Now showing items 1-20 of 32856

    • Family Therapy Makes the Grade

      Murray, Denis (Family Therapy Association of Ireland, 2020-11-23)
    • Evidence summary for use of rapid antigen testing for screening or surveillance of asymptomatic individuals to limit transmission of SARS-CoV-2

      Health Information and Quality Authority (HIQA) (Health Information and Quality Authority (HIQA), 2021-09-20)
    • Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients.

      Meagher, David J; O'Connell, Henry; Leonard, Maeve; Williams, Olugbenga; Awan, Fahad; Exton, Chris; Tenorio, Michael; O'Connor, Margaret; Dunne, Colum P; Cullen, Walter; et al. (2020-04-19)
      Neurocognitive diagnoses were delirium (n = 44), dementia (n = 30), comorbid delirium-dementia (n = 60) and no neurocognitive disorder (n = 46). All conventional tests had sensitivity of > 70% for delirium, with best overall accuracy for the Vigilance-B (78.3%), Vigilance-A (77.8%) and MBT (76.7%) tests. The sustained attention component of the Lighthouse test was the most distinguishing of delirium (sensitivity 84.6%; overall accuracy 75.6%). The LSD-4 had sensitivity of 74.0% and overall accuracy 74.4% for delirium identification. Combining tests allowed for enhanced sensitivity (> 90%) and overall accuracy (≥ 75%) with the highest overall accuracy for the combination of MBT-Vigilance A and the combined Vigilance A and B tests (both 78.3%). When analyses were repeated for those with dementia, there were similar findings with the MBT-Vigilance A the most accurate overall combination (80.0%). Combining the Lighthouse-SA with the LSD-4, a fail in either test had sensitivity for delirium of 91.4 with overall accuracy of 74.4%.
    • Economic burden of maternal morbidity - A systematic review of cost-of-illness studies.

      Moran, Patrick S; Wuytack, Francesca; Turner, Michael; Normand, Charles; Brown, Stephanie; Begley, Cecily; Daly, Deirdre (2020-01-16)
    • Application of the critical incident technique in refining a realist initial programme theory.

      Cunningham, U; De Brún, A; McAuliffe, E (2020-05-26)
      Background: As realist methodology is still evolving, there is a paucity of guidance on how to conduct theory driven interviews. Realist researchers can therefore struggle to collect interview data that can make a meaningful contribution to refining their initial programme theory. Collecting data to inform realist Inital Programme Theories (IPTs) in healthcare contexts is further compounded due to the healthcare workers' busy work schedules. In this case study of team interventions in acute hospital contexts, we explore the benefits of using the Critical Incident Technique (CIT) in order to build and refine an initial programme theory. We contend that use of the CIT helps to draw on more specific experiences of "Key Informants" and therefore elicits richer and more relevant data for realist enquiry. Methods: The five steps of the CIT were mapped against realist methods guidance and adapted into an interview framework. Specifications to identify an incident as "critical" were agreed. Probes were embedded in the interview framework to confirm, refine and/or refute previous theories. Seventeen participants were interviewed and recordings were transcribed and imported for analysis into NVivo software. Using RAMESES guidelines, Context-Mechanism-Outcomes configurations were extrapolated from a total of 31 incidents. Results: We found that the CIT facilitated construction of an interview format that allowed participants to reflect on specific experiences of interest. We demonstrate how the CIT strengthened initial programme theory development as it facilitated the reporting of the specifics of team interventions and the contexts and mechanisms characteristic of those experiences. As new data emerged, it was possible to evolve previous theories synthesised from the literature as well as to explore new theories. Conclusions: Utilising a CIT framework paid dividends in terms of the relevance and usefulness of the data for refining the initial programme theory. Adapting the CIT questioning technique helped to focus the participants on the specifics relating to an incident allowing the interviewers to concentrate on probes to explore theories during the interview process. The CIT interview format therefore achieved its purpose and can be adapted for use within realist methodology.
    • Gait speed, cognition and falls in people living with mild-to-moderate Alzheimer disease: data from NILVAD.

      Dyer, Adam H; Lawlor, Brian; Kennelly, Sean P (2020-03-30)
      Background: Previous evidence suggests that slower gait speed is longitudinally associated with cognitive impairment, dementia and falls in older adults. Despite this, the longitudinal relationship between gait speed, cognition and falls in those with a diagnosis of dementia remains poorly explored. We sought to assess this longitudinal relationship in a cohort of older adults with mild to-moderate Alzheimer Disease (AD). Methods: Analysis of data from NILVAD, an 18-month randomised-controlled trial of Nilvadipine in mild to moderate AD. We examined: (i) the cross-sectional (baseline) association between slow gait speed and cognitive function, (ii) the relationship between baseline slow gait speed and cognitive function at 18 months (Alzheimer Disease Assessment Scale, Cognitive Subsection: ADAS-Cog), (iii) the relationship between baseline cognitive function and incident slow gait speed at 18 months and finally (iv) the relationship of baseline slow gait speed and incident falls over the study period. Results: Overall, one-tenth (10.03%, N = 37/369) of participants with mild-to-moderate AD met criteria for slow gait speed at baseline and a further 14.09% (N = 52/369) developed incident slow gait speed at 18 months. At baseline, there was a significant association between poorer cognition and slow gait speed (OR 1.05, 95% CI 1.01-1.09, p = 0.025). Whilst there was no association between baseline slow gait speed and change in ADAS-Cog score at 18 months, a greater cognitive severity at baseline predicted incident slow gait speed over 18 months (OR 1.04, 1.01-1.08, p = 0.011). Further, slow gait speed at baseline was associated with a significant risk of incident falls over the study period, which persisted after covariate adjustment (IRR 3.48, 2.05-5.92, p < 0.001). Conclusions: Poorer baseline cognition was associated with both baseline and incident slow gait speed. Slow gait speed was associated with a significantly increased risk of falls over the study period. Our study adds further evidence to the complex relationship between gait and cognition in this vulnerable group and highlights increased falls risk in older adults with AD and slow gait speed.
    • A risk score for prediction of venous thromboembolism in gynecologic cancer: The Thrombogyn score.

      Norris, Lucy A; Ward, Mark P; O'Toole, Sharon A; Marchocki, Zibi; Ibrahim, Nadia; Khashan, Ali S; Abu Saadeh, Feras; Gleeson, Noreen (2020-05-28)
      Background: Gynecologic cancers are associated with high rates of venous thromboembolism (VTE), which is exacerbated by pelvic surgery and chemotherapy. Objectives: The aim of this study was to develop and validate a risk score for VTE in patients with gynecologic cancer and to test the predictive ability of the score following addition of procoagulant biomarker data. Patients and methods: Clinical and laboratory variables were used to develop a risk score for the prediction of VTE in patients with gynecological cancer (n = 616), which was validated in a separate cohort of patients (n = 406). Endogenous thrombin potential and D-dimer levels were determined in a subset (n = 290) of patients and used to produce an extended score in the validation cohort. Results: Multivariable regression analysis identified BMI >30, hemoglobin <11.5 g/dL and chemotherapy as independent predictors of VTE, which formed the Thrombogyn score. Following competing risk regression analysis, subdistribution hazard ratios (SHRs), adjusted for cancer stage, were 8.16 (95% confidence interval [CI], 1.69-43.77) in the high-risk group (score = 2-3) and 4.12 (95% CI, 0.85-20.15) in the intermediate-risk group (score = 1) compared with the low-risk group (score = 0). SHRs for the validation cohort were 6.26 (95% CI, 1.24-31.39) and 3.00 (95% CI, 0.67-13.32), respectively. Cumulative incidence of VTE in the validation cohort high-risk group was 10.34% (95% CI, 6.51-16.41) per women-years compared with 1.06% (95% CI, 0.26-4.26) in the low-risk group. Using the extended Thrombogyn score, adjusted SHRs were 16.83 (95% CI, 4.20-67.37) in the high-risk group with a cumulative incidence of 21.15% (95% CI, 10.32-45.24). External validation of the score is required. Conclusions: The Thrombogyn score identifies patients with gynecologic cancer at high and low risk of VTE. Addition of biomarker data improves the predictive power of the score.
    • Large-scale genome-wide analysis links lactic acid bacteria from food with the gut microbiome.

      Pasolli, Edoardo; De Filippis, Francesca; Mauriello, Italia E; Cumbo, Fabio; Walsh, Aaron M; Leech, John; Cotter, Paul D; Segata, Nicola; Ercolini, Danilo (2020-05-25)
    • Vancomycin and nisin A are effective against biofilms of multi-drug resistant Staphylococcus aureus isolates from human milk.

      Angelopoulou, Angeliki; Field, Des; Pérez-Ibarreche, Mariana; Warda, Alicja K; Hill, Colin; Ross, R Paul (2020-05-29)
    • Multi-parametric single cell evaluation defines distinct drug responses in healthy hematologic cells that are retained in corresponding malignant cell types.

      Majumder, Muntasir M; Leppä, Aino-Maija; Hellesøy, Monica; Dowling, Paul; Malyutina, Alina; Kopperud, Reidun; Bazou, Despina; Andersson, Emma; Parsons, Alun; Tang, Jing; et al. (2019-08-22)
      Innate drug sensitivity in healthy cells aids identification of lineage specific anti-cancer therapies and reveals off-target effects. To characterize the diversity in drug responses in the major hematopoietic cell types, we simultaneously assessed their sensitivity to 71 small molecules utilizing a multi-parametric flow cytometry assay and mapped their proteomic and basal signaling profiles. Unsupervised hierarchical clustering identified distinct drug responses in healthy cell subsets based on their cellular lineage. Compared to other cell types, CD19+/B and CD56+/NK cells were more sensitive to dexamethasone, venetoclax and midostaurin, while monocytes were more sensitive to trametinib. Venetoclax exhibited dose-dependent cell selectivity that inversely correlated to STAT3 phosphorylation. Lineage specific effect of midostaurin was similarly detected in CD19+/B cells from healthy, acute myeloid leukemia and chronic lymphocytic leukemia samples. Comparison of drug responses in healthy and neoplastic cells showed that healthy cell responses are predictive of the corresponding malignant cell response. Taken together, understanding drug sensitivity in the healthy cell-of-origin provides opportunities to obtain a new level of therapy precision and avoid off-target toxicity.
    • Reduction of the minimum age for the application of mask wearing requirements and recommendations – Updated advice [V3.0]

      Health Information and Quality Authority (HIQA) (Health Information and Quality Authority (HIQA), 2021-09-20)
    • Propylthiouracil-induced antineutrophil cytoplasmic antibody-associated vasculitis and agranulocytosis in a patient with Graves' disease.

      Tomkins, Maria; Tudor, Roxana Maria; Smith, Diarmuid; Agha, Amar (2020-01-08)
      Summary: This case is the first to describe a patient who experienced concomitant agranulocytosis and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis as an adverse effect of propylthiouracil treatment for Graves' disease. A 42-year-old female with Graves' disease presented to the emergency department (ED) with a 2-week history of fevers, night sweats, transient lower limb rash, arthralgia, myalgia and fatigue. She had been taking propylthiouracil for 18 months prior to presentation. On admission, agranulocytosis was evident with a neutrophil count of 0.36 × 109/L and immediately propylthiouracil was stopped. There was no evidence of active infection and the patient was treated with broad-spectrum antibodies and one dose of granulocyte colony-stimulation factor, resulting in a satisfactory response. On further investigation, ANCAs were positive with dual positivity for proteinase 3 and myeloperoxidase. There was no evidence of end-organ damage secondary to vasculitis, and the patient's constitutional symptoms resolved completely on discontinuation of the drug precluding the need for immunosuppressive therapy. Learning points: Continued vigilance and patient education regarding the risk of antithyroid drug-induced agranulocytosis is vital throughout the course of treatment. ANCA-associated vasculitis is a rare adverse effect of antithyroid drug use. Timely discontinuation of the offending drug is vital in reducing end-organ damage and the need for immunosuppressive therapy in drug-induced ANCA-associated vasculitis. Similarities in the pathogenesis of agranulocytosis and drug-induced ANCA-associated vasculitis may offer insight into an improved understanding of vasculitis and agranulocytosis.
    • COVID-19 Database of public health guidance - 15 September 2021

      Health Information and Quality Authority (HIQA) (Health Information and Quality Authority (HIQA), 2021-09-15)
    • Pharmacological Activation of Pyruvate Kinase M2 Inhibits CD4 T Cell Pathogenicity and Suppresses Autoimmunity.

      Angiari, Stefano; Runtsch, Marah C; Sutton, Caroline E; Palsson-McDermott, Eva M; Kelly, Beth; Rana, Nisha; Kane, Harry; Papadopoulou, Gina; Pearce, Erika L; Mills, Kingston H G; et al. (2019-11-21)
      Pyruvate kinase (PK) catalyzes the conversion of phosphoenolpyruvate to pyruvate during glycolysis. The PK isoform PKM2 has additional roles in regulation of gene transcription and protein phosphorylation. PKM2 has been shown to control macrophage metabolic remodeling in inflammation, but its role in T cell biology is poorly understood. Here, we report PKM2 upregulation, phosphorylation, and nuclear accumulation in murine and human CD4+ T cells following activation in vitro. Treatment of T cells with TEPP-46, an allosteric activator that induces PKM2 tetramerization and blocks its nuclear translocation, strongly reduces their activation, proliferation, and cytokine production by inhibiting essential signaling pathways and thus preventing the engagement of glycolysis. TEPP-46 limits the development of both T helper 17 (Th17) and Th1 cells in vitro and ameliorates experimental autoimmune encephalomyelitis (EAE) in vivo. Overall, our results suggest that pharmacological targeting of PKM2 may represent a valuable therapeutic approach in T cell-mediated inflammation and autoimmunity.
    • Structures of lipoprotein signal peptidase II from Staphylococcus aureus complexed with antibiotics globomycin and myxovirescin.

      Olatunji, Samir; Yu, Xiaoxiao; Bailey, Jonathan; Huang, Chia-Ying; Zapotoczna, Marta; Bowen, Katherine; Remškar, Maja; Müller, Rolf; Scanlan, Eoin M; Geoghegan, Joan A; et al. (2020-01-09)
    • Occupational Exposures to Organic Dust in Irish Bakeries and a Pizzeria Restaurant.

      Viegas, Carla; Fleming, Gerard T A; Kadir, Abdul; Almeida, Beatriz; Caetano, Liliana Aranha; Quintal Gomes, Anita; Twarużek, Magdalena; Kosicki, Robert; Viegas, Susana; Coggins, Ann Marie (2020-01-15)
      For decades, occupational exposure to flour dust has been linked to a range of respiratory diseases, including occupational asthma, thought to result from exposure to fungi present in the flour. Antifungal resistance is of increasing prevalence in clinical settings, and the role of occupational and environmental exposures, particularly for specific fungal species, is of concern. Occupational exposure to flour dust can occur in a range of occupational settings, however, few studies have focused on restaurant workers. The objective of this study was to measure occupational exposure to flour and microbial contamination, including azole resistance screening, in two small commercial bakeries and in a pizzeria. Personal full shift inhalable dust measurements were collected from workers, and were analyzed for inhalable dust and fungi, bacteria, azole resistance, and mycotoxins. Samples of settled dust were collected, and electrostatic dust cloths (EDC) were deployed and analyzed for microbial contamination, including azole resistance screening, and mycotoxins. Geometric mean exposures of 6.5 mg m-³ were calculated for inhalable dust, however, exposures of up to 18.30 mg m-³ were measured-70% of personal exposure measurements exceeded the occupational exposure limit for flour dust of 1.0 mg m-³. The air and EDC fungal counts were similar to those reported in previous studies for similar occupational environments. The fungi were dominated by Penicillium genera, however Aspergillus genera, including Fumigati and Flavi sections, were observed using culture-based methods, and the Fumigati section was also observed by molecular tools. Both Aspergillus sections were identified on the azole resistance screening. Mycotoxins were also detected in the settled dust samples, dominated by deoxynivalenol (DON). The role of environmental exposure in both the development of antimicrobial resistance and the total mycotoxin body burden is a growing concern; therefore, the presence of azole-resistant fungi and mycotoxin contamination, although low in magnitude, is of concern and warrants further investigation.
    • Syncope, Fear of Falling and Quality of Life Among Older Adults: Findings From the Irish Longitudinal Study on Aging (TILDA).

      McCarthy, Kevin; Ward, Mark; Romero Ortuño, Román; Kenny, Rose Anne (2020-02-07)
      Objective: Syncope is a prevalent condition that has a marked impact on quality of life. We examined the association between syncope and quality of life (QoL) and whether this association was explained by fear of falling (FoF). Methods: We examined data from Wave 3 of The Irish Longitudinal Study on Aging (TILDA), of adults aged ≥50 years (n = 4,946) who were asked to report syncope and who completed the CASP-12 QoL instrument. Analyses were stratified by age and gender. Results: Over 20% of participants reported having a previous syncopal episode, while 8% reported a faint, blackout or unexplained fall in the last year. QoL scores decreased as the burden of syncope increased: linear regression models adjusted for covariates showed that those having had two or more syncopal episodes in the last year reported a significantly lower CASP-12 score compared to those with none (p = 0.011). FoF partially mediated the association between syncope and QoL, particularly among younger participants. Conclusions: Syncope is a common condition among older adults that has a deleterious effect on QoL, with ≥2 recent syncopal episodes having a particularly adverse impact on QoL. FoF is a potential pathway which may both explain this association and allow therapeutic interventions by health practitioners.