Attitudes toward hand hygiene among medical students on placement in primary care

Attitudes toward hand hygiene among medical students on placement in primary car

Dynapaenic obesity and its association with health outcomes in older adult populations: Protocol for a systematic review

Two major global health challenges are the rapidly ageing population and the high prevalence of obesity in all age groups. Older adults are also susceptible to age-related loss of muscle strength, termed dynapaenia. The co-occurrence of both obesity and dynapaenia, termed dynapaenic obesity (DO), has been associated with poorer health outcomes and increased healthcare usage compared with either state alone. The purpose of this systematic review is to quantify the prevalence and incidence of DO in older adult populations, and to explore the association between DO and health outcomes, specifically chronic disease and multimorbidity, functional disability and healthcare usage. Methods and analysis Using the Meta-analyses Of Observational Studies in Epidemiology guidelines, we will conduct a systematic review of cross-sectional and longitudinal observational studies of older adults, which include measures of DO and specified outcomes. Detailed literature searches of will be conducted using six electronic databases: Excerpta Medica database (EMBASE), PubMed, MEDLINE, SCOPUS, ScienceDirect and Cumulative Index of Nursing and Allied Health Complete (CINAHL), including articles published from database inception until Febuary 2019. The reference lists of included articles will also be searched. Two independent reviewers will undertake a three-step screening and review process using the Population, Risk Factor, Outcome framework to define eligibility. The Newcastle Ottawa Scale for non-randomised studies will be used to assess risk of bias and to rate study quality. The findings will be synthesised in a narrative summary, and a meta-analysis will be conducted where appropriate. Ethics and dissemination Ethical approval is not required for this systematic review. Findings from this research will be submitted for peer-reviewed publication in academic journals, and presented at relevant academic conferences

“You’re stuck in the middle here”: a qualitative study of GPs’ experiences of managing knee pain attributed to a degenerative meniscal tear

Background Exercise is the recommended first-line therapy for a degenerative meniscal tear (DMT). Despite this,  knee pain attributed to DMTs are a common presentation to specialist orthopaedic clinics. In the primary care setting,  the general practitioner (GP) plays a central role in managing patients with knee pain, but to date their perspective  has not been explored in relation to DMTs. This study explored GPs’ experiences of managing people with knee pain  attributed to a DMT. Methods A qualitative research design was adopted and practices in the South and Mid-West of Ireland were  contacted via recruitment emails circulated through professional and research networks. Interested GPs contacted  the researchers via email, and purposive and snowball sampling was used for recruitment. Semi-structured interviews  were conducted online or over the telephone. Interviews were digitally recorded and transcribed. Data was analysed  using an inductive approach to thematic analysis. Ethical approval was granted by the Irish College of General  Practitioners (ICGP_REC_21_0031). Results Seventeen semi-structured one-on-one interviews were conducted. Three main themes were identified  with related subthemes: (1) GPs’ experiences of relational aspects of care, (2) GP beliefs about what constitutes best  care for patients with a DMT, and (3) how GP practice is enacted within the current healthcare setting. GPs described  the challenge of maintaining a strong clinical alliance, while managing perceived patient expectations of a ‘quick fix’  and advanced imaging. They reported slowing down clinical decisions and feeling ‘stuck’ with limited options when  conservative treatment had failed. GPs believed that exercise should be the core treatment for DMTs and emphasised  engaging patients in an active approach to recovery. Some GPs believed arthroscopy had a role in circumstances  where patients didn’t improve with physiotherapy. Limited access to public physiotherapy and orthopaedic services  hampered GPs’ management plans and negatively impacted patient outcomes. Conclusions GP beliefs around what constitutes best care for a DMT generally aligned with the evidence base.  Nonetheless, there was sometimes tension between these beliefs and the patient’s own treatment expectations.The ability to enact their beliefs was hampered by limited access to conservative management options, sometimes  leading to early escalation of care  </p

Non-­specific effects of pneumococcal and haemophilus vaccines in children aged 5 years and under: a systematic review

Objective To determine the evidence for non-specific effects of the Pneumococcal and Haemophilus influenza vaccine in children aged 5 years and under. Data sources A key word literature search of MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, the European Union Clinical Trials Register and ClinicalTrials.gov up to June 2023. Study eligibility criteria Randomised controlled trials (RCTs), quasi-RCT or cohort studies. Participants Children aged 5 or under. Study appraisal and synthesis methods Studies were independently screened by two reviewers, with a third where disagreement arose. Risk of bias assessment was performed by one reviewer and confirmed by a second. Results were tabulated and a narrative description performed. Results Four articles were identified and included in this review. We found a reduction in hospitalisations from influenza A (44%), pulmonary tuberculosis (42%), metapneumovirus (45%), parainfluenza virus type 1–3 (44%), along with reductions in mortality associated with pneumococcal vaccine. No data on the Haemophilus vaccine was found. Conclusions and implications In this systematic review, we demonstrate that there is a reduction in particular viral infections in children aged 5 years and under who received the 9-valent pneumococcal conjugate vaccine which differ from those for which the vaccine was designed to protect against. While limited studies have demonstrated a reduction in infections other than those which the vaccine was designed to protect against, substantial clinical trials are required to solidify these findings.</p

Impact of serum sodium concentrations, and effect modifers on mortality in the Irish Health System

Background Abnormalities of serum sodium are associated with increased mortality risk in hospitalised patients, but it is unclear whether, and to what extent other factors infuence this relationship. We investigated the impact of dysnatraemia on total and cause-specifc mortality in the Irish health system while exploring the concurrent impact of age, kidney function and designated clinical work-based settings. Methods A retrospective cohort study of 32,666 participants was conducted using data from the National Kidney Disease Surveillance System. Hyponatraemia was defned as145 mmol/L with normal range 135–145 mmol/L. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HR’s) and 95% Confdence Intervals (CIs) while penalised spline models further examined patterns of risk. Results There were 5,114 deaths (15.7%) over a median follow up of 5.5 years. Dysnatraemia was present in 8.5% of patients overall. In multivariable analysis, both baseline and time-dependent serum sodium concentrations exhibited a U-shaped association with mortality. Hyponatremia was signifcantly associated with increased risk for cardiovascular [HR 1.38 (1.18–1.61)], malignant [HR: 2.49 (2.23–2.78)] and non-cardiovascular/non-malignant causes of death [1.36 (1.17–1.58)], while hypernatremia was signifcantly associated with cardiovascular [HR: 2.16 (1.58–2.96)] and non-cardiovascular/ non-malignant deaths respectively [HR: 3.60 (2.87–4.52)]. The sodium-mortality relationship was signifcantly infuenced by age, level of kidney function and the clinical setting at baseline (P Conclusion Serum sodium concentrations outside the standard normal range adversly impact mortality and are associated with specifc causes of death. The thresholds at which these risks appear to vary by age, level of kidney function, and are modifed in specifc clinical settings within the health system.</p

Supporting medical students towards future careers in general practice: A quantitative study of Irish medical schools

Aim In Ireland there is a significant, and increasing, shortage of general practitioners. By 2025, this shortfall could be as high as 1,380, from a current workforce of 3,923. We aimed to determine the proportions of EU medical graduates from each of the six Irish medical schools who applied to the national GP Training Program for 2017-21 inclusive. Methods The Spearman rank correlation was used to examine the correlations between the proportions of graduate entrants, the number of weeks spent directly on GP placement teaching at each medical school and the proportions of applicants, to GP training, from each medical school.  Results Between 2017-2021 inclusive, the average annual percentage of EU graduates applying to the national GP Training Program (n=1,302) ranged from 25-55% for each of the six Irish medical schools - a 2.2 fold difference. There was a strong correlation between the average annual percentage of EU graduates applying to the ICGP Training Program with the proportions of graduate entrants, but this did not reach statistical significance, (r=0.81; p=0.20) and no association with the number of GP placement weeks (r=0.2; p>0.50). Conclusion We found a marked difference in the proportions of EU graduates, from the six medical schools, opting for a career in general practice. Further work is required to inform how best medical schools can support the generation of tomorrows general practitioners.   </p

Implementation of clinical guidelines for osteoarthritis together (IMPACT): protocol for a participatory health research approach to implementing high value care

Background: The evidence-based interventions of exercise and education have been strongly recommended as  part of prominent clinical guidelines for hip and knee osteoarthritis (OA) for more than ten years. Despite the wealth  of strong evidence that exists, implementation in practice is sub-optimal. This paper describes the key methodologies used in the co-design, tailoring, and evaluation of the IMPACT project implementation strategies, to confront this  problem across multiple levels (micro, meso, macro) in public and private healthcare settings in Ireland. Methods: Using a type III hybrid implementation-efectiveness design, a participatory, dynamic and iterative process  will be used to tailor and evaluate multi-level implementation strategies using the following stages: 1) Co-design the  implementation strategies with key stakeholders using best evidence, a theory-driven implementation framework  (Consolidated Framework for Implementation Research), local context and expert consensus; 2) Pilot and evaluate the implementation strategies by training physiotherapists to deliver the evidence-based Good Life with osteoArthritis Denmark (GLA:D®) education and exercise programme using the implementation strategies, and conduct a mixed-methods process evaluation; 3) Adapt the implementation strategies based on implementation process evaluation indicators from stage two. The adapted strategies will be used for scale-up and sustainability in subsequent GLA:D® Ireland training programmes that will be rolled out nationally. Evaluation of efectiveness on patient and cost outcomes will continue up to 12months post-programme delivery, using an online patient registry and pre-post design. Discussion: This implementation science project aims to use participatory health research to address a gap in management of OA across public and private healthcare settings. This research has the potential to change practice and  promote a policy of exercise and physical activity referral for chronic musculoskeletal disease that utilises community engagement efectively and enacts change ‘together’, with involvement of researchers, decision-makers, clinicians and patients. </p

Exercise compared to mindfulness for physical and mental wellbeing in medical students

Physical Activity (PA) and Mindfulness-Based Stress Reduction (MBSR) both have positive effects on medical student well-being. The ‘MED-WELL’ programme is a curricular intervention that combines PA and education on exercise as medicine. This trial evaluates whether there is a mean difference in outcomes of participants of an exercise intervention, the ‘MED-WELL’ programme, versus a control group which engages in a MBSR programme. Methods All second-year medical students were voluntarily allocated into the intervention or control group. Data on overall health and well-being, sleep quality, loneliness, current level of PA, and confidence in prescribing exercise as medicine was analysed from both groups at baseline and after eight weeks. Results Within groups the intervention and control groups showed statistically significant improvements in overall well-being (p=0.010, p=0.005 respectively) and in sleep quality (p<0.001, p=0.007 respectively). The intervention group had statistically significant improvements in levels of PA (p=0.003) and confidence in prescribing exercise (p<0.001). However, there were no statistically significant differences in changes in outcome measures between groups. Conclusion This study has shown that participants in an exercise intervention, the ‘MED-WELL’ programme, had similar improvements in overall wellbeing and sleep quality to those in a control group who participated in a MBSR programme of the same duration

Towards an integrated blood pressure self-monitoring solution for stroke/TIA in Ireland: a mixed methods feasibility study for the TASMIN5S IRL randomised controlled trial

Background Optimising blood pressure (BP) control is one of the most important modifable risk factors in preventing subsequent stroke where the risk increases by one-third for every 10 mmHg rise in systolic BP. This study evaluated the feasibility and potential efectiveness of blood pressure self-monitoring with planned medication titration, to inform a defnitive trial of the intervention, in patients with a previous stroke or transient ischaemic attack (TIA). Methods Patients with a history of stroke/TIA and sub-optimal BP control were invited to take part in a mixed methods feasibility study for a randomised controlled trial. Those meeting the inclusion criteria with systolic BP >130 mmHg were randomised to a self-monitoring intervention group or usual care group. The intervention involved self-monitoring BP twice a day for 3 days within a 7-day period, every month, following text message reminders. Treatment escalation, based on a pre-agreed plan by the general practitioner (GP) and patient, was initiated according to the results of these readings. Semi-structured interviews were carried out with patients and clinicians and analysed thematically. Results Of those identifed, 47% (32/68) attended for assessment. Of those assessed, 15 were eligible for recruitment and were consented and randomised to the intervention or control group on a 2:1 basis. Of those randomised, 93% (14/15) completed the study and there were no adverse events. Systolic BP was lower in the intervention group at 3 months. Participants found the intervention acceptable and easy to use. GPs found it easy to incorporate into their practice activity without increasing workload. Conclusions TASMIN5S, an integrated blood pressure self-monitoring intervention in patients with a previous stroke/TIA, is feasible and safe to deliver in primary care. A pre-agreed three-step medication titration plan was easily implemented, increased patient involvement in their care, and had no adverse efects. This feasibility study provides important information to inform a defnitive trial to determine the potential efectiveness of the intervention in patients post-stroke or TIA.</p

Injury trends in Irish amateur rugby: an epidemiological comparison of men and women

Background: Rugby union is a physically demanding sport that carries an inherent risk of injury. Despite being a popular and widely played team sport, little is known about injuries occurring across the male and female amateur game. Purpose: To establish and compare injury incidence, nature, and severity in male and female Irish amateur rugby union. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: Data were collected prospectively from 25 male teams (959 players) and 8 female teams (234 players) over 2 full seasons. Both time-loss (24-hour time-loss injury definition) and non-time-loss match injury reports were collected, alongside match exposure data. Results: Time-loss match injury incidence rates were 49.1/1000 and 35.6/1000 player-hours for male and female players, respectively. Concussion and ankle ligament sprains were the most common diagnoses for male (5.6/1000 and 4.4/1000 player-hours, respectively) and female players (5.5/1000 and 3.9/1000 player-hours, respectively). Anterior cruciate ligament injuries presented the highest injury burden for male and female players with 200.3 and 307.2 days of absence per 1000 player-hours, respectively. In female players, 83% of noncontact injuries occurred in the fourth quarter of match play. Conclusion: While female players had a lower overall injury incidence rate compared with male players, concussion and ankle ligament injuries were the most common injuries in both cohorts. In female players, a high rate of noncontact injuries in the second half points to the need for strength and conditioning training programs to reduce fatigue-related injuries. Clinical Relevance: Establishing the incidence and burden of rugby-related injuries is an essential step in minimizing injury risk. This epidemiological information will aid the development of future reduction strategies, including education and coaching strategies and strength and conditioning programs, informed by the most common injuries observed and the mechanism of injury