Impact of enhancing GP access to diagnostic imaging: A scoping review.

BACKGROUND: Direct access to diagnostic imaging in General Practice provides an avenue to reduce referrals to hospital-based specialities and emergency departments, and to ensure timely diagnosis. Enhanced GP access to radiology imaging could potentially reduce hospital referrals, hospital admissions, enhance patient care, and improve disease outcomes. This scoping review aims to demonstrate the value of direct access to diagnostic imaging in General Practice and how it has impacted on healthcare delivery and patient care. METHODS: A search was conducted of 'PubMed', 'Cochrane Library', 'Embase' and 'Google Scholar' for papers published between 2012-2022 using Arksey and O'Malley's scoping review framework. The search process was guided by the PRISMA extension for Scoping Reviews checklist (PRISMA-ScR). RESULTS: Twenty-three papers were included. The studies spanned numerous geographical locations (most commonly UK, Denmark, and Netherlands), encompassing several study designs (most commonly cohort studies, randomised controlled trials and observational studies), and a range of populations and sample sizes. Key outcomes reported included the level of access to imaging serves, the feasibility and cost effectiveness of direct access interventions, GP and patient satisfaction with direct access initiatives, and intervention related scan waiting times and referral process. CONCLUSION: Direct access to imaging for GPs can have many benefits for healthcare service delivery, patient care, and the wider healthcare ecosystem. GP focused direct access initiatives should therefore be considered as a desirable and viable health policy directive. Further research is needed to more closely examine the impacts that access to imaging studies have on health system operations, especially those in General Practice. Research examining the impacts of access to multiple imaging modalities is also warranted.

The availability of general practice in Ireland's Mid-West Region: does the 'Inverse Care Law' still apply?

INTRODUCTION: The 'Inverse Care Law' suggests the availability of good medical care tends to vary inversely with the needs of the local population. Dr Julian Tudor Hart's observations related to lack of access to care for those in both socially deprived and geographically remote areas. In this study, we aim to examine if the 'Inverse Care Law' is still relevant to GP service provision in the Mid-West of Ireland. METHODS: GP clinic locations in Limerick and Clare were identified using the Health Service Executive (HSE) Service Finder and geocoded. GeoHive.ie was used to determine Electoral District (ED) centroids across the Mid-West. The shortest linear distance to a GP clinic was calculated for each ED. PobalMaps.ie was used to determine population and social deprivation scores of each ED. RESULTS: In total, 122 GP practices were identified across 324 EDs. The average travel distance to a GP clinic in the Mid-West is 4.7 km. Limerick City EDs had the smallest patient population per GP clinic and were all found to be within 1.5 km of a GP clinic. Proximity to GP clinics did not correlate with deprivation. However, by removing GP clinics from the analyses, it was possible to determine how vulnerable different areas (rural vs urban, deprived vs affluent) are to potential changes in GP clinic availability in the future. DISCUSSION: People living in urban areas such a Limerick City have improved geographic accessibility to GP clinics compared with their rural counterparts. However, within urban areas assessed, GP clinics were rarely found in deprived areas. Therefore, remote and urban-deprived areas are far more vulnerable to negative proximity effects secondary to practice closures, suggesting the principles of the 'Inverse Care Law' may still be active in the Mid-West of Ireland.

GPs at the Edge: a quantitative description of Irish Rural General Practice.

INTRODUCTION: Currently, more than 1.6 million Irish people live rurally. Rural populations in Ireland are older and have more health needs compared with younger urban areas. Meanwhile, since 1982, the proportion of general practices in rural areas has decreased by 10%. In this study, we look at new survey data to investigate the needs and challenges of rural general practice in Ireland. METHODS: This study will make use of survey responses from the 2021 membership survey by the Irish College of General Practitioners (ICGP). The anonymous, online, survey was sent by email to the ICGP membership in late 2021, with a series of questions pertaining to practice location, and prior experience of living and working in a rural area designed specifically for this project. A series of statistical tests will be undertaken as appropriate for the data. RESULTS: This study is ongoing; we aim to present data on the demographics of those working in rural general practice and related factors. DISCUSSION: Previous research has shown that people who grew up or trained in rural areas are more likely to work there after qualifying. As the analysis of this survey continues, it will be important to see if this pattern is evident here as well.

COVID-19 in north-western Europe: learning lessons from open data.

INTRODUCTION: The COVID-19 pandemic has caused huge disruption to all communities and health care worldwide. This ongoing pandemic has encouraged international collaboration and cooperation, and this important activity needs to intensify further. Open Data sharing offers researchers the opportunity to compare public health and political responses and subsequent COVID-19 trends. METHODS: This project uses Open Data to summarise trends relating to COVID-19 cases, deaths and eventual engagement with vaccination campaigns for six countries in the Northern Periphery and Arctic Programme (i.e. Ireland, Northern Ireland, Scotland, Finland, Sweden, Norway). RESULTS: Countries examined fell into two groups - countries that achieved near elimination between smaller outbreaks, and those that did not. Rural areas generally experienced slower increases in COVID-19 activity than urban areas, presumably due to the lower density of population and other factors. Rural areas experienced approximately half the COVID-19 deaths when compared with more urbanised regions within the same countries. Interestingly, countries that opted for a more local approach to public health management, particularly Norway, seemed to control outbreaks more effectively than those with a more centralised approach. DISCUSSION: While contingent on the quality and reach of testing and reporting systems, Open Data can offer us useful insights to appraise national responses and provides context for public health-related decision making.

GPs at the Edge: GATE, a qualitative investigation into the experience of delivering care in Irish Rural General Practice.

INTRODUCTION: Over a third of Irish people live rurally. However, only a fifth of Irish general practices are located in rural communities and longstanding issues such as distance to other health services, professional isolation, and recruitment and retention of rural healthcare professionals (HCPs) threaten rural general practice's sustainability. This ongoing study seeks to understand what it is like to provide care to Ireland's rural and remote populations. METHODS: This is a qualitative study, consisting of semi-structured interviews with GPs and practice nurses working in practices that serve rural populations across Ireland. Topic guides were developed after a literature review and a series of pilot interviews. Interviews are scheduled to be finished in February 2022. RESULTS: This study is ongoing so results are yet to be finalised. Initial key themes include a great level of professional satisfaction that GPs and practice nurses experience from caring for entire families from the 'cradle to grave' and from the complex issues they face in practice. A rural general practice acts as the medical port-of-call for patients, with both practice nurses and GPs having experiences with emergency and pre-hospital medicine. A key difficulty identified is access to secondary and tertiary care services, with distance to services and high demand as the main barriers. DISCUSSION: Working in rural general practice gives HCPs great professional satisfaction but access to other health services remains a challenge. Final conclusions may be compared with other delegates' experiences.

Collaboration to reduce antibiotic use and resistance and identify opportunities for improvement and awareness (CARA).

INTRODUCTION: CARA is a five-year Health Research Board (HRB) project. Superbugs cause resistant infections that are difficult to treat and pose a serious threat to human health. Providing tools to explore the prescription of antibiotics by GPs may help identify gaps where improvements can be made. CARA's aim is to combine, link and visualise data on infections, prescribing and other healthcare information. METHODS: The CARA team is creating a dashboard to provide GPs with a tool to visualise their own practice data and compare this with other GPs in Ireland. Anonymous patient data can be uploaded and visualised to show details, current trends and changes in infections and prescribing. The CARA platform will also provide easy options to generate audit reports. RESULTS: After registration, a tool for anonymous data upload will be provided. Through this uploader, data will be used to create instant graphs and overviews as well as comparisons with other GP practices. With selection options, graphical presentations can be further explored or audits generated. Currently, few GPs are involved in the development of the dashboard to ensure it will be efficient. Examples of the dashboard will be shown at the conference. DISCUSSION: The CARA project will provide GPs with a tool to access, analyse and understand their patient data. GPs will have secure accounts accessible through the CARA website to allow easy anonymous data upload in a few steps. The dashboard will show comparisons of their prescribing with other (unknown) practices, identify areas for improvement and conduct audit reports.

General practice Electronic Medical Record (EMR) data: exploring patient and healthcare practitioner activity from 2019 to 2021.

INTRODUCTION: General practice (GP) in Ireland is almost entirely computerised. Computerised records hold great potential for large-scale data analyses but existing software packages do not readily provide such analyses. For a profession facing considerable workforce and workload challenges, harnessing GP electronic medical record (EMR) data can facilitate critical analysis of general practice activity and can highlight important trends for service planning. METHODS: Medical students in the ULEARN network of general practices using the GP EMR 'Socrates' in the Midwest region of Ireland supplied our research team with three reports on consulting and prescribing activity from 1 January 2019 to 31 December 2021. The three reports, anonymised on site using custom software, detailed chart activity (i.e. types of notes recorded in patient charts), consultation types and headline prescribing figures. RESULTS: Preliminary analyses of data from these sites reveal that while consultation activity faltered in the early stages of the pandemic, telephone consultations and prescribing continued apace. Interestingly, childhood vaccination appointments did not falter, whereas cervical smears, which were not allowed due to processing laboratory constraints, stopped for many months of the pandemic. There are differences between how different doctors in different practices record consultation types, which weakens some analyses, particularly when estimating face-to-face consultation rates. DISCUSSION: GP EMR data have great potential for highlighting workforce and workload pressures being experienced by Irish general practitioners and GP nurses. Small modifications to how information is recorded by clinical staff would further strengthen analyses.

Lessons learned from a pandemic: implications for a combined exercise and educational programme for medical students.

BACKGROUND: The 'MED-WELL' programme is a combined exercise and educational intervention designed to promote well-being among medical students and educate students about prescribing exercise as medicine in clinical practice. Due to COVID-19 public health restrictions of social distancing the 'MED-WELL' programme was offered online instead of in-person in 2021. The aim of this study is to compare the experiences of participants in the 'MED-WELL' programme online to those that previously participated in the same programme in-person to understand the student experience and optimize programme delivery. METHODS: Purposive sampling was used to recruit 20 participants to a qualitative study using semi-structured interviews. Ten study participants took part in the 'MED-WELL' programme when it was offered in-person, and the other ten study participants took part in the programme when it was offered online. All interviews were audio-recorded and transcribed using Microsoft Teams. A combined inductive and deductive approach was used for analysis. An inductive thematic analysis was utilized to categorize data into higher order codes, themes, and overarching themes. The theory of online learning provided the theoretical framework for a deductive approach. RESULTS: Analysis of the data produced five overarching themes: 'student-student', 'student-teacher', 'student-content', 'student-environment', and 'effects of a pandemic'. The first four themes detail distinct types of interaction that participants had with various entities of the 'MED-WELL' programme and the effects that these interactions had on participant experiences. 'Effects of a pandemic' refers to the context of delivering the 'MED-WELL' programme online during a pandemic and how this mode of delivery influenced participants and the programme. CONCLUSIONS: Optimizing the 'MED-WELL' programme relies on an understanding of how participants interact with different entities of the programme and are motivated to attend and engage. Participants tended to favour an in-person mode of delivery, however certain advantages of delivering the programme online were also identified. The findings from this study can be used to inform similar experiential and educational exercise interventions, and may help plan for potential future restrictions on in-person educational and exercise-based programmes.

Sentiment analysis of user feedback on the HSE's Covid-19 contact tracing app.

BACKGROUND: Digital Contact Tracing is seen as a key tool in reducing the propagation of Covid-19. But it requires high uptake and continued participation across the population to be effective. To achieve sufficient uptake/participation, health authorities should address, and thus be aware of, user concerns. AIM: This work manually analyzes user reviews of the Irish Heath Service Executive's (HSE) Contact Tracker app, to identify user concerns and to lay the foundations for subsequent, large-scale, automated analyses of reviews. While this might seem tightly scoped to the Irish context, the HSE app provides the basis for apps in many jurisdictions in the USA and Europe. METHODS: Manual analysis of (1287) user reviews from the Google/Apple playstores was performed, to identify the aspects of the app that users focused on, and the positive/negative sentiment expressed. RESULTS: The findings suggest a largely positive sentiment towards the app, and that users thought it handled data protection and transparency aspects well. But feedback suggests that users would appreciate more targeted feedback on the incidence of the virus, and facilities for more proactive engagement, like notifications that prompt users to submit their health status daily. Finally, the analysis suggests that the "android battery" issue and the backward-compatibility issue with iPhones seriously impacted retention/uptake of the app respectively. CONCLUSION: The HSE have responded to the public's desire for targeted feedback in newer versions, but should consider increasing the app's proactive engagement. The results suggest they should also raise the backward compatibility issue, regarding older iPhones, with Apple.

Head-Only Stunning of Turkeys Part 2: Subjective and Objective Assessment of the Application of AC and DC Waveforms.

Electrical stunning is likely to remain an important stunning method for turkeys at slaughter. The purpose of this study is to understand the application of various waveforms of alternating current (AC) and pulsed direct currents (DC), head-only, to turkeys and to improve the effectiveness of handheld stunning of turkeys. We evaluated the effectiveness of stunning by documenting physical responses and recording electroencephalograms (EEGs). For the assessment of physical responses, the stunning voltage was varied depending on the proportion of animals effectively stunned at a certain voltage level. If all turkeys in a group of 10 were stunned, the voltage was decreased, and the next group was stunned. This was repeated until not all turkeys showed signs of being effectively stunned. The experiment was then repeated at the voltage level just above the one that showed incomplete effective stunning. The effects of the stunning on the EEG recording was assessed in 16 turkeys to measure the occurrence of epileptiform EEGs, in 14 turkeys to assess epileptiform EEGs after neck-cut (bleeding), and in 14 turkeys to assess the effect of increased voltage and reduced frequency on epileptiform EEGs. Assessing EEGs in a laboratory setting contributes considerably to the understanding of electrical stunning procedures. Voltages between 125 and 250 V, depending on the waveform assessed, were effective in producing an effective stun in turkeys in this study.

Head-Only Stunning of Turkeys Part 1: The Minimum Voltage Necessary to Break Down the Inherent High Resistance.

Pre-slaughter stunning is required for humane slaughter. For turkeys, head-only electrical stunning is most often used by small scale producers. To ensure immediate and effective stunning, the impedance (resistance) of the tissue of the head of the animal situated between the two electrodes needs to be overcome swiftly. The impedance is a function of the voltage and decreases non-linearly with increasing voltage. In this paper, we describe a method to assess the minimum voltage needed at which the impedance no longer decreases, that is likely to produce an effective stun. For ethical reasons, gas stunned, electrically naïve turkeys were used to measure impedance at various levels of voltage and current. Several combinations of voltage and frequency, alternate current (AC), direct current (DC) and pulsed DC, were identified that would be sufficient to achieve the maximum decrease in the impedance, and therefore would allow the highest current and the most effective stun. A minimum, expressed as Root Mean Squared voltage, of 150 V and 50 Hz. would be required in AC, 175 V in pulsed DC at 30% cycle (150 at 50% cycle), and 225 V if voltage spikes of very short duration were used. Sinusoidal AC applied at 150 V, 50 Hz was selected for further testing.

The COVID-19 pandemic in Ireland: An overview of the health service and economic policy response.

OBJECTIVES: To outline the situation in Ireland with regard to the COVID-19 pandemic. METHODS: Analyse the evolution of the COVID-19 pandemic in Ireland. Review the key public health and health system responses. RESULTS: Over 1700 people have died with COVID-19 by July 19th while almost 3000 people had been admitted to hospital with COVID-19. A high proportion of the deaths occurred in nursing homes and other residential centres who did not receive sufficient attention during the early phase of the pandemic. CONCLUSIONS: Ireland's response to the COVID-19 crisis has been comprehensive and timely. Transparency, a commitment to a relatively open data policy, the use of traditional and social media to inform the population, and the frequency of updates from the Department of Health and the Health Services Executive are all commendable and have led to a high level of compliance among the general public with the various non-medical measures introduced by the government.