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.

ICGP Library: Health Horizon Monthly, July 2020

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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

ICGP Library: Health Horizon Monthly, July 2020

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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.

ICGP Library: Health Horizon Monthly, July 2020

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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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ICGP Library & Information Centre | Recommended Reading – July 2021 7

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.

ICGP Library: Health Horizon Monthly, July 2020

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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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