Showing papers by "Connolly Hospital Blanchardstown published in 2011"

Risk and protective genetic variants in suicidal behaviour: association with SLC1A2, SLC1A3, 5-HTR1B &NTRK2 polymorphisms.

Abstract: Suicidal behaviour is known to aggregate in families. Patients with psychiatric disorders are at higher risk for suicide attempts (SA), however protective and risk genetic variants for suicide appear to be independent of underlying psychiatric disorders. Here we investigate genetic variants in genes important for neurobiological pathways linked to suicidal behaviour and/or associated endophenotypes, for association with SA among patients with co-existing psychiatric illness. Selected gene-gene and gene-environment interactions were also tested. DNA was obtained from bloods of 159 patients (76 suicide attempters and 83 non-attempters), who were profiled for DSM-IV Axis I psychiatric diagnosis. Twenty-eight single nucleotide polymorphisms (SNPs) from 18 candidate genes (COMT, 5-HT2A, 5-HT1A, 5-HTR1B, TPH1, MAO-A, TPH2, DBH, CNR1, BDNF, ABCG1, GABRA5, GABRG2, GABRB2, SLC1A2, SLC1A3, NTRK2, CRHR1) were genotyped. Genotyping was performed by KBioscience. Tests of association between genetic variants and SA were conducted using Chi squared and Armitage Trend tests. Binary logistical regression analyses were performed to evaluate the contribution of individual genetic variants to the prediction of SA, and to examine SNPs for potential gene-gene and gene-environment interactions. Our analysis identified 4 SNPs (rs4755404, rs2269272, rs6296 and rs1659400), which showed evidence of association with SA compared to a non-attempter control group. We provide evidence of a 3-locus gene-gene interaction, and a putative gene-environment interaction, whereby genetic variation at the NTRK2 locus may moderate the risk associated with history of childhood abuse. Preliminary findings suggest that allelic variability in SLC1A2/3, 5-HTR1B and NTRK2 may be relevant to the underlying diathesis for suicidal acts.

Improved Late Survival and Disability After Stroke With Therapeutic Anticoagulation for Atrial Fibrillation A Population Study

Abstract: Background and Purpose—Although therapeutic anticoagulation improves early (within 1 month) outcomes after ischemic stroke in hospital-admitted patients with atrial fibrillation, no information exists on late outcomes in unselected population-based studies, including patients with all stroke (ischemic and hemorrhagic). Methods—We identified patients with atrial fibrillation and stroke in a prospective, population-based study in North Dublin. Clinical characteristics, stroke subtype, stroke severity (National Institutes of Health Stroke Scale), prestroke antithrombotic medication, and International Normalized Ratio (INR) at onset were documented. Modified Rankin Scale (mRS) score was measured before stroke and at 7, 28, and 90 days; 1 year; and 2 years after stroke. Results—One hundred seventy-five patients had atrial fibrillation–associated stroke and medication data at stroke onset (159 ischemic, 16 hemorrhagic); 17% of those with ischemic stroke were anticoagulated before stroke (27 of 159.) On multivar...

Excision and primary closure of pilonidal sinus disease: worthwhile option with an acceptable recurrence rate

Abstract: Background Treatment of pilonidal sinus disease is controversial. Many claim policy of marsupialisation and healing by secondary intention. This is demanding in terms of nursing care and time lost from work.

Subtrochanteric stress fractures in patients on oral bisphosphonate therapy: an emerging problem.

Abstract: The emergence of a new variant of subtrochanteric stress fractures of the femur, affecting patients on oral bisphosphonate therapy, has only recently been described. This fracture is often preceded by pain and distinctive radiographic changes (lateral cortical thickening), and associated with a characteristic fracture pattern (transverse fracture line and medial cortical spike). A retrospective review (2007-2009) was carried out for patients who were taking oral bisphosphonates and who sustained a subtrochanteric fracture after a low velocity injury. Eleven fractures were found in 10 patients matching the inclusion criteria outlined. All were females, and taking bisphosphonates for a mean of 43 years. Five of the 10 patients mentioned prodromal symptoms, for an average of 9.4 months before the fracture. Although all fractures were deemed low velocity, 5 of 11 were even atraumatic. Two patients had previously sustained contralateral subtrochanteric fractures. Plain radiographs of two patients showed lateral cortical thickening on the contralateral unfractured femur; the bisphosphonate therapy was stopped and close surveillance was started. Patients taking oral bisphosphonates may be at risk of a new variant of stress fracture of the proximal femur. Awareness of the symptoms is the key to ensure that appropriate investigations are undertaken.

Interns as teachers of medical students: a pilot programme.

Abstract: In recent years, rising numbers of medical students and an increasingly demanding clinical workload has put pressures on the educational systems for medical students in the hospital. Bedside teaching remains central to education, but tutorial delivery by registrars, tutors and consultants has proven to be increasingly difficult with the greater numbers of students now in the undergraduate system. We have performed a pilot study to determine the feasibility of developing a Junior Tutor Programme, to assist in the delivery of tutorials to undergraduate medical students. This was designed and delivered by interns under the supervision of the academic staff in the Departments of Medicine and Surgery in Connolly Hospital. The programme was evaluated by a questionnaire filled in by the students anonymously. A supervised programme of tutorials delivered by interns is a potentially useful way to ensure delivery of clinical teaching to undergraduate medical students.

Differences in expression of virulence genes amongst invasive and colonizing isolates of meticillin-resistant Staphylococcus aureus

Abstract: The prevalence of meticillin-resistant Staphylococcus aureus (MRSA) is an important global concern in healthcare due to potentially life-threatening infections and difficulties in treatment. The organism can colonize the mucosa, e.g. anterior nares, or cause invasive infections, e.g. bloodstream infections, through the coordinated expression of extracellular and cell-bound virulence factors (Goerke et al., 2000; Novick et al., 1993). The transcription profiles of virulence genes vary in vivo depending on the dynamic interaction between the host environment and the pathogen. Since the dynamic environment may be differentially altered in MRSA carriage compared to infection, the expression of S. aureus virulence genes may also vary. We previously found no significant correlation between the presence of 17 virulence genes and invasiveness of MRSA isolates (O’Donnell et al., 2008) and this nonassociation of specific genes or combinations of genes with invasive isolates is in agreement with other larger studies (Lindsay et al., 2006). The lack of a definitive correlation between invasive S. aureus strains and the carriage of virulence genes suggests that the expression, rather than carriage of virulence determinants in vivo, may mediate pathogenicity.

Prescription chart writing practices in an acute psychiatric unit.

Abstract: Objectives: The survey was designed to evaluate the current prescribing practice of the doctors in our local psychiatric unit against the standards outlined by the National Health Office in the Code of Practice for Healthcare Records Management, and to assess the changes in practice by completing an audit cycle.Method: The survey was carried out in a 27 bed acute psychiatric unit. A single assessor reviewed 51 inpatient drug prescription charts using a standardised data collection form derived from the Code of Practice document. Results were presented to the relevant clinical staff and a repeat survey was conducted a few months afterwards. All data were categorical and the frequencies were computed using SPSS 13.0.Results: A total of 51 medication prescription charts were analysed on each occasion during the period of the study. The information contained on the drug charts were assessed against explicit predefined criteria as per the approved standard. At the initial survey, allergy documentation was absent in 59% of charts, only 18% of charts had generic only prescriptions, 90% of ‘as required’ medication lacked review dates, and only 33% of charts were considered to be reasonably neat. The repeat survey showed improvements in these practices, generic only prescribing increased to 39%, and 55% of charts were considered to be reasonably neat by the assessor.Conclusion: Our study has identified deficiencies in prescribing practices and we have shown improvement in some of these practices at the repeat survey, however, further improvement is required. Given that the non-consultant hospital doctors are mostly involved in prescribing on drug charts, approved standards should be incorporated into the induction programme at the commencement of training in this unit. This standard should be monitored and maintained through the means of regular audits.

Overweight and obesity among older adults on admission to hospital.

Abstract: Poor nutritional status, which includesboth under- a nd over-nutrition, i s associated w it h poor health outcomes. T his cross-sectional study assessed the nutritional status of older patients admitted to an acute geriatric ward of a Dublin hospital. Anthropometric and clinical measurements were made. Thirty patients, mean (sd) age 79 (7) y and body mass index 26.6 (4.7) kg/m2, participated. More patients were overweight (n = 12) or obese (n = 9) than underweight (n= 1) or healthy weight (n = 8) which indicates that this age-group may be part of the Irish obesity epidemic.