99 research outputs found
Helping problem drinkers
Under the guidance of brief interventions, how best can GPs help problem drinkers who also use other drugs, ask Jan Klimas and Walter Culle
Early intervention in youth mental health: development of guidelines for general practice
Aims: GPs, as healthcare professionals with whom young people commonly interact, have a central role in early intervention for youth mental health. To support GPs in this important role, we aim to develop clinical guidelines to promote identification and treatment of mental and substance use disorders among young adults (age 16-24).
Methods: Following a qualitative study of young people and healthcare professionals in two urban deprived areas, we conducted a modified Delphi study using the following steps: i) Established an Expert Panel involving 18 key stakeholders; ii) Identified key areas which the guidelines should address using a group meeting and survey; iii) Reviewed and synthesised relevant literature; iv) Review of items created again by the stakeholder panel, with another meeting and survey.
Results: Twenty-two items were considered important for inclusion in the guidelines and 17 items important for implementing them. These items could be divided into five different domains 1. Prevention, Health Promotion and Access; 2. Assessment and Identification; 3. Interaction with Other Agencies/Referral; 4. Ongoing Support; and 5. Implementation issues.
Conclusions: Guidelines which would include all 22 items and 17 implementations would be too unwieldy for reasonable use by GPs. However, once split into the different domains, followed by further literature synthesis and review from the expert panel, it is hoped guidelines more applicable and feasible for use in practice will be created under these headings
Continuous professional competence (CPC) for emergency medical technicians in Ireland: educational needs assessment
Background: As in other countries, the Irish Regulator for Pre-Hospital practitioners, the Pre-Hospital Emergency
Care Council (PHECC), will introduce a Continuous Professional Competence (CPC) framework for all Emergency
Medical Technicians (EMTs), Paramedics and Advanced Paramedics (APs). This framework involves EMTs participating
in regular and structured training to maintain professional competence and enable continuous professional
developments. To inform the development of this framework, this study aimed to identify what EMTs consider the
optimum educational outcomes and activity and their attitude towards CPC.
Methods: All EMTs registered in Ireland (n = 925) were invited via email to complete an anonymous online survey.
Survey questions were designed based on Continuous Professional Development (CPD) questionnaires used by
other healthcare professions. Quantitative and qualitative analyses were performed.
Results: Response rate was 43% (n = 399). 84% of participants had been registered in Ireland for less than
24 months, while 59% had been registered EMTs for more than one year. Outcomes were: evidence of CPC should
be a condition for EMT registration in Ireland (95%), 78% believed that EMTs who do not maintain CPC should
be denied the option to re-register. Although not required to do so at the time of survey, 69% maintained a
professional portfolio and 24% had completed up to 20 hours of CPC activities in the prior 12 months. From a list
of 22 proposed CPC activities, 97% stated that practical scenario-based exercises were most relevant to their role.
E-learning curricula without practical components were considered irrelevant (32%), but the majority of participants
(91%) welcomed access to e-learning when supplemented by related practical modules.
Conclusion: EMTs are supportive of CPC as a key part of their professional development and registration. Blended
learning, which involves clinical and practical skills and e-learning, is the optimum approach
Continuous professional competence (CPC) for Irish paramedics and advanced paramedics: a national study
Background: Internationally, continuing professional competence (CPC) is an increasingly important issue for all
health professionals. With the imminent introduction of a CPC framework for paramedics and advanced paramedics
(APs) in Ireland, this paper aims to identify factors that will inform the implementation of this CPC framework by
seeking stakeholder input into the development of a CPC model for use by the regulatory body. Our secondary
objective is to determine the attitudes of registrants towards CPC and what they consider as optimal educational
outcomes and activities, for the purposes of CPC.
Methods: All paramedics and APs registered in Ireland (n = 1816) were invited by email to complete an anonymous
on-line survey. The study instrument was designed based on CPD questionnaires used by other healthcare professions.
Quantitative and qualitative analyses were performed.
Results: The overall response rate was 43% (n = 789), with 82% of APs and 38% of paramedics participating. Eighty-nine
per cent agreed that registration was of personal importance; 74% agreed that evidence of CPC should be maintained
and 39% believed that persistent failure to meet CPC requirements should mandate denial of registration. From a
pre-determined list of activities, respondents indicated practical training scenarios (94%), cardiac re-certification
(92%), e-learning supplemented by related practice (90%) and training with simulation manikins (88%) were most
relevant, while e-learning alone (36%), project work (27%) and reading journal articles (24%) were least relevant.
Conclusions: Irish Paramedics and APs are supportive of CPC linked with their professional development and
registration. Blended learning, involving evidence of patient contact, team-based learning and practical skills are
preferred CPC activities
A national study of continuous professional competence (CPC) amongst pre-hospital practitioners
Background: Internationally, continuing professional competence (CPC) is an increasingly important issue for all
health professionals. With the introduction of the first CPC framework for Emergency Medical Technicians (EMTs)
and the imminent introduction of CPC for Paramedics and Advanced Paramedics (APs) in Ireland, this study aimed
to identify attitudes towards CPC and factors that might influence such a framework.
Methods: All EMTs (n = 925), Paramedics and APs (n = 1816) registered in Ireland were invited by email to complete
an anonymous on-line survey. The study instrument was designed based on continuous professional development
(CPD) questionnaires used by other healthcare professions. Quantitative and qualitative analyses were performed.
Results: The overall response rates were: EMTs 43 % (n = 399), Paramedics and APs 43 % (n = 789), with 82 % of
APs and 38 % of Paramedics participating. The majority of participants in all groups agreed that registration
was of personal importance and that evidence of CPC should be maintained; 39 % of Paramedics/APs
and 78 % of EMTs believed that persistent failure to meet CPC requirements should mandate denial of
registration. From a pre-determined list of activities, in excess of 88 % of all respondents indicated practical training
scenarios, cardiac re-certification, e-learning supplemented by related practice, and training with simulation manikins
were most relevant to these roles. However, least relevant to them were: e-learning alone (Paramedic/AP 36 %; EMT
35 %); project work (Paramedic/AP 27 %; EMT 48 %); and appraisal of journal articles (Paramedic/AP 24 %; EMT 39 %).
Conclusion: Irish EMTs, Paramedics and Advanced Paramedics were supportive of CPC and favoured a âmixedâ model
approach which includes: blended learning, practical skills, simulation, practical/team-based exercises, e-learning
combined with practical skills, and evidence of patient contact. It is hoped that these insights will inform the CPC
guidelines to be introduced
What legal and ethical issues should primary care researchers consider in the development and conduct of research involving population health datasets: a discussion paper
no abstract availabl
Continuous professional competence for Irish paramedics and advanced paramedics - a national study
no abstract availabl
Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months
Background: Opioid dependence is a major health concern across the world and does also occur in adolescents.
While opioid substitution treatment (OST) has been thoroughly evaluated in adult populations, very few studies
have examined its use in adolescents. There are concerns that OST is underutilised in adolescents with heroin
dependence. We sought to measure changes in drug use among adolescents receiving OST and also to examine
treatment attrition during the first 12 months of this treatment.
Methods: We included all heroin dependent patients aged under 18.5 years commencing OST at one outpatient
multidisciplinary adolescent addiction treatment service in Dublin, Ireland. Psycho-social needs were also addressed
during treatment. Drug use was monitored by twice weekly urine drugs screens (UDS). Change in the proportion of
UDS negative for heroin was examined using the Wilcoxon signed rank test. Attrition was explored via a Cox
Regression multivariate analysis.
Results: OST was commenced by 120 patients (51% female and mean age 17.3 years). Among the 39 patients who
persisted with OST until month 12, heroin abstinence was 21% (95% confidence interval [CI] = 9â36%) at month three and
it was 46% (95% CI = 30â63%) at month 12. Heroin use declined significantly from baseline to month three (p < 0.001) and
from month three to month 12 (p = 0.01). Use of other drugs did not change significantly. People using cocaine during
month 12 were more likely to be also using heroin (p = 0.02). Unplanned exit occurred in 25% patients by 120 days. The
independent predictors of attrition were having children, single parent family of origin, not being in an intimate
relationship with another heroin user and evidence of cocaine use just before treatment entry.
Conclusions: We found that heroin dependent adolescent patients achieved significant reductions in heroin
use within three months of starting OST and this improved further after a year of treatment, about half being
heroin abstinent at that stage. Patient drop out from treatment remains a challenge, as it is in adults. Cocaine
use before and during treatment may be a negative prognostic factor
Additional file 1: of A national study of Continuous Professional Competence (CPC) amongst pre-hospital practitioners
Core Questionnaire Summary. (DOCX 25 kb
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