Ireland ’s Assisted Decision Making Capacity Act—the potential for unintended effects in critical emergencies: a cross-sectional study of Advanced Paramedic decision making
ConclusionIrish legislation which changes the traditional basis of medical practice away from the best interests of the patient may affect the resuscitation practices of Advanced Paramedics in life-threatening situations. It has significant implications for medical education, professional practice and clinician-patient interactions. This legislation and similar planned legislation may have implications for other EU jurisdictions. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 27, 2019 Category: General Medicine Source Type: research

The effect of re-audit and education on antibiotic prescribing practice at Causeway Hospital, Northern Ireland
AbstractBackgroundAntimicrobial resistance is a growing global problem. There has been increasing emphasis on promoting antimicrobial stewardship. Accurate completion of antibiotic prescriptions, such as documentation of clinical indication and a stop/review date, helps promote antimicrobial stewardship.AimsTo investigate the impact of educational interventions on the completeness of antibiotic prescriptions at Causeway Hospital surgical unit.MethodsInpatient drug prescription charts were audited to monitor the completeness of antibiotic prescriptions on the surgical unit. Two educational interventions were implemented, wi...
Source: Irish Journal of Medical Science - February 27, 2019 Category: General Medicine Source Type: research

A retrospective study (2001 –2017) of acute and chronic morbidity and mortality associated with Staphylococcus aureus bacteraemia in a tertiary neonatal intensive care unit
ConclusionsPreterm and low birth weight infants were at highest risk of SAB. Only a small proportion of affected children had long-term clinical sequelae on follow-up. The high rate of recurrence and breakthrough bacteraemia suggests that early implementation of a targeted anti-staphylococcal antimicrobial regimen may be of particular benefit. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 25, 2019 Category: General Medicine Source Type: research

Antibacterial and antioxidant activities of traditional medicinal plants from the Erzurum region of Turkey
ConclusionsDue to their antimicrobial, antifungal, and antioxidant properties, the extracts of these plants might be used as natural sources in the pharmaceutical and cosmetic industries. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 25, 2019 Category: General Medicine Source Type: research

Ethical dilemmas related to living donor liver transplantation in Asia
AbstractLiving donor liver transplantation (LDLT) has evolved rapidly in Asia with good outcomes for both donor and recipient. Nonetheless, LDLT remains a highly demanding technique and complex surgery. The potential risks to the donors provide the basis for many of the ethical dilemmas associated with LDLT. The transplant team must have a good knowledge of the principles of bioethics in order to handle these matters. To look after the need, donor ’s safety and the chance for good recipient outcomes, the principles of respect for the donor’s autonomy, beneficence, and non-maleficence should be practiced. In acc...
Source: Irish Journal of Medical Science - February 23, 2019 Category: General Medicine Source Type: research

Assessing suitability for sacubitril-valsartan therapy in an Irish cohort: challenges and opportunities
ConclusionsOur study showed that a smaller than expected proportion of our patients in real-world practice are suitable for sacubitril-valsartan therapy at discharge. Most patients were in the HFPEF cohort which does not currently have evidence for treatment with sacubitril-valsartan. Low rates of prescribing of basic heart failure medicatons and the absence of dedicated heart failure services in a non-tertiary centre may explain the poor compliance observed. Improving guideline adherence and increasing awareness of evidence-based medication use at primary and secondary care levels would be of benefit to Irish heart failur...
Source: Irish Journal of Medical Science - February 22, 2019 Category: General Medicine Source Type: research

Why our doctors are leaving Irish emergency medicine training
ConclusionsOur findings indicate the need to improve training and working conditions in Emergency Medicine in Ireland. These improvements are necessary to reduce attrition and improve retention of EM staff. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 18, 2019 Category: General Medicine Source Type: research

Arthroscopic anterior shoulder stabilisation in overhead sport athletes: 5-year follow-up
DiscussionFavourable outcomes can be expected for overhead contact sport athletes undergoing anterior arthroscopic stabilisation for recurrent instability. Players from these groups returned to sport sooner than those from other sports and no difference in recurrence was noted. The level at which they can expect to return to is favourable with most athletes reaching their pre-injury level. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 15, 2019 Category: General Medicine Source Type: research

Impact of the CYP2D6 phenotype on hyperprolactinemia development as an adverse event of treatment with atypical antipsychotic agents in pediatric patients
ConclusionsFor the slow and intermediate metabolizers, atypical antipsychotics determined a significant increase of prolactinemia with high risk of adverse events. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 15, 2019 Category: General Medicine Source Type: research

Acute multiple sclerosis lesion pathology does not predict subsequent clinical course —a biopsy study
ConclusionUniform white matter subacute demyelination is associated with a diverse clinical course ranging from a monophasic illness to progressive MS, suggesting that extraneous factors distinct from the basic pathology significantly influence the clinical course in MS. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 15, 2019 Category: General Medicine Source Type: research

Overexpression of apoptosis-related protein, survivin, in fibroblasts from patients with systemic sclerosis
ConclusionsOur results showed thatsurvivin is upregulated in SSc skin fibroblast which may lead to resistance to apoptosis. Further studies should be performed to reveal the role ofsurvivin in apoptosis pathway of SSc fibroblasts. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 13, 2019 Category: General Medicine Source Type: research

Twenty-four-hour urine NE level as a predictor of the therapeutic response to metoprolol in children with recurrent vasovagal syncope
AbstractBackgroundVasovagal syncope (VVS) is a heterogeneous disorder that creates challenges for treatment. Metoprolol is an important therapeutic option for children with VVS.AimsThe study examined the predictive value of 24-h urine norepinephrine (NE) levels in the assessment of the therapeutic efficacy of metoprolol for recurrent VVS in children.MethodsThirty-eight children with recurrent VVS and 20 healthy children were enrolled in our study. Twenty-four-hour urine NE levels were measured by LC-MS-MS. VVS children were diagnosed by BHUTT and/or SNHUTT, and received metoprolol treatment for 3  months. Symptom scor...
Source: Irish Journal of Medical Science - February 13, 2019 Category: General Medicine Source Type: research

Quantification of the impact of interventional radiology in the management of acute pancreatitis
ConclusionThe diagnosis and treatment of complicated acute pancreatitis is heavily dependent on the interventional radiology department. A substantial proportion of patients with pancreatitis required radiological intervention as part of their management, the proportion of which increased significantly in complex disease. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 13, 2019 Category: General Medicine Source Type: research

An analysis of childhood consultations in general practice: a multi-practice study
ConclusionThis study provides a comprehensive snapshot of what children commonly present with in general practice, common diagnoses and the actions taken by GPs. The findings will help GPs to organise their practice systems and will inform healthcare service planners. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 12, 2019 Category: General Medicine Source Type: research

Utilisation of critical care services for surgical patients in a model three hospital
ConclusionsThis study demonstrates the need to protect sufficient numbers of ICU beds for delivery of emergency surgical care. It highlights the potential utility of an HDU in this setting. The introduction of such a facility would impact cost savings and increase access for those requiring definitive ICU level care. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 9, 2019 Category: General Medicine Source Type: research

GDPR: an impediment to research?
ConclusionsWe propose five recommendations, which would ameliorate some of the more restrictive impositions of these regulations. This review was commissioned by the Irish Academy of Medical Science. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 8, 2019 Category: General Medicine Source Type: research

Ward stories: lessons learned from patient perception of the ward round
ConclusionThe presented data underlines a weakness in knowledge transfer to the patient during the ward round which may have a detrimental impact on post discharge morbidity where understanding and treatment adherence is critical. Improving communication is vital to establishing the WR as a practice of significance in order to deliver superior, safe patient-centred care. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 2, 2019 Category: General Medicine Source Type: research

The long-term outcomes following internal fixation for intracapsular hip fractures in an Irish tertiary referral centre
ConclusionWhilst a good functional outcome can be achieved with internal fixation, particularly in younger patients, the risk of requiring revision surgery approaches 50% for these patients. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 2, 2019 Category: General Medicine Source Type: research

The role of real-time PCR testing in the investigation of paediatric patients with community-onset osteomyelitis and septic arthritis
ConclusionsSequential culture and PCR testing can improve the detection rate of causative organisms in paediatric bone and joint infections, particularly for fastidious microorganisms such asK. kingae. PCR testing can be reserved for cases where culture is negative after 48  h. These results have been used to develop a standardised diagnostic test panel for bone and joint infections at our institution. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 31, 2019 Category: General Medicine Source Type: research

Clinical impact of rapid polymerase chain reaction (PCR) test for group B Streptococcus (GBS) in term women with ruptured membranes
ConclusionsIn a centre adhering to a risk-factor-based GBS policy, the introduction of limited rapid GBS screening for term women with pre-labour rupture of membranes resulted in a clinically significant reduction in prophylactic antibiotic use. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 31, 2019 Category: General Medicine Source Type: research

Incidence and outcome of interrupted geriatric rehabilitation requiring acute hospital transfer
ConclusionInterrupted geriatric rehabilitation requiring acute hospital transfer occurred in 9.3% of patients; acute severe infection was the most common cause. These transfers were associated with significant mortality. Rehabilitation programs should focus improvement efforts on identifying suitable patients for rehabilitation, optimizing care transitions, and minimizing rates of transfers. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 25, 2019 Category: General Medicine Source Type: research

Spectrum of rhabdomyolysis in an acute hospital
AbstractRhabdomyolysis is a state of muscle necrosis with the hallmark being elevated creatine kinase that may cause acute kidney injury with serious consequences. It happens in many clinical settings. We sought to investigate all cases of rhabdomyolysis admitted to an acute hospital in Ireland over one calendar year. All cases of rhabdomyolysis admitted to a tertiary hospital over a 12-month period were reviewed. It was defined as serum creatine kinase greater than five times upper limit normal. The incidence, presenting characteristics and clinical outcomes, was collected from electronic records, electronic consult syste...
Source: Irish Journal of Medical Science - January 24, 2019 Category: General Medicine Source Type: research

Packing versus mushroom catheters following incision and drainage in anorectal abscess
ConclusionMushroom catheter drainage of anorectal abscesses is a safe alternative to traditional packing and results in higher patient satisfaction. This study provides a rationale for a future randomised controlled trial. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 23, 2019 Category: General Medicine Source Type: research

Room 101: are gender-specific cigarette packets the way forward?
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 21, 2019 Category: General Medicine Source Type: research

Satisfaction of the Irish Trauma and Orthopaedic training programme with the Intercollegiate Surgical Curriculum Programme
ConclusionsOur survey demonstrated significant concerns and reservations amongst the Irish users of ISCP. The demonstrable level of trainee dissatisfaction with ISCP may represent a frustration that key problems such as the regulated training content of jobs remains unaddressed while ISCP does little to improve meaningful formative feedback. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 21, 2019 Category: General Medicine Source Type: research

The dangers of hurling —genital injuries arising in the modern game
ConclusionHurling is a physical sport with a notable proportion of blunt scrotal trauma arising due to the sport. Prompt physical examination and diagnostic ultrasonography are essential in investigations of injuries, and surgical exploration should be considered in all cases with concerns of testicular survival. Groin protection should be recommended to all players and in particular to those at high risk such as single testis or prior injury. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 19, 2019 Category: General Medicine Source Type: research

Food-dependent exercise-induced reactions: lessons from a 15-year retrospective study
ConclusionsFDEIA is an increasingly recognised serious allergic disease. The clinical diagnosis is supported by targeted sensitisation testing and molecular-based allergy diagnostics. These tools allow implementation of effective dietary and lifestyle modifications that mitigate against future serious reactions. Given the limited access to physicians with specialist allergy training in Ireland, increased awareness of this condition amongst sports medicine specialists and general physicians is required. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 19, 2019 Category: General Medicine Source Type: research

The Great Irish Famine (1845 –52) and the Irish asylum system: remembering, forgetting, and remembering again
AbstractThe Great Irish Famine (1845 –52) saw the Irish population fall by 20% as one million people died and another million emigrated. The Famine occurred at a time when the Irish asylums were growing rapidly anyway, so its precise effects on mental health are difficult although not impossible to study. Three groups merit considera tion. First, for adults living through the Famine, starvation and poverty contributed to the continued rise in asylum presentations. Second, babies in utero during the Famine were reported to have accounted for an increase in first admissions when they reached the high-risk age for menta...
Source: Irish Journal of Medical Science - January 16, 2019 Category: General Medicine Source Type: research

Obesity cardiomyopathy: the role of obstructive sleep apnea and obesity hypoventilation syndrome
AbstractThe negative long-term health consequences of obesity are well known to both the medical profession and general public. Despite this, the number of obese and overweight individuals worldwide continues to steadily rise. Although obesity has long been associated with an increased risk for cardiovascular disease and mortality, the classification of a cardiomyopathy of obesity is a more recent development. Obesity cardiomyopathy is characterized as myocardial dysfunction or heart failure in obese individuals independent of other cardiovascular risk factors. The purpose of this report is to provide an overview of obesit...
Source: Irish Journal of Medical Science - January 15, 2019 Category: General Medicine Source Type: research

Profiling frequent attenders at an inner city emergency department
ConclusionsThis retrospective review is the most detailed assessment of Irish FAs undertaken to date. Further studies are required to examine the Irish hospitals most at need of Case Management Strategy Programmes which we postulate could minimise the risk of adverse outcomes for these patients and improve overall ED efficiency. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 11, 2019 Category: General Medicine Source Type: research

The clinical characteristics and correlates of lithium toxicity in a tertiary referral centre
ConclusionLithium toxicity is common in our population. Given the narrow therapeutic index, this demonstrates the need for careful monitoring and prescribing, especially patients aged 65 and over. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 10, 2019 Category: General Medicine Source Type: research

Worldwide scientific production in obstetrics: a bibliometric analysis
ConclusionsTotal scientific production rate in obstetrics increased from 2002 to 2013, especially randomised clinical trials. However, randomised clinical trials continue to represent a small proportion of total production. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 9, 2019 Category: General Medicine Source Type: research

Comparison of 4 different techniques in first metatarsophalangeal joint arthrodesis
AbstractAimsThe aim of this study was to evaluate outcomes and fusion rates of 4 different methods of first metatarsophalangeal joint (MTPJ) arthrodesis.MethodsWe performed a retrospective analysis of first MTPJ fusion using Bold ® and Acutrak® compression screws, universal 1/3 tubular plate and Hallu®-S non-locking plate in 6 hospitals in Dublin over 4 years. A cohort of 300 patients (351 feet) was operated on by 3 feet and ankle fellowship trained orthopaedic surgeons (PK, MMS, JVMcK) over 4 years. Mean age was 62.4  years. There were 261 females and 39 males. One hundred three patients had a f...
Source: Irish Journal of Medical Science - January 8, 2019 Category: General Medicine Source Type: research

Appropriate use of elective coronary angiography in patients with suspected stable coronary artery disease
ConclusionThis is the first Irish study to evaluate the appropriate use of elective coronary angiography. Rates were similar to those of studies in other jurisdictions; however, there remains significant potential for quality improvement. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 5, 2019 Category: General Medicine Source Type: research

Prevalence of sarcopenia in patients with geriatric depression diagnosis
ConclusionFor GD patients, diagnosis of sarcopenia in the early stages and precautions like improving muscle functions with protein support in diet and resistance exercises will make it possible to contribute to improving clinical results of the disease. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 4, 2019 Category: General Medicine Source Type: research

Risk factors for miscarriage among women attending an early pregnancy assessment unit (EPAU): a prospective cohort study
ConclusionsOur findings indicated that maternal, psychological and obstetric factors may have an influence on miscarriage among women attending an EPAU. The insight of a relationship between emotional wellbeing and miscarriage opens a window for prevention in this area. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 3, 2019 Category: General Medicine Source Type: research

Burning mouth syndrome —a diagnostic dilemma
ConclusionThe results of this study indicate that there is a need for an increased awareness of the symptoms reported in BMS, particularly in peri and postmenopausal women. This should aid prompt diagnosis and may alleviate some of the anxiety that patients may experience. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 2, 2019 Category: General Medicine Source Type: research

UCD School of Medicine Summer Student Research Awards 2018
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 21, 2018 Category: General Medicine Source Type: research

Self-confidence and clinical skills: the case of students who study medicine in English in a non-English speaking setting
ConclusionActive supervision by teaching staff is also recommended in an attempt to rectify the lack of confidence at performing a range of clinical procedures which is present among international students. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 19, 2018 Category: General Medicine Source Type: research

Total hip replacement —the cause of failure in patients under 50 years old?
ConclusionThe changing trend of early revision due to metal-on-metal failure is important to recognise. Continuous review of the mechanism of primary total hip replacement failure is necessary to ensure the best patient outcome and maximise implant survivorship. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 19, 2018 Category: General Medicine Source Type: research

Dialysis independence following single-agent daratumumab in refractory myeloma with renal failure
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 19, 2018 Category: General Medicine Source Type: research

Obesity and cardiovascular risk in an oncology day ward population
AbstractIntroductionThe burden of obesity and risk of cardiovascular (CV) disease amongst an oncology population receiving active treatment is ill-defined. We performed a retrospective analysis assessing the incidence of obesity and cardiovascular (CV) risk factors in this group (grp) of patients as well as the predicted 10-year risk of a CV event.MethodsData from all patients (pts) receiving intravenous chemotherapy in an Irish oncology satellite unit over an 18-month period was extracted from chemotherapy prescriptions and electronic patient records. To calculate patients ’ 10-year risk of developing CV disease, we...
Source: Irish Journal of Medical Science - December 18, 2018 Category: General Medicine Source Type: research

Equestrian injuries presenting to a regional trauma centre in Ireland
ConclusionThis study identifies a high incidence of morbidities associated with equestrian presentations. In addition, we recognised populations at risk of specific injuries and describe high-risk mechanisms of injury. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 18, 2018 Category: General Medicine Source Type: research

Primary total hip arthroplasty: registry data for fixation methods and bearing options at a minimum of 10  years
We describe 10-year THA outcomes from an Irish perspective using regional THA registry data for the first time.AimsWe assess the main predictors of revision in primary total hip arthroplasty (THA) using regional registry data.MethodsThis was a prospective study of registry data from a National Orthopaedic Hospital for all THAs with 10-year follow-up data. All metal-on-metal THAs and resurfacings were excluded from the analysis. All-cause revision was the primary outcome. Univariate and multivariate analyses controlling for confounding variables were performed to assess predictor impact on primary and secondary outcomes.Res...
Source: Irish Journal of Medical Science - December 17, 2018 Category: General Medicine Source Type: research

Parental awareness of newborn bloodspot screening in Ireland
AbstractBackgroundThere is little known regarding how familiar parents are with the newborn bloodspot screening (NBS) test or how well parents of a child with a screen-detected condition understand that condition initially.AimThe study aim was to examine parental NBS awareness and conditions screened.MethodsTwo studies were conducted: [1] Parents of children with cystic fibrosis (CF) detected via NBS and subsequently, diagnosed (n = 124) completed a telephone questionnaire regarding information they received at the time of NBS. [2] A cross-sectional study of women (n = 662 (58%) antenatal;n&thin...
Source: Irish Journal of Medical Science - December 15, 2018 Category: General Medicine Source Type: research

Transmission electron microscopy and histological analysis of the peridural membrane
ConclusionThe peridural membrane is a distinctive and important membrane in the spinal canal, and given its high collagen to elastin ratio and it tightly packed nature, we conclude that it forms a protective layer around the spinal cord which may help in minimising the compressive nature of intervertebral disc herniation. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 15, 2018 Category: General Medicine Source Type: research

Achieving proficiency in rigid bronchoscopy —a study in manikins
ConclusionsThis study shows that the technical skill of rigid bronchoscopy can be acquired within 10 repetitions in a manikin model. As procedural competence and complication frequency vary with the laryngoscopic grade of the model, both easy and difficult configurations should be used for training. Advanced laryngoscopic skills are not required prior to training in this technique. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 14, 2018 Category: General Medicine Source Type: research

Acute ischaemic stroke: a systematic review of the cost-effectiveness of emergency endovascular therapy using mechanical thrombectomy
ConclusionsIf the outcomes of the trials underpinning the evidence of clinical effectiveness can be replicated, then mechanical thrombectomy is likely to be cost-effective by typical willingness-to-pay thresholds. This finding holds under the assumption that no investment is required to develop stroke centres to the standard required to provide a safe emergency endovascular service and that additional expenditure on timely patient transport is not required. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 8, 2018 Category: General Medicine Source Type: research

The role of increased synovial fluid A disintegrin and metalloproteinase with thrombospondin motifs4 and serglycin levels in osteoarthritis
AbstractBackgroundThe first research to determine synovial fluid ADAMTS4 and serglycin levels in osteoarthritis and OA progression.AimWe aimed to determine ADAMTS4 and serglycin levels, interactions, and changes in the synovial fluid of knee OA, and also to determine effective in OA progression.MethodsA case-control study was carried out including a total of 88 participants (29 patients late OA [LOA], 28 early OA [EOA], and 30 controls). Synovial fluid serglycin and ADAMTS4 levels were measured by commercially available ELISA kits, and knee functions of the patients were evaluated with The Western Ontario and McMaster Univ...
Source: Irish Journal of Medical Science - December 7, 2018 Category: General Medicine Source Type: research

Current concepts on bibliometrics: a brief review about impact factor, Eigenfactor score, CiteScore, SCImago Journal Rank, Source-Normalised Impact per Paper, H -index, and alternative metrics
ConclusionsSince there is a journal performance market and an article performance market, each one with its patterns, an integrative use of these metrics, rather than just the impact factor alone, might represent the fairest and most legitimate approach to assess the influence and importance of an acceptable research issue, and not only a sound journal in their respective disciplines. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 3, 2018 Category: General Medicine Source Type: research