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Background: Cardiopulmonary resuscitation-induced consciousness (CPRIC) is an important but under-researched area. CPRIC in Irish emergency services has never been examined and this study aimed to explore the experiences of prehospital practitioners. Methods: This study includes qualitative and quantitative elements, using an online anonymous survey followed by a confidential, one-to-one, semi-structured interview with emergency medical technicians, paramedics and advanced paramedics. Results: Of the respondents surveyed, 93% had been involved in the care of at least one case of out-of-hospital cardiac arrest (OHCA); 36% had managed 6–10 OHCAs within the previous 12 months. Three-quarters (75%) were aware of CPRIC and 57% reported that they had witnessed at least one episode of this. CPRIC incidents were characterised by a range of clinical features, which sometimes interrupted care provision and were managed using wide-ranging and non-standardised responses including drug therapy. Both high-quality manual and mechanical CPR were linked to CPRIC. The rate of reported return of spontaneous circulation (63%) was significantly higher than that in Irish national data for OHCA. Seven volunteers participated in confidential sem-istructured interviews. Themes identified included the impact on resuscitation, unfamiliarity with CPRIC manifestations, how CPRIC affected practitioners and educational needs. Practitioners experienced distress because of this phenomenon. All highlighted their desire to have CPRIC addressed by clinical practice guidelines.

Background Language and communication have an impact on how a clinical condition is treated and experienced, from both the health care professional (HCP) and patient perspective. Malnutrition is prevalent among community-dwelling older adults, yet perceptions of patient understanding of the term malnutrition to date remain underexplored. Objective This qualitative study explored the use and perceptions of the term malnutrition among HCPs and older adults at risk of malnutrition. Design Semi-structured interviews and focus groups were conducted with HCPs and older adults with a prescription for oral nutritional supplements (ONS) in the community, to explore perspectives. Participants and setting HCPs with experience of working with older adults were recruited in primary care centers, general practitioner practices, community health organizations, and community pharmacies in County Dublin, Ireland, between 2018 and 2019. Older adults, aged ≥60 years, with a current or previous prescription for ONS were recruited from daycare centers. One-to-one interviews were conducted with general practitioners (n = 16) and patients (n = 13), and focus groups were conducted with other HCPs, including dietitians (n = 22), nurses (n = 22), pharmacists (n = 9), physiotherapists (n = 12), occupational therapists (n = 6), and speech and language therapists (n = 4). Data analysis Data from interviews and focus groups were transcribed verbatim and analyzed using thematic analysis. Results There was mutual agreement between HCPs and patients on the main theme, “malnutrition is a term to be avoided.” There were three subthemes with varying input from the different HCP groups and patients: “Malnutrition is a term a patient doesn’t want to hear”—malnutrition has negative connotations that imply neglect and stigma; “malnutrition is a clinical term which patients don’t understand”—with perceptions that it is better to substitute the term with simpler motivating messages; and “lack of confidence identifying malnutrition”—expressed by non-dietetics HCPs who believed they had insufficient expertise on malnutrition to communicate effectively with patients. Conclusions HCPs and patients perceived negative connotations with the term malnutrition, and HCPs used alternatives in practice. Additional consultation with HCPs and patients is recommended to explore appropriate language for conveying health risks associated with malnutrition. Future research should also address how current communication challenges can be addressed as part of strategic management programs or interventions to prevent and treat malnutrition.

Summary Background & aim Protein-energy malnutrition is under-recognised in the community despite being common in older adults due to physiological and social changes which are often compounded by chronic disease. This qualitative study aimed to explore the opinions of healthcare professionals (HCPs) working in the primary care and community settings about the management of malnutrition and the prescription of oral nutritional supplements (ONS), often included in the treatment of malnutrition. Methods Twelve healthcare professional (HCP) focus groups with 75 participants were conducted: community dietitians (n = 17), registered dietitians working in industry (n = 5), community and residential care nurses (n = 22), physiotherapists (n = 12), pharmacists (n = 9), occupational therapists (n = 6) and speech and language therapists (n = 4). Focus group discussions were audio-recorded and transcribed verbatim. The data were coded and analysed using thematic analysis and key themes with illustrative quotes extracted are presented. Results Similar views on malnutrition management existed across professions. ‘Gaps in Primary Care Management’ was the first key theme wherein HCPs identified limitations in malnutrition management in the community. Barriers included limited or no dietetic services available in primary care and poor communication between general practitioners and wider primary care team members which resulted in inappropriate or delayed treatment. The second key theme, ‘Challenges with ONS use in the Community’, encapsulated several issues HCPs experienced with ONS usage including inappropriate prescribing and lack of monitoring of treatment goals. Conflicts of interest regarding dietitians working in industry assessing and treating older adults in residential care settings was highlighted by participants. Conclusions This study highlights that more emphasis is needed to identify patients when they are at risk of malnutrition to avoid advanced or severe malnutrition presentations currently seen. Community dietitians for older people are required to address many of the issues raised including the need for awareness, education and training, resources, and malnutrition care pathway structures.

Malnutrition is under-diagnosed in primary care. General practitioners (GPs) are key healthcare contacts for older adults at risk of protein-energy malnutrition; however, lack of knowledge and confidence in its diagnosis and treatment is often reported.To evaluate the impact of a bespoke online education module on GP malnutrition knowledge and management.Six-week pre-post pilot study with 31 GPs in Ireland.The module included units on: 'malnutrition definition, prevalence and latest evidence', 'identifying malnutrition in clinical practice', 'food-first advice', 'reviewing malnutrition' and 'oral nutritional supplements'. Participant knowledge was measured using a multiple-choice questionnaire (MCQ) before and after the module (n=31), and 6-weeks following completion (n=11). Case studies assessing identification and management of malnutrition were evaluated by a clinical specialist dietitian with expertise in managing malnutrition. Changes in assessment performance were calculated using paired t-tests. Acceptability was evaluated using a questionnaire.Post-training 97.5% of GPs increased MCQ scores from baseline (+25%,This e-learning module improved malnutrition knowledge, with good short-term retention in a small cohort. Development of online evidence-based nutrition education may improve GP nutrition care.

The involvement of healthcare professionals (HCPs) as research participants is essential to generate high quality evidence for enhancing health services and practice. Research teams face many challenges in recruiting HCPs for research, and barriers and enablers for interdisciplinary research are not well described in the literature. The Oral Nutritional Supplement Prescribing Malnutrition Research Study (ONSPres Study) examined malnutrition identification, management, and appropriate oral nutritional supplement prescribing in primary care in Ireland. The ONSPres Study offers a unique view of recruiting HCPs for research because a range of disciplines were sought for participation in a mixed methods study. The purpose of this open letter is to describe the experiences of recruitment and participation. Sixteen general practitioners (GPs) were recruited to participate in one-to-one interviews, eighty health and social care professionals working in community care (including nurses, pharmacists, dietitians, physiotherapists, speech and language therapists, and occupational therapists) were recruited to take part in 12 focus groups, and 31 GPs and trainee GPs were recruited to participate in an education programme developed by the study team. Strategies required to gain access and reach HCPs differed between disciplines. Professional networks enhanced access to HCPs working in practice and recruitment was slower and more tailored when those networks were less available to the team. An interest in malnutrition, to assist in research, to advance patient care, and the opportunity for learning were incentives for the participating HCPs. Limitations in the diversity of the sample arose, with a bias towards female participants and GPs motivated by an interest in the topic. It is recommended that study teams collaborate early with relevant HCP disciplines so they can contribute to recruitment planning at project concept and design stages. To enhance and incentivise HCP participation in research, dedicated time and acknowledgement of participation as continuous professional development is proposed.

Background: The care provided in general practice to intravenous drug users (IDUs) with hepatitis C (HCV) extends beyond opioid substitution therapy. An aggregated analysis of HCV service utilization within general practice specifically related to diagnosis and treatment outcomes remains unknown from previous literature. Aims: This study aims to estimate the prevalence of HCV and analyze data related to the diagnosis and treatment-related outcomes of HCV patients with a history of intravenous drug use in the general practice setting. Design and setting: A systematic review and meta-analysis in general practice. Methods: This review included studies published in the following databases: EMBASE, PubMed, and Cochrane Central Register of Controlled Trials. Two reviewers independently extracted data in standard forms in Covidence. A meta-analysis was done using a DerSimonian and Laird random-effects model with inverse variance weighting. Results: A total of 20,956 patients from 440 general practices participated in the 18 selected studies. A meta-analysis of 15 studies showed a 46% (95% confidence interval (CI), 26–67%) prevalence rate of hepatitis C amongst IDUs. Genotype information was available in four studies and treatment-related outcomes in 11 studies. Overall, treatment uptake was 9%, with a cure rate of 64% (95% CI, 43–83%). However, relevant information, such as specific treatment regimens, treatment duration and doses, and patient comorbidities, was poorly documented in these studies. Conclusion: The prevalence of HCV in IDUs is 46% in general practice. Only ten studies reported HCV-related treatment outcomes; however, the overall uptake rate was below 10%, with a cure rate of 64%. Likewise, the genotypic variants of HCV diagnoses, medication types, and doses were poorly reported, suggesting a need for further research into this aspect of care within this patient group to ensure optimal treatment outcomes.

Background Out-of-hospital cardiac arrest (OHCA) is a leading cause of preventable mortality that now affects almost 3,000 people each year in Ireland. Survival is low at 6-7%, compared to a European average of 8%. The Irish Out-of-Hospital Cardiac Registry (OHCAR) prospectively gathers data on all OHCA in Ireland where emergency medical services attempted resuscitation. The Irish health system has undergone several developments that are relevant to OHCA care in the period 2012-2020. OHCAR data provides a means of exploring temporal trends in OHCA incidence, care, and outcomes over time. It also provides a means of exploring whether system developments were associated with a change in key outcomes. This research aims to summarise key trends in available OHCAR data from the period 2012 – 2020, to explore and model predictors of bystander CPR, bystander defibrillation, and survival, and to explore the hypothesis that significant system level temporal developments were associated with improvements in these outcomes. Methods The following protocol sets out the relevant background and research approach for an observational study that will address the above aims. Key trends in available OHCAR data (2012 – 2020) will be described and evaluated using descriptive summaries and graphical displays. Multivariable logistic regression will be used to model predictors of ‘bystander CPR’, ‘bystander defibrillation’ and ‘survival to hospital discharge’ and to explore the effects (if any) of system level developments in 2015/2016 and the COVID-19 pandemic (2020) on these outcomes. Discussion The findings of this research will be used to understand temporal trends in the care processes and outcomes for OHCA in Ireland over the period 2012-2020. The results can further be used to optimise future health system developments for Out-of-Hospital Cardiac Arrest in both Ireland and internationally.

Background Clinical guidelines are integral to a general practitioner’s decision to refer a paediatric patient to emergency care. The influence of non-clinical factors must also be considered. This review explores the non-clinical factors that may influence general practitioners (GPs) when deciding whether or not to refer a paediatric patient to the Emergency Department (ED). Methods A systematic review of peer-reviewed literature published from August 1980 to July 2019 was conducted to explore the non-clinical factors that influence GPs’ decision-making in referring paediatric patients to the emergency department. The results were synthesised using a narrative approach. Results Seven studies met the inclusion criteria. Non-clinical factors relating to patients, GPs and health systems influence GPs decision to refer children to the ED. GPs reported parents/ caregivers influence, including their perception of severity of child’s illness, parent’s request for onward referral and GPs’ appraisal of parents’ ability to cope. Socio-economic status, GPs’ aversion to risk and system level factors such as access to diagnostics and specialist services also influenced referral decisions. Conclusions A myriad of non-clinical factors influence GP referrals of children to the ED. Further research on the impact of non-clinical factors on clinical decision-making can help to elucidate patterns and trends of paediatric healthcare and identify areas for intervention to utilise resources efficiently and improve healthcare delivery.

Background COVID-19 required rapid innovation in health systems, in the context of an infection which placed healthcare professionals at high risk; general practice has been a key component of that innovative response. In Ireland, GPs were asked to work in a network of community assessment hubs. A focused training programme in infection control procedures/clinical use of personal protective equipment (PPE) was rapidly developed in advance. University departments of general practice were asked to develop and deliver that training. Aim The aim of this article is to describe infection control procedure training in Ireland, the uptake by GPs and the initial experience of GPs working in this unusual environment. Design and setting Two anonymous cross-sectional online surveys are sent to participants in training courses. Method Survey 1 followed completion of training; survey 2 followed establishment of the hubs. Results Six hundred seventy-five participants (including 439 GPs, 156 GP registrars) took part in the training. Two hundred thirty-nine (50.3%) out of four hundred seventy-five responded to Survey 1-over 95% reported an increase in confidence in the use of PPE. Two hundred ten (44.2%) out of four hundred seventy-five participants responded to Survey 2; 195 had completed hub shifts. Younger, female GPs predominated. Very high levels of infection control procedures were reported. Participants commented positively on teamworking, environment and systems. However, 'real-time' ambulance service data suggest the peak of the surge may have passed by the time the hubs were established. Conclusion Academic departments, GPs and the Irish health system collaborated effectively to respond to the need for community assessment of COVID-19 patients.

Study purpose Out-of-hospital cardiac arrests (OHCA) in the young population have only been examined in a limited number of regional studies. Hence, we sought to describe OHCA characteristics and predictors of survival to hospital discharge for the young Irish population. Study design An observational analysis of the national Irish OHCA register for all OHCAs aged ≤35 years between January 2012 and December 2017 was performed. The young population was categorised into three age groups: ≤1 year, 1–15 years and 16–35 years. Multivariable logistic regression was used to determine the independent predictors of survival to hospital discharge. Results A total of 1295 OHCAs aged ≤35 years (26.9% female, median age 25 (IQR 17–31)) had resuscitation attempted. OHCAs in those aged ≥16 years (n=1005) were more likely to happen outside the home (38.5% vs 22.8%, p Conclusions The high prevalence of non-medical OHCAs and the OHCA location need to be considered when developing OHCA care pathways and preventative strategies to reduce the burden of OHCAs in the young population.

The introduction of treat and referral by ambulance practitioners is under active consideration in Ireland. The Irish ambulance services have traditionally transported all patients following an emergency (112/999) call to an emergency department. The introduction of treat and referral will present a significant care pathway change. To engage GPs in relation to the proposed introduction of treat and referral. A postal survey of 50 general practices in the southeast of Ireland was completed in 2019 to identify their opinion on the introduction of treat and referral. Descriptive statistics were calculated, and Pearson’s chi-square tests were used to identify statistically significant differences among GP cohorts. A 78% response rate was achieved. Respondents indicated that informal treat and referral was practised by 40% of GPs. A significant majority of GPs indicated that their patients with diabetes or epilepsy would benefit from treat and referral and were happy for paramedics to make appointments posthypoglycaemia or seizure. There was no clear consensus in relation to confining treat and referral to adults only. Barriers to the implementation of treat and referral were a significant issue for GPs. GPs are in the main supportive of the introduction of treat and referral; however, they have identified several barriers that may inhibit successful introduction. Importantly, a GP appointment within 48 h does not appear to be a barrier. The adequacy of the working relationships between GPs and the ambulance service and its practitioners appears to have reduced since 2006, which is concerning.

AimsThis study explores the opinions and experiences of Irish Defences Forces’ (IDF) graduates from University College Dublin’s Diploma in Military Medicine Care (DMMC). It aims to identify which aspects of medical education are relevant for the development of military graduates in the role of Combat Medical Technician (CMT) in future.MethodsA validated Clinical Learning Environment Score tool was adapted and incorporated into an online survey. This was sent electronically to 71 graduates. Responses were anonymous.Results38 (54%) graduates responded. Student feedback was positive regarding teaching and clinical placements in the DMMC. In total 16 (42%) students reported use of their new skills in their daily work. Of the 9 (24%) deployed overseas, all used their new skills. Emergency and occupational health skills were used more frequently, while advanced skills were used rarely.ConclusionAn increased emphasis on frequently used skills should be considered. Links to healthcare services would be of benefit to graduates in skills maintenance. Key advanced skills, such as intravenous cannulation and advanced airway management are rarely used but mechanisms to maintain them will improve the relevance of the programme to the CMT role. A change in how the IDF acknowledges qualifications may support more graduates in advancing and maintaining their career in the military medical workforce.

Background: Out-of-hospital cardiac arrest (OHCA) is a major cause of premature mortality. Survival is possible when timely cardiopulmonary resuscitation and defibrillation are available in the community. GPs are well placed to provide early OHCA care and significantly increased rates of survival are achieved when GPs participate in resuscitation. A novel project alerts volunteer GP first responders to nearby OHCAs in Ireland. Objectives: To explore the reasons why GPs volunteer to be OHCA first responders and their experience of participation. Methods: A qualitative study involving in-depth, semi-structured interviews followed by thematic analysis was undertaken in 2017/18. Fourteen GPs from differing geographical areas in Ireland, who volunteered as OHCA first-responders were recruited to participate by purposive methods. Results: GP participation in OHCA voluntary first response was understood as a function of GPs relationship to the community, their ability to manage competing demands in their personal and professional lives and also specific participatory gains. GPs expressed both altruistic motivations and a sense of obligation. GPs described a complex, multifaceted role in providing OHCA first response; they derived an inherent sense of satisfaction in delivering potentially life-saving interventions but also in the provision of holistic, compassionate end-of-life care for patients and their families. Participation was not without psychosocial risk for GPs. Conclusion: GPs volunteer to provide early OHCA emergency care because of their relationship to the community. Care provided is complex and includes both resuscitation and end-of-life care.

When treating malnutrition, oral nutritional supplements (ONSs) are advised when optimising the diet is insufficient; however, ONS usage and user characteristics have not been previously analysed. A retrospective secondary analysis was performed on dispensed pharmacy claim data for 14,282 anonymised adult patients in primary care in Ireland in 2018. Patient sex, age, residential status, ONS volume (units) and ONS cost (EUR) were analysed. The categories of ‘Moderate’ (

Ireland does not yet have a comprehensive system of universal access to primary care. In 2015, access to general practitioner (GP) care at no charge was introduced for the 70% of children aged under six who previously paid out-of-pocket fees. This study uses data from 16 practices and a regional out-of-hours (OOH) GP service to assess the impact of this policy on attendance. A difference-in-difference (DiD) analysis was applied to visit records of paediatric patients over a period of five years, two years of which were pre-policy, with treatment and control differentiated by age. Attendance at daytime GP by children aged under-six increased by 20%–21% in the three years following the introduction of the policy, largely explained by an increase in the number of patients attending (17.4%–18.6%). Of children aged under-six attending pre-policy, 14.9%–15.8% had >6 visits annually, increasing to 18.5%– 20.3% post-policy. OOH GP attendance also increased by 20.5%–29.4% over the same period. Findings are consistent with international literature on the provision of financially accessible healthcare. Prior unmet need, the provision of additional assessments to children aged under six, parental response to a service at no charge, and rerouting of access to the ED through GP, are all possible contributors to this increased demand. A more integrated policy of boosting supply as well as demand is desirable, particularly in the context of future expansion plans, to ensure the health benefits anticipated from the introduction of this policy have every opportunity to be realised.

BackgroundMalnutrition is underdiagnosed in primary care. GPs are key healthcare contacts for older adults at risk of protein-energy malnutrition; however, lack of knowledge and confidence in its diagnosis and treatment is often reported.AimTo evaluate the impact of a bespoke online education module on GP malnutrition knowledge and management.Design & settingA prospective pre—post pilot study with 23 GPs and eight GP trainees in the Republic of Ireland.MethodThe module included units on the following: ‘malnutrition definition, prevalence, and latest evidence’; ‘identifying malnutrition in clinical practice’; ‘food-first advice’; ‘reviewing malnutrition’; and ‘oral nutritional supplements’. Participant knowledge was measured using a multiple choice questionnaire (MCQ) before and after the module (n= 31), and 6 weeks following completion (n= 11). Case studies assessing identification and management of malnutrition were evaluated by a clinical specialist dietitian with expertise in managing malnutrition. Changes in assessment performance were calculated using pairedt-tests. Acceptability was evaluated using a questionnaire.ResultsPost-training, 97% of GPs increased MCQ scores from baseline (+25%,PPP= 0.005); ‘identifying malnutrition in clinical practice’ remained the most highly scored (mean increase 40%,PConclusionThis e-learning module improved malnutrition knowledge, with good short-term retention in a small cohort. Development of online evidence-based nutrition education may improve GP nutrition care.

This is the first study on acute severe pain management involving sport and exercise medicine Doctors who are leaders in football medicine in their respective countries. An online survey was designed describing the management of acute severe pain in this expert cohort. The survey captured participant sex, age, years working in sports medicine, core specialty and use of clinical practice guidelines (CPGs). Finally, three clinical vignettes exploring the management of acute pain were presented. Forty-four senior team doctors across 55 European countries completed the survey. There were no consistent guidelines proposed, with 33 (75%) participants indicating they did not use any. Methoxyflurane was proposed by 14 (32%) and 13 (30%) participants for female anterior cruciate ligament rupture and male ankle fracture, respectively. Strong opioids were not used in 17 (39%) and 6 (14%) participants regarding female cruciate injuries and male fractures, respectively. Despite 75% of participants having paediatric life support training, eight (18%) participants expressed uncertainty administering medications in this population, and 15 (34%) would avoid using strong opioids altogether. There is a tendency to undertreat pain and avoid strong opioids for reasons including lack of monitoring equipment, anti-doping concerns and lack of comfort treating paediatric patients with opioids.

Introduction Opiate use disorder is a common condition in healthcare services in Ireland, where over 200 opiate overdose deaths occur annually. There is limited addiction medicine education at undergraduate level and medical graduates may not be adequately prepared to diagnose and manage opioid use disorders and emergency drug overdose presentations. Therefore, we examined final-year medical students' learning experiences and attitudes toward opioid use disorder, overdose and community naloxone provision as an emerging overdose treatment. Methods We administered an anonymous paper-based survey to 243 undergraduate medical students undertaking their final professional completion module prior to graduation from University College Dublin, Ireland. Results were compared with parallel surveys of General Practitioners (GPs) and GP trainees. Results A total of 197 (82.1%) completed the survey. Just under half were male, and most were aged under 25 (63.3%) and of Irish nationality (76.7%). The students felt moderately prepared to recognise opioid use disorder, but felt less prepared to manage other aspects of its care. Most had taken a history from a patient with an opioid use disorder (82.8%), and a third had witnessed at least one opioid overdose. Although 10.3% had seen naloxone administered, most had never administered naloxone themselves (98.5%). Half supported wider naloxone availability; this was lower than support rates among GPs (63.6%) and GP trainees (66.1%). Conclusions Our findings suggest an unmet learning need in undergraduate training on opioid use disorder, with potential consequences for patient care.

Universal health coverage (UHC) aims to improve child health. Ireland, the only country in the European Union without universal access to primary care, introduced general practitioner (GP) care at no charge for children aged under six in 2015. This paper aims to evaluate the impact of this policy on attendance at the emergency department (ED). A difference-in-difference (DiD) analysis was applied to visit records of 367,000 paediatric patients at five hospitals over a period of five years, with treatment and control differentiated by age. DiD was also used to assess if GP referrals and the severity of presentations altered as a consequence of this policy. While existing research estimates that this policy increased attendance by children aged under six at general practice by over 25%, this policy did not lead to a reduction in ED attendance. Hospital level effects on attendance varied from no impact to increased attendance by children aged under six of 28.9%. While increased GP referrals, particularly for injury and medical reasons, indicated more patients presented to their GP prior to ED attendance, walk-ins without referral did not decrease. Attendance increased at both regional hospitals, which also had the highest proportion of GP referred visits. While the marginal probability of a visit being GP referred increased at four of the five hospitals in this study, only in two of these can the entire effect be attributed to the introduction of this policy (effects 1.4 and 1.8 percentage points). Previous unmet need, capacity constraints in general practice, regional variability in the GP to population ratio, restricted hours of access to GPs, coupled with faster access to diagnostics in the ED setting, may explain variability in the effect and why the expected reduction in ED attendances did not occur.

BackgroundInvolving medical students in research in their undergraduate careers may increase the likelihood that they will be research active after graduation. To date, there has been a paucity of published research of students doing research in general practice.AimThe study aims to evaluate the impact of general practice clinical audits on early-stage graduate entry students’ audit and research self-efficacy and explore feasibility issues from the student and GP perspective.MethodsTwo student questionnaires (pre- and post-intervention), a qualitative GP survey of the 25 participating GPs and semi-structured interviews of a purposeful sample of GPs were conducted.ResultsParticipating students who completed the follow-up survey found that it had a positive educational impact (55%), increased their understanding of the audit cycle (72%) and real-world prescribing (77%). Research confidence wise, there was a statistically significant difference in the student group who completed the audit project compared to those students who did not in knowledge of the audit cycle and the difference between research and audit (p = 0.001) but not in other research skills. Ninety-six percent of responding GPs would be happy for students to do future audits in their practice but some feasibility issues similar to other research initiatives in general practice were identified.ConclusionWe found this audit initiative feasible and useful in helping students learn about audit skills, patient safety and real-world prescribing. GPs and students would benefit more if it were linked to a substantial clinical placement, focussed on a topic of interest and given protected time. Separate research projects may be needed to develop research skills confidence.

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.

Background: Although it is accepted that providing medical students with opportunities to engage in research activity is beneficial, little data has been collated on how medical degree curricula may address this issue. This review aims to address this knowledge gap by conducting a scoping review examining curriculum initiatives that seek to enhance research experience for medical students.Methods: This review looks to specifically look at ’doing research’ as defined by the MEDINE 2 consensus rather than ‘using research’ for the bachelor component of the Bologna Cycle. The five-stage framework developed by Arksey & O’Malley was utilised.Results: Ultimately, 120 articles were included in this scoping review; 26 related to intercalated degree options and 94 to non-intercalated degree options. Research initiatives from the United States were most featured (53/120 articles). For non-intercalated research options, mandatory and elective research projects predominated. The included studies were heterogeneous in their methodology. The main outcomes reported were student research output, description of the curriculum initiative(s) and self-reported research skills acquisition. For the intercalated degree options, the three main findings were descriptions of more ‘novel’ intercalated degree options than the traditional BSc, student perspectives on intercalating and the effect of intercalating on medical student performance and careers. Conclusion: There are a number of options available to faculty involved in planning medical degree programmes but further research is needed to determine whether research activity should be optional or mandatory. For now, flexibility is probably appropriate depending on a medical school’s resources, curriculum, educational culture and population needs.

Objectives: Overcrowding in emergency departments (EDs) is an international issue and ambulance bypass is seen as one element of the solution to a complex problem. Irish EDs are not immune to this healthcare crisis, which, together with increased off-load delays for ambulances, is one catalyst for the introduction of Treat and Referral (paramedic non-ED disposition decision). The confidence of consultants in emergency medicine in paramedics and advanced paramedics offering Treat and Referral to patients presenting with hypoglycaemia or seizure was explored. Other specific clinical presentations were also investigated for suitability for Treat and Referral and a consensus was sought on an upper age limit for such patients. Methods: Public-sector consultants in emergency medicine in Ireland at the time of the study, were invited to complete an online survey. A 62% response was received from the targeted population. Results: Confidence was expressed in advanced paramedics offering Treat and Referral to patients with hypoglycaemia or seizure by the majority (78%) of respondents. However, confidence was reduced for paramedics (53%). Six of the twelve specific clinical presentations received clear support as suitable for Treat and Referral, with the remaining receiving reducing support and ‘falls in the elderly (without injury)’ was opposed. There was no consensus on an upper age limit for patients being offered Treat and Referral. Conclusions: Support for the highest level of EMS practitioner in Ireland, advanced paramedic, to expand their scope of practice to include Treat and Referral was identified. Clinical presentations have been identified that would be conducive to a Treat and Referral clinical care pathway. A trial implementation period may be essential to build confidence in the programme before a universal roll out.

Introduction Health systems offer access to unscheduled care through numerous routes; however, it is typically provided by general practitioners (GPs), by emergency medicine doctors in in emergency departments (EDs) and by GPs in out-of-hours GP services such as practitioner cooperatives. Unscheduled healthcare constitutes a substantial portion of healthcare delivery. A systematic review was conducted to establish the factors that influence parents’ decision making when seeking unscheduled healthcare for their children. The systematic review question was “What are the factors that influence the decision making of parents and families seeking unscheduled paediatric healthcare?” Method Five databases (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and four grey literature databases (Proquest, Lenus, OpenGrey, Google Scholar) were searched. The titles and abstracts of 3746 articles were screened and full-text screening was performed on 177 of these articles. Fifty-six papers were selected for inclusion in the review. Data relating to different types of unscheduled health services (namely primary care, the emergency department and out-of-hours services) were extracted from these articles. A narrative approach was used to synthesise the extracted data. Results Several factors were identified as influencing parental preferences and decision making when seeking unscheduled healthcare for their children. A number of the included studies identified pre-disposing factors such as race, ethnicity and socioeconomic status (SES) as impacting the healthcare-seeking behaviour of parents. Unscheduled healthcare use was often initiated by the parent’s perception that the child’s condition was urgent and their need for reassurance. The choice of unscheduled service was influenced by a myriad of factors such as: waiting times, availability of GP appointments, location of the ED, and the relationship that the parent or caregiver had with their GP. Conclusion Policy and planning initiatives do not always reflect how patients negotiate the health system as a single entity with numerous entry points. Altering patients’ behaviour through public health initiatives that seek to improve, for instance, health literacy or reducing emergency hospital admissions through preventative primary care requires an understanding of the relative importance of factors that influence behaviour and decision making, and the interactions between these factors.

Slaintecare, the Irish government’s plan for the coming decade, relies heavily on integrated, team-based care in the community to achieve its goals. General practice nursing is a key component of that care, both now and in the future, but little is known about the experience and views of those providing this service. This preliminary study is part of a wider national project on teamworking in primary care. To document the experiences and views of practice nurses (PNs) and general practices in a single county of Ireland, in relation to current and future roles. Confidential questionnaires sent to all practices and all practice nurses in the county. Overall, 28/35 (80%) practices and 36/59 (61%) PNs responded; most PNs work part-time. Almost all practices have PNs; in 93% of practices, patients can see the PN without referral by the GP and there is very good concordance between practices and PNs about the wide range of tasks undertaken. Ninety-four percent of practices and 81% of PNs rated an expanded role for PNs as high or highest priority; barriers identified by both groups were financial and indemnity issues. Practice nursing contributes extensively to general practice, and an expansion of the role is advocated by PNs and practices.