Irish Journal of Medical Science (1971 -)最新文献

{"title":"Pharmacokinetic enhancers (cobicistat/ritonavir) and the potential for drug-drug interactions.","authors":"Paul Hollywood, Rachel MacCann, David Lorigan, Eoghan de Barra, Samuel McConkey","doi":"10.1007/s11845-019-02125-1","DOIUrl":"10.1007/s11845-019-02125-1","url":null,"abstract":"<p><strong>Background: </strong>The potential for clinically significant drug interactions (CSDIs) for patients taking ritonavir and cobicistat is high because of their powerful pharmacokinetic effect on the cytochrome P450 (CYP) enzyme system, most notably their inhibitory effect on CYP3A4.</p><p><strong>Aims: </strong>An audit was conducted to measure and correct for patients exposed to potentially dangerous drug interactions.</p><p><strong>Methods: </strong>Two hundred individuals attending a regional specialist human immunodeficiency virus (HIV) clinic between June and September 2014 who were receiving the pharmacokinetic enhancers ritonavir or cobicistat were interviewed to determine a medication history including medications prescribed by their general practitioner (GP), over-the-counter (OTC) medicines, herbal remedies and recreational drugs.</p><p><strong>Results: </strong>Of the 200 patients interviewed, patients were aged 23-76 years (median age was 41.5), 64% were female and 173 reported taking a co-medication. Sixty-six (33%) were taking a medication or medications which had no significant drug interaction associated with them. One hundred and seven (54%) were taking one or more medications with a CSDI which could require a dose adjustment, close monitoring or an absolute contraindication. Only 27% of these co-medications were identified in the normal course of an outpatient visit outside of the audit.</p><p><strong>Conclusion: </strong>A detailed medication history is often lacking at routine HIV follow-up visits. There is a significant risk of CSDIs in this cohort. Awareness of physicians and pharmacists needs to be raised. Implementation of several innovative strategies to capture the most accurate medication histories and avoid drug toxicities now employed in this cohort is also discussed here.</p>","PeriodicalId":14616,"journal":{"name":"Irish Journal of Medical Science (1971 -)","volume":"3 1","pages":"693-699"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72808921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cost-effectiveness analysis of dialectical behaviour therapy for treating individuals with borderline personality disorder in the community.","authors":"Aileen Murphy, Jane Bourke, Daniel Flynn, Mary Kells, Mary Joyce","doi":"10.1007/s11845-019-02091-8","DOIUrl":"10.1007/s11845-019-02091-8","url":null,"abstract":"<p><strong>Background/aims: </strong>This paper investigates the cost-effectiveness of dialectical behaviour therapy (DBT) for treating individuals with borderline personality disorder (BPD) in a community setting in Ireland, in the short term.</p><p><strong>Methods: </strong>Resource utilisation and effectiveness data were collected as part of the National DBT Project, Ireland, and are incorporated into a cost-effectiveness analysis. The perspective taken was that of the service provider and payer. Direct health resources were included and effectiveness was measured using the EQ-5D-5L questionnaire. To examine cost-effectiveness, incremental costs are compared with incremental quality-adjusted life years, to estimate an incremental cost-effectiveness ratio. A probabilistic sensitivity analysis was employed to investigate parameter uncertainty. Scenario analyses are employed to investigate cost-effectiveness of DBT with varying assumptions around effectiveness and costs.</p><p><strong>Results: </strong>The baseline analysis reveals that DBT is more expensive and more effective than routine clinical care (without DBT). The low incremental cost-effectiveness ratio suggests DBT can be considered cost effective in the short term. In each scenario analyses considered, the probability that DBT is cost effective is greater than 50%.</p><p><strong>Conclusions: </strong>Mental health care provision, including that of DBT, varies across jurisdictions, necessitating economic evaluations of current practice in community-based services, on a country-by-country basis, to inform resource allocation decisions. In line with previous research, the analysis here indicates DBT can be considered cost effective in the short term. Future data collection on alternative comparators and long-term outcomes associated with DBT is warranted to investigate the longer term cost-effectiveness of DBT.</p>","PeriodicalId":14616,"journal":{"name":"Irish Journal of Medical Science (1971 -)","volume":"41 1","pages":"415-423"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76288138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of low-temperature plasma treatment on pulmonary function in children with obstructive sleep apnea-hypopnea syndrome.","authors":"Xiaoyong Wang, Yehai Liu, Guanglei Tang, Hui Wang, Yi Zhao","doi":"10.1007/s11845-019-02132-2","DOIUrl":"10.1007/s11845-019-02132-2","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a common sleep-related respiratory disease. Despite reports of low-temperature plasma radiofrequency ablation of tonsils and adenoids for the treatment of OSAHS, the effects on lung function and quality of life are unclear.</p><p><strong>Aims: </strong>This study aims to explore the effects of low-temperature plasma treatment on pulmonary function in children with OSAHS.</p><p><strong>Methods: </strong>A total of 110 children with OSAHS were included in this prospective study. Low-temperature plasma radiofrequency treatment and routine surgical treatment were performed in group A and group B, respectively. Maximal voluntary ventilation (MVV), forced vital capacity (FVC), and total lung capacity (TLC) were measured. OSA-18 survey was used to evaluate the quality of life 1 year after operation.</p><p><strong>Results: </strong>Group A had significantly higher effective treatment rate (P < 0.05) and lower operative period, bleeding volume, visual analog score, pseudomembrane detachment time, and time required to feed after operation than group B (all P < 0.001). There were no significant difference in the incidence of postoperative complications between the groups and MVV, FVC, and TLC between the groups before and after operation (all P > 0.05), and the above indexes in both groups were significantly increased after operation (all P < 0.05). OSA-18 scores in group A were significantly lower than group B after operation (P < 0.001).</p><p><strong>Conclusions: </strong>Low-temperature plasma technique performed in OSAHS children has a good clinical effect, which can reduce the operation time, intraoperative blood loss, postoperative pain, pseudomembrane detachment time, hospitalization time, and improve pulmonary function and quality of life.</p>","PeriodicalId":14616,"journal":{"name":"Irish Journal of Medical Science (1971 -)","volume":"57 1","pages":"603-609"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77353460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient experience in a surgical assessment unit following a closed-loop audit using a Kaizen Lean system.","authors":"Muhammad Fahad Ullah, Christina Fleming, Christopher Fox, Tej Tewary, Shona Tormey","doi":"10.1007/s11845-019-02105-5","DOIUrl":"10.1007/s11845-019-02105-5","url":null,"abstract":"<p><strong>Background: </strong>The Acute Surgical Assessment Unit (ASAU) in University Hospital Limerick (UHL) has provided a solution to overcrowding and long waiting times since centralization of emergency services to UHL. Recognising the importance of its evolving role, the ASAU in UHL has recently undergone a major revamp to ease the pressure in the overcrowded emergency department (ED). This included a new purpose state-of-the-art-built unit and equipment, improved staffing levels and use of a Kaizen Lean system to identify key area of delays and inefficiency with subsequent implementation of suggestions derived after Kaizen Lean. Patient satisfaction reporting was analysed in the older building and subsequently in the new site post Kaizen Lean to complete a closed-loop audit. The aim of the study was to examine patient satisfaction response rates with the ASAU prior to and following Kaizen Lean implementation and transfer to a new purpose-built unit.</p><p><strong>Methods: </strong>The survey comprised of two phases. In phase 1, 100 questionnaires were distributed to patients in ASAU (older building, pre-Kaizen Lean). In phase 2, the survey was repeated (100 patients) after Kaizen Lean implementation and transfer to the new state-of-the-art unit. Questionnaire design was based on WHO strategy on responsiveness measurement guidelines and was tailored to a population of surgical patients. Results were analysed using IBM SPSS, version 21 and Excel 2013.</p><p><strong>Results: </strong>Two hundred questionnaires were analysed. Implementation of suggestions derived post Kaizen Lean translated into improved resource usage with reduced waiting time to be seen by nurses and doctors. Patients had better awareness about their treatment plan and planned next steps in the management. Satisfaction across different domains, perceptions of privacy and overall treatment were also improved.</p><p><strong>Conclusions: </strong>A Kaizen Lean approach improved the transition of an ASAU to a new purpose-built unit and further improved overall patient satisfaction with services of the ASAU.</p>","PeriodicalId":14616,"journal":{"name":"Irish Journal of Medical Science (1971 -)","volume":"151 1","pages":"641-647"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88114654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dorsal root ganglion pulsed radiofrequency treatment for chronic cervical radicular pain: a retrospective review of outcomes in fifty-nine cases.","authors":"Aine O'Gara, Aine Leahy, Connail McCrory, Basabjit Das","doi":"10.1007/s11845-019-02087-4","DOIUrl":"10.1007/s11845-019-02087-4","url":null,"abstract":"<p><p>Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is used to treat persistent cervical radicular pain that has not responded to conservative therapies. This technique has gained popularity in years for both cervical and lumbosacral radicular pain. The evidence to support its use is still evolving.</p><p><strong>Methods: </strong>We performed a retrospective review of outcomes in 59 patients who underwent this therapy over a 3-year period in our institution. We evaluated a reduction in pain, duration of pain relief, reduction in use of analgesics and progression to surgery.</p><p><strong>Results: </strong>Our results demonstrated 49 patients experienced some relief. Forty patients of the 59 experienced an improvement in pain of 50% or more. The mean duration of relief in this group was 37 weeks. Seven patients experienced complete resolution of their pain. In this group, the mean duration of relief was 39 weeks. Regarding the 53 patients who were taking medication for pain prior to the procedure, 37 patients reduced or discontinued their usage after the procedure.</p><p><strong>Conclusion: </strong>Despite the limitations of a retrospective study, we feel our study adds to the growing evidence base that pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion has a role in the treatment of chronic cervical radicular pain.</p>","PeriodicalId":14616,"journal":{"name":"Irish Journal of Medical Science (1971 -)","volume":"32 1","pages":"299-303"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89424541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rhegmatogenous retinal detachments: primary reattachment rates and visual outcomes over a 4-year period.","authors":"Patrick J Murtagh, Kirk A Stephenson, Maedbh Rhatigan, Elizabeth M McElnea, Paul P Connell, David J Keegan","doi":"10.1007/s11845-019-02084-7","DOIUrl":"10.1007/s11845-019-02084-7","url":null,"abstract":"<p><strong>Background and aims: </strong>To describe rhegmatogenous retinal detachment surgery in a Dublin tertiary referral centre over a 4-year period and to examine factors predictive of surgical and anatomical success.</p><p><strong>Methods: </strong>A retrospective study was performed by reviewing the surgical log and the charts of patients who underwent a primary retinal detachment repair in a specialist centre over a 4-year period between 2012 and 2015. We excluded exudative and tractional cases. Multiple parameters were recorded including macular status, visual acuity, type of procedure, complications and visual and anatomical outcomes at 6 months post operation. Primary reattachment rate was calculated alongside change in visual acuity. Chi-square testing and analysis of variance were utilized to determine the effect which lens status, macular status, extent of breaks and type of procedure had on outcome and visual success.</p><p><strong>Results: </strong>A total of 613 primary rhegmatogenous retinal detachment repairs were performed over the 4-year period. Our primary reattachment rate was calculated to be 88.58% (annual range 85.25-91.30%) with a perioperative complication rate of 2.94%. We noted a statistical significant improvement in VA with a median logMAR VA of 1.0 at presentation to 0.5 at 6 months post procedure. Macular status (chi-square test p = 0.15, X² = 2.072) and lens status (chi-square test p = 0.2974, X² = 1.086) had no statistical effect on the final anatomical outcome. However, eyes with giant retinal tears were more likely to redetach than those without (chi-square test p = 0.0069, X² = 7.3). There was no statistical significant difference in the proportion of eyes achieving visual success by surgery category (one-way ANOVA analysis p = 0.501).</p><p><strong>Conclusions: </strong>This is the first study of its kind in Ireland and will help surgeons benchmark their results against international standards in the future. Accurate recording of logMAR acuity and intraoperative complications is imperative to assist with prospective studies.</p>","PeriodicalId":14616,"journal":{"name":"Irish Journal of Medical Science (1971 -)","volume":"38 1","pages":"355-363"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76245466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Participation of the hospitals in the Republic of Ireland in international research over more than a decade: a bibliometric analysis.","authors":"Ahmed Abdelaal Ahmed Mahmoud, Mohamed I Younis, Christopher Holmes, Amr Sallam, Mohamed Gomaa Kamel, Eugene Dempsey, Orla Mulhern","doi":"10.1007/s11845-019-02077-6","DOIUrl":"10.1007/s11845-019-02077-6","url":null,"abstract":"<p><strong>Background: </strong>This study provides an accurate awareness of the present situation of health research in Irish hospitals both public and private. We aimed to analyze factors that may influence it and provide recommendations for active steps to improve the current situation of Irish health research based on our findings.</p><p><strong>Methods: </strong>We performed a bibliometric analysis to assess qualitatively and quantitatively the publications from Ireland over a period between 2007 and 2018. We also investigated the associated variables with the quality of research. Furthermore, we conducted a Joinpoint analysis to see the trends in Irish research over these years.</p><p><strong>Results: </strong>From 12,828 included peer-reviewed articles, the average citation count per article was 19.98. Furthermore, we showed that a higher impact factor (IF) and institutions number, present per article, were significantly associated with more citations. Also, the publication count and the mean IF showed an increase over the years according to the Joinpoint analysis. Moreover, the oncology research had the highest output, followed by pediatrics, then neurology while the specialties with least publications were ear, nose, and throat (ENT), urology, plastic surgery, and dentistry. Additionally, cardiovascular, obstetrics and gynecology, oncology, pediatrics, pulmonology, dermatology, ophthalmology, dentistry, and radiology research showed an increased publication count trend in recent years. While anesthesiology, ENT, general surgery, gastroenterology and hepatology, infection and tropical medicine, nephrology, neurology, orthopedics, plastic surgery, and urology showed a decrease in the publications trend.</p><p><strong>Conclusions: </strong>Our findings may serve as a useful approach to benchmark scientific output from hospitals and guide the future allocation of research spending.</p>","PeriodicalId":14616,"journal":{"name":"Irish Journal of Medical Science (1971 -)","volume":"1 1","pages":"51-69"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83003480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tobacco control and 'plain packaging': performativity, cigarettes and the semiotics of brand names.","authors":"Margaret J Moran Stritch, Frank Houghton, Diane O'Doherty, Derek McInerney, Bruce Duncan","doi":"10.1007/s11845-019-02066-9","DOIUrl":"10.1007/s11845-019-02066-9","url":null,"abstract":"","PeriodicalId":14616,"journal":{"name":"Irish Journal of Medical Science (1971 -)","volume":"134 1","pages":"405-407"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74699678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oropharyngeal dysphagia among patients newly discharged to nursing home care after an episode of hospital care.","authors":"Ellen Horgan, Susan Lawson, Desmond O'Neill","doi":"10.1007/s11845-019-02061-0","DOIUrl":"10.1007/s11845-019-02061-0","url":null,"abstract":"<p><strong>Background: </strong>Oropharyngeal dysphagia (OPD) is a common but under-recognized problem among older residents in nursing homes. If not detected and properly managed, it is a risk factor for failure to thrive and aspiration pneumonia. Discharge to nursing home from hospital may provide an opportunity for detection and subsequent management.</p><p><strong>Objective: </strong>To assess the extent of transfer of communication of swallow disorders in patients newly discharged to nursing homes from a university teaching hospital and catalogue recommendations suggested at discharge.</p><p><strong>Setting: </strong>University teaching hospital METHOD: Speech and language therapy (SLT) consultation notes of referrals from 100 consecutive patients discharged to nursing homes for the first time are reviewed for presence of a swallow disorder. The discharge documentation was then assessed to determine transfer recommendations for management of swallow disorders.</p><p><strong>Results: </strong>Fifty-three patients had been referred to SLT for suspected OPD during hospitalization. At time of discharge, 35 (35%) continued to present with OPD and swallow recommendations were made as part of the management plan. An SLT report was transmitted to the nursing home in 80% of these cases.</p><p><strong>Conclusions: </strong>OPD is present at discharge in over one-third of patients newly discharged to nursing home following a hospital admission, and this may be an under-estimate. This is significant in terms of planning of future care of management in nursing homes. It is important that the syndrome is duly noted in transfer documentation and that appropriate multi-disciplinary support arranged for residents in nursing homes with OPD.</p>","PeriodicalId":14616,"journal":{"name":"Irish Journal of Medical Science (1971 -)","volume":"1808 1","pages":"295-297"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86526770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AdCom study-adolescent communication group therapy for externalising disorders.","authors":"Farzana Sadiq, Aisling Mulligan","doi":"10.1007/s11845-019-02076-7","DOIUrl":"10.1007/s11845-019-02076-7","url":null,"abstract":"<p><strong>Background: </strong>Communication difficulties are associated with oppositional symptoms in young people. We hypothesise that a communication group intervention will reduce oppositional symptoms in young people. Previous research on communication and social skills training in young people with externalising disorders is limited.</p><p><strong>Aims: </strong>We aimed to (1) develop and describe a group communication intervention to promote social competence in adolescents with behaviour difficulties, for use in CAMHS with those with attention-deficit/hyperactivity disorder (ADHD)/externalising disorders, and (2) collect pilot data on the effectiveness of this intervention.</p><p><strong>Methods: </strong>We developed and delivered a programme of eight sessions to eight adolescents aged 12 to 13 years. We describe the intervention and challenges running the programme. We present pilot study data on pre- and post-oppositional symptoms.</p><p><strong>Results: </strong>Our programme was relatively well attended; pilot data indicated a small reduction in oppositional symptoms in all participants. Challenges in running the group were noted.</p><p><strong>Conclusions: </strong>Our pilot study data suggest that further research is needed to study the effects of a communication group intervention on oppositional symptoms in a larger number of adolescents.</p>","PeriodicalId":14616,"journal":{"name":"Irish Journal of Medical Science (1971 -)","volume":"77 1","pages":"261-265"},"PeriodicalIF":0.0,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80149650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}