7786 research outputs found
Sort by
Impact of measurement location on direct mitral regurgitation quantification using four-dimensional flow cardiovascular magnetic resonance
No full textBackground: Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) shows promise for quantifying mitral regurgitation (MR) by allowing for direct regurgitant volume (RVol) measurement using a plane precisely placed at the MR jet. However, the ideal location of a measurement plane remains unclear. This study aims to systematically examine how varying measurement locations affect RVol quantification and determine the optimal location using the momentum conservation principle of a free jet.Methods: Patients diagnosed with MR by transthoracic echocardiography (TTE) and scheduled for CMR were prospectively recruited. Regurgitant jet flow volume (RVoljet) and regurgitant jet flow momentum (RMomjet) were quantified using 4D flow CMR at seven locations along the jet axis, x. The reference plane (mid-plane, x = 0 mm) was positioned at the peak velocity of the jet at each cardiac phase, and three additional planes were positioned on either side of the jet, each 2.5 mm apart. RVoljet was compared to RVolTTE, measured by the proximal isovelocity surface area method, and RVolindirect, measured by subtracting aortic forward flow volume from the left ventricle stroke volume derived from two-dimensional phase contrast at the aortic valve and a stack of short-axis cine CMR techniques.Results: RVoljet and RMomjet were quantified in 45 patients (age 63±13, male 26). In patients with RVoljet at x = 0 mm ≥ 10 mL (n = 25), RVoljet consistently increased as the plane moved downstream. RVoljet measured furthest upstream (x = -7.5 mm) was significantly lower (39±11%, pjet measured furthest downstream (x = 7.5 mm) was significantly higher (16±19%, pjet at x = 0 mm. RMomjet similarly increased from x = -7.5 to 0 mm (57±12%, pjet was in consistent moderate agreement with RVolindirect (n = 41, bias = -2±24 to 8±32 mL, intraclass correlation coefficient = 0.55-0.63, pConclusion: The location of a measurement plane significantly influences RVol quantification using the direct 4D flow CMR approach. Based on the converging profile of RMomjet, we propose the peak velocity of the jet as the optimal position.</p
"You're not taught to think about the words you use and then it just perpetuates" - a qualitative examination of medical students' perspectives of stigmatising language in healthcare
No full textBackground: Stigmatising language is used commonly in healthcare, affecting healthcare providers' perceptions of patients and care delivery. Using person-first language is best practice, however, it does not reflect reality.Method: This study examined medical students' perspectives on stigmatising language in healthcare. Twenty-one medical students at the RCSI University of Medicine and Health Sciences participated in four focus group interviews; a thematic analysis of the data was conducted.Results: Seven themes were identified: prevalence of stigmatising language, its impact on students and patients, being sensitive versus medically accurate, evolving nature of recommendations for language use, barriers to changing practice, power dynamics and cultural context influencing language use, stigmatising language being a societal issue. Participants provided recommendations for improving language use in healthcare: open discussions and student feedback on language in the learning environment, lecturers signposting person-first language, training workshops on person-first language for clinicians and lecturers, and social intelligence skills training.Conclusion: Study findings highlight the impact of stigmatising language in healthcare. To address this issue and inform guidance for future generations of professionals, medical students recommended more open dialogue and improved social intelligence.</p
Global comparison of research ethical review protocols: insights from an international research collaborative
No full textScientific ethical review is a cornerstone of conducting medical research. It aims to ensure human subject research is conducted in a manner that safeguards and respects participants’ rights and well-being. Research ethics committees (RECs) or institutional review boards (IRBs) are responsible for ethical evaluations before approval. This entails assessing potential risks and benefits associated with the research. For effective international research collaboration, researchers must be cognisant of participating countries’ ethical and regulatory requirements. Although these processes may be managed at various levels—local, regional or national; their implementation across countries often remains opaque and varies significantly. The British Urology Researchers in Training (BURST) Research Collaborative houses a network of international representatives to guide prospective study sites within their countries in acquiring ethical approval. We provide an overview of the ethical approval processes across 17 countries, emphasising on approvals for audits, observational studies, and randomised controlled trials (RCTs).</p
The role of neutrophils in allergic disease
No full textNeutrophils are short-lived cells of the innate immune system and represent 50-70% of the circulating leucocytes. Their primary role is antimicrobial defence which they accomplish through rapid migration to sites of inflammation followed by phagocytosis, degranulation, and the release of neutrophil extracellular traps (NETosis). While previously considered terminally differentiated cells, they have been shown to have great adaptability and to play a role in conditions ranging from cancer to autoimmunity. This review focuses on their role in allergic disease. In particular: their role as potential amplifiers of type 1 hypersensitivity reactions leading to anaphylaxis; their involvement in alternative pathways of food and drug allergy; their role in allergic rhinitis and asthma and neutrophil dysfunction in atopic dermatitis. The use of potential biomarkers and therapeutic targets is also discussed with a view to guiding future research.</p
An Exploration of Factors Affecting How Medical Students Seek, Use and Respond to Feedback.
No full textThe overall aim of this thesis is to explore how medical students respond to feedback to support future learning and to explore how cultural factors impact their response to feedback. With both aims, my unit of analysis was the individual learner. My interest lay in a deep exploration of the processes or potential processes that occur within the learner when they encounter feedback. </p
Delirium and cognitive screening in national hip fracture registries: scoping review protocol [version 2; peer review: 2 approved]
No full textBackground: Delirium and cognitive impairment are common in hip fracture populations and are associated with significant adverse patient outcomes. National hip fracture registries facilitate improvements in patient outcomes and care quality, such as reduced mortality and the development of specialist multidisciplinary services. However, there is substantial variation in the data collected and reported in relation to delirium and cognition, which impedes international comparison and may reduce quality of care.Objective: This scoping review aims to identify delirium and cognition data items currently collected by hip fracture registries internationally, to identify associated registry guidance that exists for the administration of delirium and cognitive screening tools, and report outcomes of these data items across the most recently published annual reports of identified hip fracture registries.Methods: This scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews (PRISMA-ScR). We will search the following databases: Medline Ovid; Embase; CINAHL EBSCOHost. Relevant websites such as the Fragility Fracture Network (FFN) will also be searched. Study selection and review will be carried out independently by two research team members, with discrepancies resolved by a third member of the research team. Data extraction and synthesis will be conducted by one reviewer and checked for accuracy and omissions by another. The scoping review findings will be informed and validated through engagement with the FFN Hip Fracture Audit Special Interest Group, who will share their knowledge, expertise, and research to achieve consensus over core aspects of the scoping review findings.Conclusion: By identifying existing heterogeneity in delirium and cognitive screening tool use and administration, it is hoped that administration and specific screening tool use will become standardised to optimise comparability across countries and ensure that high quality and reliable data are included across international registry reports.</p
Neoadjuvant HER2 inhibition induces <i>ESR1 </i>DNA methylation alterations resulting in clinically relevant ER expression changes in breast cancers
No full textThe expression of estrogen receptor (ER) and human epidermal growth factor receptor-2 (HER2) in breast cancer can change in response to treatment and pivotally influence tumor behavior and clinical management [1]. Receptor discordance has been observed at various distant metastatic site (bone, lung, liver, and brain), with a routine loss of ER and gains in HER2 reported [2]. This receptor discordance can influence tumor responsiveness to both HER2 inhibitor and endocrine therapies. Although the mechanisms underlying receptor expression changes are not fully understood, we recently reported gains in ESR1 promoter hypermethylation as a potential driver of ER loss during disease progression [3]. In this study, mechanisms underlying altered receptor expression and associated disease outcomes were examined following neoadjuvant trastuzumab treatment.</p
TLR/NLRP3 inflammasome signaling pathways as a main target in frailty, cachexia and sarcopenia
No full textMobility disability is a common condition affecting older adults, making walking and the performance of activities of daily living difficult. Frailty, cachexia and sarcopenia are related conditions that occur with advancing age and are characterized by a decline in muscle mass, strength, and functionality that negatively impacts health. Chronic low-grade inflammation is a significant factor in the onset and progression of these conditions. The toll-like receptors (TLRs) and the NLRP3 inflammasome are the pathways of signaling that regulate inflammation. These pathways can potentially be targeted therapeutically for frailty, cachexia and sarcopenia as research has shown that dysregulation of the TLR/NLRP3 inflammasome signaling pathways is linked to these conditions. Activation of TLRs with pathogen-associated molecular patterns (PAMPs or DAMPs) results in chronic inflammation and tissue damage by releasing pro-inflammatory cytokines. Additionally, NLRP3 inflammasome activation enhances the inflammatory response by promoting the production and release of interleukins (ILs), thus exacerbating the underlying inflammatory mechanisms. These pathways are activated in the advancement of disease in frail and sarcopenic individuals. Targeting these pathways may offer therapeutic options to reduce frailty, improve musculoskeletal resilience and prevent or reverse cachexia-associated muscle wasting. Modulating TLR/NLRP3 inflammasome pathways may also hold promise in slowing down the progression of sarcopenia, preserving muscle mass and enhancing overall functional ability in elderly people. The aim of this review is to investigate the signaling pathways of the TLR/NLRP3 inflammasome as a main target in frailty, cachexia and sarcopenia.</p
Twist of fate: resolving cecal volvulus with timely surgical intervention in a middle-aged female
No full textIntroduction and importance: Cecal volvulus is an uncommon cause of large bowel obstruction that typically presents in older adults with a history of chronic constipation or prior abdominal surgery. However, this report documents a rare and atypical case of cecal volvulus presenting in a middle-aged female with no significant past medical or surgical history. This case also highlights the benefits of adopting a synergistic approach between a physician's clinical judgment and the patient's presentation when making a diagnosis to ensure timely interventions and prevent life-threatening complications.Case presentation: A 40-year-old female with no significant medical or surgical history presented to the emergency department with acute onset of severe abdominal pain radiating to the lower back, associated with nausea, vomiting, and constipation. CT imaging revealed a markedly distended cecum with evidence of volvulus. Despite the absence of common predisposing factors of cecal volvulus, the patient was correctly diagnosed. She underwent an urgent right hemicolectomy with primary anastomosis, which was uneventful. The patient had a complete recovery and was discharged home on postoperative day 5.Clinical discussion: This case is particularly noteworthy due to the patient's atypical demographic profile and the absence of common risk factors associated with cecal volvulus. The timely recognition and surgical intervention were critical in preventing severe complications such as bowel ischemia or perforation. Furthermore, this case underscores the importance of considering cecal volvulus in the differential diagnosis of acute abdominal pain, even in patients who do not exhibit conventional risk factors.Conclusion: This case report highlights a rare presentation of cecal volvulus in a previously healthy middle-aged woman, emphasizing the importance of prompt diagnosis and intervention. The favorable outcome in this patient demonstrates the critical role of timely surgical management in such high risk cases.</p
The European drug-drug interaction (EuroDDI) study protocol: a cross-country comparison of drug-drug interaction prevalence in the older community-dwelling population
No full textBackground: Drug-drug interactions (DDIs), highly prevalent amongst the elderly, can lead to avoidable medication-related harm. Cardiovascular and central nervous system (CNS) drugs are commonly implicated. To date, there is no consensus on how to measure DDIs, making comparisons across countries challenging.Objective: To (i) establish a common data model (CDM) to measure DDI prevalence in the older (aged ≥ 70 years) community-dwelling population of three European countries and (ii) compare and describe cardiovascular and CNS DDI prevalence rates across these countries.Methods: This cross-country study will apply a harmonised method of DDI identification and analysis using the WHO ATC classification system and national pharmacy claims data from three European countries (Ireland, Italy, Spain). Patients aged ≥ 70 years dispensed ≥ 2 medications during 2016 will be identified from each country's national database. 'Severe' cardiovascular and CNS DDIs (i.e., may result in a life-threatening event/permanent detrimental effect) will be identified using the British National Formulary and Stockley's Drug Interactions. Two separate lists of 'severe' DDIs, per medications reimbursed, will be applied to each database: (i) DDIs relevant to each individual country and (ii) DDIs relevant to all three countries. DDIs will be defined as co-dispensed (same day) and concomitantly (±7 days) dispensed.Results: Descriptive statistics, including DDI prevalence and 95% confidence intervals, will be reported for each country. Prevalence will be pooled and compared across countries using random effects models and meta-regression, where feasible.Conclusion: The EuroDDI study will develop a harmonised method to measure and compare DDI prevalence across health-related databases in Europe.</p