Midland Regional Hospital Mullingar

In this chapter, you learn about another revolutionary deep learning architecture, the variational autoencoder. Variational autoencoders (VAEs) are similar to autoencoders and GANs, learning the latent variables of the data to understand how to represent and create new data. Variational autoencoders have gained popularity in recent years due to their ability to describe observations in a probabilistic manner. This ability makes variational autoencoders able to be employed in a wide range of applications, for example, generating audio, video or text; anomaly detection; and denoising; just to name a few. In this chapter, you learn the theory behind the variational autoencoders and implement some examples using Julia and Python.

Background and objective: Malaria remains a major health issue in Sudan, and physicians' non-adherence to treatment protocols has negatively impacted patient outcomes. The 2023 Sudan Malaria Case Management Protocol advocated new developments per the national and globally WHO-recommended levels, but there are still gaps in clinical practices. To improve physician compliance and standardize malaria care, decision-support tools can be based on artificial intelligence (AI). This study aims to examine the effect of the introduction of an AI-based clinical decision-support system (CDSS) on the adherence of physicians to the 2023 Sudan Malaria Case Management Protocol at Al-Managil Teaching Hospital (Managil, GZ, SDN).Methods: A two-cycle clinical audit was conducted between July and September 2025 (baseline audit followed by AI intervention and then re-audit after AI intervention). The current practice and pre-intervention knowledge (n=50 physicians) were evaluated through questionnaires. An AI-CDSS was implemented together with training, incorporating diagnostics, treatment recommendations, and special group advice (pregnancy, neonatal, and G6PD). Compliance rates before and after the intervention were compared, with statistical testing including effect sizes and 95% confidence intervals.Results: Recognition of the 2023 protocol increased from 38% to 100% (risk difference +62%, 95% CI: 48-76; p<0.001), and awareness of intravenous (IV)/intramuscular (IM) artesunate as first-line treatment rose from 53% to 98% (risk difference +45%, 95% CI: 32-58; p<0.001). Attitudes towards severe malaria improved from 15% to 91% (risk difference +76%, 95% CI: 61-91; p<0.001). The timely initiation of treatment within 24 to 48 hours improved to 100% (p < 0.001). Mean compliance increased from 50.7% (95% CI: 42-59) to 96.8% (95% CI: 92-100, p<0.001). Residual deficiencies persisted in microscopy reporting and G6PD testing.Conclusion: A combination of an AI-driven CDSS and focused training demonstrated a substantial improvement in physician compliance with the 2023 Sudan Malaria Case Management Protocol, particularly in critical care aspects. However, a possible Hawthorne effect and the absence of clinical outcome data (e.g., morbidity, mortality) should be acknowledged as limitations. Greater scale-up of this approach, while addressing infrastructural and digital literacy challenges, could have a major impact on malaria case management and disease burden in Sudan.

Aims: To establish the current prevalence of type 2 diabetes in children and adolescents aged under 16 years in the Republic of Ireland, to identify modes of presentation, patient characteristics, comorbidities, management, and outcomes.Methods: We conducted a cross-sectional study of children and adolescents aged under 16 years with a diagnosis of type 2 diabetes in September 2023 using a standardized proforma. This was circulated to all clinicians providing care to children with diabetes in all 19 centers in the Republic of Ireland.Results: Thirty-two cases of type 2 diabetes were identified, giving an estimated prevalence in children and adolescents under 16 years of 3/100,000 population, a significant increase from 1.2/100,000 population in 2015 (p < 0.004). This was due to increased prevalence rates in, both White and Asian populations, as well as an increase in the size of the Asian population under 16. Nineteen (59%) were girls. Median duration of diabetes was 1.2 (0.1–4.9) years. Median body mass index (BMI) z-score at diagnosis was identical to the 2015 study (+2.3). Sixteen (50%) achieved the target HbA1c specified by the International Society for Pediatric and Adolescent Diabetes (ISPAD) of 48 mmol/mol (6.5%) or less. Completion of screening for comorbidities and complications of type 2 diabetes were not in accordance with guidelines.Conclusion: There has been a significant increase in the prevalence of type 2 diabetes in under 16's in a short timeframe. Establishment of a National Diabetes Register will facilitate ongoing monitoring of disease epidemiology in this and other age cohorts.

Abstract Abstract Cancer therapy-related cardiac dysfunction (CTRCD) is a common cause of early suspension of chemotherapy (QT), potentially impacting survival rates. Permissive cardiotoxicity emphasises the continuation of cancer treatments while managing cardiotoxic effects. This study assesses clinical outcomes in patients with CTRCD undergoing a permissive strategy. Methods Retrospective analysis of outpatients (P) with CTRCD referred to a cardio-oncology outpatient clinic at a tertiary centre from April 2021 to December 2023. Results 110P were diagnosed with CTRCD, of these 31P underwent permissive cardiotoxicity strategy. 61% were female and median age of 59 years (IQR 54-69). 65% had 2 or more cardiovascular risk factors and 4P presented pre-existing reduced ejection fraction HF. Breast cancer and haematological malignancies accounted for 77% cases, 48% were stage IV. The majority of cardiotoxic QT regimens included HER2-targeted agents, alkylating agents, and taxanes. 68% developed asymptomatic CTRCD. The baseline median LVEF was 60% (IQR 54–64), which declined to a minimum of 49% (IQR 45–54). All patients started cardioprotective therapy (74% were treated with 3 or 4 classes of foundational HF prognosis-modifying drugs; 29% treated with sacubitril/valsartan). Over a median follow-up of 13 months, 20P continued their planned QT (Subgroup A), while 11 discontinued treatments later (Subgroup B). In Subgroup B, only 3P stopped due to severe symptomatic CTRCD. Comparative analysis showed that older age, male sex, hypertension and pre-existing HF were associated with QT suspension (p&amp;lt;0.05). Although Subgroup B had a higher incidence of NT-proBNP elevation (p=0.012) and lower median minimum LVEF (p=0.008), the relative impairment from baseline did not differ significantly between subgroups. In Subgroup B, 7P (64%) died after QT suspension, with a median survival of 152 days after suspension. In contrast, no deaths or significant cardiac events were reported in Subgroup A, and 13P (42%) already completed prescribed oncological therapy. Conclusion In this cohort under permissive cardiotoxicity strategy, 9% experienced severe CTRCD, leading to suspension of QT; 42% resumed oncologic treatment with no mortality. A permissive cardiotoxicity approach enabled more patients to complete life-saving treatments. The current HF guideline-directed medical therapy and specialized cardio-oncology care may facilitate permissive cardiotoxicity strategies for potentially improved outcomes.

Good nutrition promotes a healthy population and mitigates the risk of disease. Integrating nutrition care in the primary healthcare system is considered an essential plan of action to manage poor nutritional status in the population. The role of primary healthcare professionals (HCPs) in the delivery of nutrition care is especially crucial due to a current lack of dietitians and dietary support in the primary care setting in Ireland. This qualitative research explored the current practice, barriers, facilitators, and feasible solutions proposed to optimize the provision of nutrition care by primary HCPs. Twenty semi-structured interviews (pharmacists (n = 14), dietitians (n = 3), a physiotherapist (n = 1), a speech and language therapist (n = 1), and a healthcare assistant (n = 1) were conducted. Six themes were derived from the data: current practice of nutrition care in primary care, perceived role, barriers and facilitators, the importance of a multidisciplinary patient-centred approach, training needs and preferences, and addressing barriers. Participants acknowledged the importance of nutrition care in clinical practice, the principal role of the dietitian as part of the multidisciplinary team, and the essential clinical competencies and nutrition training models that may facilitate the provision of nutrition care in primary practice. A paradigm shift to a multidisciplinary care model that prioritises the integration of nutrition care into primary care practice to ensure optimal dietary counselling is afforded to patients is essential.

ABSTRACTAimTo analyse the literature on parents' experiences of accessing mental health services with their adolescents for mental health challenges in Ireland.BackgroundHealth systems globally have inadequately addressed mental health service needs resulting in notable gaps between population needs and access to adolescent mental health services.MethodsThis scoping review followed Arksey and O'Malley's six‐stage framework and PRISMA‐ScR reporting guidelines. Five electronic databases SocINDEX, MEDLINE, CINHAL, Scopus and EBSCO were searched and reference lists screened 2015–2024.ResultsTwenty‐three studies were included. Applying Braun and Clarke's thematic analysis identified three themes: adolescent community mental health services for adolescents with mental health challenges, accessing mental healthcare services via emergeny departments for adolescents with mental health challenges and parents' experiences of accessing mental health services for their adolescents with mental health challenges.ConclusionParents' experiences of accessing mental health services for their adolescents are not fully understood, and further research is required to map key concepts to inform practice and policymaking.Relevance to Clinical PracticeThe findings from this scoping review highlight challenges for adolescent mental health services in Ireland and internationally. Heightening awareness of these issues is necessary to improve the clinical practice of nurses.No Patient or Public ContributionThis was a scoping review study.

ObjectivesThe WHO estimate that one in seven 10–19-year-olds experiences a mental health disorder while ‘My World Survey 2’/The National Study of Youth Mental Health in Ireland conducted in 2019 involved 10,459 adolescents revealed 49% of participants had anxiety while 40% suffered from depression.1 2 Mental health conditions and behavioural issues were seen to be on the rise even before the COVID-19 pandemic.3 However, extremely long waiting lists to access Psychology or Child and Adolescent Mental Health Services (CAMHS) further compounds the problem. The Happiness Toolkit is a resource comprising of six evidence-based techniques that has proven to boost self-esteem, develop resilience and promote positive mental health while awaiting Psychology and CAMHS input.4 We aim to explore if the Happiness Toolkit allows children and their families to engage in positive mental health practices that may lead to improved mental health or cessation of symptoms in an inpatient setting.MethodsWe undertook retrospective chart review of children less than 16 years of age with behavioural and mental health disorders who presented to the Paediatrics Unit in a Regional Hospital in Ireland from May 2022 to September 2023 and received intervention in the form of the Happiness Toolkit.ResultsThirteen patients aged 10 to 15 years were included during this study period. 69% of patients were 14 to 15 years old, while 84.6% were female. Eating disorder was the leading diagnosis in this study (61.5%) followed by intentional medication overdose (38.4%). Anxiety was the most common co-existing symptom (87.5%) along with eating disorder. 3 out of 5 patients with intentional medications overdose had suicidal intention. 38.5% of patients required more than one-week inpatient stay, and 15.4% required 2–3 months inpatient stay. 61.5% of patients had review with CAMHS as inpatient and subsequently 76.9% of patients are linked with CAMHS. All patients received the Happiness Toolkit as part of their management care plan. All of them expressed satisfaction with the Happiness Toolkit intervention during the inpatient stay and follow up. All patients were compliant with self-care skills of smiling a vision, mindfulness and positive physical contact. Twelve patients expressed satisfaction with practising the Hand Brain model. Nine patients expressed compliance with social relatedness and positive physical contact. All thirteen patients reported cessation of symptoms with only one patient having recurrence of symptoms but subsequently recovered. Only 50% of them continued to be linked with psychology or CAMHS.ConclusionOur study showed that the Happiness Toolkit can be effective in management of Paediatrics behavioural and mental health conditions.The results of this study are promising regarding the use of this novel model of care alongside psychology and CAMHS in treating paediatric mental health conditions in an inpatient setting.ReferencesWorld Health Organization. Mental health of adolescents. November 2021.B Dooley, C O’Connor, A Fitzgerald, A O’Reilly. My World Survey 2. The National Study of Youth Mental Health in Ireland. 2019.Z Yusuf, F Sharif. A time for action: tackling paediatrics behavioural and emotional disorders. Irish Medical Journal. 2019.E Power, F Sharif. Primary and secondary care approach to paediatric mental health conditions: a novel model of care. BMJ Paediatrics. 2022.