Browsing Royal College of Surgeons in Ireland (RCSI) by Date published
Now showing items 1-20 of 219
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Asian medical students' attitudes towards professionalism.Background: Professionalism is the basis of trust in patient-physician relationships; however, there is very limited evidence focusing on attitudes towards professionalism among medical students. Hence, the main aim of our study was to investigate Malaysian medical students' attitudes towards professionalism with specific emphasis on the comparison between pre-clinical and clinical students. Our secondary aim was to compare the differences in perception of medical students in Malaysia (pre-clinical and clinical) with Asian medical students studying in Dublin, IrelandMethods: This study utilized the Professionalism Mini-Evaluation Exercise (P-MEX) instrument which consists of 25 items that represent four skill categories: Doctor-Patient Relationship skills, Reflective skills, Time Management and Inter-Professional Relationship skills. Descriptive statistics were used to describe the demographic information of students and given the ordinal nature of the data, Mann-Whitney U-tests were used.Results: Overall, students have positive attitudes to all the professionalism items with more than 80% of the students agreeing that each of the professionalism attributes is important or very important. There was evidence of a significant difference between Malaysian pre-clinical and clinical students in relation to 'avoiding derogatory language' only (p = 0.015). When comparing between Malaysian and Dublin Asian students, there was a statistically significant difference in relation to 'show interest in patient as a person' (p < 0.003) for clinical students.Conclusion: Our results point to several curriculum implications such as 1) assessing students' attitudes towards professional attributes is essential when developing the professionalism curriculum, 2) integrating more effective clinical modules early in the curriculum and 3) considering geographical and cultural factors when assessing perception towards professional attributes.
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Well-being, Interventions and Support during Epidemics (WISE): Protocol for a qualitative longitudinal study of older adults' experiences during COVID-19.Background: The coronavirus disease 2019 (COVID-19) pandemic has the potential to trigger multiple stress domains and lead to long-term repercussions in an individual's quality of life, health, and well-being. Stressors from the pandemic are likely to be experienced in many ways by older adults with heterogeneous life experiences and supports available. In this context, it is necessary to tease out the underlying mechanisms leading to positive and negative well-being and mental health across interdependent individual, social and environmental factors. The aim of the present study is to explore community-dwelling older adults' experiences during the COVID-19 pandemic, with a particular focus on mental health and psychosocial well-being. Methods: An exploratory longitudinal qualitative study will be conducted with data collected through written submissions, narrative interviews and go-along interviews with older adults living in Irish community settings. To enable the exploration of participants' responses to the evolving social, economic and environmental circumstances, data collection will take during the implementation of public health restrictions and once these are eased and the vaccination program is rolled out. Framework analysis will be carried out to identify data themes, linkages, and explanations within Bronfenbrenner's socio-ecological model. Ethics and dissemination: Ethical approval has been granted by the Royal College of Surgeons in Ireland, Research Ethics Committee (REC202011028). Findings will be disseminated through peer-reviewed journal publications, presentations at relevant conferences, and in consultation with Public and Patient Involvement (PPI) contributors. A lay summary of findings and infographic will be distributed to multiple stakeholders including our PPI panel, older people, caregivers, community organizations, charities, and media.
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Role of Common Genetic Variants for Drug-Resistance to Specific Anti-Seizure Medications.Objective: Resistance to anti-seizure medications (ASMs) presents a significant hurdle in the treatment of people with epilepsy. Genetic markers for resistance to individual ASMs could support clinicians to make better-informed choices for their patients. In this study, we aimed to elucidate whether the response to individual ASMs was associated with common genetic variation. Methods: A cohort of 3,649 individuals of European descent with epilepsy was deeply phenotyped and underwent single nucleotide polymorphism (SNP)-genotyping. We conducted genome-wide association analyses (GWASs) on responders to specific ASMs or groups of functionally related ASMs, using non-responders as controls. We performed a polygenic risk score (PRS) analyses based on risk variants for epilepsy and neuropsychiatric disorders and ASM resistance itself to delineate the polygenic burden of ASM-specific drug resistance. Results: We identified several potential regions of interest but did not detect genome-wide significant loci for ASM-specific response. We did not find polygenic risk for epilepsy, neuropsychiatric disorders, and drug-resistance associated with drug response to specific ASMs or mechanistically related groups of ASMs. Significance: This study could not ascertain the predictive value of common genetic variants for ASM responder status. The identified suggestive loci will need replication in future studies of a larger scale.
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A randomised controlled trial of the effect of a connected inhaler system on medication adherence in uncontrolled asthmatic patients.Suboptimal adherence to maintenance therapy contributes to poor asthma control and exacerbations. This study evaluated the effect of different elements of a connected inhaler system (CIS), comprising clip-on inhaler sensors, a patient-facing app and a healthcare professional (HCP) dashboard, on adherence to asthma maintenance therapy.This was an open-label, parallel-group, 6-month, randomised controlled trial in adults with uncontrolled asthma (asthma control test (ACT) score less than 20) on fixed-dose inhaled corticosteroids/long-acting β-agonist maintenance therapy (n=437). All subjects received fluticasone furoate/vilanterol ELLIPTA dry-powder inhalers for maintenance and salbutamol/albuterol metered-dose inhalers for rescue, with a sensor attached to each inhaler. Participants were randomised to one of five CIS study arms (allocation ratio 1:1:1:1:1) reflecting the recipient of the data feedback from the sensors, as follows: 1) maintenance use to participants and HCPs (n=87); 2) maintenance use to participants (n=88); 3) maintenance and rescue use to participants and HCPs (n=88); 4) maintenance and rescue use to participants (n=88); and 5) no feedback (control) (n=86).For the primary endpoint, observed mean±sd adherence to maintenance therapy over months 4-6 was 82.2±16.58% (n=83) in the "maintenance to participants and HCPs" arm and 70.8±27.30% (n=85) in the control arm. The adjusted least squares mean±se was 80.9±3.19% and 69.0±3.19%, respectively (study arm difference: 12.0%, 95% CI 5.2-18.8%; p<0.001). Adherence was also significantly greater in the other CIS arms versus the control arm. The mean percentage of rescue medication free days (months 4-6) was significantly greater in participants receiving data on their rescue use compared with controls. ACT scores improved in all study arms with no significant differences between groups.A CIS can improve adherence to maintenance medication and reduce rescue medication use in patients with uncontrolled asthma.
