Annual Report of the Chief Medical Officer for the year 1999

The general purpose of the Report is: To make a contribution to the debate on issues relevant to the development of public health policy. To describe aspects of the health status of the Irish people by reference to certain indicators of mortality and lifestyle. To identify particular factors which are relevant to the major disease entities affecting the Irish population. To identify a specific theme of particular contemporary relevance to health in Ireland Download the Report here

Report of the Expert Group on Medical Laboratory Technician / Technologist Grades

The Labour Relations Commission (Ref. CC97/566) in May 1997, recommended the establishment of an Expert Group for medical laboratory technicians/technologists as part of a set of proposals to settle their pay claims under the PCW. Download the Report here

Feasibility Study on a Helicopter Emergency Medical Service (HEMS) for the Island of Ireland

A feasibility study on the costs and benefits associated with the introduction of dedicated Helicopter Emergency Medical Service (HEMS) was commissioned by the Department of Health and Children, Dublin and the Department of Health, Social Services and Public Safety, Belfast. The study was commissioned on foot of advice by the Cross Border Working Group on Pre-Hospital Care Working Group, one of the Groups established under the “Good Friday Agreement”. Click here to download PDF

Review of governance and accountability mechanisms in the General Medical Services schemes

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Vom Finanz- zum Wissenschaftsbetrug : Methode, den Irrungen in der medizinischen Literatur beizukommen [From financial to scientific fraud : Methods to detect discrepancies in the medical literature].

Fraud is as old as Mankind. There are an enormous number of historical documents which show the interaction between truth and untruth; therefore it is not really surprising that the prevalence of publication discrepancies is increasing. More surprising is that new cases especially in the medical field generate such a huge astonishment. In financial mathematics a statistical tool for detection of fraud is known which uses the knowledge of Newcomb and Benford regarding the distribution of natural numbers. This distribution is not equal and lower numbers are more likely to be detected compared to higher ones. In this investigation all numbers contained in the blinded abstracts of the 2009 annual meeting of the Swiss Society of Anesthesia and Resuscitation (SGAR) were recorded and analyzed regarding the distribution. A manipulated abstract was also included in the investigation. The χ(2)-test was used to determine statistical differences between expected and observed counts of numbers. There was also a faked abstract integrated in the investigation. A p<0.05 was considered significant. The distribution of the 1,800 numbers in the 77 submitted abstracts followed Benford's law. The manipulated abstract was detected by statistical means (difference in expected versus observed p<0.05). Statistics cannot prove whether the content is true or not but can give some serious hints to look into the details in such conspicuous material. These are the first results of a test for the distribution of numbers presented in medical research.

The Swiss Systemic lupus erythematosus Cohort Study (SSCS) - cross-sectional analysis of clinical characteristics and treatments across different medical disciplines in Switzerland.

OBJECTIVES: To describe disease characteristics and treatment modalities in a multidisciplinary cohort of systemic lupus erythematosus (SLE) patients in Switzerland. METHODS: Cross-sectional analysis of 255 patients included in the Swiss SLE Cohort and coming from centres specialised in Clinical Immunology, Internal Medicine, Nephrology and Rheumatology. Clinical data were collected with a standardised form. Disease activity was assessed using the Safety of Estrogens in Lupus Erythematosus National Assessment-SLE Disease Activity Index (SELENA-SLEDAI), an integer physician's global assessment score (PGA) ranging from 0 (inactive) to 3 (very active disease) and the erythrocyte sedimentation rate (ESR). The relationship between SLE treatment and activity was assessed by propensity score methods using a mixed-effect logistic regression with a random effect on the contributing centre. RESULTS: Of the 255 patients, 82% were women and 82% were of European ancestry. The mean age at enrolment was 44.8 years and the median SLE duration was 5.2 years. Patients from Rheumatology had a significantly later disease onset. Renal disease was reported in 44% of patients. PGA showed active disease in 49% of patients, median SLEDAI was 4 and median ESR was 14 millimetre/first hour. Prescription rates of anti-malarial drugs ranged from 3% by nephrologists to 76% by rheumatologists. Patients regularly using anti-malarial drugs had significantly lower SELENA-SLEDAI scores and ESR values. CONCLUSION: In our cohort, patients in Rheumatology had a significantly later SLE onset than those in Nephrology. Anti-malarial drugs were mostly prescribed by rheumatologists and internists and less frequently by nephrologists, and appeared to be associated with less active SLE.

La violence ou le traumatisme médical dans une consultation pluridisciplinaire spécialisée [Violence our medical trauma in specialized multidisciplinary consultation].

In this article a particular patient/physician relationship is described and analyzed: The described interaction between patient and physician during a consultative investigation by several specialists differs markedly from the common trustful relation between a patient and his family doctor. In this context the term and phenomenon pain is discussed and the necessity for an understandable, patient-oriented presentation of diagnosis and hypotheses considering the patient's individual bio-psycho-social dimension is stressed. Consequences for student education are mentioned.

Recent clinical trials with omapatrilat: new developments.

Omapatrilat belongs to the vasopeptidase inhibitors, ie, drugs that possess the ability to inhibit simultaneously the membrane-bound zinc metalloproteases, angiotensin-converting enzyme (ACE), and the neutral endopeptidase EC 3.4.24.11 (NEP). Omapatrilat was targeted to treat patients with hypertension and congestive heart failure. The preclinical and early clinical studies conducted with omapatrilat were very promising. Indeed, omapatrilat appeared to be a very potent antihypertensive agent with very favorable effects on cardiac function in heart failure patients. In contrast to these early studies, the large clinical trials were more disappointing. The results of the OCTAVE trial confirmed the antihypertensive efficacy of omapatrilat, but at the price of an angioedema rate more than threefold higher than that of an ACE inhibitor in the overall population (2.17% vs 0.68%), and close to fourfold higher in the black population. In OVERTURE, a large randomized control trial in heart failure, angioedema was also more common with omapatrilat, but the incidence was much lower (0.8% with omapatrilat vs 0.5% with enalapril). However, omapatrilat was not convincingly superior to the ACE inhibitor. Because angioedema is probably a class side effect of vasopeptidase inhibitors, the higher incidence of this potentially life-threatening complication with omapatrilat has likely stopped the development of this new class of agents. The future of vasopeptidase inhibitors will depend on the ability to improve the risk/benefit ratio either by developing agents that produce less angioedema, or by defining more precisely a high-risk population that could take advantage of dual ACE/NEP inhibition.

Medical Education in Ireland: A New Direction

These two reports make a series of comprehensive recommendations for the development and reform of medical education Read the Report (PDF, 1.3 mb) Read The Cost of Medical Education in Ireland, commissioned by the Group and undertaken by Indecon Consultants (PDF, 1.5mb)  

Obstetric analgesia and anesthesia in Switzerland in 2007

Introduction: The last twenty years has witnessed important changes in the field of obstetric analgesia and anesthesia. In 2007, we conducted a survey to obtain information regarding the clinical practice of obstetric anesthesia in our country. The main objective was to ascertain whether recent developments in obstetric anesthesia had been adequately implemented into current clinical practice. Methodology: A confidential questionnaire was sent to 391 identified wiss obstetric anesthetists. The questionnaire included 58 questions on 5 main topics: activity and organization of the obstetric unit, practice of labor analgesia, practice of anesthesia for caesarean section, prevention of aspiration syndrome, and pain treatment after cesarean section. Results: The response rate was 80% (311/391). 66% of the surveyed anesthetists worked in intermediate size obstetric units (500-1500 deliveries per year). An anesthetist was on site 24/24 hours in only 53% of the obstetric units. Epidural labor analgesia with low dose local anesthetics combined with opioids was used by 87% but only 30% used patient controlled epidural analgesia (PCEA). Spinal anesthesia was the first choice for elective and urgent cesarean section for 95% of the responders. Adequate prevention of aspiration syndrome was prescribed by 78%. After cesarean section, a multimodal analgesic regimen was prescribed by 74%. Conclusion: When comparing these results with those of the two previous Swiss surveys [1, 2], it clearly appears that Swiss obstetric anesthetists have progressively adapted their practice to current clinical recommendations. But this survey also revealed some insufficiencies: 1. Of the public health system: a. Insufficient number of obstetric anesthetists on site 24 hours/24. b. Lack of budget in some hospitals to purchase PCEA pumps. 2. Of individual medical practice: a. Frequent excessive dosage of hyperbaric bupivacaine during spinal anesthesia for cesarean section. b. Frequent use of cristalloid preload before spinal anesthesia for cesarean section. c. Frequent systematic use of opioids when inducing general anesthesia for cesarean section. d. Fentanyl as the first choice opioid during induction of general anesthesia for severe preeclampsia. In the future, wider and more systematic information campaigns by the mean of the Swiss Association of Obstetric Anesthesia (SAOA) should be able to correct these points.

Assessment of the capacity to consent to treatment in patients admitted to acute medical wards

RAPPORT DE SYNTHÈSE : Introduction: L'évaluation de la capacité de discernement est importante d'un point de vue légal et éthique dans l'activité médicale quotidienne. Dans cette étude, nous avons évalué attentivement la capacité de discernement chez les patients admis dans un service médical aigu en utilisant l'évaluation du personnel médical, le score spécifique de Silberfeld, le MMSE ainsi que l'évaluation du psychiatre. Méthode : Pendant 3 mois, 195 patients admis dans un service de médecine interne d'un hôpital universitaire ont été inclus et leur capacité de discernement a été évaluée durant les premières 72 heures d'admission. Résultats : Sur les 195 patients, 38 furent incapables de discernement manifestement (patients inconscients ou avec des déficits cognitifs sévères) et 14 furent considérés incapables de discernement par le psychiatre (prévalence de l'incapacité de discernement de 26.7%). La corrélation entre l'évaluation du psychiatre et le questionnaire de Silberfeld fut faible (sensibilité 35.7%, spécificité 91.6%). Les cliniciens expérimentés montrèrent une plus haute corrélation (sensibilité 57.1 %, spécificité 96.5%). L'avis partagé par l'assistant, par le chef de clinique et l'infirmière se révéla le meilleur indicateur de l'évaluation psychiatrique (sensibilité 78.6%, spécificité 94.3%). Conclusion : La prévalence de l'incapacité de discernement chez les patients admis dans un service de médecine interne est élevée. Alors que le questionnaire de Silberfeld et le MMSE ne sont pas indiqués pour évaluer la capacité de discernement dans cette étude, l'évaluation par une équipe médicale multidisciplinaire reflète le mieux l'évaluation du psychiatre.

Medical Practitioners Act 2007

Medical Practitioners Act 2007 ACT FOR THE PURPOSE OF BETTER PROTECTING AND INFORMING THE PUBLIC IN ITS DEALINGS WITH MEDICAL PRACTITIONERS AND, FOR THAT PURPOSE, TO INTRODUCE MEASURES, IN ADDITION TO MEASURES PROVIDING FOR THE REGISTRATION AND CONTROL OF MEDICAL PRACTITIONERS, TO BETTER ENSURE THE EDUCATION, TRAINING AND COMPETENCE OF MEDICAL PRACTITIONERS, TO AMEND THE MEMBERSHIP AND FUNCTIONS OF THE MEDICAL COUNCIL, TO INVESTIGATE COMPLAINTS AGAINST MEDICAL PRACTITIONERS AND TO INCREASE THE PUBLIC ACCOUNTABILITY OF THEMEDICAL COUNCIL; Click here to download PDF 266kb

Private Medical Insurance in Ireland

Private Medical Insurance in Ireland On 17 January 2007 The Minister for Health and Children announced that she had appointed a three person group comprising Colm Barrington (chair), Seamus Creedon and Dorothea Dowling (the Group) to carry out a business appraisal of the private medical insurance (PMI) market in Ireland and to report back to her on the subject by 31 March 2007. The Ministerâ?Ts announcement included the following terms of reference for the Group: Click here to download PDF 351kb

Medical Card for Over 70s: Fees payable to General Practitioners (Sullivan Report)

Medical Card for Over 70s: Fees payable to General Practitioners (Sullivan Report) In the context of the Government decision to end the arrangements whereby medical cards are issued automatically, without a means test, to all those aged 70 and over, a new income threshold was set and the Government decided to introduce a new single capitation rate payable in respect of patients aged 70 and over. I was asked to recommend a new rate for consideration by the Minister for Health & Children and the Government. Click here to download PDF 58kb

A Review of the Bio-medical Evidence on Breast, Ovarian and Cervical Cancer

This review aims to provide good quality, up-to-date biomedical evidence of the therapies available to women in Ireland to treat breast, cervical and ovarian cancer. This review summarises evidence from guidelines and high quality studies. It should be noted however that scientific evidence is not infallible, and knowledge in this field is constantly evolving. The evidence summarised in this review presents the current consensus. Download document here   Download summary of report