Connolly Hospital Blanchardstown

About: Connolly Hospital Blanchardstown is a healthcare organization based out in Dublin, Ireland. It is known for research contribution in the topics: Population & Ambulatory blood pressure. The organization has 302 authors who have published 213 publications receiving 3858 citations. The organization is also known as: James Connolly Memorial Hospital.

Spurious HbA1c results in patients with diabetes treated with dapsone

Abstract: Measurement of glycated haemoglobin (HbA1c) has been utilised in assessing long-term control of blood glucose in patients with diabetes, as well as diagnosing diabetes and identifying patients at increased risk of developing diabetes in the future. HbA1c reflects the level of blood glucose to which the erythrocyte has been exposed during its lifespan, and there are a number of clinical situations affecting the erythrocyte life span in which HbA1c values may be spuriously high or low and therefore not reflective of the true level of glucose control. In the present case series, we describe the particulars of three patients with diabetes who had spuriously low HbA1c levels as a result of dapsone usage. Furthermore, we discuss the limitations of HbA1c testing and the mechanisms by which it may be affected by dapsone in particular. Learning points: Various conditions and medications can result in falsely low HbA1c. Dapsone can lead to falsely low HbA1c by inducing haemolysis and by forming methaemoglobin. Capillary glucose measurement, urine glucose measurements and fructosamine levels should be used as alternatives to HbA1c for monitoring glycaemic control if it was falsely low or high. Patient Demographics: Adult, Female, Male, Other, Ireland Clinical Overview: Pancreas, Diabetes, Insulin, Diabetes mellitus type 1, Diabetes mellitus type 2, Anaemia, Haemolysis*, Methemoglobinemia*, Dermatitis herpetiformis*, Coeliac disease*, Hyperglycaemia, Hypoglycaemia, Urticarial rash*, Granuloma Diagnosis and Treatment: Diabetes mellitus type 1, Diabetes mellitus type 2, Haemolysis*, Methemoglobinemia*, Coeliac disease, Dermatitis herpetiformis*, Polydipsia, Polyuria, Weight loss, Hypoglycaemia, Hyperglycaemia, Rash, Anaemia, Haemoglobin A1c, Fructosamine*, Glucose (blood), GADA, Methaemoglobin*, Haptoglobin*, Mean corpuscular volume*, Haemoglobin , Bilirubin, Reticulocyte count*, Lactate dehydrogenase, Antibiotics, Dapsone*, Metformin, Gliclazide, Sulphonylureas, Dapagliflozin, SGLT2 inhibitors, Insulin Publication Details: Unusual effects of medical treatment, September, 2019 Background HbA1c reflects the level of blood glucose to which the erythrocyte has been exposed during its lifespan, and there are a number of clinical situations affecting the erythrocyte life span in which HbA1c values may be spuriously high or low and therefore not reflective of the true level of glucose control. In the present case series, we describe the particulars of three patients with diabetes who had spuriously low HbA1c levels as a result of dapsone usage. Furthermore, we discuss the limitations of HbA1c testing and the mechanisms by which it may be affected by dapsone in particular.

Interarm blood pressure difference in a post-stroke population.

Abstract: An increased interarm systolic blood pressure (SBP) difference of ≥10 mm Hg is associated with increased cardiovascular risk and a difference of ≥15 mm Hg with increased cerebrovascular risk. The stroke population presents a high-risk group for future cardiovascular and cerebrovascular events and therefore estimation of interarm SBP difference as a predictive tool may assist with further secondary stroke prevention. The aim of the study was to determine the prevalence of interarm SBP and diastolic blood pressure difference in a post-stroke population. A comprehensive assessment of secondary risk factors along with blood pressure measurements were taken 6-months' post-ischemic stroke from the Action on Secondary Prevention Interventions and Rehabilitation in Stroke cohort. Descriptive and logistic regression analyses were performed. Odds ratios and 95% confidence intervals are presented. Two hundred thirty-eight (M: F,139:99; mean age, 68.4 years) of 256 patients followed up at 6 months post-stroke had suitable blood pressure readings from both arms. Ninety-six patients (40.3%) had an interarm SBP difference of ≥10 mm Hg and 49 (20.6%) had a difference of ≥15 mm Hg. A history of hypertension, diabetes, smoking, and obesity was not significantly associated with an increased risk of interarm SBP difference. After multivariate logistic analysis, a history of alcohol excess was associated with an increased IASBP ≥15 mm Hg (odds ratio 2.32, 95% confidence interval 1.03–5.22). We have demonstrated that interarm SBP difference is commonly seen in a post stroke population.

Workshops: an important element in medical education

Abstract: Workshops are used in many psychiatric teaching and learning contexts, from undergraduate to continuing professional development. Most psychiatrists have at some time attended a workshop. However, the terms workshop, tutorial and small-group teaching are used indiscriminately. It is therefore important to reflect on what characterises a workshop, the learning theories behind their development and what learning needs workshops best meet. We give an outline of the evidence for workshops in medical education and review the principles governing how to conduct workshops and the use of technology to enhance their delivery. Data collected from an undergraduate psychiatry course delivered in an Irish university are used to illustrate how applying these principles contributes to optimising the use of workshops from both the learners’ and facilitators’ perspective.LEARNING OBJECTIVES• Understand what an educational workshop is• Be able to relate workshops to current approaches in medical education• Appreciate the use of an effective educational workshopDECLARATION OF INTERESTNone.

The nutritional status of older adults on admission to hospital

Abstract: mechanical effects of overnutrition, in combination with the increased prevalence of chronic disease with increasing age, may cause more overnourished older patients to be admitted to hospital than in previous years. A cross-sectional study was performed that aimed to assess the nutritional status and dietary intake of older patients admitted to an acute geriatric ward of a Dublin hospital. A secondary aim was to identify characteristics associated with under- and overnutrition among the patient sample. Thirty patients aged ‡ 65 years who were not on artificial nutritional support, not actively under the care of a clinical nutritionist and not terminally ill were recruited within 72 h of admission. Patients were profiled by the collection of anthropometric, biochemical and clinical data. Dietary assessment commenced within this time and continued for three subsequent consecutive days. When Malnutrition Universal Screening Tool (MUST) (5) classifications of BMI were applied it was found that a greater number of older patients admitted were overweight (n 12) or obese (n 9) than underweight (n 2) or of healthy weight (n 7). When data were analysed by tertiles of BMI, characteristics found to be associated with undernutrition were more frequently seen in the lowest tertile; three of nine patients in the lowest tertile were found to be depressed compared with one of eleven in the highest tertile, while three of nine patients in the lowest tertile were found to be cognitively impaired compared with two of eleven patients in the highest tertile. No correlation was found between BMI and serum albumin (r 0.264, P = 0.166); however, a correlation was found between serum albumin and midupper-arm circumference (r 0.392, P = 0.032) and serum albumin and mid-arm muscle circumference (r 0.506, P = 0.005). Mean energy intake (4092 (SD 1396) kJ/d) did not meet individual energy requirements for the entire sample, while ten patients had intakes of < 50 % of requirements. A greater number of older patients were classified as overnourished than undernourished on admission to hospital. Despite the observation of a well-nourished older patient group, nutritional status may have deteriorated before admission or deteriorated rapidly on admission as a result of poor dietary intake and increased energy requirements, leaving the patient at risk of significant weight loss, undernutrition and ultimately a poorer outcome. This finding is an indicator of the need for nutritional services and nutritional screening for all acute medical services for older adults.