Irish Journal of Medical Science

Supervised exercise for cardiovascular rehabilitation—the Limerick programme

Interns as medical educators: student and intern experiences from the intern-delivered teaching program at University Hospital Limerick Abstract Background The acquisition and assimilation of knowledge through history-taking and clinical skills practice are core aspects of training for medical students. Interns, who have recently graduated and have entered into clinical practice, are uniquely positioned to assume a pivotal role in student education. Aims The goal of this study was to evaluate feedback from both students as well as intern tutors on the intern-delivered teaching program at University Hospital Limerick (UHL) from 2015 to 2016. Methods Eighty-five interns participated in the program at UHL in 2015 and 2016, aiming to deliver four 1-h tutorials to 285 Year 3 or Year 4 students from UL Graduate Entry Medical (GEMS) Program. A flexible schedule focused on practical skills and knowledge translation was created with oversight from Lead Interns and Professor of Medicine, with administrative support. Feedback was assessed using anonymous survey questionnaires. Results The survey response rate was 74% in 2015 and 75% in 2016. Student feedback on the performance of intern tutors was positive. More than 50% of students deemed tutorials on history-taking and clinical examination as the most valuable. Over 76% of students indicated a desire to participate as tutors after graduation. Logistical issues in agreeing mutually suitable timeslots were identified as the major barrier for delivery of teaching. From the intern perspective, over 85% reported benefits in areas of professional development and knowledge consolidation. Conclusions Participation in intern-delivered teaching leads to clinical and educational benefits for both students and interns. However, several logistical barriers were identified and require refinement.

A novel approach using 3-D printing in the Irish National Centre for pelvic and acetabular surgery Abstract Background Complex pelvic fractures present the orthopaedic surgeon with many challenges. 3-D printed models may provide assistance in pre-operative planning, may lead to improvements in intra-operative (i) decision making and (ii) efficiencies (time reduction, blood loss reduction, screening reduction) and may result in improvements in post-operative outcomes (fracture reduction & quality of life). The models also provide hands-on opportunities for orthopaedic trainees and patients. This may result in improvements in (i) education/training regarding the management of pelvic and acetabular fractures for orthopaedic trainees and (ii) improvements in patient consenting and overall patient satisfaction. Design Single-centre, two orthopaedic surgeons (pelvic and acetabular fellowship trained), prospective observational study. Twenty patients with acute displaced pelvic/acetabular fracture(s); ten 3-D–printed pelvis and ten non-printed cases for comparison. The comparison cohorts were matched for fracture classification, sex and age. Outcome measures Classification assistance, intra-operative time, estimated blood loss, screening amount, post-operative reduction and infection, EQ-5D-5L, teaching/educational assistance and pre-operative counselling. Results The models provided more information regarding fracture pattern, however, this did not result in change of CT-planned approach/procedure or patient outcomes. The models scored highly on surgeon's questionnaire. The models were found to have a positive impact on trainee education and patient consenting/counselling. With regard to objective comparisons, there was no significant improvements in time-to-surgery, intra-operative time, estimated blood loss, screening amount, fracture reduction or infection rate. There was no significant difference in quality of life questionnaire ~ 12 months post-surgery (statistical tests used; Cohen's effect size and Fisher's exact test). Conclusions Whilst the authors recognize the positive subjective findings with respect to the use of 3-D printing in pelvic and acetabular trauma in our National Centre, objective findings were lacking.

A cross-sectional survey of services for young adults with life-limiting conditions making the transition from children's to adult services in Ireland Abstract Background Increasing numbers of young adults with life-limiting conditions are living into adulthood and consequently making the transition from children's to adult services. A poorly planned transition is associated with adverse outcomes such as non-adherence to treatment and loss to follow-up, together with negative social and emotional outcomes. However, there is little descriptive data on how organisations are currently managing transition. Aim To obtain an overview of organisational approaches to transition on the island of Ireland, and to explore important organisational factors that may influence the effectiveness of the process. Methods A cross-sectional questionnaire survey. One of the four Health Services Executive areas in the Republic of Ireland and the whole of Northern Ireland. Participants were service providers in statutory and non-statutory organisations providing transition services to young adults with life-limiting conditions. Results The survey was distributed to 55 organisations. The overall response rate was 29/55 (53%). The approach to transition most commonly used focused on interagency communication and collaboration. Key factors in an effective transition were reported as: early commencement; effective communication between the young adult, their family, and services; the availability of appropriate adult services; and effective preparation through collaboration with the young adult and their family. However, implementation of these processes was inconsistent. Conclusions The findings demonstrate that caring for young adults with life-limiting conditions presents a considerable challenge to organisations and that transition from children's to adult services is an important part of this challenge.

Correction to: PERioperative Fluid Management in Elective ColecTomy (PERFECT)—a national prospective cohort study The above article originally published with Christina Fleming and Irish Surgical Research Collaborative listed in the authorship line.

Automated quantification of foveal avascular zone and vascular density in Behçet's disease Abstract Purpose To measure the vascular density (VD) and foveal avascular zone (FAZ) area in patients with Behçet's disease (BD) obtained by optical coherence tomography angiography (OCTA). Methods VD and FAZ area in the deep and superficial retinal vascular networks were measured in all eyes. Results Thirty BD and 31 control subjects were included in the study. The mean overall VD measured in the entire scan was lower in BD compared with control group in both the superficial (49.52 ± 6.54 vs 53.57 ± 2.87%, respectively; p = 0.003) and deep (53.44 ± 7.44 vs 58.41 ± 3.01%, respectively; p = 0.002) areas. The FAZ in the BD group was significantly increased at the level of the superficial (0.52 ± 0.67 vs 0.28 ± 0.1 mm2, respectively; p = 0.05) and deep (0.91 ± 1.25 vs 0.39 ± 0.14 mm2, respectively; p = 0.024) areas compared with those of the control group. The deep and the superficial FAZ areas were positively correlated with disease duration and negatively with VA. Conclusion In the patients with BD, OCTA showed decreased VD in both the superficial and deep retinal vascular networks. Besides, the VA was correlated with the VD and FAZ.

Proceedings of the Psychiatry Section of the Royal Academy of Medicine in Ireland (RAMI) and the Faculty of Academic Psychiatry of the College of Psychiatrists of Ireland, BST and HST competition. Venue: Albert Theatre, Royal College of Surgeons, 123, St. Stephen's Green, Dublin 2 on Thursday 30 th May 2019

Awareness of atrial fibrillation—effectiveness of a pilot national awareness campaign Abstract Background Although atrial fibrillation (AF) causes one-third of strokes in Ireland, studies have shown that public awareness and knowledge of AF are poor. The Irish Heart Foundation conducted a national AF awareness campaign in 2013. Aims The aim of this study was to assess the effectiveness of the campaign in promoting awareness of AF in the general Irish population, by analyzing knowledge of AF at a population level pre- and post-campaign. Methods Two thousand people were surveyed before the campaign to establish baseline knowledge, and the survey was then repeated in a sample of 1000 people in 2 months after the end of the campaign. Results Awareness of AF was low, with 28% (560/2000) of those surveyed reporting they had heard of AF prior to the campaign and 30% (297/1002) after (p 0.347). Of those that had heard of the condition, 58% (174/300) in the pre-campaign group correctly identified AF as an irregular heartbeat compared with 35% (105/297) of the post-campaign group (p < 0.01). Conclusions Our study shows that overall public knowledge of AF in Ireland is generally poor. While this pilot national awareness campaign had no positive impact on awareness levels, there are several possible reasons for this including the limited funding allocation to the campaign. A further AF awareness campaign is planned for next year.

Irish Maternal Early Warning Score Abstract Early Warning Systems (EWS) track the physiological parameters of individual patients and trigger a response when the parameter threshold has been reached. The use of early warning scores in adult hospital medicine has been shown to be beneficial in facilitating the early recognition of the deteriorating patient, thereby enabling prompt treatment. In 2012, a standardised National Early Warning Score was introduced in Ireland for all non-pregnant patients. The 2007 Confidential Enquiry into Maternal and Child Health recommended that EWS be introduced into maternity practice. However, the unique physiological changes of pregnancy even in health means that any scoring system must be specially adapted. The Obstetric Early Warning Score (OEWS) aims to promote early recognition of the pregnant patient at risk of deterioration. In 2013, a standardised Irish Maternity Early Warning System (IMEWS) was introduced nationally. However, the scoring system is only part of the package, once triggered it needs to be effectively communicated and acted upon promptly by appropriately trained clinicians. Despite undoubted shortcomings, the international evidence to date is supportive of the beneficial role of the OEWS in preventing maternal morbidity. Further research is needed to improve the sensitivity and specificity of the OEWS and how to better integrate it into every-day clinical practice.

Development of a simulation-based sub-module in undergraduate medical education Abstract Background It is well documented that medical students struggle to bridge the theory-practice gap. Competently integrating classroom-taught skills into the clinical setting is a challenge. Methods A survey of final year medical students identified a lack of confidence in managing common clinical emergencies that are experienced in the Intern role. The researchers devised a new sub-module to include high-fidelity simulation in the undergraduate medical curriculum. This development was underpinned by an educational curriculum model. Students attended small group teaching using high-fidelity simulation training (Sim-Man 3G ™) and practiced managing common emergencies. Training sessions were facilitated by clinical tutors and anaesthetic lecturers. Cases were supplied by clinical staff. An evidence-based format was utilised as an integrative teaching method. Results A simulation-based sub-module based on Finks Taxonomy was planned, introduced and evaluated. Utilisation of a high-fidelity simulation-based approach to teaching had a marked effect on student's confidence in their ability to manage clinical emergencies. Students reported very positive attitudes to this new method of teaching, specifically related to the integration of previously acquired knowledge and skills. A hands-on practical approach in a safe learning environment was valued by students. Conclusions The module descriptor devised can be used as a template for further curricular reform. Simulation-based teaching is feasible in the undergraduate setting and may ease the transition to postgraduate teaching modalities.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com