The Irish Trainee Emergency Research Network (ITERN): five years of collaboration.

In 2018, a group of Irish emergency medicine (EM) trainees recognised their common interest in collaborative research and the difficulties that trainees can encounter when trying to broaden their research capacity, prompting the beginning of the Irish Trainee Emergency Research Network (ITERN) journey. Trainee-led collaboratives have been shown to be feasible and have the potential to deliver impactful research projects, generating an evidence base that may not have been possible without collaboration. This article describes the successes and achievement of ITERN and describes the processes and challenges that a trainee-led research network can encounter. The authors believe that trainee-led collaboratives can deliver powerful and impactful research for patients and broaden the research capacity of individuals, hospitals, and groups of healthcare professionals.

Attitudes and knowledge of emergency doctors towards end-of-life care in the emergency department: a national survey.

BACKGROUND: Emergency departments (EDs) are seeing an increase in patients requiring end-of-life (EOL) care. There is paucity of data of attitudes and knowledge of physicians providing EOL care in the ED both internationally and in Ireland. OBJECTIVE: The aim of this project was to assess the attitudes and knowledge of ED physicians towards EOL care. METHODS: This was a cross-sectional electronic survey of ED physicians working in Irish EDs and was facilitated through the Irish Trainee Emergency Research Network over a 6-week period. The questionnaire covered the following domains: demographic data, awareness of EOL Care, views and attitudes towards EOL care. RESULTS: Of a potential 679 respondents, 441 responses were received, of which 311 (response rate of 44.8%) had fully completed the survey across 23 participant sites. Majority of the respondents were under the age of 35 (62%), were male (58%) and at Senior House Officer level (36%). In terms of awareness, 32% (98) of respondents were not aware of palliative care services in their hospitals while only 29% (91) were aware of national EOL guidance. Fifty-five percent (172) reported commencing EOL care in the ED, however 75.5% (234) respondents reported their knowledge of EOL care to be limited or non-existent. Only 30.2% respondents felt comfortable commencing EOL care in the ED without speciality team input. There appears to be a lack of clarity on the roles and responsibilities of emergency medicine nurses and doctors in the care of the dying patient in ED with only 31.2% (95) being clear on this role. Significant differences were observed associated with clinical experience and physician grade. CONCLUSION: This study has highlighted a lack of awareness and knowledge of EOL care particularly amongst less experienced emergency medicine doctors. Formalized training and education programs in the provision of EOL care in the ED will improve comfort levels and knowledge amongst the emergency medicine doctors and improve the quality of care provided.

Head and neck injury in major trauma in Ireland: a multicentre retrospective analysis of patterns and surgical workload.

PURPOSE: Head and neck injuries are common in major trauma patients, but the prevalence is poorly documented in the literature. This study aims to investigate this further, particularly in the context of increasing development of Irish and European trauma systems. AIMS: To determine the prevalence of, and patterns behind head and neck injury in major trauma in an Irish population. MATERIALS AND METHODS: The Trauma Audit Research Network database was analysed for major trauma patients (injury severity score > 15) with head and neck injuries admitted to any of the 26 participating hospitals in the Republic of Ireland between 2014 and 2017. The data was studied for patterns in the epidemiology of injuries and outcomes. RESULTS: A total of 5364 patients were identified. Males were affected more than females (M:F 2.1:1). The most common mechanism of injury was falls. There were 1272 counts of soft tissue injury, and 5814 counts of bony injury recorded within the cohort. Twenty-six percent of patients underwent some form of surgical procedure. Median length of hospital stay was 8 days, and the 30-day survival rate was 90%. CONCLUSIONS: A substantial number of Irish major trauma patients of all ages and genders sustain some form of head and neck injury. It produces significant injury and surgical workload involving input from multiple disciplines.

Out-of-hospital cardiac arrest quality of life follow-up study of survivors in Munster, Ireland.

Quality of life of out-of-hospital cardiac arrest (OHCA) survivors is believed to be as important as a factor in resuscitation outcome as the survival rate. The aim of this investigation is to assess the quality of life outcomes of survivors of out-of- hospital cardiac arrest in the Munster region. OHCAR was used to identify survivors who were contacted in writing to invite their participation. Internationally standardized phone based questionnaires were utilized to assess quality of life. The mean age of participants was 63.5 years with 85% male and 15% female. Eighty percent (n = 16) had no issues with mobility, 90% (n = 18) had no issues with personal care, 90% could undertake all usual activities, and 90% (n = 18) experienced no anxiety or depression. In conclusion, survivors of OHCA in the Munster area, who participated in this study, survive at a very high functional level.

Sex differences in baseline and drug-induced behavioural responses in classical behavioural tests.

Behavioural pharmacology relies on animal models which are primarily validated using the male laboratory rat. Many researchers solely employ male animals in studies; this is primarily due to concerns about the impact of variations in the female estrous cycle on behavioural responses. The objective of the present study therefore was to examine whether sex has any effect in some commonly employed behavioural pharmacology tests. Male and female Sprague Dawley rats were examined in the following behavioural pharmacology tests: diazepam (DZP) effects on anxiolytic behaviour in the elevated plus maze (EPM); desipramine (DMI) effects on immobility time in the forced swim test (FST); amphetamine (AMP) and apomorphine (APO) effects on locomotor activity in the homecage monitoring apparatus (HCMA). Baseline investigations revealed that females were more active than males in all three tests. DZP increased open arm time and entries for males but not for females. Similarly, significant reduction in immobility time with DMI was found for males in the FST, with no effect observed in females. There was a significant effect of AMP dose on distance moved for both sexes; the peak locomotor stimulating effects were seen following 1-2 mg kg⁻¹ AMP doses for males, while 0.5 mg kg⁻¹ produced the greatest effect in females. APO impaired locomotor activity in both sexes. These results demonstrate that male and female rats respond differently to psychotropic drugs. The absence of female responses to the effects of DZP and DMI in the EPM and FST respectively was due to the high baseline activity levels seen with females; thus behavioural tests must be designed to account for sex differences in baseline behaviours to allow for unambiguous extrapolation of the results.