Showing papers by "Connolly Hospital Blanchardstown published in 2015"

Methotrexate use and risk of lung disease in psoriasis, psoriatic arthritis, and inflammatory bowel disease: systematic literature review and meta-analysis of randomised controlled trials.

Abstract: Objective To evaluate the relative risk of pulmonary disease among patients with psoriasis, psoriatic arthritis, and inflammatory bowel disease treated with methotrexate Data sources PubMed, Cochrane central register of controlled trials, and Embase to 9 January 2014 Study selection Double blind randomised controlled trials of methotrexate versus placebo or active comparator agents in adults with psoriatic arthritis, psoriasis, or inflammatory bowel disease Studies with fewer than 50 participants or of less than 12 weeks’ duration were excluded Data synthesis Two investigators independently searched both databases All authors reviewed selected studies We compared relative risk differences using the Mantel-Haenszel random effects method to assess total respiratory adverse events, infectious respiratory adverse events, non-infectious respiratory adverse events, interstitial lung disease, and death Results Seven studies met our inclusion criteria, six with placebo as the comparator Heterogeneity across the studies was not significant (I 2 =0%), allowing combination of trial results 504 respiratory adverse events were documented in 1630 participants Methotrexate was not associated with an increased risk of adverse respiratory events (relative risk 103, 95% confidence interval 090 to 117), respiratory infections (102, 088 to 119), or non-infectious respiratory events (107, 058 to 196) No pulmonary deaths occurred Conclusions Findings suggested that there was no increased risk of lung disease in methotrexate treated patients with non-malignant inflammatory diseases Given the limitations of the study, however, we cannot exclude a small but clinically important risk

Secondary prevention after ischaemic stroke: the ASPIRE-S study

Abstract: Survivors of ischaemic stroke (IS) are at high-risk for future vascular events. Comprehensive information on the adequacy of secondary prevention after IS is lacking despite the knowledge that appropriate secondary prevention improves long-term patient outcomes. ASPIRE-S (Action on Secondary Prevention Interventions and Rehabilitation in Stroke) aimed to prospectively assess secondary prevention in patients 6 months following IS. Consenting patients admitted with IS to three Dublin hospitals were recruited over 1 year, from October 2011. At 6 months post IS a comprehensive assessment was completed, modelled on the EUROASPIRE protocol for evaluation of the adequacy of secondary prevention in post-discharge cardiac patients. This assessment included measurements of blood pressure, body mass index and fasting lipid and glucose profiles. Secondary preventive medications and smoking status were also documented. Three hundred two patients (58 % male) participated, of whom 256 (85 %) were followed-up at 6 months. Mean age was 69 years (range 22–95). At follow-up, 68 % of patients had a BMI >25 kg/m2 and 16.4 % were still smoking. Almost two-thirds (63.4 %) had a blood pressure >140/90 and 23 % had low-density-lipoprotein >2.5 mmol/L. 28 % of diabetic patients had HbA1c ≥7 %. Ninety seven percent of patients were on anti-platelet and/or anticoagulant therapy. Of those with atrial fibrillation, 82 % were anti-coagulated (mean INR of 2.4). Ninety-five percent were on lipid-lowering therapy and three-quarters were on anti-hypertensive therapy. This prospective multi-centre survey of IS patients demonstrated a high prevalence of remaining modifiable risk factors at 6 months post stroke, despite the widespread prescription of secondary preventive medications. There is scope to improve preventive measures after IS (in particular blood pressure) by incorporating evidence-based guidelines into quality assurance cycles in stroke care.

Short-term blood pressure variability over 24 h and target organ damage in middle-aged men and women.

Abstract: Blood pressure variability (BPV) has been associated with cardiovascular events; however, the prognostic significance of short-term BPV remains uncertain. As uncertainty also remains as to which measure of variability most accurately describes short-term BPV, this study explores different indices and investigates their relationship with subclinical target organ damage (TOD). We used data from the Mitchelstown Study, a cross-sectional study of Irish adults aged 47–73 years (n=2047). A subsample (1207) underwent 24-h ambulatory BP monitoring (ABPM). As measures of short-term BPV, we estimated the s.d., weighted s.d. (wSD), coefficient of variation (CV) and average real variability (ARV). TOD was documented by microalbuminuria and electrocardiogram (ECG) left ventricular hypertrophy (LVH). There was no association found between any measure of BPV and LVH in both unadjusted and fully adjusted logistic regression models. Similar analysis found that ARV (24 h, day and night), s.d. (day and night) and wSD were all univariately associated with microalbuminuria and remained associated after adjustment for age, gender, smoking, body mass index (BMI), diabetes and antihypertensive treatment. However, when the models were further adjusted for the mean BP the association did not persist for all indices. Our findings illustrate choosing the appropriate summary measure, which accurately captures that short-term BPV is difficult. Despite discrepancies in values between the different measures, there was no association between any indexes of variability with TOD measures after adjustment for the mean BP.

Night-time blood pressure and target organ damage: a comparative analysis of absolute blood pressure and dipping status

Abstract: Background:The prognostic significance of abnormal circadian blood pressure (BP) patterns is well established Research to date has focused on both nocturnal dipping and absolute night-time BP levels; however, which of these variables should be the primary target for therapy remains unclear The aim

Smoking, attitudes to smoking and provision of smoking cessation advice in two teaching hospitals in Ireland: do smoke-free policies matter?

Abstract: Brief cessation advice from health-care professionals in the hospital setting significantly increases the likelihood of patients quitting smoking, yet patients are not routinely provided with this advice. Smoke-free hospital policies aim to protect individuals from the adverse effects of smoking; however, it is unclear if such policies encourage systematic delivery of cessation advice by health-care professionals. The study's aim was to determine the prevalence of smoking and cessation advice received by in-patients in two teaching hospitals in Ireland which have implemented smoke-free hospital policies, and to examine patient attitudes towards smoking cessation. Change in smoking prevalence and delivery of smoking cessation advice prior to and post-policy implementation was also examined in one hospital. This study surveyed 466 in-patients across 2 hospital sites, over a 3-week and 5-week period, respectively. Data were also compared to a survey completed prior to the implementation of the smoke-free pol...

Prevalence of Mental Disorder among young adults in Ireland: a population based study

Abstract: Background There is a lack of epidemiological research on the mental health of young adults in Ireland. OBJECTIVEs To determine prevalence of psychiatric disorders in a cohort of young Irish adults. METHODS The Challenging Times study was a landmark study of the prevalence of psychiatric disorders in adolescents in North Dublin, Ireland: 212 school children aged 12-15 years were recruited through schools and interviewed using the K-SADS semi-structured diagnostic instrument. This cohort was traced again at age 19-24 years (mean age 20.8 years) and interviewed using SCID I & II. Main outcome measures were current and lifetime Axis I and Axis II psychiatric disorders. RESULTS Follow-up rate was 80%. Using a weighted population prevalence analysis 19.8% of the cohort had a current mental disorder, 56.0% had a lifetime mental disorder of whom 28.4% had mood disorders, 27.1% had anxiety disorders, 22.7% had substance use disorders; 25.4% had lifetime multi-morbidity. Cluster A personality disorders were found in 2.3%. Lifetime prevalence of binge-drinking was 75.0%, cannabis use 65% and 17% of young adults had fulfilled criteria for an alcohol use disorder at sometime in their life. Lifetime prevalence of suicidal thoughts/behaviour was 21.1%. CONCLUSIONS Lifetime prevalence of psychiatric disorder and substance use were high in this sample of young Irish adults. Mental Health service provision for this age group is a priority. Larger studies of nationally representative samples are needed to inform service development.

Virtual colonoscopy, optical colonoscopy, or fecal occult blood testing for colorectal cancer screening: results of a pilot randomized controlled trial

Abstract: No head-to-head randomized controlled trials have demonstrated the superiority of one colorectal screening modality over another in reducing colorectal cancer mortality. We conducted a pilot randomized controlled trial of fecal occult blood testing (FOBT), optical colonoscopy (OC), and virtual colonoscopy (VC), to inform the planning of a larger evaluative trial. Eligible patients (aged 50 to 70) were recruited from five primary care practices in Hamilton, ON, Canada, between March 23, 2010 and August 11, 2010, and randomized 1:1:1 in a parallel design using an automated, centralized telephone service to either FOBT, OC, or VC. To reflect conventional practice, patients received no additional reminders to complete their allocated screening test beyond those received in usual practice. The primary outcome was completion of the assigned screening procedure. Results of the index test and any follow-up investigations were ascertained at 6 months. Participants, caregivers, and outcome assessors were not blinded to group assignment. The trial was stopped early due to lack of ongoing funding. A total of 198 participants were enrolled, of whom 67 were allocated to FOBT, 66 to OC, and 65 to VC. The allocated screening procedure was completed by 43 (64 %) subjects allocated to FOBT (95 % confidence interval [CI], 52–75 %), 53 (80 %) subjects allocated to OC (95 % CI, 69–88 %), and 50 (77 %) subjects allocated to VC (95 % CI, 65–85 %); because the trial stopped early, we had insufficient statistical power to detect clinically relevant differences in completion rates. During 6 months follow-up, colorectal adenomas were detected in 0 (0 %) subjects allocated to FOBT, 12 (18 %) subjects allocated to OC, and 2 (3 %) subjects allocated to VC. One subject in the OC arm had histological evidence of high-grade dysplasia. No subjects were diagnosed with colorectal cancer. In this pilot randomized controlled trial of colorectal cancer screening in a primary care setting, 64–80 % of subjects completed their allocated screening test. These findings may be of value to investigators planning clinical trials to evaluate the effectiveness of colorectal cancer screening. ClinicalTrials.gov NCT00865527. https://clinicaltrials.gov/ct2/show/NCT00865527

A review of the diagnosis and management of hyponatremia in connolly hospital: an audit of current practice and the construction of a clinical aid for the diagnosis and treatment of Hyponatremia

Abstract: Background Hyponatraemia is the most common example of body fluid and electrolyte imbalance encountered in clinical practice, and is associated with increased mortality, morbidity and length of hospital stay in patients [1]. In spite of this, the diagnosis and management of hyponatremia remains inconsistent as clinicians adopt a broad range of hospitaland specialty-specific approaches [1, 2]. In light of this observed inconsistency, the objectives of the present project were: (i) To audit all patients admitted to Connolly Hospital Blanchardstown (CHB) Emergency Department (ED) with hyponatremia (<135 mmol/L) over a 14 day period. (ii) Record the diagnostic and management methods employed, comparing them with recent guidelines published by the European Society of Endocrinology (ESE). (iii) To construct a clinical aid for the diagnosis and treatment of hyponatremia, specific to CHB.

57 Novel roles for dietary nitrate in non ischaemic dilated cardiomyopathy and resistant hypertension

Abstract: Introduction Non ischaemic dilated cardiomyopathy (NIDCM) and resistant hypertension (HTN) are common, chronic diseases. Blood nitrate/nitrite indicate nitric oxide (NO) bioavailability and levels are typically lower in NIDCM and HTN compared to controls indicating perturbed nitric oxide (NO) metabolism. In addition to the well-characterised L-arginine-NO synthase pathway, a second independent pathway for NO synthesis in vivo has been recently discovered whereby dietary nitrate is reduced to nitrite and consequently NO. Exploitation of this pathway represents a promising strategy for increasing NO bioavailability, with possible physiological benefits. Methods To assess effects in HTN, 19 eligible subjects wore an ambulatory blood pressure (BP) monitor (ABPM) for 24 h and fasting blood was taken before and after 14 d of nitrate-rich beetroot juice (BRJ). To assess effects in NIDCM, we recorded exercise capacity (incremental shuttle walk test) and BP before and 3 h after both BRJ and placebo in a randomised, double-blind, crossover trial among 11 subjects. There was 7 d between testing days with the alternate beverage. Results In the HTN study, 11 subjects had controlled blood pressure while 8 had uncontrolled blood pressure. There were similar increases in serum nitrate (p = 0.01) and nitrite (p = 0.001) in both controlled and uncontrolled hypertension. Further, there were no differences in either group regarding serum lipids (triglycerides, total cholesterol, LDL cholesterol, HDL cholesterol). We observed very little chance in BP variables among the controlled hypertensives. In contrast, there were reductions in 24 h, daytime, and nighttime BP as well an increase in nocturnal BP dipping. The decreases in mean nighttime DBP and ambulatory arterial stiffness index (AASI) reached significance (p = 0.03 and p = 0.05 respectively). In the NIDCM trial, there were no significant differences in heart rate, arterial oxygen concentrations, breathlessness, leg fatigue or blood pressure at any time point with either beverage. However, NIDCM subjects walked significantly when took BRJ (+65 m) than when they took PL (-5 m) (p = 0.006). Conclusions Dietary nitrate has potential as a novel therapeutic, adjunct strategy to increase NO bioavailability in cardiovascular disease with potential physiological benefits. Our preliminary results require confirmation in larger trials. However, considering the low cost and safety profile of dietary nitrate containing foods and supplements, this concept appears promising as an adjunct therapeutic strategy for cardiovascular diseases.

THU0635-HPR Do Physiotherapists Working in New Patient Rheumatology Clinics Miss Inflammatory Arthritis: A Retrospective Review of 296 Patients

Abstract: Background Physiotherapists working in triage roles are well established in orthopaedic and spinal clinics, but there is less literature available on their role in rheumatology. We have shown previously that a physiotherapist can diagnose inflammatory arthritis with an accuracy of 89% (Kirwan and Duffy, 2014). Objectives This audit set out to ascertain whether a physiotherapist working in a rheumatology new patient clinic, as a first point of contact clinician, misses inflammatory arthritis. Methods Data was collected consecutively on all patients assessed by the Physiotherapist at the Rheumatology New Patient Clinic from December 2010 to June 2014. Patients who were diagnosed with an inflammatory condition were omitted from this review. The remaining patients were given non-inflammatory diagnoses. Medical charts were reviewed to establish whether any of these patients subsequently developed an inflammatory arthritis. Results A total of 294 patients were assessed over the time period. 233 patients were diagnosed with a non-inflammatory condition. Seven charts were unavailable at time of review. Of the 226 charts reviewed, none of these patients had developed an inflammatory arthritis . This review did not set out to establish if this group had resolution of their presenting complaint but instead focused on whether any patients presenting with non-inflammatory symptoms were misdiagnosed by the Physiotherapist. Over a 3 and a half year period and upon completing assessments on 294 patients, our previous study (Kirwan and Duffy, 2014) revealed the Physiotherapist displayed high accuracy when diagnosing inflammatory joint disease. This review highlighted that the Physiotherapist did not miss inflammatory arthritis upon assessment and diagnosis of 226 patients with non-inflammatory conditions. Conclusions This study highlights the high number of non-inflammatory conditions (79%) seen in a new patient rheumatology clinic. Patients presented with a wide spectrum of symptoms indicating a range of clinical assessments skills are required. The data indicate that a physiotherapist with specialist training in rheumatology does not miss inflammatory arthritis, and can safely and effectively assess inflammatory (Kirwan and Duffy, 2014) and non-inflammatory conditions, while working in a new patient rheumatology clinic. The findings from this review confirm the value, and benefit, in having a physiotherapist present in rheumatology new patient clinics, to assist in diagnosing and managing the large number of mechanical/degenerative conditions seen. References Kirwan P, Duffy T. Physiotherapist9s accuracy in recognizing and diagnosing inflammatory joint disease while working in a new patient rheumatology clinic. (Abstract). In: Ann Rheum Dis 2014;73(Suppl2); 2014 Jun 11-14; Paris, France. Disclosure of Interest None declared