Showing papers in "Irish Journal of Medical Science in 2008"
TL;DR: The main barriers to receiving adequate screening were lack of knowledge regarding the need for ocular examination and the effect of mydriasis in prohibiting driving.
Abstract: To assess whether patients were receiving regular diabetic retinopathy screening and to examine factors influencing screening uptake. A questionnaire covering demographics, diabetic medical history and the knowledge of and attitudes to diabetic retinopathy was administered to all adults who were due to attend diabetes clinics in two centres in Dublin, Ireland over two months in 2001/2002. Of the 209 people who completed the questionaire, 169 (81%) had a dilated fundal examination within the last year. The most significant predictor for receiving screening was a previous physician recommendation about the necessity of a regular eye examination. The main barriers to receiving adequate screening were lack of knowledge regarding the need for ocular examination and the effect of mydriasis in prohibiting driving. It is essential that patients are fully aware of the need for a regular eye examination. Once a physician recommends this the screening rate improves.
68 citations
TL;DR: Strict adherence to swab counts, and the avoidance of change of staff during procedures is important in decreasing the incidence of gossypiboma.
Abstract: Introduction
Post-operative complications in surgery may frequently be unavoidable. However, some complications result from human error, both in the intra-operative and post-operative period. One such complication, which is frequently underreported, is the retained swab, or gossypiboma.
65 citations
TL;DR: Multi-foetal gestations remain the principal cause of adverse perinatal outcomes after ART and Singleton ART pregnancies have an increased risk of preterm delivery and low birth weight at term.
Abstract: Background
Increasing use of fertility therapy has elicited concerns regarding adverse effects for expectant mothers and the health of children thus conceived.
55 citations
TL;DR: Investigation of the quality and consistency of medication details generated for such transfer from an Irish teaching hospital found inaccuracy of medication information at hospital discharge is common and compromises quality of care.
Abstract: Medication discrepancies at the time of hospital discharge are common and can result in error, patient/carer inconvenience or patient harm. Providing accurate medication information to the next care provider is necessary to prevent adverse events. To investigate the quality and consistency of medication details generated for such transfer from an Irish teaching hospital. This was an observational study of 139 cardiology patients admitted over a 3 month period during which a pharmacist prospectively recorded details of medication inconsistencies. A discrepancy in medication documentation at discharge occurred in 10.8% of medication orders, affecting 65.5% of patients. While patient harm was assessed, it was only felt necessary to contact three (2%) patients. The most common inconsistency was drug omission (20.9%). Inaccuracy of medication information at hospital discharge is common and compromises quality of care.
51 citations
TL;DR: Early recognition of aggressive localised scleroderma and appropriate referral is imperative for a good outcome, and treatment was generally well tolerated with few side effects.
Abstract: Juvenile localised scleroderma (JLS) is a rare connective tissue disorder in childhood. Most lesions are benign and self-limiting, but some progress to cause functional disabilities and cosmetic disfigurement. These lesions require systemic treatment, the mainstay of which is corticosteroids and methotrexate. To report the experience of the use of systemic treatment in children with JLS in our department. We performed a retrospective chart review looking at the patients who received systemic treatment over 14 years and recorded their outcomes. Ten children with aggressive JLS were treated with systemic immunosuppressive therapy. There was an 80% response to treatment. Three of the responders relapsed off treatment, but responded to a further course of therapy. Mean disease duration at diagnosis was 8 months. Treatment was generally well tolerated with few side effects. Early recognition of aggressive localised scleroderma and appropriate referral is imperative for a good outcome.
46 citations
TL;DR: It is suggested that training in musculoskeletal medicine is inadequate at multiple levels of medical education with reform urgently required.
Abstract: Basic competency in musculoskeletal medicine is essential for many specialties being particularly relevant to primary care. The purpose of this study was to objectively assess the adequacy of musculoskeletal education at multiple levels of medical training from undergraduate level to primary care. A previously validated musculoskeletal examination was administered to 303 volunteers consisting of medical students, orthopaedic specialist registrars, general practice trainees and general practitioners. Forty (71%) general practitioners and 74 (71.8%) general practice trainees failed to obtain the passing score of 70. Sixty-three (87.5%) medical students who had completed an intensive 1-week long course in musculoskeletal medicine failed the examination. The pass rate improved significantly for general practitioners who had completed a postgraduate rotation in musculoskeletal medicine (47.8 vs 18.1%, P < 0.01). These findings suggest that training in musculoskeletal medicine is inadequate at multiple levels of medical education with reform urgently required.
39 citations
TL;DR: More than half of the children surveyed had used some form of CAM, usually without their Paediatrician's knowledge, and use varied between paediatric specialties, with the highest in neurological patients.
Abstract: Background
Although very little scientific data exists on the efficacy and side effects of complementary and alternative medicines, their profile and availability is increasing. Use among Irish children is unknown.
34 citations
34 citations
TL;DR: Almost half of the patients receiving clozapine have metabolic syndrome and are consequently at risk of cardiovascular morbidity and mortality and should be closely monitored in order to facilitate interventions, which could alleviate the adverse health consequences of this syndrome.
Abstract: There is increasing concern that the use of second-generation antipsychotic medications in schizophrenia is associated with the development of metabolic syndrome. This study assessed the prevalence and clinical associations of metabolic syndrome among patients receiving clozapine within the catchment area of a mental health service in the west of Ireland. A total of 84 patients (96% response rate) taking clozapine were interviewed and thoroughly investigated using physical assessments, comprehensive laboratory testing and review of medical records. Of the patients, 46.4% taking clozapine fulfilled the criteria for metabolic syndrome. Male gender, high body mass index, high insulin level and receiving a concomitant antipsychotic medication were significantly associated with the presence of metabolic syndrome. Almost half of the patients receiving clozapine have metabolic syndrome and are consequently at risk of cardiovascular morbidity and mortality. Such patients should be closely monitored in order to facilitate interventions, which could alleviate the adverse health consequences of this syndrome.
32 citations
TL;DR: Combined modality therapy, i.e. chemotherapy followed by radiotherapy, is the preferred treatment option unless adverse neurology or an unstable fracture presents first.
Abstract: Primary bone lymphoma (PBL) is a rare condition and accounts for less than 2% of adult lymphomas and 3% of all primary bone malignancies. Because of the rarity of this disease, there is a lack of prospective randomised clinical trials and hence optimal treatment is uncertain. We report on our experience of treating PBL over 20 years. Using our hospital database, we identified all patients with PBL, their treatment, and long-term follow-up. From January 1989 to July 2007, we identified 12 patients with PBL. Long extremity bones were the most common presenting sites. Multifocal disease was present in three cases. Treatment modalities included surgery, chemotherapy, and radiotherapy. Median follow-up was 8 years (range 0.5–18.5 years), and overall survival was 100%. Combined modality therapy, i.e. chemotherapy followed by radiotherapy, is the preferred treatment option unless adverse neurology or an unstable fracture presents first.
31 citations
TL;DR: Vitamin D insufficiency is not confined to “at-risk groups” and is likely to be prevalent in the general public in Ireland, especially in wintertime.
Abstract: Specific sub-groups of the population, such as older people, are at increased risk of poor vitamin D status. There is growing evidence, however, that vitamin D insufficiency may be a more widespread problem. To determine the prevalence of vitamin D insufficiency in a group of healthy Irish adults. Serum 25-hydroxyvitamin D was measured by radioimmunoassay in 70 healthy Irish adults working in South Dublin. Overall, half of the group (51%) had vitamin D insufficiency; this was more pronounced in wintertime, with prevalence rising to 58%. Winter was a significant negative predictor of serum 25-OH D levels. Sixteen percent of the participants reported taking a vitamin D-containing supplement (multivitamin), but this did not significantly influence the serum 25-OH D levels. Vitamin D insufficiency is not confined to “at-risk groups” and is likely to be prevalent in the general public in Ireland, especially in wintertime.
TL;DR: Irish LLAs maintain functional capacity despite suffering moderate intensity BP and RLP, with BP intensity increased with age; RLP intensity was greatest among vasculopaths.
Abstract: Aims
To examine the prevalence and impact of back pain (BP) and residual limb pain (RLP) in ambulatory lower limb amputees (LLAs)
TL;DR: Systematic feedback appears to enhance colonoscopy performance among GI trainees.
Abstract: The medical literature describes disparity in colonoscopy performance. This randomised, controlled study aimed to characterise the impact of feedback on colonoscopy performance among gastroenterology (GI) trainees. Gastroenterology trainees of similar experience levels who independently performed 581 colonoscopies over the study period were randomised to receive feedback/no feedback on their colonoscopy performance. Baseline colonoscopy performance was similar in both groups. Following feedback, caecal intubation improved by 10.5% (from 72.9 to 83.4%, p = 0.04) in the feedback group and declined by 6.1% (from 78 to 71.9%, p = 0.2) in the control group; polyp detection improved by 5.1% (from 12.9 to 18.0%, p = 0.2) in the feedback group and by 2.9% (from 16.7 to 19.6%, p = 0.5) in the control group. Systematic feedback appears to enhance colonoscopy performance among GI trainees.
TL;DR: One of Fleming’s cultures was accidentally contaminated by a mould containing penicillin which came from the collection of Charles La Touche, an Irish mycologist who was researching whether cobwebs caused asthma in the same hospital, and who later taught in UCD.
Abstract: Background
Pasteur commented that if we could intervene in the antagonism observed between some bacteria, it would offer ‘perhaps the greatest hopes for therapeutics.’ Some Irish scientists were crucially involved in the eventual realization of these hopes.
TL;DR: SNS offers improvement in continence and quality of life in patients with faecal incontinence whose only other option might otherwise be a permanent colostomy.
Abstract: Faecal incontinence resulting from obstetric injury is a socially disabling condition with a significant impact on quality of life. Sacral nerve stimulation (SNS) is a relatively new treatment modality, which offers patients a potential for improved continence. We reviewed our initial experience of SNS in 14 patients (mean age 54 years, range 30–72) with faecal incontinence from January 2006 to June 2007. Background demographics, past medical and obstetric history, anal manometry, endoanal ultrasound and pudendal nerve studies were recorded on all patients. All patients who had permanent SNS implants inserted had pre and post operative questionnaires consisting of the Wexner Continence Score and the Rockwood and SF-36 Quality of Life Indices. Out of 14 patients, 13 had incontinence related to obstetric injuries while one was related to a cauda equina syndrome. All patients had a test procedure consisting of placement of temporary electrodes and a 2-week trial of external SNS. Ten patients noted a significant improvement in their continence and these 10 patients subsequently had a permanent SNS device implanted with an overall significant improvement in continence (P < 0.001) and quality of life (P < 0.01). There were no immediate postoperative complications and one late failure consisting of a lead fracture, which was replaced successfully. Four (29%) patients did not have a significant benefit from temporary SNS and two of these patients subsequently had a colostomy. SNS offers improvement in continence and quality of life in patients with faecal incontinence whose only other option might otherwise be a permanent colostomy.
TL;DR: The incidence of PONV post-discharge suggests that adding an antiemetic to take-home analgesic packs may improve patient comfort, and shows the importance of post- Discharge follow-up of ambulatory surgery patients.
Abstract: Laparoscopic cholecystectomy has been performed as a day-case procedure for over a decade. This procedure can be associated with a high incidence of pain and post-operative nausea and vomiting (PONV). There is a paucity of information regarding the post-discharge care of these patients. To determine the effectiveness and adequacy of take-home analgesic packs given to patients undergoing ambulatory surgery. A prospective study of 40 patients undergoing laparoscopic cholecystectomy to evaluate post-operative pain, analgesia requirements and PONV following discharge. Data regarding unplanned admissions, patient satisfaction and GP attendance rates were also recorded. At 24 h, 65% of patients reported moderate pain, 23% severe pain and 25% of patients reported PONV. The rate of GP attendance for further analgesia or antiemetics was 12.5%. Unexpected admission rate was 10%. The incidence of PONV post-discharge suggests that adding an antiemetic to our take-home analgesic packs may improve patient comfort. The 2-day supply of diclofenac and co-codamol could also be extended as 65% of patients had moderate to severe pain. The information gathered shows the importance of post-discharge follow-up of ambulatory surgery patients.
TL;DR: A reminder would eradicate more than half of non-attendance at outpatient clinic, allowing significantly more new patients to be seen, translating to more efficient use of clinic time.
Abstract: Background
Non-attendance at outpatient clinic leads to significant time wasting and inefficient use of resources.
TL;DR: Percutaneous EVAR is both a feasible and safe method of performing endovascular abdominal aortic aneurysm repair, which is associated with a reduction in wound complication rates.
Abstract: Introduction
While endovascular aortic aneurysm repair (EVAR) has significantly reduced the morbidity associated with open surgery, efforts continue to minimise the surgical insult to the patient. We report our experience of percutaneous EVAR.
TL;DR: Two main themes emerged: policy factors (the health care system, the medico-legal system), and patient factors (need for reassurance, lack of patient adherence) that operate at national and local levels.
Abstract: Introduction
General practitioners and consultants in the Republic of Ireland manage patients with chronic low back pain (LBP), but little is known about the non-clinical factors that impact on their management.
TL;DR: Findings suggest a relationship between atmospheric pressure and RAAA and there was significantly greater daily atmospheric pressure variability on days when patients with RAAA were admitted.
Abstract: Ruptured abdominal aortic aneurysm (RAAA) presents with increased frequency in the winter and spring months. Seasonal changes in atmospheric pressure mirrors this pattern. To establish if there was a seasonal variation in the occurrence of RAAA and to determine if there was any association with atmospheric pressure changes. A retrospective cohort-based study was performed. Daily atmospheric pressure readings for the region were obtained. There was a statistically significant monthly variation in RAAA presentation with 107 cases (52.5%) occurring from November to March. The monthly number of RAAA and the mean atmospheric pressure in the previous month were inversely related (r = 0.752, r
2 = 0.566, P = 0.03), and there was significantly greater daily atmospheric pressure variability on days when patients with RAAA were admitted. These findings suggest a relationship between atmospheric pressure and RAAA.
TL;DR: Knowledge of medications which prolong the QT interval is important to minimize the risk of ventricular arrhythmias, which may lead to sudden death in patients with a congenitally long QT intervals.
Abstract: Background
Clarithromycin is a commonly used macrolide antibiotic. It is known to cause QT prolongation. Medication induced QT prolongation is a major risk factor for the development of torsade de pointes.
TL;DR: The study shows the clinical relevance of 3D reconstructions to plan surgical procedures and illustrates the benefit of carrying out numerical validations as a prerequisite to experimental modelling and as a method of pre-validating surgical procedures.
Abstract: Background
The current clinical procedure for mandible fracture fixation is plate application. 3D reconstructions are used to validate procedures numerically preceding experimental analysis. This study outlines the methods used to reconstruct a numerical model of the mandible.
TL;DR: The NEOMOD evaluates daily the severity of the multiple organ dysfunction syndrome (MODS) and is an accurate predictor of mortality.
Abstract: Background
The neonatal multiple organ dysfunction score (NEOMOD) predicts mortality during the first 28 days of life, and provides information on organ functions influencing mortality.
TL;DR: Anxiety and depression are highly prevalent in surgical inpatients and an increased awareness of the possibility of undiagnosed psychiatric disorders is required, along with prompt and appropriate use of liaison psychiatry services.
Abstract: Depression is the most common mental disease in patients hospitalized with physical illness. Disorders of anxiety and depression in general hospitals are frequently underdiagnosed and inappropriately treated. To assess the prevalence of undiagnosed anxiety and depression in surgical inpatients and assess the referral rate and utilization of liaison psychiatry services. A prospective study of surgical admissions (n = 96) to two surgical services at two separate institutions between 01/01/05 and 31/12/05. The Hospital Anxiety and Depression (HADS) scale was used to evaluate all patients. About 12.5% of patients had significant depression, 18.75% had significant anxiety, and 8.3% had significant mixed anxiety and depression. About 22.9% of patients warranted referral to liaison psychiatry services for further assessment and management. Anxiety and depression are highly prevalent in surgical inpatients. An increased awareness of the possibility of undiagnosed psychiatric disorders is required, along with prompt and appropriate use of liaison psychiatry services.
TL;DR: This is the first recorded case of hypoglycaemia in a non-diabetic patient being detected by a dog and also it is believed to be the first report of hyp glucosecaemia being detectedBy a dog in this country (Ireland).
Abstract: One of the life threatening complications of diabetes is hypoglycaemia. It is a common complication, with times of greatest risk being before meals and during the night. Symptoms usually develop when the blood glu- cose level falls below 3.5 mmol/l. Many patients with long-standing diabetes report loss of warning symptoms. Prevention of such hypoglycaemic attacks is highly desir- able. Recently a dog's ability to detect hypoglycaemia in diabetic patients has been recorded. This is the first recorded case of hypoglycaemia in a non-diabetic patient being detected by a dog and also we believe it to be the first report of hypoglycaemia being detected by a dog in this country (Ireland).
TL;DR: The outcome for surgical re-implantation in infants with a diagnosis of ALCAPA is very good however, early diagnosis is crucial to survival, and ventricular dysfunction was usually present, requiring long-term follow-up.
Abstract: Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare condition presenting in infancy with acute myocardial ischaemia. A retrospective study was undertaken to assess the presenting features and long-term outcome of all cases of ALCAPA presenting to our institution over a 15-year period. All the cases were located using the hospital discharge system and charts were reviewed. The mean age at diagnosis was 4.5 months (2 weeks to 16 months). The predominant presenting symptoms were irritability, pallor, and tachypnoea. The predominant electrocardiogram findings were Q waves and ST segment changes in the anterolateral chest leads. One died from the 11 patients in our series. The outcome for surgical re-implantation in infants with a diagnosis of ALCAPA is very good however, early diagnosis is crucial to survival. Although once successfully repaired, patients in general were free of symptoms, ventricular dysfunction was usually present, requiring long-term follow-up.
TL;DR: The ROSIER is a suitable and useful adjunct in the assessment of stroke patients in Ireland and was associated with increasing length of stay in survivors.
Abstract: Background
A study was performed to determine the utility of the 8-point recognition of stroke in the emergency room (ROSIER) instrument as a diagnostic tool in a large Irish emergency department.
TL;DR: The first profile of VSS attendees in terms of their functioning across the range of recommended WHO International Classification of Functioning, Disability and Health outcomes is provided.
Abstract: The Volunteer Stroke Scheme (VSS) provides patients with the opportunity to participate in community-based therapeutic activities and physiotherapy sessions. To provide the first profile of VSS attendees in terms of their functioning across the range of recommended WHO International Classification of Functioning, Disability and Health (ICF) outcomes. A convenience sample of 41 VSS patients completed standardised measures of cognitive functioning (MMSE), activity levels [Frenchay Activity Index (FAI), and Barthel Index (BI)], depression [Hospital Anxiety and Depression Scale (HADS)] and Quality of Life (SF-36). A total of 37% met the criteria for mild cognitive impairment and 44% met the criteria for clinical depression. Scores on the BI (M = 79.5) and FAI (M = 18.4) incidated limitations in activity levels. Quality of life levels was low. High levels of psychological morbidity, severe disability across a range of domains and poor quality of life were reported.
TL;DR: The overall risk of bleeding is related to surgical technique, and a ‘hot’ technique had a higher risk of hemorrhage than ‘cold” technique.
Abstract: Introduction
Post-tonsillectomy bleeding (PTB) is still one of the most common complications of tonsillectomy. The rate of PTB varies with different methods.
TL;DR: Many aspects of Dr Hallaran’s progressive approach to psychiatric care remain relevant today.
Abstract: Dr William Saunders Hallaran wrote the first Irish textbook of psychiatry in 1810. To explore the relevance of Dr Hallaran’s textbook: An Enquiry into the Causes producing the Extraordinary Addition to the Number of Insane together with Extended Observations on the Cure of Insanity with Hints as to the Better Management of Public Asylums for Insane Persons. This paper uses Dr Hallaran’s textbook to explore dominant themes in nineteenth-century psychiatry. Dr Hallaran’s approach was characterized by (a) recognition of organic factors in aetiology; (b) concern about apparent increases in mental illness; (c) systematic engagement with causes, courses, outcomes; (d) reconsideration of traditional treatments (venesection, emetics, purgatives); (e) exploration of novel approaches (Dr Cox’s Circulating Swing); and (f) re-evaluation of traditional remedies (digitalis, opium, camphor, mercury) and physical treatments (shower baths, diet, exercise). Many aspects of Dr Hallaran’s progressive approach to psychiatric care remain relevant today.