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Biomedical subjects

A W Murphy

Publications and source records attributed to A W Murphy.

52 records · Page 3Linked to original sources
PubMed1992

Pre-hospital management of acute myocardial infarction.

Two-hundred and eleven Irish GPs responded to a questionnaire survey of their experience and management of acute myocardial infarction (MI) and their attitudes to the use of thrombolytic therapy Three-quarters of the respondents felt they dealt with three or more MIs per year; most felt that the majority of MIs were initially seen by a GP. Diagnosis is based on clinical findings; only 11% routinely take an ECG. Management is largely oriented to relief of pain but intravenous narcotics are only used by a minority. Hospital referral for suspected acute MI was the preferred choice for almost all GPs in a variety of patient-care scenarios. Home care for MI was chosen only for a minority of elderly patients when some hours had elapsed since the onset of symptoms. Definitive guidelines on the pre-hospital use of thrombolysis are not yet available. However, eighty per cent of respondents in this study feel that thrombolysis is beneficial and many feel that it has value in the pre-hospital situation. Respondents identified educational, organisational and financial problems to be overcome before this could happen.

Adult↗
PubMed1992

Awareness of heart attack signals and cardiac risk markers amongst the general public in Dublin.

Following myocardial infarction, early access to medical care is essential. In order to assess the ability to recognise and manage heart attack and its risk factors, 302 members of the public were surveyed. A surprisingly comprehensive knowledge base was revealed, together with apparently appropriate ideas about the management of myocardial infarction and its risk factors. The significance of this finding is discussed in the light of the well documented delays by members of the public in summoning help when they suspect heart attack.

Adult↗
PubMed1992

The hospital component of general practice vocational training--the Irish experience.

All second and third year general practice vocational trainees in the Irish Republic in 1991 were invited to complete a questionnaire concerning the hospital component of their training. The questionnaire was based on specific recommendations published by the I.C.G.P. regarding hospital training posts. Replies were received from 39 trainees constituting 70% of the total number of eligible trainees. In general, hospital posts were perceived to be of relevance and to offer adequate exposure to outpatient management and to the development of useful practical skills. More than 70% of the trainees were free to attend at least 75% of the study release course. Everyone entitled to study leave for examination purposes obtained it. However, 95% of trainees found their hospital teachers unfamiliar with the aims and objectives of Vocational Training. Two-thirds of trainees received less than two hours a week of formal or informal teaching. More than two-thirds did not participate in an introductory general practice period and less than a quarter had their individual needs assessed early on. Substantial realisation of the guidelines issued by the ICGP has been achieved. Further work is necessary in the areas of individual needs assessment, relevant structured teaching and general practice liaison. Three specific recommendations are made to achieve these aims.

Education, Medical, Graduate↗
PubMed1992

Sports injuries and the accident and emergency department--ten years on.

A six month prospective survey in 1990 of sports injuries presenting to the A+E department of St James and the Mater hospitals revealed 1594 patients, accounting for 3.8% of the total number of new patients seen in that period. These results were compared to a similar study conducted in the Mater in 1980. Comparison with the 1980 study showed similar patterns with respect to sex, sport and site of injury. There was an increase of the age at which sport was played as evidence by the age of those injured. Whilst delay in presentation has improved somewhat, 57% of patients stil waited more than 12 hours before attending. Management of the total spectrum of injury has changed. More X-Rays were taken and on-site physiotherapy has been established in both A+E departments. Despite such an accessible facility the use of physiotherapy in sports injuries could be improved. There was also variation in the treatment of non-orthopaedic injury. We recommend that education of sport participants continue, especially in the areas of protective equipment and early presentation for medical assessment. We further propose that A+E staff be educated in the special needs of sports men and women, and that as recommended previously in the 1980 study, a Central Sports Injury Clinic for the six Dublin hospitals be established.

Adolescent↗
PubMed1990

Resuscitation skills among the general public in Dublin.

Evidence exists that many of the victims of cardiac arrest due to ischemic heart disease can be resuscitated if cardiopulmonary resuscitation (CPR) and defibrillation are made available in the minutes following collapse. In order to evaluate the ability of the general public in Dublin to perform CPR appropriately, 225 people were asked when CPR was indicated and how cardiac arrest was diagnosed and then asked to perform CPR on a mannequin. In the knowledge sections, 45% gave an appropriate indication for CPR and 34% gave appropriate criteria for diagnosing cardiac arrest. However, only eight participants were able to perform CPR correctly and only six (2.6%) had both the correct skills and knowledge. There is an urgent need to improve the public's knowledge of and ability to perform CPR as part of an overall strategy to decrease mortality from ischemic heart disease in Ireland.

Educational Status↗
PubMedDate not supplied

Primary care anticoagulant management using near patient testing.

BACKGROUND: Indications for anticoagulant treatment are increasing and new approaches to anticoagulant services require a shift from hospital to primary care. AIM: To pragmatically test the validity and effectiveness of primary care anticoagulant management using near patient testing. METHODS: Twelve CoaguCheck monitors were supplied to 16 rural practices that had previously provided supervision of anticoagulant therapy. Practices were required to record data for eligible patients from September 1998 to April 1999 and to forward one blood sample per week to the regional hospital laboratory for parallel testing. RESULTS: Nine practices returned data on 122 patients. Indications for anticoagulation Included atrial fibrillation (n = 56), valve replacement (n = 12) and deep venous thrombosis or pulmonary embolus (n=12). Regression of the mean of 185 paired readings against their difference confirmed the validity of the CoaguCheck monitor (r2 = 0.00 [95% CI -0.38 to 0.38]). There were 692 International Normalised Ratio (INR) tests performed representing an average of 5.7 tests per patient. The desired therapeutic range was provided for 609 (88%) of these tests; 294 (48.3%) were within the desired therapeutic range. Results differed significantly between practices. CONCLUSIONS: This study confirmed the validity of anticoagulant management using the CoaguCheck monitor in primary care.

Anticoagulants↗
PubMedDate not supplied

The provision of secondary cardiac prevention measures in a hospital cardiac clinic population and the relationship to psychological variables.

BACKGROUND: Implementing preventive measures in patients with established heart disease is one of the most effective health promotion activities, but there is little research on the relationship between cognition and secondary preventive behaviour. AIM: To determine the provision of secondary cardiac prevention measures among patients with established heart disease attending a cardiac outpatient clinic. METHODS: The study was conducted in an outpatient department over a 14-week period in 1999. Management of risk markers was noted from the medical records and lifestyle and psychological variables were self-reported. RESULTS: Of 294 patients with heart disease, 41% were available for study. Fourteen per cent were current smokers, one-quarter of males and one-third of females had a body mass index (BMI) greater that 30. Almost 90% attend their GP bimonthly, 67% had a normal systolic and 88.3% a normal diastolic pressure, 34% had normal cholesterol levels and 75% were on aspirin. Lifestyle variables were significantly affected by patient cardiac knowledge, sense of control over their heart disease and perceptions of their illness. CONCLUSIONS: These results highlight the potential health gain available to patients with established heart disease. The results also suggest that psychological factors may play a role in patients' health behaviours.

Coronary Disease↗
PubMedDate not supplied

Socio-economic gradients in self-reported health in Ireland and Northern Ireland.

BACKGROUND: Research and policy related to reducing health inequalities has progressed separately within Ireland and Northern Ireland. This paper describes the first exploration of the socio-economic influences on health on the island of Ireland since 1922. METHODS: Postal survey. RESULTS: The response rate was 52%; 11,870 respondents. Men reported more long-standing illness (LLTI) or poor general health (PGH); depression was more common amongst women. Socio-economic gradients in health were evident in both jurisdictions, with the effects of household income being particularly marked. Overall, morbidity levels were significantly better in Ireland than in Northern Ireland: adjusted odds ratio of 0.79 (95% CI 0.71 - 0.88) for LLTI; 0.64 (0.57 - 0.72) for PGH; 0.90 (0.82 - 0.99) for depression. CONCLUSIONS: There is evidence of strong and similar socio-economic gradients in health throughout the island of Ireland. This would suggest joint policy approaches or at least further comparative evaluation of the initiatives in each jurisdiction.

Adolescent↗
PubMedDate not supplied

An approach to the education about, and assessment of, attitudes in undergraduate medical education.

BACKGROUND: Attitudes have been shown to be important determinants of the quality and efficacy of medical care. There is little research on the education about, and assessment of, attitudes in undergraduate medical education. AIM: To describe the design and delivery of an attitude awareness workshop, and the associated objective structured clinical examination (OSCE) station used as the assessment tool. METHODS: Development, delivery, assessment and evaluation of an attitude awareness workshop were performed. RESULTS: Data are presented from 144 students. In 1999, the overall mean OSCE score was 62.44% (SD 7.6, n=73). The mean score for the attitude station was 57.97% (SD 12.9). In 2000, these figures were 67.11% (SD 8.3, n=71) and 73.75% (SD 10.8) respectively. In 1998/99, the average mark out of 10 for the educational quality of the attitude workshop was 6.6 and in 1999/00 this rose to 7.8. CONCLUSION: Development of both an educational and assessment programme concerning attitudes appears feasible.

Attitude of Health Personnel↗
PubMedDate not supplied

Implementation of anticoagulation guidelines in general practice: a practice report.

There is evidence that patients with atrial fibrillation (AF) are not being anticoagulated according to the published guidelines. Difficulty in identifying such patients may partly explain this. In this study, we examined the yield of different methods for detecting people with AF in a single general practice: hospital discharge letters, referrals to cardiology, staff recall of cases, records of relevant prescriptions from the local pharmacist and similar records from the GMS Payments Board. A review of all files of patients over 45 was undertaken as the definitive method of case identification. Recommended anticoagulation guidelines were applied using structured patient interviews. The practice population was 5,473. Sixty-eight patients with AF were identified giving a practice prevalence of 1.2%. The GMS Payment Board records for the prescribing of all specified medications was the most sensitive method (58.8%) with a positive predictive value of 21.6%. Of nine patients without cognitive impairment at consultation, four (44.4%) opted to change to the recommended treatment. Reluctance of patients to adopt current treatment guidelines points to the need for further work in this area.

Aged↗
PubMedDate not supplied

Job stressors and coping strategies as predictors of mental health and job satisfaction among Irish general practitioners.

Previous research has shown that many general practitioners were experiencing stress levels detrimental to their well-being. To examine coping strategies of Irish general practitioners and the possible impact of their stress on mental health and job satisfaction. Anonymous questionnaires were posted to 226 general practitioners in the Western Health Board. Just over one third of stressors caused moderate to considerable stress. Coping was important in the stress process. Sometimes, coping strategies predicted stress-related outcomes better than stressors. General practitioners' mental health was slightly better than that of a normative group. They tended to be satisfied with all aspects of the job, except hours of work. The provision of counselling services for general practitioners suffering from stress should be encouraged. Stress-management strategies should include training in coping skills and time management. The increased use of co-operatives could help alleviate the stress of out-of-hours work.

Adaptation, Psychological↗
PubMedDate not supplied

"Céad Míle Fáilte"--an assessment of the screening of 178 Bosnian refugees to Ireland.

The number of refugees in Western Europe has risen dramatically. Such an increase poses unique challenges for all health personnel. This paper describes how the Republic of Ireland, a country with little experience of refugees, initially coped with 178 Bosnian refugees. An open-access general practitioner service was combined with a general screening protocol. Patients with significant problems tended to visit GP's, for appropriate treatment, soon after arrival. Of a total of 92 problems diagnosed at screening, general medical (14%), psychiatric (14%) and gynaecological (11%) were the most frequently encountered. Of the 30 problems referred, 80% were referred by a GP. Deficiencies in immunisation and drug history are highlighted. We make recommendations to improve the quality of future initial refugee assessment procedures.

Adolescent↗
PubMedDate not supplied

MMR immunisation status among Dublin paediatric A&E attenders.

The objectives of this study were to establish the need for opportunistic MMR immunisation among paediatric A&E attenders to the three Dublin paediatric hospitals and to examine the relationship between immunisation status and socioeconomic factors. Design was that of a two month cross sectional study. Survey data was then compared with information on the Eastern Health Board (EHB) records system. Small area and multiple regression analysis of socioeconomic factors derived from participants addresses was also performed. Subjects were 337 children who attended these departments and were aged between fifteen months and five years. For 66% of cases there was a history of MMR immunisation, 30% gave a negative history and 4% did not know. Of those giving a negative history, one third said immunisation had been omitted for no specific reason. EHB records suggested that 39% were immunised, 41% were not and 20% were not on file. Eligibility for the GMS was not associated with failure to immunise. Small area and multiple regression analysis showed little association between immunisation uptake and socioeconomic factors. An opportunistic MMR immunisation policy in A&E Departments would make an important contribution to increasing overall uptake figures. Parental knowledge of the implications of measles and the effectiveness of immunisation needs to be improved. Computerised child health systems must have high data quality standards and access to these systems should be made available in A&E departments.

Child, Preschool↗
PubMedDate not supplied

Impact of a collaborative immunisation programme in an inner city practice.

OBJECTIVES: To describe the impact of a collaborative immunisation programme, between an inner city practice and the Eastern Health Board (EHB). DESIGN: An observational study using a computer database formed from practice and EHB records. SETTING: One Dublin inner city practice with three partners located in an area with a deprived socio-economic profile. SUBJECTS: All patients in the practice aged more than six months and less than five years identified both from practice registers and opportunistically during study period. RESULTS: 342 children, older than six months and less than five years were identified at start and 464 (a 36% increase) by end of the programme. Uptake changed for DPT from 30% before, to 57% after the programme (p < 0.0005), for DT from 15% to 13%, for Hib from 7% to 50% (p < 0.0005) and for MMR (over 15 months) from 53% to 75% (p < 0.0005). Uptake of the DPT, Hib and MMR was 35% among GMS eligible, 51% among GMS ineligible (p < 0.005). CONCLUSION: A collaborative immunisation programme significantly improved practice uptake rates. These improved rates still do not attain declared national targets. To achieve these targets, radical overhaul of the immunisation service is required.

Cooperative Behavior↗