%0 Journal Article %J British Journal of General Practice %D 2020 %T Why evidence still matters to general practice: James Mackenzie Lecture 2019 %A Fahey, T %B British Journal of General Practice %V 70 %P 198-199 %8 03/2020 %G eng %N 693 %R 10.3399/bjgp20X709241 %0 Journal Article %J Fam Pract %D 2012 %T Variation in medical practice: getting the balance right %A Wallace, E %A Smith, SM %A Fahey, T %K clinical practice %K medical interventions %K variation in medical practice %X Contemporary clinical practice is characterized by its complexity as the volume and diversity of medical interventions, whether they are drugs, procedures or diagnostic tests, are increasing and threaten to overwhelm our capacity to deliver patient-centred care. Consider some statistics: the average American citizen can expect to undergo seven operations in their lifetime, 10% will undergo an MRI scan annually (three times higher than the rate in neighbouring Canada) and 50% of Medicare beneficiaries are prescribed five or more medications. In Ireland, one-fifth of the whole population aged over 70 years are taking long-term Proton Pump Inhibitor (PPI) therapy.1–3 The consequences of this phenomenon for patients in terms of benefit (increase quantity and quality of life) versus harm (medicalization of a person, side effects of therapies and costs to the health service budget) give rise to questions concerning the epidemiology of health care utilization and how it differs between and within countries. Seminal work carried out by John Wennberg, a health services researcher and epidemiologist who developed the Dartmouth Atlas Health Project (www.dartmouthatlas.org), has produced an emerging science that examines variation in medical practice and raises important questions about what constitutes ‘appropriate’ health care. This editorial outlines the taxonomy of medical practice variation with clinical … %B Fam Pract %V 29 %P 501-2 %8 2012 Oct %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/23008518 %N 5 %R 10.1093/fampra/cms061 %0 Journal Article %J Br J Gen Pract %D 2010 %T Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis %A McNally, Maggie %A Curtain, James %A O'Brien, K %A Dimitrov, B %A Fahey, T %K Family Practice %K Great Britain %K Humans %K Pneumonia %K Prognosis %K Risk Assessment %K Severity of Illness Index %K Validation Studies as Topic %X BACKGROUND: The CRB-65 score is a clinical prediction rule that grades the severity of community-acquired pneumonia in terms of 30-day mortality. AIM: The study sought to validate CRB-65 and assess its clinical value in community and hospital settings. DESIGN OF STUDY: Systematic review and meta-analysis of validation studies of CRB-65. METHOD: Medline (1966 to June 2009), Embase (1988 to November 2008), British Nursing Index (BNI) and PsychINFO were searched, using a diagnostic accuracy search filter combined with subject-specific terms. The derived (index) rule was used as a predictive model and applied to all validation studies. Comparison was made between the observed and predicted number of deaths stratified by risk group (low, intermediate, and high) and setting of care (community or hospital). Pooled results are presented as risk ratios (RRs) in terms of over-prediction (RR>1) or under-prediction (RR<1) of 30-day mortality. RESULTS: Fourteen validation studies totalling 397 875 patients are included. CRB-65 performs well in hospitalised patients, particularly in those classified as intermediate (RR 0.91, 95% confidence interval [CI] = 0.71 to 1.17) or high risk (RR 1.01, 95% CI = 0.87 to 1.16). In community settings, CRB-65 over-predicts the probability of 30-day mortality across all strata of predicted risk, low (RR 9.41, 95% CI = 1.75 to 50.66), intermediate (RR 4.84, 95% CI = 2.61 to 8.69), and high (RR 1.58, 95% CI = 0.59 to 4.19). CONCLUSION: CRB-65 performs well in stratifying severity of pneumonia and resultant 30-day mortality in hospital settings. In community settings, CRB-65 appears to over-predict the probability of 30-day mortality across all strata of predicted risk. Caution is needed when applying CRB-65 to patients in general practice. %B Br J Gen Pract %V 60 %P e423-33 %8 2010 Oct %G eng %U http://bjgp.org/content/60/579/e423 %N 579 %R 10.3399/bjgp10X532422 %0 Journal Article %J Thromb Haemost %D 2011 %T Validation of the CHADS2 clinical prediction rule to predict ischaemic stroke. A systematic review and meta-analysis %A Keogh, C %A Wallace, E %A Dillon, C %A Dimitrov, B %A Fahey, T %K Atrial Fibrillation %K Humans %K Myocardial Ischemia %K Practice Guidelines as Topic %K Predictive Value of Tests %K Prognosis %K Quality Assurance, Health Care %K Research Design %K Risk %K Sensitivity and Specificity %K Stroke %X The CHADS2 predicts annual risk of ischaemic stroke in non-valvular atrial fibrillation. This systematic review and meta-analysis aims to determine the predictive value of CHADS2. The literature was systematically searched from 2001 to October 2010. Data was pooled and analysed using discrimination and calibration statistical measures, using a random effects model. Eight data sets (n = 2815) were included. The diagnostic accuracy suggested a cut-point of ≥ 1 has higher sensitivity (92%) than specificity (12%) and a cut-point of ≥ 4 has higher specificity (96%) than sensitivity (33%). Lower summary estimates were observed for cut-points ≥ 2 (sensitivity 79%, specificity 42%) and ≥ 3 (specificity 77%, sensitivity 50%). There was insufficient data to analyse cut-points ≥ 5 or ≥ 6. Moderate pooled c statistic values were identified for the classic (0.63, 95% CI 0.52-0.75) and revised (0.60, 95% CI 0.43-0.72) view of stratification of the CHADS2. Calibration analysis indicated no significant difference between the predicted and observed strokes across the three risk strata for the classic or revised view. All results were associated with high heterogeneity, and conclusions should be made cautiously. In conclusion, the pooled c statistic and calibration analysis suggests minimal clinical utility of both the classic and revised view of the CHADS2 in predicting ischaemic stroke across all risk strata. Due to high heterogeneity across studies and low event rates across all risk strata, the results should be interpreted cautiously. Further validation of CHADS2 should perhaps be undertaken, given the methodological differences between many of the available validation studies and the original CHADS2 derivation study. %B Thromb Haemost %V 106 %P 528-38 %8 2011 Sep %G eng %U http://th.schattauer.de/en/contents/archive/issue/1439/manuscript/16384.html %N 3 %R 10.1160/TH11-02-0061 %0 Journal Article %J BMJ Open %D 2015 %T Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study %A Moriarty, F %A Hardy, C %A Bennett, K %A Smith, SM %A Fahey, T %X Objectives To examine: (1) changes in polypharmacy in 1997, 2002, 2007 and 2012 and; (2) changes in potentially inappropriate prescribing (PIP) prevalence and the relationship between PIP and polypharmacy in individuals aged ≥65 years over this period in Ireland. Methods This repeated cross-sectional study using pharmacy claims data included all individuals eligible for the General Medical Services scheme in the former Eastern Health Board region of Ireland in 1997, 2002, 2007 and 2012 (range 338 025–539 752 individuals). Outcomes evaluated were prevalence of polypharmacy (being prescribed ≥5 regular medicines) and excessive polypharmacy (≥10 regular medicines) in all individuals and PIP prevalence in those aged ≥65 years determined by 30 criteria from the Screening Tool for Older Persons’ Prescriptions. Results The prevalence of polypharmacy increased from 1997 to 2012, particularly among older individuals (from 17.8% to 60.4% in those aged ≥65 years). The adjusted incident rate ratio for polypharmacy in 2012 compared to 1997 was 4.16 (95% CI 3.23 to 5.36), and for excessive polypharmacy it was 10.53 (8.58 to 12.91). Prevalence of PIP rose from 32.6% in 1997 to 37.3% in 2012. High-dose aspirin and digoxin prescribing decreased over time, but long-term proton pump inhibitors at maximal dose increased substantially (from 0.8% to 23.8%). The odds of having any PIP in 2012 were lower compared to 1997 after controlling for gender and level of polypharmacy, OR 0.39 (95% CI 0.39 to 0.4). Conclusions Accounting for the marked increase in polypharmacy, prescribing quality appears to have improved with a reduction in the odds of having PIP from 1997 to 2012. With growing numbers of people taking multiple regular medicines, strategies to address the related challenges of polypharmacy and PIP are needed. %B BMJ Open %V 5 %8 09/2015 %G eng %U http://bmjopen.bmj.com/content/5/9/e008656.full %N 9 %R 10.1136/bmjopen-2015-008656 %0 Journal Article %J BMC Geriatrics %D 2014 %T 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 %A Barry, E %A Galvin, R %A Keogh, C %A Horgan, F %A Fahey, T %K falls %K Older adults %K Timed Up and Go Test %K TUG %X 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. %B BMC Geriatrics %V 14 %8 02/2014 %G eng %U http://www.biomedcentral.com/1471-2318/14/14#abs %N 14 %R 10.1186/1471-2318-14-14 %0 Journal Article %J BMJ Open %D 2015 %T TElehealth in CHronic disease: mixed-methods study to develop the TECH conceptual model for intervention design and evaluation %A Salisbury, C %A Thomas, C %A O'Cathain, A %A Rogers, A %A Pope, C %A Yardley, L %A Hollinghurst, S %A Fahey, T %A Lewis, G %A Large, S %A Edwards, L %A Rowsell, A %A Segar, J %A Brownsell, S %A Montgomery, A %X Objective: To develop a conceptual model for effective use of telehealth in the management of chronic health conditions, and to use this to develop and evaluate an intervention for people with two exemplar conditions: raised cardiovascular disease risk and depression. Design: The model was based on several strands of evidence: a metareview and realist synthesis of quantitative and qualitative evidence on telehealth for chronic conditions; a qualitative study of patients’ and health professionals’ experience of telehealth; a quantitative survey of patients’ interest in using telehealth; and review of existing models of chronic condition management and evidence-based treatment guidelines. Based on these evidence strands, a model was developed and then refined at a stakeholder workshop. Then a telehealth intervention (‘Healthlines’) was designed by incorporating strategies to address each of the model components. The model also provided a framework for evaluation of this intervention within parallel randomised controlled trials in the two exemplar conditions, and the accompanying process evaluations and economic evaluations. Setting: Primary care. Results: The TElehealth in CHronic Disease (TECH) model proposes that attention to four components will offer interventions the best chance of success: (1) engagement of patients and health professionals, (2) effective chronic disease management (including subcomponents of self-management, optimisation of treatment, care coordination), (3) partnership between providers and (4) patient, social and health system context. Key intended outcomes are improved health, access to care, patient experience and cost-effective care. Conclusions: A conceptual model has been developed based on multiple sources of evidence which articulates how telehealth may best provide benefits for patients with chronic health conditions.It can be used to structure the design and evaluation of telehealth programmes which aim to be acceptable to patients and providers, and cost-effective. %B BMJ Open %V 5 %8 02/15 %G eng %U http://bmjopen.bmj.com/content/5/2/e006448.full %N 2 %9 Published Journal Article %R 10.1136 %0 Journal Article %J Fam Pract %D 2013 %T Tackling transitions in patient care: the process of medication reconciliation %A Redmond, P %A Grimes, T %A McDonnell, R %A Boland, F %A Hughes, CM %A Fahey, T %K medication reconciliation %B Fam Pract %V 30 %P 483-4 %8 2013 Oct %@ http://fampra.oxfordjournals.org/content/30/5/483.extract %G eng %U http://fampra.oxfordjournals.org/content/30/5/483.extract %N 5 %R 10.1093/fampra/cmt051 %0 Journal Article %J J Am Geriatr Soc %D 2013 %T A systematic review of the probability of repeated admission score in community-dwelling adults %A Wallace, E %A Hinchey, T %A Dimitrov, B %A Bennett, K %A Fahey, T %A Smith, SM %K Aged %K Aged, 80 and over %K Brazil %K Calibration %K Decision Support Techniques %K Europe %K Female %K Health Care Costs %K Health Services for the Aged %K Humans %K Male %K Mortality %K Patient Readmission %K Probability %K Reproducibility of Results %K Risk Assessment %K Sensitivity and Specificity %K United States %K Validation Studies as Topic %X OBJECTIVES: To perform a systematic review of the Probability of Repeated Admission (Pra) score in community-dwelling adults to assess its performance in a range of validation studies in the community setting. DESIGN: Systematic review and meta-analysis. SETTING: Primary and community care. PARTICIPANTS: Community-dwelling older people. MEASUREMENTS: The primary outcome was hospital admission; secondary outcomes were mortality, hospital days, functional decline, other health service use, and costs. RESULTS: Nine validation studies describing 11 cohorts of individuals aged 65 and older were identified. A metaanalysis of the Pra score in five cohorts (8,843 individuals) with comparable and available data revealed good discrimination performance (summary area under the receiver operating characteristic curve 69.7% (standard error 2.8%)). Pooled specificity was high (96%, 95% confidence interval (CI)=95.8–96.7%), indicating that a Pra score of 0.5 or greater effectively rules in the likelihood of admission, but pooled sensitivity was low (12%, 95% CI=10.5–13.6%). Calibration performance was good, with an overall risk ratio of 1.12 (95% CI=0.89–1.42), indicating that the Pra score reliably predicted hospital admissions. CONCLUSION: The Pra score performs well in predicting hospital admission in community-dwelling adults categorized as high risk according to the score. This tool has clinical and healthcare policy utility in terms of targeting elderly people at highest risk of hospital admission, but the low pooled sensitivity of the score indicates that it is not a reliable way of excluding hospital admission in those stratified as low risk. %B J Am Geriatr Soc %V 61 %P 357-64 %8 2013 Mar %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/jgs.12150/abstract %N 3 %R 10.1111/jgs.12150 %0 Journal Article %J Implementation Science %D 2016 %T Sustained effectiveness of a multifaceted intervention to reduce potentially inappropriate prescribing in older patients in primary care (OPTI-SCRIPT study) %A Clyne, B %A Smith, SM %A Hughes, CM %A Boland, F %A Cooper, J %A Fahey, T %A on behalf of the OPTI-SCRIPT study team %B Implementation Science %V 11 %P 1-8 %8 2016 %G eng %N 79 %R 10.1186/s13012-016-0442-2 %0 Journal Article %J Clinical Epidemiology %D 2015 %T A simplified approach to the pooled analysis of calibration of clinical prediction rules for systematic reviews of validation studies %A Dimitrov, B %A Motterlini, N %A Fahey, T %K clinical prediction rules %K derivation %K Meta-analysis %K primary care %K validation %X Objective: Estimating calibration performance of clinical prediction rules (CPRs) in systematic reviews of validation studies is not possible when predicted values are neither published nor accessible or sufficient or no individual participant or patient data are available. Our aims were to describe a simplified approach for outcomes prediction and calibration assessment and evaluate its functionality and validity. Study design and methods: Methodological study of systematic reviews of validation studies of CPRs: a) ABCD2 rule for prediction of 7 day stroke; and b) CRB-65 rule for prediction of 30 day mortality. Predicted outcomes in a sample validation study were computed by CPR distribution patterns (“derivation model”). As confirmation, a logistic regression model (with derivation study coefficients) was applied to CPR-based dummy variables in the validation study. Meta-analysis of validation studies provided pooled estimates of “predicted:observed” risk ratios (RRs), 95% confidence intervals (CIs), and indexes of heterogeneity (I2) on forest plots (fixed and random effects models), with and without adjustment of intercepts. The above approach was also applied to the CRB-65 rule. Results: Our simplified method, applied to ABCD2 rule in three risk strata (low, 0–3; intermediate, 4–5; high, 6–7 points), indicated that predictions are identical to those computed by univariate, CPR-based logistic regression model. Discrimination was good (c-statistics =0.61–0.82), however, calibration in some studies was low. In such cases with miscalibration, the under-prediction (RRs =0.73–0.91, 95% CIs 0.41–1.48) could be further corrected by intercept adjustment to account for incidence differences. An improvement of both heterogeneities and P-values (Hosmer-Lemeshow goodness-of-fit test) was observed. Better calibration and improved pooled RRs (0.90–1.06), with narrower 95% CIs (0.57–1.41) were achieved. Conclusion: Our results have an immediate clinical implication in situations when predicted outcomes in CPR validation studies are lacking or deficient by describing how such predictions can be obtained by everyone using the derivation study alone, without any need for highly specialized knowledge or sophisticated statistics. %B Clinical Epidemiology %V 7 %P 267-280 %8 04/2015 %G eng %U http://www.dovepress.com/articles.php?article_id=21355 %9 Published Journal Article %& 267 %R http://dx.doi.org/10.2147/CLEP.S67632 %0 Journal Article %J Med Care %D 2014 %T Risk prediction models to predict emergency hospital admission in community-dwelling adults. A systematic review %A Wallace, E %A Stuart, Ellen %A Vaughan, Niall %A Bennett, K %A Fahey, T %A Smith, SM %K community-dwelling adults %K emergency hospital admission %K risk prediction model %X Abstract BACKGROUND: Risk prediction models have been developed to identify those at increased risk for emergency admissions, which could facilitate targeted interventions in primary care to prevent these events. OBJECTIVE: Systematic review of validated risk prediction models for predicting emergency hospital admissions in community-dwelling adults. METHODS: A systematic literature review and narrative analysis was conducted. Inclusion criteria were as follows; POPULATION: community-dwelling adults (aged 18 years and above); Risk: risk prediction models, not contingent on an index hospital admission, with a derivation and ≥1 validation cohort; PRIMARY OUTCOME: emergency hospital admission (defined as unplanned overnight stay in hospital); STUDY DESIGN: retrospective or prospective cohort studies. RESULTS: Of 18,983 records reviewed, 27 unique risk prediction models met the inclusion criteria. Eleven were developed in the United States, 11 in the United Kingdom, 3 in Italy, 1 in Spain, and 1 in Canada. Nine models were derived using self-report data, and the remainder (n=18) used routine administrative or clinical record data. Total study sample sizes ranged from 96 to 4.7 million participants. Predictor variables most frequently included in models were: (1) named medical diagnoses (n=23); (2) age (n=23); (3) prior emergency admission (n=22); and (4) sex (n=18). Eleven models included nonmedical factors, such as functional status and social supports. Regarding predictive accuracy, models developed using administrative or clinical record data tended to perform better than those developed using self-report data (c statistics 0.63-0.83 vs. 0.61-0.74, respectively). Six models reported c statistics of >0.8, indicating good performance. All 6 included variables for prior health care utilization, multimorbidity or polypharmacy, and named medical diagnoses or prescribed medications. Three predicted admissions regarded as being ambulatory care sensitive. CONCLUSIONS: This study suggests that risk models developed using administrative or clinical record data tend to perform better. In applying a risk prediction model to a new population, careful consideration needs to be given to the purpose of its use and local factors. %B Med Care %V 52 %8 08/2014 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/25023919 %N 8 %9 Published Article Journal %& 751-65 %R 10.1097/MLR.0000000000000171 %0 Journal Article %J Addiction %D 2015 %T Risk of mortality on and off methadone substitution treatment in primary care: a national cohort study %A Cousins, G %A Boland, F %A Courtney, Brenda %A Barry, Joe %A Lyons, S %A Fahey, T %K All-cause mortality;cohort study;drug-related deaths;maintenance treatment;methadone;mortality;opioid;supervised consumption %X Aim To assess whether risk of death increases during periods of treatment transition, and investigate the impact of supervised methadone consumption on drug-related and all-cause mortality. Design National Irish cohort study. Setting Primary care. Participants A total of 6983 patients on a national methadone treatment register aged 16–65 years between 2004 and 2010. Measurement Drug-related (primary outcome) and all-cause (secondary outcome) mortality rates and rate ratios for periods on and off treatment; and the impact of regular supervised methadone consumption. Results Crude drug-related mortality rates were 0.24 per 100 person-years on treatment and 0.39 off treatment, adjusted mortality rate ratio 1.63 [95% confidence interval (CI) = 0.66–4.00]. Crude all-cause mortality rate per 100 person-years was 0.51 on treatment versus 1.57 off treatment, adjusted mortality rate ratio 3.64 (95% CI = 2.11–6.30). All-cause mortality off treatment was 6.36 (95% CI = 2.84–14.22) times higher in the first 2 weeks, 9.12 (95% CI = 3.17–26.28) times higher in weeks 3–4, compared with being 5 weeks or more in treatment. All-cause mortality was lower in those with regular supervision (crude mortality rate 0.60 versus 0.81 per 100 person-years) although, after adjustment, insufficient evidence exists to suggest that regular supervision is protective (mortality rate ratio = 1.23, 95% CI = 0.67–2.27). Conclusions Among primary care patients undergoing methadone treatment, continuing in methadone treatment is associated with a reduced risk of death. Patients' risk of all-cause mortality increases following treatment cessation, and is highest in the initial 4-week period. %B Addiction %V 111 %8 09/2015 %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/add.13087/full %N 1 %& 73-82 %R 10.1111/add.13087 %0 Journal Article %J QJM %D 2011 %T The risk of foot ulceration in people with diabetes screened in community settings: findings from a cohort study %A Crawford, F %A McCowan, Colin %A Dimitrov, B %A Woodburn, J %A Wylie, G H %A Booth, E %A Leese, G P %A Bekker, H L %A Kleijnen, J %A Fahey, T %K Adult %K Aged %K Aged, 80 and over %K Delivery of Health Care %K Diabetes Mellitus, Type 2 %K Diabetic Foot %K Diabetic Neuropathies %K Female %K Humans %K Male %K Mass Screening %K Middle Aged %K Predictive Value of Tests %K Risk Factors %K Scotland %X BACKGROUND: Annual foot checks are recommended in patients with diabetes mellitus (DM) to identify those at risk of foot ulceration. Systematic reviews have found few studies evaluating the predictive value of tests in community-based diabetic populations. AIM: To quantify the predictive value of clinical risk factors in relation to foot ulceration in a community population. METHODS: A cohort of 1192 people with diabetes receiving care in community settings was recruited and a screening procedure, covering symptoms, signs and diagnostic tests was conducted at baseline. At an average 1-year follow-up patients who developed a foot ulcer were identified by an independent blind assessor. Multivariable analysis was performed to identify clinical predictors of foot ulceration. FINDINGS: The incidence of foot ulceration was 1.93% [95% confidence interval (CI) 1.27-2.89). Three time-independent clinical predictors with five factors were selected: previous amputation [odds ratio (OR) 14.7, 95% CI 3.1-69.5), use of insulin before 3 months with inability to distinguish between cool and cold temperatures (OR 2.97, 95% CI 1.9-4.5) and failure to obtain at least one blood pressure reading for the calculation of ankle-brachial index with the failure to feel touch with a 10-g monofilament (OR 1.7, 95% CI 1.3-2.2). INTERPRETATION: Recommendations for annual diabetic foot check in low-risk, community-based patients should be reviewed as absolute events of ulceration are low. The accuracy of foot risk assessment tools to predict ulceration requires evaluation in randomized controlled trials with concurrent economic evaluations. %B QJM %V 104 %P 403-10 %8 2011 May %G eng %U http://qjmed.oxfordjournals.org/content/104/5/403 %N 5 %R 10.1093/qjmed/hcq227 %0 Journal Article %J J Subst Abuse Treat %D 2011 %T Risk of drug-related mortality during periods of transition in methadone maintenance treatment: a cohort study %A Cousins, G %A Teljeur, C %A Motterlini, N %A McCowan, Colin %A Dimitrov, B %A Fahey, T %K Adolescent %K Adult %K Cohort Studies %K Databases, Factual %K Female %K Humans %K Lung Diseases %K Male %K Medical Records %K Methadone %K Middle Aged %K Opiate Substitution Treatment %K Opioid-Related Disorders %K Patient Dropouts %K Prescriptions %K Risk %K Time Factors %K Young Adult %X This study aims to identify periods of elevated risk of drug-related mortality during methadone maintenance treatment (MMT) in primary care using a cohort of 3,162 Scottish drug users between January 1993 and February 2004. Deaths occurring during treatment or within 3 days after last methadone prescription expired were considered as cases "on treatment." Fatalities occurring 4 days or more after leaving treatment were cases "off treatment." Sixty-four drug-related deaths were identified. The greatest risk of drug-related death was in the first 2 weeks of treatment (adjusted hazard ratio 2.60, 95% confidence interval 1.03-6.56). Risk of drug-related death was lower after the first 30 days following treatment cessation, relative to the first 30 days off treatment. History of psychiatric admission was associated with increased risk of drug-related death in treatment. Increasing numbers of treatment episodes and urine testing were protective. History of psychiatric admission, increasing numbers of urine tests, and coprescriptions of benzodiazepines increased the risk of mortality out of treatment. The risk of drug-related mortality in MMT is elevated during periods of treatment transition, specifically treatment initiation and the first 30 days following treatment dropout or discharge. %B J Subst Abuse Treat %V 41 %P 252-60 %8 2011 Oct %G eng %U http://www.sciencedirect.com/science/article/pii/S0740547211000973 %N 3 %R 10.1016/j.jsat.2011.05.001 %0 Journal Article %J BMJ Open %D 2013 %T A retrospective cohort study of mode of delivery among public and private patients in an integrated maternity hospital setting %A Murphy, Deirdre J %A Fahey, T %K Caesarean Section %K Cohort Study %K Operative Delivery %K Operative Vaginal Delivery %K Private Healthcare %X Objective: To examine the associations between mode of delivery and public versus privately funded obstetric care within the same hospital setting. Design: Retrospective cohort study. Setting: Urban maternity hospital in Ireland. Population: A total of 30 053 women with singleton pregnancies who delivered between 2008 and 2011. Methods: The study population was divided into those who booked for obstetric care within the public(n=24 574) or private clinics (n=5479). Logistic regression analyses were performed to examine the associations between operative delivery and type of care, adjusting for potential confounding factors. Main outcome measures: Caesarean section (scheduled or emergency), operative vaginal delivery (vacuum or forceps), indication for caesarean section as classified by the operator. Results: Compared with public patients, private patients were more likely to be delivered by caesarean section (34.4% vs 22.5%, OR 1.81; 95% CI 1.70 to 1.93) or operative vaginal delivery (20.1% vs 16.5%, OR 1.28; 95% CI 1.19 to 1.38). The greatest disparity was for scheduled caesarean sections; differences persisted for nulliparous and parous women after controlling for medical and social differences between the groups (nulliparous 11.9% vs 4.6%, adjusted (adj) OR 1.82; 95% CI 1.49 to 2.24 and parous 26% vs 12.2%, adj OR 2.08; 95% CI 1.86 to 2.32). Scheduled repeat caesarean section accounted for most of the disparity among parous patients. Maternal request per se was an uncommonly reported indication for caesarean section (35 in each group, p<0.000). %B BMJ Open %V 3 %8 10/2013 %G eng %U http://www.bmjopen.bmj.com/content/3/11/e003865.full.pdf+html %N 11 %9 Published Article Journal %R 10.1136/bmjopen-2013-003865 %0 Journal Article %J BMJ %D 2014 %T Retraction of statins article is not in the public interest: better characterisation of benefits and risks is crucial %A Fahey, T %A Smith, SM %B BMJ %V 348 %8 06/2015 %G eng %N g4028 %R 10.1136/bmj.g4028. %0 Journal Article %J BMJ %D 2016 %T Reducing emergency admissions through community based interventions %A Wallace, E %A Smith, SM %A Fahey, T %A Roland, M %X Reducing emergency admissions to hospital, both as a measure of care quality and to contain spiralling healthcare expenditure, is gathering interest internationally. Emergency admissions in the United Kingdom rose by 47% from 1998 to 2013, from 3.6 million to 5.3 million, with only a 10% increase in population over this period.1 These admissions are expensive; in 2012 they cost the NHS £12.5bn (€16.8bn; $18.3bn).1 Emergency admission is used as a performance measure for healthcare systems. One of the quality measures for accountable care organisations under the US Affordable Care Act2 is to reduce emergency admissions for three chronic medical conditions: chronic obstructive pulmonary disease (COPD), congestive heart failure, and asthma.3 UK policy makers took a step further and introduced a financial incentive for general practitioners to identify the 2% of their practice population at highest risk of emergency admission and to manage them proactively (case management). We discuss the uncertainties around identification, prevention, and management of patients at high risk of emergency admission and suggest alternative approaches. %B BMJ %V 352 %8 2016 %G eng %U http://www.bmj.com/content/352/bmj.h6817.long %N h6817 %R http://dx.doi.org/10.1136/bmj.h6817 %0 Journal Article %J BMJ Open %D 2021 %T The quality of prescribing in primary care in England - observational study of the Drug Utilisation 90% indicator using administrative GP prescribing data %A Chiedozie, C %A Murphy, ME %A Fahey, T %A Moriarty, F %B BMJ Open %V 11 %8 03/2021 %G eng %N 3 %R https://doi.org/10.1136/bmjopen-2020-043049 %0 Journal Article %J BMC Pediatrics %D 2015 %T Psychostimulant prescribing trends in a paediatric population in Ireland: a national cohort study %A Boland, F %A Galvin, R %A Reulbach, U %A Motterlini, N %A Kelly, D %A Bennett, K %A Fahey, T %K ADHD %K children %K pharmacoepidemiology %K Psychostimulant treatment %X 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. %B BMC Pediatrics %V 15 %8 09/2015 %G eng %U http://www.biomedcentral.com/1471-2431/15/118 %N 118 %R DOI 10.1186/s12887-015-0435-3 %0 Journal Article %J BMC Health Services Research %D 2012 %T Proton pump inhibitors: potential cost reductions by applying prescribing guidelines %A Cahir, C %A Fahey, T %A Tilson, L %A Teljeur, C %A Bennett, K %K Cost-effective %K Generic %K Guidelines %K Proton pump inhibitors %X Background There are concerns that proton pump inhibitors (PPI) are being over prescribed in both primary and secondary care. This study aims to establish potential cost savings in a community drug scheme for a one year period according to published clinical and cost-effective guidelines for PPI prescribing. Methods Retrospective population-based cohort study in the Republic of Ireland using the Health Services Executive (HSE) Primary Care Reimbursement Services (PCRS) pharmacy claims database. The HSE-PCRS scheme is means tested and provides free health care including medications to approximately 30% of the Irish population. Prescription items are WHO ATC coded and details of every drug dispensed and claimants’ demographic data are available. Potential cost savings (net ingredient cost) were estimated according to UK NICE clinical guidelines for all HSE-PCRS claimants on PPI therapy for ≥3 consecutive months starting in 2007 with a one year follow up (n=167,747). Five scenarios were evaluated; (i) change to PPI initiation (cheapest brand); and after 3 months (ii) therapeutic switching (cheaper brand/generic equivalent); (iii) dose reduction (maintenance therapy); (iv) therapeutic switching and dose reduction and (v) therapeutic substitution (H2 antagonist). Results Total net ingredient cost was €88,153,174 for claimants on PPI therapy during 2007. The estimated costing savings for each of the five scenarios in a one year period were: (i) €36,943,348 (42% reduction); (ii) €29,568,475 (34%); (iii) €21,289,322 (24%); (iv) €40,505,013 (46%); (v) €34,991,569 (40%). Conclusion There are opportunities for substantial cost savings in relation to PPI prescribing if implementation of clinical guidelines in terms of generic substitution and step-down therapy is implemented on a national basis. %B BMC Health Services Research %V 12 %P 408 %8 11/2012 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/23163956 %N 1 %R doi:10.1186/1472-6963-12-408 %0 Journal Article %J Int. J. Environ. Res. Public Health %D 2014 %T A Prospective Cohort Study of Alcohol Exposure in Early and Late Pregnancy within an Urban Population in Ireland %A Murphy, Deirdre J %A Dunney, Clare %A Mullally, Aoife %A Adnan, Nita %A Fahey, T %A Barry, Joe %K alcohol exposure %K perinatal outcomes %K Pregnancy %K prospective cohort study %X Abstract: Most studies of alcohol consumption in pregnancy have looked at one time point only, often relying on recall. The aim of this longitudinal study was to determine whether alcohol consumption changes in early and late pregnancy and whether this affects perinatal outcomes. We performed a prospective cohort study, conducted from November 2010 to December 2011 at a teaching hospital in the Republic of Ireland. Of the 907 women with a singleton pregnancy who booked for antenatal care and delivered at the hospital, 185 (20%) abstained from alcohol in the first trimester but drank in the third trimester, 105 (12%) consumed alcohol in the first and third trimesters, and the remaining 617 (68%) consumed no alcohol in pregnancy. Factors associated with continuing to drink in pregnancy included older maternal age (30–39 years), Irish nationality, private healthcare, smoking, and a history of illicit drug use. Compared to pre-pregnancy, alcohol consumption in pregnancy was markedly reduced, with the majority of drinkers consuming ≤ 5 units per week (92% in first trimester, 72–75% in third trimester). Perhaps because of this, perinatal outcomes were similar for non-drinkers, women who abstained from alcohol in the first trimester, and women who drank in the first and third trimester of pregnancy. Most women moderate their alcohol consumption in pregnancy, especially in the first trimester, and have perinatal outcomes similar to those who abstain. %B Int. J. Environ. Res. Public Health %V 11 %P 2049-2063 %8 02/2014 %G eng %U http://www.mdpi.com/1660-4601/11/2/2049 %N 2 %9 Published Journal Article %& 2049 %R doi:10.3390/ijerph110202049 %0 Journal Article %J BJU Int %D 2013 %T Prognostic value of the CAPRA clinical prediction rule: a systematic review and meta-analysis %A Meurs, Pieter %A Galvin, R %A Fanning, Deirdre M %A Fahey, T %X 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. %B BJU Int %V 111 %P 427-436 %G eng %N 3 %R 10.1111/j.1464-410X.2012.11400.x %0 Journal Article %J Fam Pract %D 2011 %T Prognostic value of the ABCD² clinical prediction rule: a systematic review and meta-analysis %A Galvin, R %A Geraghty, Colm %A Motterlini, N %A Dimitrov, B %A Fahey, T %K Humans %K Ischemic Attack, Transient %K Predictive Value of Tests %K Risk Assessment %K Risk Factors %K Stroke %K Time Factors %X 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. %B Fam Pract %V 28 %P 366-76 %8 2011 Aug %G eng %U http://fampra.oxfordjournals.org/content/28/4/366 %N 4 %R 10.1093/fampra/cmr008 %0 Journal Article %J Trials %D 2016 %T A process evaluation of a cluster randomised trial to reduce potentially inappropriate prescribing in older people in primary care (OPTI-SCRIPT study) %A Clyne, B %A Cooper, J %A Hughes, CM %A Fahey, T %A Smith, SM %B Trials %V 17 %P 1-15 %8 2016 %G eng %N 1 %& 1 %0 Journal Article %J BMC Pregnancy Childbirth %D 2011 %T Prevalence, predictors and perinatal outcomes of peri-conceptional alcohol exposure--retrospective cohort study in an urban obstetric population in Ireland %A Mullally, Aoife %A Cleary, B %A Barry, Joe %A Fahey, T %A Murphy, Deirdre J %K Adult %K Age Factors %K Alcohol Drinking %K Cohort Studies %K Female %K Fertilization %K Fetal Alcohol Syndrome %K Humans %K Ireland %K Pregnancy %K Premature Birth %K Retrospective Studies %K Risk Factors %K Self Report %K Socioeconomic Factors %K Substance-Related Disorders %K Urban Population %X BACKGROUND: Evidence-based advice on alcohol consumption is required for pregnant women and women planning a pregnancy. Our aim was to investigate the prevalence, predictors and perinatal outcomes associated with peri-conceptional alcohol consumption. METHODS: A cohort study of 61,241 women who booked for antenatal care and delivered in a large urban maternity hospital between 2000 and 2007. Self-reported alcohol consumption at the booking visit was categorised as low (0-5 units per week), moderate (6-20 units per week) and high (>20 units per week). RESULTS: Of the 81% of women who reported alcohol consumption during the peri-conceptional period, 71% reported low intake, 9.9% moderate intake and 0.2% high intake. Factors associated with moderate alcohol consumption included being in employment OR 4.47 (95% CI 4.17 to 4.80), Irish nationality OR 16.5 (95% CI 14.9 to 18.3), private health care OR 5.83 (95% CI 5.38 to 6.31) and smoking OR 1.86 (95% CI 1.73 to 2.01). Factors associated with high consumption included maternal age less than 25 years OR 2.70 (95% CI 1.86 to 3.91) and illicit drug use OR 6.46 (95% CI 3.32 to 12.60). High consumption was associated with very preterm birth (<32 weeks gestation) even after controlling for socio-demographic factors, adjusted OR 3.15 (95% CI 1.26-7.88). Only three cases of Fetal Alcohol Syndrome were recorded (0.05 per 1000 total births), one each in the low, moderate and high consumption groups. CONCLUSIONS: Public Health campaigns need to emphasise the importance of peri-conceptional health and pre-pregnancy planning. Fetal Alcohol Syndrome is likely to be under-reported despite the high prevalence of alcohol consumption in this population. %B BMC Pregnancy Childbirth %V 11 %P 27 %8 2011 %G eng %U http://www.biomedcentral.com/1471-2393/11/27 %R 10.1186/1471-2393-11-27 %0 Journal Article %J BMC Pregnancy and Childbirth %D 2015 %T Prevalence of prescribing in pregnancy using the Irish primary care research network: a pilot study %A Dillon, P %A O'Brien, K %A McDonnell, R %A Donnelly-Swift, E %A Galvin, R %A Roche, A %A Cronin, K %A Walsh, DR %A Schelten, R %A Smith, SM %A Fahey, T %K FDA pregnancy-risk categories %K Medication use %K Pregnancy %K Prescribing %X 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. %B BMC Pregnancy and Childbirth %V 15 %8 03/15 %G eng %U http://www.biomedcentral.com/1471-2393/15/67/abstract %N 67 %9 Published Journal Article %R 10.1186/s12884-015-0489-0 %0 Journal Article %J European Journal of Clinical Pharmacology %D 2014 %T Prevalence of potentially inappropriate prescribing and prescribing omissions in older Irish adults: findings from The Irish LongituDinal Study on Ageing study (TILDA) %A Galvin, R %A Moriarty, F %A Cousins, G %A Cahir, C %A Motterlini, N %A Bradley, MC %A Hughes, CM %A Bennett, K %A Smith, SM %A Fahey, T %A Kenny, RA %K older people %K Potential prescribing omissions %K potentially inappropriate prescribing %K START %K STOPP %X 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. %B European Journal of Clinical Pharmacology %8 02/2014 %G eng %U http://link.springer.com/article/10.1007/s00228-014-1651-8# %R 10.1007/s00228-014-1651-8 %0 Journal Article %J BMJ Open %D 2020 %T Prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department patients with acute bacterial skin and skin structure infection: a pilot, prospective cohort study %A Quirke, M %A Mitchell, N %A Varley, J %A Kelly, S %A Boland, F %A Moughty, A %A McKeever, J %A Fahey, T %A Wakai, A %B BMJ Open %V 10 %8 08/2020 %G eng %N 8 %R 10.1136/bmjopen-2019-034057 %0 Journal Article %J BMJ Open %D 2015 %T Prevalence and predictors of initial oral antibiotic treatment failure in adult emergency department patients with cellulitis: a pilot study %A Quirke, M %A Boland, F %A Fahey, T %A O'Sullivan, R %A Hill, A %X Introduction Assessment of cellulitis severity in the emergency department (ED) setting is problematic. Given the lack of research performed to describe the epidemiology and management of cellulitis, it is unsurprising that heterogeneous antibiotic prescribing and poor adherence to guidelines is common. It has been shown that up to 20.5% of ED patients with cellulitis require either a change in route or dose of the initially prescribed antibiotic regimen. The current treatment failure rate for empirically prescribed oral antibiotic therapy in Irish EDs is unknown. The association of patient risk factors with treatment failure has not been described in our setting. Lower prevalence of community-acquired methicillin-resistant Staphylococcus aureus-associated infection, differing antibiotic prescribing preferences and varying availability of outpatient intravenous therapy programmes may result in different rates of empiric antibiotic treatment failure from those previously described. %B BMJ Open %V 5 %G eng %U http://bmjopen.bmj.com/content/5/6/e008150.full?sid=0db5be06-30df-4230-8fa4-2449ec3e3ce6 %N 6 %R 2015;5:e008150 doi:10.1136/bmjopen-2015-008150 %0 Journal Article %J BMJ Qual Saf %D 2011 %T Prevalence and outcomes of use of potentially inappropriate medicines in older people: cohort study stratified by residence in nursing home or in the community %A Barnett, K %A McCowan, Colin %A Evans, J M M %A Gillespie, N D %A Davey, P G %A Fahey, T %K Age Factors %K Aged %K Aged, 80 and over %K Cohort Studies %K Drug Utilization %K Female %K Humans %K Independent Living %K Male %K Medication Errors %K Nursing Homes %K Polypharmacy %K Prescription Drugs %K Prevalence %K Scotland %K Sex Factors %X OBJECTIVES: To compare the prevalence of use of potentially inappropriate medicines (PIMs) between older patients living in their own homes versus those living in nursing or residential homes, and to test the association between exposure to PIMs and mortality. DESIGN: Cohort study stratified by place of residence. SETTING: Tayside, Scotland. PARTICIPANTS: All people aged between 66 and 99 years who were resident or died in Tayside from 2005 to 2006. MAIN OUTCOME MEASURES: The exposure variable was PIM use as defined by Beers' Criteria. All cause mortality was the main outcome measure. RESULTS: 70,299 people were enrolled in the cohort of whom 96% were exposed to any medicine and 31% received a PIM. Place of residence was not associated with overall risk of receiving PIMs, adjusted OR 0.94, 95% CI 0.87 to 1.01. Exposure to five of the PIMs (including long-acting benzodiazepines) was significantly higher in nursing homes whereas exposure to five other PIMs (including amitriptyline and NSAIDs) was significantly lower. Exposure to PIMs was similar (20-46%) across all 71 general practices in Tayside and was not associated with increased risk of mortality after adjustment for age, gender and polypharmacy (adjusted OR 0.98, 95% CI 0.92 to 1.05). CONCLUSIONS: The authors question the validity of the full list of PIMs as an indicator of safety of medicines in older people because one-third of the population is exposed with little practice variation and no significant impact on mortality. Future studies should focus on management of a shorter list of genuinely high-risk medicines. %B BMJ Qual Saf %V 20 %P 275-81 %8 2011 Mar %G eng %U http://qualitysafety.bmj.com/content/20/3/275.full %N 3 %R 10.1136/bmjqs.2009.039818 %0 Journal Article %J BMC Complementary & Alternative Medicine %D 2013 %T Prescribing patterns of glucosamine in an older population: a national cohort study %A Galvin, R %A Cousins, G %A Boland, F %A Motterlini, N %A Bennett, K %A Fahey, T %K Cost-effectiveness %K Glucosamine %K Osteoarthritis %X 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. %B BMC Complementary & Alternative Medicine %V 13 %8 11/2013 %G eng %U http://www.biomedcentral.com/content/pdf/1472-6882-13-316.pdf %9 Published Article Journal %& 316 %R 10.1186/1472-6882-13-316 %0 Journal Article %J BMC Family Practice %D 2014 %T Prescriber variation in potentially inappropriate prescribing in older populations in Ireland %A Cahir, C %A Fahey, T %A Teljeur, C %A Bennett, K %K General Practice %K older populations %K potentially inappropriate prescribing %K Prescriber variation %K STOPP %X Abstract Background Health care policy-makers look for prescribing indicators at the population level to evaluate the performance of prescribers, improve quality and control drug costs. The aim of this research was to; (i) estimate the level of variation in potentially inappropriate prescribing (PIP) across prescribers in the national Irish older population using the STOPP criteria; (ii) estimate how reliably the criteria could distinguish between prescribers in terms of their proportion of PIP and; (iii) examine how PIP varies between prescribers and by patient and prescriber characteristics in a multilevel regression model. Methods 1,938 general practitioners (GPs) with 338,375 registered patients’ ≥70 years were extracted from the Health Service Executive Primary Care Reimbursement Service (HSE-PCRS) pharmacy claims database. HSE-PCRS prescriptions are WHO ATC coded. Demographic data for claimants’ and prescribers’ are available. Thirty STOPP indicators were applied to prescription claims in 2007. Multilevel logistic regression examined how PIP varied between prescribers and by individual patient and prescriber level variables. Results The unadjusted variation in PIP between prescribers was considerable (median 35%, IQR 30-40%). The STOPP criteria were reliable measures of PIP (average >0.8 reliability). The multilevel regression models found that only the patient level variable, number of different repeat drug classes was strongly associated with PIP (>2 drugs v none; adjusted OR, 4.0; 95% CI 3.7, 4.3). After adjustment for patient level variables the proportion of PIP varied fourfold (0.5 to 2 times the expected proportion) between prescribers but the majority of this variation was not significant. Conclusion PIP is of concern for all prescribers. Interventions aimed at enhancing appropriateness of prescribing should target patients taking multiple medications. %B BMC Family Practice %V 15 %8 04/2014 %G eng %U http://www.biomedcentral.com/1471-2296/15/59 %N 59 %9 Published Journal Article %R 10.1186/1471-2296-15-59 %0 Journal Article %J BMC Med %D 2011 %T Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score %A Aalbers, Jolien %A O'Brien, K %A Chan, Wai-Sun %A Falk, G %A Teljeur, C %A Dimitrov, B %A Fahey, T %K Adult %K Diagnosis, Differential %K Humans %K Pharyngitis %K Predictive Value of Tests %K Primary Health Care %K Streptococcal Infections %K Streptococcus pyogenes %X BACKGROUND: Stratifying patients with a sore throat into the probability of having an underlying bacterial or viral cause may be helpful in targeting antibiotic treatment. We sought to assess the diagnostic accuracy of signs and symptoms and validate a clinical prediction rule (CPR), the Centor score, for predicting group A β-haemolytic streptococcal (GABHS) pharyngitis in adults (> 14 years of age) presenting with sore throat symptoms. METHODS: A systematic literature search was performed up to July 2010. Studies that assessed the diagnostic accuracy of signs and symptoms and/or validated the Centor score were included. For the analysis of the diagnostic accuracy of signs and symptoms and the Centor score, studies were combined using a bivariate random effects model, while for the calibration analysis of the Centor score, a random effects model was used. RESULTS: A total of 21 studies incorporating 4,839 patients were included in the meta-analysis on diagnostic accuracy of signs and symptoms. The results were heterogeneous and suggest that individual signs and symptoms generate only small shifts in post-test probability (range positive likelihood ratio (+LR) 1.45-2.33, -LR 0.54-0.72). As a decision rule for considering antibiotic prescribing (score ≥ 3), the Centor score has reasonable specificity (0.82, 95% CI 0.72 to 0.88) and a post-test probability of 12% to 40% based on a prior prevalence of 5% to 20%. Pooled calibration shows no significant difference between the numbers of patients predicted and observed to have GABHS pharyngitis across strata of Centor score (0-1 risk ratio (RR) 0.72, 95% CI 0.49 to 1.06; 2-3 RR 0.93, 95% CI 0.73 to 1.17; 4 RR 1.14, 95% CI 0.95 to 1.37). CONCLUSIONS: Individual signs and symptoms are not powerful enough to discriminate GABHS pharyngitis from other types of sore throat. The Centor score is a well calibrated CPR for estimating the probability of GABHS pharyngitis. The Centor score can enhance appropriate prescribing of antibiotics, but should be used with caution in low prevalence settings of GABHS pharyngitis such as primary care. %B BMC Med %V 9 %P 67 %8 2011 %G eng %U http://www.biomedcentral.com/1741-7015/9/67 %R 10.1186/1741-7015-9-67 %0 Journal Article %J BMC Fam Pract %D 2010 %T Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs %A Giesen, Leonie G M %A Cousins, G %A Dimitrov, B %A Van de Laar, F A %A Fahey, T %K Adult %K Bayes Theorem %K Female %K Humans %K Predictive Value of Tests %K Urinalysis %K Urinary Tract Infections %X BACKGROUND: Acute urinary tract infections (UTI) are one of the most common bacterial infections among women presenting to primary care. However, there is a lack of consensus regarding the optimal reference standard threshold for diagnosing UTI. The objective of this systematic review is to determine the diagnostic accuracy of symptoms and signs in women presenting with suspected UTI, across three different reference standards (10(2) or 10(3) or 10(5) CFU/ml). We also examine the diagnostic value of individual symptoms and signs combined with dipstick test results in terms of clinical decision making. METHODS: Searches were performed through PubMed (1966 to April 2010), EMBASE (1973 to April 2010), Cochrane library (1973 to April 2010), Google scholar and reference checking.Studies that assessed the diagnostic accuracy of symptoms and signs of an uncomplicated UTI using a urine culture from a clean-catch or catherised urine specimen as the reference standard, with a reference standard of at least ≥ 10(2) CFU/ml were included. Synthesised data from a high quality systematic review were used regarding dipstick results. Studies were combined using a bivariate random effects model. RESULTS: Sixteen studies incorporating 3,711 patients are included. The weighted prior probability of UTI varies across diagnostic threshold, 65.1% at ≥ 10(2) CFU/ml; 55.4% at ≥ 10(3) CFU/ml and 44.8% at ≥ 10(2) CFU/ml ≥ 10(5) CFU/ml. Six symptoms are identified as useful diagnostic symptoms when a threshold of ≥ 10(2) CFU/ml is the reference standard. Presence of dysuria (+LR 1.30 95% CI 1.20-1.41), frequency (+LR 1.10 95% CI 1.04-1.16), hematuria (+LR 1.72 95%CI 1.30-2.27), nocturia (+LR 1.30 95% CI 1.08-1.56) and urgency (+LR 1.22 95% CI 1.11-1.34) all increase the probability of UTI. The presence of vaginal discharge (+LR 0.65 95% CI 0.51-0.83) decreases the probability of UTI. Presence of hematuria has the highest diagnostic utility, raising the post-test probability of UTI to 75.8% at ≥ 10(2) CFU/ml and 67.4% at ≥ 10(3) CFU/ml. Probability of UTI increases to 93.3% and 90.1% at ≥ 10(2) CFU/ml and ≥ 10(3) CFU/ml respectively when presence of hematuria is combined with a positive dipstick result for nitrites. Subgroup analysis shows improved diagnostic accuracy using lower reference standards ≥ 10(2) CFU/ml and ≥ 10(3) CFU/ml. CONCLUSIONS: Individual symptoms and signs have a modest ability to raise the pretest-risk of UTI. Diagnostic accuracy improves considerably when combined with dipstick tests particularly tests for nitrites. %B BMC Fam Pract %V 11 %P 78 %8 2010 %G eng %U http://www.biomedcentral.com/1471-2296/11/78 %R 10.1186/1471-2296-11-78 %0 Journal Article %J European Journal of Clinical Pharmacology %D 2016 %T Potentially inappropriate prescribing in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria %A Cooper, J %A Moriarty, F %A Ryan, C %A Smith, SM %A Bennett, K %A Fahey, T %A Wallace, E %A Cahir, C %A Williams, David %A Teeling, Mary %A Hughes, CM %X The purpose of this study is to establish the prevalence of potentially inappropriate prescribing (PIP) in middle-aged adults (45–64 years) in two populations with differing socio-economic profiles, and to investigate factors associated with PIP, using the PROMPT (PRescribing Optimally in Middle-aged People's Treatments) criteria. %B European Journal of Clinical Pharmacology %P 1–9 %G eng %U http://dx.doi.org/10.1007/s00228-015-2003-z %R 10.1007/s00228-015-2003-z %0 Journal Article %J Annals of Pharmacotherapy %D 2014 %T Potentially inappropriate prescribing and vulnerability and hospitalization in older community-dwelling patients. %A Cahir, C %A Moriarty, F %A Teljeur, C %A Fahey, T %A Bennett, K %K Beers 2012 criteria; STOPP; functional decline; health care use; older populations; potentially inappropriate prescribing; vulnerability %X BACKGROUND: The predictive validity of existing explicit process measures of potentially inappropriate prescribing (PIP) is not established. OBJECTIVE: To determine the association between PIP, and vulnerability and hospital visits in older community-dwelling patients. METHODS: This was a retrospective cohort study of 931 community-dwelling patients aged ≥70 years in 15 general practices in Ireland in 2010. PIP was defined by the Beers 2012 criteria and the Screening Tool of Older Person's Potentially Inappropriate Prescriptions (STOPP). Vulnerability was measured by the Vulnerable Elders Survey (score ≥3). The number of hospital visits was measured using patients' medical records and self-report for the previous 6 months. Multilevel logistic and Poisson regression was used to examine the association between PIP, and vulnerability and hospital visits after adjusting for patient and practice level covariates, socioeconomic status, comorbidity, number of drug classes, social support, and adherence. RESULTS: The prevalence of PIP determined by the Beers 2012 and STOPP criteria was 28% (n = 246) and 42% (n = 377), respectively. Patients with ≥2 PIP indicators were almost twice as likely to be classified as vulnerable (Beers adjusted odds ratio [OR] = 1.80; 95% CI = 1.08, 3.01; P < 0.05; STOPP adjusted OR = 1.86; 95% CI = 1.13, 3.04; P < 0.05). Patients with ≥2 STOPP indicators had an increased risk in the expected rate of hospital visits (adjusted incidence rate ratio = 1.32; 95% CI = 1.14, 1.54; P < 0.01). The Beers 2012 criteria were not associated with increased hospital visits. CONCLUSION: STOPP is a more sensitive measure of PIP than the Beers 2012 criteria and of clinical benefit in primary care settings. %B Annals of Pharmacotherapy %V 48 %P 1546-54 %8 09/14 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/25248541 %N 12 %9 Published Journal Article %& 1546 %R 10.1177/1060028014552821 %0 Journal Article %J Br J Clin Pharmacol %D 2010 %T Potentially inappropriate prescribing and cost outcomes for older people: a national population study %A Cahir, C %A Fahey, T %A Teeling, Mary %A Teljeur, C %A Feely, John %A Bennett, K %K Aged %K Aged, 80 and over %K Cohort Studies %K Costs and Cost Analysis %K Drug Prescriptions %K Female %K Humans %K Inappropriate Prescribing %K Ireland %K Male %K Medication Errors %K Polypharmacy %K Treatment Outcome %X AIMS: Optimization of drug prescribing in older populations is a priority due to the significant clinical and economic costs of drug-related illness. This study aimed to: (i) estimate the prevalence of potentially inappropriate prescribing (PIP) in a national Irish older population using European specific explicit prescribing criteria; (ii) investigate the association between PIP, number of drug classes, gender and age and; (iii) establish the total cost of PIP. METHODS: This was a retrospective national population study (n= 338 801) using the Health Service Executive Primary Care Reimbursement Service (HSE-PCRS) pharmacy claims database. The HSE-PCRS uses the WHO Anatomical Therapeutic Chemical (ATC) classification system and details of every drug dispensed and claimants' demographic data are available. Thirty PIP indicators (STOPP) were applied to prescription claims for those >or=70 years in Ireland in 2007. STOPP is a physiological system based screening tool of older persons' potentially inappropriate prescriptions assessing drug-drug and drug-disease interactions, dose and duration. RESULTS: In our study population PIP prevalence was 36% (121 454 claimants). The main contributors to this were: 56 560 (17%) prescribed proton pump inhibitors at maximum therapeutic dose for >8 weeks, 29 691 (9%) prescribed non-steroidal anti-inflammatories for >3 months, 17 676 (5%) prescribed long-acting benzodiazepines for >1 month and 16 201 (5%) prescribed duplicate drugs. The main determinant of PIP was polypharmacy. The likelihood of PIP increased with a significant linear and quadratic trend (P < 0.0001) with the number of drug classes.The maximum net ingredient cost of PIP was estimated to be euro38 664 640. Total PIP expenditure was estimated to be euro45 631 319, 9% of the overall expenditure on pharmaceuticals in those >or=70 years in 2007. CONCLUSIONS: The findings identify a high prevalence of PIP in Ireland with significant cost consequences. %B Br J Clin Pharmacol %V 69 %P 543-52 %8 2010 May %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.2010.03628.x/abstract %N 5 %R 10.1111/j.1365-2125.2010.03628.x %0 Journal Article %J Eur J Clin Pharmacol %D 2012 %T Potentially inappropriate prescribing and cost outcomes for older people: a cross-sectional study using the Northern Ireland Enhanced Prescribing Database %A Bradley, MC %A Fahey, T %A Cahir, C %A Bennett, K %A O'Reilly, Dermot %A Parsons, Carole %A Hughes, CM %K older people %K potentially inappropriate prescribing %K Quality Cost %K STOPP %X PURPOSE: We sought to estimate the prevalence of potentially inappropriate prescribing (PIP) in the Northern Ireland (NI) population aged ≥70 years, to investigate factors associated with PIP and to calculate total gross cost of PIP. METHODS: A retrospective cross-sectional population study was carried out in those aged ≥70 years in 2009/2010 who were in primary care in NI. Data were extracted from the Enhanced Prescribing Database, which provides details of prescribed and dispensed medications for each individual registered with a general practitioner. Twenty-eight PIP indicators from the Screening Tool of Older Persons potentially inappropriate Prescriptions (STOPP) criteria were applied to these data. PIP prevalence according to individual STOPP criteria and the overall prevalence of PIP were estimated. The relationship between PIP and polypharmacy, age and gender was examined using logistic regression. Gross cost of PIP was ascertained. RESULTS: The overall prevalence of PIP in the study population (n = 166,108) was 34 %. The most common examples of PIP identified were proton pump inhibitors at maximum therapeutic dose for >8 weeks (17,931 patients, 11 %), non-steroidal anti-inflammatory drugs >3 months (14,545 patients, 9 %) and long-term long-acting benzodiazepines (10,147 patients, 6 %). PIP was strongly associated with polypharmacy, with those receiving seven different medications being fivefold more likely to be exposed to PIP than those on zero to three medications (odds ratio 5.04, 95 % confidence interval 4.84-5.25) The gross cost of PIP was estimated to be 6,098,419 CONCLUSIONS: Consistent with other research, the prevalence of PIP was high among the study cohort, increased with polypharmacy and was associated with significant cost. %B Eur J Clin Pharmacol %V 68 %P 1425-33 %8 2012 Oct %G eng %U http://link.springer.com/article/10.1007%2Fs00228-012-1249-y %N 10 %R 10.1007/s00228-012-1249-y %0 Journal Article %J Br J Clin Pharmacol %D 2014 %T Potentially inappropriate prescribing and adverse health outcomes in community dwelling older patients %A Cahir, C %A Bennett, K %A Teljeur, C %A Fahey, T %K adverse drug events %K health care use %K HRQOL %K older populations %K potentially inappropriate prescribing %K STOPP %X Abstract AIMS: This study aimed to determine the association between potentially inappropriate prescribing (PIP) and health related outcomes [adverse drug events (ADEs), health related quality of life (HRQOL) and hospital accident and emergency (A&E) visits] in older community dwelling patients. METHODS: A retrospective cohort study of 931 community dwelling patients aged ≥70 years in 15 general practices in Ireland in 2010. PIP was defined by the Screening Tool of Older Person's Prescriptions (STOPP). ADEs were measured by patient self-report and medical record for the previous 6 months and reviewed by two independent clinicians. HRQOL was measured by the EQ-5D. A&E visits were measured by patients' medical records and self-report. Multilevel logistic, linear and Poisson regression examined how ADEs, HRQOL and A&E visits varied by PIP after adjusting for patient and practice level covariates: socioeconomic status, co-morbidity, number of drug classes and adherence. RESULTS: The overall prevalence of PIP was 42% (n = 377). Patients with ≥2 PIP indicators were twice as likely to have an ADE (adjusted OR 2.21; 95% CI 1.02, 4.83, P < 0.05), have a significantly lower mean HRQOL utility (adjusted coefficient -0.09, SE 0.02, P < 0.001) and nearly a two-fold increased risk in the expected rate of A&E visits (adjusted IRR 1.85; 95% CI 1.32, 2.58, P < 0.001). The number of drug classes and adherence were also significantly associated with these same adverse health outcomes. CONCLUSIONS: Reducing PIP in primary care may help lower the burden of ADEs, its associated health care use and costs and enhance quality of life in older patients. %B Br J Clin Pharmacol %V 77 %P 201-210 %8 01/2014 %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/bcp.12161/abstract %N 1 %& 201 %R doi: 10.1111/bcp.12161 %0 Journal Article %J BMC Geriatics %D 2014 %T Potentially inappropriate prescribing among older people in the United Kingdom %A Bradley, MC %A Padmanabhan, Shivani %A Cahir, C %A Williams, Tim %A Fahey, T %A Hughes, CM %K CPRD %K older people %K potentially inappropriate prescribing %K Screening tool of older persons potentially inappropriate Prescriptions (STOPP) %X Abstract (provisional) Background Potentially inappropriate prescribing (PIP) in older people is associated with increases in morbidity, hospitalisation and mortality. The objective of this study was to estimate the prevalence of and factors associated with PIP, among those aged >=70 years, in the United Kingdom, using a comprehensive set of prescribing indicators and comparing these to estimates obtained from a truncated set of the same indicators. Methods A retrospective cross-sectional study was carried out in the UK Clinical Practice Research Datalink (CPRD), in 2007. Participants included those aged >= 70 years, in CPRD. Fifty-two PIP indicators from the Screening Tool of Older Persons Potentially Inappropriate Prescriptions (STOPP) criteria were applied to data on prescribed drugs and clinical diagnoses. Overall prevalence of PIP and prevalence according to individual STOPP criteria were estimated. The relationship between PIP and polypharmacy (>=4 medications), comorbidity, age, and gender was examined. A truncated, subset of 28 STOPP criteria that were used in two previous studies, were further applied to the data to facilitate comparison. Results Using 52 indicators, the overall prevalence of PIP in the study population (n = 1,019,491) was 29%. The most common examples of PIP were therapeutic duplication (11.9%), followed by use of aspirin with no indication (11.3%) and inappropriate use of proton pump inhibitors (PPIs) (3.7%). PIP was strongly associated with polypharmacy (Odds Ratio 18.2, 95% Confidence Intervals, 18.0-18.4, P < 0.05). PIP was more common in those aged 70-74 years vs. 85 years or more and in males. Application of the smaller subset of the STOPP criteria resulted in a lower PIP prevalence at 14.9% (95% CIs 14.8-14.9%) (n = 151,598). The most common PIP issues identified with this subset were use of PPIs at maximum dose for > 8 weeks, NSAIDs for > 3 months (3.2% 32,373 patients), and use of long-term neuroleptics. Conclusions PIP was prevalent in the UK and increased with polypharmacy. Application of the comprehensive set of STOPP criteria allowed more accurate estimation of PIP compared to the subset of criteria used in previous studies. These findings may provide a focus for targeted interventions to reduce PIP. %B BMC Geriatics %V 14 %8 06/2014 %G eng %U http://www.biomedcentral.com/1471-2318/14/72/abstract %N 72 %9 Published Journal Article %R doi:10.1186/1471-2318-14-72 %0 Journal Article %J British Journal of Clinical Pharmacology %D 2016 %T Potentially inappropriate prescribing according to STOPP and START and adverse outcomes in community-dwelling older people: a prospective cohort study %A Moriarty, F %A Bennett, K %A Cahir, C %A Kenny, RA %A Fahey, T %B British Journal of Clinical Pharmacology %V 82(3) %8 2016 %G eng %U http://epubs.rcsi.ie/gpart/102/ %& 849–857 %R 10.1111/bcp.12995. %0 Journal Article %J BMC Family Practice %D 2016 %T ‘Potentially inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people %A Clyne, B %A Cooper, J %A Hughes, CM %A Fahey, T %A Smith, SM %B BMC Family Practice %V 17 %P 1-9 %8 2016 %G eng %N 1 %& 1 %0 Journal Article %J BMC Geriatics %D 2014 %T Potential for alcohol and drug interactions in older adults: evidence from the Irish longitudinal study on ageing %A Cousins, G %A Galvin, R %A Flood, Michelle %A Kennedy, Marie Claire %A Motterlini, N %A Henman, M %A Kenny, RA %A Fahey, T %K Aged %K Alcohol drinking/epidemiology %K Alcohol interactive medications %K Drug interactions %X 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. %B Family Practice %V 33 %P 172-178 %G eng %U http://fampra.oxfordjournals.org/content/33/2/172.abstract %R 10.1093/fampra/cmw006 %0 Journal Article %J 11 %D 2021 %T Geographical variation of emergency hospital admissions for ambulatory care sensitive conditions in older adults in Ireland 2012–2016 %A Walsh, ME %A Cronin, S %A Boland, F %A Ebell, MH %A Fahey, T %A Wallace, E %B 11 %8 01/2021 %G eng %R https://doi.org/10.1136/ bmjopen-2020-042779 %0 Journal Article %J BMC Med Inform Decis Mak %D 2011 %T Framework for the impact analysis and implementation of Clinical Prediction Rules (CPRs) %A Wallace, E %A Smith, SM %A Perera-Salazar, Rafael %A Vaucher, Paul %A McCowan, Colin %A Collins, Gary %A Verbakel, Jan %A Lakhanpaul, Monica %A Fahey, T %K Decision Support Techniques %K Evidence-Based Medicine %K Humans %K Physician's Practice Patterns %K Research Design %X Clinical Prediction Rules (CPRs) are tools that quantify the contribution of symptoms, clinical signs and available diagnostic tests, and in doing so stratify patients according to the probability of having a target outcome or need for a specified treatment. Most focus on the derivation stage with only a minority progressing to validation and very few undergoing impact analysis. Impact analysis studies remain the most efficient way of assessing whether incorporating CPRs into a decision making process improves patient care. However there is a lack of clear methodology for the design of high quality impact analysis studies.We have developed a sequential four-phased framework based on the literature and the collective experience of our international working group to help researchers identify and overcome the specific challenges in designing and conducting an impact analysis of a CPR.There is a need to shift emphasis from deriving new CPRs to validating and implementing existing CPRs. The proposed framework provides a structured approach to this topical and complex area of research. %B BMC Med Inform Decis Mak %V 11 %P 62 %8 2011 %G eng %U http://www.biomedcentral.com/1472-6947/11/62 %R 10.1186/1472-6947-11-62 %0 Journal Article %J Age and Aging %D 2021 %T Factors associated with initiation of bone-health medication among older adults in primary care in Ireland %A Walsh, M %A Nerdrum, M %A Fahey, T %A Moriarty, F %B Age and Aging %8 03/2021 %G eng %U https://academic.oup.com/ageing/advance-article/doi/10.1093/ageing/afab033/6161551?guestAccessKey=fe9828a3-cb6c-4ce3-89f0-19435e846e37 %R https://doi.org/10.1093/ageing/afab033/ %0 Journal Article %J BMC Family Practice %D 2009 %T The external validity of published randomized controlled trials in primary care %A Jones, R %A Jones, R %A Mc Cowan, C %A Montgomery, A %A Fahey, T %K primary care %K randomized controlled trials %X Abstract Background A criticism of Randomized Controlled Trials (RCTs) in primary care is that they lack external validity, participants being unrepresentative of the wider population. Our aim was to determine whether published primary care-based RCTs report information about how the study sample is assembled, and whether this is associated with RCT characteristics. Methods We reviewed RCTs published in four primary care journals in the years 2001–2004. Main outcomes were: (1) eligibility fraction (proportion eligible of those screened), (2) enrolment fraction (proportion randomised of those eligible), (3) recruitment fraction (proportion of potential participants actually randomised), and (4) number of patients needed to be screened (NNS) in order to randomize one participant. Results A total of 148 RCTs were reviewed. One hundred and three trials (70%) reported the number of individuals assessed by investigators for eligibility, 119 (80%) reported the number eligible for participation, and all reported the actual number recruited. The median eligibility fraction was 83% (IQR 40% to 100%), and the median enrolment fraction was 74% (IQR 49% to 92%). The median NNS was 2.43, with some trials reportedly recruiting every patient or practice screened for eligibility, and one trial screening 484 for each patient recruited. We found no association between NNS and journal, trial size, multi- or single-centre, funding source or type of intervention. There may be associations between provision of sufficient recruitment data for the calculation of NNS and funding source and type of intervention. Conclusion RCTs reporting recruitment data in primary care suggest that once screened for eligibility and found to match inclusion criteria patients are likely to be randomized. This finding needs to be treated with caution as it may represent inadequate identification or reporting of the eligible population. A substantial minority of RCTs did not provide sufficient information about the patient recruitment process. %B BMC Family Practice %8 01/2009 %G eng %U http://www.biomedcentral.com/1471-2296/10/5 %R doi:10.1186/1471-2296-10-5 %0 Journal Article %J The Lancet Oncology %D 2015 %T The expanding role of primary care in cancer control %A Rubin, G %A Berendsen, A %A Crawford, SM %A Dommett, R %A Earle, C %A Emery, J %A Fahey, T %A Grassi, L %A Grunfeld, E %A Gupta, W %A Hamilton, W %A Hiom, S %A Hunter, D %A Lyratzopoulos, G %A Macleod, U %A Mason, R %A Mitchell, G %X The nature of cancer control is changing, with an increasing emphasis, fuelled by public and political demand, on prevention, early diagnosis, and patient experience during and after treatment. At the same time, primary care is increasingly promoted, by governments and health funders worldwide, as the preferred setting for most health care for reasons of increasing need, to stabilise health-care costs, and to accommodate patient preference for care close to home. It is timely, then, to consider how this expanding role for primary care can work for cancer control, which has long been dominated by highly technical interventions centred on treatment, and in which the contribution of primary care has been largely perceived as marginal. In this Commission, expert opinion from primary care and public health professionals with academic and clinical cancer expertise—from epidemiologists, psychologists, policy makers, and cancer specialists—has contributed to a detailed consideration of the evidence for cancer control provided in primary care and community care settings. Ranging from primary prevention to end-of-life care, the scope for new models of care is explored, and the actions needed to eff ect change are outlined. The strengths of primary care—its continuous, coordinated, and comprehensive care for individuals and families—are particularly evident in prevention and diagnosis, in shared follow-up and survivorship care, and in end-of-life care. A strong theme of integration of care runs throughout, and its elements (clinical, vertical, and functional) and the tools needed for integrated working are described in detail. All of this change, as it evolves, will need to be underpinned by new research and by continuing and shared multiprofessional development. %B The Lancet Oncology %V 16 %P 1231-72 %8 09/2015 %G eng %U http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00205-3/abstract %N 12 %R http://dx.doi.org/10.1016/S1470-2045(15)00205-3 %0 Journal Article %J Journal of Clinical Epidemiology %D 2021 %T Existing validated clinical prediction rules for predicting response to physiotherapy interventions for musculoskeletal conditions have limited clinical value: A systematic review %A Walsh, M %A French, HP %A Wallace, E %A Madden, S %A King, P %A Fahey, T %A Galvin, R %B Journal of Clinical Epidemiology %V 135 %8 02/2021 %G eng %& 90 %R https://doi.org/10.1016/j.jclinepi.2021.02.005 %0 Journal Article %J BMJ Open %D 2013 %T The epidemiology of malpractice claims in primary care; a systematic review %A Wallace, E %A Lowry, J %A Smith, SM %A Fahey, T %K malpractice %K primary care %X Abstract Objectives The aim of this systematic review was to examine the epidemiology of malpractice claims in primary care. Design A computerised systematic literature search was conducted. Studies were included if they reported original data (≥10 cases) pertinent to malpractice claims, were based in primary care and were published in the English language. Data were synthesised using a narrative approach. Setting Primary care. Participants Malpractice claimants. Primary outcome Malpractice claim (defined as a written demand for compensation for medical injury). We recorded: medical misadventure cited in claims, missed/delayed diagnoses cited in claims, outcome of claims, prevalence of claims and compensation awarded to claimants. Results Of the 7152 articles retrieved by electronic search, a total of 34 studies met the inclusion criteria and were included in the narrative analysis. Twenty-eight studies presented data from medical indemnity malpractice claims databases and six studies presented survey data. Fifteen studies were based in the USA, nine in the UK, seven in Australia, one in Canada and two in France. The commonest medical misadventure resulting in claims was failure to or delay in diagnosis, which represented 26–63% of all claims across included studies. Common missed or delayed diagnoses included cancer and myocardial infarction in adults and meningitis in children. Medication error represented the second commonest domain representing 5.6–20% of all claims across included studies. The prevalence of malpractice claims in primary care varied across countries. In the USA and Australia when compared with other clinical disciplines, general practice ranked in the top five specialties accounting for the most claims, representing 7.6–20% of all claims. However, the majority of claims were successfully defended. Conclusions This review of malpractice claims in primary care highlights diagnosis and medication error as areas to be prioritised in developing educational strategies and risk management systems. %B BMJ Open %V 3 %P 1-8 %8 07/2013 %G eng %U http://bmjopen.bmj.com/content/3/7/e002929.abstract %N 7 %R doi:10.1136 %0 Journal Article %J Clin Geriatr Med %D 2012 %T Electronic prescribing and other forms of technology to reduce inappropriate medication use and polypharmacy in older people: a review of current evidence %A Clyne, B %A Bradley, MC %A Hughes, CM %A Fahey, T %A Lapane, Kate L %K Aged %K Aged, 80 and over %K Clinical Pharmacy Information Systems %K Decision Support Systems, Clinical %K Drug Prescriptions %K Drug Utilization Review %K Electronic Prescribing %K Evidence-Based Medicine %K Female %K Humans %K Inappropriate Prescribing %K Male %K Medication Errors %K Physician's Practice Patterns %K Polypharmacy %K Randomized Controlled Trials as Topic %X This review provided an overview of the current evidence in relation to the use of e-prescribing and other forms of technology, such as CDSS, to reduce inappropriate prescribing in older people. The evidence indicates that various types of e-prescribing and CDSS interventions have the potential to reduce inappropriate prescribing and polypharmacy in older people, but the magnitude of their effect varies according to study design and setting. There was significant heterogeneity in the studies reported in terms of study designs, intervention design, patient settings, and outcome measures with patient outcomes seldom reported. Widespread diffusion of these interventions has not occurred in any of the health care settings examined. Overall, health care providers report being satisfied with e-prescribing systems and see the systems as having a positive impact on the safety of their prescribing practices, yet the problem of overriding or ignoring alerts persists. The problem of large numbers of inaccurate and insignificant alerts and this issue, along with the other barriers that have been identified, warrant further investigation. %B Clin Geriatr Med %V 28 %P 301-22 %8 2012 May %G eng %U http://www.sciencedirect.com/science/article/pii/S0749069012000109 %N 2 %R 10.1016/j.cger.2012.01.009 %0 Journal Article %J HRB Open Research %D 2021 %T Efficacy and safety of sacubitril/valsartan in the treatment of heart failure: protocol for a systematic review incorporating unpublished clinical study reports [version 2; peer review: 3 approved]. %A Byrne, D %A Fahey, T %A Moriarty, F %B HRB Open Research %V 3:5 %8 04/2021 %G eng %R https://doi.org/10.12688/hrbopenres.12951.2 %0 Journal Article %J BMC Trials %D 2013 %T Effectiveness of medicines review with web-based pharmaceutical treatment algorithms in reducing potentially inappropriate prescribing in older people in primary care: a cluster randomized trial (OPTI-SCRIPT study protocol) %A Clyne, B %A Bradley, MC %A Motterlini, N %A Clear, Daniel %A McDonnell, R %A Smith, SM %A Hughes, CM %A Fahey, T %B BMC Trials %V 14 %P 72 %8 03/2013 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/23497575 %N 1 %& 72 %R doi: 10.1186/1745-6215-14-72 %0 Journal Article %J Annals of Family Medicine %D 2015 %T Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study) %A Clyne, B %A Smith, SM %A Hughes, CM %A Boland, F %A Bradley, MC %A Cooper, J %A Fahey, T %A on behalf of the OPTI-SCRIPT study team %B Annals of Family Medicine %V 13 %P 545 - 553 %8 11/2015 %G eng %U http://www.annfammed.org/content/13/6/545.abstractN2 - PURPOSE Potentially inappropriate prescribing (PIP) is common in older people and can result in increased morbidity, adverse drug events, and hospitalizations. The OPTI-SCRIPT study (Optimizing Prescr %N 6 %! The Annals of Family Medicine %R 10.1370/afm.1838. %0 Journal Article %J Br J Cancer %D 2010 %T Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer %A Olde Bekkink, M %A McCowan, Colin %A Falk, G %A Teljeur, C %A Van de Laar, F A %A Fahey, T %K Adenocarcinoma %K Adult %K Aged %K Anemia %K Barium Sulfate %K Cohort Studies %K Colonoscopy %K Colorectal Neoplasms %K Enema %K Family Practice %K Female %K Gastrointestinal Hemorrhage %K Humans %K Male %K Middle Aged %K Pain %K Primary Health Care %K Prospective Studies %K Rectum %K Reference Standards %K Risk %K Sensitivity and Specificity %K Sigmoidoscopy %K Weight Loss %X BACKGROUND: Rectal bleeding is a recognised early symptom of colorectal cancer. This study aimed to assess the diagnostic accuracy of symptoms, signs and diagnostic tests in patients with rectal bleeding in relation to risk of colorectal cancer in primary care. METHODS: Diagnostic accuracy systematic review. Medline (1966 to May 2009), Embase (1988 to May 2009), British Nursing Index (1991 to May 2009) and PsychINFO (1970 to May 2009) were searched. We included cohort studies that assessed the diagnostic utility of rectal bleeding in combination with other symptoms, signs and diagnostic tests in primary care. An eight-point quality assessment tool was produced to assess the quality of included studies. Pooled positive likelihood ratios (PLRs), sensitivities and specificities were calculated. RESULTS: Eight studies incorporating 2323 patients were included. Average weighted prior probability of colorectal cancer was 7.0% (range: 3.3-15.4%, median: 8.1%). Age > or = 60 years (pooled PLR: 2.79, 95% confidence interval (CI) 2.00-3.90), weight loss (pooled PLR: 1.89, 95% CI: 1.03-3.07) and change in bowel habit (pooled PLR: 1.92, 95% CI: 0.54-3.57) raise the probability of colorectal cancer into the range of referral to secondary care but do not conclusively 'rule in' the diagnosis. Presence of severe anaemia has the highest diagnostic value (pooled PLR: 3.67, 95% CI: 1.30-10.35), specificity 0.95 (95% CI: 0.93-0.96), but still only generates a post-test probability of 21.6%. CONCLUSIONS: In patients with rectal bleeding who present to their general practitioner, additional 'red flag' symptoms have modest diagnostic value. These findings have implications in relation to recommendations contained in clinical practice guidelines. %B Br J Cancer %V 102 %P 48-58 %8 2010 Jan 5 %G eng %U http://www.nature.com/bjc/journal/v102/n1/full/6605426a.html %N 1 %R 10.1038/sj.bjc.6605426 %0 Journal Article %J BMC Fam Pract %D 2012 %T Diagnostic accuracy of the STRATIFY clinical prediction rule for falls: A systematic review and meta-analysis %A Billington, Jennifer %A Galvin, R %A Fahey, T %K Falls assessment %K Meta-analysis %K Sensitivity and Specificity %K STRATIFY %K systematic review %X 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. %B BMC Fam Pract %V 13 %P 76 %8 2012 Aug 7 %G eng %U http://www.biomedcentral.com/1471-2296/13/76 %N 1 %R 10.1186/1471-2296-13-76 %0 Journal Article %J Headache %D 2011 %T Diagnostic accuracy of the ID Migraine: a systematic review and meta-analysis %A Cousins, G %A Hijazze, Samira %A Van de Laar, F A %A Fahey, T %K Humans %K Migraine Disorders %K Predictive Value of Tests %K Reproducibility of Results %K Sensitivity and Specificity %X OBJECTIVE: The purpose of this systematic review with meta-analysis is to determine the diagnostic accuracy of the identification of migraine (ID Migraine) as a decision rule for identifying patients with migraine. BACKGROUND: The ID Migraine screening tool is designed to identify patients with migraine in primary care settings. Several studies have validated the ID Migraine across various clinical settings, including primary care, neurology departments, headache clinics, dental clinics, ear, nose, and throat (ENT) and ophthalmology. METHODS: A systematic literature search was conducted to identify all studies validating the ID Migraine, with the International Headache Criteria as the reference standard. The methodological quality of selected studies was assessed using the Quality of Diagnostic Accuracy Studies tool. All selected studies were combined using a bivariate random effects model. A sensitivity analysis was also conducted, pooling only those studies using representative patient groups (primary care, neurology departments, and headache clinics) to determine the potential influence of spectrum bias on the results. RESULTS: Thirteen studies incorporating 5866 patients are included. The weighted prior probability of migraine across the 13 studies is 59%. The ID Migraine is shown to be useful for ruling out rather than ruling in migraine, with a greater pooled sensitivity estimate (0.84, 95% confidence interval 0.75-0.90) than specificity (0.76, 95% confidence interval 0.69-0.83). A negative ID Migraine score reduces the probability of migraine from 59% to 23%. The sensitivity analysis reveals similar results. CONCLUSIONS: This systematic review quantifies the diagnostic accuracy of the ID Migraine as a brief, practical, and easy to use diagnostic tool for Migraine. Application of the ID Migraine as a diagnostic tool is likely to improve appropriate diagnosis and management of migraine sufferers. %B Headache %V 51 %P 1140-8 %8 2011 Jul-Aug %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2011.01916.x/abstract;jsessionid=D4B74FF3BAD1073878D910966C56835A.f03t04 %N 7 %R 10.1111/j.1526-4610.2011.01916.x %0 Journal Article %J Arch Phys Med Rehabil %D 2012 %T Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis %A Alqunaee, Marwan %A Galvin, R %A Fahey, T %K Humans %K Muscle Weakness %K Pain Measurement %K Physical Examination %K ROC Curve %K Sensitivity and Specificity %K Shoulder Impingement Syndrome %X 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. %B Arch Phys Med Rehabil %V 93 %P 229-36 %8 2012 Feb %G eng %U http://www.sciencedirect.com/science/article/pii/S0003999311007957# %N 2 %R 10.1016/j.apmr.2011.08.035 %0 Journal Article %J Science Direct %D 2013 %T 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 %A McNally E %A Keogh, C %A Galvin, R %A Fahey, T %K clinical prediction rule %K Rheumatoid arthritis %K Undifferentiated arthritis %X 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. %B Science Direct %V 43 %P 498-507 %8 02/2014 %G eng %U http://www.sciencedirect.com/science/article/pii/S0049017213001728 %N 4 %& 498 %R 10.1016/j.semarthrit.2013.08.005 %0 Journal Article %J BMC Cancer %D 2014 %T Development and validation of a clinical prediction rule to identify suspected breast cancer: a prospective cohort study %A Galvin, R %A Joyce, D %A Downey, E %A Boland, F %A Fahey, T %A Hill, A %K Breast cancer %K Diagnosis %K primary care %X 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. %B BMC Cancer %V 14 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/25277332 %N 743 %R 10.1186/1471-2407-14-743 %0 Journal Article %J Ann of Fam Med %D 2014 %T Developing an International Register of Clinical Prediction Rules for Use in Primary Care: A Descriptive Analysis %A Keogh, C %A Wallace, E %A O'Brien, K %A Galvin, R %A Smith, SM %A Lewis, Cliona %A Cummins, Anthony %A Cousins, G %A Dimitrov, B %A Fahey, T %K clinical decision support systems %K clinical prediction rule %K decision aid %K decision making %K primary care %K score card %X 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. %B Ann of Fam Med %V 12 %P 359-366 %8 07/2014 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/25024245 %N 4 %9 Published Article Journal %& 359 %R 10.1370/afm.1640 %0 Journal Article %J BMC Med Inform Decis Mak %D 2011 %T Developing an electronic health record (EHR) for methadone treatment recording and decision support %A Xiao, Liang %A Cousins, G %A Courtney, Brenda %A Hederman, Lucy %A Fahey, T %A Dimitrov, B %K Decision Support Techniques %K Drug Therapy, Computer-Assisted %K Electronic Health Records %K Episode of Care %K Humans %K Medical Record Linkage %K Methadone %K Practice Guidelines as Topic %K Semantics %K Systematized Nomenclature of Medicine %K User-Computer Interface %X BACKGROUND: In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. METHODS: A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. RESULTS: The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. CONCLUSIONS: The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland. %B BMC Med Inform Decis Mak %V 11 %P 5 %8 2011 %G eng %U http://www.biomedcentral.com/1472-6947/11/5 %R 10.1186/1472-6947-11-5 %0 Journal Article %J Fam Pract %D 2009 %T C-reactive protein and community-acquired pneumonia in ambulatory care: systematic review of diagnostic accuracy studies %A Falk, G %A Fahey, T %K Ambulatory Care %K C-Reactive Protein %K Community-Acquired Infections %K Humans %K Pneumonia %X BACKGROUND: There is uncertainty regarding the diagnostic value of C-reactive protein (CRP) in patients presenting with symptoms suggestive of community-acquired pneumonia (CAP) in community or ambulatory settings. OBJECTIVE: We assessed the diagnostic value of CRP in primary care and accident and emergency departments in terms of ruling in or ruling out CAP. METHODS: Diagnostic accuracy systematic review, we searched PubMed from January 1966 to September 2008 and EMBASE from January 1980 to September 2008 using a diagnostic accuracy search filter. We included cross-sectional or cohort studies that assess the diagnostic utility of CRP at different cut-points against a reference standard of chest X-ray. We calculated pooled positive and negative likelihood ratios (LRs) and assessed heterogeneity using the I(2) index. RESULTS: Eight studies incorporating 2194 patients were included. The median prevalence of CAP was 14.6% (range 5%-89%). At a CRP cut-point of < or =20 mg/l, the pooled positive LR+ was 2.1 [95% confidence interval (CI) 1.8-2.4] and the pooled negative LR- was 0.33 (95% CI 0.25-0.43). At the two other CRP cut-points (< or =50, >100 mg/l), the results were heterogeneous, so the pooled results should be interpreted with caution. CONCLUSIONS: CRP may be of value in ruling out a diagnosis of CAP in situations where the probability of CAP >10%, typically accident and emergency departments. In primary care, additional diagnostic testing with CRP is unlikely to alter the probability of CAP sufficiently to change subsequent management decisions such as antibiotic prescribing or referral to hospital. %B Fam Pract %V 26 %P 10-21 %8 2009 Feb %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/19074757 %N 1 %R 10.1093/fampra/cmn095 %0 Journal Article %J BMC Public Health %D 2009 %T Comparison of self-reported health & healthcare utilisation between asylum seekers and refugees: an observational study %A Toar, Magzoub %A O'Brien, K %A Fahey, T %K Adult %K Aged %K Cross-Sectional Studies %K Female %K Health Services %K Humans %K Male %K Middle Aged %K Observation %K Patient Acceptance of Health Care %K Psychometrics %K Questionnaires %K Refugees %K Stress Disorders, Post-Traumatic %X BACKGROUND: Adult refugees and asylum seekers living in Western countries experience a high prevalence of mental health problems, especially post traumatic stress disorder (PTSD), depression and anxiety. This study compares and contrasts the prevalence of health problems, and potential risk factors as well as the utilisation of health services by asylum seekers and refugees in the Irish context. METHODS: Cross sectional study using validated self reported health status questionnaires of adult asylum seekers (n = 60) and refugees (n = 28) from 30 countries, living in Ireland. Outcome measures included: general health status (SF-36), presence of PTSD symptoms and anxiety/depression symptoms. Data on chronic conditions and pre or post migration stressors are also reported. The two groups are compared for utilisation of the health care system and the use of over the counter medications. RESULTS: Asylum seekers were significantly more likely than refugees to report symptoms of PTSD (OR 6.3, 95% CI: 2.2-17.9) and depression/anxiety (OR 5.8, 95% CI: 2.2-15.4), while no significant difference was found in self-reported general health. When adjusted by multivariable regression, the presence of more than one chronic disease (OR 4.0, 95%CI: 1.3-12.7; OR 3.4, 95% CI: 1.2-10.1), high levels of pre migration stressors (OR 3.6, 95% CI: 1.1-11.9; OR 3.3, 95% CI: 1.0-10.4) or post migration stressors (OR 17.3, 95% CI: 4.9-60.8; OR 3.9, 95% CI: 1.2-12.3) were independent predictors of self reported PTSD or depression/anxiety symptoms respectively, however, residence status was no longer significantly associated with PTSD or depression/anxiety. Residence status may act as a marker for other explanatory variables; our results show it has a strong relationship with post migration stressors (chi2 = 19.74, df = 1, P < 0.001).In terms of health care utilisation, asylum seekers use GP services more often than refugees, while no significant difference was found between these groups for use of dentists, medication, hospitalisation or mental health services. CONCLUSION: Asylum seekers have a higher level of self reported PTSD and depression/anxiety symptoms compared to refugees. However, residence status appears to act as a marker for post migration stressors. Compared to refugees, asylum seekers utilise GP services more often, but not mental health services. %B BMC Public Health %V 9 %P 214 %8 2009 %G eng %R 10.1186/1471-2458-9-214 %0 Journal Article %J Clinical Evidence (Online) %D 2010 %T Clinical prediction rules in primary care: what can be done to maximise their implementation? %A Keogh, C %A Fahey, T %K clinical practice %K clinical prediction rules %X Clinical prediction rules (CPRs) have become more prevalent in the published literature in recent years. Known by an array ofsynonymous terms including risk score, scorecard, algorithm, guide, and model, CPRs are clinical tools that quantify the contribution ofa patient’s history, physical examination, and diagnostic tests to stratify patients in terms of the probability of having a specific target disorder. Outcomes of CPRs can be presented as diagnosis, prognosis, referral, or treatment. Although not designed to replace clinical knowledge and experience, CPRs do offer a way to assist with the overall diagnostic and prognostic process.[1] Despite the value of these clinical tools, relatively few CPRs have been quantified and their utility validated. One CPR that has gained widespread acceptance is the Centor score,[2] which is based on four clinical features (tonsillar exudate, tender cervical anterior adenopathy, history of fever, and absence of cough) and is used to identify patients with group A beta-haemolytic streptococcal throat infections. What can be done to expedite implementation of other CPRs into routine primary care? %B Clinical Evidence (Online) %8 10/2010 %G eng %U http://clinicalevidence.bmj.com/x/set/static/ebm/learn/678151.html %0 Journal Article %J British Journal of General Practice %D 2014 %T Clinical prediction rules in practice:review of clinical guidelines and survey of GPs %A Plüddemann, A %A Wallace, E %A Bankhead, Clare %A Keogh, C %A Van der Windt, D %A Lasserson, D %A Galvin, R %A Moschetti, I %A Kearley, K %A O'Brien, K %A Sanders, S %A Mallett, S %A Malanda, U %A Thompson, M %A Fahey, T %A Stevens, R %K clinical guidelines %K clinical prediction rules %K survey %X 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. %B British Journal of General Practice %V 64 %P 233-243 %8 01/2014 %G eng %U http://bjgp.org/content/64/621/e233.full %N 621 %9 Published Journal Article %& 233 %R 10.3399/bjgp14X677860 %0 Journal Article %J BMJ %D 2009 %T Clinical prediction rules %A Falk, G %A Fahey, T %K Diagnosis %K Diagnostic Errors %K Family Practice %K Humans %K Likelihood Functions %K Predictive Value of Tests %K Questionnaires %K Unnecessary Procedures %B BMJ %V 339 %P b2899 %8 2009 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/19666679 %R 10.1136/bmj.b2899 %0 Journal Article %J BMJ Open 2015 %D 2015 %T Benzodiazepine prescribing in children under 15 years of age receiving free medical care on the General Medical Services scheme in Ireland %A O Sullivan, K %A Reulbach, U %A Boland, F %A Moschetti, I %A Kelly, D %A Bennett, K %A Fahey, T %X Objective To examine the prevalence and secular trends in benzodiazepine (BZD) prescribing in the Irish paediatric population. In addition, we examine coprescribing of antiepileptic, antipsychotic, antidepressant and psychostimulants in children receiving BZD drugs and compare BZD prescribing in Ireland to that in other European countries. Setting Data were obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database from the Health Service Executive (HSE)—Primary Care Reimbursement Services (PCRS). Participants Children aged 0–15 years, on the HSE-PCRS database between January 2002 and December 2011, were included. Primary and secondary outcome measures Prescribing rates were reported over time (2002–2011) and duration (≤ or >90 days). Age (0–4, 5–11, 12–15) and gender trends were established. Rates of concomitant prescriptions for antiepileptic, antipsychotics, antidepressants and psychostimulants were reported. European prescribing data were retrieved from the literature. Results Rates decreased from 2002 (8.56/1000 GMS population: 95% CI 8.20 to 8.92) to 2011 (5.33/1000 GMS population: 95% CI 5.10 to 5.55). Of those children currently receiving a BZD prescription, 6% were prescribed BZD for >90 days. Rates were higher for boys in the 0–4 and 5–11 age ranges, whereas for girls they were higher in the 12–15 age groups. A substantial proportion of children receiving BZD drugs are also prescribed antiepileptic (27%), antidepressant (11%), antipsychotic (5%) and psychostimulant (2%) medicines. Prescribing rates follow a similar pattern to that in other European countries. Conclusions While BZD prescribing trends have decreased in recent years, this study shows that a significant proportion of the GMS children population are being prescribed BZD in the long term. This study highlights the need for guidelines for BZD prescribing in children in terms of clinical indication and responsibility, coprescribing, dosage and duration of treatment. %B BMJ Open 2015 %V 5 %G eng %U http://bmjopen.bmj.com/content/5/6/e007070.long %N 6 %R 2015;5:e007070 doi:10.1136/bmjopen-2014-007070 %0 Journal Article %J BMC Pregnancy and Childbirth %D 2013 %T Behavioural change in relation to alcohol exposure in pregnancy and impact on perinatal outcomes. A prospective cohort study %A Murphy, Deirdre J %A Mullally, Aoife %A Cleary, B %A Fahey, T %A Barry, Joe %K alcohol exposure %K perinatal outcomes %K Pregnancy %K prospective cohort study %X Background There has been limited research addressing whether behavioural change in relation to alcohol exposure in pregnancy results in better perinatal outcomes. Methods A cohort study of 6725 women who booked for antenatal care and delivered in a large urban teaching hospital in 2010–2011. A detailed history of alcohol consumption pre-pregnancy and during early pregnancy was recorded at the first antenatal visit with follow-up of the mother and infant until discharge following birth. Adverse perinatal outcomes were compared for ‘non-drinkers’, ‘ex-drinkers’ and ‘current drinkers’. Results Of the 6017 (90%) women who reported alcohol consumption prior to pregnancy 3325 (55%) engaged in binge drinking and 266 (4.4%) consumed more than 14 units on average per week. At the time of booking 5649 (94%) women were ex-drinkers and of the 368 women who continued to drink 338 (92%) had a low intake (0–5 units per week), 30 (8%) an excess intake (6-20+ units per week) and 93 (25%) reported at least one episode of binge drinking. Factors associated with continuing to drink in early pregnancy included older maternal age (30–39 years), (OR 1.6; 95% CI 1.3 to 1.8), Irish nationality (OR 3.1; 95% CI 2.2 to 4.3) and smoking (OR 2.6; 95% CI 1.9 to 3.5). Ex-drinkers had similar perinatal outcomes to non-drinkers. Compared to non-drinkers current drinking was associated with an increased risk of intrauterine growth restriction (IUGR) (13% versus 19%, crude OR 1.6; 95% CI 1.1 to 2.2, adjusted OR 1.2; 95% CI 0.8 to 1.8). The greatest risk of IUGR was among women who continued to both drink and smoke, (9% versus 32%, crude OR 4.8; 95% CI 3.3 to 7.0, adjusted OR 4.5; 95% CI 3.1 to 6.7). %B BMC Pregnancy and Childbirth %V 13 %8 2013 %G eng %U http://www.biomedcentral.com/1471-2393/13/8 %N 8 %R doi:10.1186/1471-2393-13-8 %0 Journal Article %J BMJ %D 2014 %T Assembling the evidence for patient centred care %A Fahey, T %B BMJ %V 349 %8 07/2014 %G eng %N g4855 %R dx.doi.org/10.1136/bmj.g4855 %0 Journal Article %J Preventative Medicine %D 2021 %T Aspirin prescribing for cardiovascular disease in middle-aged and older adults in Ireland: Findings from The Irish Longitudinal Study on Ageing %A Moriarty, F %A Barry, A %A Kenny, RA %A Fahey, T %B Preventative Medicine %8 03/2021 %G eng %R https://doi.org/10.1016/j.ypmed.2021.106504 %0 Journal Article %J BMC Pediatrics %D 2015 %T Antidepressant prescribing in Irish children:secular trends and international comparison in the context of a safety warning %A O’Sullivan, K %A Boland, F %A Reulbach, U %A Motterlini, N %A Kelly, D %A Bennett, K %A Fahey, T %K Anti-depressants %K children %K Paediatric prescribing %K Safety warning %X Background: In 2003, the Irish Medicines Board (IMB) warned against the treatment of childhood depression with selective serotonin reuptake inhibitors (SSRIs) due to increased risk of suicide. This study examined the effect of this warning on the prevalence of anti-depressants in Irish children and compared age and gender trends and international comparisons of prescription rates. Methods: A retrospective cohort study of the Irish Health Service Executive (HSE) pharmacy claims database for the General Medical Services (GMS) scheme for dispensed medication. Data were obtained for 2002–2011 for those aged ≤15 years. Prevalence of anti-depressants per 1000 eligible population, along with 95 % confidence intervals, were calculated. A negative binomial regression analysis was used to investigate trends and compare rates across years, sex and age groups (0–4, 5–11, 12–15 years). International prescribing data were retrieved from the literature. Results: The prevalence of anti-depressants decreased from 4.74/1000 population (95 % CI: 4.47-5.01) in 2002 to 2.61/1000 population (95 % CI: 2.43-2.80) in 2008. SSRI rates decreased from 2002 to 2008. Prescription rates for contra-indicated SSRIs paroxetine, sertraline and citralopram decreased significantly from 2002 to 2005, and, apart from paroxetine, only small fluctuations were seen from 2005 onwards. Fluoxetine was the most frequently prescribed anti-depressant and rates increased between 2002 and 2011. Anti-depressant rates were higher for younger boys and older girls. The Irish prevalence was lower than the US, similar to the U.K. and higher than Germany and Denmark. Conclusions: The direction and timing of these trends suggest that medical practitioners followed the IMB advice. %B BMC Pediatrics %V 15 %G eng %U http://www.biomedcentral.com/content/pdf/s12887-015-0436-2.pdf %N 119 %R DOI 10.1186/s12887-015-0436-2 %0 Journal Article %J British Journal of General Practice %D 2020 %T Anticipatory care planning for older adults: a trans-jurisdictional feasibility study %A Corry, D %A Doherty, J %A McCann, A %A Doyle, F %A Cardwell, C %A Carter, G %A Clarke, M %A Fahey, T %A Gillespie, P %A McGlade, K %A O'Halloran, P %A Wallace, E %A Brazil, K %B British Journal of General Practice %V 70 %8 06/2020 %G eng %N Suppl 1 %R 10.3399/bjgp20X711197 %0 Journal Article %J JAMA %D 2014 %T Antibiotics for Acute Bronchitis %A Smith, SM %A Smucny, J %A Fahey, T %K adverse effects %K clinical improvement %K Cough-related outcomes %X CLINICAL QUESTION: Are antibiotics associated with improved outcomes in patients with acute bronchitis? BOTTOM LINE: Prescribing antibiotics for acute bronchitis was associated with reduced overall and nighttime cough and with an approximately half-day reduction in duration of cough, in days feeling ill, and in days with impaired activities. However, at follow-up, there were no significant differences in patients receiving antibiotics compared with those receiving placebo in overall clinical improvements or limitations in work or other activities. There was a significant increase in adverse effects in the antibiotic group, particularly gastrointestinal symptoms. %B JAMA %V 312 %P 2678-9 %8 12/2014 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/25536260 %N 24 %9 Published Article Journal %& 2678 %R 10.1001/jama.2014.12839 %0 Journal Article %J Pharmacoepidemiol Drug Saf %D 2012 %T Antibiotic prescribing trends in a paediatric sub-population in Ireland %A Keogh, C %A Motterlini, N %A Reulbach, U %A Bennett, K %A Fahey, T %K antimicrobial practice %K antimicrobial treatment %K children %K pharmacoepidemiology %X PURPOSE: Little is known about antibiotic prescribing in Irish children. This study aims to examine antibiotic prescribing patterns in Irish children and associated costs and to compare this with European findings. METHODS: A retrospective analysis of the Irish Health Services Executive (HSE) pharmacy claims database 2004-2009 for the General Medical Services (GMS) scheme for dispensed medications. This represents 28% of Irish children but over-represents lower socio-economic groups. Overall prescribing rates were reported over time (2004-2009), age (0-4, 5-11, 12-15 years) and gender. Statistical comparison is made using negative binomial regression. Overall prescribing rates for the most commonly prescribed drugs were calculated. Associated cost of prescribing also was calculated. European prescribing data were retrieved from the literature. RESULTS: Rates remained stable from 2004 (631/1000 GMS population; 95%CI 628-634) to 2009 (621/1000; 95%CI 618-624). An interaction effect emerged between gender and age. Rates were generally higher for girls, except for the boys aged 0-4 years. The preferred choice of agents changed across years, with co-amoxiclav becoming the most prescribed drug in 2009 (308/1000; 95%CI 306-310). The total cost of antibiotics increased from €4.4 million in 2004 to €6.0 million in 2009. Higher overall rates of antibiotic prescribing emerged compared with available European data. Differences were observed between prescribing of some first-line and second-line drugs. CONCLUSIONS: Age and gender trends are consistent with international literature. However, Ireland has higher overall prescribing rates relative to some European countries. This suggests that a quality improvement in prescribing intervention is warranted. Copyright © 2012 John Wiley & Sons, Ltd. %B Pharmacoepidemiol Drug Saf %V 21 %P 945-52 %8 2012 Sep %G eng %U http://onlinelibrary.wiley.com/doi/10.1002/pds.2346/abstract %N 9 %R 10.1002/pds.2346 %0 Journal Article %J BMC Med %D 2011 %T The Alvarado score for predicting acute appendicitis: a systematic review %A Ohle, Robert %A O'Reilly, Fran %A O'Brien, K %A Fahey, T %A Dimitrov, B %K Appendicitis %K Humans %K Predictive Value of Tests %K Severity of Illness Index %X BACKGROUND: The Alvarado score can be used to stratify patients with symptoms of suspected appendicitis; the validity of the score in certain patient groups and at different cut points is still unclear. The aim of this study was to assess the discrimination (diagnostic accuracy) and calibration performance of the Alvarado score. METHODS: A systematic search of validation studies in Medline, Embase, DARE and The Cochrane library was performed up to April 2011. We assessed the diagnostic accuracy of the score at the two cut-off points: score of 5 (1 to 4 vs. 5 to 10) and score of 7 (1 to 6 vs. 7 to 10). Calibration was analysed across low (1 to 4), intermediate (5 to 6) and high (7 to 10) risk strata. The analysis focused on three sub-groups: men, women and children. RESULTS: Forty-two studies were included in the review. In terms of diagnostic accuracy, the cut-point of 5 was good at 'ruling out' admission for appendicitis (sensitivity 99% overall, 96% men, 99% woman, 99% children). At the cut-point of 7, recommended for 'ruling in' appendicitis and progression to surgery, the score performed poorly in each subgroup (specificity overall 81%, men 57%, woman 73%, children 76%). The Alvarado score is well calibrated in men across all risk strata (low RR 1.06, 95% CI 0.87 to 1.28; intermediate 1.09, 0.86 to 1.37 and high 1.02, 0.97 to 1.08). The score over-predicts the probability of appendicitis in children in the intermediate and high risk groups and in women across all risk strata. CONCLUSIONS: The Alvarado score is a useful diagnostic 'rule out' score at a cut point of 5 for all patient groups. The score is well calibrated in men, inconsistent in children and over-predicts the probability of appendicitis in women across all strata of risk. %B BMC Med %V 9 %P 139 %8 2011 %G eng %U http://www.biomedcentral.com/1741-7015/9/139 %R 10.1186/1741-7015-9-139 %0 Journal Article %J BMC Health Services Research %D 2013 %T Addressing potentially inappropriate prescribing in older patients: Design and pilot study of an intervention in primary care %A Clyne, B %A Bradley, MC %A Smith, SM %A Hughes, CM %A Clear, Daniel %A McDonnell, R %A Williams, David %A Fahey, T %K Medical research council framework %K Multifaceted intervention %K potentially inappropriate prescribing %K Randomised controlled trial %X Background Potentially inappropriate prescribing (PIP) in older people is common in primary care and can result in increased morbidity, adverse drug events, hospitalizations and mortality. The prevalence of PIP in Ireland is estimated at 36% with an associated expenditure of over €45 million in 2007. The aim of this paper is to describe the application of the Medical Research Council (MRC) framework to the development of an intervention to decrease PIP in Irish primary care. Methods The MRC framework for the design and evaluation of complex interventions guided the development of the study intervention. In the development stage, literature was reviewed and combined with information obtained from experts in the field using a consensus based methodology and patient cases to define the main components of the intervention. In the pilot stage, five GPs tested the proposed intervention. Qualitative interviews were conducted with the GPs to inform the development and implementation of the intervention for the main randomised controlled trial. Results The literature review identified PIP criteria for inclusion in the study and two initial intervention components - academic detailing and medicines review supported by therapeutic treatment algorithms. Through patient case studies and a focus group with a group of 8 GPs, these components were refined and a third component of the intervention identified - patient information leaflets. The intervention was tested in a pilot study. In total, eight medicine reviews were conducted across five GP practices. These reviews addressed ten instances of PIP, nine of which were addressed in the form of either a dose reduction or a discontinuation of a targeted medication. Qualitative interviews highlighted that GPs were receptive to the intervention but patient preference and time needed both to prepare for and conduct the medicines review, emerged as potential barriers. Findings from the pilot study allowed further refinement to produce the finalised intervention of academic detailing with a pharmacist, medicines review with web-based therapeutic treatment algorithms and tailored patient information leaflets. Conclusions The MRC framework was used in the development of the OPTI-SCRIPT intervention to decrease the level of PIP in primary care in Ireland. Its application ensured that the intervention was developed using the best available evidence, was acceptable to GPs and feasible to deliver in the clinical setting. The effectiveness of this intervention is currently being tested in a pragmatic cluster randomised controlled trial. Trial registration Current controlled trials ISRCTN41694007 %B BMC Health Services Research %I BMC Health Services Research %V 13 %P 307 %G eng %U http://www.biomedcentral.com/1472-6963/13/307 %N 1 %R 10.1186/1472-6963-13-307 %0 Journal Article %J BMC Fam Pract %D 2008 %T The accuracy of symptoms, signs and diagnostic tests in the diagnosis of left ventricular dysfunction in primary care: a diagnostic accuracy systematic review %A Madhok, V %A Falk, G %A Rogers, A %A Struthers, A D %A Sullivan, F M %A Fahey, T %K Bias (Epidemiology) %K Diagnostic Techniques and Procedures %K Humans %K Patient Selection %K Primary Health Care %K Quality Control %K Ventricular Dysfunction, Left %X BACKGROUND: To assess the accuracy of findings from the clinical history, symptoms, signs and diagnostic tests (ECG, CXR and natriuretic peptides) in relation to the diagnosis of left ventricular systolic dysfunction (LVSD) in a primary care setting. METHODS: Diagnostic accuracy systematic review, we searched Medline (1966 to March 2008), EMBASE (1988 to March 2008), Central, Cochrane and ZETOC using a diagnostic accuracy search filter. We included cross-sectional or cohort studies that assess the diagnostic utility of clinical history, symptoms, signs and diagnostic tests, against a reference standard of echocardiography. We calculated pooled positive and negative likelihood ratios and assessed heterogeneity using the I2 index. RESULTS: 24 studies incorporating 10,710 patients were included. The median prevalence of LVSD was 29.9% (inter-quartile range 14% to 37%). No item from the clinical history or symptoms provided sufficient diagnostic information to "rule in" or "rule out" LVSD. Displaced apex beat shows a convincing diagnostic effect with a pooled positive likelihood ratio of 16.0 (8.2-30.9) but this finding occurs infrequently in patients. ECG was the most widely studied diagnostic test, the negative likelihood ratio ranging from 0.06 to 0.6. Natriuretic peptide results were strongly heterogeneous, with negative likelihood ratios ranging from 0.02 to 0.80. CONCLUSION: Findings from the clinical history and examination are insufficient to "rule in" or "rule out" a diagnosis of LVSD in primary care settings. BNP and ECG measurement appear to have similar diagnostic utility and are most useful in "ruling out" LVSD with a normal test result when the probability of LVSD is in the intermediate range. %B BMC Fam Pract %V 9 %P 56 %8 2008 %G eng %U http://www.biomedcentral.com/1471-2296/9/56 %R 10.1186/1471-2296-9-56 %0 Generic %D 2013 %T What levels of alcohol consumption is hazardous for adults: comparing US and Irish guidelines. TILDA 2013 Conference, 13 March 2013, Dublin %A Cousins, G %A Galvin, R %A Kennedy, Marie Claire %A Motterlini, N %A Henman, M %A Fahey, T %A Kenny, RA %G eng %0 Generic %D 2011 %T Variations in General Practice prescribing patterns in Ireland: preliminary result. Faculty of Public Health Medicine Winter Scientific Meeting 2011, RCPI, 14 December 2011, Dublin %A Motterlini, N %A Dimitrov, B %A Bradley, MC %A Bennett, K %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Motterlini_Practice%20Variation_Poster%20WSM2011.pdf %0 Generic %D 2016 %T Variation in prescribing of anti-diabetic medications, including newer injectable medications, in Ireland in 2013 and 2014. RCSI Research Day 25th February 2016 %A Murphy, M %A Bennett, K %A Fahey, T %A Smith, SM %G eng %0 Generic %D 2012 %T Validity of the Blatchford score to predict need for intervention for patients with upper gastrointestinal haemorrhage: a systematic review and meta-analysis. AUDGPI 2012, 9 March 2012 Dublin %A Hullegie, K %A Keogh, C %A Smith, SM %A Fahey, T %G eng %U http://hrbcentreprimarycare.ie/ppt/Blatchford%20score_WSM.pdf %0 Generic %D 2011 %T Validity of the Blatchford score to predict need for intervention for patients with upper gastrointestinal haemorrhage: a systematic review and meta-analysis. Winter Scientific Meeting 2011, Royal College of Physicians, 14 December 2011, Dublin %A Hullegie, K %A Keogh, C %A Smith, SM %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Hullegie_Blatchford%20score_WSM.pdf %0 Generic %D 2012 %T Validity of the Blatchford score to predict need for intervention for patients with upper gastrointestinal haemorrhage: a systematic review and meta-analysis. RCSI Research Day, 25 April 2012, Dublin %A Hullegie, K %A Keogh, C %A Smith, SM %A Fahey, T %G eng %U http://hrbcentreprimarycare.ie/ppt/Blatchford%20score_WSM.pdf %0 Generic %D 2010 %T Trends in Systemic Antibiotic Prescribing for Children in Ireland. 26th International Conference on Pharmacoepidemiology and Therapeutic Risk Management, 19-22 August 2010, ICPE, Brighton UK %A Keogh, C %A Reulbach, U %A Bennett, K %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Claire%20Keogh_SSM%202010_Antibiotic%20prescring%202004-2009.pdf %0 Generic %D 2009 %T A systematic review of the diagnostic accuracy of signs and symptoms and the validation of the Centor score in predicting group A haemolytic streptococcal pharyngitis in adults in primary care. 12th Annual Scientific Meeting of the Association of Universi %A O'Brien, K %A Aalbers, Jolien %A Chan, Wai-Sun %A Dimitrov, B %A Falk, G %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/AalbersJ/Strep%20throat%20poster%20audgpi%20v2.ppt %0 Generic %D 2013 %T Risk management in general practice; an educational initiative for the undergraduate general practice curriculum. The International Forum on Quality and Safety in Health Care, 16-19 April 2013, London %A Wallace, E %A Lowry, J %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2012 %T Risk management in General Practice: an educational initiative for undergraduate general practice teaching. Society of Academic Primary Care, 2-4 October 2012, Glasgow, Scotland %A Wallace, E %A Lowry, J %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2012 %T Prognostic value of the ABCD2 clinical prediction rule – a prospective cohort study. SAPC Conference 2012, 2-4 October 2012, Glasgow, Scotland %A Galvin, R %A Atanassova, P %A Motterlini, N %A Fahey, T %A Dimitrov, B %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Galvin_ABCD2 cohort.ppt %0 Generic %D 2013 %T Prevalence of potentially inappropriate prescribing in older irish adults, TILDA 2013 Conference, 13 March 2013, Dublin %A Galvin, R %A Cousins, G %A Cahir, C %A Motterlini, N %A Bradley, MC %A Hughes, CM %A Bennett, K %A Fahey, T %A Kenny, RA %G eng %U http://www.hrbcentreprimarycare.ie/ppt/PIP poster_TILDA.pdf %0 Generic %D 2015 %T Prevalence of potentially inappropriate medicines and potential prescribing omissions over time in cohort of a community-dwelling older people. All Ireland Pharmacy Conference January 2015 %A Moriarty, F %A Bennett, K %A Fahey, T %A Kenny, RA %A Cahir, C %K community-dwelling older people %K Potential prescribing omissions %K potentially inappropriate medicines %G eng %U http://www.hrbcentreprimarycare.ie/ppt/FMoriarty AIPC Poster.pdf %0 Generic %D 2014 %T Prevalence of Medication Use in Pregnancy Using the Irish Primary Care Research Network Database. RCSI Research Day 20th March 2014 %A Roche, A %A Walsh, DR %A Cronin, K %A Schelten, R %A McDonnell, R %A O'Brien, K %A Boland, F %A Swift-Donnelly, Erica %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2011 %T 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 %A Galvin, R %A Cousins, G %A Motterlini, N %A Bennett, K %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Glucosamine.ppt %0 Generic %D 2010 %T 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 %A Geraghty, Colm %A Galvin, R %A Motterlini, N %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/posters/ACBD2.pdf %0 Generic %D 2010 %T Predicting stroke in non-rheumatic atrial fibrillation: A systematic review of validation of the CHADS2 clinical prediction rule. RCSI Research Day, 7th April 2010, Dublin, Ireland %A Wallace, E %A Keogh, C %A Dillion, C %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/posters/CHADS2.pdf %0 Generic %D 2010 %T Predicting stroke in adults with non-rheumatic atrial fibrillation: A systematic review of the validation of CHADS2 Clinical Prediction Rule (preliminary results). 6th Annual Cochrane in Ireland Conference, 28 January 2010, School of Nursing, Dublin City %A Wallace, E %A Dillon, C %A Keogh, C %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/WallaceE/CHDADS2%20Cochrane%20poster.ppt %0 Generic %D 2016 %T Predicting malignant melanoma in primary care: a systematic review of clinical prediction rules. RCSI Research Day February 2016, Dublin %A Harrington, E %A Wesseling, N %A Clyne, B %A Sandu, H %A Armstrong, L %A Bennett, H %A Fahey, T %G eng %0 Generic %D 2016 %T Predicting malignant melanoma in primary care: a systematic review of clinical prediction rules. AUDGPI and ICGP annual scientific meeting, Dublin, 10th of March 2016 %A Harrington, E %A Wesseling, N %A Clyne, B %A Sandu, H %A Armstrong, L %A Bennett, H %A Fahey, T %G eng %0 Generic %D 2016 %T Potentially inappropriate prescribing, comorbidity and hospitalisation in older patients in an Irish general practice. Poster Presentation. RCSI Research Day,February 2016 %A Oludare Alabi %A Munir, K %A Redmond, P %A McDowell, R %A Dockeray, L %A Fahey, T %G eng %0 Generic %D 2014 %T Potentially inappropriate prescribing and its association with Instrumental Activities of Daily Living (IADL) impairment in older people. AUDGPI Cork 6-7 March 2014 %A Moriarty, F %A Cahir, C %A Fahey, T %A Bennett, K %G eng %U http://www.hrbcentreprimarycare.ie/ppt/FMoriartyIADL.pdf %0 Generic %D 2013 %T Potentially inappropriate prescribing and its association with Instrumental Activities of Daily Living (IADL) impairment in older people. Society for Pharmacoeconomics and Outcomes Research (ISPOR), 16th Annual European Congress, Dublin, November 2013 (Be %A Moriarty, F %A Cahir, C %A Fahey, T %A Bennett, K %X Award for Best Student Poster Research Presentation at ISPOR 2013 %G eng %U http://www.hrbcentreprimarycare.ie/ppt/FMoriartyIADL.pdf %0 Generic %D 2013 %T Potentially inappropriate prescribing and adverse health outcomes in community dwelling older populations. TILDA Scientific Advisory Board Meeting 16 May 2013, Trinity College, Dublin %A Moriarty, F %A Cahir, C %A Richardson, Kathryn %A Fahey, T %A Kenny, RA %A Bennett, K %G eng %U http://www.hrbcentreprimarycare.ie/ppt/PIPHealthOutcomesTILDA.pdf %0 Generic %D 2014 %T Potentially inappropriate medicines and potential prescribing omissions in older people and their association with health care utilization: a retrospective cohort study. ISPOR, 17th Annual European Congress, Amsterdam, November 2014. %A Moriarty, F %A Cahir, C %A Fahey, T %A Bennett, K %X Award for Best Student Poster Research Presentation at ISPOR 2014 %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Poster FMoriarty PIP Healthcare Utilization.pdf %0 Generic %D 2014 %T Patient preferences for breast cancer referral: Development and pilot study. ICHAMS RCSI Dublin October 2014. Awarded 1st Prize %A Aherne, Emma %A O'Brien, K %A Quinlan, A %A McDonnell, R %A Hardy, C %A Galvin, R %A Fahey, T %G eng %0 Generic %D 2015 %T Patient preferences for breast cancer referral: Development and pilot study. RCSI Research Day. March 2015 %A Aherne, Emma %A O'Brien, K %A Walsh, A %A McDonnell, R %A Joyce, D %A Galvin, R %A Fahey, T %G eng %0 Generic %D 2016 %T Opinions of key stakeholders on medication management at transitions of care in Ireland. Poster Presentation. RCSI Research Day February 2016, Dublin %A Munir, K %A Redmond, P %A Alabi O %A Clyne, B %A Grimes, T %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2012 %T New simplified approach to the pooled analysis of calibration of clinical prediction rules for systematic reviews of validation studies. Poster at the Population Health USRG Launch Meeting, 8 Nov 2012, University of Southampton, Southampton, UK %A Dimitrov, B %A Motterlini, N %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Dimitrov B et al 2012 Poster - NEW SIMPL APPROACH - PHUSRG-v3.pdf %0 Generic %D 2012 %T New Simplified approach to the pooled analysis of calibration of clinical predicition rules for systematic reviews of validation studies. 32nd Conference on Applied Statistics in Ireland 2012. 16-18 May 2012, ISA, Ballymascanlon H H, Dundalk, Co Louth %A Dimitrov, B %A Motterlini, N %A Fahey, T %G eng %U http://hrbcentreprimarycare.ie/ppt/SIMPLIFIED%20APPROACH%20TO%20CALIBRATION.pdf %0 Generic %D 2009 %T Medication use in early pregnancy - prevalence, appropriateness and prescribing for chronic medical disorders in a prospective cohort of women. 12th Annual Scientific Meeting of the Association of University Departments of General Practice in Ireland, 27 %A Cleary, B %A Butt, Hajeera %A Strawbridge, Judith D %A Gallagher, Paul J %A Fahey, T %A Murphy, Deirdre J %G eng %U http://www.hrbcentreprimarycare.ie/ppt/ClearyBJ/Early%20pregnancy%20medication%20use.pdf %0 Generic %D 2014 %T Medication Reconciliation - Unintentional discontinuation of long term medication post hospitalisation NAPCRG New York 21-24 Nov 2014 %A Redmond, P %A Grimes, T %A McDonnell, R %A Boland, F %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2013 %T Medication adherence and adverse health outcomes in community dwelling older patients. International Society for Pharmacoeconomics and Outcomes Research (ISPOR), 16th Annual European Congress, Dublin, November 2013 (Best general poster research presentati %A Cahir, C %A Fahey, T %A Teljeur, C %A Bennett, K %G eng %0 Generic %D 2015 %T Interventions to address potentially inappropriate prescribing in primary care: a systematic review of randomised control trials. RCSI Research Day. March 2015 %A Fitzgerald, C %A Clyne, B %A Quinlan, A %A Hardy, C %A Galvin, R %A Fahey, T %A Smith, SM %G eng %0 Generic %D 2012 %T Health and use of health services of a homeless population in Dublin: A comparison study. SAPC Conference 2012, 2-4 October 2012, Glasgow, Scotland %A O'Connor, D %A Keogh, C %A Hoban, A %A Cronin, M %A O'Brien, K %A O'Carroll, A %A Robinson, J %A Fahey, T %G eng %0 Generic %D 2011 %T Health and Healthcare needs of the homeless in Dublin. Research Summer School, RCSI, October 2011, Royal College of Surgeons, Dublin %A Cronin, M %A Hoban, A %A O'Brien, K %A Keogh, C %A Robinson, J %A O'Carroll, A %A Fahey, T %G eng %U http://hrbcentreprimarycare.ie/ppt/Hoban_AUDGPI_final%20poster.pdf %0 Generic %D 2012 %T Health and healthcare needs of a homeless population in Dublin. RCSI Research Day, 25 April 2012, Dublin %A Hoban, A %A Cronin, M %A Keogh, C %A O'Brien, K %A O'Connor, C %A O'Carroll, A %A Robinson, J %A Fahey, T %G eng %U http://hrbcentreprimarycare.ie/ppt/Hoban_AUDGPI_final%20poster.pdf %0 Generic %D 2012 %T Health and healthcare needs of a homeless population in Dublin. AUDGPI 2012, 9 March 2012 Dublin %A Hoban, A %A Cronin, M %A Keogh, C %A O'Brien, K %A O'Connor, C %A O'Carroll, A %A Robinson, J %A Fahey, T %G eng %U http://hrbcentreprimarycare.ie/ppt/Hoban_AUDGPI_final%20poster.pdf %0 Generic %D 2012 %T GP variability in the prescribing of potentially inappropriate medication in older populations in Ireland. 41st Annual Scientific Meeting of the Society of Academic Primary Care. 2 – 4 October 2012, Glasgow, Scotland %A Cahir, C %A Bennett, K %A Teljeur, C %A Fahey, T %G eng %0 Generic %D 2013 %T Feasibility of medicines review to reduce Potentially Inappropriate Medicines in the elderly: the OPTI-SCRIPT cluster randomized controlled trial. ISPOR 16th Annual European Congress, Dublin, November 2013 %A Clyne, B %A Bradley, MC %A Smith, SM %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2013 %T The epidemiology of malpractice claims in primary care: a systematic review. AUDGPI Annual Scientific Meeting 2013, University of Limerick, 8 March 2013. Limerick %A Wallace, E %A Lowry, J %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2016 %T 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 %A Murphy, M %A Galvin, R %A Fahey, T %A Byrne, S %A Smith, SM %G eng %0 Generic %D 2016 %T 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.. %A Murphy, M %A Galvin, R %A Fahey, T %A Byrne, M %A Smith, SM %G eng %0 Generic %D 2015 %T Does the EQ-5D capture the effect of physical and mental health on subjective well-being among older people. IAGG-ER Congress 2015, Dublin %A Sexton,Eithne %A Cahir, C %A Fahey, T %A Bennett, K %G eng %0 Generic %D 2012 %T 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 %A Billington, Jennifer %A Galvin, R %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/STRATIFY poster.pdf %0 Generic %D 2013 %T Developing a web-based international register of clinical prediction rules for primary care SAPC ASM, University of Nottingham, 3 – 5 July 2013, Nottingham, UK %A Keogh, C %A Wallace, E %A O'Brien, K %A Galvin, R %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2015 %T Cross-sectional survey of general practitioners’ and community pharmacists’ opinions on medication management at transitions of care in Ireland. RCSI Research Day. March 2015 %A Carroll, H %A Redmond, P %A Grimes, T %A Galvin, R %A McDonnell, R %A Boland, F %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2016 %T Cochrane review: Antiviral agents for infectious mononucleosis (glandular fever). SAPC 6th -8th of July 2016 Dublin Castle/RCSI. %A De Paor, M %A O'Brien, K %A Fahey, T %A Smith, SM %G eng %0 Generic %D 2010 %T 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 %A Callaghan, Claire %A Galvin, R %A Chan, Wai-Sun %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/posters/TE.pdf %0 Generic %D 2014 %T Antibiotic prescribing patterns of Irish general practitioners in the international context: preliminary results from a pilot study RCSI Research Day 20 March 2014 %A Schelten, K %A Cronin, K %A Walsh, DR %A Roche, A %A McAteer, C %A O'Brien, K %A McDonnell, R %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2010 %T Antibiotic Prescribing in Irish Children Receiving Free Medical Care. The Society for Social Medicine, 6-8 September 2010, Belfast %A Keogh, C %A Reulbach, U %A Motterlini, N %A Bennett, K %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Claire%20Keogh_SSM%202010_Antibiotic%20prescring%202004-2009.pdf %0 Generic %D 2014 %T Addressing potentially inappropriate prescribing in primary care: results from the OPTI-SCRIPT cluster randomised controlled trial. AUDGPI Cork 6-7March 2014 %A Clyne, B %A Smith, SM %A Hughes, CM %A Bradley, MC %A Boland, F %A Fahey, T %G eng %U http://hrbcentreprimarycare.ie/ppt/AUDGPI_14 Final.pdf %0 Generic %D 2014 %T Addressing potentially inappropriate prescribing in primary care: results from the OPTI-SCRIPT cluster randomised controlled trial. IGS October 2014 %A Clyne, B %A Smith, SM %A Hughes, CM %A Bradley, MC %A Boland, F %A Fahey, T %G eng %0 Generic %D 2016 %T Variation in prescribing of anti-diabetic medications, including newer injectable medications, in Ireland in 2013 and 2014. AUDGPI 10th March 2016 %A Murphy, M %A Bennett, K %A Fahey, T %A Smith, SM %G eng %0 Generic %D 2016 %T Variation in prescribing of anti-diabetic medications, including newer injectable medications, in Ireland in 2013 and 2014. SAPC 6th -8th of July 2016 Dublin Castle/RCSI. (Elevator Pitch) %A Murphy, M %A Bennett, K %A Fahey, T %A Smith, SM %G eng %0 Generic %D 2016 %T Variation in prescribing of anti-diabetic medications, including newer injectable medications, in Ireland in 2013 and 2014. SPHeRE Research Day 29th February 2016 %A Murphy, M %A Bennett, K %A Fahey, T %A Smith, SM %G eng %0 Generic %D 2016 %T Unintentional discontinuation of long term medication post hospitalisation. AUDGPI 10th March 2016 %A Redmond, P %A McDonnell, R %A Grimes, T %A Boland, F %A Zarabzadeh, A %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2015 %T Trends in polypharmacy and prescribing appropriateness from 1997 to 2012. Health Services Research and Pharmacy Practice (HSRPP) Conference, Belfast, 16/17th April 2015. Frank Moriarty Awarded Best Oral Presentation %A Moriarty, F %A Hardy, C %A Bennett, K %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2015 %T Trends and interaction of potentially inappropriate prescribing and polypharmacy over 15 years in Ireland: a repeated cross-sectional study. Society for Social Medicine 59th Annual Scientific Meeting 2-4th September 2015 %A Moriarty, F %A Hardy, C %A Bennett, K %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2010 %T Systematic review on the diagnostic accuracy of signs and symptoms predicting UTI in women. 13th Annual Scientific Meeting of the Association of University Departments of General Practice in Ireland, 19 March 2010, RCSI, Dublin, Ireland %A Giesen, Leonie G M %A Cousins, G %A Dimitrov, B %A Van de Laar, F A %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/GiesenL/GC_LG_AUDGPI_presentation_final.ppt %0 Generic %D 2010 %T Systematic review of validation studies of the Alvarado Clinical Prediction Rule for Appendicitis. 39th Annual Scientific Meeting of the SAPC, 7- 9 July 2010, University of East Anglia, Norwich, UK %A Cummins, Anthony %A Ohle, Robert %A O'Reilly, Fran %A O'Brien, K %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/AlvaradoSAPC2010.pptx %0 Generic %D 2009 %T A Systematic Review of the diagnostic accuracy of signs and symptoms and the validation of the Centor score in predicting group A β-haemolytic streptococcal pharyngitis in adults in primary care. SAPC Conference, 8-10 July 2009, University of Dundee, UK %A O'Brien, K %A Aalbers, Jolien %A Chan, Wai-Sun %A Dimitrov, B %A Falk, G %A Teljeur, C %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/AalbersJ/Presentation%20Sore%20Throat%2015%20Jan.ppt %0 Generic %D 2014 %T Risk prediction models to predict emergency hospital admission in community dwelling adults: a systematic review. NAPCRG New York 21-24 Nov 2014 %A Wallace, E %A Stuart, Ellen %A Vaughan, Niall %A Bennett, K %A Fahey, T %A Smith, SM %G eng %0 Generic %D 2014 %T Risk prediction models to predict emergency hospital admission in community-dwelling adults AUDGPI Cork 6-7 March 2014 %A Wallace, E %A Stuart, Ellen %A Vaughan, Niall %A Bennett, K %A Fahey, T %A Smith, SM %G eng %U http://hrbcentreprimarycare.ie/ppt/Emma Wallace AUDGPI 2014.pdf %0 Generic %D 2015 %T Risk prediction models to predict emergency hospital admission in community-dwelling adults: a systematic review. SPHeRE Conference, RCSI Dublin, January 2015 %A Wallace, E %A Stuart, Ellen %A Vaughan, Niall %A Bennett, K %A Fahey, T %A Smith, SM %G eng %0 Generic %D 2010 %T Risk of stroke following transient ischaemic attack: The ABCD2 CPR. The Society for Social Medicine, 6-8 September 2010, Belfast %A Galvin, R %A Geraghty, Colm %A Motterlini, N %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/ABCD2Sept10.ppt %0 Generic %D 2010 %T Risk of overdose mortality during the initial two weeks after entering or re-entering methadone treatment in Scotland: Retrospective cohort study. The Society for Social Medicine, 6-8 September 2010, Belfast %A Cousins, G %A Teljeur, C %A Motterlini, N %A McCowan, Colin %A Dimitrov, B %A Fahey, T %G eng %0 Generic %D 2015 %T The rise and fall of potentially inappropriate prescribing: trends and interaction with polypharmacy over 15 years in Ireland. Society for Academic Primary Care 44th Annual Conference, University of Oxford, 8th July 2015 %A Moriarty, F %A Hardy, C %A Bennett, K %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2010 %T Register of Clinical Prediction Rules, methodological quality assessment and implementation strategies. European General Practice Research Network conference. October 14-17th, 2010, Zurich, Switzerland %A Wallace, E %A Keogh, C %A Smith, SM %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Emma%20Wallace%20EGPRN%20presentation.ppt %0 Generic %D 2010 %T Register of Clinical Prediction Rules, Methodological Quality assessment and Implementation Strategies. 39th Annual Scientific Meeting of the SAPC, 7- 9 July 2010, University of East Anglia, Norwich %A Wallace, E %A Keogh, C %A Smith, SM %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Emma%20Wallace%20SAPC%20presentation.pdf %0 Generic %D 2013 %T Quality of Prescribing Indicators for Children in Primary Care. SAPC ASM, University of Nottingham, 3 – 5 July 2013, Nottingham, UK %A O'Brien, K %A Cooper, J %A Boland, F %A Cummins, Anthony %A Redmond, P %A Smith, SM %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2013 %T Psychotropic medication in Irish children; trends and areas of inappropriate prescribing. AUDGPI Annual Scientific Meeting 2013, University of Limerick, 8 March 2013. Limerick %A Reulbach, U %A Boland, F %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Udo Reulbach AUDGPI 2013.pdf %0 Generic %D 2013 %T 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 %A Galvin, R %A Atanassova, P %A Motterlini, N %A Fahey, T %A Dimitrov, B %G eng %0 Generic %D 2014 %T A process evaluation of a cluster randomised trial to reduce potentiallt inappropiate prescribing in older patients in Primary Care (OPTI-SCRIPT) SAPC July 9-11 2014 Edinburgh %A Clyne, B %A Cooper, J %A Hughes, CM %A Fahey, T %A Smith, SM %G eng %0 Generic %D 2013 %T Prescribing patterns of glucosamine in an elderly population: A national cohort study. AUDGPI Annual Scientific Meeting 2013, University of Limerick, 8 March 2013. Limerick %A Galvin, R %A Cousins, G %A Boland, F %A Motterlini, N %A Bennett, K %A Fahey, T %G eng %0 Generic %D 2011 %T Prescribing patterns of cartilage constituents in a national elderly population. Irish Gerontological Society Meeting, 9-10 September, 2011 Aviva Stadium, Dublin %A Galvin, R %A Cousins, G %A Motterlini, N %A Bennett, K %A Fahey, T %G eng %U http://hrbcentreprimarycare.ie/ppt/Glucosamine_RG.ppt %0 Generic %D 2009 %T Predictive value of symptoms, signs and diagnostic tests in patients presenting with rectal bleeding in primary care: diagnostic accuracy systematic review in relation to colorectal cancer. SAPC Conference, 8-10 July 2009, University of Dundee, UK %A Olde Bekkink, M %A McCowan, Colin %A Falk, G %A Van de Laar, F A %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/OldeBekkinkM/SAPC%2008July09_Parallel%20session%20Cancer_Abstract%20nr%201430_Syst%20review%20colorectal%20cancer.ppt %0 Generic %D 2009 %T Predictive value of symptoms, signs and diagnostic tests in patients presenting with rectal bleeding in primary care: diagnostic accuracy systematic review in relation to colorectal cancer. 12th ASM, AUDGPI, 27th February 2009, RCSI, Dublin %A Olde Bekkink, M %A McCowan, Colin %A Falk, G %A Van de Laar, F A %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/OldeBekkinkM/AUDGPI%2027Feb09_Syst%20rev_colorectal%20cancer_M.OldeBekkink.ppt %0 Generic %D 2010 %T Prediction Stroke in Adults with Non-rheumatic Atrail Fibrillation: Validating the CHADS2 Rule. 39th Annual Scientific Meeting of the SAPC, 7- 9 July 2010, University of East Anglia, Norwich, UK %A Keogh, C %A Wallace, E %A Dimitrov, B %A Dillon, C %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/KeoghSAPC.pptx %0 Generic %D 2009 %T Predicting severity of pneumonia in general practice: a meta-analysis of the CRB-65 criteria. 12th Annual Scientific Meeting of the Association of University Departments of General Practice in Ireland, 27 February 2009 RCSI, Dublin, Ireland %A McNally, Maggie %A Curtain, James %A O'Brien, K %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Maggie/SAPC%20Presentation.ppt %0 Generic %D 2009 %T Predicting severity of pneumonia in general practice: a meta-analysis of the CRB-65 criteria. SAPC Conference, 8-10 July 2009, University of Dundee & St. Andrews on behalf of the Scottish School of Primary Care, Dundee, UK %A McNally, Maggie %A Curtain, James %A O'Brien, K %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Maggie/SAPC%20Presentation.ppt %0 Generic %D 2010 %T 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 %A Galvin, R %A Geraghty, Colm %A Motterlini, N %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/ABCD2SAPCJuly10.ppt %0 Generic %D 2011 %T 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 %A Galvin, R %A Meurs, Pieter %A Van de Laar, F A %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/B15%20Meurs.ppt %0 Generic %D 2016 %T Predicting malignant melanoma in primary care: a systematic review of clinical prediction rules. SAPC annual scientific meeting, SAPC 6th-8th of July 2016 Dublin Castle/RCSI. %A Harrington, E %A Wesseling, N %A Clyne, B %A Sandu, H %A Armstrong, L %A Bennett, H %A Fahey, T %G eng %0 Generic %D 2016 %T Potentially inappropriate prescribing (PIP) in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria. SPHeRE conference, RCSI, 29 February 2016 2016. %A Moriarty, F %A Cooper, J %A Bennett, K %A Cahir, C %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2014 %T Potentially Inappropriate Prescribing (PIP): evidence and potential solutions. Bristol Social Medical Seminar May 2014 %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/bristol social med seminar may 2014 fahey.pdf %0 Generic %D 2011 %T Potentially Inappropriate Prescribing in older people: Irish and UK epidemiology and proposed solutions. Pharmacoepidemiology symposium: spanning the spectrum from research to policy. Centre for Health Improvement, 25 October 2011, Queen’s Univ Belfast %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/primary%20care%20conference%20fahey%20nov%202011.ppt %0 Generic %D 2015 %T Potentially inappropriate prescribing in a middle-aged population: a cross-sectional study in Northern Ireland using the Enhanced Prescribing Database. Health Services Research & Pharmacy Practice Conference April 2015 %A Cooper, J %A Moriarty, F %A Ryan, C %A Smith, SM %A Wallace, E %A Bennett, K %A Cahir, C %A Williams, David %A Teeling, Mary %A Fahey, T %A Hughes, CM %G eng %0 Generic %D 2016 %T Potentially inappropriate prescribing and healthcare utilisation in older people: a cohort study using marginal structural models. Health Services Research & Pharmacy Practice (HSRPP) conference, University of Reading, 7-8 April 2016. %A Moriarty, F %A Bennett, K %A Cahir, C %A Kenny, RA %A Fahey, T %G eng %0 Generic %D 2009 %T Potentially inappropriate prescribing and cost outcomes for older people: a national population study. HRB Centre for Primary Care Research seminar on older people. Winter Scientific Meeting of the Faculty of Public Health Medicine, 9 December 2009, RCSI %A Cahir, C %A Fahey, T %A Teeling, Mary %A Teljeur, C %A Feely, John %A Bennett, K %G eng %U http://www.hrbcentreprimarycare.ie/ppt/CahirC/PrescribingOlderPopCC-10Sept09.ppt %0 Generic %D 2015 %T Potentially Inappropriate Medicines: the importance of research evidence in terms of clinical practice and health policy. Health Services Research and Pharmacy Practice (HSRPP) Conference, Belfast, 16/17th April 2015. %A Fahey, T %G eng %0 Generic %D 2014 %T Potentially inappropriate medicines and potential prescribing omissions in older people and their association with healthcare utilization: a retrospective cohort study NAPCRG New York 21-24 Nov 2014 %A Moriarty, F %A Fahey, T %A Cahir, C %A Bennett, K %G eng %0 Generic %D 2014 %T Overview of activities at the Department of General Practice and HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland Beaux Lane House. 16-17 September 2014 %A Fahey, T %G eng %0 Generic %D 2010 %T Methadone and Perinatal Outcomes: a Retrospective Cohort Study. Joint Schools of Pharmacy Research Day, 29th March 2010, School of Pharmacy, Queen’s University Belfast %A Cleary, B %A Donnelly, Jean %A Strawbridge, Judith D %A Gallagher, Paul J %A White, Martin J %A Fahey, T %A Murphy, Deirdre J %G eng %U http://www.hrbcentreprimarycare.ie/ppt/JointSchoolsResearchSeminar%20Presentation180310.ppt %0 Generic %D 2010 %T Methadone and Perinatal Outcomes: a Retrospective Cohort Study. 26th International Conference on Pharmacoepidemiology and Therapeutic Risk Management, 19-22 August 2010, ICPE, Brighton, UK %A Cleary, B %A Donnelly, Jean %A Strawbridge, Judith D %A Gallagher, Paul J %A White, Martin J %A Fahey, T %A Murphy, Deirdre J %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Cleary%20ISPE%202010.pptx %0 Generic %D 2008 %T Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women. Friends of the Coombe Research Symposium, December 2008, Dublin %A Cleary, B %A Strawbridge, Judith D %A Butt, Hajeera %A Gallagher, Paul J %A Fahey, T %A Murphy, Deirdre J %G eng %U http://www.hrbcentreprimarycare.ie/ppt/ClearyBJ/CWIUH%20Research%20Symposium.ppt %0 Generic %D 2009 %T Medication use in early pregnancy – prevalence, appropriateness and prescribing for chronic medical disorders in a prospective cohort of women. 12th ASM, AUDGPI, 27th February, RCSI, Dublin %A Cleary, B %A Butt, Hajeera %A Strawbridge, Judith D %A Gallagher, Paul J %A Fahey, T %A Murphy, Deirdre J %G eng %U http://www.hrbcentreprimarycare.ie/ppt/ClearyBJ/Early%20pregnancy%20medication%20use.pdf %0 Generic %D 2015 %T Medication Reconciliation Cohort Study – The potentially unintentional discontinuation of long term medication post hospitalisation. WONCA October 2015, Istanbul %A Redmond, P %A Grimes, T %A McDonnell, R %A Boland, F %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2009 %T Measuring and evaluating indicators of appropriate prescribing in older populations. 12th Annual Scientific Meeting of the Association of University Departments of General Practice in Ireland, 27 February 2009 RCSI, Dublin %A Cahir, C %A Teeling, Mary %A Feely, John %A Byrne, S %A Fahey, T %A Bennett, K %G eng %U http://www.hrbcentreprimarycare.ie/ppt/CahirC/AUDGPPrescribingCC270209.ppt %0 Generic %D 2011 %T Knowledge representation in TRANSFoRm. AMIA CDSS workshop, 24 October 2011, Washington DC, USA %A Corrigan, D %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/AMIA%20Presentation.ppt %0 Generic %D 2015 %T 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 %A Clyne, B %A Fitzgerald, C %A Quinlan, A %A Hardy, C %A Galvin, R %A Fahey, T %A Smith, SM %G eng %0 Generic %D 2015 %T 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 %A Clyne, B %A Fitzgerald, C %A Quinlan, A %A Hardy, C %A Galvin, R %A Fahey, T %A Smith, SM %G eng %0 Generic %D 2015 %T Interventions for improving medication reconciliation across transitions of care – systematic review. Oral Presentation. SAPC, Oxford, UK %A Redmond, P %A Grimes, T %A McDonnell, R %A Boland, F %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2010 %T Implementing Clinical Prediction Rules in primary care: evidence, challenges and possible solutions. Keynote speaker: Methods for Evaluating Medical Tests and Biomarkers. July 1-2, 2010. University of Birmingham, UK %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/FaheyBirmingham.ppt %0 Generic %D 2016 %T Impact of potentially inappropriate prescribing on adverse health outcomes in community-dwelling older people: a prospective cohort study. SAPC 6th-8th of July 2016 Dublin Castle/RCSI. %A Wallace, E %A McDowell, R %A Bennett, K %A Fahey, T %A Smith, SM %G eng %0 Generic %D 2013 %T The HRB Centre for Primary Care Research. Collaborative Funding Meeting. Health Services and Population Health Research Alliance, 29th January 2013. NUI Galway %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2011 %T How research participation enhances patient care. National Primary Care Conference, 17 November 2011, Mitchelstown, Co. Cork %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/primary%20care%20conference%20fahey%20nov%202011.ppt %0 Generic %D 2016 %T How does potentially inappropriate prescribing measured by STOPP and START relate to healthcare utilisation in older people? A cohort study. SAPC 6th -8th of July 2016 Dublin Castle/RCSI. (Elevator Pitch) %A Moriarty, F %A Bennett, K %A Cahir, C %A Kenny, RA %A Fahey, T %G eng %0 Generic %D 2016 %T Is hospitalisation associated with the unintentional discontinuation of appropriate long-term medication in the GP record? SAPC 6th -8th of July 2016 Dublin Castle/RCSI. %A Redmond, P %A McDowell, R %A Grimes, T %A Boland, F %A Zarabzadeh, A %A McDonnell, R %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2014 %T Health, Medication and Use of Health Services in a Homeless Population. SAPC July 9-11 2014 Edinburgh %A O'Brien, K %A Keogh, C %A Hoban, A %A O'Carrol, A %A Fahey, T %G eng %0 Generic %D 2012 %T Health and use of health services of a homeless population in Dublin: a comparison study. Accepted for presentation at the Jacqueline Horgan Bronze Medal RCPI Conference. 15th November 2012, Dublin %A Keogh, C %A Hoban, A %A O'Brien, K %A O'Carroll, A %A Robinson, J %A Fahey, T %G eng %0 Generic %D 2013 %T Enhancing rational and safe prescribing in primary care. Second National Medicines Forum: Medicines management: the safe, effective and cost effective use of medicines to improve patient care. RCPI,Thursday Nov 28th 2013. Dublin %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/fahey RCPI meeting 2013.ppt %0 Generic %D 2010 %T Enhancing drug safety with Information & Communication Technology (ICT).2010 Summer Scientific Meeting, 24-25 May 2010, Faculty of Public Health Medicine, Royal College of Physicians of Ireland %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/FPHMIfahey.ppt %0 Generic %D 2016 %T 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 %A Murphy, M %A Galvin, R %A Fahey, T %A Byrne, S %A Smith, SM %G eng %0 Generic %D 2016 %T 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 %A Murphy, M %A Galvin, R %A Fahey, T %A Byrne, S %A Smith, SM %G eng %0 Generic %D 2010 %T 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 %A Galvin, R %A Callaghan, Claire %A Chan, Wai-Sun %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/HISI_RCSI_Pres.ppt %0 Generic %D 2015 %T Effectiveness of a quality improvement intervention on potentially inappropriate prescribing in older patients in primary care: a cluster randomised controlled trial (the OPTI-SCRIPT study)(NAPCRG winner B Clyne from 2014) SAPC Oxford July 2015 %A Clyne, B %A Smith, SM %A Hughes, CM %A Boland, F %A Bradley, MC %A Cooper, J %A Fahey, T %G eng %0 Generic %D 2014 %T Effectiveness of a multifaceted intervention on potentially inappropriate prescribing in older patients in primary care: a cluster randomised controlled trial (the OPTI-SCRIPT study) NAPCRG New York 21-24 Nov 2014 %A Clyne, B %A Smith, SM %A Hughes, CM %A Boland, F %A Bradley, MC %A Cooper, J %A Fahey, T %G eng %0 Generic %D 2014 %T Effectiveness of a multifaceted intervention on potentially inappropriate prescribing in older patients in primary care: a cluster randomised controlled trial (the OPTI-SCRIPT study). SAPC July 9-11 2014 Edinburgh %A Clyne, B %A Smith, SM %A Hughes, CM %A Boland, F %A Bradley, MC %A Cooper, J %A Fahey, T %G eng %0 Generic %D 2012 %T Diagnostic accuracy of the STRATIFY clinical prediction rule for falls: A systematic review and meta-analysis. AUDGPI, 9 March 2012, Dublin %A Billington, Jennifer %A Galvin, R %A Fahey, T %G eng %U http://hrbcentreprimarycare.ie/ppt/AUDGPI%20-%20Jennifer%20Billington_RG.ppt %0 Generic %D 2012 %T Diagnostic accuracy of the STRATIFY clinical prediction rule for falls: A systematic review and meta-analysis. RCSI Research Day, 25th April 2012, Dublin %A Billington, Jennifer %A Galvin, R %A Fahey, T %G eng %U http://hrbcentreprimarycare.ie/ppt/AUDGPI%20-%20Jennifer%20Billington_RG.ppt %0 Generic %D 2011 %T Diagnostic accuracy of the ID-Migraine: a systematic review and meta-analysis. SAPC 2011 conference 2011 6 - 8 July 2011, Bristol, UK %A Cousins, G %A Hijazze, Samira %A Van de Laar, F A %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/A41%20Cousins.ppt %0 Generic %D 2010 %T Development of an electronic register of clinical prediction rules relevant to primary care. RCSI Research Summer School Symposium, 8 October 2010, Dublin %A Halfpenny, Sarah %A Pirani, Zameer %A Keogh, C %A Wallace, E %A Fahey, T %G eng %0 Generic %D 2014 %T 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 %A Zarabzadeh, A %A McDonnell, R %A Corrigan, D %A Galvin, R %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2014 %T 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 %A Galvin, R %A Joyce, D %A Downey, E %A Boland, F %A Fahey, T %A Hill, A %G eng %0 Generic %D 2014 %T Development and validation of a clinical prediction rule to identify suspected breast cancer: a prospective cohort study SAPC July 9-11 2014 Edinburgh %A Galvin, R %A Joyce, D %A Downey, E %A Boland, F %A Fahey, T %A Hill, A %X 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. %G eng %0 Generic %D 2012 %T 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 %A Smith, SM %A Keogh, C %A Wallace, E %A Galvin, R %A O'Brien, K %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/International register for primary care CPRs.pptx %0 Generic %D 2015 %T Determining the Relationship between Potentially Inappropriate Medications and Quality of Life in a Cohort of Older People. SPHeRE Conference, RCSI Dublin, January 2015 %A Moriarty, F %A Bennett, K %A Cahir, C %A Kenny, RA %A Fahey, T %G eng %0 Generic %D 2015 %T Determining the relationship between potentially inappropriate medications and quality of life in a cohort of older people.IAGG-ER Congress 2015, Dublin %A Moriarty, F %A Bennett, K %A Cahir, C %A Kenny, RA %A Fahey, T %G eng %0 Generic %D 2013 %T Connected health: collaborative opportunities for ICON and academia. ICON Dec 16th 2013. Dublin %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/ICON meeting 16 dec 2013 fahey.ppt %0 Generic %D 2009 %T Comparison of self reported health and healthcare utilisation between asylum seekers and refugees: an observational study. 12th ASM, AUDGPI , 27 February 2009 RCSI, Dublin %A Toar, Magzoub %A O'Brien, K %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/magzoub/Presentation_27_Feb.2009.ppt %0 Generic %D 2022 %T Clinical Study Reports published by the European Medicines Agency 2016-2018: A cross-sectional analysis. Presented by David Byrne at EBM Live, Oxford July 2022 %A Byrne, D %A Prendergast, C %A Fahey, T %A Moriarty, F %G eng %0 Generic %D 2013 %T Clinical prediction rules in cancer diagnosis NCRI Conference in Liverpool Nov 3-6th 2013 %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/ncri conference fahey.pdf %0 Generic %D 2010 %T Clinical Prediction Rules as a basis for Clinical Decision Support. 15th Annual Health Informatics Society of Ireland Conference, 18 November 2010, Dublin. %A Corrigan, D %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/HISI_OpenEHR_Pres.ppt %0 Generic %D 2014 %T Benzodiazpine prescribing in Irish children. SAPC July 9-11 2014 Edinburgh %A O Sullivan, K %A Reulbach, U %A Boland, F %A Kelly, D %A Bennett, K %A Fahey, T %G eng %0 Generic %D 2011 %T Aspects of the TRANSFoRm Project. HIQA conference, 7 July 2011, Dublin %A Corrigan, D %A Ohmann, C %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/TRANSFORM_HIQA_Final.ppt %0 Generic %D 2010 %T Antibiotic prescribing in Irish children: Describing rates and trends and comparing with EU prescribing behaviour, 8 December 2010, Faculty of Public Health Medicine, Dublin %A Keogh, C %A Motterlini, N %A Reulbach, U %A Bennett, K %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Keogh_Winter scientific meeting Dec 2010.ppt %0 Generic %D 2010 %T Antibiotic Prescribing in Irish children: A Preliminary Analysis. 13th Annual Scientific Meeting of the Association of University Departments of General Practice in Ireland, 19 March 2010, RCSI, Dublin, Ireland %A Keogh, C %A Reulbach, U %A Motterlini, N %A Bennett, K %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/KeoghC/C%20Keogh%20AUDGPI%20Abstract_antibiotic%20prescribing.pdf %0 Generic %D 2010 %T Trends in psychostimulant prescribing in Irish children. Patient Safety and Quality Drug Prescribing Meeting, 12 May 2010, Dublin %A Reulbach, U %A Motterlini, N %A Keogh, C %A Bennett, K %A O'Dowd, T %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Presentation%20Public%20Health%20Study%20Day.ppt %0 Generic %D 2010 %T Systematic review of the diagnostic accuracy of signs & symptoms and validation of the Centor Score in predicting group A b-haemolytic streptococcal pharyngitis in adults in Primary Care. International Forum for Diagnostic, HRB Centre, Dublin %A O'Brien, K %A Aalbers, Jolien %A Chan, Wai-Sun %A Dimitrov, B %A Teljeur, C %A Falk, G %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 %0 Generic %D 2010 %T A Systematic Review of the CHADS2 Score for Predicting Stroke Risk in Patients with Non-rheumatic Atrial Fibrillation. International Forum for Diagnostic and Prognostic Strategies in Primary Care, 4 June 2010, HRB Centre, Dublin %A Keogh, C %A Wallace, E %A Dillon, C %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 %0 Generic %D 2010 %T A Systematic Review of the Alvarado Score in predicting acute Appendicitis. Clinical Prediction Rules – International Forum for Diagnostic and Prognostic Strategies in Primary Care, 4 June 2010, HRB Centre for Primary Care Research, Dublin %A Ohle, Robert %A O'Reilly, Fran %A O'Brien, K %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 %0 Generic %D 2009 %T Stages of assessment of a CPR. International Clinical Prediction Rules Meeting, 27 November 2009, HRB Centre for Primary Care Research, Dublin, Ireland %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/TFahey/CPR%20examples%20TFahey.ppt %0 Generic %D 2010 %T 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 %A Galvin, R %A Geraghty, Colm %A Motterlini, N %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 %0 Generic %D 2010 %T Rates and Trends in Antibiotic Prescribing in Irish Children Receiving Free Medical Care. Patient Safety and Quality Drug Prescribing Meeting, 12 May 2010, Dublin %A Keogh, C %A Reulbach, U %A Motterlini, N %A Bennett, K %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/ppt/Quality%20in%20prescribing_Antibiotics%20in%20Irish%20children.ppt %0 Generic %D 2009 %T Potentially inappropriate prescribing and cost outcomes for older people: a national population study. HRB Centre for Primary Care Research seminar on older people, 10 September 2009, HRB Centre for Primary Care Research, Dublin %A Cahir, C %A Fahey, T %A Teeling, Mary %A Teljeur, C %A Feely, John %A Bennett, K %G eng %U http://www.hrbcentreprimarycare.ie/ppt/CahirC/PrescribingOlderPopCC-10Sept09.ppt %0 Generic %D 2010 %T Patient Safety and Clinical Prediction Rules. Clinical Prediction Rules – International Forum for Diagnostic and Prognostic Strategies in Primary Care, 4 June 2010, HRB Centre for Primary Care Research, Dublin %A Corrigan, D %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 %0 Generic %D 2010 %T Overview of utilization and examples of CDSSs and eCPRs. Clinical Prediction Rules – International Forum for Diagnostic and Prognostic Strategies in Primary Care, 4 June 2010, HRB Centre for Primary Care Research %A Courtney, Brenda %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 %0 Generic %D 2010 %T Methodological Quality of Clinical Prediction Rules. Clinical Prediction Rules – International Forum for Diagnostic and Prognostic Strategies in Primary Care, 4 June 2010, HRB Centre for Primary Care Research %A Wallace, E %A Smith, SM %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 %0 Generic %D 2010 %T International Register and Clinical Domains in Primary Care. Clinical Prediction Rules – International Forum for Diagnostic and Prognostic Strategies in Primary Care, 4 June 2010, HRB Centre for Primary Care Research, Dublin %A Keogh, C %A Wallace, E %A O'Brien, K %A Murphy, Paul J %A Teljeur, C %A McGrath, Brid %A Smith, SM %A Niall Doherty %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 %0 Generic %D 2010 %T Indices of performances of CPRs. Clinical Prediction Rules – International Forum for Diagnostic and Prognostic Strategies in Primary Care, 4 June 2010, HRB Centre for Primary Care Research %A Motterlini, N %A Dimitrov, B %A Fahey, T %G eng %U http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 %0 Generic %D 2012 %T Implementing best evidence for patient care: Irish Primary Care Research Network (IPCRN). Royal Academy of Medicine In Ireland, GP Section seminar. 29th November 2012, RCSI, Dublin %A Higgins, S %A Fahey, T %G eng %0 Generic %D 2016 %T Family Medicine training in Ireland: opportunities for collaboration. 29th February 2016. Seminar Family Practice Unit, Mount Sinai Hospital. %A Fahey, T %G eng %0 Generic %D 2008 %T Evidence-based diagnosis and primary care. Invited Lecture, Institute for Social and Preventative Medicine (ISPM), October 2008, University of Bern, Bern, Switzerland %A Fahey, T %G eng %0 Generic %D 2012 %T Essential Ingredients for Successful Clinical Research. 5th Annual Graduate Entry Medical School (GEMS) Research Forum. UL Medical Research Forum, UL School of Medicine. 3 February 2012, Limerick %A Fahey, T %G eng %0 Generic %D 2016 %T Epidemiology of the quality and safety of medicines in primary care: impact on patient outcomes. 25th February 2016. Seminar to the Department of Family & Community Medicine (DCFM), University of Toronto %A Fahey, T %G eng %0 Generic %D 2016 %T Epidemiology of the quality and safety of medicines in primary care: impact on patient outcomes. 9th March 2016. Seminar to Department of Family Medicine, University of British Columbia, presentation at research rounds %A Fahey, T %G eng %0 Generic %D 2016 %T Epidemiology of the quality and safety of medicines in primary care: impact on patient outcomes. 24th February 2016. Clinical Epidemiology Seminar, University of Ottawa, Centre for Practice-Changing Research (CPCR), The Ottawa Hospital Research Institute, %A Fahey, T %G eng %0 Generic %D 2016 %T Drug safety and potentially inappropriate prescribing. 24th February 2016. Seminar to Department of Family Medicine, Bruyère Research Institute, University of Ottawa %A Fahey, T %G eng %0 Conference Proceedings %B 9th International Conference on Knowledge, Information and Creativity Support Systems %D 2014 %T 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 %A Zarabzadeh, A %A McDonnell, R %A Corrigan, D %A Galvin, R %A Smith, SM %A Fahey, T %B 9th International Conference on Knowledge, Information and Creativity Support Systems %G eng %0 Conference Proceedings %B In: Proceedings of the Transforming Government Workshop "Enabling Citizen Participation, Social Inclusion & Democracy through Electronic Systems & Processes" (tGov) 2010, March 18-19 2010, Brunel University, London, UK %D 2010 %T Primary health care models and suitability for provision of e-services: an overview %A Dimitrov, B %A Fahey, T %B In: Proceedings of the Transforming Government Workshop "Enabling Citizen Participation, Social Inclusion & Democracy through Electronic Systems & Processes" (tGov) 2010, March 18-19 2010, Brunel University, London, UK %G eng %0 Conference Paper %B The 29th International Symposium on Computer-Based Medical Systems (CBMS 2016) %D 2016 %T Utility of electronic international register of clinical prediction rules relevant to primary care %A Zarabzadeh, A %A McDonnell, R %A Paz Berrios, S %A Dempsey, J %A Harrington, E %A Smith, SM %A Fahey, T %B The 29th International Symposium on Computer-Based Medical Systems (CBMS 2016) %C Dublin (June 20, 2016) and in Belfast (June 21 – 23, 2016) %8 06/2016 %G eng %0 Conference Paper %B ITI 2009 31st International Conference on Information Technology Interfaces (ITI Book Series) %D 2009 %T Towards knowledge sharing and patient privacy in a clinical decision support system %A Xiao, Liang %A Hu, B %A Hederman, Lucy %A Lewis P %A Dimitrov, B %A Fahey, T %B ITI 2009 31st International Conference on Information Technology Interfaces (ITI Book Series) %G eng %0 Conference Paper %D 2013 %T European Federation of Medical Informatics Conference 2013 - Data and Knowledge for Medical Decision Support. 17th-19th April 2013, Prague, Czech Republic. Accepted for publication %A Corrigan, D %A Taweel, A %A Fahey, T %A Arvanitis, T %A Delaney, B %G eng %0 Conference Paper %B IEEE 14th International Conference on e-Health Networking, Applications and Services (Healthcom) %D 2012 %T Developing a rule-driven clinical decision support system with an extensive and adaptative architecture %A Xiao, Liang %A Cousins, G %A Fahey, T %A Dimitrov, B %A Hederman, Lucy %B IEEE 14th International Conference on e-Health Networking, Applications and Services (Healthcom) %I IEEE %C Beijing, China %8 10/2012 %@ 978-1-4577-2039-0 %G eng %U http://ieeexplore.ieee.org/xpl/login.jsp?tp=&arnumber=6379416&url=http%3A%2F%2Fieeexplore.ieee.org%2Fstamp%2Fstamp.jsp%3Ftp%3D%26arnumber%3D6379416 %0 Book Section %B The Evidence Base of Clinical Diagnosis: Theory and methods of diagnostic research, Second Edition %D 2009 %T Producing and Using Clinical Prediction Rules %A Fahey, T %A Van der Lei, J %K barriers and strategies to clinical prediction rule effective implementation %K coverage of clinical prediction rules %K CPRs into CDSSs into personal digital assistants (PDAs) %K error in heuristics of decision making and influence on CPRs %K MEDLINE and EMBASE clinical literature databases %K methodological standards and levels of evidence %K thresholds approach to diagnosis %K use and application of CPRs and probabilistic or Bayesian diagnostic reasoning %K • producing and using clinical prediction rules %B The Evidence Base of Clinical Diagnosis: Theory and methods of diagnostic research, Second Edition %7 Second Edition %I Blackwell Publishing Ltd %G eng %& 11 %R DOI: 10.1002/9781444300574.ch11