The Ulster medical journal最新文献

Discussion of bioethical issues using four principles approach proposed by Beauchamp and Childress is now standard practice in the UK. An earlier paper documented the history of principlism before considering its impact and reviewing some criticisms of the approach. This paper will examine some of the philosophical difficulties in greater depth. A particular concern is that principlism leads to thin debate with consideration of means without due concern regarding their intended ends.

The integration of genomic medicine within mainstream patient care promises advances in healthcare and potential benefits for disease prediction and personalised treatment approaches. This paper explores the challenges of integrating genomic medicine within the UK's National Health Service (NHS) and potential solutions for alignment with the NHS's proposed long-term plan and Genome UK strategy. Critical challenges and knowledge gaps have been identified, including a referral-dependent system, unclear eligibility criteria, lack of policies and guidelines, gaps in clinical genomic competence, genomic sequencing costs, equity issues for genomic testing access across the UK, and data management and patient privacy concerns. Proposed solutions and future directions include extending genetic test ordering authority to include mainstream clinicians and establishing unambiguous eligibility criteria, policies and guidelines through a developing trained workforce and appropriate patient engagement. Moreover, expanded Whole Genome Sequencing (WGS) and pharmacogenomic testing approaches through up-scaling genomic sequencing capacity and standardising genetic testing across the UK will lower consumable costs. Leveraging artificial intelligence (AI) and data warehousing approaches will improve data management, particularly in the context of integration within electronic health records. In summary, the successful integration of genomic medicine within mainstream patient care holds transformative potential for healthcare provision. By recognising the challenges identified and embracing the proposed solutions, healthcare systems can revolutionise patient outcomes, advancing precision medicine and shaping the future of genomic-driven healthcare.

Background: Retroperitoneal sarcomas (RPS) are a heterogeneous group of rare tumours that require complex surgical management with outcomes tightly correlated to quality of surgery.This study aimed to examine the determine patient demographics, treatment approaches and outcomes for patients with primary RPS in this single center during the period 2010-2021.

Methods: All patients diagnosed with RPS from 2010 to 2021 that underwent surgical resection in a single trust in Northern Ireland were identified. Data was collated using histopathology records, electronic care records and retrospective chart review.

Results: Fifty-four resections were performed for RPS in a 10 year period. 30 day mortality rate was 3.7%, in-hospital mortality was 1.9% and 90 day mortality was 7.4%. 11.1% of patients were recorded as having a severe postoperative adverse event. 90.4% patients achieved an R0/R1 resection. The 1, 3, and 5-year overall survival were 80% [95% confidence interval (CI) 67-89), 69% (95% CI 53-79), and 62% (95% CI 48-75). The 1 and 5-year crude-cumulative-incidence (CCI) for local recurrence were 32% (95%CI 20, 46) and 55% (95%CI 32,77). 1 and 5-year CCI for distant metastases were 11% (95%CI 4, 23) and 35% (95%CI 15,59). Median overall survival was 6.3 years (IQR 5.0-7.6).

Conclusion: Survival outcomes in this LVH are similar to those reported by a number of HVHs worldwide, with an additional low rate of severe postoperative complication. Given that there are only between 250 and 300 new diagnoses of retroperitoneal sarcoma (RPS) in the UK each year prospective data collection and participation in multi-institution studies, specifically a UK collaboration, is critical to expand upon current knowledge and further improve management, outcomes and follow-up of patients with this rare and complex surgical disease.

In recent years, simulation has come to prominence as an educational method within the healthcare professions, aiming to shield learners from real-world consequences. However, the associated risks of this educational method have largely remained unaddressed. One of the most potent risks of simulation is felt to be the experience of psychological stress. Over the last two decades, researchers have suggested that an increase in simulation-related stress goes hand-in-hand with diminishing performance, but the evidence base for this claim is lacking. A medical educator thus has no robust scientific steering on which to gauge how 'hard to push' a trainee in a simulation environment to best assist their learning. In this review we systematically analyse the literature to further understand the impact of simulation-related stress on learner performance and report that inducing a high-stress environment during simulation is generally associated with impaired performance.

Assisted Dying (AD), the ending of a person's life pre-emptively under a legal criterion is widely debated, both in the United Kingdom (UK) and Ireland. The expectation is often those doctors closest to dying would be both the proponents and facilitators of this action. A survey of Palliative Medicine in Northern Ireland (NI) on this topic has never been previously undertaken. The Regional Palliative Medicine Group (RPMG) a representative body of all the Palliative Medicine Consultants in NI organised an anonymous 'Google Forms' survey on AD from 3/6/24 to 17/6/24 of all doctors of all grades working within Specialist Palliative Medicine at the time. The survey had a 69% response rate (56/81) demonstrating 80% of all responding doctors working within Palliative Medicine and 100% of responding Palliative Medicine Consultants and Registrars in Northern Ireland do not favour a change in legislation allowing for AD. 91% (n=51) have concerns that AD will be influenced by a lack of availability of personal care at home. 93% (n=52) are concerned that AD will be influenced by cost-saving for the patient and their family and 82% (n=46) are concerned that AD will be influenced by cost savings for health and social care. 98% (n=55) stated if AD is legalised it should not be 'part of mainstream healthcare' with 45% (n=25) saying it should be 'via the legal system' and 46% (n=26) saying 'via a separate independent facility'. 53% (n=28) 'would not' and 40% (n=21) 'don't know', if they could remain working for an organisation that undertakes AD. These results clearly show that Palliative Medicine in Northern Ireland will not be part of an AD service model. The question is who will be? Healthcare leaders now need to support their Palliative Medicine workforce by stating there will be AD-free healthcare facilities if AD is legalised.