The Ulster medical journal最新文献

{"title":"'More than Skin Deep: Listening, Learning and Living with Hailey'.","authors":"Anna Rea, Emma Keelan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94250,"journal":{"name":"The Ulster medical journal","volume":"94 2","pages":"106"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric Sinogenic Subdural and Extradural Empyema: A Review of Local Surgical Management Over 10 Years.","authors":"David McCrory, Grigoris Iosif, Keith Trimble","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To investigate timing and surgical approaches of multidisciplinary management of sinogenic subdural and extradural empyema in the paediatric population.</p><p><strong>Methods: </strong>We performed a retrospective analysis of all cases of sinogenic subdural and extradural empyema at our tertiary referral centre over a 10-year study period from 1^st May 2012 to 1^st May 2022. Data on demographics, presenting features, surgical management, length of stay, radiological investigations, microbiology results and long-term morbidity was recorded in a spreadsheet for analysis.</p><p><strong>Results: </strong>We identified 11 children (mean age 11.3 years ± 2.3). In this sample, 7 were male (63.6%) and 4 female (36.4%). There were 7 cases of subdural empyema (63.6%), 2 cases of extradural empyema (18.2%) and 2 cases with both subdural and extradural empyema (18.2%). There were significant underlying co-morbidities in 2 cases (18%). The frontal sinus was suspected source in 10 cases (91%). Endoscopic sinus surgery was performed in 10 cases (91%); with 9 of these cases (90%) as/with the initial operation or within 24 hours of initial operation. Craniotomy was required in 9 cases total (81%), with 5 cases (56%) as/with the initial operation or within 24 hours of initial operation. After initial craniotomy 4 cases (44%) required further neurosurgical evacuation of abscess. Additionally, 2 cases managed with initial burrhole later required craniotomy. All 3 cases of small volume subdural empyema without neurological deficit were initially managed with endoscopic sinus surgery only and all cases subsequently required craniotomy. All cases with subdural empyema required craniotomy (n=9) whereas all cases with isolated extradural empyema avoided craniotomy (n=2). There was a longer length of stay in those that presented with neurology or low GCS than those that did not (27 days ± 10 compared to 86 days ± 41, p= 0.009). Long term morbidity and repeated neurosurgical intervention were more common in those cases with subdural empyema than those without subdural empyema, (55% vs 0% and 67% vs 0% respectively) although only 2 patients did not have subdural empyema (no statistical analysis available given small numbers). A Streptococcus milleri group microbe was isolated in 82% of cases.</p><p><strong>Conclusions: </strong>Endoscopic sinus surgery does not seem effective at preventing the need for craniotomy in cases of subdural empyema. It does have a role in aiding microbiological diagnosis. ESS may have a role in the treatment of extradural empyema and avoiding craniotomy. Subdural empyema has a higher morbidity and return to theatre rate than extradural empyema. Those that present with a neurological deficit or decreased GCS have a longer length of stay. Larger studies are required to assess the timing and extent of surgical interventions for subdural and extradural empyema.</p>","PeriodicalId":94250,"journal":{"name":"The Ulster medical journal","volume":"94 2","pages":"83-88"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introductions.","authors":"James Lucas","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>It is a great privilege to assume the role of Honorary Editor of the Ulster Medical Journal from my predecessor, Professor David Armstrong. In doing so, it is important to mark his contribution to the Journal. During his tenure, David oversaw the publication of an eclectic mix of original papers, covering history, ethics and clinical medicine. His thought-provoking and erudite editorial pieces were crafted with literary flair. As I have recently come to appreciate, the role of editor involves considerable tenacity with regards to the independent peer-review process, a careful eye for detail and the skills of a diplomat. David is a busy clinician, and it could not have been easy to juggle an additional commitment as demanding as this one. The success of the UMJ flows, in no small part, from the wisdom of its Editorial Board. My colleague, Professor Peter Maxwell, opens a series of Guest Editorials, below, with a discussion on the challenges facing clinical academics in the workforce. I hope that policy makers will give careful consideration to the solutions that he proposes. A longstanding and steadfast supporter of this Journal, Professor John Hedley-Whyte, who is the David S. Sheridan Professor of Anaesthesia and Respiratory Therapy at Harvard University, has recently stepped down from the Editorial Board. His contribution as an author, particularly to the Medical History Section of this Journal, has been immense and continues in this Issue, on the subject of Hugh Percy, 10^th Duke of Northumberland. Professor Hedley-Whyte's colleagues on the Editorial Board have asked me to thank him for his many years of service and to wish him well for the future. My satisfaction in seeing this Issue of the Journal take shape over the summer was considerably tempered by the news of Professor Barry Kelly's death, in June. To describe Barry simply as a 'former editor' of this Journal hardly does justice to his contribution. I am grateful, therefore, to Professor Patrick Morrison, who has penned a fitting and moving obituary to a great thinker, whose loss will be felt far beyond his family, friends and colleagues.</p>","PeriodicalId":94250,"journal":{"name":"The Ulster medical journal","volume":"94 2","pages":"61-63"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Curiositas - Psychiatric Puzzles.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94250,"journal":{"name":"The Ulster medical journal","volume":"94 2","pages":"107-108"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mutation characterisation of the cystic fibrosis transmembrane conductance regulator (CFTR) gene in people with cystic fibrosis in Northern Ireland.","authors":"Philippa J Blevings, John E Moore, John McCaughan, Alastair Reid, Jacqueline C Rendall, Beverley C Millar","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cystic fibrosis (CF), which is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene is the most common life-limiting autosomal recessive genetic disease in Northern Ireland. Currently, Northern Ireland has approximately 520 people with CF (PwCF) (312 adults, 208 children) and a defective gene carrier rate of 1 in 22 persons, with approximately 86,507 carriers within the general population. Advances in DNA sequencing technology has allowed for better genetic characterisation of CFTR mutations. The aim of this project was to (i) examine current CFTR mutation frequency and type in paediatric and adult CF populations in Northern Ireland, (ii) examine CFTR mutational trends in relation to CF patients' age groups, (iii) compare Northern Ireland CFTR most common allele frequencies with those documented globally and (iv) establish a reference/baseline of CFTR mutation information prior to the effect of CFTR modulator therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Anonymised data comprising of birth year, sex, and known alleles of adult and paediatric individuals (n=520) from the Northern Ireland CF population was examined. Alleles were recorded according to legacy, protein and cDNA name and organised by mutation class and type, in accordance with CFTR2 database nomenclature. Individual known alleles frequencies from the complete Northern Ireland CF population (n=1005) were calculated and compared with the CFTR2 database, globally with CFTR data obtained from CF national registries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Within the Northern Ireland CF population, there were 61 different CFTR mutational variants identified in a population of 1005 alleles. In descending occurrence, the most common was F508del with 626 alleles (62.3%), followed by R117H (8.9%), G551D (5.0%), G542X (3.3%), R560T (2.8%) and P67L (2.2%). The remaining alleles were present at a frequency of &lt;2.0%. The six most frequently detected CFTR mutations accounted for 84.4% of all alleles. Over approximately two and a half decades (1996-2021), 23 CFTR mutations remain shared. Six alleles, which were described in the 1996 CFTR analysis, were absent from the 2021 data, whilst there were additional descriptions of 39 allelic mutations, which occurred in the 2021 analysis, but which were not described in the 1996 analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Characterisation of CFTR mutation alleles from people with cystic fibrosis provides essential information to help predict disease severity and effect of targeted CFTR modulator therapy. These 2021 data provide a valuable genetic update from the 1996 data and a reference point on the status of the Northern Ireland CFTR mutation types and frequencies. CFTR modulator therapy has the potential to indirectly alter the current &lt;i&gt;status quo&lt;/i&gt; and distribution of CFTR mutation types amongst children of PwCF, due to improved clinical status and fecundity. Revisiting this in a decade from n","PeriodicalId":94250,"journal":{"name":"The Ulster medical journal","volume":"94 2","pages":"64-76"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hugh Percy, 10th Duke of Northumberland: Chairmanship of the Agricultural and Medical Research Councils.","authors":"John Hedley-Whyte, Debra R Milamed","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94250,"journal":{"name":"The Ulster medical journal","volume":"94 2","pages":"96-103"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes In Acute Kidney Injury Requiring Haemodialysis - A Retrospective Cohort Study.","authors":"S Chetcuti, A Masengu","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acute kidney injury (AKI) requiring intermittent haemodialysis (AKI-IHD) is associated with significant morbidity and high mortality. There is limited data regarding clinical outcomes in individuals with AKI-IHD in Northern Ireland. The aim of this study was to explore clinical outcomes in a cohort of individuals with AKI-IHD, including rates of recovery to self-sustaining kidney function, mortality rates at 30 days and 2 years from start of haemodialysis, and to investigate potential predictors of these key outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Acute Haemodialysis Unit in the Royal Victoria Hospital, Belfast, Northern Ireland, was established in 2011 to provide onsite inpatient intermittent haemodialysis (IHD) to individuals requiring this supportive treatment. A retrospective review of 188 incident IHD patients in the Royal Victoria Hospital from January 2018-December 2022 was undertaken. Demographic and clinical outcome information on 12th May 2023 was obtained from the nephrology electronic database eMed (Mediqal) and the Northern Ireland Electronic Care Record.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;188 individuals commenced IHD for the first time as a consequence of life-threatening complications of AKI during the 5-year period (January 2018-December 2022).75% of these patients were not previously known to the nephrology service, (GROUP A, n=142, mean age 63 years, mean baseline serum creatinine 99 μmol/L) while 25% (GROUP B, n=46, mean age 67 years, mean baseline creatinine 278 μmol/L) had been attending a Nephrology Clinic for at least 12 months.A significant proportion of AKI developed during the inpatient admission rather than at initial presentation (GROUP A 47%, GROUP B 50%).92% of GROUP A recovered self-sustaining kidney function before discharge, compared to 59% of GROUP B. A lower baseline serum creatinine was the only predictor of kidney recovery in GROUP B, p value=0.02. No predictors for kidney recovery were identified in GROUP A.The diagnosis of either AKI and/or dialysis was documented in 80% of electronic discharge letters for patients in GROUP A but only 54% of letters for patients in GROUP B.The 30-day mortality (from IHD start) in GROUPA was 14% compared to 9% in GROUP B. Individuals with a diagnosis of heart failure were four times more likely to die before discharge (p value=0.02) and those aged ≥ 70 years twice as likely to die before discharge (p value=0.049). The two-year mortality rate in the two groups was similar (GROUP A 35% vs. GROUP B 37%) despite GROUP B being significantly older.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In this cohort of individuals with AKI-IHD, managed in the Royal Victoria Hospital, Belfast, the majority recovered self-sustaining kidney function.The mortality rates at 30 days were lower than reported in the literature and may be due to careful patient selection. The poorer outcomes associated with AKI-IHD support and a concomitant diagnosis of heart failure or age","PeriodicalId":94250,"journal":{"name":"The Ulster medical journal","volume":"94 2","pages":"77-82"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Self-directed learning and clinical decision support.","authors":"Kieran Walsh, Lynsey Morton","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94250,"journal":{"name":"The Ulster medical journal","volume":"94 2","pages":"94-95"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions of Obesity and Bariatric Surgery Among Newly Qualified Doctors: A UK-based Multi-Hospital Survey Study.","authors":"Christopher R Smith, Robin Pontonnier, Theodore Patel, Ravikrishna Mamidanna, Michail Chatzikonstantinou","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a major public health challenge, yet formal education on bariatric and metabolic surgery (BMS) remains limited in undergraduate and early postgraduate medical training. Foundation Year 1 (FY1) doctors are often responsible for managing post-operative bariatric patients, but their confidence and preparedness in this area are unclear. This study aimed to assess FY1 doctors' confidence, knowledge, and perceptions of BMS, identifying educational gaps to guide future training.</p><p><strong>Methods: </strong>A cross-sectional survey was distributed to FY1 doctors across seven hospitals in South-East London (August- December 2024). The questionnaire assessed demographics, confidence in managing BMS patients, prior training knowledge, and perceptions of obesity and BMS.</p><p><strong>Results: </strong>Seventy-seven FY1 doctors participated. The majority (77.9%, n=60) had no formal BMS training, and fewer than half (42.9%, n=33) had clinical exposure to BMS patients. Only 20.8% (n=16) felt comfortable managing these patients, with confidence levels higher among those with prior clinical exposure but without statistical significance (p = 0.0682). Misconceptions were present, with 41.6% (n=32) believing obesity is self-inflicted and 7.8% (n=6) viewing BMS as cosmetic. A majority (84.4%, n=65) supported integrating BMS education into medical training.</p><p><strong>Conclusion: </strong>FY1 doctors demonstrated low confidence in managing bariatric patients, possibly due to limited training and exposure. Findings highlight the need for structured BMS education, focusing on peri-operative care rather than procedural details, to better equip future doctors in managing obesity and post-bariatric surgery patients.</p>","PeriodicalId":94250,"journal":{"name":"The Ulster medical journal","volume":"94 2","pages":"89-93"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoughts on the Passing of Dr John Geddes.","authors":"S W Webb, J A Purvis","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":94250,"journal":{"name":"The Ulster medical journal","volume":"94 1","pages":"40-41"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}