Our Lady of Lourdes Hospital

BackgroundOutpatient parenteral antimicrobial therapy (OPAT) enhances health-related quality of life; however, unplanned readmissions may reduce patient satisfaction and the cost-effectiveness of the treatment. By predicting and minimizing these unplanned readmissions, patient outcomes can be significantly improved. Predictive models for unplanned OPAT readmissions can help identify high-risk patients, enabling tailored care and support. However, data on the effectiveness of OPAT-specific models is limited. This systematic review assessed the impact of risk assessment models on 30 day unplanned hospital readmissions among adult OPAT patients.MethodsA systematic review aiming to measure the impact of readmission risk models on 30 day unplanned hospital readmissions in adult OPAT patients. Searching CINAHL, Medline, Embase, ASSIA and Web of Science identified 435 potential articles. Independent selection, data extraction, tabulation of findings, and analysis were completed. Meta-analysis was conducted using JBI Sumari. When a meta-analysis was not feasible due to inappropriate data formats, the results were reported narratively.ResultsThree studies met the inclusion criteria. The primary outcome of the review was to measure the impact of OPAT readmission risk models on 30 day hospital readmissions by evaluating their ability to accurately predict readmissions within 30 days. Two studies reported low c-statistics, indicating poor discriminative capability, while one study showed a c-statistic of 0.75 in a temporal validation cohort, suggesting modest discriminative ability but lower accuracy in a broader group. A meta-analysis of the likelihood of unplanned readmissions in OPAT patients found no significant differences in unplanned readmissions. Across the studies, the most common reason for readmission was infection-related, followed by adverse drug events and complications from vascular access devices. There were few reported readmissions for diarrhoea. The studies identified different risk factors for readmission depending on the patient case mix, the structure of the OPAT service, and the methods of OPAT delivery. Aminoglycosides and daptomycin were linked to a lower likelihood of readmissions, while other factors showed no clear trends. Results on endovascular infections and concurrent antimicrobial use had low heterogeneity indicating that the results can be trusted, but findings regarding drug-resistant organisms, age, Charlson Comorbidity Index, and previous admissions should be interpreted with caution due to high heterogeneity.ConclusionsThe most common reason for readmissions was infection related. The review did not definitively identify risk factors for readmission and the impact of the OPAT readmission risk models was inconclusive. Further research is needed to enhance the transportability of these models and to develop versions tailored to different settings.

ObjectivesPatients with advanced cancer, their caregivers, and healthcare professionals can differ in their preferences for patient treatment and care. The objectives of this study were to (1) identify what healthcare professionals in specialist palliative care feel aids or challenges patients with advanced cancer and their caregivers to manage their discordance, and (2) decipher what is helpful or challenging for healthcare professionals themselves to manage discordance between patients with advanced cancer and their caregivers.MethodsA qualitative study was conducted comprising online focus groups with 19 healthcare professionals from different professions in specialist palliative care. Participants were purposively and snowball sampled, and recruited from specialist palliative care settings, including hospital, hospice, and community-based care. The data were member checked and analyzed using thematic analysis.ResultsTrust and consistent communication between the patient, caregiver, and healthcare professional, were considered by participants as helpful for patients and caregivers to manage discordance. Emotional and psychological burden for both the patient and caregiver together with preexisting conflict between the patient and caregiver, were perceived as barriers for patients and caregivers to manage their discordance. Knowledge and expertise gained from practice combined with professional resilience and peer support enabled participants to help patients and caregivers navigate discordance. Relational conflict between the patient and caregiver combined with participants’ own uncertainty about ethical and legal connotations of helping the patient and caregiver resolve their differences, were barriers to helping the patient and caregiver manage their discordance.Significance of resultsInterventions focused on assisting patients with advanced cancer in palliative care and their caregivers manage their differences in decision-making could serve to alleviate emotional burden for both the patient and caregiver. Healthcare professionals in specialist palliative care value the perspective of both patients with advanced cancer and their caregivers when helping them manage their discordance in decision-making.

Abstract Background Evidence shows that a recent fracture is the leading risk factor for another. The Irish Fracture Liaison Service (FLS) identifies assesses, treats and monitors those age 50+ years who present with a new ‘fragility’ (low-trauma) fracture. The Irish FLS Database reports on secondary fracture prevention standards across Ireland. Its 3rd national report with a facilities audit has been recently published. The International Osteoporosis Foundation’s “Capture the Fracture” framework provides 11 key performance indicators (KPIs), widely adopted by FLSs globally. Two of these KPIs address falls: falls risk assessment, and strength and balance exercise referrals, the latter being the leading intervention for falls prevention. Methods To examine the pattern of engagement in strength and balance programmes, data collected in 2023 from the 3rd Irish FLS Annual Report and Facilities Audit were analysed, focusing on referral patterns and access to strength and balance programmes, along with sixteen-week follow-up data where available. Results In 2023, FLS data showed that of 3,770 fragility fractures, 51% were assessed for falls risk by the FLS, i.e. only half the cohort, with rates varying from 2-90%. Of these, one third were referred or advised to self-refer to strength and balance programmes. At 16 weeks, only 56% were contactable. Of these, only 21% had started a programme, with four hospitals reporting no patient participation in exercise at 16 weeks. The facilities audit showed geographic disparity: five of six Dublin hospitals reported access to such programmes, while none of the FLS’s outside Dublin reported awareness, despite availability through councils and community organisations. Conclusion The Irish FLS’s show significant variability in access to, and awareness of strength and balance exercise programmes, particularly outside Dublin. The audit concludes that national strategies to improve access, referral pathways, and awareness are needed.

Background: The Emergency Department (ED) Now Uses High-Flow Nasal Oxygen (HFNO) Treatment As An Advanced Approach To Treating Patients Experiencing Acute Respiratory Failure. HFNO Provides Warm Humidified Oxygen Through Nasal Channels With High Flow Rates Which Builds Oxygenation While Decreasing Respiratory Work And Providing Better Comfort To The Patient. Objectives: to determine both the effectiveness and various clinical outcomes achieved through high-flow nasal oxygen therapy when treating patients with acute respiratory failure in emergency departments. Study design: A Retrospective Study. Place and duration of study: Department of Diabetes, Endocrinology & Metabolic diseases, Hayat Abad Medical Complex, Peshawar, Pakistan from jan 2023 to jan 2024 Methods: Adults aged ≥18 years who received high-flow nasal oxygen (HFNO) for acute respiratory failure were eligible. Investigators abstracted demographics, baseline clinical measures (vital signs, arterial blood gas, SpO₂/FiO₂), HFNO settings, and clinical response, and recorded outcomes of endotracheal intubation, ICU admission, and in-hospital mortality. Continuous variables were summarized as mean±SD (or median [IQR]) and compared using Student’s t-test (or Mann–Whitney U when non-normal); categorical variables used χ² tests (Fisher’s exact when appropriate). Two-sided p<0.05 denoted statistical significance. Results: Among 100 patients, the mean (SD) age was 64.7 (13.2) years, and 58% were male (n=58). Pneumonia was the leading etiology of acute respiratory failure (34%), followed by COPD exacerbation (22%) and pulmonary edema (19%). Within 2 hours of HFNO initiation, oxygenation and respiratory rate improved (SpO₂ 85.2% ± 5.4 to 94.7% ± 3.8; p<0.001). During hospitalization, 18.2% required endotracheal intubation and 36.5% were admitted to the ICU; overall in-hospital mortality was 12.8%. Conclusion: Strategy with high-flow nasal oxygen helps security along with effectiveness to treat acute respiratory failure inside emergency departments. Hospital patients receive better oxygenation through this therapy while clinicians need less invasive ventilation and may avoid sending patients to intensive care units. Better clinical results accompany rapid patient reactions to HFNO therapy. More prospective study should be done to verify and extend the information discovered.

Oropharyngeal squamous cell carcinoma (OPSCC) is among the most common head and neck cancers, with increasing use of surgical treatment for stage T1/T2 cases. This study compares the oncological outcomes of transoral robotic surgery (TORS) with non-robotic transoral surgery. A systematic review of the Ovid database was conducted using defined inclusion and exclusion criteria. Data extraction was performed independently by two authors, and publication quality was assessed using the Oxford Centre for Evidence-Based Medicine criteria. Outcomes related to oncological margins, swallowing, and voice function were analyzed descriptively. Ten studies met the inclusion criteria, most of which were retrospective cohort studies. The comparative analysis demonstrated that TORS provides better overall oncological outcomes than non-TORS in patients with T1/T2 OPSCC. In addition, TORS was associated with a 30% higher rate of achieving clear surgical margins. While these findings suggest that TORS may be the superior modality for oncological and functional outcomes, the study is limited by the lack of randomized controlled trials and non-randomized treatment assignments. Further prospective randomized trials are necessary to confirm these results and establish clinical practice guidelines.

Abstract Background The National Office of Clinical Audit Irish Hip Fracture Standards 5 and 6 advise “patients with hip fracture should have their bone health assessed to determine their need for therapy to prevent future osteoporotic fractures” and “hip fracture patients should receive a specialist falls assessment and intervention to prevent further falls”. Ideally, these assessments should be communicated clearly via discharge summaries to avoid omission or duplication of treatment. Methods An admission proforma for an acute orthogeriatric service assessing inpatients with fragility fractures was developed. We retrospectively audited orthogeriatric patients’ discharge summaries prior and post introduction of the proforma. Patients who had atraumatic fractures were appropriately excluded from audit on their falls assessment. Results The total number of patients was 98. There were 70 patients in the pre-orthogeriatric proforma group and 28 patients in the post-orthogeriatric proforma group. The average age was 80.34 (SD 8.78). There were 55 females. The average length of stay was 18.08 days (SD 10.49). In the pre-orthogeriatric proforma group a falls assessment was reported in the discharge summary for 85.29% (n=58), bone protection; 60% (n=42). In the post-orthogeriatric proforma group a falls assessment was reported in the discharge summary for; 96.15% (n=25), bone protection; 61% (n=17). 100% of patients included had a bone protection plan: IV Zoledronic acid for 56 patients, denosumab for 26 patients, DEXA for 4 patients, virtual follow-up for 8 patients, onward specialty referral for 2. One patient was from overseas and for follow-up locally. Conclusion An orthogeriatric proforma may improve communication of falls assessment and bone protection plans in discharge summaries. Despite 100% of patients having a bone protection plan, there was a discrepancy of this in the discharge summaries. A dedicated orthogeriatric intern would ensure communication is accurate. This could avoid potential duplication or omission of prescribing of anti-resorptive treatment.

Multiple sclerosis (MS) is the most common chronic demyelinating disease affecting the central nervous system (CNS) and is distinguished by neuroinflammation and neurodegeneration. It has four categories based on clinical course, with relapsing-remitting being the most common type. MS predominantly manifests with motor and sensory dysfunctions. However, neuropsychiatric manifestations such as depression, anxiety, schizophrenia, and bipolar disorder are not uncommon. Various factors may contribute to the development of these manifestations; therefore, this study aimed to unravel them. This systematic review implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Five databases (PubMed, PubMed Central (PMC), ScienceDirect, Cochrane Library, and Google Scholar) were used to acquire articles published in the past five years. After screening and quality appraisal were completed, eight articles were deemed eligible for inclusion in this study. The study designs included cohort, cross-sectional, randomized-controlled trial (RCT), case report, case-control, and narrative review. The development of neuropsychiatric manifestations in persons with MS is influenced by various factors. These were categorized into morphological changes of the brain, immunological mechanisms, socioeconomic factors, and individual factors for discussion. Each factor was found to intermingle with the others, requiring further research to understand the features that each factor contributes. This is crucial for improving the quality of life (QOL) and prognosis for persons living with MS.

ObjectivesTo describe a case report on cricopharyngeal achalasia in an infant with 49XXXXY genetic disorder.MethodsThe case report describes a rare diagnosis of cricopharyngeal achalasia in a rare genetic disorder of 49XXXXY. Informed consent was obtained from parents. It highlighted the presentation with nonspecific clinical symptoms and signs leading to challenges in the final diagnosis, also the supporting investigations to confirm the diagnosisResultsAn 11-month-old male infant with a rare genetic disorder of 49XXXXY presented with recurrent choking, aspirations, and chest infections. Born at 36 weeks due to intrauterine growth restriction, after an uneventful antenatal course with a birth weight of 2.28 kg. Admitted postnatally due to respiratory distress, and hypotonia. He had electrolyte imbalance with high sodium and serum osmolarity and MRI brain suggestive of conatal cysts adjacent to the frontal horns of both lateral ventricles. He had ongoing issues of striking hypotonia, recurrent aspirations with chest infections, poor weight gain, developmental delay and micro-penis on examination, that led to investigations including genetics and metabolic diseases. At 8 months, he was diagnosed to have a rare genetic disorder of 49XXXXY. A video fluoroscopy was performed showing indentation at cricopharyngeal muscle, consistent with cricopharyngeal achalasia, explaining, recurrent aspirations.ConclusionCricopharyngeal achalasia is a rare diagnostic entity. The spectrum of associated signs and symptoms can reflect numerous diseases and rare genetic disorders, hence it can be misleading. The key to diagnosis is to have a high index of suspicion as early diagnosis and management can prevent any morbidity or mortality.

Endometriosis is a chronic inflammatory condition that significantly impacts the quality of life (QoL) of affected women. This systematic review aimed to compare the effects of surgical interventions, acupuncture, and exercise programs on the QoL in women with endometriosis. A comprehensive search was conducted in databases such as PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). Randomized controlled trials (RCTs) and observational studies evaluating the impact of these interventions on the QoL were included. The review identified 10 studies (six RCTs and four observational studies) involving a total of 493 participants. Surgical interventions, particularly the laparoscopic excision of endometriotic lesions, demonstrated substantial reductions in pain and improvements in the QoL. Acupuncture effectively alleviated pain and enhanced overall well-being. Exercise programs improved the QoL, physical function, and pain reduction. The findings suggest that surgical-, acupuncture-, and exercise-based approaches can significantly improve the QoL for women with endometriosis. However, more personalized treatment approaches and further research are needed to understand the long-term benefits, optimal protocols, and underlying mechanisms of these interventions.

Abstract From the years of 1845 to 1852, the Great Famine (An Gorta Mór) ravaged the island of Ireland. A multitude of factors contributed to the eventual extent of its devastation; however, at its core was the widespread failure of the potato crop. The most destitute year came in 1847, and by 1852 Ireland’s population is estimated to have declined from 8.5 million to 6.5 million, with 1 million having emigrated and another million dead. Starvation was the principal cause of death for some of those who succumbed to the Great Famine, but the majority who died did so as a result of illnesses arising from the crisis, both infectious and nutritional, and not only their toll on physical health but the consequent social ramifications. In this manner, infestations and cutaneous manifestations of illness played a vital role in the eventual morbidity and mortality of the Irish famine. General fever was common, mostly originating from lice infestation of the skin, which flourished in deteriorating conditions in settlements. Two variants developed that broadly separated between social classes: recurrent fever in the poor who had previous exposure, known colloquially as ‘getting the cool’, and the more deadly typhus fever that killed many of the middle and upper classes, in particular those who attempted to help the sick such as doctors and priests [Geary L. Epidemic diseases of the Great Famine. History Ireland. Available at: https://www.historyireland.com/epidemic-diseases-of-the-great-famine/ (last accessed 29 February 2024)]. Smallpox arose in frequent epidemics, and the associated widespread pustular rash, crusting lesions and eventual scabbing offered an obvious visual cue of illness. With limited quality food available, nutritional deficiencies contributed too to the deathly appearance of those afflicted. Lack of vitamin B3 resulted in pellagra, with its associated dermatitis, and a dire lack of vitamin C gave rise to scurvy, whose ecchymosis became known in Irish as ‘cos dubh’ or black leg. With such a constellation of symptoms, it can be appreciated why there was misunderstanding and fear of the sick. This led to division in communities about the construction of fever hospitals. Some pleaded for their establishment to quarantine the sick, while others resisted for fear of contagion and, in instances such as in Fethard, County Tipperary and Belturbet, County Cavan, committed arson attacks against the hospitals. Many who did not succumb were left pauperized and ostracized by their communities, in no small part as a result of their cutaneous manifestations of a multitude of diseases.