Showing papers in "Irish Journal of Medical Science in 2006"

Depression and anxiety in rheumatoid arthritis: the role of perceived social support.

Abstract: Rheumatoid arthritis is a common, disabling, autoimmune disease with significant psychiatric sequelae. We aimed to identify the prevalence of depression and anxiety in patients with rheumatoid arthritis attending hospitals, and to elucidate the role played by illness variables, disability variables and psychosocial variables in predicting levels of depression and anxiety. We assessed depression, anxiety, arthritis-related pain, arthritis-related disability and perceived social support in 68 adults with rheumatoid arthritis. Sixty-five per cent of patients had evidence of depression (37.5% moderate or severe) and 44.4% had evidence of anxiety (17.8% moderate or severe). Both depression and anxiety were highly correlated with several measures of arthritis-related pain and functional impairment. After controlling for age, gender, marital status and duration of arthritis, perceived social support was a highly significant independent predictor of both depression and anxiety. These findings suggest that increasing social support may be particularly important in the management of depression and anxiety in rheumatoid arthritis.

Validation of a point of care lipid analyser using a hospital based reference laboratory.

Abstract: Lipid measurements are essential in cardiovascular disease management in primary care. However, utilizing hospital laboratories may result in excess patient travel, sample loss and repeat clinic visits. Point of care (POC) lipid measurement would overcome these difficulties but has not been validated in an Irish setting. To compare POC lipid profile measurements using a cholestech LDX analyser with a hospital reference laboratory (Lab). One-hundred subjects (30 men, 70 women) participated. Finger prick and venous samples were analysed directly by Cholestech LDX and the Lab. A broad range of lipid values were measured. Absolute differences between POC and Lab measurements were insignificant except for a small over-estimation by the POC method of triglyceride 0.25mmol/l (95% CI 0.17 to 0.24), and an underestimation of HDLc — 0.11mmol/l (95% CI −0.143 to −0.078). There were significant correlations between POC and Lab. levels; total cholesterol r=0.92, triglyceride r=0.93, HDLc r=0.92 and LDLc r=0.86 (all p< 0.0001). These results validate the use of the Cholestech LDX® analyser for point of care lipid measurements in clinical practice, provided well trained operators are supported by a hospital laboratory delivering quality assurance support.

Iodine intake in pregnancy in Ireland--a cause for concern?

Abstract: Adequate dietary iodine intake is necessary to maintain maternal thyroid function at a level permitting normal neuropsychological development of the foetus. To determine dietary iodine status by measuring urinary iodine excretion (UIE), proportional to dietary intake, in Irish mothers during the first trimester of pregnancy. Median UIE showed seasonal variations, being lower in summer than in winter. The median values in pregnant women were, summer 45μg/l, winter 68μg/l. Equivalent values for controls were 43 and 91μg/l respectively UIE required to achieve WHO recommended daily iodine intakes would be 120–180μg/l. In the Irish subjects UIE values suggestive of iodine deficiency (<50μg/l) were observed in 55% of pregnant women tested in summer and 23% in winter. Dairy milk iodine, a major dietary iodine source, showed similar variation. While there is as yet no available evidence of widespread thyroid hypofunction in the Irish obstetric population, the findings are a cause of concern, which if confirmed by a more comprehensive investigation, may indicate the need for iodine prophylaxis.

Primary abdominal wall clear cell carcinoma arising in a Caesarean section scar endometriosis.

Abstract: Endometriosis occurring in a surgical scar is well recognized and occurs mainly in patients with a history of hysterectomy or Caesarean section. Scar endometriosis, as well as endometriosis at other sites, can undergo malignant change. Endometrioid carcinoma is the most common malignant tumour arising in endometriosis. However, clear cell carcinoma can also occur but is unusual. To discuss the diagnosis and management of such a case. We report a case of primary clear cell carcinoma in endometriosis of a Caesarean section scar and review the literature. The patient presented with a large right lower quadrant abdominal wall mass within a Caesarean section scar. Histological examination revealed a clear cell carcinoma. The patient had a prior history of pelvic endometriosis. According to the Irish National Cancer Registry, this is the first reported case of a primary abdominal wall clear cell carcinoma developing within a Caesarean section scar in Ireland. Any lesion occurring in a Caesarean section scar with a history of previous endometriosis cannot be underestimated and warrants careful clinical follow-up and histological evaluation as appropriate.

The financial implications of falls in older people for an acute hospital

Abstract: Falls are a common occurrence in older people and frequently lead to hospital admission. There is a current lack of cohesive fall prevention strategies in the Republic of Ireland. To demonstrate the cost of fall-related admissions to an acute hospital. A review of Hospital Inpatient Enquiry (HIPE) data and medical case notes was performed for all fall-related admissions over a one-year period. The cost of fall-related admissions was calculated. In addition a detailed cost analysis was performed to determine the true cost of a hip fracture admission. There were 810 fall-related admissions, resulting in 8,300 acute bed days, and 6,220 rehabilitation bed days, costing €10.3 million. Fall-related readmissions resulted in 650 bed-days, bringing the total cost to €10.8 million. A typical hip fracture incident admission episode costs €14,300. Fall-related admissions of older people are a significant financial burden to the health service.

Prevalence of anaemia in patients with diabetes mellitus

Abstract: Anaemia is an increasingly recognised entity in patients with diabetes mellitus. We aimed to determine the prevalence of anaemia in our population of patients with diabetes, and to examine the factors associated with anaemia. The haemoglobin (Hb) levels in a consecutive series of patients attending for annual review of their diabetes over a three-month period were measured. Patients were classified as anaemic as per the WHO criteria. During the period of study, 270 patients attended for review. Eleven per cent of males and 16% of females were anaemic. Seventy four per cent of anaemic patients had a serum creatinine 60ml/min. Anaemia was relatively common in patients attending for routine out-patient diabetes clinic review. The high prevalence of anaemia supports the routine screening for anaemia in the diabetes out-patient clinic, including in those without overt nephropathy.

The need for a national strategy for chronic pain management in Ireland

Abstract: Chronic pain is defined as pain on a daily basis for more than six months.1 It affects 13% of the Irish population.2 Despite its prevalence and the impact on patient’s quality of life there is no national strategy for this problem. To determine the need for a national strategy for chronic pain in Ireland. The cost of low back pain (LBP) (common chronic pain condition), the level of education and research and current chronic pain clinic resources were investigated. The cost of LBP in Ireland is enormous: disability payments from the Department of Social and Family Affairs amounted to €348 million and insurance payments cost €10.5 million.The number of teaching hours timetabled for pain education in the schools of Medicine, Physiotherapy Dentistry, Nursing and Psychology in Ireland’s six universities varied significantly (e.g. 11.5-72 hrs in nursing). Research grants awarded from state organisations were limited to one over a four-year period. No current chronic pain clinics comply with recommended International Association for the Study of Pain (IASP) guidelines.3 A national strategy is needed to reduce costs, standardise teaching and increase pain clinic resources to maximise patient care.

Trends in RTA related spinal injuries: the post penalty points era

Abstract: Background On October 31st 2002 a system of cumulative penalty points for road traffic offences was introduced. Early evidence suggested a reduction in road traffic accident (RTA) related morbidity.

Vitamin D intake and status in Irish elderly women and adolescent girls.

Abstract: Aim To assess vitamin D status during summer and winter in Irish girls and elderly women, and to estimate vitamin D intake in these two age-groups.

Co-immunotherapy with interleukin-2 and taurolidine for progressive metastatic melanoma.

Abstract: Recombinant interleukin-2(rIL-2) therapy in metastatic melanoma is limited by toxicities, particularly vascular leak syndrome(VLS). Taurolidine potentiates the anti-neoplastic effects of IL-2 while reducing its associated endothelial cell dysfunction in experimental settings. We hypothesized that co-administration of rIL-2 with taurolidine could enhance tolerability without weakening effectiveness. Eleven patients with progressive metastatic melanoma received high-dose rIL-2 with co-infusion of taurolidine. Patients were monitored for the development of toxicities and evidence of response. Ten patients tolerated twenty-nine courses of high-dose rIL-2 without dose-reduction. Most toxicities were low-grade. No patient developed VLS. Seven patients died from disease progression. Two had complete clinical and radiological responses to treatment. Two patients remain alive despite evidence of disease progression a mean of 175 months after diagnosing metastatic disease. Co-administration of taurolidine with high-dose rIL-2 in stage IV melanoma patients appears to greatly enhance the tolerability of this regime without diminishing its therapeutic value.

Regional variation in prescribing for chronic conditions among an elderly population using a pharmacy claims database

Abstract: Background Age, gender and geographical regions are recognised factors in inequalities in prescribing for chronic diseases in the elderly.

Smoking, occupancy and staffing levels in a selection of Dublin pubs pre and post a national smoking ban, lessons for all.

Abstract: On the 29th March 2004 the Irish government introduced a comprehensive workplace smoking ban to protect the health of workers. This study evaluates the impact the ban had on staffing levels, customer numbers and smoking rates in a sample of 38 public houses in Dublin. A total of 38 public houses were visited prior to the introduction of the ban, each visit lasted at least three hours, and the number of staff, customers and the number of people smoking was recorded each hour. Follow-up visits were conducted exactly one year later, on the same day of the week and at the same time of day, allowing controlling for seasonal and weekday effects. There was a decrease (8.82%) in average staff levels while customer numbers increased by 11% and there was a dramatic reduction in numbers smoking on a visit to a pub (77.8%). The hospitality industry predicted major job losses as a consequence of the introduction of the smoking ban; this work has shown that there was no significant decrease in the number of staff employed or in customer numbers. There was full compliance, with no customers smoking inside the public houses following the introduction of the ban. The ban has been good for the industry, staff, and customers.

Aorto-enteric fistula: changing management strategies.

Abstract: Background Traditionally treatment of aorto-enteric fistulae involved placement of an extra-anatomic bypass and graft excision. This is associated with limb loss (10–40%) and high mortality (10–70%). More recentlyin situ revascularisation has been advocated.

Poor awareness of colorectal cancer symptoms; a preventable cause of emergency and late stage presentation.

Abstract: To assess knowledge of colorectai cancer (CRC) symptoms among outpatient attendees, and to review disease stage, presentation and duration of symptoms in patients diagnosed with CRC. A questionnaire survey was used to evaluate knowledge of symptoms of CRC and other malignancies. A review of patients diagnosed with CRC during a two-year period was performed. Of 350 survey participants 26.6% could name a CRC symptom, compared to 53.4% for lung cancer and 71.5% for breast cancer. Of 102 patients diagnosed with CRC 3.9% had Dukes A disease, 324% had Dukes B, 39.2% had Dukes C and 24.5% had distant metastases. Forty per cent of patients presented acutely.The mean duration of symptoms was 24 weeks. Knowledge of CRC symptoms is poor and is reflected in the percentage of late stage and emergency presentations. Increasing public awareness of CRC may lead to earlier presentation and improved survival.

Pack-size legislation reduces severity of paracetamol overdoses in Ireland

Abstract: Background Legislation was introduced in Ireland in October 2001 to control the sale of paracetamol in non-pharmacy outlets. Preparations are now limited to 12 tablets per pack and only one pack can be sold per transaction.

Coracoid impingement syndrome: a treatable cause of anterior shoulder pain.

Abstract: Coracoid Impingement Syndrome is a relatively uncommon but generally treatable cause of anterior shoulder pain that can be easily overlooked. It typically presents with anterior shoulder joint pain in activities involving forward flexion, adduction and internal rotation. To assess the outcome of a cohort of patients diagnosed with Coracoid Impingement Syndrome. Patients were investigated clinically and radiologically. They received appropriate therapeutic measures and were followed-up in an orthopaedic outpatient setting. Twelve patients were identified over a four-year period. All patients have made good progress. Thus far, none have needed operative intervention for symptom relief. Coracoid impingement syndrome is an uncommon cause of anterior shoulder pain but diagnosed patients can expect good symptomatic relief following referral to a dedicated shoulder unit. An increase in clinical awareness of the condition may prevent undue diagnostic delay in such cases.

Acute haemodynamic effects of cigarette smoking in healthy young subjects

Abstract: Background Invasive studies in middle-aged patients suggest an acute adverse haemodynamic effect of smoking.

Small bowel volvulus secondary to a mesenteric lipoma: a case report and review of the literature.

Abstract: Small bowel volvulus is rare in adults and often has a precipitating factor. This report describes a case of small bowel volvulus secondary to a mesenteric lipoma and reviews the literature describing this condition. Mesenteric lipoma is a rare precipitating cause of small bowel volvulus in adults. Computed tomography scanning may be useful for diagnosis preoperatively. The treatment of choice is surgery with complete excision of the lipoma.

Abdominal Aortic Aneurysm neck morphology: Proposed classification system

Abstract: Background While aneurysm neck length, angulation and width have all been previously assessed in endovascular abdominal aortic aneurysm repair (EVAR), aneurysm neck shape has not been considered.

Lessons learned using Snodgrass hypospadias repair.

Abstract: This is a review of our experience with the Snodgrass technique for distal hypospadias repair and we point to lessons learned in improving results. We reviewed all patients who underwent Snodgrass hypospadias repair for distal hypospadias over a four-year period by a single surgeon. Chart review followed by parental telephone interview was used to determine voiding function, cosmesis and complication rate. Thirty children and three adults were identified. Age at surgery ranged from seven months to 39 years. The urinary stream was straight in 94%, and 97% reported a good or satisfactory final cosmetic outcome. One patient (3.3%) developed a urethral fistula and 21% developed meatal stenosis which required general anaesthetic. The Snodgrass urethroplasty provides satisfactory cosmetic and functional results. High rates of meatal stenosis initially encountered have improved with modifications to technique which include modified meatoplasty and routine meatal dilatation by the parents.

Laparoscopic Nissen fundoplication: predicting outcome from peri-operative evaluation.

Abstract: Background Although laparoscopic Nissen fundoplicaton is a safe, effective treatment for gastrooesophageal reflux (GOR), questions remain about the durability of the procedure and patient selection criteria.

Assessment and management of transient ischaemic attack — the role of the TIA clinic

Abstract: Background As the risk of early stroke following transient ischaemic attack (TIA) is increasingly recognised, the management of patients presenting with symptoms suggestive of TIA presents a clinical challenge.

The pattern of plasma sodium abnormalities in an acute elderly care ward: a cross-sectional study.

Abstract: Introduction The combination of ageing, illness, and medications can lead to hyponatraemia or hypernatraemia.

Low molecular weight heparin prophylaxis in day case surgery.

Abstract: Background The role of Low molecular weight heparins (LAAWH) in day case/ short-stay surgery is unknown.

AA amyloidosis in psoriatic arthritis

Abstract: Background Amyloidosis is an extremely rare complication of psoriatic arthritis (PsA) and is associated with a poor prognosis. We report a case of amyloidosis secondary to severe PsA in a young patient and the course of his disease over a 13-year period of aggressive immunosuppression.

Structuring diabetes care in general practices: many improvements, remaining challenges.

Abstract: BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.

Socio-economic gradients in self-reported health in Ireland and Northern Ireland

Abstract: Background Research and policy related to reducing health inequalities has progressed separately within Ireland and Northern Ireland. This paper describes the first exploration of the socio-economic influences on health on the island of Ireland since 1922.

Haemodynamic determinants of elevated pulse wave velocity during acute isometric handgrip exercise.

Abstract: Background Measure ment of pulse wave velocity (PWV) provides a reliable index of vascular stiffness. Despite its widespread application, the physiological inter-relationships between PWV, blood pressure (BP) and in particular, heart rate (HR), have yet to be fully elucidated. Furthermore, little is known about altered arterial compliance during acute exercise.

FDG-PET scanning in the management of cancer of the oesophagus and oesophagogastric junction: early experience with 100 consecutive cases.

Abstract: Background The aim was to evaluate the impact of FDG-PET scan on tumour staging and management decisions in oesophageal cancer.