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Biomedical subjects

Paul Finucane

Publications and source records attributed to Paul Finucane.

8 recordsLinked to original sources
PubMed2005

Working and training as an intern: a national survey of Irish interns.

The Medical Council of Ireland recently introduced some initiatives to enhance the education and training of interns. These include the development of a generic job description, a logbook to monitor training outcomes and a national network of supervisors to plan and oversee intern training. To get feedback on the impact of these reforms, the Medical Council surveyed all interns with Irish addresses in March 2003. Three hundred (65%) of 461 interns responded. The majority provided positive feedback on many aspects of their education and training, their work environment and professional relationships. However, a majority also reported a lack of protected time for education, a lack of formal educational programmes, insufficient feedback on performance and an unnecessarily stressful work environment. Overall, 61% reported being bullied and 4% had experienced sexual harassment. While feedback on the Irish internship experience is generally positive, further work is necessary to address the problems identified.

Agonistic Behavior↗
PubMed2004

An outreach intervention to implement evidence based practice in residential care: a randomized controlled trial [ISRCTN67855475].

BACKGROUND: The aim of this project was to assess whether outreach visits would improve the implementation of evidence based clinical practice in the area of falls reduction and stroke prevention in a residential care setting. METHODS: Twenty facilities took part in a randomized controlled trial with a seven month follow-up period. Two outreach visits were delivered by a pharmacist. At the first a summary of the relevant evidence was provided and at the second detailed audit information was provided about fall rates, psychotropic drug prescribing and stroke risk reduction practices (BP monitoring, aspirin and warfarin use) for the facility relevant to the physician. The effect of the interventions was determined via pre- and post-intervention case note audit. Outcomes included change in percentage patients at risk of falling who fell in a three month period prior to follow-up and changes in use of psychotropic medications. Chi-square tests, independent samples t-test, and logistic regression were used in the analysis. RESULTS: Data were available from case notes at baseline (n = 897) and seven months follow-up (n = 902), 452 residential care staff were surveyed and 121 physicians were involved with 61 receiving outreach visits. Pre-and post-intervention data were available for 715 participants. There were no differences between the intervention and control groups for the three month fall rate. We were unable to detect statistically significant differences between groups for the psychotropic drug use of the patients before or after the intervention. The exception was significantly greater use of "as required" antipsychotics in the intervention group compared with the control group after the pharmacy intervention (RR = 4.95; 95%CI 1.69-14.50). There was no statistically significant difference between groups for the numbers of patients "at risk of stroke" on aspirin at follow-up. CONCLUSIONS: While the strategy was well received by the physicians involved, there was no change in prescribing patterns. Patient care in residential settings is complex and involves contributions from the patient's physician, family and residential care staff. The project highlights challenges of delivering evidence based care in a setting in which there is a paucity of well controlled trial evidence but where significant health outcomes can be attained.

Accidental Falls↗
PubMed2003

Evidence-based clinical practice in falls prevention: a randomised controlled trial of a falls prevention service.

AIMS: Evidence-based guidelines recommend a range of treatments for falls and injury prevention. We undertook a randomised trial of a falls prevention service to screen for falls risk factors and recommend to GPs an evidenced base prescription for falls prevention. METHODS: All patients who presented with a fall to the Emergency Department at Flinders Medical Centre over a 22-week period were considered for the study. We excluded patients with dementia, resident in high care or those transferred to other hospitals and outside our catchment area. Of those who consented, we randomised patients between usual care or to an intervention consisting of a falls risk assessment and writing of an evidence-based prescription faxed to their GP for action. Patients were followed for six months and uptake of advice and fall rates were monitored. RESULTS: Four hundred and fifty patients presented with a fall-related attendance and of these 261 patients were eligible for inclusion in the trial. Of these 261 patients, 140 consented and were enrolled in the trial. Over the six months patients in the intervention group were more likely to uptake preventative advice (OR=12.3; 95%CI=4.2-35.9). We were unable to show a reduction in falls (OR= 1.7; 95%CI=0.7-4.4). CONCLUSIONS: A patient centered evidence-based approach is feasible and effective in increasing uptake of falls prevention advice. Long term compliance with advice needs further exploration.

Accident Prevention↗
PubMed2002

Is there a problem with the problems in problem-based learning?

OBJECTIVE: To determine the balance between acute and chronic medical problems in the PBL cases at 2 Australian medical schools. METHODS: Analysis of 162 PBL cases. RESULTS: Cases concentrate on acute problems in young people and neglect chronic disease in the old. CONCLUSION: This imbalance may contribute to negative attitudes towards elderly patients and people with chronic disease.

Acute Disease↗
PubMed2001

The new medical curriculum at Flinders University, South Australia: from concept to reality.

After much discussion and planning, Flinders University in Adelaide, South Australia recently introduced a new Graduate-Entry Medical Program (GEMP) which centres on problem-based learning (PBL). We describe the factors that stimulated the development of this new course, discuss its aims and philosophies and provide a brief outline of its structure. Advice and practical help was freely provided by several institutions who had undertaken similarly radical curricular reform and without this, a difficult task would have been much harder. We hope that our experiences will be of interest and help to others who are considering curricular reform.

Journal Article↗
PubMed2001

Clinical problem solving (CPS) as a teaching strategy: a 'dual teacher' approach.

A desire to take a 'problem-solving' approach to clinical teaching, combined with a lack of resources for a 'standard' problem-based learning (PBL) approach prompted the authors to develop a new teaching strategy that builds on the ideas of others and which they call clinical-problem solving (CPS). In this paper, they describe the CPS approach, its perceived strengths and weaknesses, and their experience with it to date. They believe that CPS provides a dynamic learning environment and one that can be adapted to a variety of settings. Perhaps its greatest attribute is its ability to provide a problem-solving approach to learning while requiring far fewer resources than PBL. For example, course material that would have required 300 hours of tutor time in PBL now requires 18 hours of teacher time. CPS also saves on student time and classroom space. The authors consider it to be complementary to, rather than a substitute for, PBL.

Journal Article↗
PubMed1991

Factors affecting physicians' decisions on caring for an incompetent elderly patient: an international study.

OBJECTIVES: To determine what treatment decisions physicians will make when faced with a hypothetical incompetent elderly patient with life-threatening gastrointestinal bleeding and to examine the relative importance of physician characteristics and factors (legal and ethical concerns, hospital costs, level of dementia, patient's age, physician's religion, patient's wishes and family's wishes) in making those decisions. DESIGN: Survey. SETTING: Family practice, medical and geriatrics rounds in academic medical centres and community hospitals in seven countries. PARTICIPANTS: Physicians who regularly cared for incompetent elderly patients. MAIN OUTCOME MEASURES: A self-administered questionnaire describing the elderly patient. Respondents were asked to choose one of four levels of care and to identify the level of importance factors had in making that decision. Older physicians, those less concerned about litigation, those for whom the level of dementia was important and those for whom the patient's age was important were expected to give less aggressive care than the other physicians. MAIN RESULTS: Supportive care was chosen by 8.1% of the respondents, limited therapeutic care by 41.5%, maximum therapeutic care without admission to the intensive care unit (ICU) by 32.2% and maximum care with admission to the ICU by 18.2%. The patient's wishes were reported by 91.0% as being extremely or very important in choosing the treatment. Stepwise logistic regression analysis revealed that the following variables independently predicted the level of treatment: level of dementia, country of residence, duration of practice, legal concerns, patient's age and ethical concerns. These factors were significantly correlated with the physicians' treatment choices (p less than 0.05). CONCLUSIONS: The importance that the physicians placed on the level of dementia was the strongest predictor of the level of care that would be provided. A societal consensus on the influence of cognitive function on the appropriate level of care as well as training of physicians in ethical issues are required.

Adult↗