TY - JOUR T1 - What is the level of nutrition care provided to older adults attending emergency departments? A scoping review protocol. [version 2; peer review: 2 approved]. JF - HRB Open Research Y1 - 2022 A1 - Griffin A, A1 - Cerenay, S A1 - Ryan, L A1 - Conneely, M A1 - Bowers, S A1 - Dore, L A1 - Galvin, R VL - 5:7 ER - TY - JOUR T1 - Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis JF - BMC Geriatrics Y1 - 2014 A1 - Barry, E A1 - Galvin, R A1 - Keogh, C A1 - Horgan, F A1 - Fahey, T KW - falls KW - Older adults KW - Timed Up and Go Test KW - TUG AB - Abstract Background The Timed Up and Go test (TUG) is a commonly used screening tool to assist clinicians to identify patients at risk of falling. The purpose of this systematic review and meta-analysis is to determine the overall predictive value of the TUG in community-dwelling older adults. Methods A literature search was performed to identify all studies that validated the TUG test. The methodological quality of the selected studies was assessed using the QUADAS-2 tool, a validated tool for the quality assessment of diagnostic accuracy studies. A TUG score of ≥13.5 seconds was used to identify individuals at higher risk of falling. All included studies were combined using a bivariate random effects model to generate pooled estimates of sensitivity and specificity at ≥13.5 seconds. Heterogeneity was assessed using the variance of logit transformed sensitivity and specificity. Results Twenty-five studies were included in the systematic review and 10 studies were included in meta-analysis. The TUG test was found to be more useful at ruling in rather than ruling out falls in individuals classified as high risk (>13.5 sec), with a higher pooled specificity (0.74, 95% CI 0.52-0.88) than sensitivity (0.31, 95% CI 0.13-0.57). Logistic regression analysis indicated that the TUG score is not a significant predictor of falls (OR = 1.01, 95% CI 1.00-1.02, p = 0.05). Conclusion The Timed Up and Go test has limited ability to predict falls in community dwelling elderly and should not be used in isolation to identify individuals at high risk of falls in this setting. VL - 14 UR - http://www.biomedcentral.com/1471-2318/14/14#abs IS - 14 ER - TY - JOUR T1 - Psychostimulant prescribing trends in a paediatric population in Ireland: a national cohort study JF - BMC Pediatrics Y1 - 2015 A1 - Boland, F A1 - Galvin, R A1 - Reulbach, U A1 - Motterlini, N A1 - Kelly, D A1 - Bennett, K A1 - Fahey, T KW - ADHD KW - children KW - pharmacoepidemiology KW - Psychostimulant treatment AB - Background: Psychotropic paediatric prescribing trends are increasing internationally. The aim of this study is to examine the prevalence and secular trends in psychotropic prescribing in Irish children and adolescents between 2002 and 2011. Methods: Data was obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database from the Health Service Executive Primary Care Reimbursement Services (HSE-PCRS). Prescribing rates per 1000 eligible population and associated 95 % confidence intervals (CIs) were calculated across years (2002–2011), age groups (0–4, 5–11, 12–15 years) and gender. Rates of concomitant prescriptions for psycholeptics and antidepressants were also examined. The total expenditure costs were calculated and expressed as a percentage of the cost of all prescriptions for this age group (≤15 years). Results: In 2002, 3.77/1000 GMS population (95 % CI: 3.53–4.01) received at least one psychostimulant prescription and this rate increased to 8.63/1000 GMS population (95 % CI: 8.34–8.92) in 2011. Methylphenidate was the most frequently prescribed psychostimulant. For both males and females the prevalence of medication use was highest among the 12–15 year old group. On average, a psycholeptic medication was prescribed to 8 % of all psychostimulant users and an antidepressant was concomitantly prescribed on average to 2 %. Total expenditure rose from €89,254 in 2002 to €1,532,016 in 2011. Conclusions: The rate and cost of psychostimulant prescribing among GMS children and adolescents in Ireland increased significantly between 2002 and 2011. Further research is necessary to assess the safety, efficacy and economic impact of concomitant psychotropic prescribing in this population. VL - 15 UR - http://www.biomedcentral.com/1471-2431/15/118 IS - 118 ER - TY - JOUR T1 - A protocol for the establishment and evaluation of an older adult stakeholder panel for health services research [version 2; peer review: 2 approved]. JF - HRB Open Research Y1 - 2020 A1 - Conneely, M A1 - Boland, P A1 - O'Neill, A A1 - Byrne, D A1 - Cronin, S A1 - Quinn, D A1 - Trépel, D A1 - Leahy, S A1 - Salsberg, J A1 - Galvin, R A1 - Robinson, K VL - 3:1 ER - TY - JOUR T1 - Prognostic value of the CAPRA clinical prediction rule: a systematic review and meta-analysis JF - BJU Int Y1 - 2013 A1 - Meurs, Pieter A1 - Galvin, R A1 - Fanning, Deirdre M A1 - Fahey, T AB - Study Type - Prognosis (systematic review) Level of Evidence 1a What's known on the subject? and What does the study add? Prostate cancer is a significant cause of mortality among men. A number of prognostic instruments exist to predict the risk of recurrence among patients with localised prostate cancer. This systematic review examines the totality of evidence in relation to the predictive value of the CAPRA clinical predication rule by combining all studies that validate the rule. OBJECTIVES: •  To perform a systematic review with meta-analysis that assesses the 3- and 5-year predictive value of the CAPRA rule, a clinical prediction rule derived to predict biochemical-recurrence-free survival in men with localized prostate cancer after radical prostatectomy. •  To examine the predictive value of the CAPRA rule at 3 and 5 years stratified by risk group (0-2 low risk, 3-5 intermediate risk, 6-10 high risk). PATIENTS AND METHODS: •  A systematic literature search was performed to retrieve papers that validated the CAPRA score. •  The original derivation study was used as a predictive model and applied to all validation studies with observed and predicted biochemical-recurrence-free survival at 3 and 5 years stratified by risk group (0-2 low, 3-5 intermediate, 6-10 high). •  Pooled results are presented as risk ratios (RRs) with 95% confidence intervals, in terms of over-prediction (RR >1) or under-prediction (RR <1) of biochemical-recurrence-free survival at 3 and 5 years. •  A chi-squared test for trend was computed to determine if there was a decreasing trend in survival across the three CAPRA risk categories. RESULTS: •  Seven validation studies (n= 12 693) predict recurrence-free survival at 5 years after radical prostatectomy. The CAPRA score significantly under-predicts recurrence-free survival across all three risk strata (low risk, RR 0.94, 95% CI 0.90-0.98; intermediate risk, RR 0.94, 95% CI 0.89-0.99; high risk, RR 0.72, 95% CI 0.60-0.85). •  Data on six studies (n= 6082) are pooled to predict 3-year recurrence-free survival. The CAPRA score correctly predicts recurrence-free survival in all three groups (low risk, RR 0.98, 95% CI 0.95-1.00; intermediate risk, RR 1.03, 95% CI 0.99-1.08; high risk, RR 0.87, 95% CI 0.73-1.05). •  The chi-squared trend analysis indicates that, as the trichotomized CAPRA score increases, the probability of survival decreases (P < 0.001). CONCLUSIONS: •  The results of this pooled analysis confirm the ability of the CAPRA rule to correctly predict biochemical-recurrence-free survival at 3 years after radical prostatectomy. •  The rule under-predicts recurrence-free survival 5 years after radical prostatectomy across all three strata of risk. VL - 111 IS - 3 ER - TY - JOUR T1 - Prognostic value of the ABCD² clinical prediction rule: a systematic review and meta-analysis JF - Fam Pract Y1 - 2011 A1 - Galvin, R A1 - Geraghty, Colm A1 - Motterlini, N A1 - Dimitrov, B A1 - Fahey, T KW - Humans KW - Ischemic Attack, Transient KW - Predictive Value of Tests KW - Risk Assessment KW - Risk Factors KW - Stroke KW - Time Factors AB - OBJECTIVE: The purpose of this systematic review with meta-analysis is to determine the predictive value of the ABCD ²at 7 and 90 days across three strata of risk. Background. The risk of stroke after transient ischaemic attack (TIA) is significant. The ABCD ²clinical prediction rule is designed to predict early risk of stroke after TIA. A number of independent validation studies have been conducted since the rule was derived. METHODS: A systematic literature search was conducted to identify studies that validated the ABCD². The derived rule was used as a predictive model and applied to subsequent validation studies. Comparisons were made between observed and predicted number of strokes stratified by risk group: low (0-3 points), moderate (4-5 points) and high (6-7 points). Pooled results are presented as risk ratios (RRs) with 95% confidence intervals (CIs), in terms of over-prediction (RR > 1) or under-prediction (RR < 1) of stroke at 7 and 90 days. RESULTS: We include 16 validation studies. Fourteen studies report 7-day stroke risk (n = 6282, 388 strokes). The ABCD² rule correctly predicts occurrence of stroke at 7 days across all three risk strata: low [RR 0.86, 95% CI (0.47-1.58), I² = 16%], moderate [RR 0.99, 95% CI (0.67-1.47), I² = 68%] and high [RR 0.84, 95% CI (0.6-1.19), I² = 46%]. Eleven studies report 90-day stroke risk (n = 6304). There is a non-significant trend towards over-prediction of stroke in all risk categories at 90 days. There are 426 strokes observed in contrast to a predicted 626 strokes. As the trichotomized ABCD² score increases, the risk of stroke increases (P < 0.01). There is no evidence of publication bias in these studies (P > 0.05). CONCLUSION: The ABCD² is a useful CPR, particularly in relation to 7-day risk of stroke. VL - 28 UR - http://fampra.oxfordjournals.org/content/28/4/366 IS - 4 ER - TY - JOUR T1 - Prevalence of prescribing in pregnancy using the Irish primary care research network: a pilot study JF - BMC Pregnancy and Childbirth Y1 - 2015 A1 - Dillon, P A1 - O'Brien, K A1 - McDonnell, R A1 - Donnelly-Swift, E A1 - Galvin, R A1 - Roche, A A1 - Cronin, K A1 - Walsh, DR A1 - Schelten, R A1 - Smith, SM A1 - Fahey, T KW - FDA pregnancy-risk categories KW - Medication use KW - Pregnancy KW - Prescribing AB - Abstract Background: To establish the prevalence and patterns of prescribing to pregnant women in an Irish primary care setting. Methods: We reviewed electronic healthcare records routinely collected in primary care, of pregnant women attending nine Dublin-based General Practices affiliated to the Irish Primary Care Research Network (IPCRN) for antenatal care between January 2007 and October 2013 (n = 2,361 pregnancies). Results: Excluding folic acid, 46.8% (n = 1,104) of pregnant women were prescribed at least one medication. Amoxicillin (11.1%, n = 263) and co-amoxiclav (8.0%, n = 190) were the most commonly prescribed medication followed by topical clotrimazole (4.9%, n = 117), salbutamol inhalers (4.1%, n = 96) and paracetamol (4.0%, n = 95). General Medical Services (GMS) patients were more likely to receive a prescription than private patients (OR 2.81; 95%CI (2.28, 3.47)). We applied the US FDA pregnancy-risk categories as a proxy measure of prescribing appropriateness, with FDA Category D and X medications considered inappropriate. FDA Category D drugs were prescribed in 5.9% (n = 140) of pregnancies. FDA Category X drugs were prescribed in 4.9% (n = 116) of pregnancies but after exclusion of oral contraceptives, progestogens, infertility treatments Category X medications were prescribed in 0.6% (n = 13) of pregnancies. After the initial antenatal consultation the prescribing prevalence of FDA Category D medications reduced to 4.7% (n = 110) and Category X to 3.1% (n = 72). Conclusions: The overall prevalence of prescribing to pregnant women in our cohort is low compared to studies internationally, however similar levels of prescribing for FDA Category D and X were found. Following the initial antenatal consultation levels of prescribing of the FDA Category D and X medications reduced, however there is potential to further reduce their use in early pregnancy. The IPCRN database has provided valuable information on the current practice of antenatal prescribing within this pilot group of practices however it is limited by the absence of morbidity and pregnancy outcome data. VL - 15 UR - http://www.biomedcentral.com/1471-2393/15/67/abstract IS - 67 ER - TY - JOUR T1 - Prevalence of potentially inappropriate prescribing and prescribing omissions in older Irish adults: findings from The Irish LongituDinal Study on Ageing study (TILDA) JF - European Journal of Clinical Pharmacology Y1 - 2014 A1 - Galvin, R A1 - Moriarty, F A1 - Cousins, G A1 - Cahir, C A1 - Motterlini, N A1 - Bradley, MC A1 - Hughes, CM A1 - Bennett, K A1 - Smith, SM A1 - Fahey, T A1 - Kenny, RA KW - older people KW - Potential prescribing omissions KW - potentially inappropriate prescribing KW - START KW - STOPP AB - Abstract Purpose We sought to estimate the prevalence of potentially inappropriate prescriptions (PIP) and potential prescribing omissions (PPOs) using a subset of the STOPP/START criteria in a population based sample of Irish adults aged ≥65 years using data from The Irish LongituDinal Study on Ageing (TILDA). Methods A subset of 26 PIP indicators and 10 PPO indicators from the STOPP/START criteria were applied to the TILDA dataset. PIP/PPO prevalence according to individual STOPP/START criteria and the overall prevalence of PIP/PPO were estimated. The relationship between PIP and PPOs and polypharmacy, age, gender and multimorbidity was examined using logistic regression. Results The overall prevalence of PIP in the study population (n = 3,454) was 14.6 %. The most common examples of PIP identified were NSAID with moderate-severe hypertension (200 participants; 5.8 %) and aspirin with no history of coronary, cerebral, or peripheral vascular symptoms or occlusive event (112 participants; 3.2 %). The overall prevalence of PPOs was 30 % (n = 1,035). The most frequent PPO was antihypertensive therapy where systolic blood pressure consistently >160 mmHg (n = 341, 9.9 %), There was a significant association between PIP and PPO and polypharmacy when adjusting for age, sex and multimorbidity (adjusted OR 2.62, 95 % CI 2.05–3.33 for PIP and adjusted OR 1.46, 95 % CI 1.23–1.75 for prescribing omissions). Conclusion Our findings indicate prescribing omissions are twice as prevalent as PIP in the elderly using a subset of the STOPP/START criteria as an explicit process measure of potentially inappropriate prescribing and prescribing omissions. Polypharmacy was independently associated with both PPO and PIP. Application of such screening tools to prescribing decisions may reduce unnecessary medication, related adverse events, healthcare utilisation and cost. UR - http://link.springer.com/article/10.1007/s00228-014-1651-8# ER - TY - JOUR T1 - Prescribing patterns of glucosamine in an older population: a national cohort study JF - BMC Complementary & Alternative Medicine Y1 - 2013 A1 - Galvin, R A1 - Cousins, G A1 - Boland, F A1 - Motterlini, N A1 - Bennett, K A1 - Fahey, T KW - Cost-effectiveness KW - Glucosamine KW - Osteoarthritis AB - Background: Glucosamine is commonly prescribed as a disease modulating agent in osteoarthritis. However, the evidence to date suggests that it has a limited impact on the clinical symptoms of the disease including joint pain, radiological progression, function and quality of life. The aim of this study was to examine the prescribing patterns of glucosamine from 2002–2011 in an elderly Irish national population cohort using data from the Health Service Executive Primary Care Reimbursement (HSE-PCRS) General medical services (GMS) Scheme. Methods: Patients aged ≥ 70 years on the HSE-PCRS pharmacy claims database between January 2002 and December 2011 were included. ATC code M01AX05 (glucosamine) was extracted. Prevalence rates per 1000 eligible population with 95% confidence intervals were calculated for all years and age groups (70–74 years, ≥75 years). A negative binomial regression analysis was used to determine longitudinal usage trends and compare prevalence rates across years, sex and age groups. Results: The annual patient rate of glucosamine prescribing increased significantly from 13.0/1000 eligible population (95% CI 12.6-13.4) in 2002 to 68.7/1000 population (95% CI 67.8-69.5) in 2009 before decreasing to 62.4/1000 population (95% CI 61.6-63.2) in 2011. The rate of prescribing of glucosamine varied with sex, with women receiving significantly more prescriptions than men. The cost of glucosamine also increased from 2002–2008. In 2008 total expenditure reached a high of €4.6 million before decreasing to €2.6 million in 2011. Conclusion: The national trend in prescribing of glucosamine increased significantly from 2002 to 2009 before decreasing in 2010 and 2011, in keeping with current international guidelines. There is a need for awareness among healthcare professionals and patients alike of the best available evidence to inform decision making relating to theprescription and consumption of such supplements. VL - 13 UR - http://www.biomedcentral.com/content/pdf/1472-6882-13-316.pdf ER - TY - JOUR T1 - Potential for alcohol and drug interactions in older adults: evidence from the Irish longitudinal study on ageing JF - BMC Geriatics Y1 - 2014 A1 - Cousins, G A1 - Galvin, R A1 - Flood, Michelle A1 - Kennedy, Marie Claire A1 - Motterlini, N A1 - Henman, M A1 - Kenny, RA A1 - Fahey, T KW - Aged KW - Alcohol drinking/epidemiology KW - Alcohol interactive medications KW - Drug interactions AB - Abstract (provisional) Background Older adults are susceptible to adverse effects from the concomitant use of prescription medications and alcohol. This study estimates the prevalence of exposure to alcohol interactive (AI) medications and concomitant alcohol use by therapeutic class in a large, nationally representative sample of older adults. Methods Cross-sectional analysis of a population based sample of older Irish adults aged ?60?years using data from The Irish Longitudinal Study on Ageing (TILDA) (N?=?3,815). AI medications were identified using Stockley?s Drug Interactions, the British National Formulary and the Irish Medicines Formulary. An in-home inventory of medications was used to characterise AI drug exposure by therapeutic class. Self-reported alcohol use was classified as non-drinker, light/moderate and heavy drinking. Comorbidities known to be exacerbated by alcohol were also recorded (diabetes mellitus, hypertension, peptic ulcer disease, liver disease, depression, gout or breast cancer), as well as sociodemographic and health factors. Results Seventy-two per cent of participants were exposed to AI medications, with greatest exposure to cardiovascular and CNS agents. Overall, 60% of participants exposed to AI medications reported concomitant alcohol use, compared with 69.5% of non-AI exposed people (p?90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.Conclusions. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it. VL - 33 UR - http://fampra.oxfordjournals.org/content/33/2/172.abstract ER - TY - JOUR T1 - Existing validated clinical prediction rules for predicting response to physiotherapy interventions for musculoskeletal conditions have limited clinical value: A systematic review JF - Journal of Clinical Epidemiology Y1 - 2021 A1 - Walsh, M A1 - French, HP A1 - Wallace, E A1 - Madden, S A1 - King, P A1 - Fahey, T A1 - Galvin, R VL - 135 ER - TY - JOUR T1 - Effectiveness of occupational therapy interventions on function and satisfaction with occupational performance among adults with conditions of the hand, wrist, and forearm: a protocol for a systematic review [version 1; peer review: 1 approved]. JF - HRB Open Research Y1 - 2022 A1 - Sheerin, M A1 - O'Riordan, C A1 - Conneely, M A1 - Carey, L A1 - Ryan, D A1 - Galvin, R A1 - Morrissey, AM VL - 5:56 ER - TY - JOUR T1 - The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review. JF - BMC Geriatrics Y1 - 2022 A1 - Conneely, M A1 - Leahy, S A1 - Dore, L A1 - Trépel, D A1 - Robinson, K A1 - Jordan, F A1 - Galvin, R VL - 22:462 ER - TY - JOUR T1 - Effectiveness of interventions to reduce adverse outcomes among older adults following emergency department discharge: Protocol for an overview of systematic reviews [version 2; peer review: 2 approved]. JF - HRB Open Research Y1 - 2021 A1 - Conneely, M A1 - Robinson, K A1 - Leahy, S A1 - Trépel, D A1 - Jordan, F A1 - Galvin, R VL - 3:27 ER - TY - JOUR T1 - THE EFFECTIVENESS OF INTERVENTIONS TO REDUCE ADVERSE OUTCOMES AMONG OLDER ADULTS FOLLOWING EMERGENCY DEPARTMENT DISCHARGE JF - Age and Ageing Y1 - 2022 A1 - Conneely, M A1 - Leahy, S A1 - Dore, L A1 - Trépel, D A1 - Robinson, K A1 - Jordan, F A1 - Galvin, R VL - 51 IS - 2 ER - TY - JOUR T1 - Effectiveness of acute geriatric unit care on functional decline, clinical and process outcomes among hospitalised older adults with acute medical complaints: a systematic review and meta-analysis JF - Age and Ageing Y1 - 2022 A1 - O'Shaughnessy, Í A1 - Robinson, K A1 - O'Connor, M A1 - Conneely, M A1 - Ryan, D A1 - Steed, F A1 - Carey, L A1 - Leahy, A A1 - Shanahan, E A1 - Quinn, C A1 - Galvin, R VL - 51 IS - 4 ER - TY - JOUR T1 - Diagnostic accuracy of the STRATIFY clinical prediction rule for falls: A systematic review and meta-analysis JF - BMC Fam Pract Y1 - 2012 A1 - Billington, Jennifer A1 - Galvin, R A1 - Fahey, T KW - Falls assessment KW - Meta-analysis KW - Sensitivity and Specificity KW - STRATIFY KW - systematic review AB - ABSTRACT: BACKGROUND: The STRATIFY score is a clinical prediction rule (CPR) derived to assist clinicians to identify patients at risk of falling. The purpose of this systematic review and meta-analysis is to determine the overall diagnostic accuracy of the STRATIFY rule across a variety of clinical settings. METHODS: A literature search was performed to identify all studies that validated the STRATIFY rule. The methodological quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. A STRATIFY score of greater than or equal to 2 points was used to identify individuals at higher risk of falling. All included studies were combined using a bivariate random effects model to generate pooled sensitivity and specificity of STRATIFY at a cut point of greater than or equal to 2 points. Heterogeneity was assessed using the variance of logit transformed sensitivity and specificity. RESULTS: Seventeen studies were included in our meta-analysis, incorporating 11,378 patients. At a score greater than or equal to 2 points, the STRATIFY rule is more useful at ruling out falls, with a greater pooled sensitivity estimate (0.67, 95% CI 0.52 - 0.80) than specificity (0.57, 95% CI 0.45 - 0.69). The sensitivity analysis which examined the performance of the rule in different settings and subgroups also showed broadly comparable results, indicating that the STRATIFY rule performs in a similar manner across a variety of different 'at risk' patient groups in different clinical settings. CONCLUSION: This systematic review shows that the diagnostic accuracy of the STRATIFY rule is limited and should not be used in isolation for identifying individuals at high risk of falls in clinical practice. VL - 13 UR - http://www.biomedcentral.com/1471-2296/13/76 IS - 1 ER - TY - JOUR T1 - Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis JF - Arch Phys Med Rehabil Y1 - 2012 A1 - Alqunaee, Marwan A1 - Galvin, R A1 - Fahey, T KW - Humans KW - Muscle Weakness KW - Pain Measurement KW - Physical Examination KW - ROC Curve KW - Sensitivity and Specificity KW - Shoulder Impingement Syndrome AB - OBJECTIVE: To examine the accuracy of clinical tests for diagnosing subacromial impingement syndrome (SIS). DATA SOURCES: A systematic literature search was conducted in January 2011 to identify all studies that examined the diagnostic accuracy of clinical tests for SIS. The following search engines were used: Cochrane Library, EMBASE, Science Direct, and PubMed. STUDY SELECTION: Two reviewers screened all articles. We included prospective or retrospective cohort studies that examined individuals with a painful shoulder, reported any clinical test for SIS, and used arthroscopy or open surgery as the reference standard. The search strategy yielded 1338 articles of which 1307 publications were excluded based on title/abstract. Sixteen of the remaining 31 articles were included. The PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines were followed to conduct this review. DATA EXTRACTION: The number of true positives, false positives, true negatives, and false negatives for each clinical test were extracted from relevant studies, and a 2×2 table was constructed. Studies were combined using a bivariate random-effects model. Heterogeneity was assessed using the variance of logit-transformed sensitivity and specificity. DATA SYNTHESIS: Ten studies with 1684 patients are included in the meta-analysis. The Hawkins-Kennedy test, Neer's sign, and empty can test are shown to be more useful for ruling out rather than ruling in SIS, with greater pooled sensitivity estimates (range, .69-.78) than specificity (range, .57-.62). A negative Neer's sign reduces the probability of SIS from 45% to 14%. The drop arm test and lift-off test have higher pooled specificities (range, .92-.97) than sensitivities (range, .21-.42), indicating that they are more useful for ruling in SIS if the test is positive. CONCLUSIONS: This systematic review quantifies the diagnostic accuracy of 5 clinical tests for SIS, in particular the lift-off test. Accurate diagnosis of SIS in clinical practice may serve to improve appropriate treatment and management of individuals with shoulder complaints. VL - 93 UR - http://www.sciencedirect.com/science/article/pii/S0003999311007957# IS - 2 ER - TY - JOUR T1 - Diagnostic accuracy of a clinical prediction rule (CPR) for identifying patients with recent-onset undifferentiated arthritis who are at a high risk of developing rheumatoid arthritis: A systematic review and meta-analysis JF - Science Direct Y1 - 2013 A1 - McNally E A1 - Keogh, C A1 - Galvin, R A1 - Fahey, T KW - clinical prediction rule KW - Rheumatoid arthritis KW - Undifferentiated arthritis AB - Objectives The Leiden clinical prediction rule (CPR) was developed in 2007 to predict disease progression in patients with recent-onset undifferentiated arthritis (UA). This systematic review and meta-analysis investigates the predictive ability of the rule at identifying patients who are at a high risk of developing rheumatoid arthritis (RA). Methods A systematic review of the literature search was conducted from 2007 to May 2013 to identify studies that validated the rule. This study adhered to the PRISMA guidelines. The methodological quality of studies was assessed using the QUADAS-2 tool. Pooled sensitivity and specificity values for each of the cut points were generated using a bivariate random-effects model. Heterogeneity was assessed using the variance of logit-transformed sensitivity and specificity. Bayes' theorem was used to calculate post-test probability of progression from UA to RA. Results The search identified four relevant studies, resulting in six data sets (n = 1084). A cut point of ≥9 was identified as the optimal cut point for determining progression to RA. It is associated with a greater pooled specificity (0.99, 95% CI 0.95–1.00) than sensitivity (0.31, 95% CI 0.24–0.37). Using Bayes' theorem, a score of ≥9 points increased the pre-test probability from 40.04% to 93.63%. A less stringent cut-off of ≥8 also identified a significant proportion of patients at risk of RA who have a high likelihood of progressing to RA (LR + 9.5, 95% CI 6.21–14.54). Conclusion A cut point of ≥9 offers an optimal estimate for identifying patients with UA who are at a high risk of developing RA and warrant intervention. However, a number of methodological limitations identified across studies suggest that the results should be interpreted cautiously and that further validation of the Leiden CPR is necessary. VL - 43 UR - http://www.sciencedirect.com/science/article/pii/S0049017213001728 IS - 4 ER - TY - JOUR T1 - Development and validation of a clinical prediction rule to identify suspected breast cancer: a prospective cohort study JF - BMC Cancer Y1 - 2014 A1 - Galvin, R A1 - Joyce, D A1 - Downey, E A1 - Boland, F A1 - Fahey, T A1 - Hill, A KW - Breast cancer KW - Diagnosis KW - primary care AB - Abstract BACKGROUND: The number of primary care referrals of women with breast symptoms to symptomatic breast units (SBUs) has increased exponentially in the past decade in Ireland. The aim of this study is to develop and validate a clinical prediction rule (CPR) to identify women with breast cancer so that a more evidence based approach to referral from primary care to these SBUs can be developed. METHODS: We analysed routine data from a prospective cohort of consecutive women reviewed at a SBU with breast symptoms. The dataset was split into a derivation and validation cohort. Regression analysis was used to derive a CPR from the patient's history and clinical findings. Validation of the CPR consisted of estimating the number of breast cancers predicted to occur compared with the actual number of observed breast cancers across deciles of risk. RESULTS: A total of 6,590 patients were included in the derivation study and 4.9% were diagnosed with breast cancer. Independent clinical predictors for breast cancer were: increasing age by year (adjusted odds ratio 1.08, 95% CI 1.07-1.09); presence of a lump (5.63, 95% CI 4.2-7.56); nipple change (2.77, 95% CI 1.68-4.58) and nipple discharge (2.09, 95% CI 1.1-3.97). Validation of the rule (n = 911) demonstrated that the probability of breast cancer was higher with an increasing number of these independent variables. The Hosmer-Lemeshow goodness of fit showed no overall significant difference between the expected and the observed numbers of breast cancer (χ(2)HL: 6.74, p-value: 0.56). CONCLUSIONS: This study derived and validated a CPR for breast cancer in women attending an Irish national SBU. We found that increasing age, presence of a lump, nipple discharge and nipple change are all associated with increased risk of breast cancer. Further validation of the rule is necessary as well as an assessment of its impact on referral practice. VL - 14 UR - http://www.ncbi.nlm.nih.gov/pubmed/25277332 IS - 743 ER - TY - JOUR T1 - Developing an International Register of Clinical Prediction Rules for Use in Primary Care: A Descriptive Analysis JF - Ann of Fam Med Y1 - 2014 A1 - Keogh, C A1 - Wallace, E A1 - O'Brien, K A1 - Galvin, R A1 - Smith, SM A1 - Lewis, Cliona A1 - Cummins, Anthony A1 - Cousins, G A1 - Dimitrov, B A1 - Fahey, T KW - clinical decision support systems KW - clinical prediction rule KW - decision aid KW - decision making KW - primary care KW - score card AB - Abstract PURPOSE We describe the methodology used to create a register of clinical prediction rules relevant to primary care. We also summarize the rules included in the register according to various characteristics. METHODS To identify relevant articles, we searched the MEDLINE database (PubMed) for the years 1980 to 2009 and supplemented the results with searches of secondary sources (books on clinical prediction rules) and personal resources (eg, experts in the field). The rules described in relevant articles were classified according to their clinical domain, the stage of development, and the clinical setting in which they were studied. RESULTS Our search identified clinical prediction rules reported between 1965 and 2009. The largest share of rules (37.2%) were retrieved from PubMed. The number of published rules increased substantially over the study decades. We included 745 articles in the register; many contained more than 1 clinical prediction rule study (eg, both a derivation study and a validation study), resulting in 989 individual studies. In all, 434 unique rules had gone through derivation; however, only 54.8% had been validated and merely 2.8% had undergone analysis of their impact on either the process or outcome of clinical care. The rules most commonly pertained to cardiovascular disease, respiratory, and musculoskeletal conditions. They had most often been studied in the primary care or emergency department settings. CONCLUSIONS Many clinical prediction rules have been derived, but only about half have been validated and few have been assessed for clinical impact. This lack of thorough evaluation for many rules makes it difficult to retrieve and identify those that are ready for use at the point of patient care. We plan to develop an international web-based register of clinical prediction rules and computer-based clinical decision support systems. VL - 12 UR - http://www.ncbi.nlm.nih.gov/pubmed/25024245 IS - 4 ER - TY - JOUR T1 - Clinical prediction rules in practice:review of clinical guidelines and survey of GPs JF - British Journal of General Practice Y1 - 2014 A1 - Plüddemann, A A1 - Wallace, E A1 - Bankhead, Clare A1 - Keogh, C A1 - Van der Windt, D A1 - Lasserson, D A1 - Galvin, R A1 - Moschetti, I A1 - Kearley, K A1 - O'Brien, K A1 - Sanders, S A1 - Mallett, S A1 - Malanda, U A1 - Thompson, M A1 - Fahey, T A1 - Stevens, R KW - clinical guidelines KW - clinical prediction rules KW - survey AB - Abstract Background The publication of clinical prediction rules (CPRs) studies has risen significantly. It is unclear if this reflects increasing usage of these tools in clinical practice or how this may vary across clinical areas. Aim To review clinical guidelines in selected areas and survey GPs in order to explore CPR usefulness in the opinion of experts and use at the point of care. Design and setting A review of clinical guidelines and survey of UK GPs. Method Clinical guidelines in eight clinical domains with published CPRs were reviewed for recommendations to use CPRs including primary prevention of cardiovascular disease, transient ischaemic attack (TIA) and stroke, diabetes mellitus, fracture risk assessment in osteoporosis, lower limb fractures, breast cancer, depression, and acute infections in childhood. An online survey of 401 UK GPs was also conducted. Results Guideline review: Of 7637 records screened by title and/or abstract, 243 clinical guidelines met inclusion criteria. CPRs were most commonly recommended in guidelines regarding primary prevention of cardiovascular disease (67%) and depression (67%). There was little consensus across various clinical guidelines as to which CPR to use preferentially. Survey: Of 401 responders to the GP survey, most were aware of and applied named CPRs in the clinical areas of cardiovascular disease and depression. The commonest reasons for using CPRs were to guide management and conform to local policy requirements. Conclusion GPs use CPRs to guide management but also to comply with local policy requirements. Future research could focus on which clinical areas clinicians would most benefit from CPRs and promoting the use of robust, externally validated CPRs. VL - 64 UR - http://bjgp.org/content/64/621/e233.full IS - 621 ER - TY - JOUR T1 - Adverse outcomes in older adults attending emergency department: systematic review and meta-analysis of the Triage Risk Stratification Tool. JF - European Journal of Emergency Medicine Y1 - 2013 A1 - Cousins, G A1 - Bennett, K A1 - Dillon, Grace A1 - Smith, SM A1 - Galvin, R KW - Aged KW - emergency service KW - systematic review KW - triage/methods AB - Abstract The objective of this study was to assess the predictive ability of the Triage Risk Stratification Tool (TRST) in identifying older adults at risk of adverse outcomes [return to emergency department (ED), hospitalization, or a composite outcome] within 30 and 120 days following discharge from ED. A systematic search was conducted to identify studies validating the TRST in older adults aged at least 65 years discharged from ED. The methodological quality of selected studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. A score of at least 2 was used to identify high-risk patients. A bivariate random effects model was applied to generate pooled estimates of sensitivity and specificity. The discriminative ability of the tool was assessed using the c statistic. Heterogeneity was assessed graphically and statistically using the variance of the logit-transformed sensitivity and specificity. Six studies (3233 patients) were included. With a cutoff of at least 2, the pooled sensitivity of the TRST for a composite outcome at 30 days was 0.58 (95% confidence interval 0.52-0.65), the specificity was 0.61 (95% confidence interval 0.58-0.64). Similar values were obtained for the composite outcome at 120 days and the individual outcomes at both timepoints. The c statistic was consistently low across the outcomes and timepoints. There was little heterogeneity across studies. In conclusion, the TRST is limited in its ability to discriminate between older adults with or without an adverse outcome following discharge from ED. The low levels of heterogeneity gives us confidence that the pooled estimates reflect the predictive ability of the TRST in clinical practice. VL - 20 UR - http://www.ncbi.nlm.nih.gov/pubmed/23510897 IS - 4 ER - TY - Generic T1 - What levels of alcohol consumption is hazardous for adults: comparing US and Irish guidelines. TILDA 2013 Conference, 13 March 2013, Dublin Y1 - 2013 A1 - Cousins, G A1 - Galvin, R A1 - Kennedy, Marie Claire A1 - Motterlini, N A1 - Henman, M A1 - Fahey, T A1 - Kenny, RA ER - TY - Generic T1 - A protocol for the establishment and evaluation of an older adult stakeholder panel for health services research. Poster presented at the HRI Research Open Day, 2 December 2019 Y1 - 2019 A1 - Conneely, M A1 - Robinson, K A1 - Leahy, S A1 - Trépel, D A1 - Jordan, F A1 - Galvin, R ER - TY - Generic T1 - Prognostic value of the ABCD2 clinical prediction rule – a prospective cohort study. SAPC Conference 2012, 2-4 October 2012, Glasgow, Scotland Y1 - 2012 A1 - Galvin, R A1 - Atanassova, P A1 - Motterlini, N A1 - Fahey, T A1 - Dimitrov, B UR - http://www.hrbcentreprimarycare.ie/ppt/Galvin_ABCD2 cohort.ppt ER - TY - Generic T1 - Prevalence of potentially inappropriate prescribing in older irish adults, TILDA 2013 Conference, 13 March 2013, Dublin Y1 - 2013 A1 - Galvin, R A1 - Cousins, G A1 - Cahir, C A1 - Motterlini, N A1 - Bradley, MC A1 - Hughes, CM A1 - Bennett, K A1 - Fahey, T A1 - Kenny, RA UR - http://www.hrbcentreprimarycare.ie/ppt/PIP poster_TILDA.pdf ER - TY - Generic T1 - Prescribing patterns of cartilage constituents in a national elderly population. Faculty of Public Health Medicine Winter Scientific Meeting 2011, Royal College of Physicians, 14 December 2011, Dublin Y1 - 2011 A1 - Galvin, R A1 - Cousins, G A1 - Motterlini, N A1 - Bennett, K A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/Glucosamine.ppt ER - TY - Generic T1 - Predictive accuracy of the ABCD² clinical prediction rule: A systematic review and preliminary analysis of pooled data. IHF Stroke Conference 2010, March 26 2010, Dublin, Ireland Y1 - 2010 A1 - Geraghty, Colm A1 - Galvin, R A1 - Motterlini, N A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/posters/ACBD2.pdf ER - TY - Generic T1 - Patient preferences for breast cancer referral: Development and pilot study. ICHAMS RCSI Dublin October 2014. Awarded 1st Prize Y1 - 2014 A1 - Aherne, Emma A1 - O'Brien, K A1 - Quinlan, A A1 - McDonnell, R A1 - Hardy, C A1 - Galvin, R A1 - Fahey, T ER - TY - Generic T1 - Patient preferences for breast cancer referral: Development and pilot study. RCSI Research Day. March 2015 Y1 - 2015 A1 - Aherne, Emma A1 - O'Brien, K A1 - Walsh, A A1 - McDonnell, R A1 - Joyce, D A1 - Galvin, R A1 - Fahey, T ER - TY - Generic T1 - Interventions to address potentially inappropriate prescribing in primary care: a systematic review of randomised control trials. RCSI Research Day. March 2015 Y1 - 2015 A1 - Fitzgerald, C A1 - Clyne, B A1 - Quinlan, A A1 - Hardy, C A1 - Galvin, R A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Effectiveness of interventions in primary care to improve glycated haemoglobin and cardiovascular risk factor levels in patients with poorly-controlled type 2 diabetes mellitus: a systematic review. SPHeRE Research Day 29th February 2016 Y1 - 2016 A1 - Murphy, M A1 - Galvin, R A1 - Fahey, T A1 - Byrne, S A1 - Smith, SM ER - TY - Generic T1 - Effectiveness of interventions in primary care to improve glycated haemoglobin and cardiovascular risk factor levels in patients with poorly-controlled type 2 diabetes mellitus: a systematic review.SAPC 6th-8th of July 2016 Dublin Castle/RCSI.. Y1 - 2016 A1 - Murphy, M A1 - Galvin, R A1 - Fahey, T A1 - Byrne, M A1 - Smith, SM ER - TY - Generic T1 - Diagnostic accuracy of the STRATIFY clinical prediction rule for falls: A systematic review and meta-analysis. SAPC Conference 2012, 2-4 October 2012, Glasgow, Scotland Y1 - 2012 A1 - Billington, Jennifer A1 - Galvin, R A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/STRATIFY poster.pdf ER - TY - Generic T1 - Developing a web-based international register of clinical prediction rules for primary care SAPC ASM, University of Nottingham, 3 – 5 July 2013, Nottingham, UK Y1 - 2013 A1 - Keogh, C A1 - Wallace, E A1 - O'Brien, K A1 - Galvin, R A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Cross-sectional survey of general practitioners’ and community pharmacists’ opinions on medication management at transitions of care in Ireland. RCSI Research Day. March 2015 Y1 - 2015 A1 - Carroll, H A1 - Redmond, P A1 - Grimes, T A1 - Galvin, R A1 - McDonnell, R A1 - Boland, F A1 - Hughes, CM A1 - Fahey, T ER - TY - Generic T1 - Botulinum Toxin injection in the treatment of tennis elbow – a systematic and meta-analysis: a preliminary study. 13th Annual Scientific Meeting of the Association of University Departments of General Practice in Ireland, 19 March 2010, RCSI, Dublin, Irel Y1 - 2010 A1 - Callaghan, Claire A1 - Galvin, R A1 - Chan, Wai-Sun A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/posters/TE.pdf ER - TY - Generic T1 - What is the impact of levels of activity and function on the development multimorbidity over time? Elevator pitch SAPC 6th-8th of July 2016 Dublin Castle/RCSI. Y1 - 2016 A1 - Ryan, A A1 - Murphy, C A1 - Galvin, R A1 - Smith, SM ER - TY - Generic T1 - Risk of stroke following transient ischaemic attack: The ABCD2 CPR. The Society for Social Medicine, 6-8 September 2010, Belfast Y1 - 2010 A1 - Galvin, R A1 - Geraghty, Colm A1 - Motterlini, N A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/ABCD2Sept10.ppt ER - TY - Generic T1 - Prognostic value of the ABCD2 clinical prediction rule – a hospital based validation study. Irish Heart Foundation (IHF) Annual Stroke Study Day, 12 April 2013, Dublin Y1 - 2013 A1 - Galvin, R A1 - Atanassova, P A1 - Motterlini, N A1 - Fahey, T A1 - Dimitrov, B ER - TY - Generic T1 - Prescribing patterns of glucosamine in an elderly population: A national cohort study. AUDGPI Annual Scientific Meeting 2013, University of Limerick, 8 March 2013. Limerick Y1 - 2013 A1 - Galvin, R A1 - Cousins, G A1 - Boland, F A1 - Motterlini, N A1 - Bennett, K A1 - Fahey, T ER - TY - Generic T1 - Prescribing patterns of cartilage constituents in a national elderly population. Irish Gerontological Society Meeting, 9-10 September, 2011 Aviva Stadium, Dublin Y1 - 2011 A1 - Galvin, R A1 - Cousins, G A1 - Motterlini, N A1 - Bennett, K A1 - Fahey, T UR - http://hrbcentreprimarycare.ie/ppt/Glucosamine_RG.ppt ER - TY - Generic T1 - Predicting risk of stroke following TIA: A systematic review of the validation of ABCD2 Clinical Prediction Rule. 39th Annual Scientific Meeting of the SAPC, 7- 9 July 2010, University of East Anglia, Norwich Y1 - 2010 A1 - Galvin, R A1 - Geraghty, Colm A1 - Motterlini, N A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/ABCD2SAPCJuly10.ppt ER - TY - Generic T1 - Predicting recurrence free survival after radical prostatectomy: A systematic review of the validation of the CAPRA Clinical prediction rule. SAPC 2011 Conference 2011. 6 - 8 July 2011, Bristol, UK Y1 - 2011 A1 - Galvin, R A1 - Meurs, Pieter A1 - Van de Laar, F A A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/B15%20Meurs.ppt ER - TY - Generic T1 - Interventions to address potentially inappropriate prescribing in primary care: a systematic review of randomised control trials Society for Social Medicine 59th Annual scientific Meeting 2-4 Sept 2015 Dublin Y1 - 2015 A1 - Clyne, B A1 - Fitzgerald, C A1 - Quinlan, A A1 - Hardy, C A1 - Galvin, R A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Interventions to address potentially inappropriate prescribing in primary care: a systematic review of randomised control trials. Health Services Research & Pharmacy Practice (HSRPP) Conference April 2015 Y1 - 2015 A1 - Clyne, B A1 - Fitzgerald, C A1 - Quinlan, A A1 - Hardy, C A1 - Galvin, R A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - The Importance of National and International Networking. Networking Event Graduation, What’s Next? RCSI Dublin Dec 18th 2014 Y1 - 2014 A1 - Galvin, R ER - TY - Generic T1 - Effectiveness of interventions in primary care to improve glycated haemoglobin and cardiovascular risk factor levels in patients with poorly-controlled type 2 diabetes mellitus: a systematic review.RCSI Research Day 25th February 2016 Y1 - 2016 A1 - Murphy, M A1 - Galvin, R A1 - Fahey, T A1 - Byrne, S A1 - Smith, SM ER - TY - Generic T1 - Effectiveness of interventions in primary care to improve glycated haemoglobin and cardiovascular risk factor levels in patients with poorly-controlled type 2 diabetes mellitus: a systematic review. AUDGPI 10th March 2016 Y1 - 2016 A1 - Murphy, M A1 - Galvin, R A1 - Fahey, T A1 - Byrne, S A1 - Smith, SM ER - TY - Generic T1 - The effectiveness of botulinum toxin injection in the management of lateral epicondylitis: a systematic review. Irish Society of Chartered Physiotherapists conference 12 – 13 November 2010. HRB Centre for Primary Care Research., Dublin Y1 - 2010 A1 - Galvin, R A1 - Callaghan, Claire A1 - Chan, Wai-Sun A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/HISI_RCSI_Pres.ppt ER - TY - Generic T1 - Diagnostic accuracy of the STRATIFY clinical prediction rule for falls: A systematic review and meta-analysis. AUDGPI, 9 March 2012, Dublin Y1 - 2012 A1 - Billington, Jennifer A1 - Galvin, R A1 - Fahey, T UR - http://hrbcentreprimarycare.ie/ppt/AUDGPI%20-%20Jennifer%20Billington_RG.ppt ER - TY - Generic T1 - Diagnostic accuracy of the STRATIFY clinical prediction rule for falls: A systematic review and meta-analysis. RCSI Research Day, 25th April 2012, Dublin Y1 - 2012 A1 - Billington, Jennifer A1 - Galvin, R A1 - Fahey, T UR - http://hrbcentreprimarycare.ie/ppt/AUDGPI%20-%20Jennifer%20Billington_RG.ppt ER - TY - Generic T1 - Diagnostic accuracy of clinical tests for subacromial impingement syndrome (SIS): a systematic review and meta-analysis. Annual Society for Social Medicine Conference, 14-16 September 2011, University of Warwick, UK Y1 - 2011 A1 - Galvin, R UR - http://www.hrbcentreprimarycare.ie/ppt/Marwan%20Alqunaee_SIS_%20SSM.PPT ER - TY - Generic T1 - Development of an electronic platform for an international register of Clinical Prediction Rules relevant to primary care. Healthcare Informatics Society of Ireland Conference, Dublin Castle 19-20 Nov 2014 Y1 - 2014 A1 - Zarabzadeh, A A1 - McDonnell, R A1 - Corrigan, D A1 - Galvin, R A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Development and validation of a clinical prediction rule to identify women with suspected breast cancer: a prospective cohort study AUDGPI Cork 6-7 March 2014 Y1 - 2014 A1 - Galvin, R A1 - Joyce, D A1 - Downey, E A1 - Boland, F A1 - Fahey, T A1 - Hill, A ER - TY - Generic T1 - Development and validation of a clinical prediction rule to identify suspected breast cancer: a prospective cohort study SAPC July 9-11 2014 Edinburgh Y1 - 2014 A1 - Galvin, R A1 - Joyce, D A1 - Downey, E A1 - Boland, F A1 - Fahey, T A1 - Hill, A AB - The problem The number of primary care referrals of women with breast symptoms to symptomatic breast units (SBU) has increased yet the number of new cases with breast cancer has remained the same. The aim of this study is to develop and validate a clinical prediction rule (CPR) to identify women with breast cancer using routine data from an Irish national SBU so that a more evidence based approach to referral can be developed. The approach We analysed routine data from a prospective cohort of consecutive women reviewed at a SBU with breast symptoms. The dataset was split into a derivation and validation cohort. Regression analysis was used to derive a CPR from the patient’s history and clinical findings. Validation of the CPR consisted of estimating the number of breast cancers predicted to occur compared with the actual number of observed breast cancers across deciles of risk. Findings A total of 6,590 patients were included in the derivation study and 4.9% were diagnosed with breast cancer. Independent clinical predictors for breast cancer were: increasing age by year (adjusted odds ratio 1.08, 95%CI 1.07-1.09); presence of a lump (5.63, 95%CI 4.2-7.56); nipple change (2.77, 95%CI 1.68-4.58) and nipple discharge (2.09, 95% CI 1.1-3.97). Validation of the rule (n=911) demonstrated that the probability of breast cancer was higher with an increasing number of these independent variables. The Hosmer-Lemeshow goodness of fit showed no overall significant difference between the expected and the observed numbers of breast cancer (χ2HL: 6.74, p-value: 0.5647). Consequences This study derived and validated a CPR for breast cancer in women attending an Irish national SBU. We found that increasing age, presence of a lump, nipple discharge and nipple change are all associated with increased risk of breast cancer. Further validation of the rule is necessary as well as an assessment of its impact on referral practice. ER - TY - Generic T1 - Developing a Web-based International Register of Clinical Prediction Rules for Primary Care. North American Primary Care Research Group (NAPCRG), 1-5 December 2012, New Orleans, Louisiana, USA Y1 - 2012 A1 - Smith, SM A1 - Keogh, C A1 - Wallace, E A1 - Galvin, R A1 - O'Brien, K A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/International register for primary care CPRs.pptx ER - TY - Generic T1 - Career progression in Primary Care: Opportunities for International Networking, AUDGPI Study Day 24th Oct 2014 Y1 - 2014 A1 - Galvin, R ER - TY - Generic T1 - Workshop for early career academics in primary care on systematic reviews. AUDGPI Conference, Belfast March 2015 Y1 - 2015 A1 - Wallace, E A1 - Galvin, R A1 - Smith, SM ER - TY - Generic T1 - Risk of stroke following transient ischaemic attack: the ABCD² CPR. Clinical Prediction Rules – International Forum for Diagnostic and Prognostic Strategies in Primary Care, 4 June 2010, HRB Centre for Primary Care Research, Dublin Y1 - 2010 A1 - Galvin, R A1 - Geraghty, Colm A1 - Motterlini, N A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 ER - TY - Generic T1 - A Proposed Clinical Prediction Rule Register Supporting Primary Care Decision Making 9th International Conference on Knowledge, Information and Creativity Support Systems Cyprus 6-8 Nov 2014 T2 - 9th International Conference on Knowledge, Information and Creativity Support Systems Y1 - 2014 A1 - Zarabzadeh, A A1 - McDonnell, R A1 - Corrigan, D A1 - Galvin, R A1 - Smith, SM A1 - Fahey, T JF - 9th International Conference on Knowledge, Information and Creativity Support Systems ER -