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Hospital physicians' and older patients' agreement with individualised STOPP/START-based medication optimisation recommendations in a clinical trial setting.139 patients were included, mean (SD) age 78.3 (5.1) years, 47% male and median (IQR) number of medications at admission 11 (9-14). In total, 371 recommendations were discussed with patients and physicians, overall agreement was 61.6% for STOPP and 60.7% for START recommendations. Highest agreement was found for initiation of osteoporosis agents and discontinuation of proton pump inhibitors (both 74%). Factors associated with higher agreement in multivariate analysis were: female gender (+ 17.1% [3.7; 30.4]), ≥ 1 falls in the past year (+ 15.0% [1.5; 28.5]) and renal impairment i.e. eGFR 30-50 ml/min/1.73 m2; (+ 18.0% [2.0; 34.0]). The main reason for disagreement (40%) was patients' reluctance to discontinue or initiate medication.
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Have Legislative Interventions Impacted the Incidence of Needlestick Injuries?Introduction The aim of this study was to examine the impact the EU Directive for the Prevention of Sharps injuries had on the incidence of needlestick injuries (NSI) in Ireland. Methods A five-year retrospective study prior to, and after the introduction of these regulations, was conducted. Secondary data from the Occupational Health Department's annual NSI reports were used. The population studied were healthcare workers who reported a NSI from 2013 to 2017. Results The incidence of NSI varied from 157 in 2017 to 207 in 2014. 'Miscellaneous needles' was the category which caused the most NSI (23%). 'Disposable needles with syringes' accounted for 20% of all NSI before the legislation; this figure was reduced to 12-15% after the regulations were introduced. Conclusion The EU regulations did not reduce the incidence of NSI. A lower incidence of NSI was reported from 'disposable needles with syringes' after the implementation of the regulations.
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Association between Psychiatric Disorders and Glomerular Disease.Data were available for 950 participants, with a median of 58 months of follow-up. 110 (12%) participants were diagnosed with psychiatric disorder during the follow-up. The estimated rate of psychiatric diagnosis after kidney disease was 14.7 cases per 1,000 person-years and was highest among those of adolescent age at the time of kidney disease diagnosis. Adjusted analyses found adolescent age (vs. adult, hazard ratio [HR] = 3.11, 95% confidence interval [CI] 1.87-5.17) and Asian race (vs. white, HR = 0.34, 95% CI 0.16-0.71) were associated with psychiatric diagnosis. A higher UPCR per 1 log unit (HR 1.13, 95% CI 1.01-1.27) and a higher total number of oral medications were associated with psychiatric disorder (p < 0.001). Psychiatric diagnosis was also associated with progression to ESKD (HR = 2.45, 95% CI 1.53-3.92) in adjusted models.
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Study protocol: assessing SleeP IN infants with early-onset atopic Dermatitis by Longitudinal Evaluation (The SPINDLE study).Background: Atopic dermatitis (AD) is the most common chronic inflammatory skin condition in childhood. Most (50-60%) children with AD report sleep disturbance, which is secondary to itch, dry skin, inflammation, and abnormal circadian rhythm. Sleep is essential for brain development, learning, and growth. Sleep disruption in early life is associated with cognitive and psychological dysfunction in later life. The aim of this study is to describe in detail the sleep architecture of infants with early-onset atopic dermatitis (AD), compared to controls, by using EEG polysomnography, sleep actigraphy, and parental reporting. Methods: This observational study will recruit six- to eight-month old infants with moderate to severe AD and age-matched control infants who do not have AD. At six-eight months diurnal sleep electroencephalography and polysomnography will be performed in our research center. Nocturnal sleep actigraphy will be performed at home for five consecutive nights at six-eight months and 12 months. Between six and 12 months, monthly questionnaires will capture data on quantitative sleep and parental sleep. Skin barrier and immune profiles will be captured at six-eight and 12 months. AD will be assessed using standardized severity assessment tools and treated according to protocol. A neurodevelopmental assessment will be performed at 18 months to assess cognition and behaviour. An estimated sample size of 50 participants in each group is required to power the primary outcome of disturbed macrostructure of sleep and secondary outcomes of disturbed microstructure of sleep, and disturbed parental sleep, assuming an attrition rate of 60%. Potential confounding factors which will be controlled for in the data analysis will include parental educational level, parental depression, feeding practice, and number of siblings. Discussion: This study will provide a rich analysis of sleep in infants with AD in the first year of life using detailed electroencephalography, novel actigraphy techniques, and longitudinal parent-reported data. It may provide guidance on the optimal treatment of AD to prevent or reduce sleep disruption. Trial registration: clinicaltrials.gov NCT05031754 , retrospectively registered on September 2nd, 2021.
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Porokeratotic adnexal ostial nevus: A paradigm of cutaneous mosaicism.Porokeratotic adnexal ostial nevus (PAON) is a term encompassing porokeratotic eccrine ostial and dermal duct naevus (PEODDN) and porokeratotic eccrine and hair follicle naevus (PEHFN). We present the case of a 7‐year‐old girl who presented with hyperkeratotic verrucous papules in a blaschkolinear distribution on the sole of her left foot.
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KBG syndrome mimicking genetic generalized epilepsy.KBG syndrome is a rare autosomal dominant disorder characterised by short stature, craniofacial dysmorphism and other developmental skeletal and dental anomalies such as macrodontia [1]. The acronym KBG was chosen to represent the initial of the surnames of the three original families described and epileptic seizures are a common feature [1,2,3]. In addition shyness, anxiety, autistic spectrum disorders and hearing loss have all been reported and most affected patients exhibit developmental delay and intellectual disability [1,4,5]. Although considered polygenic in nature, Genetic Generalized Epilepsy (GGE) typically occurs sporadically [6]. Early descriptions reported high concordance rates among monozygotic twins [7,8]. Descriptive reports highlighted consistent clinical and electroencephalographic (EEG) similarities in twin pairs. Because the clinical and EEG phenotypes are often striking and collectively pathognomonic, GGE is less frequently misdiagnosed compared to other subtypes of epilepsy. Nonetheless, GGE can be erroneously misdiagnosed in Glut-1 deficiency, CHD-2 mutations and focal epilepsy with a midline dipole [9,10]. We report a pair of monozygotic twins who were initially diagnosed with GGE on clinical and EEG grounds. Whole exome trio testing was undertaken in their teenage years when their epilepsy proved drug-resistant and atypical clinical features became more prominent. Mutations in the ANKRD11 gene confirmed a diagnosis of KBG syndrome. We report that mutations in the ANKRD11 gene may produce a clinical syndrome that closely simulates sporadic GGE.
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Uropathogenic Biofilm-Forming Capabilities are not Predictable from Clinical Details or from Colonial Morphology.Antibiotic resistance is increasing to an extent where efficacy is not guaranteed when treating infection. Biofilm formation has been shown to complicate treatment, whereby the formation of biofilm is associated with higher minimum inhibitory concentration values of antibiotic. The objective of the current paper was to determine whether biofilm formation is variable among uropathogenic Escherichia coli isolates and whether formation is associated with recurrent urinary tract infection (UTI), and whether it can be predicted by phenotypic appearance on culture medium A total of 62 E. coli isolates that were reported as the causative agent of UTI were studied (33 from patients denoted as having recurrent UTI and 29 from patients not specified as having recurrent UTI). The biofilm forming capability was determined using a standard microtitre plate method, using E. coli ATCC 25922 as the positive control. The majority of isolates (93.6%) were found to be biofilm formers, whereby 81% were denoted as strong or very strong producers of biofilm when compared to the positive control. Through the use of a Wilcox test, the difference in biofilm forming propensity between the two patient populations was found to not be statistically significant (p = 0.5). Furthermore, it was noted that colony morphology was not a reliable predictor of biofilm-forming propensity. The findings of this study indicate that biofilm formation is very common among uropathogens, and they suggest that the biofilm-forming capability might be considered when treating UTI. Clinical details indicating a recurrent infection were not predictors of biofilm formation.
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Inside the skin of a patient with diabetes: fostering cognitive empathy through insulin pump simulation.In order to best treat a patient, the carer must be able to clearly see their point of view. In the case of the complexities of insulin pump therapy, physicians may not fully understand the common challenges that drive patients to non-adherence. The author undertook a three-day simulation using wearable technology to explore this experience. This form of simulation represents a simple yet effective means by which to foster cognitive empathy in undergraduate and postgraduate medical education settings alike.
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Severe maternal morbidity in Ireland annual report 2017The sixth report from the National Clinical Audit of Severe Maternal Morbidity (SMM) in Ireland reports on 391 cases of SMM occurring in all 19 Irish maternity units in 2017.
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Severe maternal morbidity in Ireland annual report 2018The seventh report from the National Clinical Audit of Severe Maternal Morbidity (SMM) in Ireland reports on 401 cases of SMM occurring in all 19 Irish maternity units in 2018.
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Staff-Care by Chaplains during COVID-19.The aim of this study was to understand how chaplains delivered spiritual care to staff during the Covid-19 pandemic. The researchers analyzed data collected from an International Survey of Chaplain Activity and Experience during Covid-19 (N = 1657). The findings revealed positive changes that emerged and new practices evolved around the use of technology as useful tools for maintaining contact with staff.
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Skin deep: Cutaneous manifestation of PIP implant rupture.PIP (Poly Implant Prothèse, France) implants were readily employed for breast reconstruction until withdrawn from the market in 2010. These implants have an early and increased risk of rupture compared to non-PIP implants. This report outlines a significant cutaneous manifestation of PIP-implant rupture not previously described in the literature. This patient developed significant cutaneous xanthomatous inflammation with sinus tract formation that has yet to resolve despite explantation. Further investigation is warranted to elucidate the aetiology of this clinical sign and the optimal management of the cutaneous manifestation.
