Disturbing and distressing: a mixed methods study on the psychological impact of end of life care on junior doctors
ConclusionsJunior doctors are regularly carrying out tasks related to end of life care, resulting in high levels of psychological distress. Further training and a change in culture are required. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - August 24, 2018 Category: General Medicine Source Type: research

CT cervico-cerebral angiography in acute stroke. Can we justify aortic arch imaging?
ConclusionsRoutine inclusion of the upper chest on CTCCA is currently difficult to justify in the evaluation of a suspected acute anterior circulation stroke, contributing significantly to total radiation dose without demonstrating significant extra-cranial vascular findings. Prospective studies adopting narrower fields of view excluding the upper chest are necessary. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - August 24, 2018 Category: General Medicine Source Type: research

Large loop excision of the transformation zone and preterm delivery over a decade in a major women ’s hospital
ConclusionsDespite having a lower mean depth of excision, women with CIN 3 comprised the majority of those who experienced PTD, suggesting that factors other than mechanical weakness are implicated in PTD for these women. This is in keeping with recent suggestions that the common denominator in high grade CIN and PTD is an altered vaginal microbiome. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - August 23, 2018 Category: General Medicine Source Type: research

Non-pharmacological management of hypertension: in the light of current research
AbstractHypertension is a major risk factor for a number of cardiovascular diseases. Proper management of hypertension may require both pharmacological and non-pharmacological interventions. Non-pharmacological interventions help reduce the daily dose of antihypertensive medication and delay the progression from prehypertension to hypertension stage. Non-pharmacological interventions include lifestyle modifications like dietary modifications, exercise, avoiding stress, and minimizing alcohol consumption. Nutritional requirements of hypertensive individuals can be addressed through adopting either the DASH diet or through t...
Source: Irish Journal of Medical Science - August 22, 2018 Category: General Medicine Source Type: research

Irrational use of proton pump inhibitors in general practise
ConclusionIrrational prescribing of PPIs continues both in hospital and in general practise. It is imperative that the side-effects of these medicines are weighed against the benefit and cost effectiveness, especially in the elderly population where polypharmacy remains a substantial concern. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - August 22, 2018 Category: General Medicine Source Type: research

Non-pharmacological management of hypertension: in the light of current research
AbstractHypertension is a major risk factor for a number of cardiovascular diseases. Proper management of hypertension may require both pharmacological and non-pharmacological interventions. Non-pharmacological interventions help reduce the daily dose of antihypertensive medication and delay the progression from prehypertension to hypertension stage. Non-pharmacological interventions include lifestyle modifications like dietary modifications, exercise, avoiding stress, and minimizing alcohol consumption. Nutritional requirements of hypertensive individuals can be addressed through adopting either the DASH diet or through t...
Source: Irish Journal of Medical Science - August 22, 2018 Category: General Medicine Source Type: research

Irrational use of proton pump inhibitors in general practise
ConclusionIrrational prescribing of PPIs continues both in hospital and in general practise. It is imperative that the side-effects of these medicines are weighed against the benefit and cost effectiveness, especially in the elderly population where polypharmacy remains a substantial concern. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - August 22, 2018 Category: General Medicine Source Type: research

Antenatal breastfeeding self-efficacy and breastfeeding outcomes among mothers participating in a feasibility breastfeeding-support intervention
ConclusionsBreastfeeding outcomes differed by maternal education. Future interventions should target mothers with lower education and possibly also overweight and obese mothers. Increasing breastfeeding self-efficacy, particularly among older and Irish-born mothers, may be a mechanism for improving breastfeeding outcomes. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - August 21, 2018 Category: General Medicine Source Type: research

Prevalence and co-variates of burnout in consultant hospital doctors: burnout in consultants in Ireland Study (BICDIS)
ConclusionsThis study demonstrated that over 40% of the consultants studied are affected by burnout. This finding raises concerns for patient safety and standard of care as well as doctors well-being. Interventions to address and minimise burnout are important to guarantee high patient outcomes and retain medical staff. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - August 20, 2018 Category: General Medicine Source Type: research

Ethical implications of population ageing in the intensive care unit
AbstractPopulation ageing has significant ethical implications in the management of elderly patients in the intensive care unit (ICU). In the aspects of beneficence and non-maleficence, conflicting evidence has long existed regarding an association of older age with poorer prognosis, but elderly patients who have poor prognosis in the ICU may have a worse outcome if not admitted. More randomised controlled studies are needed to study the benefits of ICU admission to different subgroups of critically ill elderly patients. The acute care for the elderly unit could be developed to provide more comprehensive care to the elderl...
Source: Irish Journal of Medical Science - August 18, 2018 Category: General Medicine Source Type: research

Does an elective induction policy negatively impact on vaginal delivery rates? A 30-month review of an elective induction policy
AbstractBackgroundThe rate of induction of labour varies across Health Service Executive hospital regions in Ireland averaging at 23.3 per 100 deliveries in 2005 –2009. The increasing rate of elective induction of labour in Ireland calls for more studies looking into associated maternal and/or neonatal outcomes.Study aimThe aim of this study is to show that an elective induction policy with management by a sole consultant obstetrician can decrease caesarean section rates as well as positively impact maternal and neonatal complications.MethodsWe conducted a retrospective review of women attending a named obstetrician ...
Source: Irish Journal of Medical Science - August 18, 2018 Category: General Medicine Source Type: research

Paediatric airway management and concerns: a survey of advanced paramedics in Ireland
ConclusionPaediatric airway management has key relevance for pre-hospital care in Ireland. The overall frequency of exposure to children who may benefit from definitive airway management is however likely to represent a significant barrier to the acquisition and maintenance of competency. The ongoing practice of pre-hospital paediatric intubation by APs may not justify its risks. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - August 15, 2018 Category: General Medicine Source Type: research

Percutaneous dilatational tracheostomy versus fibre optic bronchoscopy-guided percutaneous dilatational tracheostomy in critically ill patients: a randomised controlled trial
AbstractBackgroundTo determine whether fibre optic bronchoscopy-guided percutaneous dilatational tracheostomy (FOB-PDT) is a better option in critically ill patients, we compared the efficacy and incidence of procedure complications between PDT with and without FOB.MethodsWe included 90 patients with oral intubation and mechanical ventilation who received PDT with (n = 45, FOB-PDT group) and without (n = 45, PDT group) FOB. For all patients, a simplification of the Griggs technique was used in this study with a central venous catheter set and dilating forceps. Demographic data, body mass index (...
Source: Irish Journal of Medical Science - August 11, 2018 Category: General Medicine Source Type: research

High prevalence of risk factors for low bone mineral density and estimated fracture and fall risk among elderly medical inpatients: a missed opportunity
ConclusionsA very high prevalence of fracture and fall risk was noted. A medical inpatient stay offers a window of opportunity for assessment of osteoporotic fracture risk. With these findings, a bone health protocol has been developed. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - August 11, 2018 Category: General Medicine Source Type: research

Medical device patents —a review of contemporary global trends with an Irish comparison
ConclusionsIreland demonstrates high levels of medical technology patent filing per head of population, reflecting the importance of this industry. However, both Switzerland and Israel demonstrate dominance amongst smaller nations, and serving as benchmarks for national planning. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - August 11, 2018 Category: General Medicine Source Type: research

Lung metastases from benign uterine leiomyoma: does 18-FDG-PET/CT have a role to play?
We present three cases with pulmonary metastases from BML and discuss the pathogenesis and management of this rare condition. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - August 3, 2018 Category: General Medicine Source Type: research

Long non-coding RNA TRPM2-AS as a potential biomarker for hepatocellular carcinoma
ConclusionLong non-coding RNA TRPM2-AS is upregulated in HCC and represents a new biomarker for HCC and the inhibition of TRPM2-AS promotes apoptosis in HCC cells in vitro. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 25, 2018 Category: General Medicine Source Type: research

Donor human milk use in neonatal units: practice and opinions in the Republic of Ireland
ConclusionThis is the first study to evaluate current practices and opinions regarding donor milk use in the Republic of Ireland and highlights the necessity to develop a national guideline of evidence-based best practice. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 24, 2018 Category: General Medicine Source Type: research

The pregnancy experience: a mixed methods analysis of women ’s understanding of the antenatal journey
ConclusionsThis research demonstrates the varied experiences of women attending our services, highlighting both the positive and negative aspects of care. Topics of poor knowledge are highlighted, particularly in primiparous women and regarding the postnatal period. Using this information, women can be provided with an optimised, personalised experience in our maternity services. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 23, 2018 Category: General Medicine Source Type: research

Treatment of osteoporosis with recombinant parathyroid hormone, utilisation of total body DXA to observe treatment effects on total body composition and factors determining response to therapy
ConclusionsHypercalciuria which is a frequent feature in osteoporotic population may predict non-responders at 6  months of rPTH, and it may help to optimise individual patient’s treatment. Unlike endogenous PTH in pathological conditions, rPTH is anabolic to bone and has no detrimental effects on the body fat and muscle composition. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 21, 2018 Category: General Medicine Source Type: research

Treatment history and association between allergic rhinitis symptoms and quality of life
ConclusionsIn persistent AR despite consistent ICS use, nasal symptoms may be the dominant drivers of AR-associated decreased general health-related QOL in contrast to persistent AR on no medication, when extranasal symptoms of AR are most significant. Longitudinal study is needed to investigate whether these results are predictive of responsiveness to ICS. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 21, 2018 Category: General Medicine Source Type: research

The changing cost of breast cancer care: lessons from a centralised modern cancer centre
ConclusionWithin an evolving context where services are centralised, new therapies emerge and subsequently come off patent, our understanding of the value of cancer therapies continues to evolve. This has important implications for the evaluation of new therapies and broader policy initiatives in this area. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 21, 2018 Category: General Medicine Source Type: research

Co-occurrence of EGFR sensitising and resistance mutations at diagnosis in NSCLC
ConclusionThis is the largest Irish review of de novo synchronous EGFR mutations. The incidence of co-occurring EGFR mutations in our cohort of non-small cell lung carcinoma (NSCLCA) is 1% on routine assays. Erlotinib appears to have activity in this cohort in both in the first- and second-line setting. De novo S768I and T790M represent distinct clinical entities. For de novo T790M mutations cytotoxic chemotherapy may still be considered first line. For de novo S768I mutations, erlotinib appears to be a reasonable therapeutic option. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 20, 2018 Category: General Medicine Source Type: research

Prof Ronan O ’Connell Festschrift: Stricture pathogenesis in Crohn’s disease—the role of intestinal fibroblasts
AbstractApproximately one-third of patients with Crohn ’s disease have a distinct fibrostenosing phenotype predisposing them to recurrent intestinal stricture formation. The intestinal fibroblast was thought to play a critical role in the abnormal wound healing which ends in stricture formation. Recognising this, a laboratory-based research study was initiated at the Mater Misericordiae Hospital and University College Dublin with the aim of investigating the key steps in intestinal fibroblast-mediated stricture pathogenesis. An in vitro model was developed using cultured fibroblasts taken from sites of stricture in p...
Source: Irish Journal of Medical Science - July 18, 2018 Category: General Medicine Source Type: research

An audit of discharge summaries from secondary to primary care
ConclusionsThis audit shows deficits in adhering to HIQA standards. These must be addressed as a matter of urgency. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 17, 2018 Category: General Medicine Source Type: research

Physical activity and mental health in an Irish population
ConclusionCompared with those who do not, those who report meeting-recommended physical activity requirements are more and less likely to report experiencing positive and negative mental health, respectively. Future policy development around physical activity should take cognisance of the impact of this activity on both physical and mental health outcomes. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 17, 2018 Category: General Medicine Source Type: research

A novel role for estrogen-induced signaling in the colorectal cancer gender bias
AbstractColorectal cancer (CRC) is a malignancy whose incidence is increasing globally, and there is a gender difference in the increasing risk. Evidence from hormone replacement therapy studies points to a role for circulating estrogens in suppressing the development of CRC. Estrogen receptor- β has been identified as a tumor suppressor, but other actions of estrogen may also contribute to the difference in CRC incidence between men and women. The KCNQ1/KCNE3 potassium channel is regulated by estrogen in order to modulate chloride secretion during the menstrual cycle; the effect of estro gen on the colon is to promot...
Source: Irish Journal of Medical Science - July 17, 2018 Category: General Medicine Source Type: research

In recognition of Ireland ’s doctor scientists: Carel le Roux, Seamas Donnelly and Michael P Keane
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 16, 2018 Category: General Medicine Source Type: research

Pharmacy quality improvement project to enhance the medication management process in pediatric patients
ConclusionPharmacists can have a key role in improving the health-care system ’s quality in developing countries’ health-care systems. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 14, 2018 Category: General Medicine Source Type: research

Assessment of the value of gastroenterologists ’ activity in the outpatient setting: applying the “Moneyball” approach to clinical care
ConclusionMeasurement of the value of clinical activity represents an important component of gastroenterologists ’ performance. There was a threefold variation among physician levels of value with more experienced clinicians demonstrating higher value levels. Further studies will be required to more clearly define valid metrics for physician value. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 11, 2018 Category: General Medicine Source Type: research

Dementia —a major public health problem: the role of in-patient psychiatric facilities
AbstractThis paper reviews data on admissions to Irish psychiatric units and hospitals for those suffering from organic mental disorders, in particular dementia, over the course of the last half century. Admission and census data from the National Psychiatric In-patient Reporting System (NPIRS) from 1963 to 2016 are examined and discussed in light of Ireland ’s ageing population. The NPIRS database was established in the 1960s to record admission and discharge activity in Irish psychiatric units and hospitals. Admission data from the database are presented in 5-yearly intervals from 1965 to 2015, while census data ar...
Source: Irish Journal of Medical Science - July 10, 2018 Category: General Medicine Source Type: research

The effect of indirect admission via hospital transfer on hip fracture patients in Ireland
AbstractBackground and aimsCurrent best practice states that hip fracture patients should undergo surgery within 48 hours to minimise perioperative complications. There are 10 emergency departments (EDs) in Ireland that receive hip fracture patients without a trauma and orthopaedic surgery unit on site. Idle periods and duplicated preoperative investigations can lead to a prolonged time to surgery. The aim of this study was to identify the effect of admission route on the time to surgery, length of stay and pressure ulcer development in patients who sustain a hip fracture in Ireland.MethodsA retrospective cohort study was ...
Source: Irish Journal of Medical Science - July 4, 2018 Category: General Medicine Source Type: research

Antihypertensive effect of azilsartan versus olmesartan in patients with essential hypertension: a meta-analysis
ConclusionsThis meta-analysis provides the evidence that the reduction of office systolic blood pressure treated with azilsartan was greater than olmesartan in patients with essential hypertension. These findings suggest the importance of strict designed randomized controlled trials in determining antihypertensive effects of angiotensin II receptor blockers in clinical practice. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - July 3, 2018 Category: General Medicine Source Type: research

General Data Protection Regulation (GDPR) and paediatric medical practice in Ireland: a personal reflection
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - June 29, 2018 Category: General Medicine Source Type: research

Correction to: Transition from tube feeding to oral feeding: experience in a tertiary care paediatric cardiology unit
The original version of this article inadvertently used early drafts of Figs. 1 and 2. The correct figures are shown here. The original article has been corrected. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - June 29, 2018 Category: General Medicine Source Type: research

Long-term outcomes following partial atrioventricular septal defect (AVSD) repair in Ireland
ConclusionsShort- and long-term survival following partial AVSD repair in Ireland revealed excellent results compared with other published series. Reoperation incidence also compared excellently with other reports published in the literature. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - June 25, 2018 Category: General Medicine Source Type: research

Change of paradigm in treating elderly with breast cancer: are we undertreating elderly patients?
AbstractDeveloped countries face significant population ageing in the near future. Within 20  years, the average age will approach 50 years and the largest population cohort will be those over 65 years. The incidence of breast cancer increases with age, with a risk in women of 0.44% by the age of 30, 3.82% by the age of 70 and 10% by the age of 80. Breast cancer is responsible for one ou t of every three cancer-related deaths. Elderly patients have higher mortality rates and most breast cancer-related deaths are observed in women over 65. There appears to be a trend that elderly patients with breast cancer r...
Source: Irish Journal of Medical Science - June 23, 2018 Category: General Medicine Source Type: research

Age considerations in the management of recurring miscarriage
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - June 21, 2018 Category: General Medicine Source Type: research

Outcomes of transoral laser microsurgery for oropharyngeal squamous cell carcinoma in Ireland and review of the literature on transoral approaches
ConclusionsIn selected patients with OPSCC, TLM offers excellent functional and survival outcomes, and as such offers an alternative approach to chemoradiotherapy as primary treatment. We compare TLM to other transoral approaches and discuss its potential use in the Irish healthcare system. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - June 21, 2018 Category: General Medicine Source Type: research

Human studies of anorectal sensory function
AbstractThis review addresses three main questions: (1) Why is anorectal sensory function important in humans? (2) What is the evidence for anorectal sensory dysfunction in disease? (3) Can anorectal sensory function be modified for therapeutic benefit? (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - June 20, 2018 Category: General Medicine Source Type: research

The effect of aerobic exercise on stroke rehabilitation
ConclusionsIncorporation of aerobic exercises into conventional rehabilitation programs of early stroke patients may provide positive contributions, particularly to mood and aerobic capacity. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - June 19, 2018 Category: General Medicine Source Type: research

Brain death diagnosis in 2018
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - June 19, 2018 Category: General Medicine Source Type: research

A systematic review of Appropriate Use Criteria for transthoracic echocardiography: are they relevant outside the United States?
This study systematically reviewed published evidence to identify (1) whether the 2011 AUC are applicable to medical centers outside the US (2) the level of adherence to the AUC across multiple centers, (3) the main factors which cause deviation from AUC, (4) any changes in referral rates since the publication of AUC, and (5) any factors and/or intervention strategies which promote adherence to AUC.Methods and resultsElectronic databases were systematically searched for papers related to AUC and cardiac imaging. Following screening and application of eligibility criteria, data was extracted from ten reports involving 8561 ...
Source: Irish Journal of Medical Science - June 18, 2018 Category: General Medicine Source Type: research

Three-dimensional indices of renal perfusion in normal pregnancy and pre-eclampsia
ConclusionUsing 3D ultrasound, we failed to demonstrate a difference in maternal renal perfusion in normal pregnancy compared to pre-eclampsia. The lack of observed difference may be a reflection of the high variability in 3D measurements (i.e. poor investigative tool) rather than a true lack of difference in renal perfusion. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - June 18, 2018 Category: General Medicine Source Type: research

The identification of maternal smokers postnatally in an Irish maternity hospital
ConclusionsThis suggests that postnatal smoking cessation interventions should receive greater attention. We recommend that all women who identify themselves as current smokers at the first antenatal visit should complete a short questionnaire postnatally and should be offered support to quit smoking or maintain cessation after they bring their baby home. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - June 18, 2018 Category: General Medicine Source Type: research

Examining the association of body mass index and the depth of epidural space, radiation dose exposure and fluoroscopic screening time during transforaminal nerve block injection: a retrospective cohort study
AbstractObjectiveThe primary objective of this study was to examine the association between body mass index (BMI) and the depth of tissue overlying the epidural space. Secondary objectives examined the association between BMI and (1) radiation dose exposure and (2) fluoroscopic screening time during transforaminal nerve block (TFNB) injections.MethodologyThis is a retrospective cohort study including patients aged ≥ 16 years who underwent unilateral single-level TFNB in a single centre over a 28-month period, by a single spinal orthopaedic surgeon. Demographic data, BMI (kg/m2), fluoroscopic screening time (...
Source: Irish Journal of Medical Science - June 17, 2018 Category: General Medicine Source Type: research

Neoadjuvant chemoradiation and breast reconstruction: the potential for improved outcomes in the treatment of breast cancer
ConclusionThis pilot study confirms that neoadjuvant chemoradiation is a feasible way of delivering breast cancer treatment and may facilitate improved access to IBR. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - June 14, 2018 Category: General Medicine Source Type: research

Absence of thyroid transcription factor-1 expression is associated with poor survival in patients with advanced pulmonary adenocarcinoma treated with pemetrexed-based chemotherapy
AbstractIntroductionAdenocarcinoma is the commonest histologic subtype of lung cancer and is often identified by immunohistochemical staining for thyroid transcription factor-1 (TTF-1). However, up to 20% of lung adenocarcinomas do not express TTF-1, and there is uncertainty regarding the significance of this. We aimed to evaluate the prognostic effect of TTF-1 expression status on survival in patients treated with pemetrexed-based chemotherapy for advanced adenocarcinoma of the lung.MethodsThis retrospective study included patients treated with pemetrexed-based chemotherapy for stage IIIB/IV lung adenocarcinoma, who had k...
Source: Irish Journal of Medical Science - June 9, 2018 Category: General Medicine Source Type: research

The impact of sample processing delay on  deep molecular responses in chronic myeloid leukemia
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - June 6, 2018 Category: General Medicine Source Type: research