptability, side-effects/safety, and equity of
each intervention was rated by 39 stakeholders (health services researchers, ICU staff, and
the public). Results: Ensuring the availability of essential supplies for HH compliance was
the intervention that received most approval from stakeholders. Interventions involving role
models and peer-to-peer accountability and support were also well regarded by stakeholders.
Education/training interventions were commonplace and popular. Punitive interventions were
poorly regarded. Conclusions: Hospitals and regulators must make decisions regarding how
to improve HH compliance in the absence of scientific consensus on effective methods.
Using collective input and a co-design approach, the guidance developed herein may usefully
support implementation of HH interventions that are considered to be effective and
acceptable by stakeholders.
Keywords: Critical care; co-design; hand disinfection; hand hygiene; infection control;
intensive care.
McCluskey G, Kinney MO, Russell A, Smithson WH, Parsons L, Morrison
PJ, Bromley R, MacKillop L, Heath C, Liggan B, Murphy S, Delanty N,
Irwin B, Campbell E, Morrow J, Hunt SJ, Craig JJ. Zonisamide safety in
pregnancy: Data from the UK and Ireland epilepsy and pregnancy register.
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Seizure. 2021 Jul 9;91:311-315. doi: 10.1016/j.seizure.2021.07.002. Epub
ahead of print. PMID: 34273670. Article available via Inter-Library Loan, contact the ICGP Library.
Abstract
Background: Animal data suggest teratogenic effects with zonisamide use and risk of
pregnancy losses. Human data following zonisamide exposure are presently limited, but
suggest low risk of malformation with elevated risk of low birth weight.
Objective: To calculate the major congenital malformation (MCM) rate of zonisamide in
human pregnancy and assess for a signal of any specific malformation pattern and
associations with birth weight.
Methods and materials: Data were obtained from the UK and Ireland Epilepsy and
Pregnancy register (UKIEPR) which is an observational, registration, and follow up study
from December 1996 to July 2020. Eligibility criteria were use of zonisamide and to have
been referred to the UKIEPR before the outcome of the pregnancy was known. Primary
outcome was evidence of MCM.
Results: From December 1996 through July 2020 there were 112 cases of first trimester
exposure to zonisamide, including 26 monotherapy cases. There were 3 MCM for
monotherapy cases (MCM rate 13.0% (95% confidence interval 4.5-32.1)), and 5 MCM for
polytherapy cases (MCM rate 6.9% (95% confidence interval 3.0-15.2)). While the median
birth weight was on 71st and 44th centile for monotherapy and polytherapy cases
respectively, there was a high rate of infants born small for gestational age (21% for both).
Conclusion: These data raise concerns about a signal for potential teratogenicity with
zonisamide in human pregnancy. Given the low numbers reported, further data will be
required to adequately counsel women who use zonisamide in pregnancy.
Keywords: Epilepsy; Major congenital malformation; Pregnancy; Teratogenicity;
Zonisamide.
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