Wexford General Hospital

Measuring muscle mass, strength, and function is vital in nutritional assessment, offering valuable insights into overall health, including nutritional adequacy, metabolic function and physical well-being. Nonetheless, the use of these measures for nutritional assessment and monitoring in dietetic practice is not widely implemented, and gaps in care remain. This study aimed to explore Irish dietitians' current nutritional assessment practices related to muscle health. A cross-sectional descriptive 29-item online survey was adapted and distributed via link in email and social media to state-registered dietitians (N = 1340) in Ireland between 21 September 2023 and 26 October 2023. Data were analysed descriptively. The majority of dietitians (84/85) agreed that musculature was important in the assessment of nutritional status, with 80% (n = 56/70) reporting the integration of at least one assessment of muscle health into their clinical practice. Handgrip strength (HGS) was viewed as the most important (95.7%; n = 67/70), frequently applied (64.3%; n = 45/70) and most useful for monitoring muscle health (77.1%; n = 54/70). Regardless, the frequency of muscle health assessment in routine practice was low. The muscle health assessments that are routinely ( > once/week) measured include body weight (82.9%; n = 58/70), BMI (81.4%; n = 57/70), HGS (25.7%; n = 18/70) and the Timed up and go test, chair stand test or short physical performance battery (10%; n = 7/70). The main barriers to muscle health assessment were 'lack of training/application experience' (61.4%, n = 43/70) and 'lack of device availability' (58.5%, n = 41/70). This study provides insights into the application of muscle health assessments within nutritional assessment among Irish dietitians. Results indicate a gap between the recognised value of muscle health and its use in nutritional assessment. Despite an almost unanimous agreement on the importance of musculature, challenges such as insufficient training and lack of equipment hinder the widespread implementation of muscle health assessment as a standard component of nutritional assessment. These findings emphasise the need for further practical education and measures to improve the availability of equipment to bridge this gap and optimise nutritional care.

This study compares the outcomes of traditional face-to-face tinnitus retraining therapy (TRT) with mobile-based TRT in India. TRT, comprising directive counseling and sound therapy, aims to help patients habituate to tinnitus. Traditional TRT involves extensive in-person sessions, whereas mobile-based TRT employs interactive applications for weekly video counseling. The Tinnitus Handicap Inventory (THI) was used to assess tinnitus severity in two cases: Case 1 received conventional face-to-face TRT, while Case 2 received mobile-based TRT. Results indicate that mobile-based TRT is as effective as the traditional approach. After two months of therapy, Case 2 showed significant improvements in tinnitus and quality of life (QOL) due to convenient followups and self-monitoring. Mobile-based TRT is a promising alternative to face-to-face therapy.

ObjectivesMental health concerns are responsible for significant morbidity and mortality in the paediatric population (1,2). A growing number of paediatric mental-health presentations to emergency departments have been reported in the past decade in Ireland and around the world, (3,4) with a further spike in presentations during the COVID-19 pandemic (5). However, in our setting as in many others, mental-health support services to young people remain under-resourced.We set out to describe the scope and trends in paediatric mental-health admissions to Wexford General Hospital (WGH) in South-East Ireland over a five-year period in order to better understand the epidemiology and healthcare needs of our patients and to assist with appropriate resource allocation.MethodsWe conducted a descriptive, retrospective review of all mental-healthcare admissions to WGH paediatric ward from August 2016 to October 2021. All patients from the age of 5 to 18 years were included, using an existing patient register of all mental-health admissions.Results249 patients were included, 70% of which were female. Figure 1 details the characteristics of admissions in terms of diagnosis, duration of stay, readmission rates and age at admission.The most common single diagnosis was overdose (22%), followed by eating disorders (10%), suicidality (10%) and deliberate self-harm (9%). Co-morbid illness was common, with 23% of patients having more than one mental-health diagnosis. Readmission was frequent, with 32% of patients being readmitted at least once. 70% of patients were between 14 and 18 years of age, 26% were aged 11 to 14 and only 4% were aged between 5 and 11 years.Figure 2 shows the change in incidence of mental health admissions over time. Admission rates peaked in 2017 with 72 admissions, declining to 27 in 2019. Admission rates then rose to 35 patients in 2020, coinciding with the pandemic, and 45 admissions in the first 10 months of 2021. Admission rates for eating disorders rose during the pandemic, with a peak of 6 admissions in the first quarter of 2020. 711 Figure 1Conclusion249 Paediatric mental-health admissions and a cumulative 1095 admission days were recorded in WGH over the five-year period, constituting a significant burden of disease in a hospital which currently has no resident psychiatrist, social worker or psychologist. Readmissions were common. Adolescents aged 14 to 17 made up the majority of admissions. Greater capacitation is required to adequately care for these patients and to allow for smooth transitioning to adult services.Referenceswww.who.int. (n.d.). Adolescent mental health. [online] Available at: http://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health.Building the Future Children and the Sustainable Development Goals in Rich Countries UNICEF Innocenti Report Card 14 Children in the Developed World. (n.d.). [online] Available at: http://cdn.thejournal.ie/media/2017/06/unicef-child-wellbeing-report-card.pdfFitzgerald E, Foley D, McNamara R, Barret E, Boylan C, Butler J, Morgan S, Okafor I. (2020). Trends in Mental Health Presentations to a Paediatric Emergency Department. I. Irish Medical Journal, [online] 113(20). Available at: https://www.researchgate.net/publication/341381154_Trends_in_Mental_Health_Presentations_to_a_Paediatric_Emergency_DepartmentMaguire E, Glynn K, McGrath C, Byrne P. (2020) ‘Children, seen and heard: a descriptive study of all children (aged 12 years and under) referred for acute psychiatric assessment in Tallaght University Hospital over a 10-year period,’ Irish Journal of Psychological Medicine, Cambridge University Press, pp. 1–9.Ougrin D, Wong BH, Vaezinejad M, Plener PL, Mehdi T, Romaniuk L, Barrett E, Hussain H, Lloyd A, Tolmac J, Rao M, Chakrabarti S, Carucci S, Moghraby OS, Elvins R, Rozali F, Skouta E, McNicholas F, Kuruppuaracchi N, Stevanovic D. (2021). Pandemic-related emergency psychiatric presentations for self-harm of children and adolescents in 10 countries (PREP-kids): a retrospective international cohort study. European Child & Adolescent Psychiatry, [online] pp.1–13. doi:10.1007/s00787-021-01741-6.

Introduction:Health service capacity has been an issue in Ireland since the 1980s swinging cuts. Government reports from 2003 have consistently identified a requirement for 3,000-5,000 extra beds on top of the current approximately 10,500 capacity. Acute hospital bed capacity issues have escalated, the formal system of recording “over capacity” patients or “patients on trolleys” has developed. A “Trolleygar” reports issues from the Health Service Executive (HSE) three times daily. This count is an underestimate as patients temporarily housed in day care units, surgical, or medical assessment units, discharge lounges and other clinical areas which have a bed space are not counted in this overcapacity measure. This study's aim is to calculate the annual number of days on which no patients were lodged on trolleys in Wexford General Hospital.Method:Descriptive study using anonymized freely available data from the national HSE Trolley GAR reports on trolley patients in Wexford General Hospital from January 2019 until September 2022. A Golden Zero trolley day was stated as a day on which there were no reported trolley-patients at the three time points, Silver Zero trolley day when two of the time periods recorded no trolleys and a Bronze Zero Trolley day when one period recorded a zero trolley count.Results:Data was collected on 1,369 days, with 90 days excluded due to missing data sets. There were 162 Golden days recorded (12.67% of total days). The year 2020 recorded the highest number of Golden days at 28.69% (105 days), followed by 2021 with 11.23% (41 days). During 2019 there were 3.84% (14 days) Golden days and 2022 had the lowest number (January-September) with 0.73% (2 days).Conclusion:Despite a zero-tolerance policy, Golden days are disappearing rapidly, capacity is urgently required with post-pandemic ED attendance surges worldwide. True recording of overcapacity patients is required for appropriate capacity modeling.

Abstract Poly(2,6‐dimethyl‐1, 4‐phenylene oxide) (PPO) is a well‐known high heat‐resistant polymer and miscible with polystyrene. However, it is not miscible with many polymers containing polar groups. In the present study, PPO was nitrated to prepare a nitrated PPO (NPPO) containing polar nitro groups and blended with a copolymer of styrene/acrylonitrile (SAN). Dynamic mechanical analysis (DMA) data showed that NPPO in SAN‐rich phase was miscible with SAN, while NPPO in NPPO‐rich phase was partially phase‐separated from SAN, both over the entire blend composition range from NPPO wt. fractions of 0.1–0.5 investigated for this work. Analyses of Fourier‐transform infrared (FTIR) and ultra‐violet (UV–VIS) spectra indicated that the miscibility of NPPO with SAN was caused by intermolecular hydrogen bonding of CN group of SAN with OH end‐group of NPPO in the NPPO/SAN blends. NPPO's OH end‐group, meta‐nitro 2,6‐dimethyl phenol, was produced during nitration of PPO due to chain scission of aryl ether bond. Besides the intermolecular hydrogen bonding, dipole‐diplo interaction of the CN and nitro groups resulted in dissociation of the CN dimers and trimers to the CN monomers in the NPPO/SAN blends.

Abstract Background Long COVID is a heterogenous condition. We previously demonstrated distinct phenotypes of long COVID, but the impact of later waves caused by SARS-CoV-2 variants on long COVID presentations has not been described. Methods We selected individuals with ongoing symptoms > 4 weeks from PCR-confirmed COVID-19 in a multicentre, prospective cohort study. We used multiple correspondence analysis and hierarchical clustering on self-reported symptoms to identify symptom clusters, in individuals recruited during two periods; cohort 1 from March 2020 to April 2021, and cohort 2 from April 2021 to March 2022. We explored differences in symptoms by mapping acute infection to one of four COVID-19 waves in Ireland (table 1) as well as vaccination status, and used Chi2 test to compare symptoms frequencies. Results Demographics are shown in Table 2. Cluster analysis of each cohort demonstrated 3 distinct clusters in both cohorts, which shared similar clinical characteristics; a musculoskeletal/pain symptom cluster, a cardiorespiratory cluster and a third less symptomatic cluster (Figure 1). While symptoms within clusters were similar across both periods, in the cardiorespiratory cluster, the frequency of palpitations decreased (56% vs 16%) and cough increased (14% vs 45%) between reporting periods (both P< 0.01). Furthermore, a greater proportion of palpitations were reported in those with COVID-19 from waves 1 and 2 (35% and 28%) compared to 3 and 4 (both 12%, P< 0.001), and a greater proportion of chest pain in waves 1, 2 and 4 compared to wave 3. There were no differences in other symptoms (Table 3). Additionally there were significantly less palpitations reported in those vaccinated at the time of review (17% vs 31% P=0.002), but not chest pain (30% vs 39% P=0.13). In multivariate analysis, infection in wave 3 and 4 but not vaccination status remained significantly associated with lower reported palpitations (OR (95% CI) 0.28 (0.13–0.97) and 0.5 (0.06–0.87) for waves 3 and 4, both P< 0.05), and wave 3 infection remained independently associated with lower reported chest pain (OR 0.3 (0.25–0.7)). Conclusion Three symptom clusters define long COVID across the two cohorts, but characteristics of the cardiorespiratory phenotype have evolved over time with evolution of SARS-CoV-2 variants. Disclosures All Authors: No reported disclosures.

Measurement of quantitative antibody responses are increasingly important in evaluating the immune response to infection and vaccination. In this study we describe the validation of a quantitative, multiplex serologic assay utilising an electrochemiluminescence platform, which measures IgG against the receptor binding domain (RBD), spike S1 and S2 subunits and nucleocapsid antigens of SARS-CoV-2. The assay displayed a sensitivity ranging from 73 to 91% and specificity from 90 to 96% in detecting previous infection with SARS-CoV-2 depending on antigenic target and time since infection, and this assay highly correlated with commercially available assays. The within-plate coefficient of variation ranged from 3.8–3.9% and the inter-plate coefficient of variation from 11 to 13% for each antigen.