Irish Journal of Medical Science最新文献

Background: To date, there is one university offering the Physician Associate (PA) Studies programme in Ireland. Responding to a demand for PAs outside of Dublin, a hybrid model was introduced, allowing students undertake the didactic phase of the programme online for synchronous instruction, attending campus twice a month for anatomy learning, clinical skills, and integration sessions.

Aims: The aim of this study was to evaluate the hybrid model from the perspectives of students and their teachers, including the external examiner.

Methods: This was a mixed methods study, using surveys (n = 15), focus groups with students (n = 10), teaching staff (n = 4), and a one-to-one interview with an external examiner. Action points of programme board meetings were also analysed.

Results: While attitudes to online learning were positive, the need for improvements was highlighted. During online teaching sessions, the students expressed the need to feel more a part of the traditional classroom experience. Even though lecturers were aware of students online, some found it difficult to engage with these students. Clinical teachers did not detect any differences between hybrid and on-campus students on their clinical application to practice.

Conclusion: Findings suggest that hybrid learning is influenced by previous online learning experiences. Students admitted to a feeling of social isolation at times and the reminder for faculty to support an inclusive environment. Student performance showed that hybrid students did as well or better across both years of the programme, and this translated into clinical practice too.

Background/aim: In 2018, the European Medicines Agency strengthened warnings in relation to fluoroquinolone (FQ)-associated tendon injury. There is a lack of published data on FQs and tendon injury in an Irish context. The aim of the study was to investigate incidents and claims relating to FQs and tendon injury through an analysis of National Incident Management System (NIMS) data.

Methods: The NIMS database was searched for incidents created between 1st June 2018 and 31st May 2023 which involved any FQ and referenced tendon injury. The incident data was analysed under predetermined field headings. NIMS was also searched for clinical claims involving any FQ with a Claim Finalised Date between 1st June 2018 and 31st May 2023. The claims were analysed to identify common themes.

Results: The study identified 20 incidents which related to FQs and tendon injury, although only six reported an actual tendon injury. In 15 (75%) of the incidents, the prescription of a FQ was deemed inappropriate by the reporter. The study found four finalised claims, all of which related to bilateral Achilles tendon rupture following FQ exposure. In all four cases, the patient was aged over 60 and the injury occurred within days of commencing treatment.

Conclusions: This study confirms that FQs continue to be prescribed inappropriately in high-risk patients and that incidents of tendon injury following FQ exposure continue to occur despite regulatory moves of raise awareness of this issue. Additional measures to minimise the risk of avoidable patient harm may be warranted.

Background: Preterm neonates have underdeveloped organs, a fragile skin barrier and an immature immune system rendering them susceptible to infection. These infants are at an increased risk of developing a healthcare-associated infection because of antibiotic exposure, invasive monitoring and the general risk of outbreaks within a hospital setting. The aim of this study was to investigate the prevalence of antimicrobial resistant organism carriage in very preterm neonates (i.e. born ≤ 32 weeks gestation) in the neonatal intensive care unit (NICU).

Methods: Neonates born ≤ 32 weeks' gestation in NMH from September 2022 to January 2023 were included. Swabs were taken at admission and fortnightly until week 10 of life. Screening investigations included ESBL (Extended Spectrum Beta-Lactamases) and AmpC producers, organisms resistant to gentamicin and ciprofloxacin, CPE (Carbapenemase-producing Enterobacterales), MRSA (Methicillin-resistant Staphylococcus aureus) and VRE (Vancomycin-resistant Enterococci). This differed from baseline screening by frequency of screening, and the recording of presence of AmpC-producers and ciprofloxacin-resistance. Ethical approval was sought and granted.

Results: Overall, 20 out of the 53 neonates (38%) included in the study were colonised with one or more resistant-gram-negative organism; 5 with ESBL (9%), 2 resistant to gentamicin (4%), 6 resistant to ciprofloxacin (11%) and 14 (26%) with AmpC producers. Three (6%) resistant gram-negative bacilli were detected on admission screens, and resistance rates peaked at week 4 where 14 screens were positive. No CPE, MRSA or VRE were isolated.

Discussion/conclusion: This study highlights the prevalence of antibiotic-resistant organisms in a vulnerable patient cohort, the very preterm infants. This review should prompt revision of the importance of infection prevention and control, antimicrobial stewardship and regular MDRO (multi-drug resistant organism) screening in the neonatal critical care setting.

Background: People living with rare diseases have reported high unmet support needs for access to psychological services despite the significant impact rare diseases have on mental health.

Aims: This study aimed to explore experiences in accessing psychological supports in the Republic of Ireland, and ways in which supports can be improved.

Methods: An online survey was distributed to people living with rare diseases through Irish rare disease patient organisations and expert centres (May-June 2023). Paediatric and adult participants were included with carers providing information on behalf of those age < 18 years. A PRISMA-based scoping review was conducted to explore reported gaps in psychological supports for people living with rare diseases.

Results: Eligible responses were received from 142 participants (87 adults, 55 children, 94 females, 47 males). People living with rare diseases reported a need for psychological supports at all stages of their patient journey. Participants indicated that a rare disease has an impact on educational, social, and financial aspects of daily living. A lack of understanding of the rare disease by healthcare professionals, extended waiting times, and the financial burden of accessing supports were key themes identified by participants.

Conclusion: Living with a rare disease is associated with an increased mental health burden. Gaps remain in the provision of psychological supports for people affected by rare diseases. The integration of mental health supports into the care of people living with rare diseases should be a priority for the Irish health service.

Background: The rise in usage of smartphones and digital devices among pediatric population has raised concerns about their eye's health. It is of particular interest in relation to dry eye disease (DED) and inflammatory conjunctivitis. Prolonged screen exposure is linked to reduced blink rates, tear evaporation, and tear break-up time (TBUT), that can lead to ocular discomfort and tear instability.

Objective: To find association between excessive screen time, dry eye disease, and inflammatory conjunctivitis in children aged 3 to 11 years.

Methods: A cross-sectional correlational study was conducted at a tertiary care hospital Islamabad. Non-probability purposive sampling technique was adopted. Detailed ophthalmic examinations, including TBUT and blink rate assessments, were performed. The relationship between excessive screen time, TBUT, blink rate, and inflammatory conjunctivitis was assessed using multivariate analysis. A 95% confidence interval was kept significant.

Results: A total of 479 participants aged 6.7 ± 1.9 were included. The mean screen time was 4.52 ± 1.49 hour/day, while mean TBUT was 10.29 ± 3.17. A significant negative relationship was found between screen time and TBUT (B =  - 0.351, p < 0.001). The TBUT and inflammatory conjunctivitis showed a significant relationship (χ² = 134.1(3); p value < 0.001). A significant relationship was also found among dry eyes and children having a dedicated gadget (χ² = 27.6(3); p value < 0.001). Blink rate was directly associated with TBUT (p < 0.001). Approximately 48.64% of participants exhibited abnormal Tear Break-Up Time (TBUT).

Conclusion: Excessive screen time is significantly associated with reduced TBUT and a lower blink rate in children, contributing to dry eye disease and inflammatory conjunctivitis.

Background: Celiac disease (CD) is an autoimmune disorder known to be highly associated with autoimmune manifestations and genetic factors. The aim of this paper was to assess the diagnostic accuracy of serum I-FABP in CD patients.

Methods: Fifty patients with CD were classified into two groups: (30) exhibiting positive titers of tTG-IgA test and tTG-IgG test value more than 18 AU/mL and (20) patients with a potential diagnosis of CD (equivocal titers of IgG and IgA tTG 12-18 AU/mL) for comparison, as well as 50 healthy individuals were included as a control. The ELISA Kit was used to measure serum I-FABP where serum iron and serum ferritin were measured through the standard methods on the Smart-150 autoanalyzer biochemistry, instead of IgG and IgA tTG that was determined using an immunoenzymatically technique.

Results: The concentration of serum I-FABP in the CD group was significantly higher than that of the healthy subjects (p < 0.05). There was a significant difference in the serum I-FABP concentrations between two patients. There were substantial positive connections between serum 1-FAPB concentration and IgG, as well as strong positivity correlations between serum 1-FAPB and serum IgA Ttg in CD patients. The concentration of serum 1-FAPB, on the other hand, had no significant association with the anti Ttg IgG and serum IgA Ttg. The area under the curve was excellent (AUC = 1, p = 0.0001), with high diagnostic accuracy (96.2) in differentiating CD from the healthy subject group.

Conclusion: I-FABP levels in the sera of were shown to be higher and I-FABP levels were shown to be significantly linked between activated immune response (IgA-tTG) and enterocyte damage (I-FABP) in CD patients.

Background: Ireland is experiencing high levels of overweight and obesity. The adverse health impacts of excess weight include cancer, cardiovascular disease, diabetes, and dental decay, as well as a host of other conditions. In response, the Irish Government introduced a Sugar-Sweetened Beverage Tax (SSBT) in 2018.

Aims: This research sought to explore the impact of Ireland's Sugar-Sweetened Beverage Tax.

Method: Euromonitor International Ltd data for the years 2010 - 2022 detailing carbonated drinkrelated sugar consumption in Ireland was examined.

Results: A gradual decline in sugar consumption via carbonated soft drinks was evident before the introduction of the SSBT in Ireland. However, in the first full year since the introduction of the SSBT, there was a marked 30.2% reduction in sugar intake via carbonates through retailers and a 19.8% reduction in sugar intake via carbonates via food service venues.

Conclusions: The reduction in sugar intake via carbonates in the aftermath of the introduction of the SSBT was dramatic. However, it is unclear how much of this reduction was caused by industry reformulation of soft drinks and how much by consumers choosing lower-sugar or sugar-free soft beverages. Whatever the precise contribution of either factor, these results suggest that the SSBT has effectively reset national sugar consumption via soft drinks at a lower level.

Background: Thromboembolic complications are common in trauma orthopaedic practise. Despite extensive research, there remain a number of unanswered questions regarding the use of thromboprophylaxis.

Aims: To establish the current practise among Irish consultant orthopaedic surgeons regarding thromboprophylaxis.

Methods: A confidential online questionnaire regarding VTE prophylaxis was circulated to all consultant orthopaedic surgeons in training hospitals in the Republic of Ireland. Questions investigated surgeon awareness of local/national guidelines, inpatient and outpatient prescribing preferences and agreement/disagreement with the statement that defensive medicine, rather than evidence-based medicine, has driven increased emphasis on VTE prophylaxis in Ireland in recent years.

Results: The response rate was 72% (69/96). 72% (50/79) of surgeons were aware of local VTE prophylaxis guidelines. 38% (29/96) were aware of national guidelines. 89% (62/69) routinely used mechanical prophylaxis modalities. 73.9% (51/69) routinely used chemical prophylaxis for inpatients. However, this practise was z extremely heterogenous with five other pharmacological agents used by the remainder. 82.6% (57/69) routinely discharged patients on extended duration chemical prophylaxis. 67% (46/69) agreed that the recent increased emphasis on VTE prophylaxis was due to defensive medicine and not evidence-based medicine.

Conclusion: The results of this survey show that venous thromboembolism is regarded as a significant complication of orthopaedic surgery and most orthopaedic surgeons actively try to prevent it. There was a higher rate of intervention compared to previous surveys of Irish orthopaedic surgeons, possibly reflecting surgeon concerns regarding the high rate of litigation nationally. However, there is no consensus as to the optimum therapy which reflects the conflicting evidence available in the many publications on this subject.

Aim: The study was carried out to investigate the effect of tele-nursing based motivational interviewing on diabetes self-efficacy, self-management, and metabolic control parameters in individuals with Type 2 diabetes.

Method: A parallel-group randomized controlled trial. The study was completed with 70 participants (intervention: 36; control: 34). The data were collected using the Socio-demographic and Health Related Questionnaire, the Diabetes Self-Efficacy Scale, the Diabetes Self-Management Scale. The intervention group received eight sessions tele-nursing based motivational interviewing. Instruments were administered to both groups before the intervention, at the end of the last motivational interviewing session (post-test, 3rd-month), and at 6th-month follow-up. The data were analyzed using chi-square test, independent sample t-test, and one-way ANOVA.

Results: In the pre-test, there was no difference between the intervention and control groups in terms of independent variables (p > 0.05). Self-efficacy and self-management scores increased in the post-test and follow-up test of the group to which telenursing-based MI was applied, and there was a difference between the groups (p < 0.05). FBG and triglyceride levels of the intervention group decreased significantly in the post-test and follow-up test (FBG = 217.46 ± 73.88, 166.13 ± 50.71, and 161.41 ± 50.50, respectively; triglyceride = 225.28 ± 148.32, 159.68 ± 68.62, and 161.09 ± 73.06, respectively) (p < 0.05). HbA1c% level decreased significantly only in the post-test. However, no significant differences were found in terms of other metabolic parameters (p > 0.05).

Conclusions: This result shows the positive effectiveness of tele-nursing based MI intervention on self-efficacy, self-management, HbA1c%, FBG, triglyceride. Public health nurses should be provided with tele-nursing based MI to individuals with type 2 diabetes in primary health care institutions.

Study registration: The study was registered in ClinicalTrials NCT05628259 (prospective). Trial registration number and date of registration for prospectively registered trials. The study was registered in ClinicalTrials NCT05628259 (prospective). 2023-02-01.

Background: Depression is common in patients with gliomas, but few studies focused on the association between depression and glioma laterality.

Aims: This study was purposed to investigate depression difference and prognostic value between patients with left-hemispheric gliomas and right-hemispheric gliomas.

Methods: This study included 212 patients with left-hemispheric gliomas and 218 patients with right-hemispheric gliomas. Hospital Anxiety and Depression Scale (HADS) and Zung self-rating depression scale (SDS) were independently performed before surgery, 3 months and 6 months after surgery. All patients were followed up to death or 36 months. Overall survival (OS) and progression-free survival (PFS) were performed to evaluate the survival of glioma patients.

Results: The preoperative prevalence and scores of depression in patients with left-hemispheric gliomas were higher than those in patients with right-hemispheric gliomas. But there were no differences in postoperative prevalence and scores of depression between patients with left-hemispheric gliomas and right-hemispheric gliomas. In patients with left-hemispheric gliomas or with right-hemispheric gliomas, the preoperative scores of depression were higher than postoperative scores of depression, whereas there was no difference in depression score between 3 months after surgery and 6 months after surgery. In addition, patients with right-hemispheric gliomas had better PFS and OS than patients with left-hemispheric gliomas.

Conclusions: Patients with left-hemispheric gliomas are more likely to bring about depression than patients with right-hemispheric gliomas. Besides, patients with right-hemispheric gliomas are more likely to have better survival than patients with left-hemispheric gliomas. Surgery is considered as a useful treatment to alleviate depression of glioma patients.