• The national and international implications of a decade of doctor migration in the Irish context.

      Bidwell, Posy; Humphries, Niamh; Dicker, Patrick; Thomas, Steve; Normand, Charles; Brugha, Ruairí; Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin 2, Ireland. Electronic address: pbidwell@tcd.ie. (2012-12-17)
      BACKGROUND: Between 2000 and 2010, Ireland became increasingly dependent on foreign-trained doctors to staff its health system. An inability to train and retain sufficient doctors to meet demand is the primary reason for the dependence on foreign-trained doctors. By 2008 the proportion of foreign-trained doctors was the second highest in the OECD. This increased dependence on international medical migration has both national and international policy implications. METHODS: Registration data were obtained from the Medical Council of Ireland (MCI) for a 10-year period: 2000-2010. Data indicate country of qualification but not nationality. The total number of registrants and entrants (n) was determined for each year. Immigration data were also obtained on the number of work visas issued to doctors. Registration and visa data were then compared in order to estimate doctor migration to Ireland 2000-2010. RESULTS: The proportion of foreign-trained doctors rose from 13.4% of all registered doctors in 2000 to 33.4% by 2010. The largest increase was in foreign-trained doctors from outside the EU, rising from 972 (7.4%) in 2000 to 4740 (25.3%) of registered doctors in 2010. The biggest source country in 2000 was Pakistan. By 2010, South Africa had become the biggest source country. The number of foreign-trained doctors from other EU countries doubled from 780 in 2000 to 1521 in 2010. CONCLUSIONS: Registration data are likely to over-estimate and visa data under-estimate the numbers of doctors actively working in Ireland. However, they serve to illustrate Ireland's rapidly increasing and potentially unsustainable reliance on foreign-trained doctors; and to highlight the need for better data to measure migratory flows. Improved measurement of health worker migration is necessary both for national workforce planning and to fulfil the requirements of the WHO Global Code on the International Recruitment of Health Personnel.
    • National and subnational hypertension prevalence estimates for the Republic of Ireland: better outcome and risk factor data are needed to produce better prevalence estimates

      Barron, Steve; Balanda, Kevin; Hughes, John; Fahy, Lorraine (2014-01-10)
      Abstract Background Hypertension is a global public health challenge. National prevalence estimates can conceal important differences in prevalence in subnational areas. This paper aims to develop a consistent set of national and subnational estimates of the prevalence of hypertension in a country with limited data for subnational areas. Methods A nationally representative cross-sectional Survey of Lifestyle, Attitudes and Nutrition (SLÁN) 2007 was used to identify risk factors and develop a national and a subnational model of the risk of self-reported, doctor-diagnosed hypertension among adults aged 18+ years in the Republic of Ireland. The subnational model’s group-specific risk estimates were applied to group-specific population count estimates for subnational areas to estimate the number of adults with doctor-diagnosed hypertension in subnational areas in 2007. A sub-sample of older adults aged 45+ years who also had their blood pressure objectively measured using a sphygmomanometer was used to estimate the national prevalence of diagnosed and undiagnosed hypertension among adults aged 45+ years. Results The prevalence of self-reported, doctor-diagnosed hypertension among adults aged 18+ years was 12.6% (95% CI = 11.7% - 13.4%). After adjustment for other explanatory variables the risk of self-reported, doctor-diagnosed hypertension was significantly related to age (p < 0.001), body mass index (p < 0.001), smoking (p = 0.001) and fruit and vegetable consumption (p = 0.003). Among adults aged 45+ years the prevalence of undiagnosed hypertension (38.7% (95% CI 34.6% - 42.8%)) was higher than self-reported, doctor-diagnosed hypertension (23.4% (95% CI = 22.0% - 24.7%)). Among adults aged 45+ years, the prevalence of undiagnosed hypertension was higher among men (46.8%, 95% CI 41.2% - 52.4%) than women (31.2%, 95% CI 25.7% - 36.6%). There was no significant variation in the prevalence of self-reported, doctor-diagnosed hypertension across subnational areas. Conclusions Services need to manage diagnosed hypertension cases and to detect and manage undiagnosed cases. Further population level improvements in lifestyle risk factors for hypertension are key in developing a more integrated approach to prevent cardiovascular disease. Better subnational data on hypertension outcomes and risk factors are needed to better describe the distribution of hypertension risk and hypertension prevalence in subnational areas.
    • National and subnational hypertension prevalence estimates for the Republic of Ireland: better outcome and risk factor data are needed to produce better prevalence estimates.

      Barron, Steve; Balanda, Kevin; Hughes, John; Fahy, Lorraine (BMC public health, 2014-01-10)
      Hypertension is a global public health challenge. National prevalence estimates can conceal important differences in prevalence in subnational areas. This paper aims to develop a consistent set of national and subnational estimates of the prevalence of hypertension in a country with limited data for subnational areas.
    • National Audit of Hospital Mortality Annual Report 2016

      National Office of Clinical Audit (National Office of Clinical Audit, 2017)
    • National Audit of Hospital Mortality Annual Report 2017

      National Office of Clinical Audit (NOCA); National Office of Clinical Audit (National Office of Clinical Audit, 2018-12)
    • National Health Models and the Adoption of E-Health and E-Prescribing in Primary Care – New Evidence from Europe

      Brennan, James; McElligott, Annette; Power, Norah; Department of Computer Science and Information Systems, Faculty of Science and Engineering, University of Limerick, Ireland (Journal of Innovation in Health Informatics, 2015-11-26)
    • National Major Trauma Audit National Report 2014-2015.

      National Office of Clinical Audit (National Office of Clinical Audit, 2016)
    • National narcolepsy survey

      Doherty, L.; Crowe, C.; Sweeney, B.; Bon Secours Hospital, College Road, Cork. lsdoherty1@hotmail.com (2010-04)
      Narcolepsy is characterised by excessive daytime sleepiness and cataplexy and has a prevalence of 25 per 100,000. We suspect this is higher than presently seen in the Republic of Ireland. We aimed to calculate the Irish prevalence of Narcolepsy and to examine current management practices. We conducted an online survey of respiratory physicians, neurologists, paediatric neurologists, and psychiatrists with an interest in sleep disorders (73% response rate). Of this group, a total of 16 physicians managed 180 patients prior to January 2009. A clinical diagnosis alone was reached in 67 (41%) patients, the remainder by polysomnography or multiple sleep latency testing. No patients were diagnosed by cerebro-spinal fluid analysis of hypocretin levels. While 70 (42%) patients received modafanil, only 7 (4%) were treated with sodium oxybate. Even allowing for missing data it is apparent that Narcolepsy is hugely under-diagnosed in Ireland, however, current practises adhere with new international guidelines.
    • A national study of Continuous Professional Competence (CPC) amongst pre-hospital practitioners

      Knox, Shane; Cullen, Walter; Dunne, Colum P (2015-12-02)
      Abstract Background Internationally, continuing professional competence (CPC) is an increasingly important issue for all health professionals. With the introduction of the first CPC framework for Emergency Medical Technicians (EMTs) and the imminent introduction of CPC for Paramedics and Advanced Paramedics (APs) in Ireland, this study aimed to identify attitudes towards CPC and factors that might influence such a framework. Methods All EMTs (n = 925), Paramedics and APs (n = 1816) registered in Ireland were invited by email to complete an anonymous on-line survey. The study instrument was designed based on continuous professional development (CPD) questionnaires used by other healthcare professions. Quantitative and qualitative analyses were performed. Results The overall response rates were: EMTs 43 % (n = 399), Paramedics and APs 43 % (n = 789), with 82 % of APs and 38 % of Paramedics participating. The majority of participants in all groups agreed that registration was of personal importance and that evidence of CPC should be maintained; 39 % of Paramedics/APs and 78 % of EMTs believed that persistent failure to meet CPC requirements should mandate denial of registration. From a pre-determined list of activities, in excess of 88 % of all respondents indicated practical training scenarios, cardiac re-certification, e-learning supplemented by related practice, and training with simulation manikins were most relevant to these roles. However, least relevant to them were: e-learning alone (Paramedic/AP 36 %; EMT 35 %); project work (Paramedic/AP 27 %; EMT 48 %); and appraisal of journal articles (Paramedic/AP 24 %; EMT 39 %). Conclusion Irish EMTs, Paramedics and Advanced Paramedics were supportive of CPC and favoured a ‘mixed’ model approach which includes: blended learning, practical skills, simulation, practical/team-based exercises, e-learning combined with practical skills, and evidence of patient contact. It is hoped that these insights will inform the CPC guidelines to be introduced.
    • A national survey (NAP5-Ireland baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in Ireland.

      Jonker, W R; Hanumanthiah, D; O'Sullivan, E P; Cook, T M; Pandit, J J; Department of Anaesthesia and Intensive Care Medicine, Sligo Regional Hospital, Sligo, Ireland. (Anaesthesia, 2014-06-29)
      As part of the 5th National Audit Project of the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland concerning accidental awareness during general anaesthesia, we issued a questionnaire to every consultant anaesthetist in each of 46 public hospitals in Ireland, represented by 41 local co-ordinators. The survey ascertained the number of new cases of accidental awareness becoming known to them for patients under their care or supervision for a calendar year, as well as their career experience. Consultants from all hospitals responded, with an individual response rate of 87% (299 anaesthetists). There were eight new cases of accidental awareness that became known to consultants in 2011; an estimated incidence of 1:23 366. Two out of the eight cases (25%) occurred at or after induction of anaesthesia, but before surgery; four cases (50%) occurred during surgery; and two cases (25%) occurred after surgery was complete, but before full emergence. Four cases were associated with pain or distress (50%), one after an experience at induction and three after experiences during surgery. There were no formal complaints or legal actions that arose in 2011 related to awareness. Depth of anaesthesia monitoring was reported to be available in 33 (80%) departments, and was used by 184 consultants (62%), 18 (6%) routinely. None of the 46 hospitals had a policy to prevent or manage awareness. Similar to the results of a larger survey in the UK, the disparity between the incidence of awareness as known to anaesthetists and that reported in trials warrants explanation. Compared with UK practice, there appears to be greater use of depth of anaesthesia monitoring in Ireland, although this is still infrequent.
    • National survey of clinical communication assessment in medical education in the United Kingdom (UK)

      Laidlaw, Anita; Salisbury, Helen; Doherty, Eva M; Wiskin, Connie; on behalf of the UK Council for Clinical Communication in Undergraduate Medical Education (2014-01-13)
      Abstract Background All medical schools in the UK are required to be able to provide evidence of competence in clinical communication in their graduates. This is usually provided by summative assessment of clinical communication, but there is considerable variation in how this is carried out. This study aimed to gain insight into the current assessment of clinical communication in UK medical schools. Methods The survey was sent via e-mail to communication leads who then were asked to consult with all staff within their medical school involved in the assessment of communication. Results Results were obtained from 27 out of 33 schools (response rate 82%) and a total of 34 courses. The average number of assessments per year was 2.4 (minimum 0, maximum 10). The Objective Structured Clinical Exam (OSCE) was the most commonly used method of assessment (53%). Other assessments included MCQ and workplace based assessments. Only nine courses used a single method of assessment. Issues raised included, logistics and costs of assessing mainly by OSCE, the robustness and reliability of such exams and integration with other clinical skills. Conclusions It is encouraging that a variety of assessment methods are being used within UK medical schools and that these methods target different components of clinical communication skills acquisition.
    • National survey of MRSA: Ireland, 1995.

      Johnson, Z; Fitzpatrick, P; Hayes, C; Sayers, G; Pelly, H; McDonnell, B; Thornton, L; Buttimer, J; Health Information Unit, Eastern Health Board, Dublin, Ireland. (1997-03)
      The objective of this survey was to obtain an indication of the size of the methicillin-resistant Staphylococcus aureus (MRSA) problem in Ireland prior to introducing national MRSA control guidelines. A survey of all microbiology laboratories in Ireland was carried out over two weeks in Spring 1995. For patients from whom MRSA was isolated during the study period standard demographic and clinical data were requested and period prevalence/1000 discharges was calculated. All 45 microbiology laboratories surveyed responded. MRSA was isolated from 448 patients during the two-week period. The period prevalence of MRSA was 16.5/1000 discharges. Males aged > or = 65 had the highest rate (50/1000 discharges). Half of all isolates were from patients in surgical or medical wards, but 4% were from community-based sources such as GPs, nursing homes and hospices. Thirty-two percent of MRSA patients were infected rather than colonized. MRSA is clearly a significant problem in Ireland. While it is largely a hospital problem at present, the increasing trend towards day procedures and shorter hospital stay means that infection will increase in the community.
    • A national survey of prevalence of cardiopulmonary resuscitation training and knowledge of the emergency number in Ireland.

      Jennings, S; Hara, TO; Cavanagh, B; Bennett, K; Department of Public Health, Health Service Executive, Dr. Steevens Hospital, Dublin 8, Ireland. (2009-07-06)
      AIM: The aim of this survey was to establish prevalence of cardiopulmonary resuscitation (CPR) training within the last 5 years and reasons preventing training and initiation of CPR in Ireland as well as awareness of the emergency numbers. METHODS: An in-home omnibus survey was undertaken in 2008 with quota sampling reflecting the age, gender, social class and geography of Ireland. RESULTS: Of the 974 respondents, 23.5% had undergone CPR training in the previous 5 years with lower social class and age 65 years and older significantly less likely to be trained. The workplace was both a major source of awareness as well as training for those trained. In the untrained group lack of awareness of the need for CPR training was the most significant reason for non-training. Cost was not cited as a barrier. 88.9% of people gave a correct emergency number with geographical variation. Notably, the European emergency number 112 was not well known. CONCLUSION: Previous Irish and American population targets for CPR training have been surpassed in Ireland in 2008. New internationally agreed targets are now required. Meanwhile older people and those in lower socio-economic groups should be targeted for training. Awareness of at least one emergency number is very high in Ireland. Some geographical variation was found and this should be studied further.
    • National women's strategy 2007 - 2016

      Department of Justice, Equality and Law Reform (The Stationary Office, 2007-04)
    • NCCP breast cancer referral guidelines – are breast cancer patients prioritised?

      Neary, M; Lowery, A; O'Conghaile, M (Irish Medical Journal, 2011-02)