• 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; Raya, Reynie Purnama; Schellekens, Arnt (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.
    • 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.
    • 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)
    • 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)
    • 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)
    • 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)
    • 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.
    • In-hospital training in addiction medicine: A mixed-methods study of health care provider benefits and differences.

      Gorfinkel, Lauren; Klimas, Jan; Reel, Breanne; Dong, Huiru; Ahamad, Keith; Fairgrieve, Christopher; McLean, Mark; Mead, Annabel; Nolan, Seonaid; Small, Will; Cullen, Walter; Wood, Evan; Fairbairn, Nadia (2019-01-28)
      Hospital-based clinical addiction medicine training can improve knowledge of clinical care for substance-using populations. However, application of structured, self-assessment tools to evaluate differences in knowledge gained by learners who participate in such training has not yet been addressed. Participants (n = 142) of an elective with the hospital-based Addiction Medicine Consult Team (AMCT) in Vancouver, Canada, responded to an online self-evaluation survey before and immediately after the structured elective. Areas covered included substance use screening, history taking, signs and symptoms examination, withdrawal treatment, relapse prevention, nicotine use disorders, opioid use disorders, safe prescribing, and the biology of substance use disorders. A purposefully selected sample of 18 trainees were invited to participate in qualitative interviews that elicited feedback on the rotation. Of 168 invited trainees, 142 (84.5%) completed both pre- and post-rotation self-assessments between May 2015 and May 2017. Follow-up participants included medical students, residents, addiction medicine fellows, and family physicians in practice. Self-assessed knowledge of addiction medicine increased significantly post-rotation (mean difference in scores = 11.87 out of the maximum possible 63 points, standard deviation = 17.00; P < .0001). Medical students were found to have the most significant improvement in addiction knowledge (estimated mean difference = 4.43, 95% confidence interval = 0.76, 8.09; P = .018). Illustrative quotes describe the dynamics involved in the learning process among trainees. Completion of a hospital-based clinical elective was associated with improved knowledge of addiction medicine. Medical students appear to benefit more from the addiction elective with a hospital-based AMCT than other types of learners.
    • Interventions to develop collectivistic leadership in healthcare settings: a systematic review.

      De Brún, Aoife; O'Donovan, Roisin; McAuliffe, Eilish (BMC Health Services Research, 2019-01-25)
      Collective or shared leadership approaches have been associated with team performance outcomes in several sectors. Based on this evidence, there have been calls for more inclusive approaches to leadership in healthcare settings, but guidance on how to achieve collective leadership is lacking. This study synthesised knowledge of interventions to introduce collectivistic leadership in healthcare settings. The databases of PubMed, PsychInfo, ABI Inform, Cochrane and CINAHL and three grey literature databases were searched. Studies from any country were included if they reported on the development and evaluation and/or implementation of training/interventions to develop collectivistic leadership and reported individual and/or team-level outcomes. Results were synthesised using a narrative approach. The searches yielded 4448 records of which 21 met the eligibility criteria and were reviewed. Studies used a variety of interventions; eleven employed a team training approach, four described co-leadership, three explored service improvement, two detailed co-design approaches and one described an individual team development intervention. Most demonstrated moderate to good success in enabling collectivistic leadership, with benefits reported in staff engagement, satisfaction, and team performance. Whilst collectivistic leadership interventions have demonstrated positive outcomes, there is a need for more rigor and consistency in the evaluation of interventions aimed at developing collectivistic leadership approaches in health settings.
    • The Burden of Severe Lactational Mastitis in Ireland from 2006 to 2015

      Cooney, F; Petty-Saphon, N; Department of Public Health, Dr Steevens' Hospital (irish Medical Journal, 2019-01-15)
    • A Profile of Psychiatric In-Patient Admissions With No Fixed Abode (NFA) 2007-2016

      Daly, A; Craig, S; O’ Sullivan, E (Irish Medical Journal, 2019-01)
    • Five-year standardised mortality ratios in a cohort of homeless people in Dublin

      Ivers, Jo-Hanna; Zgaga, Lina; O'Donoghue-Hynes, Bernie; Heary, Aisling; Gallwey, Brian; Barry, Joe (BMJ Open, 2019-01)
    • Clarifying the mechanisms and resources that enable the reciprocal involvement of seldom heard groups in health and social care research: A collaborative rapid realist review process

      Ní Shé, Éidín; Morton, Sarah; Lambert, Veronica; Ní Cheallaigh, Cliona; Lacey,  Vanessa; Dunn, Eleanor; Loughnane, Cliona; O'Connor, Joan; McCann, Amanda; Adshead, Maura; Kroll, Thilo (Health Expectations, 2019-01)
    • Blue care: a systematic review of blue space interventions for health and wellbeing.

      Britton, Easkey; Kindermann, Gesche; Domegan, Christine; Carlin, Caitriona (Health Promotion International, 2018-12-18)
      There is increasing interest in the potential use of outdoor water environments, or blue space, in the promotion of human health and wellbeing. However, therapeutic nature-based practices are currently outpacing policy and the evidence base for health or wellbeing benefits of therapeutic interventions within blue space has not been systematically assessed. This systematic review aims to address the gap in understanding the impacts of blue space within existing interventions for targeted individuals. A systematic review was carried out, searching Google Scholar, SCOPUS, PubMed, etc. through to August 2017. Only blue space interventions were included that were specifically designed and structured with a therapeutic purpose for individuals with a defined need and did not include nature-based promotion projects or casual recreation in the outdoors. Thirty-three studies met the inclusion criteria and were assessed. Overall, the studies suggest that blue care can have direct benefit for health, especially mental health and psycho-social wellbeing. The majority of papers found a positive or weak association between blue care and health and wellbeing indicators. There was also some evidence for greater social connectedness during and after interventions, but results were inconsistent and mixed across studies with very few findings for physical health. This is the first systematic review of the literature on blue care. In summary, it has been shown that mental health, especially psycho-social wellbeing, can be improved with investment in blue spaces. Key areas for future research include improving understanding of the mechanisms through which blue care can improve public health promotion.
    • Irish general practitioners' view of perinatal mental health in general practice: a qualitative study.

      Noonan, Maria; Doody, Owen; O'Regan, Andrew; Jomeen, Julie; Galvin, Rose (BMC Family Practice, 2018-12-13)
      Identification of perinatal mental health problems and effective care for women who experience them are important considering the potentially serious impact that they may have on the wellbeing of the woman, her baby, family and wider society. General practitioners (GPs) play a central role in identifying and supporting women and this study aimed to explore GPs' experiences of caring for women with perinatal mental health problems in primary care. The results of this study may provide guidance to inform policy, practice, research and development of curriculum and continuous professional development resources. In-depth semi-structured interviews were undertaken between March and June 2017 with GPs (n = 10) affiliated with a University training programme for general practice in Ireland. Thematic data analysis was guided by Braun and Clarkes (2013) framework. Data were categorised into three themes with related subthemes: identification of perinatal mental health problems, decision making around perinatal mental health and preparation for a role in perinatal mental health. GPs described the multifaceted nature of their role in supporting women experiencing perinatal mental health issues and responding to complex psychological needs. Inbuilt tools on existing software programmes prompted GPs to ask questions relating to perinatal mental health. Limited access to referral options impacts on assessment and care of women. GPs desire further continuous professional development opportunities delivered in an online format and through monthly meetings and conference sessions. GPs require access to culturally sensitive; community based perinatal mental health services, translation services and evidence based perinatal psychological interventions. A standardised curriculum on perinatal mental health for trainee GPs needs to be established to ensure consistency across primary care and GP education should incorporate rotations in community and psychiatry placements.