Background: In the last two decades, sex-related differences regarding cardiovascular diagnosis, treatment, and risk factors management have been reported. The current study aims to explore differences in cardiovascular outcomes among male and female patients attending the Irish secondary cardiovascular prevention programme Heartwatch. Methods: This is a retrospective observational study. Anonymous data was extracted from the Heartwatch database from 2003 to 2017. Cardiovascular risk factors were analysed at sign-up and at four years follow-ups. An 8-point aggregate risk score (CCare Score) was assessed to calculate targeted outcomes. Generalized estimating equations models were applied for data analysis. Results: In total 8893 patients (77 % male) were included. Females exhibited a higher risk profile across all cardiovascular risk factors and were more likely to be off target than males at baseline and after 4 years of programme attendance [M to F odds ratios(95 % CI); systolic blood pressure: 1.35 (1.21-1.49), waist circumference: 2.11(1.89-2.36), physical activity: 1.72 (1.53-1.95)]. CCare scores also demonstrated the gap between male and female patients at baseline [mean(sd); M: 5.1(1.2), F: 4.8(1.2)] and after 4 years of structured care [mean(sd); M: 5.3(1.2), F: 4.9(1.2)]. Female patients were less likely to be prescribed aspirin and ACE inhibitors but more likely to be prescribed AT2 inhibitors, calcium channel blockers, and diuretics compared to male patients. Conclusions: The Heartwatch programme has demonstrably improved patient care, however, the continuous underperformance of female patients necessitates further investigation to ensure appropriate and equitable secondary CVD prevention among the Irish population.

Introduction: Rural communities can experience more barriers to accessing health care than their urban counterparts, largely due to fewer healthcare staff and services, and geographical isolation. The purpose of this study is to examine the availability of GP practices in rural communities across the Mid-West of Ireland and the potential impact of practice closure on patient access. Methods: GP clinic locations were identified in Ireland's Mid-West, specifically counties Limerick and Clare. Administrative subdivisions of both counties, Small Areas (SAs), were identified and their XY geographic centre coordinates recorded. SAs were indexed into six levels of rurality according to Irish Central Statistics Office urban/rural classifications (1, cities; 2, satellite urban towns; 3, independent urban towns; 4, rural areas with high urban influence; 5, rural areas with moderate urban influence; 6, highly rural/remote areas). The direct linear distance from the centre of each SA to its respective closest GP clinic was calculated. Simulated closure of each GP clinic was assessed programmatically by removing practices from the overall dataset and calculating the new direct linear distance from each SA to the next closest GP clinic. Results: The majority of the SAs in County Clare (63%) and County Limerick (66%) are classified as rural (rurality index ≥4), with the exception of Limerick City, where all SAs were defined as urban. Rural SAs have longer travel distances to GP clinics than their urban counterparts, and these distances are greater with increasing rurality of a population. Simulated closure of GP clinics revealed increasing travel distances to the next closest clinic with increasing level of rurality in a stepwise fashion (r2=0.31). Conclusion: Rural community dwellers across the Mid-West of Ireland face longer travel distances to GP clinics than their urban counterparts. Thus rural communities will be, on average, more adversely affected should their local GP clinic close. While these findings are unsurprising, our methodology calculates a discrete number that can be used to rank vulnerability of local communities. Rural areas are particularly vulnerable to GP clinic closure, and maintaining a solid foundation of primary care in these areas will require careful service and workforce planning.

BACKGROUND:Since winter 2020/21, general practitioners (GPs) in the Republic of Ireland (RoI) have been granted access to diagnostic imaging studies on a new publicly funded pathway, expediting access to services previously obtained via hospital-based doctors. AIMS:Outline GP perspectives on imaging studies obtained via the new "GP Access to Community Diagnostics" initiative. METHODS:A mixed-methods design was employed. Referrals over the first six months of 2019 and 2021 were collated by a private imaging provider, and a randomly selected subset of 2021 studies (maximum 30 referrals per GP) was returned to participating GPs to provide detail on the impact on each patient's care. In-depth qualitative interviews were also conducted with participating GPs. RESULTS:Eleven GPs supplied detailed information on 81 studies organized through the new initiative. GPs reported that the initiative had led to a large proportion of cases being managed solely in general practice, with an 81% reduction in referrals to acute hospital settings and a 58% reduction in referrals to secondary care clinics. GPs felt imaging studies improved patient care in 86% of cases and increased GP workload in 58% of cases. GP qualitative interviews revealed four key themes: improved patient care, increased GP workload, reduction in hospital referrals, and opinions on ongoing management of such initiatives, including guidelines. CONCLUSIONS:GPs felt enhancing access to diagnostics improved patient care by expediting diagnosis, decision-making, and treatment and by reducing hospital referrals. GPs were generally positive about the initiative and made some suggestions on future management of the initiative.

General practice (GP) is crucial to primary care delivery in the Republic of Ireland and is almost fully computerised. General practice teams were the first point of contact for much COVID-19-related care and there were concerns routine healthcare activities could be disrupted due to COVID-19 and related restrictions. The study aimed to assess effects of the pandemic on GP activity through analysis of electronic medical record data from general practice clinics in the Irish Midwest. A retrospective, descriptive study of electronic medical record data relating to patient record updates, appointments and medications prescribed across 10 GP clinics over the period 2019–2021 inclusive. Data relating to 1.18 million record transactions for 32 k patients were analysed. Over 500 k appointments were examined, and demographic trends presented. Overall appointment and prescribing activity increased over the study period, while a dip was observed immediately after the pandemic’s arrival in March 2020. Delivery of non-childhood immunisations increased sixfold as a result of COVID-19, childhood immunisation activity was maintained, while cervical smears decreased in 2020 as the screening programme was halted. A quarter of consultations in 2020 and 2021 were teleconsultations, and these were more commonplace for younger patients. General practice responded robustly to the pandemic by taking on additional activities while maintaining routine services where possible. The shift to teleconsulting was a significant change in workflow. Analysing routinely collected electronic medical record data can provide valuable insights for service planning, and access to these insights would be beneficial for future pandemic responses.

Objective This study aims to gather public opinion on the Irish “COVID Tracker” digital contact tracing (DCT) App, with particular focus on App usage, usability, usefulness, technological issues encountered, and potential changes to the App. Methods A 35-item online questionnaire was deployed for 10 days in October 2020, 3 months after the launch of the Irish DCT App. Results A total of 2889 completed responses were recorded, with 2553 (88%) respondents currently using the App. Although four in five users felt the App is easy to download, is easy to use and looks professional, 615 users (22%) felt it had slowed down their phone, and 757 (28%) felt it had a negative effect on battery life. Seventy-nine percent of respondents reported the App's main function is to aid contact tracing. Inclusion of national COVID-19 trends is a useful ancillary function according to 87% of respondents, and there was an appetite for more granular local data. Overall, 1265 (44%) respondents believed the App is helping the national effort, while 1089 (38%) were unsure. Conclusions DCT Apps may potentially augment traditional contact tracing methods. Despite some reports of negative effects on phone performance, just 7% of users who have tried the App have deleted it. Ancillary functionality, such as up-to-date regional COVID-19, may encourage DCT App use. This study describes general positivity toward the Irish COVID Tracker App among users but also highlights the need for transparency on effectiveness of App-enabled contact tracing and for study of non-users to better establish barriers to use.

Objectives This study aimed to develop and assess the feasibility and cost impact of an intervention involving a practice pharmacist embedded in general practice to improve prescribing safety, deprescribe where appropriate and reduce costs. Setting Four-doctor suburban general practice. Participants Inclusion criteria: patients receiving 10+ repeat drugs per month. Exclusion criteria: deceased, <18 years of age, nursing home resident, no longer attending, late-stage life-limiting condition, unsuitable on clinical/capacity grounds. 137 patients were eligible. 78 were recruited as participants, all of whom completed the study. Intervention Pharmacist conducting holistic medication reviews in the study group over a 6-month period. Primary outcome measures Anonymised medication changes, cost, biochemical monitoring and clinical measurements data were collected. Cost analysis of having a pharmacist as part of the general practice team was calculated. Results In total, 198 potentially inappropriate prescriptions (PIPs), and 163 opportunities for deprescribing were identified; 127 PIPs (64.1%) were actioned; 104 deprescribing opportunities were actioned (63.8%). The pharmacist identified 101 instances in which further investigations were warranted prior to prescription issue, of which 80 were actioned (79.2%). It was calculated that monthly savings of €1252 were made as a result of deprescribing. Conclusions This study has shown that the integration of pharmacists within general practice in Ireland is feasible and is an effective means of improving prescribing safety and implementing deprescribing through medication reviews. The combination of safety and cost concerns support taking a holistic approach to deprescribing with the patient. This study highlights the ease with which a pharmacist could integrate into the general practice setting in Ireland and points to how this could be sustainably funded.

BACKGROUND:Digital health technologies (DHTs), such as electronic health records and prescribing systems, are transforming health care delivery around the world. The quality of information in DHTs is key to the quality and safety of care. We developed a novel clinical information quality (CLIQ) framework to assess the quality of clinical information in DHTs. OBJECTIVE:This study explored clinicians' perspectives on the relevance, definition, and assessment of information quality dimensions in the CLIQ framework. METHODS:We used a systematic and iterative eDelphi approach to engage clinicians who had information governance roles or personal interest in information governance; the clinicians were recruited through purposive and snowball sampling techniques. Data were collected using semistructured online questionnaires until consensus was reached on the information quality dimensions in the CLIQ framework. Responses on the relevance of the dimensions were summarized to inform decisions on retention of the dimensions according to prespecified rules. Thematic analysis of the free-text responses was used to revise definitions and the assessment of dimensions. RESULTS:Thirty-five clinicians from 10 countries participated in the study, which was concluded after the second round. Consensus was reached on all dimensions and categories in the CLIQ framework: informativeness (accuracy, completeness, interpretability, plausibility, provenance, and relevance), availability (accessibility, portability, security, and timeliness), and usability (conformance, consistency, and maintainability). A new dimension, searchability, was introduced in the availability category to account for the ease of finding needed information in the DHTs. Certain dimensions were renamed, and some definitions were rephrased to improve clarity. CONCLUSIONS:The CLIQ framework reached a high expert consensus and clarity of language relating to the information quality dimensions. The framework can be used by health care managers and institutions as a pragmatic tool for identifying and forestalling information quality problems that could compromise patient safety and quality of care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR2-10.1136/bmjopen-2021-057430.

Ireland does not yet have a comprehensive system of universal access to primary care. In 2015, access to general practitioner (GP) care at no charge was introduced for the 70% of children aged under six who previously paid out-of-pocket fees. This study uses data from 16 practices and a regional out-of-hours (OOH) GP service to assess the impact of this policy on attendance. A difference-in-difference (DiD) analysis was applied to visit records of paediatric patients over a period of five years, two years of which were pre-policy, with treatment and control differentiated by age. Attendance at daytime GP by children aged under-six increased by 20%-21% in the three years following the introduction of the policy, largely explained by an increase in the number of patients attending (17.4%-18.6%). Of children aged under-six attending pre-policy, 14.9%-15.8% had > 6 visits annually, increasing to 18.5%-20.3% post-policy. OOH GP attendance also increased by 20.5%-29.4% over the same period. Findings are consistent with international literature on the provision of financially accessible healthcare. Prior unmet need, the provision of additional assessments to children aged under six, parental response to a service at no charge, and rerouting of access to the ED through GP, are all possible contributors to this increased demand. A more integrated policy of boosting supply as well as demand is desirable, particularly in the context of future expansion plans, to ensure the health benefits anticipated from the introduction of this policy have every opportunity to be realised.

Aim Physical Activity (PA) and Mindfulness-Based Stress Reduction (MBSR) both have positive effects on medical student well-being. The 'MED-WELL' programme is a curricular intervention that combines PA and education on exercise as medicine. This trial evaluates whether there is a mean difference in outcomes of participants of an exercise intervention, the 'MED-WELL' programme, versus a control group which engages in a MBSR programme. Methods All second-year medical students were voluntarily allocated into the intervention or control group. Data on overall health and well-being, sleep quality, loneliness, current level of PA, and confidence in prescribing exercise as medicine was analysed from both groups at baseline and after eight weeks. Results Within groups the intervention and control groups showed statistically significant improvements in overall well-being (p=0.010, p=0.005 respectively) and in sleep quality (p<0.001, p=0.007 respectively). The intervention group had statistically significant improvements in levels of PA (p=0.003) and confidence in prescribing exercise (p<0.001). However, there were no statistically significant differences in changes in outcome measures between groups. Conclusion This study has shown that participants in an exercise intervention, the 'MED-WELL' programme, had similar improvements in overall wellbeing and sleep quality to those in a control group who participated in a MBSR programme of the same duration.

Recent reform proposals in the healthcare systems of Ireland and Northern Ireland have highlighted the need to improve population health and to deliver more care in the community. There are significant variations between the two healthcare systems, providing an opportunity to examine how different approaches and policies impact on a range of outcomes. The aim of this research study is to analyse the primary care systems of Ireland and Northern Ireland. In doing so, it seeks to inform the reform proposals for both systems. The analysis will focus on primary care due to the key differences between the primary care systems of Ireland and Northern Ireland, including the higher prevalence of user charges in the Irish healthcare system.

Background Digital contact tracing apps have the potential to augment contact tracing systems and disrupt COVID-19 transmission by rapidly identifying secondary cases prior to the onset of infectiousness and linking them into a system of quarantine, testing, and health care worker case management. The international experience of digital contact tracing apps during the COVID-19 pandemic demonstrates how challenging their design and deployment are. Objective This study aims to derive and summarize best practice guidance for the design of the ideal digital contact tracing app. Methods A collaborative cross-disciplinary approach was used to derive best practice guidance for designing the ideal digital contact tracing app. A search of the indexed and gray literature was conducted to identify articles describing or evaluating digital contact tracing apps. MEDLINE was searched using a combination of free-text terms and Medical Subject Headings search terms. Gray literature sources searched were the World Health Organization Institutional Repository for Information Sharing, the European Centre for Disease Prevention and Control publications library, and Google, including the websites of many health protection authorities. Articles that were acceptable for inclusion in this evidence synthesis were peer-reviewed publications, cohort studies, randomized trials, modeling studies, technical reports, white papers, and media reports related to digital contact tracing. Results Ethical, user experience, privacy and data protection, technical, clinical and societal, and evaluation considerations were identified from the literature. The ideal digital contact tracing app should be voluntary and should be equitably available and accessible. User engagement could be enhanced by small financial incentives, enabling users to tailor aspects of the app to their particular needs and integrating digital contact tracing apps into the wider public health information campaign. Adherence to the principles of good data protection and privacy by design is important to convince target populations to download and use digital contact tracing apps. Bluetooth Low Energy is recommended for a digital contact tracing app's contact event detection, but combining it with ultrasound technology may improve a digital contact tracing app's accuracy. A decentralized privacy-preserving protocol should be followed to enable digital contact tracing app users to exchange and record temporary contact numbers during contact events. The ideal digital contact tracing app should define and risk-stratify contact events according to proximity, duration of contact, and the infectiousness of the case at the time of contact. Evaluating digital contact tracing apps requires data to quantify app downloads, use among COVID-19 cases, successful contact alert generation, contact alert receivers, contact alert receivers that adhere to quarantine and testing recommendations, and the number of contact alert receivers who subsequently are tested positive for COVID-19. The outcomes of digital contact tracing apps' evaluations should be openly reported to allow for the wider public to review the evaluation of the app. Conclusions In conclusion, key considerations and best practice guidance for the design of the ideal digital contact tracing app were derived from the literature.

Novel software applications (“Apps”) that can potentially simplify the laborious work of manual contact tracing during the ongoing COVID-19 pandemic are a tempting prospect. Given this potential, many countries have designed, developed and deployed Apps before their efficacy has been established. The Irish health service launched the “COVID Tracker” App on the 7th July 2020 and 8 months later it is being used by 35% of those over 16 in Ireland. Conduct a national survey with a large sample of the Irish population to gather public opinion of the COVID Tracker App and its contribution to the national COVID-19 response. A 37-item questionnaire deployed online for 10 days in early October 2020. There were 2,889 complete responses to the survey. Responses were received from all 26 counties in the Republic of Ireland and the cohort was younger, more female-predominant and had higher educational attainment than the population. Of the 2,889 respondents, 2,741 (95%) had downloaded the App at some point, while 2,553 (88%) were still using it. For the 188 respondents who had stopped using the App, 116 respondents (62%) reported battery related concerns. For the 2,741 participants who had downloaded the App at some point, 2,374 (87%) reported the App was easy to use and 2,250 (82%) agreed it looked professional and of high quality. Regarding the main function of the App, 2,333 (81%) felt this was clear, and 92% of these App users stated the main function was to assist contact tracing. Overall, 1,265 (44%) respondents stated they believe the App is helping the national effort, while 1,089 (38%) were unsure. Younger respondents, female respondents, those in low-risk groups and those less worried about COVID-19 and were more negative about the clarity of the App’s main function and its usefulness. Contact tracing Apps have the potential to augment traditional contact tracing methods. Our research describes general positivity toward the Irish COVID Tracker App but also highlights the need for users to be updated regularly on its effectiveness. While the effectiveness of digital contact tracing is difficult to ascertain, all countries using contact tracing Apps must strive to ensure citizens are clear on any contribution such Apps are making to the pandemic response. Data describing how many notified users were already aware of their recent close contact with an infected case, and if the warning actually prevented people mixing, would constitute objective evidence of the impact these Apps are having, which may in turn improve their adoption and consequent usefulness. n/a

BACKGROUND:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody testing in community settings may help us better understand the immune response to this virus and, therefore, help guide public health efforts.AIM:To conduct a seroprevalence study of immunoglobulin G (IgG) antibodies in Irish GP clinics.DESIGN & SETTING:Participants were 172 staff and 799 patients from 15 general practices in the Midwest region of Ireland.METHOD:This seroprevalence study utilised two manufacturers' point-of-care (POC) SARS-CoV-2 immunoglobulin M (IgM)-IgG combined antibody tests, which were offered to patients and staff in general practice from 15 June to 10 July 2020.RESULTS:IgG seroprevalence was 12.6% in patients attending general practice and 11.1% in staff working in general practice, with administrative staff having the lowest seroprevalence at 2.5% and nursing staff having the highest at 17.6%. Previous symptoms suggestive of COVID-19 and history of a polymerase chain reaction (PCR) test were associated with higher seroprevalence. IgG antibodies were detected in approximately 80% of participants who had a previous PCR-confirmed infection. Average length of time between participants' positive PCR test and positive IgG antibody test was 83 days.CONCLUSION:Patients and healthcare staff in general practice in Ireland had relatively high rates of IgG to SARS-CoV-2 compared with the national average between 15 June and 10 July 2020 (1.7%). Four-fifths of participants with a history of confirmed COVID-19 disease still had detectable antibodies an average of 12 weeks post-infection. While not proof of immunity, SARS-CoV-2 POC testing can be used to estimate IgG seroprevalence in general practice settings.

A natural hazard becomes a natural disaster when individuals, communities and infrastructure are impacted.The impact of a natural disaster is a function of the type and magnitude of the hazard, and the vulnerability of the people and assets exposed to the hazard.Consequently, bushfire risk is not only a function of bushfire likelihood and intensity, but also the social vulnerability of affected communities.In this paper, a framework is presented that enables the spatial distribution of bushfire risk to be quantified by considering bushfire likelihood and social vulnerability.The framework also caters to the assessment of how this risk could change into the future in response to climate change and socio-economic development.The framework is applied to the case study of Greater Adelaide, South Australia.The current distribution of social vulnerability is calculated based on a number of indicators and the current distribution of bushfire likelihood determined using the Unified Natural Hazard Risk Mitigation Exploratory Decision Support System (UNHaRMED), enabling the spatial distribution of current bushfire risk to be determined based on social vulnerability.Plausible spatial distributions of future bushfire risk based on social vulnerability are obtained in response to a number of climate and socio-economic exploratory scenarios.The impact of climate change scenarios on bushfire likelihood is quantified with UNHaRMED.The impact of the socio-economic scenarios on social vulnerability is quantified using a combination of changes in the distribution of land use and population with the aid of UNHaRMED, as well as "clues" in the narrative scenario storylines about likely changes in factors affecting social vulnerability.The results indicate that future changes in social vulnerability are likely to affect long-term bushfire risk in greater Adelaide, with spatial distributions of social vulnerability and bushfire risk changing in different ways under different plausible future scenarios.This enables areas of emerging risk to be identified, opening the door to long-term risk-reduction strategies to be targeted to these high-risk regions.

Background: High quality data should be a key resource for research and planning of healthcare, but low quality general practice data has been documented internationally. This study assessed the feasibility of collecting reliable chronic disease data in Irish general practice, using a program of training and feedback to improve the quality of coding for chronic conditions in practice information systems. Methods: Training in chronic disease coding and reporting was provided to a purposive sample of general practices in Ireland. From July to December 2020, practices reported the number of patients receiving free medical care, and the number of patients coded with each of eight chronic conditions: type 2 diabetes mellitus (T2DM), asthma, chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), heart failure (HF), atrial fibrillation (ATF), transient ischaemic attack (TIA) and cerebrovascular accident/stroke (CVA). Calculated prevalences were compared with national and international estimates. Results: We recruited and trained 16 practices with 65.5 full-time equivalent GPs and a study-eligible patient population of 36,327. There was a large degree of variation across practices for all conditions. For example, in July, reported prevalence of IHD ranged from 0.3% to 10.2% (a 34-fold difference), and reported prevalence of HF ranged from 0.2% to 4.0% (a 20-fold difference). No single practice had high or low prevalences across all conditions. Changes over time across all practices were minimal, averaging between 0.1% and 0.3% for all conditions. By December, a large degree of variation across practices remained. Across all conditions, average prevalences were higher than previously published estimates. Conclusions: Although hampered by the COVID-19 pandemic, it was feasible to implement this programme of training and feedback to report on chronic disease data recorded in general practice. Coding quality in Irish general practice is highly varied, and improvement would require a greater degree of intervention, including audit.

Background Demand for GP services in the Republic of Ireland (RoI) is increasing, and the resultant escalation in workload demands is an issue of growing concern. Accordingly, the accurate measurement and description of GP workload is essential to inform future healthcare planning. Aim To provide a real-time measurement of GP workload with respect to hours worked and of proportional time expenditure on typical workload activities. Design and setting A prospective study among GPs in the RoI that took place from January 2019 to March 2019. Method Participants were invited to enrol in the study by direct email invitation and via notifications posted within GP-specific monthly journals; online forums; and a social media platform. Participants used a time-management software program to self-record workload activity in real time over 6 weeks. Results In total, 123 GPs were included for final analyses with a total of 8930 hours of activity recorded. The mean duration of a two-session day (excluding break-time) was 9.9 hours (95% confidence interval [CI] = 9.7 to 10.0; interquartile range [IQR] 7.9 to 13.9). Of this time, 64% was spent on clinical consultations. In total, 25.4% of activity was recorded outside the hours of 9.00 am and 5.00 pm. An average of 12.4 face-to-face consultations were completed per session of activity. The mean duration of a 10-session week was greatest for the partner (50.8 hours; 95% CI = 49.8 to 51.9) and >55-year-old (50.8 hours; 95% CI = 49.3 to 52.2) demographics, relative to their respective colleagues. Conclusion To the authors’ knowledge, this is the first study to provide an objective, accurate, and granular real-time measurement of GP workload in the RoI, demonstrating the significant volume and variety of work undertaken by GPs in the RoI.

N 122 62 Age in years (range) 21⋅9 (2-69) 27⋅1 (4 – 66) 0⋅0066 Number<16 years (%) 55 (45) 21 (34) 0⋅0572 Number≥16 years (%) 67 (55) 41 (66) Female (%) 67 (54⋅9) 37 (51⋅3) 0⋅7473 Abdominal imaging (%) 81 (66⋅4) 54 (87⋅1) 0⋅0067 US (%) 62 (50⋅8) 26 (41⋅9) 0⋅0447 CT (%) 21 (17⋅2) 34 (54⋅8) 0⋅0001 US confirmed appendicitis (%) 7/62 (11⋅3) 9/26 (34⋅6) 0⋅0143 Secondary findings on US (%) 30/62 (48⋅4) 14/26 (50) 0⋅8156 CT-confirmed appendicitis (%) 19/21 (90⋅5) 27/34 (79⋅4) 0⋅4568 Complicated appendicitis on CT (%) 3/21 (14⋅3) 11/34 (32⋅4) 0⋅2046 SARS-CoV-2 swab* (%) 1 (0⋅8) 23 (37⋅1) Positive result (%) 0 1/23 (4⋅4) Operative intervention (%) 107 (87⋅7) 34 (54⋅8) 0⋅0001 Laparoscopic (%) 88/107 (82⋅2) 7/34 (20⋅6) 0⋅0001 Open (%) 19/107 (17⋅8) 27/34 (79⋅4) <16 years (%) 17/53 (32⋅1) 16/18 (88⋅9) 0⋅0001 >16 years (%) 2/54 (3⋅7) 11/16 (68⋅8) 0⋅0001 Non-operative management (%) 15/122 (12⋅29%) 28/62 (45⋅16%) 0⋅0001 Imaging performed 14/15 (93⋅33%) 21/22 (95⋅45%) US performed 13/15 (86⋅67%) 9/22 (40⋅91%) CT performed 1/15 (6⋅67%) 16/22 (72⋅73%) Imaging confirmed 0/15 (0%) 18/22 (81⋅67%) Complicated on imaging 0/15 (0%) 3/22 (13⋅67%) Alternative diagnosis at discharge** (%) 15/15 (100%) 6/28 (9⋅67%) UTI 5 0 Gynecological 1 3 Non-specific abdominal pain 9 3 Length of stay (median) 3 days 4 days 0⋅0001 Negative appendicectomy rate (%) 36/107 (33⋅64%) 0/34 (0%) 0⋅0001 Complicated appendicitis on histopathology 11/107 (10⋅28%) 13/34 (38⋅23%) 0⋅0004 Re-admission rate 2/122 (1⋅64%) 9/62 (14⋅52%) 0⋅0004 Post-operative 1/107 (0⋅93%) 2/34 (5⋅88%) 0⋅1443 Non-operative 1/15 (6⋅67%) 7/28 (25%) 0⋅2261 Conservatively managed appendicitis on discharge 6/22 (27⋅27%) Median time to readmission 7 days 9 days

Background There is a worldwide recruitment and retention crisis in general practice. Workforce planning has identified the need to train more general practitioners as an urgent priority. Exposure of medical students to general practice as part of the formal and hidden curriculum, the use of longitudinal integrated clerkships, and positive experiences and role models in general practice are all thought to be contributing factors to doctors choosing careers in general practice. Aim The aim of this study was to identify career destinations of medical school graduates in a medical school with an 18-week longitudinal integrated clerkship in general practice. Design and setting This study was conducted in a single graduate entry medical school at the University of Limerick, Ireland. Participants Medical school alumni 6–8 years after graduation. Method A survey of graduating cohorts of the medical school from 2011 to 2013 was conducted through email and telephone. Results There were a total of 175 alumni for the period 2011 to 2013. Data was collected on 92% (161/175) through an online survey, follow-up email and telephone interview, and was triangulated with searches of professional registration databases and information from key informants. Between 6 and 8 years after graduation, a total of 43% of alumni were engaged in general practice as a career. Conclusion The reform of the delivery of general practice within medical school curricula should be considered by medical schools, curriculum designers and policy-makers as part of an overall strategy to address the recruitment and retention of general practitioners as part of the global healthcare workforce.

Objective To determine the utility of mild cognitive impairment (MCI) subtypes and number of impaired cognitive domains on initial assessment at predicting progression to dementia in a sample of memory clinic patients over a 20‐year period. Methods A retrospective analysis was conducted of those presenting to a memory clinic with MCI from 1 January 1999 to 31 December 2018 inclusive. Those with MCI were broken down into one of the four subtypes using recommended cut‐off scores on the Cambridge Cognitive Assessment (CAMCOG). Binomial logistic regression analysis was used to determine the utility of MCI subtypes and number of impaired cognitive domains as predictors for dementia. Results Overall 1188 individuals with MCI diagnosis were identified, with 378 (32%) progressing to dementia, with median [range] time to diagnosis of 2 years [1‐8.4]. Six hundred and forty‐nine (55%) were identified as amnestic MCI and 539 (45%) as non‐amnestic MCI. Amnestic MCI was a significant predictor of progression compared to non‐amnestic MCI (OR = 1.85, df = 1, P < .001). Number of cognitive domains impaired was also a significant predictor of progression to dementia (OR = 1.07, df = 1, P = .01) but the single‐/multi‐domain distinction was not (OR = 1.29, df = 1, P = .36). Conclusion This study shows that approximately 32% of those diagnosed with MCI in a memory clinic progressed to dementia, with a median time to progression of 2 years. Those with amnestic MCI are almost twice as likely to progress to dementia than non‐amnestic MCI and that therefore this is a useful distinction. However, the utility of the single‐ and multi‐domain MCI distinction is called into question by our findings.

Background: Contact tracing remains a critical part of controlling the spread of COVID-19. Many countries have developed novel software applications (Apps) in an effort to augment traditional contact tracing methods. Aim: To conduct a national survey of the Irish population to examine barriers and levers to the use of a contact tracing App.Methods: Adult participants were invited to respond via an online survey weblink sent via email and messaging Apps and posted on our university website and on popular social media platforms. Results: A total of 8,088 responses were received, with all 26 counties of the Republic of Ireland represented. 54% of respondents said they would definitely download a contact tracing App, while 30% said they would probably download a contact tracing App. 95% of respondents identified at least one reason for them to download the App, with the most common reasons being the potential for the App to help family members and friends and a sense of responsibility to the wider community. 59% identified at least one reason not to download the App, with the most common reasons being fear that technology companies or the government might use the App technology for greater surveillance after the pandemic.Conclusion: Irish citizens surveyed express high levels of willingness to download a public health-backed App to augment contact tracing. Concerns raised regarding privacy and data security will be critical if the App is to achieve the large-scale adoption and ongoing use required for its effective operation.