Peter Eves, Qingzi Guo, Michelle Doherty, Ruth Fergie, Philip Gardiner
{"title":"Ask an FY1 'Expert' - Peer Assisted Learning in Smoothing the Transition from Medical School to Clinical Practice.","authors":"Peter Eves, Qingzi Guo, Michelle Doherty, Ruth Fergie, Philip Gardiner","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38815,"journal":{"name":"Ulster Medical Journal","volume":"92 2","pages":"89-92"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/77/61/umj-92-02-89.PMC10464635.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10127481","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":"The Anger of Achilles.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38815,"journal":{"name":"Ulster Medical Journal","volume":"92 2","pages":"65-66"},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ea/2f/umj-92-02-65.PMC10464636.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10127488","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}
Aims: There is evidence of disparate levels of care for members of ethnic minority communities with inflammatory bowel disease in various NHS Trusts and Health Boards in England and Scotland. The purpose of this study was to investigate whether there was any association between the existence of disparate levels of care and the ethnic composition of the management boards of NHS Trusts and Health Boards. It also examined the ethnic composition of Health and Wellbeing Boards associated with these Trusts in England.
Method: NHS Trusts in England and Health Boards in Scotland, which had been involved in previous studies of disparate levels of care, were identified through a review of the relevant published papers. Health and Wellbeing Boards associated with these Trusts were then identified. Executive and non-executive membership of the NHS Trust, Health Boards and Health and Wellbeing Boards was determined through scrutiny of their web pages.
Results: The proportion of Asians, who were executive officers, was significantly lower than the proportion who were non-executive board members both for trusts who offered disparate care (z = 2.22; p < 0.03) and those which did not (z = 2.24; p < 0.03). There was no significant difference in the proportion of Asians who were non-executive board members between the two types of trust. The proportion of ethnic minority members of English Health and Well-Being Boards, where there was evidence of disparate levels of care received by South Asian patients was significantly greater than on Boards where this was not the case. (z = 2.8. p < 0.005).
Conclusions: The relation of these findings to disparate levels of care is unclear. However, it may point to a culture of tokenism, where either the members are not truly representative of underserved communities or they are unable to have any influence on local policy decisions. In either case there is an urgent need to develop better links with minority communities who are underserved so that issues can be effectively identified and remedied.
{"title":"NHS Trust Boards and Health and Well-being Boards: Do they play any role in the management of disparate levels of care for South Asian patients with Inflammatory Bowel Disease?","authors":"A Farrukh, J F Mayberry","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aims: </strong>There is evidence of disparate levels of care for members of ethnic minority communities with inflammatory bowel disease in various NHS Trusts and Health Boards in England and Scotland. The purpose of this study was to investigate whether there was any association between the existence of disparate levels of care and the ethnic composition of the management boards of NHS Trusts and Health Boards. It also examined the ethnic composition of Health and Wellbeing Boards associated with these Trusts in England.</p><p><strong>Method: </strong>NHS Trusts in England and Health Boards in Scotland, which had been involved in previous studies of disparate levels of care, were identified through a review of the relevant published papers. Health and Wellbeing Boards associated with these Trusts were then identified. Executive and non-executive membership of the NHS Trust, Health Boards and Health and Wellbeing Boards was determined through scrutiny of their web pages.</p><p><strong>Results: </strong>The proportion of Asians, who were executive officers, was significantly lower than the proportion who were non-executive board members both for trusts who offered disparate care (z = 2.22; p < 0.03) and those which did not (z = 2.24; p < 0.03). There was no significant difference in the proportion of Asians who were non-executive board members between the two types of trust. The proportion of ethnic minority members of English Health and Well-Being Boards, where there was evidence of disparate levels of care received by South Asian patients was significantly greater than on Boards where this was not the case. (z = 2.8. p < 0.005).</p><p><strong>Conclusions: </strong>The relation of these findings to disparate levels of care is unclear. However, it may point to a culture of tokenism, where either the members are not truly representative of underserved communities or they are unable to have any influence on local policy decisions. In either case there is an urgent need to develop better links with minority communities who are underserved so that issues can be effectively identified and remedied.</p>","PeriodicalId":38815,"journal":{"name":"Ulster Medical Journal","volume":"92 1","pages":"38-42"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/60/umj-92-01-38.PMC9899024.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10689600","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":"From a Vintage Journal (1890): Dr. Whitla's Urticaria Case and Dr. J.A. Lindsay's Notes on Asthma.","authors":"Tracy Freudenthaler","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38815,"journal":{"name":"Ulster Medical Journal","volume":"92 1","pages":"50-54"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6c/c1/umj-92-01-50.PMC9899035.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9663614","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":"Letters.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38815,"journal":{"name":"Ulster Medical Journal","volume":"92 1","pages":"61"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6f/3e/umj-92-01-61a.PMC9899034.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10689602","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}
Laura Feeney, Ashleigh Hamilton, Anita Lavery, Conor O'Neill, Gerard Walls, Kirsty Taylor, Richard C Turkington
Background: Cancer has been assumed to be associated with a high-risk of morbidity and mortality from COVID-19. Protective measures have incorporated modifications in cancer treatments. There are conflicting data about the impact of COVID-19 infection and outcomes in cancer patients. We aim to describe the impact of demographic and clinical characteristics on COVID-19 outcomes in patients with cancer in Northern Ireland reported within the UK Coronavirus Cancer Monitoring Project (UKCCMP).
Method: Prospective data collection including demographics, cancer stage and type, treatment and outcomes occurred for all Northern Irish patients enrolled in the UKCCMP. The primary endpoint was all-cause mortality. Descriptive statistics and logistic regression analysis were performed using SPSSv25.
Results: Between March 2020 and March 2021, 110 cases were registered. Median age was 63 years (range 27 to 87). Seventy patients (63.6%) were >60 years and 59 (53.8%) were females. Co-morbidities were reported in 83 patients (72.7%). Most patients had metastatic disease (64, 58.2%). Sixty-seven patients (60.9%) received anticancer treatment in the 4 weeks prior to COVID-19 infection. Of those patients, 35 (52.2%) received chemotherapy. Thirty-nine patients (58.2%) continued treatment as planned; 24 (36.9%) stopped treatment due to SARS-CoV-2 infection. The majority of patients were asymptomatic or experienced mild symptoms (67, 60.9%). Fifty-one (46.3%%) were admitted to hospital for COVID-19. Risk of severe/critical COVID-19 disease was significantly associated with age (OR 1.07 [95% CI 1.03-1.11); p=0.004), pre-existing hypertension (OR 3.29 [95% CI 1.42-7.62]; p=0.02) and thoracic primary malignancy (OR 4.41 [95% CI 1.52-12.74]; p=0.042). Twenty-nine patients (26.3%) died of whom 15 (57.7%) died of COVID-19 and 13 (44.8%) died due to cancer. Risk of death was significantly associated with age (OR 1.05 [95% CI 1.01-1.09]; p=0.014), male sex (OR 3.76 [95% CI 1.51-9.34]; p=0.008) and thoracic primary malignancy (OR 5.35 [95% CI 1.88-15.25]; p=0.014). When corrected for age, gender and co-morbidities, chemotherapy within the past 4 weeks was not significantly associated with mortality (OR 0.65 [95% CI 0.20-2.11]; p=0.476).
Conclusion: Age and thoracic cancer diagnosis correlated with survival. Comparison of performance during the pandemic with national benchmarks can inform how regional services should be adapted in preparation for future healthcare crises.
背景:癌症一直被认为与COVID-19的发病率和死亡率高风险相关。保护措施包括癌症治疗的改进。关于COVID-19感染的影响和癌症患者的预后,数据相互矛盾。我们的目标是描述英国冠状病毒癌症监测项目(UKCCMP)中报告的北爱尔兰癌症患者的人口统计学和临床特征对COVID-19结局的影响。方法:前瞻性数据收集,包括在UKCCMP中登记的所有北爱尔兰患者的人口统计学、癌症分期和类型、治疗和结局。主要终点是全因死亡率。采用SPSSv25进行描述性统计和logistic回归分析。结果:2020年3月至2021年3月,共登记病例110例。中位年龄为63岁(27 - 87岁)。60岁以上患者70例(63.6%),女性59例(53.8%)。83例(72.7%)患者报告了合并症。大多数患者有转移性疾病(64,58.2%)。67例患者(60.9%)在感染前4周内接受了抗癌治疗。其中35例(52.2%)接受了化疗。39例(58.2%)患者按计划继续治疗;24例(36.9%)因感染SARS-CoV-2而停止治疗。大多数患者无症状或症状轻微(66.7%,60.9%)。51人(46.3%)因COVID-19住院。重症/危重型COVID-19疾病的风险与年龄显著相关(OR 1.07 [95% CI 1.03-1.11]);p=0.004),既往高血压(OR 3.29 [95% CI 1.42-7.62];p=0.02)和胸部原发性恶性肿瘤(OR 4.41 [95% CI 1.52-12.74];p = 0.042)。死亡29例(26.3%),其中新冠肺炎死亡15例(57.7%),癌症死亡13例(44.8%)。死亡风险与年龄显著相关(OR 1.05 [95% CI 1.01-1.09];p=0.014),男性(OR 3.76 [95% CI 1.51-9.34];p=0.008)和胸部原发性恶性肿瘤(OR 5.35 [95% CI 1.88-15.25];p = 0.014)。在校正了年龄、性别和合并症后,过去4周内的化疗与死亡率没有显著相关(OR 0.65 [95% CI 0.20-2.11];p = 0.476)。结论:年龄和胸廓癌诊断与生存率相关。将大流行期间的表现与国家基准进行比较,可以为如何调整区域服务以应对未来的卫生保健危机提供信息。
{"title":"Real world outcomes in cancer patients with COVID-19 infection: Northern Ireland experience.","authors":"Laura Feeney, Ashleigh Hamilton, Anita Lavery, Conor O'Neill, Gerard Walls, Kirsty Taylor, Richard C Turkington","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Cancer has been assumed to be associated with a high-risk of morbidity and mortality from COVID-19. Protective measures have incorporated modifications in cancer treatments. There are conflicting data about the impact of COVID-19 infection and outcomes in cancer patients. We aim to describe the impact of demographic and clinical characteristics on COVID-19 outcomes in patients with cancer in Northern Ireland reported within the UK Coronavirus Cancer Monitoring Project (UKCCMP).</p><p><strong>Method: </strong>Prospective data collection including demographics, cancer stage and type, treatment and outcomes occurred for all Northern Irish patients enrolled in the UKCCMP. The primary endpoint was all-cause mortality. Descriptive statistics and logistic regression analysis were performed using SPSSv25.</p><p><strong>Results: </strong>Between March 2020 and March 2021, 110 cases were registered. Median age was 63 years (range 27 to 87). Seventy patients (63.6%) were >60 years and 59 (53.8%) were females. Co-morbidities were reported in 83 patients (72.7%). Most patients had metastatic disease (64, 58.2%). Sixty-seven patients (60.9%) received anticancer treatment in the 4 weeks prior to COVID-19 infection. Of those patients, 35 (52.2%) received chemotherapy. Thirty-nine patients (58.2%) continued treatment as planned; 24 (36.9%) stopped treatment due to SARS-CoV-2 infection. The majority of patients were asymptomatic or experienced mild symptoms (67, 60.9%). Fifty-one (46.3%%) were admitted to hospital for COVID-19. Risk of severe/critical COVID-19 disease was significantly associated with age (OR 1.07 [95% CI 1.03-1.11); p=0.004), pre-existing hypertension (OR 3.29 [95% CI 1.42-7.62]; p=0.02) and thoracic primary malignancy (OR 4.41 [95% CI 1.52-12.74]; p=0.042). Twenty-nine patients (26.3%) died of whom 15 (57.7%) died of COVID-19 and 13 (44.8%) died due to cancer. Risk of death was significantly associated with age (OR 1.05 [95% CI 1.01-1.09]; p=0.014), male sex (OR 3.76 [95% CI 1.51-9.34]; p=0.008) and thoracic primary malignancy (OR 5.35 [95% CI 1.88-15.25]; p=0.014). When corrected for age, gender and co-morbidities, chemotherapy within the past 4 weeks was not significantly associated with mortality (OR 0.65 [95% CI 0.20-2.11]; p=0.476).</p><p><strong>Conclusion: </strong>Age and thoracic cancer diagnosis correlated with survival. Comparison of performance during the pandemic with national benchmarks can inform how regional services should be adapted in preparation for future healthcare crises.</p>","PeriodicalId":38815,"journal":{"name":"Ulster Medical Journal","volume":"92 1","pages":"29-37"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d4/48/umj-92-01-29.PMC9899036.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10698178","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":"The Launch of William Whitla's Medical Institute: Undercurrents and Outcomes.","authors":"Alun Evans Honorary","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38815,"journal":{"name":"Ulster Medical Journal","volume":"92 1","pages":"43-49"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1e/b7/umj-92-01-43.PMC9899028.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9669420","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":"Letters.","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":38815,"journal":{"name":"Ulster Medical Journal","volume":"92 1","pages":"61-62"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/43/9d/umj-92-01-61b.PMC9899022.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10698179","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}
Andreea E Stroiescu, Judita Laurinkiene, Kenneth Courtney, Heather K Moriarty, Ian P Kelly, Anthony G Ryan
Purpose: To evaluate the efficacy of ultrasound and fluoroscopic-guided aspiration and therapeutic injection of Baker's cysts in the relief of pain and pressure symptoms.
Methods: A retrospective, observational, single-arm study of consecutive patients referred from the Orthopaedic service for image-guided aspiration followed by therapeutic injection of symptomatic Baker's cysts was performed with institutional approval in the context of a Quality Improvement project. Patients' pain was graded using a 10-point Likert scale. Under standard sterile conditions, a 10 cm 5 Fr Yueh centesis needle was advanced into the cyst under direct ultrasound guidance, septae disrupted as necessary, the contents of the cyst aspirated, and a sample sent for microbiological analysis. Bursography was performed in an attempt to identify the expected communication with the knee joint, the contrast was aspirated and 40 mg of DepoMedrone and 5 ml of Bupivacaine were injected.
Results: Thirteen patients were referred, nine of whom satisfied the inclusion criteria (all female, average age 63.8 years). Over a 35-month period, 11 procedures were performed (bilateral in 1, repeated in another) yielding an average volume of 20.1 ml (range 10 - 50 mls). In 2/11 procedures the communication with the knee joint was outlined. The average follow up post-procedure was 8.3 months. The average patient's pain score reduced to zero from 5.7 for an average period of 5.96 months. After this period patients reported a gradual return of an ache, but none returned to the pre-procedure severity which, in some cases, had prevented them from sleeping.
Conclusion: Aspiration of symptomatic Baker's cysts under Ultrasound and fluoroscopic guidance followed by therapeutic injection of DepoMedrone and Bupivacaine leads to a durable reduction in pain symptoms in a majority of patients.
{"title":"Management of symptomatic Baker's cysts with ultrasound and fluoroscopic-guided aspiration followed by therapeutic injection with Depomedrone and Bupivacaine leads to a durable reduction in pain symptoms in a majority of patients; A case series and literature review.","authors":"Andreea E Stroiescu, Judita Laurinkiene, Kenneth Courtney, Heather K Moriarty, Ian P Kelly, Anthony G Ryan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the efficacy of ultrasound and fluoroscopic-guided aspiration and therapeutic injection of Baker's cysts in the relief of pain and pressure symptoms.</p><p><strong>Methods: </strong>A retrospective, observational, single-arm study of consecutive patients referred from the Orthopaedic service for image-guided aspiration followed by therapeutic injection of symptomatic Baker's cysts was performed with institutional approval in the context of a Quality Improvement project. Patients' pain was graded using a 10-point Likert scale. Under standard sterile conditions, a 10 cm 5 Fr Yueh centesis needle was advanced into the cyst under direct ultrasound guidance, septae disrupted as necessary, the contents of the cyst aspirated, and a sample sent for microbiological analysis. Bursography was performed in an attempt to identify the expected communication with the knee joint, the contrast was aspirated and 40 mg of DepoMedrone and 5 ml of Bupivacaine were injected.</p><p><strong>Results: </strong>Thirteen patients were referred, nine of whom satisfied the inclusion criteria (all female, average age 63.8 years). Over a 35-month period, 11 procedures were performed (bilateral in 1, repeated in another) yielding an average volume of 20.1 ml (range 10 - 50 mls). In 2/11 procedures the communication with the knee joint was outlined. The average follow up post-procedure was 8.3 months. The average patient's pain score reduced to zero from 5.7 for an average period of 5.96 months. After this period patients reported a gradual return of an ache, but none returned to the pre-procedure severity which, in some cases, had prevented them from sleeping.</p><p><strong>Conclusion: </strong>Aspiration of symptomatic Baker's cysts under Ultrasound and fluoroscopic guidance followed by therapeutic injection of DepoMedrone and Bupivacaine leads to a durable reduction in pain symptoms in a majority of patients.</p>","PeriodicalId":38815,"journal":{"name":"Ulster Medical Journal","volume":"92 1","pages":"24-28"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/1a/umj-92-01-24.PMC9899033.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10698180","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}