The Ulster medical journal最新文献

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

On 29 November 2024, the House of Commons voted in favour of legalising assisted suicide. The aim of the Bill is to "allow adults who are terminally ill, subject to safeguards and protections, to request and be provided with assistance to end their own life." At the time of writing, the Bill is under consideration at the Committee stage. This paper considers the implications of the bill and the appropriateness of using the "slippery slope" argument in its critique. It may be seen that when considering the practice of assisted suicide in jurisdictions where it has been legalised, the empirical form of the argument is shown to be valid. However, the logical form of the argument is less relevant as, once the principle is conceded, there are no further significant barriers and the slope is, in fact, a cliff edge. History shows that the proposed safeguards are unlikely to be robust or sufficient to withstand challenge.