Irish medical journal最新文献

{"title":"Child Psychiatrists' knowledge on medication reimbursement schemes for mental illness.","authors":"O Deighan, A MacManus, J Hayden, F McNicholas","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>The Long-Term Illness Scheme (LTI), funded by Ireland's Health Service Executive (HSE), provides free prescriptions at the primary care level for sixteen specified physical and mental health conditions. This survey aimed to assess Child and Adolescent Psychiatrists' knowledge of the scheme, its usage, and the perceived barriers or enablers to its utilization.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among Consultants and Higher Specialist Trainees in Child and Adolescent Psychiatry in Ireland (59) on an anonymous, opt-in basis.</p><p><strong>Results: </strong>The findings revealed low levels of knowledge and utilization of this scheme. Majority of Psychiatrists, 35 of 57 (61%,) were not aware of the age criteria, medications reimbursable or that initiation of medication under the LTI scheme is restricted to Consultant Psychiatrists. Content analysis highlighted significant barriers, lack of knowledge and education on this scheme, restrictive inclusion criteria, clinician burnout and administrative burden in clinical practice.</p><p><strong>Discussion: </strong>These results underline the need for national awareness campaign on the LTI scheme, a review of medication included along with improved streamlined administrative processes. Addressing these gaps could reduce barriers for clinicians and improve access to psychotropic medications for children and adolescents with mental illness. Such measures are crucial to enhancing equitable care for mental illness.</p>","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 7","pages":"133"},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818494","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":"Global Child Mortality in Children and the Lusaka Agenda.","authors":"J F A Murphy","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 7","pages":"122"},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812227","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":"Transition of care for young people with childhood-onset disability to adult services.","authors":"P Carroll, J M Ryan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 7","pages":"124"},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812790","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":"Genomic Epidemiology of Clostridioides difficile Infection: A cgMLST Analysis.","authors":"J B Sarma, V Murray, C McFadden","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To characterise the genomic epidemiology of Clostridioides difficile infection (CDI) at Letterkenny University Hospital (LUH) using core-genome Multi Locus Sequence Typing (cgMLST), quantify true nosocomial transmission, distinguish relapse from reinfection, and examine the relationship between CDI patterns and institutional antimicrobial consumption.</p><p><strong>Methods: </strong>In 2023 and 2024, 1,510 and 1,754 stool samples were screened, respectively for suspected CDI. GDH screening was positive in 153 (10.1%) and 226 (12.9%) with toxin EIA detecting active toxin in 86 (56.2%) and 106 (46.9%), respectively. PCR identified toxin genes in a further 44 (65%) and 72 (60%) of toxin-negative GDH-positive samples. Of these, 117, toxin-positive isolates from 94 patients underwent whole-genome sequencing and cgMLST. Molecular clusters were defined as ≤2 allelic differences, and epidemiological linkage required shared ward location and overlapping admission periods. National antimicrobial-use deciles were reviewed for CDI-associated agents.</p><p><strong>Results: </strong>cgMLST identified 28 sequence types, with ST11 predominating (19, 16.2%). Of 48 clusters, only one represented confirmed nosocomial transmission. Recurrent CDI occurred in 10 out of 94 (11%), with 90% representing molecular relapse. LUH ranked among the highest national consumers of CDI-associated antimicrobials.</p><p><strong>Discussion: </strong>CDI at LUH is driven primarily by endogenous activation of community-acquired strains rather than hospital transmission. High-risk antimicrobial use is the key modifiable driver, highlighting the need for strengthened antimicrobial stewardship supported by ongoing WGS surveillance.</p>","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 7","pages":"129"},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812239","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":"Acute Sector Cancer Physiotherapy Service Provision and Workforce.","authors":"E M Guinan, R Keating, F Kinsella, N Moylan, J O'Riordan, F Theron, A Walsh, S Adelakun, S Al Rashdi, J Elliott, G Sheill","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>This audit aimed to quantify cancer physiotherapy workforce and services across the acute cancer services and to examine current priorities, barriers and facilitators to service delivery.</p><p><strong>Methods: </strong>A cross-sectional survey tool was used to capture data from physiotherapist managers at 9 designated cancer centres (DCC) and 17 acute systemic anti-cancer therapy (SACT) hospitals, where regional cancer care is delivered. Quantitative data was analysed descriptively and qualitative data from open-text comments were analysed narratively.</p><p><strong>Results: </strong>All 26 physiotherapist managers responded. Within the eight adult DCC's the most frequently reported dedicated cancer physiotherapy services were lymphoedema management (7), exercise and rehabilitation during cancer treatment (6), and postoperative out-patient rehab for specific musculoskeletal conditions following surgery (5). In the SACT hospitals, the most frequent services were postoperative out-patient rehab for specific musculoskeletal conditions following surgery (8) and contribution to community cancer support centres (6). Paediatric and adolescent cancer physiotherapy services were provided to in-patients only. Nationally, 54 physiotherapy posts were dedicated (80-100% caseload) to cancer care, the majority (41) in the DCC's, where physiotherapists were highly skilled and trained. Major barriers to service development were staffing, funding, and service prioritisation.</p><p><strong>Discussion: </strong>National strategic development of a specialised cancer physiotherapy workforce is essential.</p>","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 7","pages":"134"},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818439","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":"Invasive vs Non-invasive Management of Elderly Patients with Non-ST-Elevation Myocardial Infarction (NSTEMI).","authors":"A Subramaniyan, D McGee, J O'Neill","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>Management of non-ST-elevation myocardial infarction (NSTEMI) in older patients remains challenging, particularly following the SENIOR-RITA trial, which did not demonstrate a mortality benefit with invasive management. This audit aims to compare outcomes between invasive and non-invasive management strategies in patients aged ≥75 years presenting with NSTEMI at Connolly Hospital, Blanchardstown, and to relate these findings to European Society of Cardiology (ESC) guidelines and SENIOR-RITA.</p><p><strong>Methods: </strong>A retrospective audit of 50 NSTEMI patients aged ≥75 admitted from 2020 to 2024 examined mortality, length of stay, complications, and readmission rates. Survival was analysed with Kaplan-Meier.</p><p><strong>Results: </strong>Of 50 patients, 29 (58%) underwent invasive management. Baseline features were similar between the invasive and conservative groups, though frailty was infrequently documented with formal assessment tools. Invasive patients had shorter stays (p=0.041) and lower 6-month mortality (14.3% vs 85.7%, p=0.03254). Kaplan-Meier analysis showed higher survival in the invasive group. Complication and readmission rates were similar.</p><p><strong>Discussion: </strong>Invasive management was associated with a shorter hospital stay and lower mortality. However, the findings should be interpreted cautiously, given the retrospective design and possible selection bias. These findings do not contradict the SENIOR-RITA trial, and local practice aligned with ESC guidelines.</p>","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 7","pages":"131"},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812800","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":"Physicians and the Future of Health Systems.","authors":"A Carroll","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Healthcare reform debates often focus on organisational structures and governance arrangements. However, patient outcomes are shaped not only by institutional design but also by how healthcare systems function in practice. Physicians encounter the consequences of system design daily through fragmented services, delays in diagnostics, and challenges coordinating care across sectors. This article argues that modern healthcare systems should be understood as complex adaptive systems in which outcomes emerge from the interactions of clinicians, organisations, and patients. Structural reform alone cannot deliver integrated care. Physicians therefore have an important role in engaging constructively with system improvement through clinical leadership, quality improvement, and professional collaboration. In an era of growing complexity and evolving patterns of illness, engagement with health system design represents an important dimension of professional responsibility.</p>","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 7","pages":"125"},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812809","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":"Implementation and Impact of a Dedicated Geriatric Service: A Service Improvement Study.","authors":"R Ahmed, I Marion","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To design, implement, and evaluate a consultant-led Comprehensive Geriatric Assessment (CGA) service within an Irish private acute hospital, where structured geriatric models are not routinely embedded. The study examined the early operational and clinical impact of the service on care delivery for hospitalised adults aged ≥75 years.</p><p><strong>Methods: </strong>A retrospective service-improvement audit was conducted involving 50 consecutive inpatients aged ≥75 years admitted to acute medical wards following introduction of a consultant-led geriatric service. Data were extracted from electronic health records using a structured audit tool aligned with the Health Service Executive (HSE) Model of Care for Older People, National Clinical Programme for Older People (NCPOP) quality standards, and the British Geriatrics Society Silver Book II. Primary outcomes were (1) time to first geriatric review and (2) proportion of patients reviewed within 48 hours. Secondary outcomes included multidisciplinary team (MDT) involvement, length of stay (LOS), discharge destination, and 30‑day readmission. Post‑implementation outcomes were descriptively compared with aggregated hospital activity data from the 12 months preceding service introduction.</p><p><strong>Results: </strong>The mean age of patients was 82.6 years (SD 5.1), and 29 (58%) were female. The median time to first geriatric review was 29 hours, with 42 (84%) patients assessed within 48 hours of admission. MDT involvement was documented in 35 (70%) patients, compared with an estimated pre-implementation baseline of 22 (45%). The mean length of stay was 6.8 days, compared with a historical institutional estimate of 8.7 days derived from pre-service hospital activity data, representing an approximate 22% reduction. Discharge directly home occurred in 33 (66%) patients, while 5 (10%) were readmitted within 30 days. Staff survey responses (50) demonstrated high awareness of the service among 44 (88%) respondents and a perceived improvement in discharge coordination in 41 (82%).</p><p><strong>Conclusions: </strong>Introduction of a dedicated geriatric service in a private acute Irish hospital was associated with earlier specialist review, high multidisciplinary engagement, and favourable discharge outcomes. These findings support further development of CGA-aligned services within the private healthcare sector.</p>","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 7","pages":"128"},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148812829","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":"Attitudes of Cardiac Anaesthesiologists regarding care of the Jehovah's Witness patient undergoing surgery.","authors":"N Lenggenhager-Krakoski, R Mooney, M Brohan, J R Sheehan, A Coakley, B O'Brien","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>The views of Irish cardiac anaesthesiologists on Jehovah's Witness patients who require cardiac surgery while refusing blood transfusion are unknown. We aimed to assess whether these doctors would willingly treat, or forego involvement with this patient cohort, given the foreseeable complications.</p><p><strong>Methods: </strong>All consultant cardiac anaesthesiologists in Ireland were e-mailed an anonymised cross-sectional survey with 17 quantitative and 1 free-text qualitative question. The results were analysed by Stata 17 software.</p><p><strong>Results: </strong>Valid survey results were received from 26, a response 32 (82%). The majority 23 (88.5%) professed willingness to support a colleague who conscientiously objected to treating Jehovah's Witness patients. One said they would not offer such care 1 (3.8%). Most 19 (73%) had treated Jehovah's Witnesses undergoing cardiac surgery, with 15 (58%) using different preoperative strategies.</p><p><strong>Discussion: </strong>The refusal of blood transfusions raises bioethical issues in high-risk procedures, and could prompt doctors to refuse involvement, analogously to recent legislation on termination of pregnancy. We found very low rates of such reluctance however with support for hypothetical colleagues who might feel otherwise. It appears that cardiac anaesthesiologists are willing to take a professional risk where it is consistent with the patients values but at odds with their own.</p>","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 7","pages":"130"},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813193","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":"Delayed Diagnosis of an Ischial Tuberosity Avulsion Fracture in a Young Gaelic Football Player.","authors":"S O'Grady, F Rowan, R Ryan, P O'Grady","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Presentation: </strong>Ischial tuberosity avulsion fractures account for a minority of pelvic apophyseal injuries in adolescents but are frequently misdiagnosed as hamstring strains. We report one case of delayed diagnosis following a Gaelic Football Injury.</p><p><strong>Diagnosis: </strong>A male teenaged footballer player developed persistent right buttock pain after kicking the ball at full sprint. Initial management was conservative for presumed hamstring strain. After two years of persistent pain and inability to sprint, he was referred for an Orthopaedic opinion. He had persistent focal bone tenderness over the ischium bone. Plain radiographs of the pelvis demonstrated an avulsion fracture of the ischial tuberosity, displaced over 2 cm.</p><p><strong>Treatment: </strong>Open reduction and internal fixation with screw stabilisation and autologous bone grafting was performed. The patient returned to sport at three months. At follow up after one year he was asymptomatic, plain radiograph showed bone healing and he was discharged.</p><p><strong>Discussion: </strong>Apophyseal avulsion fractures are uncommon. Failure to diagnose early may lead to a non union and failure to return to sport. Persistent buttock pain in adolescent athletes warrants early radiographic evaluation. Fractures displaced more than 2 cm may benefit from operative fixation to facilitate return to sport.</p>","PeriodicalId":14713,"journal":{"name":"Irish medical journal","volume":"119 7","pages":"138"},"PeriodicalIF":0.0,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818492","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}