TY - JOUR T1 - Variation in medical practice: getting the balance right JF - Fam Pract Y1 - 2012 A1 - Wallace, E A1 - Smith, SM A1 - Fahey, T KW - clinical practice KW - medical interventions KW - variation in medical practice AB - 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 … VL - 29 UR - http://www.ncbi.nlm.nih.gov/pubmed/23008518 IS - 5 ER - TY - JOUR T1 - Validation of the CHADS2 clinical prediction rule to predict ischaemic stroke. A systematic review and meta-analysis JF - Thromb Haemost Y1 - 2011 A1 - Keogh, C A1 - Wallace, E A1 - Dillon, C A1 - Dimitrov, B A1 - Fahey, T KW - Atrial Fibrillation KW - Humans KW - Myocardial Ischemia KW - Practice Guidelines as Topic KW - Predictive Value of Tests KW - Prognosis KW - Quality Assurance, Health Care KW - Research Design KW - Risk KW - Sensitivity and Specificity KW - Stroke AB - 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. VL - 106 UR - http://th.schattauer.de/en/contents/archive/issue/1439/manuscript/16384.html IS - 3 ER - TY - JOUR T1 - Training postgraduate doctors to manage patients with multimorbidity: a systematic review JF - PROSPERO International prospective register of systematic reviews Y1 - 2013 A1 - Lewis, Cliona A1 - Wallace, E A1 - Kyne, L A1 - Cullen, W A1 - Smith, SM UR - http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42013004010#.U_IHd_ldVqU ER - TY - JOUR T1 - A systematic review of the probability of repeated admission score in community-dwelling adults JF - J Am Geriatr Soc Y1 - 2013 A1 - Wallace, E A1 - Hinchey, T A1 - Dimitrov, B A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM KW - Aged KW - Aged, 80 and over KW - Brazil KW - Calibration KW - Decision Support Techniques KW - Europe KW - Female KW - Health Care Costs KW - Health Services for the Aged KW - Humans KW - Male KW - Mortality KW - Patient Readmission KW - Probability KW - Reproducibility of Results KW - Risk Assessment KW - Sensitivity and Specificity KW - United States KW - Validation Studies as Topic AB - 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. VL - 61 UR - http://onlinelibrary.wiley.com/doi/10.1111/jgs.12150/abstract IS - 3 ER - TY - JOUR T1 - Risk prediction models to predict emergency hospital admission in community-dwelling adults. A systematic review JF - Med Care Y1 - 2014 A1 - Wallace, E A1 - Stuart, Ellen A1 - Vaughan, Niall A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM KW - community-dwelling adults KW - emergency hospital admission KW - risk prediction model AB - 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. VL - 52 UR - http://www.ncbi.nlm.nih.gov/pubmed/25023919 IS - 8 ER - TY - JOUR T1 - Reducing emergency admissions through community based interventions JF - BMJ Y1 - 2016 A1 - Wallace, E A1 - Smith, SM A1 - Fahey, T A1 - Roland, M AB - 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. VL - 352 UR - http://www.bmj.com/content/352/bmj.h6817.long IS - h6817 ER - TY - JOUR T1 - Potentially inappropriate prescribing in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria JF - European Journal of Clinical Pharmacology Y1 - 2016 A1 - Cooper, J A1 - Moriarty, F A1 - Ryan, C A1 - Smith, SM A1 - Bennett, K A1 - Fahey, T A1 - Wallace, E A1 - Cahir, C A1 - Williams, David A1 - Teeling, Mary A1 - Hughes, CM AB - 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. UR - http://dx.doi.org/10.1007/s00228-015-2003-z ER - TY - JOUR T1 - The polypill: a magic bullet against cardiovascular disease? JF - Student BMJ Y1 - 2012 A1 - Wallace, E A1 - Fahey, T VL - 20 UR - http://student.bmj.com/student/view-article.html?id=sbmj.e6386 ER - TY - JOUR T1 - Point of care C-Reactive Protein testing and antibiotic prescribing for respiratory tract infection (letter) JF - Annals of Family Medicine Y1 - 2010 A1 - Wallace, E A1 - Fahey, T KW - C-Reactive Protein KW - Family Practice KW - Respiratory tract infection VL - 8 UR - http://annfammed.org/content/8/2/124.abstract/reply#annalsfm_el_11754 ER - TY - JOUR T1 - Overuse and underuse of cardiovascular diagnostic and therapeutic procedures for community-dwelling adults: a protocol for a systematic review [version 1; peer review: 2 approved] JF - HRB Open Research Y1 - 2021 A1 - Quinn, D A1 - Byrne, D A1 - Fahey, T A1 - Kenny, RA A1 - McGarrigle, C A1 - Wallace, E A1 - Boland, F VL - 4:99 ER - TY - JOUR T1 - Optimized retrieval of primary care clinical prediction rules from MEDLINE to establish a Web-based register JF - J Clin Epidemiol Y1 - 2011 A1 - Keogh, C A1 - Wallace, E A1 - O'Brien, K A1 - Murphy, Paul J A1 - Teljeur, C A1 - McGrath, Brid A1 - Smith, SM A1 - Niall Doherty A1 - Dimitrov, B A1 - Fahey, T KW - Abstracting and Indexing as Topic KW - Databases, Bibliographic KW - Humans KW - Information Storage and Retrieval KW - MEDLINE KW - Primary Health Care KW - Sensitivity and Specificity KW - Subject Headings AB - OBJECTIVES: Identifying clinical prediction rules (CPRs) for primary care from electronic databases is difficult. This study aims to identify a search filter to optimize retrieval of these to establish a register of CPRs for the Cochrane Primary Health Care field. STUDY DESIGN AND SETTING: Thirty primary care journals were manually searched for CPRs. This was compared with electronic search filters using alternative methodologies: (1) textword searching; (2) proximity searching; (3) inclusion terms using specific phrases and truncation; (4) exclusion terms; and (5) combinations of methodologies. RESULTS: We manually searched 6,344 articles, revealing 41 CPRs. Across the 45 search filters, sensitivities ranged from 12% to 98%, whereas specificities ranged from 43% to 100%. There was generally a trade-off between the sensitivity and specificity of each filter (i.e., the number of CPRs and total number of articles retrieved). Combining textword searching with the inclusion terms (using specific phrases) resulted in the highest sensitivity (98%) but lower specificity (59%) than other methods. The associated precision (2%) and accuracy (60%) were also low. CONCLUSION: The novel use of combining textword searching with inclusion terms was considered the most appropriate for updating a register of primary care CPRs where sensitivity has to be optimized. VL - 64 UR - http://www.sciencedirect.com/science/article/pii/S0895435610004233 IS - 8 ER - TY - JOUR T1 - Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health and Quality of Life Outcomes JF - 2015 Y1 - 2015 A1 - Ryan, A A1 - Wallace, E A1 - O'Hara, P A1 - Smith, SM VL - 13 UR - http://epubs.rcsi.ie/cgi/viewcontent.cgi?article=1100&context=gpart IS - 168 ER - TY - JOUR T1 - Measuring blood pressure in primary care: identifying 'white coat syndrome' and blood pressure device comparison JF - Br J Gen Pract Y1 - 2011 A1 - Wallace, E A1 - Fahey, T KW - Female KW - General Practice KW - Humans KW - Hypertension KW - Male KW - Sphygmomanometers AB - Hypertension is a major risk factor for cardiovascular disease, especially in the presence of other risk factors.1 Accurate identification of hypertension is challenging largely due to blood pressure variability in an office or clinic where most GP consultations take place. Blood pressure can be affected by several factors including measurement technique and observer bias.2 Ambulatory blood pressure monitoring (ABPM) and self-monitoring, two methods used to detect ‘white coat syndrome’ (the phenomenon whereby blood pressure measured by medical personnel is elevated above usual levels), have been shown to be more accurate in predicting end-organ damage than office readings.3,4 However, thresholds for diagnosis of hypertension with ABPM vary and guidelines recommend its use in specific circumstances only.5 The use of self-monitoring in diagnosis is unclear in terms of the number of blood pressure readings required.6 Furthermore, current cardiovascular risk assessment charts are based on office blood pressure readings, so when calculating cardiovascular risk clinicians need a reliable method of measuring office blood pressure. VL - 61 UR - http://www.ncbi.nlm.nih.gov/pubmed/22152729 IS - 590 ER - TY - JOUR T1 - Managing patients with multimorbidity in primary care JF - BMJ Y1 - 2015 A1 - Wallace, E A1 - Salisbury, C A1 - Guthrie, Bruce A1 - Lewis, Cliona A1 - Fahey, T A1 - Smith, SM KW - multimorbidity KW - primary care VL - 350 UR - http://www.bmj.com/content/350/bmj.h176 IS - h176 ER - TY - JOUR T1 - Interventions for improving outcomes in patients with multimorbidity in primary care and community settings JF - Cochrane Database of Systematic Reviews Y1 - 2016 A1 - Smith, SM A1 - Wallace, E A1 - O'Dowd, T A1 - Fortin, M KW - Age Factors KW - Chronic Disease [therapy] KW - Community Health Services KW - Comorbidity KW - Disease Management KW - Humans[checkword] KW - Patient-Centered Care [methods] KW - Primary Health Care KW - Randomized Controlled Trials as Topic KW - Risk Factors KW - Treatment Outcome SN - 1465-1858 UR - http://dx.doi.org/10.1002/14651858.CD006560.pub3 IS - 3 ER - TY - JOUR T1 - Impact of Potentially Inappropriate Prescribing on Adverse Drug Events, Health Related Quality of Life and Emergency Hospital Attendance in Older People Attending General Practice: A Prospective Cohort Study JF - J Gerontol A Biol Sci Med Sci Y1 - 2016 A1 - Wallace, E A1 - McDowell, R A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM ER - TY - JOUR T1 - Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review JF - BMJ Open Y1 - 2016 A1 - Wallace, E A1 - Uijen, M A1 - Clyne, B A1 - Zarabzadeh, A A1 - Keogh, C A1 - Galvin, R A1 - Smith, SM A1 - Fahey, T VL - 6:e009957 IS - 3 ER - TY - JOUR T1 - Geographical variation of emergency hospital admissions for ambulatory care sensitive conditions in older adults in Ireland 2012–2016 JF - 11 Y1 - 2021 A1 - Walsh, ME A1 - Cronin, S A1 - Boland, F A1 - Ebell, MH A1 - Fahey, T A1 - Wallace, E ER - TY - JOUR T1 - Framework for the impact analysis and implementation of Clinical Prediction Rules (CPRs) JF - BMC Med Inform Decis Mak Y1 - 2011 A1 - Wallace, E A1 - Smith, SM A1 - Perera-Salazar, Rafael A1 - Vaucher, Paul A1 - McCowan, Colin A1 - Collins, Gary A1 - Verbakel, Jan A1 - Lakhanpaul, Monica A1 - Fahey, T KW - Decision Support Techniques KW - Evidence-Based Medicine KW - Humans KW - Physician's Practice Patterns KW - Research Design AB - 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. VL - 11 UR - http://www.biomedcentral.com/1472-6947/11/62 ER - TY - JOUR T1 - Existing validated clinical prediction rules for predicting response to physiotherapy interventions for musculoskeletal conditions have limited clinical value: A systematic review JF - Journal of Clinical Epidemiology Y1 - 2021 A1 - Walsh, M A1 - French, HP A1 - Wallace, E A1 - Madden, S A1 - King, P A1 - Fahey, T A1 - Galvin, R VL - 135 ER - TY - JOUR T1 - The epidemiology of malpractice claims in primary care; a systematic review JF - BMJ Open Y1 - 2013 A1 - Wallace, E A1 - Lowry, J A1 - Smith, SM A1 - Fahey, T KW - malpractice KW - primary care AB - 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. VL - 3 UR - http://bmjopen.bmj.com/content/3/7/e002929.abstract IS - 7 ER - TY - JOUR T1 - The development of the PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) criteria JF - BMC Health Services Research Y1 - 2014 A1 - Cooper, J A1 - Ryan, C A1 - Smith, SM A1 - Wallace, E A1 - Bennett, K A1 - Cahir, C A1 - Williams, David A1 - Teeling, Mary A1 - Hughes, CM A1 - PROMPT Steering Group KW - Delphi technique KW - Explicit criteria KW - Middle-age KW - multimorbidity KW - Polypharmacy KW - potentially inappropriate prescribing AB - Abstract Background Whilst multimorbidity is more prevalent with increasing age, approximately 30% of middle-aged adults (45–64 years) are also affected. Several prescribing criteria have been developed to optimise medication use in older people (≥65 years) with little focus on potentially inappropriate prescribing (PIP) in middle-aged adults. We have developed a set of explicit prescribing criteria called PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) which may be applied to prescribing datasets to determine the prevalence of PIP in this age-group. Methods A literature search was conducted to identify published prescribing criteria for all age groups, with the Project Steering Group (convened for this study) adding further criteria for consideration, all of which were reviewed for relevance to middle-aged adults. These criteria underwent a two-round Delphi process, using an expert panel consisting of general practitioners, pharmacists and clinical pharmacologists from the United Kingdom and Republic of Ireland. Using web-based questionnaires, 17 panellists were asked to indicate their level of agreement with each criterion via a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree) to assess the applicability to middle-aged adults in the absence of clinical information. Criteria were accepted/rejected/revised dependent on the panel’s level of agreement using the median response/interquartile range and additional comments. Results Thirty-four criteria were rated in the first round of this exercise and consensus was achieved on 17 criteria which were accepted into the PROMPT criteria. Consensus was not reached on the remaining 17, and six criteria were removed following a review of the additional comments. The second round of this exercise focused on the remaining 11 criteria, some of which were revised following the first exercise. Five criteria were accepted from the second round, providing a final list of 22 criteria [gastro-intestinal system (n = 3), cardiovascular system (n = 4), respiratory system (n = 4), central nervous system (n = 6), infections (n = 1), endocrine system (n = 1), musculoskeletal system (n = 2), duplicates (n = 1)]. Conclusions PROMPT is the first set of prescribing criteria developed for use in middle-aged adults. The utility of these criteria will be tested in future studies using prescribing datasets. Keywords: Potentially inappropriate prescribing; Explicit criteria; Delphi technique; Middle-age; Polypharmacy; Multimorbidity VL - 14 UR - http://www.biomedcentral.com/1472-6963/14/484 ER - TY - JOUR T1 - Developing an International Register of Clinical Prediction Rules for Use in Primary Care: A Descriptive Analysis JF - Ann of Fam Med Y1 - 2014 A1 - Keogh, C A1 - Wallace, E A1 - O'Brien, K A1 - Galvin, R A1 - Smith, SM A1 - Lewis, Cliona A1 - Cummins, Anthony A1 - Cousins, G A1 - Dimitrov, B A1 - Fahey, T KW - clinical decision support systems KW - clinical prediction rule KW - decision aid KW - decision making KW - primary care KW - score card AB - Abstract PURPOSE We describe the methodology used to create a register of clinical prediction rules relevant to primary care. We also summarize the rules included in the register according to various characteristics. METHODS To identify relevant articles, we searched the MEDLINE database (PubMed) for the years 1980 to 2009 and supplemented the results with searches of secondary sources (books on clinical prediction rules) and personal resources (eg, experts in the field). The rules described in relevant articles were classified according to their clinical domain, the stage of development, and the clinical setting in which they were studied. RESULTS Our search identified clinical prediction rules reported between 1965 and 2009. The largest share of rules (37.2%) were retrieved from PubMed. The number of published rules increased substantially over the study decades. We included 745 articles in the register; many contained more than 1 clinical prediction rule study (eg, both a derivation study and a validation study), resulting in 989 individual studies. In all, 434 unique rules had gone through derivation; however, only 54.8% had been validated and merely 2.8% had undergone analysis of their impact on either the process or outcome of clinical care. The rules most commonly pertained to cardiovascular disease, respiratory, and musculoskeletal conditions. They had most often been studied in the primary care or emergency department settings. CONCLUSIONS Many clinical prediction rules have been derived, but only about half have been validated and few have been assessed for clinical impact. This lack of thorough evaluation for many rules makes it difficult to retrieve and identify those that are ready for use at the point of patient care. We plan to develop an international web-based register of clinical prediction rules and computer-based clinical decision support systems. VL - 12 UR - http://www.ncbi.nlm.nih.gov/pubmed/25024245 IS - 4 ER - TY - JOUR T1 - Clinical prediction rules in practice:review of clinical guidelines and survey of GPs JF - British Journal of General Practice Y1 - 2014 A1 - Plüddemann, A A1 - Wallace, E A1 - Bankhead, Clare A1 - Keogh, C A1 - Van der Windt, D A1 - Lasserson, D A1 - Galvin, R A1 - Moschetti, I A1 - Kearley, K A1 - O'Brien, K A1 - Sanders, S A1 - Mallett, S A1 - Malanda, U A1 - Thompson, M A1 - Fahey, T A1 - Stevens, R KW - clinical guidelines KW - clinical prediction rules KW - survey AB - Abstract Background The publication of clinical prediction rules (CPRs) studies has risen significantly. It is unclear if this reflects increasing usage of these tools in clinical practice or how this may vary across clinical areas. Aim To review clinical guidelines in selected areas and survey GPs in order to explore CPR usefulness in the opinion of experts and use at the point of care. Design and setting A review of clinical guidelines and survey of UK GPs. Method Clinical guidelines in eight clinical domains with published CPRs were reviewed for recommendations to use CPRs including primary prevention of cardiovascular disease, transient ischaemic attack (TIA) and stroke, diabetes mellitus, fracture risk assessment in osteoporosis, lower limb fractures, breast cancer, depression, and acute infections in childhood. An online survey of 401 UK GPs was also conducted. Results Guideline review: Of 7637 records screened by title and/or abstract, 243 clinical guidelines met inclusion criteria. CPRs were most commonly recommended in guidelines regarding primary prevention of cardiovascular disease (67%) and depression (67%). There was little consensus across various clinical guidelines as to which CPR to use preferentially. Survey: Of 401 responders to the GP survey, most were aware of and applied named CPRs in the clinical areas of cardiovascular disease and depression. The commonest reasons for using CPRs were to guide management and conform to local policy requirements. Conclusion GPs use CPRs to guide management but also to comply with local policy requirements. Future research could focus on which clinical areas clinicians would most benefit from CPRs and promoting the use of robust, externally validated CPRs. VL - 64 UR - http://bjgp.org/content/64/621/e233.full IS - 621 ER - TY - JOUR T1 - Anticipatory care planning for older adults: a trans-jurisdictional feasibility study JF - British Journal of General Practice Y1 - 2020 A1 - Corry, D A1 - Doherty, J A1 - McCann, A A1 - Doyle, F A1 - Cardwell, C A1 - Carter, G A1 - Clarke, M A1 - Fahey, T A1 - Gillespie, P A1 - McGlade, K A1 - O'Halloran, P A1 - Wallace, E A1 - Brazil, K VL - 70 IS - Suppl 1 ER - TY - Generic T1 - Risk management in General Practice: an educational initiative for undergraduate general practice teaching. Society of Academic Primary Care, 2-4 October 2012, Glasgow, Scotland Y1 - 2012 A1 - Wallace, E A1 - Lowry, J A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - 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 Y1 - 2013 A1 - Wallace, E A1 - Lowry, J A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - 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 Y1 - 2010 A1 - Wallace, E A1 - Keogh, C A1 - Dillion, C A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/posters/CHADS2.pdf ER - TY - Generic T1 - 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 Y1 - 2010 A1 - Wallace, E A1 - Dillon, C A1 - Keogh, C A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/WallaceE/CHDADS2%20Cochrane%20poster.ppt ER - TY - Generic T1 - Multimorbidity and functional decline in community-dwelling adults: a systematic review 2015. Society of Academic Primary Care Conference, University of Oxford, 8-10th July 2015 Y1 - 2015 A1 - Ryan, A A1 - Wallace, E A1 - O'Hara, P A1 - Smith, SM ER - TY - Generic T1 - The epidemiology of malpractice claims in primary care: a systematic review. AUDGPI Annual Scientific Meeting 2013, University of Limerick, 8 March 2013. Limerick Y1 - 2013 A1 - Wallace, E A1 - Lowry, J A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Developing a web-based international register of clinical prediction rules for primary care SAPC ASM, University of Nottingham, 3 – 5 July 2013, Nottingham, UK Y1 - 2013 A1 - Keogh, C A1 - Wallace, E A1 - O'Brien, K A1 - Galvin, R A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Risk prediction models to predict emergency hospital admission in community-dwelling adults AUDGPI Cork 6-7 March 2014 Y1 - 2014 A1 - Wallace, E A1 - Stuart, Ellen A1 - Vaughan, Niall A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM UR - http://hrbcentreprimarycare.ie/ppt/Emma Wallace AUDGPI 2014.pdf ER - TY - Generic T1 - Risk prediction models to predict emergency hospital admission in community-dwelling adults: a systematic review. SAPC July 9-11 2014 Edinburgh Y1 - 2014 A1 - Wallace, E ER - TY - Generic T1 - Risk prediction models to predict emergency hospital admission in community-dwelling adults: a systematic review. SPHeRE Conference, RCSI Dublin, January 2015 Y1 - 2015 A1 - Wallace, E A1 - Stuart, Ellen A1 - Vaughan, Niall A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Risk prediction models to predict emergency hospital admission in community dwelling adults: a systematic review. NAPCRG New York 21-24 Nov 2014 Y1 - 2014 A1 - Wallace, E A1 - Stuart, Ellen A1 - Vaughan, Niall A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Register of Clinical Prediction Rules, methodological quality assessment and implementation strategies. European General Practice Research Network conference. October 14-17th, 2010, Zurich, Switzerland Y1 - 2010 A1 - Wallace, E A1 - Keogh, C A1 - Smith, SM A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/Emma%20Wallace%20EGPRN%20presentation.ppt ER - TY - Generic T1 - 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 Y1 - 2010 A1 - Wallace, E A1 - Keogh, C A1 - Smith, SM A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/Emma%20Wallace%20SAPC%20presentation.pdf ER - TY - Generic T1 - 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 Y1 - 2010 A1 - Keogh, C A1 - Wallace, E A1 - Dimitrov, B A1 - Dillon, C A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/KeoghSAPC.pptx ER - TY - Generic T1 - 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 Y1 - 2015 A1 - Cooper, J A1 - Moriarty, F A1 - Ryan, C A1 - Smith, SM A1 - Wallace, E A1 - Bennett, K A1 - Cahir, C A1 - Williams, David A1 - Teeling, Mary A1 - Fahey, T A1 - Hughes, CM ER - TY - Generic T1 - Multimorbidity and functional decline in community-dwelling adults: a systematic review. Irish Society of Chartered Physiotherapists Conference, Dublin, 6th November 2015. Y1 - 2015 A1 - Ryan, A A1 - Wallace, E A1 - O'Hara, P A1 - Smith, SM ER - TY - Generic T1 - Multimorbidity and functional decline in community-dwelling adults: a systematic review. RCSI Research Day 25th February 2016. Y1 - 2016 A1 - Ryan, A A1 - Wallace, E A1 - O’Hara, P A1 - Smith, SM ER - TY - Generic T1 - Multimorbidity and functional decline in community-dwelling adults: a systematic review 2015. SPHeRE Conference, RCSI, Dublin, 29th February 2016. Y1 - 2016 A1 - Ryan, A A1 - Wallace, E A1 - O'Hara, P A1 - Smith, SM ER - TY - Generic T1 - Multidimensional relationships between medication beliefs and adherence to medications among older adults living with multimorbidity. 36th Annual Conference of the European Health Psychology Society. Bratislava, August 2022 Y1 - 2022 A1 - Foley, L A1 - Doherty, AS A1 - Wallace, E A1 - Boland, F A1 - Hynes, L A1 - Murphy, AW A1 - Molloy, GJ ER - TY - Generic T1 - International Register of Clinical Prediction Rules, methodological quality assessment and implementation strategies. AUDGPI 2011, Department of Public Health & Primary Care, Trinity College, RCPI, 20-21 January 2011, Dublin Y1 - 2011 A1 - Wallace, E UR - http://hrbcentreprimarycare.ie/ppt/AUDGPI.ppt ER - TY - Generic T1 - 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. Y1 - 2016 A1 - Wallace, E A1 - McDowell, R A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Impact analysis of clinical prediction rules in primary care: a review. AUDGPI, Belfast - 5-6 March 2015. Winner of the James McCormack prize for ‘Best Research presentation’ and overall winner of academic travel bursary for best research project Y1 - 2015 A1 - Wallace, E ER - TY - Generic T1 - The IDAPP framework for the impact analysis of Clinical Prediction Rules (CPRs). SAPC 2011, 6-8 July 2011, Bristol, UK Y1 - 2011 A1 - Wallace, E A1 - Smith, SM A1 - International Diagnostic and Prognosis Prediction (IDAPP) Group UR - http://hrbcentreprimarycare.ie/ppt/SAPC%202011.ppt ER - TY - Generic T1 - Development of an electronic register of clinical prediction rules relevant to primary care. RCSI Research Summer School Symposium, 8 October 2010, Dublin Y1 - 2010 A1 - Halfpenny, Sarah A1 - Pirani, Zameer A1 - Keogh, C A1 - Wallace, E A1 - Fahey, T ER - TY - Generic T1 - Developing a Web-based International Register of Clinical Prediction Rules for Primary Care. North American Primary Care Research Group (NAPCRG), 1-5 December 2012, New Orleans, Louisiana, USA Y1 - 2012 A1 - Smith, SM A1 - Keogh, C A1 - Wallace, E A1 - Galvin, R A1 - O'Brien, K A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/International register for primary care CPRs.pptx ER - TY - Generic T1 - Clinical prediction rules in practice: review of clinical guidelines and survey of general practitioners. AUDGPI Annual Scientific Meeting 2013, University of Limerick, 8 March 2013. Limerick Y1 - 2013 A1 - Wallace, E ER - TY - Generic T1 - Workshop for early career academics in primary care on systematic reviews. AUDGPI Conference, Belfast March 2015 Y1 - 2015 A1 - Wallace, E A1 - Galvin, R A1 - Smith, SM ER - TY - Generic T1 - Which CPRs appear in clinical guidelines. Clinical Prediction Rules – International Working Group, 29-30 September 2010, Oxford, UK Y1 - 2010 A1 - Stevens, R A1 - Wallace, E UR - http://www.hrbcentreprimarycare.ie/ppt/guidelines_slides_2.1.ppt ER - TY - Generic T1 - 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 Y1 - 2010 A1 - Keogh, C A1 - Wallace, E A1 - Dillon, C A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 ER - TY - Generic T1 - 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 Y1 - 2010 A1 - Wallace, E A1 - Smith, SM A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 ER - TY - Generic T1 - 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 Y1 - 2010 A1 - Keogh, C A1 - Wallace, E A1 - O'Brien, K A1 - Murphy, Paul J A1 - Teljeur, C A1 - McGrath, Brid A1 - Smith, SM A1 - Niall Doherty A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 ER - TY - Generic T1 - Impact analysis studies and the evidence in relation to process and outcome of clinical care. Clinical Prediction Rules – International Working Group, 29-30 September 2010, Oxford, UK Y1 - 2010 A1 - Wallace, E UR - http://www.hrbcentreprimarycare.ie/ppt/Impact%20analysis%20Oxford.ppt ER - TY - Generic T1 - Dissemination of CPRs: focus on Clinical Decision Support Systems. International Clinical Prediction Rules Meeting, 27 November 2009, HRB Centre for Primary Care Research, Dublin, Ireland Y1 - 2009 A1 - Wallace, E UR - http://www.hrbcentreprimarycare.ie/ppt/WallaceE/RCSI%20CDSS%20EW.ppt ER - TY - Generic T1 - Developing an International Register for CPRs: Identifying an Optimal Search Strategy & Quality Assessment of CPR Studies. International Clinical Prediction Rules Meeting, 27 November 2009, HRB Centre for Primary Care Research, Dublin Y1 - 2009 A1 - Wallace, E A1 - Keogh, C UR - http://www.hrbcentreprimarycare.ie/ppt/KeoghC/CK%20and%20EW%20271109.ppt ER -