The extent of polypharmacy and use of 'fall risk increasing drugs' in the oldest old admitted to a regional New South Wales hospital.

Objective(s): Polypharmacy is associated with significant morbidity including cognitive decline and falls. We sought to quantify the extent of polypharmacy and use of medications associated with fall risk in the very old admitted to a regional NSW hospital.

Methods: Cross-sectional study of patients aged over 80 years admitted to a regional NSW hospital from September to October 2019.

Relevance of anatomy to medical education and clinical practice: perspectives of medical students, clinicians, and educators.

Introduction: Against a backdrop of ever-changing diagnostic and treatment modalities, stakeholder perceptions (medical students, clinicians, anatomy educators) are crucial for the design of an anatomy curriculum which fulfils the criteria required for safe medical practice. This study compared perceptions of students, practising clinicians, and anatomy educators with respect to the relevance of anatomy education to medicine.

Methods: A quantitative survey was administered to undergraduate entry (n = 352) and graduate entry students (n = 219) at two Irish medical schools, recently graduated Irish clinicians (n = 146), and anatomy educators based in Irish and British medical schools (n = 30).

Global sharing, local innovation: Four schools, four countries, one curriculum.

Background: Many internal and external obstacles, must be overcome when establishing a new medical school, or when radically revising an existing medical curriculum.

Aims: Twenty-five years after the Flinders University curriculum was introduced as the first graduate-entry medical programme (GEMP) in Australia, we aim at describing how it has been adopted and adapted by several other schools, in Australia and in Europe (UK, Ireland, and Portugal).

Method/results: This paper reports on the experience of four schools establishing a new medical school or new curriculum at different times and in different settings.

Studying medicine - a cross-sectional questionnaire-based analysis of the motivational factors which influence graduate and undergraduate entrants in Ireland.

Objectives: The number of places available in Ireland for graduate entry to medical school has steadily increased since 2006. Few studies have, however, characterized the motivational factors underlying decision to study medicine via this route. We compared the factors motivating graduate entrants versus undergraduate entry (UGE) students to choose medicine as a course of study.

General practice career intentions among graduate-entry students: a cross-sectional study at Ireland's newest medical school.

Increased care provision and clinical activity in General Practice in Ireland will have important manpower implications. Recent developments in medical education policy including the introduction of graduate-entry medical degree programmes may help address this issue. The aim of this study was to determine GP career intentions among students on an Irish graduate-entry medical degree programme and to identify factors that influence these.

The first survey of attitudes of medical students in Ireland towards termination of pregnancy.

Background: Since the UK Abortion Act (1967), women have travelled from Ireland to the UK for legal abortion. In 2011 >4000 women did so. Knowledge and attitudes of medical students towards abortion have been published, however, this is the first such report from Ireland.

Inflammatory bowel disease and thromboembolism. Is inflammation at the centre of the clot?

Thromboembolic events are well recognised in patients with inflammatory bowel disease (IBD). We present three cases which highlight the need for vigilance with respect to this complication. We also propose that consideration be given to re-evaluating disease activity in those patients who develop thromboembolic complications.

An evidence-based assessment of primary care needs in an economically deprived urban community.

Background: As healthcare and longevity improve and fertility rates decline, we see a demographic shift towards a predominantly elderly population. Because ageing brings its own physiological changes and complications, the need arises for practical and feasible approaches in providing the healthcare required by this population. With government strategy promoting enhanced community-based healthcare, the development of primary care infrastructure should reflect population needs.

Demographic attributes and knowledge acquisition among graduate-entry medical students.

Background: Recent changes to undergraduate (basic) medical education in Ireland have linked an expansion of student numbers with wide-ranging reforms. Medical schools have broadened access by admitting more mature students from diverse backgrounds and have increased their international student numbers. This has resulted in major changes to the demographic profile of students at Irish medical schools.

Acute medical assessment units: an efficient alternative to in-hospital acute medical care.

Acute Medical Assessment Units (AMAUs) are being proposed as an alternative to congested Emergency Departments (EDs for the assessment of patients with a range of acute medical problems. We retrospectively reviewed the discharge destination of patients referred to a newly established AMAU during a six-month period. During the same period we contrasted activity in the ED for a similar group of patients.

Assessment of waist-worn tri-axial accelerometer based fall-detection algorithms using continuous unsupervised activities.

This study aims to evaluate a variety of existing and novel fall detection algorithms, for a waist mounted accelerometer based system. Algorithms were tested against a comprehensive data-set recorded from 10 young healthy subjects performing 240 falls and 120 activities of daily living and 10 elderly healthy subjects performing 240 scripted and 52.4 hours of continuous unscripted normal activities.

Evaluation of waist-mounted tri-axial accelerometer based fall-detection algorithms during scripted and continuous unscripted activities.

It is estimated that by 2050 more than one in five people will be aged 65 or over. In this age group, falls are one of the most serious life-threatening events that can occur. Their automatic detection would help reduce the time of arrival of medical attention, thus reducing the mortality rate and in turn promoting independent living.

Cross-institutional progress testing: feasibility and value to a new medical school.

Objectives: This study aimed to examine the feasibility of using a progress test to compare the rate of knowledge acquisition among students at a new medical school with that of students at a comparable but long-established school.

Methods: As part of an ongoing strategy, we administered the McMaster Personal Progress Index (PPI) on four occasions to the first two cohorts of students enrolled in the graduate-entry medical programme at the University of Limerick. We compared mean PPI scores for students at comparable stages in their courses at both schools.

Shared consultant physician posts.

Our aim was to assess the acceptability and cost-efficiency of shared consultancy posts. Two consultant physicians worked alternate fortnights for a period of twelve months. Questionnaires were distributed to general practitioners, nurses, consultants and junior doctors affected by the arrangement.

The financial costs of delivering problem-based learning in a new, graduate-entry medical programme.

Context: In discussions of the merits and limitations of problem-based learning (PBL) as an educational methodology, the cost of its delivery is often cited as a significant issue. Although there appears to be no shortage of opinion as to the perceived cost of PBL, we know of no institution that has accurately measured its cost, even in financial terms. Where factual information is lacking, opinion and misconception tend to proliferate.

Graduate medical education in Ireland: a profile of the first cohort of students.

Background: The first graduate-entry programmes to Irish medicine were established at the Royal College of Surgeons in Ireland (RCSI) and the University of Limerick (UL) in 2007. There were over 400 applications across both institutions and 306 people sat a special aptitude test (GAMSAT) in Ireland in 2007. Ultimately, 61 Irish/EU students were admitted to one or other programme.

A new direction for medical education in Ireland?

In recent years, new concepts of educational theory and practice have stimulated new approaches to medical education in many countries. For various reasons, medical education in Ireland has been slow to change such that there are now increasing concerns about educational standards. In addition, Ireland currently produces too few doctors and is therefore highly dependent on overseas doctors to maintain its health service.

Working and training as an intern: a national survey of Irish interns.

The Medical Council of Ireland recently introduced some initiatives to enhance the education and training of interns. These include the development of a generic job description, a logbook to monitor training outcomes and a national network of supervisors to plan and oversee intern training. To get feedback on the impact of these reforms, the Medical Council surveyed all interns with Irish addresses in March 2003.

Medical graduates of the National University of Ireland in 1978: who and where are they?

To inform debate on medical manpower planning and aspects of medical education, we gathered data on graduates of three Irish medical schools in 1978. Twenty six years later, four of the 236 graduates had died and seven were untraceable. All but one of the remainder were in clinical practice and in a wide range of disciplines.

Evidence-based clinical practice in falls prevention: a randomised controlled trial of a falls prevention service.

Aims: Evidence-based guidelines recommend a range of treatments for falls and injury prevention. We undertook a randomised trial of a falls prevention service to screen for falls risk factors and recommend to GPs an evidenced base prescription for falls prevention.

Methods: All patients who presented with a fall to the Emergency Department at Flinders Medical Centre over a 22-week period were considered for the study.

The career plans of Irish interns: results of a national survey.

In anticipation of major changes in medical manpower in Ireland, we surveyed all interns about their career plans. Three hundred (65% of those surveyed) responded. There were clear gender differences in career plans and overall, only 15% planned a career in general practice.

An outreach intervention to implement evidence based practice in residential care: a randomized controlled trial [ISRCTN67855475].

Background: The aim of this project was to assess whether outreach visits would improve the implementation of evidence based clinical practice in the area of falls reduction and stroke prevention in a residential care setting.

Methods: Twenty facilities took part in a randomized controlled trial with a seven month follow-up period. Two outreach visits were delivered by a pharmacist.

Reforming medical education to enhance the management of chronic disease.

Medical education must adapt to change if it is to remain relevant to the needs of doctors, patients and society. Ideally, it should anticipate and lead change. Undergraduate education remains rooted in urban medical schools where the focus is on acute disease, while most graduates spend their working lives in the community, dealing mainly with chronic health problems.