The retention of training doctors in the Irish health system.

BACKGROUND: There is limited quantitative evidence on the migration patterns of training doctors in Ireland. The aim of this study is to estimate the number of trainee doctors leaving the Irish health system and the numbers returning. METHODS: This study uses administrative data to track the migration patterns of Irish trained doctors at various career stages. RESULTS: Eighty-four percent of interns who commenced intern training in 2015 subsequently commenced a basic specialist training (BST) or general practice (GP) training programme in subsequent years (2016-2021). Of those who completed BST training in 2017, 75% went on to higher specialist training (HST) in Ireland. In 2021, of the 2016 cohort of doctors awarded Certificates of Satisfactory Completion of Specialist Training (CSCST), 68% are employed in Ireland and 32% are abroad or unknown. Of the 2016 group that are abroad, the UK is the main country of practice. There are variations in the retention rate across disciplines; from the 2016 cohort, 52% of anaesthesiology CSCSTs were working in Ireland in 2021 compared to 88% of psychiatry CSCSTs. CONCLUSION: Previous research has highlighted Irish doctor's intentions to migrate and intentions to return to Ireland. This study documents for the first time the extent to which Irish doctors are leaving and returning to the Irish health system from 2015 to 2021. The paper also gives a picture of variations across medical disciplines and the location of emigration of qualified specialists.

Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project.

BACKGROUND AND OBJECTIVES: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. METHODS: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. RESULTS: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. CONCLUSION: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia.

Regional anaesthesia in the elderly patient a current perspective.

PURPOSE OF REVIEW: The world's population is ageing. Although regional anaesthesia is well established, it seems there is limited evidence to support its use over general anaesthesia in the elderly. This review aims to examine recent publications of regional anaesthesia in relation to this specific patient subgroup. RECENT FINDINGS: There is a paucity of evidence specifically relating to regional anaesthesia in the elderly patient. Studies tend to be small, retrospective and can combine assessment of multiple surgical and anaesthetic techniques in single studies. Surgical stimulus and the associated stress response are linked with an increased risk of morbidity in elderly patients. Regional anaesthesia is associated with reduced morbidity, improved pain scores, improved patient satisfaction and reduced resource allocation. Regional anaesthesia can potentially offset some of the surgical stress response and should be considered as part of a multimodal and, where possible, the primary approach to anaesthesia and analgesia in the elderly patient. SUMMARY: Undoubtedly, peripheral nerve blocks improve analgesia and reduce opioid consumption and their associated side effects. This is beneficial in the perioperative care of elderly patients who may have less physiologic reserve to withstand these side effects. Future large prospective trials are required to evaluate the duration of action and safety profile of local anaesthetic agents and adjunct agents in the older patient.

Aerosolized intraperitoneal local anesthetic for laparoscopic surgery: a randomized, double-blinded, placebo-controlled trial.

BACKGROUND: Postoperative pain remains a significant challenge following laparoscopy. Aerosolized intraperitoneal local anesthetic (AILA) is a novel method to deliver local anesthetic. The aim was to evaluate aerosolized ropivacaine in pain management following laparoscopic Nissen fundoplication (LNF) and cholecystectomy (LC). METHODS: This prospective randomized double-blinded placebo-controlled trial enrolled consecutive patients undergoing LNF and LC. The treatment group (TG) received intraperitoneal ropivacaine (5 mL 1 % Naropin(®)) at CO2 insufflation via the AeroSurge(®) aerosolizer device through the camera port. The control group (CG) received 5 mL of saline in the same manner. Postoperative shoulder tip pain at rest 6 h postoperatively was the primary study endpoint, with secondary endpoints of shoulder and abdominal pain within the first 24 h, recovery room stay, hospital stay, and postoperative analgesia use. Pain scores were collected using the Verbal Rating Score. RESULTS: Eighty-seven patients were included in the final analysis (TG n = 40, CG n = 47). There was no significant difference between CG and TG at the primary endpoint. In the LC group, AILA significantly reduced shoulder tip pain at rest at 10 (p = 0.030) and 30 min (p = 0.040) and shoulder tip pain on movement at 10 (p = 0.030) and 30 min (p = 0.037). In the LNF group, AILA significantly reduced postoperative abdominal pain at rest at 6 h (p = 0.009). AILA reduced overall incidence of shoulder tip pain in the LC group (11.8 vs. 57.9 %, p = 0.004). CONCLUSION: This study did not demonstrate a significant difference between TG and CG in the primary endpoint, pain at 6 h postoperatively.

Determination Of The Efficacy And Side-effect Profile Of Lower Doses Of Intrathecal Morphine In Patients Undergoing Total Knee Arthroplasty.

BACKGROUND: Intrathecal (IT) morphine provides excellent post-operative analgesia, but causes multiple side effects including nausea and vomiting (PONV), pruritus and respiratory depression, particularly at higher doses. The lowest effective dose of spinal morphine in patients undergoing total knee arthroplasty is not known. METHODS: We evaluated the analgesic efficacy and side effect profile of 100 - 300 µg IT morphine in patients undergoing elective total knee replacement in this prospective, randomized, controlled, double-blind study. Sixty patients over the age of 60 undergoing elective knee arthroplasty were enrolled. Patients were randomized to receive spinal anaesthesia with 15 mg Bupivacaine and IT morphine in three groups: (i) 100 µg; (ii) 200 µg; and (iii) 300 µg. RESULTS: Both 200 µg and 300 µg IT morphine provided comparable levels of postoperative analgesia. However, patients that received 100 µg had greater pain postoperatively, with higher pain scores and a greater requirement for supplemental morphine. There were no differences between groups with regard to PONV, pruritus, sedation, respiratory depression or urinary retention. CONCLUSION: Both 200 µg and 300 µg provided comparable postoperative analgesia, which was superior to that provided by 100 mug IT morphine in patients undergoing total knee arthroplasty. Based on these findings, we recommend that 200 µg IT morphine be used in these patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT00695045.