Category: Ireland

Irish doctors trained to save by the nose

Can junior doctors learn to spray a life-saving medication into noses of people who overdosed on opioids? A new study from Ireland attempted to answer the question.

Overdose is the most common cause of fatalities among opioid users. Naloxone is a life-saving medication for reversing opioid overdose. In Ireland, it is currently available to ambulance and emergency care services, but General Practitioners (GP) are in regular contact with opioid users and their families. This positions them to provide naloxone themselves or to instruct patients how to use it. The new Clinical Practice Guidelines of the Pre-hospital Emergency Care Council of Ireland allows trained bystanders to administer intranasal naloxone.

We describe the development and process evaluation of an educational intervention, designed to help GP trainees identify and manage opioid overdose with intranasal naloxone.

Participants (N = 23) from one postgraduate training scheme in Ireland participated in a one-hour training session. The repeated-measures design, using the validated Opioid Overdose Knowledge (OOKS) and Attitudes (OOAS) Scales, examined changes immediately after training. Acceptability and satisfaction with training were measured with a self-administered questionnaire.
Knowledge of the risks of overdose and appropriate actions to be taken increased significantly post-training [OOKS mean difference, 3.52 (standard deviation 4.45); P < 0.001]; attitudes improved too [OOAS mean difference, 11.13 (SD 6.38); P < 0.001]. The most and least useful delivery methods were simulation and video, respectively.

Appropriate training is a key requirement for the distribution of naloxone through general practice. In future studies, the knowledge from this pilot will be used to inform a train-the-trainer model, whereby healthcare professionals and other front-line service providers will be trained to instruct opioid users and their families in overdose prevention and naloxone use.
BMC Medical Education 2015, 15:206  doi:10.1186/s12909-015-0487-y
The electronic version of this article is the complete one and can be found online at:http://www.biomedcentral.com/1472-6920/15/206

Writing Together: Do Too Many Cooks Spoil the Broth?

July 29: Nurse Liz Charalambous has shown how a Facebook group can really help boost writing (careers, June 3). We would like to take this idea one step further and argue that, contrary to a commonly held notion, ‘too many cooks do not spoil the broth’ when it comes to group writing. Instead, this approach fosters collaboration between writers, as Ms Charalambous suggests, and which has also been our experience.
Nursing Standard is the UK’s best selling nursing journal and the ultimate resource for students and fully qualified nurses.

The University of Limerick and University College Dublin primary mental healthcare research writing group recently skyped bimonthly to discuss a short piece of research written by one of four post-doctoral members.
The group read the sample in advance and discussed it with the author, facilitating her to think through her ideas in a supportive environment. Once the group reviewed and discussed the text, the author revised it, combined it with the rest of the article, and emailed it to the principal investigator.
The principal investigator and the author then finished the paper and emailed it out for review to all named co-authors. This way, the authorship was clearly defined, managed and assigned as per the necessary guidelines. The broth was ready and we had all helped to cook it.
J Klimas, D Swan, G McCombe and AM Henihan, University of Limerick, University College Dublin, Kings College London and University of British Columbia 

Read the article in the Nursing Standard Volume 29, Issue 48, 29 July 2015 at: http://journals.rcni.com/loi/ns 

Using Doctors Notes to See How They Treat people with Mental Health Disorders: New study out now

April 9th: Prevention and treatment of mental disorders challenge primary care doctors worldwide. Most of them use electronic medical records (EMRs) to keep track of their patients. A team of students and scientists from University of Limerick was led by Dr Cullen and wanted to see how doctors record mental health disorders in their records. They wanted to find out whether these notes can be used for research.


The researchers randomly sampled 690 patients from seven general practices in Ireland (age from18–95, 52% male, 52% low-income).

A mental disorder (most commonly anxiety/stress, depression and problem alcohol use) was recorded in the clinical records of 139 (20%) during the 2-year study period. While most patients with the common disorders had been prescribed medication (i.e. antidepressants or benzodiazepines), a minority had been referred to other agencies or received psychological interventions. ‘Free text’ consultation notes and ‘prescriptions’ were how most patients with disorders were identified. Diagnostic coding alone would have failed to identify 92% of patients with a disorder.
Although mental disorders are common in general practice, this study suggests their formal diagnosis, disease coding and access to psychological treatments are priorities for future research efforts.
Citation for the original study:  M. Gleeson, A. Hannigan, R. Jamali, K. Su Lin, J. Klimas, M. Mannix, Y. Nathan, R. O’Connor, C. O’Gorman, C. Dunne, D. Meagher and W. Cullen. Using electronic medical records to determine prevalence and treatment of mental disorders in primary care: a database study. Irish Journal of Psychological Medicine, available on CJO2015. doi:10.1017/ipm.2015.10. 
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9641472&fulltextType=RA&fileId=S0790966715000105

How to go about getting a postdoc position? Finding funding

There probably isn’t a simple answer to this question. Everybody has a different experience. My path was one of finding my own funding to do what I liked. Other people get postdocs via other routes, but I’d hope that my story bellow illustrates one of the paths people can take.

My mentor helped me identify funding calls and write funding applications. Then, I applied for everything and some of the applications were successful. Keeping up with the current funding calls via Research Newsletters and email alerts, such as Find A Phd, helped me too. I met the collaborators for my projects at conferences and seminars.

 
My experience is from Ireland, although I have a Slovakian PhD in Social Psychology(04/2011).
First, as a Research Assistant, I applied for and was successful with getting a Cochrane Training Fellowship to complete a Cochrane Systematic review over two years – 2 days p/week – from the Health Research Board Ireland (2010-12). The fellowship examined psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. The absence of evidence on the subject helped us to identify priorities for research.  To find out more about the Cochrane Systematic reviews of literature, go to: www.cochranecollaboration.org
Towards the end of my two-year Cochrane Fellowship, my Irish supervisors offered me two complementary part-time postdoc positions, both of which I accepted. The first was a three-year position in emergency medical science research. The second was a one-year position developing new projects in primary care settings and supervising medical students (2012-13). From a personal perspective, teaching literature reviews to medical students taught me how to address a training gap through addiction research education for medical students.
At the same time, I applied for two other grants. First was a three-year feasibility study in primary care from Health Research Board Ireland (Co-applicant). Second, an INVEST drug abuse fellowship from the National Institute for Drug Abuse – NIDA (Fellow). The feasibility study was a direct result of our efforts to highlight the problem of alcohol consumption among people receiving methadone treatment. We’ve trained family physicians in psychosocial interventions for concurrent problem and drug use disorders. Hence the title for the PINTA study.
Both were successful. Thanks to the patience and flexibility of my supervisors, I was able to combine and merge all of these opportunities. The INVEST postdoctoral fellowship was a six months job in at Oregon Health and Science Universityin Portland, OR, studying implementation of alcohol SBIRT in primary- versus secondary-care based opioid agonist treatment (2013). Our poster at the Annual Symposium of the Society for the Study of Addiction described qualitative component of the study. Training health care professionals in delivering alcohol SBIRT is feasible and acceptable for implementation among opioid agonist patients; however, it is not sufficient to maintain a sustainable change. After INVEST, I returned back to my composite Irish postdoc.
Eight months after the return back to Ireland, and one year before the end of my three-year Irish postdoc, I received another fellowship from the Irish Research Council. This International Career Development Award is co-funded by a European Union scheme called Marie Sklodowska Curie Actions. To improve the addiction medicine education for doctors (BEAMED), I’ll do an external and independent evaluation of the addiction medicine fellowship and plan a similar training in Ireland (2014-17). To learn more about the Marie Cure awards, go to: http://ec.europa.eu/research/mariecurieactions/

Families of opioid users in Ireland may be given drug to stop overdose deaths

Article from The Sunday Times, 21 September 2014, p4

The department of healthis reviewing distribution of Naloxone, a drug that reverses overdose, to buddies and families of heroin users. A similar scheme is in use in Britain. The department is in discussions with the Health service executive (HSE) to make the emergency drug more widely available. Currently, it is a prescription-only medication and can only be used by the person for whom it is prescribed, or by ambulance crews and medical staff.
[…]
On July 6th, 2012, The Ana Liffey Drug Project, a national addiction service, set up a Naloxone Advisory Group. Tony Duffin, the group’s director, said that while the government’s discussions on Naloxone are welcome, it would be more beneficial to fast-track legislative changes. “I don’t know why we haven’t prioritized this in Ireland,” he said. “It’s an innocuous drug. Its only purpose is to stop opioids working. If you haven’t taken opioids, it won’t have any effect. It’s a WHO recommended medicine, so the evidence is clear. It is important that we see it widely available so we can save people’s lives.”
A [our] study* published last week, which was compiled by the medical school at UCD and the Dublin Fire Brigade recorded 496 overdoses over a 12-month period, 13 of which were fatal. The majority of these were young men on the street, including in affluent areas of south Dublin. Most overdoses occurred in daytime, with a high incidence within 1000 meters radius of addiction services. Gerard Bury, a professor in general practice at UCDand one of the authors of the research, said: “Literature from other countries shows that bystanders, peers, or family members of overdose victims are most often the initial emergency responders and are best positioned to intervene immediately when the first overdose symptoms appear. These lay persons save lives if they are provided with Naloxone.”
Bury said Naloxone in a form of intranasal spray, available in America and Scotland, may be a more effective intervention than the injectable type planned by the department. “The Department of Health statement doesn’t indicate any intention to address the issue of the intranasal route, which, they told us, contravened the current regulations,” he said. “There isn’t any of the sense of urgency which you might expect in dealing with a situation in which people are literally dying in the streets.”
To read the magazine article, go to: http://www.thesundaytimes.co.uk/sto/
Related articles:
*Cited study: Urban Overdose Hotspots: A 12-Month Prospective Study in Dublin Ambulance Services http://www.ajemjournal.com/article/S0735-6757(14)00510-5/abstractby Jan Klimas, PhD, Martin O’ReillyMairead Egan, Bc, Helen Tobin, BSc, Gerard Bury, MD. Published Online: July 30, 2014
See also, my previous posts summarizing the quoted study: Urban Overdose Hotspots: New Paper out Now
Dublin ambulances see an opioid overdose every day; many times near the methadone clinics. Do people shoot heroin around methadone clinics? Yes. The common sense confirms anecdotal evidence from everyday experience of clinic staff and methadone users. Although this is no rocket science for most of us, it’s much harder to prove it. Regardless of the location, the high number of overdoses in Dublin calls for an immediate distribution of the heroin antidote – Naloxone. Visit my previous post for more info on our pilot Naloxone project.