3 Million funding to enhance primary care delivery

in Ireland
19 March 2015
Safer use of medicines, improved diagnosis, and more effective delivery
of primary care will result from a new 3 million award from the Health
Research Board (HRB) to the HRB Centre for Primary Care Research
(CPCR), based at RCSI's (Royal College of Surgeons in Ireland)
Department of General Practice.
This award will be used to build on the significant progress the CPCR has
already made in advancing the capacity and infrastructure for primary care
research in Ireland. This new phase of funding will see the centre focus on
areas such a Clinical Decision Support Systems, Clinical Prediction Rules and
multimorbidity; topics that are of national and international importance for both
policy and practice.
The research programme will be undertaken with national and international
partners where additional grant funding has been secured from two pan-
European grants, namely TRANSFoRm, a study that focuses on patient
safety in primary care, and ALICE, a study that examines the use of antivirals
for influenza like illness.
Announcing the funding, Graham Love, Chief Executive at the HRB said
Effective primary care means better outcomes for patients and less pressure
on acute services. To be effective, it must be informed by research. This 3
million investment by the HRB underlines the importance being put on primary
care interventions nationally'.
Professor Tom Fahey, Professor of General Practice, HRB Centre for Primary
Care Research, Department of General Practice, RCSI added Our
programme of primary care research is already having a great impact to
improve primary care, and primary care research, in Ireland. To date we have
created an international register of over 400 clinical prediction rules that help
GPs to better diagnose patients and we have collaborated on the
development of an infrastructure for GP's and their patients to contribute to
research projects in real time. We have also identified and pilot tested an
intervention to reduce potentially inappropriate prescribing at the point of
patient care which could save several million euros on our prescription bills'.
Details of current and past work and projects of the Centre for Primary Care
Research can be viewed online at www.hrbcentreprimarycare.ie.
RCSI is among the top 50 most international universities in the world (Times
Higher Education University World Rankings, 2014-15). It is a not-for-profit
health sciences institute which focuses on education and research to drive
positive change in all areas of human health worldwide. RCSI is
headquartered in Dublin and is a recognised College of the National
University of Ireland. In 2010, RCSI was granted independent degree
awarding status by the State, which enables the College to award degrees
alongside its traditional powers to award licentiates.
The Health Research Board (HRB) is Ireland's lead agency supporting and
funding health research. It aims to improve people's health, patient care and
health service delivery by leading and supporting research, generating new
knowledge and promoting the use of evidence in policy and practice. To date,
the HRB has supported a wide range of research which has played a key role
in driving innovation in the Irish health system and supporting economic
development.

The National Clinical Effectiveness

Committee (NCEC) is a ministerially appointed
committee made up of representatives from
various interested parties from healthcare in
Ireland and provides a framework for developing
clinical guidelines and audit. Through the NCEC,
the Minister for Health in Ireland approves clinical
guidelines and clinical audits as National Clinical
Guidelines and National Clinical Audits. These are
then implemented in the public healthcare system
by the Health Service Executive (HSE).
National Clinical Guidelines aim to provide
guidance and standards for improving the quality,
safety and cost-effectiveness of healthcare in
Ireland. They aim to promote healthcare that is
current, effective and consistent, ensuring best
outcomes for patients and people using services.
To achieve this, they must be based on the best
available scientific evidence of clinical benefits,
cost-effectiveness, and they must consider the
budget impact of their implementation.
The Health Research Board (HRB) is funding the
Collaboration in Ireland for Clinical Effectiveness
Reviews (CICER), which is hosted by HIQA.
Following a competitive process, HIQA has been
awarded research funding spanning the five-year
period from 2017 to 2022 to produce the evidence
to support the development of national clinical
guidelines.
The role of the HRB-CICER team is to
independently review evidence and provide
scientific support for the development, by guideline
development groups, of the National Clinical
Guidelines. The HRB-CICER team comprises a
dedicated multidisciplinary research team
supported by staff from the Health Technology
Assessment (HTA) team in HIQA and the HRB
Centre for Primary Care Research at the Royal
College of Surgeons in Ireland (RCSI), as well as
national and international clinical and
methodological experts.
The HRB-CICER team undertakes systematic
reviews of the clinical effectiveness and cost-
effectiveness of interventions included in the
guidelines as well as estimating the budget impact
of implementing the guidelines. The HRB-CICER
team works closely with the guideline development
groups to ensure that its work informs the
development of evidence-based recommendations
within the National Clinical Guidelines.
https://www.hiqa.ie/areas-we-work/clinical-guideline-support

Centre Aims and Objectives

Address: Beaux Lane House, Mercer Street Lower, Dublin 2
(Map) Tel: +00 353-1-4022473 Email:Contact
The HRB Centre for Primary Care Research (CPCR) was
established in 2008 and is funded by the Health Research
Board (HRB) in Ireland. The CPCR is a national centre for
research in primary care in Ireland, led by the Royal College of
Surgeons in Ireland, in collaboration with Trinity College
Dublin, Queens University Belfast and more recently the
National University of Ireland, Galway. Phase I of the CPCR
(2008-2015) aims to establish standards for the quality of care
of vulnerable patient groups, including older adults, children,
drug users and pregnant women, with a particular emphasis
on effective medicine monitoring. The educational and
research programme comprises three related work packages
(Phase 1).
The CPCR is now entering Phase II of funding (2015-2019)
and the overall aim of this phase is to build on our initial
programme of research to enhance patient safety in terms of
prescribing, diagnostic and therapeutic approaches to the care
of patients utilizing information and communication
technology (ICT). A greater emphasis to improve medicine
management in primary care is a priority (Work package 1),
and this will be carried out through further development and
evaluation of ICT interventions in the form of computer-based
support systems (CDSSs) that enhance medicine management
for acute and chronic illness. Work package 2 builds on the
work already completed relating to Clinical Prediction Rules
(CPRs) in primary care, with a particular focus on evaluating
the impact of implementing CPRs at point-of-care utilizing the
Electronic Health Record (EHR). Effective care delivery is the
focus of Work package 3. The aim is to build on our previous
observational work in patients with multimorbidity and
exploring variation in prescribing in chronic conditions.
Impact analysis studies of clinical prediction rules relevant
to primary care- a systematic review
http://bmjopen.bmj.com/content/bmjopen/6/3/e009957.full.p
df

Inaugural collaborators and funders meeting of the

Irish Primary Care Research Network (iPCRN)
14 September 2012
Members of RCSI's HRB Centre for Primary Care Research, Irish College
of General Practitioners (ICGP), Health Research Board (HRB), General
Practice Information and Technology group (GPIT) and NUI Galway at
the Inaugural collaborators and funders meeting of the Irish Primary
Care Research Network (iPCRN) with Professor Mike Pringle (front
centre), Emeritus Professor of General Practice, University of
Nottingham & President Elect, Royal College of General Practitioners on
Friday September 7th. The iPCRN aims to establish a national network
of GP practices to participate in clinical research.

Pictured in the front row (l-r) are Professor Tom Fahey and Dr. Rose Galvin,
HRB Centre for Primary Care Research, Professor Mike Pringle, Emeritus
Professor of General Practice, University of Nottingham & President Elect,
Royal College of General Practitioners, Donna Tedstone Doherty Programme
Manager, HRB. Pictured in the second row (l-r) are Dr. Liam Glynn NUIG, Dr.
Fiona Boland HRB Centre for Primary Care Research, Dr. Claire Collins
ICGP, Professor Susan Smith HRB Centre for Primary Care Research, Kieran
Ryan CEO ICGP. Pictured in the back row are Dr. Joe Gallagher GP, Brian O'
Mahoney General Practice Information and Technology group, Professor
Andrew Murphy NUIG.
Professor Tom Fahey, Royal College of Surgeons in Ireland

http://hrbcentreprimarycare.ie/images/SAPC%20ASM
%202016%20flyer%201.pdf

RCSI study finds many over the counter cough

medicines have limited effectiveness in treating
29 January 2015
A study carried out by researchers at RCSI (Royal College of Surgeons
in Ireland) has found that there is no substantial evidence that over-the-
counter medicines are effective in treating short-term coughs in children
and adults. The research which was carried out by the Health Research
Board (HRB) Centre for Primary Care Research, Department of General
Practice, RCSI has been published in The Cochrane Library.
A short term (acute) cough is a common and troublesome symptom in
children and adults suffering from upper respiratory tract infection (URTI)
caused by a cold. Many people self-prescribe over-the-counter (OTC) cough
preparations, and health practitioners often recommend their use for the initial
treatment of cough.
Data from 29 trials involving 4835 adults and children with acute coughs was
examined to determine the effectiveness of various types of over-the-counter
(OTC) medications used at different dosages when compared with a placebo.
The majority of the trials of adult medications, (which compared antitussives,
the expectorant guaifenesin, antihistamines and antihistamine-decongestant
combinations with placebo) showed either no benefit or variable results. The
majority of the child studies (which included antitussives, antihistamines,
antihistamine-decongestants and antitussive/bronchodilator combinations)
found that the medications were no more effective than placebo. A limited
number of trials showed benefits including a trial in both children and adults
which favoured active treatment with mucolytics over placebo and a trial in
children indicated that natural honey was more effective than placebo over a
three-day period.
The research found no solid evidence for or against the effectiveness of OTC
medications in acute cough. Furthermore, 19 studies reported infrequent
adverse effects of these medications which were mainly minor side effects
such as nausea, vomiting, headache and drowsiness.
Lead author on the study Professor Susan Smith, Associate Professor, HRB
Centre for Primary Care Research in the RCSI Department of General
Practice said: "There is a high prevalence of coughs and colds at this time of
year and patients often buy over the counter medications to alleviate their
symptoms. However, our study has found little evidence to support
expenditure on these over the counter medications for coughs and some of
these medicines can occasionally result in adverse side-effects. Simple
remedies such as honey and lemon can provide effective relief for coughs at a
lower cost than over-the-counter medicines. However, parents should note
that honey should not be given to children under the age of one. We
recommend that patients talk to their pharmacist or GP for advice on low-cost
safe treatments for coughs that can be prepared at home."
Graham Love, Chief Executive at the Health Research Board added:
"Research like this helps people and doctors to make sound, evidence-based
decisions about healthcare choices."
Professor Smith's co-authors on the study are Dr Knut Schroeder Academic
Unit of Primary Health Care, Department of Community Based Medicine at
the University of Bristol, UK and colleague Professor Tom Fahey, Professor of
General Practice, HRB Centre for Primary Care Research, Department of
General Practice, RCSI.
RCSI is a not-for-profit health sciences organisation that focuses on education
and research to drive positive change in all areas of human health, worldwide.
RCSI is headquartered in Dublin and is a recognised College of the National
University of Ireland. In 2010, RCSI was granted independent degree-
awarding status by the State, which enables the College to award degrees
alongside its traditional powers to award licentiates.
The Health Research Board (HRB) is Ireland's lead agency supporting and
funding health research. It aims to improve people's health, patient care and
health service delivery by leading and supporting research, generating new
knowledge and promoting the use of evidence in policy and practice. To date,
the HRB has supported a wide range of research which has played a key role
in driving innovation in the Irish health system and supporting economic
development.

Antidepressant prescribing in Irish children- secular trends

and international comparison in the context of a safety
warning
http://download.springer.com/static/pdf/363/art
%253A10.1186%252Fs12887-015-0436-2.pdf?originUrl=http
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d4e7376a0960c542c00325b247
Apple Watch & ResearchKit epilepsy
study concludes, gleans insight on seizure
triggers
By Mike Wuerthele
Wednesday, February 22, 2017, 08:52 am PT (11:52 am ET)
A research study on epilepsy with the Apple Watch and
ResearchKit at the core of the work has concluded, and is
shedding light on seizure triggers, hopefully paving the way for
better identification of precursors of the disruptive and dangerous
event.

Over the course of the 10-month survey, participants

tracked their seizures with an app custom built for the
study. When participants felt a "aura" for the seizure
building, they opened up the app, with then
commanded the Apple Watch to record heart rate
sensor and accelerometer data from the Apple Watch,
plus gyroscope data from the iPhone for 10 minutes.

During the 10 minutes, the app promoted users to

respond for reflex and awareness testing. Following
conclusion of the seizure, study participants were
surveyed about seizure type, aura, loss of awareness
and possible seizure triggers.

Nearly 1500 seizures were recorded during the testing

process.

Stress was linked to 37% of the seizure activity, with

sleep deprivation accounting for 18%, menstruation
for 12%, and over-exertion for 11%. Other notable
triggers included diet, missed medications and fever
or infection.

Defying conventional wisdom on epilepsy, seizure

triggers did not depend on the type of seizure the
participants reported.

"The data collected will help researchers better

understand epilepsy, while helping people with
epilepsy keep a more complete history of their
seizures," said study author Gregory Krauss, MD. "The
app also provides helpful tracking of seizures,
prescription medication use and drug side effects
activities that are important in helping people manage
their condition."

"Our eventual goal is to be able to use wearable

technology to predict an oncoming seizure," added
Krauss. "This could potentially save lives as well as
give people with epilepsy more freedom. The data
collected in this study helps us take a step in that
direction."
The study was originally announced in 2015, in
conjunction with Johns Hopkins University and
developer Thread Research. It launched in Sept. 2015,
with 598 people ultimately coming on board with the
study.

The full study will be published presented at the

American Academy of Neurology's 69th Annual
Meeting in Boston, April 22 to 28, 2017. AppleInsider
has requested a copy of the research following its
publication for further examination.

ResearchKit was introduced in March 2015 as an iOS-

based tool with which medical researchers can expand
candidate pools and achieve more accurate results.
One of the first integrations, a cardiovascular study
conducted by Stanford University, saw more than
10,000 participants sign up less than 24 hours after its
debut, a feat that would have taken a year under
normal circumstances.
http://appleinsider.com/articles/17/02/22/apple-watch-
researchkit-epilepsy-study-concludes-gleans-insight-on-
seizure-triggers