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  • Development and relative validation of a short food frequency questionnaire for assessing dietary intakes of non-alcoholic fatty liver disease patients.

    Bredin, Carla; Naimimohasses, Sara; Norris, Suzanne; Wright, Ciara; Hancock, Neil; Hart, Kathryn; Moore, J Bernadette (2019-02-25)
    Fifty-five patients completed both the SFFQ and the 4DDD within 30 weeks; 42 (76%) were diagnosed with simple steatosis, whereas 13 (24%) had biopsy-proven steatohepatitis; the majority were overweight or obese, with a median (25th; 75th percentile) BMI of 33.2 kg/m2 (29.3; 36.0). Reported energy intakes were well below EER with a median intake of 73% of requirements, suggesting widespread under-reporting. Significant correlations were observed between sugar (r = 0.408, P = 0.002), fat (r = 0.44, P = 0.001), fruits (r = 0.51, P = 0.0001) and vegetables (r = 0.40, P = 0.0024) measurements by the SFFQ and 4DDD. Bland Altman plots with regression analysis demonstrated broad comparability with the 4DDD for intakes of fat (bias - 13.8 g/day) and sugar (bias  + 12.9 g/day).
  • Endovascular flow-diversion of visceral and renal artery aneurysms using dual-layer braided nitinol carotid stents.

    van Veenendaal, Penelope; Maingard, Julian; Kok, Hong Kuan; Ranatunga, Dinesh; Buckenham, Tim; Chandra, Ronil V; Lee, Michael J; Brooks, Duncan Mark; Asadi, Hamed (2020-06-28)
    Background: Visceral and renal artery aneurysms (VRAAs) are uncommon but are associated with a high mortality rate in the event of rupture. Endovascular treatment is now first line in many centres, but preservation of arterial flow may be difficult in unfavourable anatomy including wide necked aneurysms, parent artery tortuosity and proximity to arterial bifurcations. Endovascular stenting, and in particular flow-diversion, is used in neurovascular intervention to treat intracranial aneurysms but is less often utilised in the treatment of VRAAs. The CASPER stent is a low profile dual-layer braided nitinol stent designed for carotid stenting with embolic protection and flow-diversion properties. We report the novel use of the CASPER stent for the treatment of VRAAs. We present a case series describing the treatment of six patients with VRAAs using the CASPER stent. Results: Six patients with unruptured VRAAs were treated electively. There were three splenic artery aneurysms and three renalartery aneurysms. Aneurysms were treated with the CASPER stent, with or without loose aneurysm coil packing or liquid embolic depending on size and morphology. All stents were successfully deployed with no immediate or periprocedural complications. Four aneurysms completely occluded after serial imaging follow up with one case requiring repeat CASPER stenting for complete occlusion. In one patient a single aneurysm remained patent at last follow up, A single case was complicated by delated splenic infarction and surgical splenectomy.
  • Determining the Effect of External Stressors and Cognitive Distraction on Microsurgical Skills and Performance.

    Carr, Shane; McDermott, Bronwyn Reid; McInerney, Niall; Hussey, Alan; Byrne, D; Potter, Shirley (2020-01-22)
    Introduction: Microsurgery is an essential element of Plastic Surgery practice. There is a paucity of studies assessing the impact of stress and cognitive distraction on technical microsurgical performance. The ability to complete cognitive and technical skills in parallel has not been assessed in a microsurgical setting. Aim: To test the hypothesis that cognitive distraction and external stressors negatively affect microsurgical performance in a high fidelity simulation setting. Materials/Methods: Fourteen surgeons across all levels of training undertook 2 microsurgical skills sessions, 1 month apart. Session one established baseline microsurgical skill. In session two, skills were assessed with the introduction of realistic operative room cognitive distractions (ORDIs). Outcome measures were efficiency and accuracy, measured by Time to Completion (TTC) and Anastomosis Lapse Index (ALI), respectively. Key Results: Fourteen participants (6 novices, 5 plastic surgery specialist trainees and 3 consultants) completed both microsurgical skills sessions. In total, 28-microvascular anastomosis were analyzed. Mean baseline TTC for the group was 20.36 min. With cognitive distraction and external stress mean TTC decreased to 17.87 min. Mean baseline ALI score for the group was 3.32 errors per anastomosis. The introduction of cognitive distraction and external stress increased the mean to 4.86 errors per anastomosis. Total errors per anastomosis increased from 91 errors at baseline to 137 errors with cognitive distraction and external stress. Under stress, participants were more efficient but had reduced anastomotic accuracy. Conclusion: Under stress, surgeons were more efficient, this translated into faster completion of a microsurgical anastomosis. Efficiency, however, came at the expense of accuracy.
  • Does CT Reduce the Rate of Negative Laparoscopies for Acute Appendicitis? A Single-Center Retrospective Study.

    Wagner, Pedro de J; Haroon, Muthana; Morarasu, Stefan; Eguare, Emmanuel; Al-Sahaf, Osama (2020-01)
    In surgical practice, surgeons request CT scans to rule out acute appendicitis, even in young patients. We aimed to assess the feasibility of using a CT scan to reduce the rate of negative laparoscopies in patients younger than 40 with equivocal signs of acute appendicitis. Therefore, we conducted a retrospective observational study on the patients admitted with a provisional diagnosis of acute appendicitis. Patients younger than 40 and with the Alvarado score between 3 and 6 were included. These were divided into two groups: those who had or did not have a CT scan. Each group was further subdivided into patients that had a laparoscopy and those that did not. Out of 204 patients included in the study, 16% were included in the CT group, and 84% in the non-CT group. 71.9% of the patients that underwent a CT scan had appendicitis and underwent an appendectomy. Five patients with a normal CT scan had appendectomy due to persistent signs of acute appendicitis. The histopathology of the 23 patients with positive CT was positive, and 3 of the 5 patients with negative CT that underwent appendectomy had positive histology results. The negative appendectomy rate for patients that had preoperative CT is 7.14% compared to 32.4% in patients without preoperative CT. The rate of negative laparoscopy in patients younger than 40 years old that undergo preoperative CT is significantly lower with a p-value of .00667.
  • Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series.

    Hannan, Enda; Ryan, Jessica; Toomey, Desmond (2020-07-16)
    Introduction: The aftermath of pelvic radiotherapy for prostate cancer (PC) can pose a significant challenge for surgeons in the management of rectal and sigmoid tumours, resulting in extensive fibrosis and difficult anatomy. Higher rates of ureteric injuries and anastomotic leakage following anterior resection (AR) have been reported with no clear consensus for an optimal approach. We present three cases, each employing a different surgical approach tailored to the individual patient-specific and disease-specific factors. Presentation of case: In each case, the patient had active radiation proctitis. Case 1 was a T3 rectal cancer 9 cm from the anal verge. A non-restorative procedure was performed with a permanent end colostomy, due to the extensive pelvic fibrosis encountered in a comorbid patient. In case 2, a large rectal polyp at 12 cm from the anal verge was managed using transanal minimally invasive surgery (TAMIS) with a covering loop ileostomy. In case 3, an elderly patient with dementia with a malignant sigmoid polyp underwent a segmental resection rather than standard oncological resection, thus avoiding either a stoma or rectal anastomosis in the context of active radiation proctitis. All three patients remain well at follow-up with no evidence of recurrence. Discussion: All three cases demonstrate an individualised approach, taking into account specific factors relating to both patient and disease. In all cases, the presence of active chronic radiation proctitis meant that primary colorectal anastomosis was not safe, thus, alternative approaches were taken. Conclusion: It is essential to tailor treatment according to patient-specific and disease-specific factors.
  • Conservative management of complete traumatic pancreatic body transection; A case report.

    Duggan, W; Hannan, E; Brosnan, C; O'Sullivan, S; Conlon, K (2020-05-21)
    Introduction: Isolated pancreatic body transection secondary to blunt abdominal trauma is a very rare injury associated with poor outcomes. Almost all previously reported cases were managed by emergency distal pancreatectomy, which is associated with high morbidity and mortality. To our knowledge, this is the first reported case of complete transection of the pancreas at the body that was successfully treated by conservative management in an adult patient. Presentation of case: A 19-year-old male was found to have complete transection of the pancreatic body on computed tomography (CT) following blunt force abdominal trauma. Given that he was haemodynamically stable without evidence of haemorrhage or bile leakage on imaging, a trial of conservative management was initiated. He remained well through his admission, gradually improving clinically and biochemically with stable appearances on serial imaging. He remains asymptomatic as of six months since discharge from the hospital and continues to be monitored in the outpatient setting. Discussion: Management of pancreatic trauma with ductal injury has typically been with emergency distal pancreatectomy, which is associated with high morbidity and mortality. The decision to operate should not be purely based on radiological findings, and should take into account clinical status, haemodynamic stability, coexisting injuries and evidence of active haemorrhage or bile leak. Conclusion: In select cases, it is reasonable to trial conservative management in isolated traumatic pancreatic body fracture by means of close clinical observation and serial imaging. This may allow the patient to avoid a high-risk emergency distal pancreatectomy.
  • Resin bonded bridges in patients with hypodontia: Clinical performance over a 7 year observation period.

    Anweigi, Lamyia; Azam, Ambreen; Mata, Cristiane de; AlMadi, Ebtissam; Alsaleh, Samar; Aldegheishem, Alhanoof (2019-12-11)
    Purpose: Resin bonded bridges (RBBs) are considered a conservative option in the management of hypodontia. This study targeted to analyze the survival of resin bonded bridges provided to patients with Hypodontia by staff and students at the Department of Restorative Dentistry, University Dental School and Hospital Cork, Ireland. It was also to determine the factors that may influence the survival of RBBs in patients with hypodontia. Methods: Forty patients with hypodontia who received 65 RBBs from 2001 to 2007 were identified and contacted to be recruited for this study. Of these, nine were not contactable, and five failed to attend. Accordingly, 26 patients (65%) participated in the study, with a total of 51 RBBs. Results: Of the 51 RBBs evaluated, 44 (86%) were still in situ and functional and 7 (14%) failed. The main reason for failure was repeated debonding. The effect of age, gender, the grade of operator and experience, bridge location, design of the bridge, span length and moisture control during cementation, could not be demonstrated. Conclusion: The effect of age, gender, the grade of operator and experience, bridge location, design of the bridge, span length and moister control on RBB survival could not be demonstrated. Majority of patients with hypodontia showed satisfaction with resin bonded bridges. In replacing congenitally missing teeth in patients with hypodontia, resin-bonded bridges would be an acceptable treatment option.
  • Initial Assessment of the Percutaneous Electrical Phrenic Nerve Stimulation System in Patients on Mechanical Ventilation.

    O'Rourke, James; Soták, Michal; Curley, Gerard F; Doolan, Aoife; Henlín, Tomáš; Mullins, Gerard; Tyll, Tomáš; Omlie, William; Ranieri, Marco V (2020-05)
    Objectives: Maintaining diaphragm work using electrical stimulation during mechanical ventilation has been proposed to attenuate ventilator-induced diaphragm dysfunction. This study assessed the safety and feasibility of temporary percutaneous electrical phrenic nerve stimulation on user-specified inspiratory breaths while on mechanical ventilation. Design: Two-center, nonblinded, nonrandomized study. Setting: Hospital ICU. Patients: Twelve patients mechanically ventilated from 48 hours to an expected 7 days. Interventions: Leads were inserted to lie close to the phrenic nerve in the neck region using ultrasound guidance. Two initial patients had left-sided placement only with remaining patients undergoing bilateral lead placement. Percutaneous electrical phrenic nerve stimulation was used for six 2-hour sessions at 8-hour intervals over 48 hours. Measurements and main results: Data collected included lead deployment success, nerve conduction, ventilation variables, work of breathing, electrical stimulation variables, stimulation breath synchrony, and diaphragm thickness measured by ultrasound at baseline, 24, and 48 hours. Primary endpoints included ability to capture the left and/or right phrenic nerves and maintenance of work of breathing within defined limits for 80% of stimulated breaths. Lead insertion was successful in 21 of 22 attempts (95.5%). Analysis of 36,059 stimulated breaths from 10 patients with attempted bilateral lead placement demonstrated a mean inspiratory lag for phrenic nerve stimulation of 23.7 ms (p < 0.001 vs null hypothesis of <88ms). Work of breathing was maintained between 0.2 and 2.0 joules/L 96.8% of the time, exceeding the 80% target. Mean diaphragm thickness increased from baseline by 7.8% at 24 hours (p = 0.022) and 15.0% at 48 hours (p = 0.0001) for patients receiving bilateral stimulation after excluding one patient with pleural effusion. No serious device/procedure-related adverse events were reported. Conclusions: The present study demonstrated the ability to safely and successfully place percutaneous electrical phrenic nerve stimulation leads in patients on mechanical ventilation and the feasibility of using this approach to synchronize electrical stimulation with inspiration while maintaining work of breathing within defined limits.
  • Technical outcome of atlantoaxial transarticular screw fixation without supplementary posterior construct for rheumatoid arthritis.

    Thomas, Philip; Amoo, Michael; Horan, Jack; Husien, Mohammed Ben; Cawley, Derek; Nagaria, Jabir; Bolger, Ciaran (2020-07-11)
    Background: transarticular screw (TAS) fixation without a supplementary posterior construct, even in rheumatoid arthritis (RA) patients, provides sufficient stability with acceptable clinical results. Here, we present our experience with 15 RA patients who underwent atlantoaxial (AA) TAS fixation without utilizing a supplementary posterior fusion. Methods: To treat AA instability, all 15 RA patients underwent C1-C2 TAS fixation without a supplementary posterior construct. Patients were followed for at least 24 months. Pre- and postoperative sagittal measures of C1- C2, C2-C7, and C1-C7 angles, atlanto-dens interval (ADI), posterior atlanto-dens interval (PADI), and adjacent segment (i.e., C2-C3) anterior disc height (ADH) were retrospectively recorded from lateral X-ray imaging. The presence or absence of superior migration of the odontoid (SMO), cervical subaxial subluxation, C1-C2 bony fusion, screw pull-out, and screw breakage were also noted. Results: There was little difference between the pre- and postoperative studies regarding angles measured. Following TAS fixation, the mean ADI shortened, and mean PADI lengthened. There was no difference in the mean measures of C2-C3 ADH. There was no evidence of SMO pre- or postoperatively. Two patients developed anterior subluxation at C5-C6; one of the two also developed anterior subluxation at C2-C3. All patients subsequently showed C1-C2 bony fusion without screw pull-out or breakage. Conclusion: In RA patients who have undergone C1-C2 TAS fixation, eliminating a supplementary posterior fusion resulted in adequate stability.
  • Editorial: Cardiovascular Adjustments and Adaptations to Exercise: From the Athlete to the Patient.

    Crisafulli, Antonio; Piepoli, Massimo F; Thijssen, Dick; Bassareo, Pier Paolo (2020-02-27)
  • Fertility-sparing treatment in early endometrial cancer: current state and future strategies.

    Obermair, Andreas; Baxter, Eva; Brennan, Donal J; McAlpine, Jessica N; Muellerer, Jennifer J; Amant, Frédéric; van Gent, Mignon D J M; Coleman, Robert L; Westin, Shannon N; Yates, Melinda S; et al. (2020-07-08)
    Endometrial cancer (EC) is the fifth most common cancer in women worldwide. Global estimates show rising incidence rates in both developed and developing countries. Most women are diagnosed postmenopausal, but 14-25% of patients are premenopausal and 5% are under 40 years of age. Established risk factors include age and hyperestrogenic status associated with nulliparity, obesity, and metabolic syndrome. Standard treatment for EC, which involves total hysterectomy and bilateral salpingo-oophorectomy, has excellent survival outcomes, particularly for low-grade endometrioid tumors. However, it leads to permanent loss of fertility among women who wish to preserve their reproductive potential. With current trends of reproductive-age women delaying childbearing, rising EC incidence rates, and a growing epidemic of obesity, particularly in developed countries, research on conservative non-surgical treatment approaches remains a top priority. Fertility-sparing treatment predominantly involves the use of oral progestins and levonorgestrel-releasing intrauterine devices, which have been shown to be feasible and safe in women with early stage EC and minimal or no myometrial invasion. However, data on the efficacy and safety of conservative management strategies are primarily based on retrospective studies. Randomized clinical trials in younger women and high-risk obese patients are currently underway. Here, we have presented a comprehensive review of the current literature on conservative, fertility-sparing approaches, defining the optimal candidates and evaluating tumor characteristics, reproductive and oncologic outcomes, and ongoing clinical trials. We have also summarized current guidelines and recommendations based on the published literature.
  • Determinants of healthcare seeking for childhood illnesses among caregivers of under-five children in urban slums in Malawi: a population-based cross-sectional study.

    Lungu, Edgar Arnold; Darker, Catherine; Biesma, Regien (2020-01-17)
    Background: There is considerable evidence that health systems, in so far as they ensure access to healthcare, promote population health even independent of other determinants. Access to child health services remains integral to improving child health outcomes. Cognisant that improvements in child health have been unevenly distributed, it is imperative that health services and research focus on the disadvantaged groups. Children residing in urban slums are known to face a health disadvantage that is masked by the common view of an urban health advantage. Granted increasing urbanisation rates and proliferation of urban slums resulting from urban poverty, the health of under-five children in slums remains a public health imperative in Malawi. We explored determinants of healthcare-seeking from a biomedical health provider for childhood symptoms of fever, cough with fast breathing and diarrhoea in three urban slums of Lilongwe, Malawi. Methods: This was a population-based cross-sectional study involving 543 caregivers of under-five children. Data on childhood morbidity and healthcare seeking in three months period were collected using face-to-face interviews guided by a validated questionnaire. Data were entered in CS-Pro 5.0 and analysed in SPSS version 20 using descriptive statistics and logistic regression analyses. Results: 61% of caregivers sought healthcare albeit 53% of them sought healthcare late. Public health facilities constituted the most frequently used health providers. Healthcare was more likely to be sought: for younger than older under-five children (AOR = 0.54; 95% CI: 0.30-0.99); when illness was perceived to be severe (AOR = 2.40; 95% CI: 1.34-4.30); when the presenting symptom was fever (AOR = 1.77; 95% CI: 1.10-2.86). Home management of childhood illness was negatively associated with care-seeking (AOR = 0.54; 95% CI: 0.36-0.81) and timely care-seeking (AOR = 0.44; 95% CI: 0.2-0.74). Caregivers with good knowledge of child danger signs were less likely to seek care timely (AOR = 0.57; 95% CI: 0.33-0.99). Conclusions: Even in the context of geographical proximity to healthcare services, caregivers in urban slums may not seek healthcare or when they do so the majority may not undertake timely healthcare care seeking. Factors related to the child, the type of illness, and the caregiver are central to the healthcare decision making dynamics. Improving access to under-five child health services therefore requires considering multiple factors.
  • When the bowel meets the bladder: Optimal management of colorectal pathology with urological involvement.

    Keady, Conor; Hechtl, Daniel; Joyce, Myles (2020-05-27)
    Fistulae between the gastrointestinal and urinary systems are rare but becoming increasingly more common in current surgical practice. They are a heterogeneous group of pathological entities that are uncommon complications of both benign and malignant processes. As the incidence of complicated diverticular disease and colorectal malignancy increases, so too does the extent of fistulous connections between the gastrointestinal and urinary systems. These complex problems will be more common as a factor of an aging population with increased life expectancy. Diverticular disease is the most commonly encountered aetiology, accounting for up to 80% of cases, followed by colorectal malignancy in up to 20%. A high index of suspicion is required in order to make the diagnosis, with ever improving imaging techniques playing an important role in the diagnostic algorithm. Management strategies vary, with most surgeons now advocating for a single-stage approach to enterovesical fistulae, particularly in the elective setting. Concomitant bladder management techniques are also disputed. Traditionally, open techniques were the standard; however, increased experience and advances in surgical technology have contributed to refined and improved laparoscopic management. Unfortunately, due to the relative rarity of these entities, no randomised studies have been performed to ascertain the most appropriate management strategy. Rectourinary fistulae have dramatically increased in incidence with advances in the non-operative management of prostate cancer. With radiotherapy being a major contributing factor in the development of these complex fistulae, optimum surgical approach and exposure has changed accordingly to optimise their management. Conservative management in the form of diversion therapy is effective in temporising the situation and allowing for the diversion of faecal contents if there is associated soiling, macerated tissues or associated co-morbidities. One may plan for definitive surgical intervention at a later stage. Less contaminated cases with no fibrosis may proceed directly to definitive surgery if the appropriate expertise is available. An abdominal approach with direct repair and omentum interposition between the repaired tissues has been well described. In low lying fistulae, a transperineal approach with the patient in a prone-jack knife position provides optimum exposure and allows for the use of interposition muscle grafts. According to recent literature, it offers a high success rate in complex cases.
  • Letter to the editor: HIV in women in the World Health Organization (WHO) European Region.

    Aebi-Popp, Karoline; Mulcahy, Fiona; Gilleece, Yvonne; On Behalf Of Wave (2020-01-30)
  • Transcutaneous bilirubinometry during and after phototherapy in preterm infants: a prospective observational study.

    Raba, Ali Ahmed; O'Sullivan, Anne; Miletin, Jan (2020-07-16)
    Objective: To examine the accuracy of transcutaneous bilirubinometry (TCB) measurements during and after phototherapy (PT) in preterm infants. Design: Prospective observational cohort study. Setting: Level III neonatal centre. Patients: Preterm infants (from 23+0 to 36+6 weeks of gestation) born between June 2017 and May 2018 requiring PT. Interventions: TCB was measured from an exposed area of the skin (the sternum; TCBU) and the covered area of the skin under the nappy (the bony part of the upper outer quadrant of the buttock; TCBC) within an hour of obtaining total serum bilirubin (TSB). Main outcome measures: Correlation and agreement between TCB (TCBU and TCBC) and TSB during and after PT. Results: We have enrolled 196 preterm infants. There was a significant correlation between TSB and TCB during PT (r=0.72, 95% CI 0.66 to 0.77 in covered area; r=0.75, 95% CI 0.70 to 0.80 in uncovered area) and after PT (r=0.87, 95% CI 0.83 to 0.91). TCB underestimated TSB level during PT, with a mean TCBC-TSB difference of -25±43 (95% agreement limits of 62 to -112) and a mean TCBU-TSB difference of -48±46 (95% agreement limits of 45 to -140). The agreement between TCB and TSB after cessation of PT improved, with TCB underestimating TSB by a mean TCB-TSB difference of -10±31 (95% agreement limits of 52 to -72). Conclusion: TCB measurements correlated strongly with TSB levels during and after PT. However, there was a wide and clinically relevant disagreement between TCB and TSB measurements during the PT phase, improving significantly after PT.
  • Factors affecting physician implementation of hospital pharmacists' medication appropriateness recommendations in older adults.

    Dalton, Kieran; Fleming, Aoife; O'Mahony, Denis; Byrne, Stephen; Aoife Fleming, Pharmacy Department, Mercy University Hospital, Grenville Place, Cork T12 WE28, Ireland. (Wiley, 2021-07-16)
    Aims: Non-implementation of pharmacist recommendations by physician prescribers may prolong potentially inappropriate prescribing in hospitalised older adults, increasing the risk of adverse clinical outcomes. The aim of this study was to ascertain the key factors affecting physician prescriber implementation of pharmacists' medication appropriateness recommendations in hospitalised older adults. Methods: Semi-structured interviews were conducted with hospital pharmacists and physicians who provided care to older adults (≥65 years) in 2 acute university teaching hospitals in Ireland. Content analysis was employed to identify the key themes that influence physician prescriber implementation of pharmacist recommendations. Results: Fourteen interviews were conducted with 6 hospital pharmacists and 8 hospital physicians between August 2018 and August 2019. Five key factors were found to affect physician implementation of pharmacist recommendations: (i) the clinical relevance and complexity of the recommendation-recommendations of higher priority and those that do not require complex decision-making are implemented more readily; (ii) interprofessional communication —recommendations provided verbally, particularly those communicated face to face with confidence and assertion, are more likely to be implemented than written recommendations; (iii) physician role and identity —the grade, specialty, and personality of the physician significantly affect implementation; (iv) knowing each other and developing trusting relationships —personal acquaintance and the development of interprofessional trust and rapport greatly facilitate recommendation implementation; and (v) the hospital environment —organisational issues such as documentation in the patient notes, having the opportunity to intervene, and the clinical pharmacy model all affect implementation. Conclusion: This study provides a deeper understanding of the underlying behavioural determinants affecting physician prescriber implementation of pharmacist recommendations and will aid in the development of theoretically-informed interventions to improve medication appropriateness in hospitalised older adults. © 2021 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.
  • Screening for cognitive impairment after stroke: Validation of the Chinese version of the Quick Mild Cognitive Impairment screen

    Xu, Yangfan; Yi, Lingrong; Lin, Yangyang; Peng, Suiying; Wang, Weiming; Lin, Wujian; Chen, Peize; Zhang, Weichao; Deng, Yujie; Guo, Suimin; et al. (Frontiers, 2021-03-05)
    Background: Screening for post-stroke cognitive impairment (PSCI) is necessary because stroke increases the incidence of and accelerates premorbid cognitive decline. The Quick Mild Cognitive Impairment (Qmci) screen is a short, reliable and accurate cognitive screening instrument but is not yet validated in PSCI. We compared the diagnostic accuracy of a Chinese version of the Qmci screen (Qmci-CN) compared with the widely-used Chinese versions of the Montreal Cognitive Assessment (MoCA-CN) and Mini-Mental State Examination (MMSE-CN). Methods: We recruited 34 patients who had recovered from a stroke in rehabilitation unit clinics in 2 university hospitals in China: 11 with post-stroke dementia (PSD), 15 with post-stroke cognitive impairment no dementia (PSCIND), and 8 with normal cognition (NC). Classification was made based on clinician assessment supported by a neuropsychological battery, independent of the screening test scores. The Qmci-CN, MoCA-CN, and MMSE-CN screens were administered randomly by a trained rater, blind to the diagnosis. Results: The mean age of the sample was 63 ± 13 years and 61.8% were male. The Qmci-CN had statistically similar diagnostic accuracy in differentiating PSD from NC, an area under the curve (AUC) of 0.94 compared to 0.99 for the MoCA-CN (p = 0.237) and 0.99 for the MMSE-CN (p = 0.293). The Qmci-CN (AUC 0.91), MoCA-CN (AUC 0.94), and MMSE-CN (AUC 0.79) also had statistically similar accuracy in separating PSD from PSCIND. The MoCA-CN more accurately distinguished between PSCIND and normal cognition than the Qmci-CN (p = 0.015). Compared to the MoCA-CN, the administration times of the Qmci-CN (329s vs. 611s, respectively, p < 0.0001) and MMSE-CN (280 vs. 611s, respectively, p < 0.0001) were significantly shorter. Conclusion: The Qmci-CN is accurate in identifying PSD and separating PSD from PSCIND in patients post-stroke following rehabilitation and is comparable to the widely-used MoCA-CN, albeit with a significantly shorter administration time. The Qmci-CN had relatively poor accuracy in identifying PSCIND from NC and hence may lack accuracy for certain subgroups. However, given the small sample size, the study is under-powered to show superiority of one instrument over another. Further study is needed to confirm these findings in a larger sample size and in other settings (countries and languages).
  • A qualitative study of parental views of HPV vaccination in Ireland

    Creed, Stephanie; Walsh, Elaine; Foley, Tony; Stephanie Creed, Mercy University Hospital, Grenville Place, Cork T12 WE28, Ireland.
    An in-depth qualitative study, using semi-structured interviews was conducted among parents of 11-13-year-old girls (n = 18) who had not yet been offered the HPV vaccine. Convenience sampling was used. Interviews, conducted in the Republic of Ireland over six-months in 2018, were audio-recorded, transcribed, and analysed by thematic analysis.
  • A national survey of oncology survivors examining nutrition attitudes, problems and behaviours, and access to dietetic care throughout the cancer journey.

    Sullivan, Erin S; Rice, Niamh; Kingston, Elaine; Kelly, Aoife; Reynolds, John V; Feighan, Jennifer; Power, Derek G; Ryan, Aoife M; Derek J. Power, Department of Medical Oncology, Mercy University Hospital, Grenville Place, Cork, Ireland. (Elsevier, 2021)
    Background: Attitudes of cancer survivors to nutrition and nutrition care have rarely been captured. A better understanding of their needs based on a review of their experiences would give voice to this patient group (which has rarely been captured) and allow for better planning of nutritional care. Aims: To conduct a national survey to determine: (1) survivors' experience in relation to nutrition and diet-related problems, (2) perceived importance of the role of nutrition to cancer survivors, (3) the experience of accessing dietetic support, (4) the sources where survivors get nutrition information, and (5) their use of alternative dietary strategies. Methods: Survivors (any adult ever diagnosed with cancer) who had been diagnosed with or treated for cancer in Ireland within the past 5 years, were asked to complete a 25-item paper-based survey at one of 20 different hospital sites in Ireland. The survey was also hosted online on the websites of major cancer charities. Descriptive statistics were used to examine quantitative data. Results: In total, 1073 valid responses were received (63% female, mean age 57 years (range 18–88)). Breast cancer was the most common (n = 362), followed by colorectal (n = 121). One third of respondents had metastatic disease. Diet-related problems were reported by 45%. Weight loss was experienced by 44% and amongst those, 42% reported they were ‘unhappy or worried’ by this, while 27% reportedbeing ‘delighted/happy’ with their weight loss. Muscle loss was noted by 52%, with 20% reporting they had noticed ‘a lot’ of muscle loss. Nutrition was rated as ‘very/extremely’ important to cancer care by 89% of respondents, yet 58% reported being asked about dietary issues by their medical team only ‘sometimes’, ‘rarely’ or ‘never’. Only 39% had been assessed/treated by a registered dietitian (RD) and 74% rated their advice/care as ‘very/extremely’ helpful. Worryingly, 39% of survivors with involuntary weight loss, and 29% of survivors on a texture modified diet had not received nutritional care from an RD. Overall, 57% of those who did not see an RD said they wanted more dietetic support (access to a helpline/dietitian/additional reliable information). Of concern, 37% of survivors were following or had tried alternative, unproven dietary strategies (e.g. restrictive diets, herbal remedies, juicing or detoxes), and 32% reported avoiding specific foods, e.g. processed meat or dairy. A majority (56%) felt confused by the often conflicting nutrition information available in the media and offered by people around them. Conclusions: While nutrition is considered highly important by cancer survivors and a high proportion experience potentially serious diet-related problems including weight and muscle loss, fewer than half surveyed had access to a dietitian. Over a third had used at least one alternative dietary strategy, and over half felt confused about nutrition. Comprehensive nutritional screening and referral programmes to oncology dietitians need to be implemented in the ambulatory setting in order to identify and facilitate early management of the nutritional concerns of cancer survivors.
  • A metapopulation network model for the spreading of SARS-CoV-2: Case study for Ireland

    Humphries, Rory; Spillane, Mary; Mulchrone, Kieran; Wieczorek, Sebastian; O'Riordain, Micheal; Hövel, Philipp; Micheal Ó Riordáin, Department of Surgery, Mercy University Hospital, Grenville Place, Cork T12 WE28, Ireland (Elsevier, 2021-02-04)
    We present preliminary results on an all-Ireland network modelling approach to simulate the spreading the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2), commonly known as the coronavirus. In the model, nodes correspond to locations or communities that are connected by links indicating travel and commuting between different locations. While this proposed modelling framework can be applied on all levels of spatial granularity and different countries, we consider Ireland as a case study. The network comprises 3440 electoral divisions (EDs) of the Republic of Ireland and 890 superoutput areas (SOAs) for Northern Ireland, which corresponds to local administrative units below the NUTS 3 regions. The local dynamics within each node follows a phenomenological SIRX compartmental model including classes of Susceptibles, Infected, Recovered and Quarantined (X) inspired from Science 368, 742 (2020). For better comparison to empirical data, we extended that model by a class of Deaths. We consider various scenarios including the 5-phase roadmap for Ireland. In addition, as proof of concept, we investigate the effect of dynamic interventions that aim to keep the number of infected below a given threshold. This is achieved by dynamically adjusting containment measures on a national scale, which could also be implemented at a regional (county) or local (ED/SOA) level. We find that - in principle - dynamic interventions are capable to limit the impact of future waves of outbreaks, but on the downside, in the absence of a vaccine, such a strategy can last several years until herd immunity is reached.

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