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Intra-temporal and intracranial radiological abnormalities in cochlear implantation
No full textAim: Radiological investigations are an important part of the work up for cochlear implantation candidacy. Inner ear anomalies and intracranial anomalies are frequently found in the preoperative investigation phase. This study aims to investigate the frequency of such abnormalities, the complication rates and the outcomes associated with such findings in adult and paediatric cohorts at a national tertiary referral centre.Methods: A retrospective review of a prospectively maintained database at a national referral centre for cochlear implantation was undertaken. We included all patients from 2013 to 2020 who had radiological abnormalities identified on review by consultant radiologists and who proceeded to cochlear implantation. Audiological outcomes were measured using BKB scores in the adult group and LiP, SIR and CAP scores for the paediatric group. Rates and types of complications were also recorded.Results: There were 898 cases reviewed at the MDT during the time frame. There were 90 (10%) radiological abnormalities noted, 57 (63%) paediatric and 33 (37%) adult. The most common type of abnormality in adult and paediatric groups was incomplete partition type 2. White matter changes associated with CMV was the most common paediatric brain abnormality and old infarction was the most common in the adult group. CSF gusher was encountered in 2/57 (3.5%) cases. Mean BKB results in adults was 68% for temporal and 46.6% for brain abnormalities. Mean LiP, SIR, CAP scores in the temporal bone (38.2, 4.6, 5.9) and brain abnormality (35.7, 3, 4.7) groups were acceptable.Discussion: Radiological abnormalities are detected in a significant number of patients with profound hearing loss who are undergoing candidacy work up for cochlear implantation. Results may be variable particularly in children with CMV related changes detectable on MRI. Complication rates are low and should not preclude these patients from undergoing implantation.</p
Evaluation of a newly introduced parenting support programme for families of children with 22q11.2 deletion syndrome
No full textAims To evaluate the implementation of a parenting programme for parents of children with 22q11.2DS at a specialised 22q clinic.Methods Both parents of 8 children, age 6-10 years, with 22q11.2DS and reported behavioural difficulties were invited to take part in an 8-week parenting programme. Questionnaires were administered at three time points: prior to, immediately after, and at six-month follow-up after the programme to measure behavioural and emotional difficulties, parental stress and satisfaction. Parents set goals for themselves and for their children for the duration of the programme and provided written feedback.Results The course was completed by 5 families. No significant difference was found over time with regards to quantitative measures. However, parents indicated significant move towards achieving their individual parenting and child-related goals. Parents reported that participation in the group provided peer support and shared experiences. The group provided sense of understanding and belonging.Discussion The favourable feedback supports future integration of a parenting programme for 22q11.2DS families as part of an integrated care pathway for rare disorders.</p
Exploring what works in mental health education for health profession students: a realist review
No full textIntroduction: Mental health education is essential for preparing healthcare professionals to address the growing needs of patients with mental health challenges. The aim of this study was to understand the current landscape of teaching and learning approaches to mental health education for undergraduate health profession students.Methodology: A realist review was chosen to explore what works for whom, how, and why in teaching and learning for mental health education for undergraduate health profession students. The search strategy was developed iteratively, with support from a research librarian, and additional searches supplemented the initial search. Following screening in duplicate, the selected studies were appraised for relevance, richness and rigour. Intervention (I), Context (C), Actor (A), Mechanism (M) and Outcome (O) configurations were extracted from the data and analysed for patterns and conceptual areas. Stakeholder and Patient and Public Involvement panels supported the refinement of both the Initial Programme Theory (IPT) and Programme Theories (PT).Results: 78 articles were included. The results identified three critical program theories: (1) direct contact with individuals with lived experience (2), longitudinal and integrative learning approach, and (3) diversity of experiential and community-engaged learning. Integrating these theories into health education curricula may lead to professionals better prepared to address mental health challenges.Conclusion: Our realist review identified three critical programme theories for teaching and learning strategies that foster this literacy, including direct engagement with individuals who have lived experiences, a longitudinal and integrative approach to education, and a diverse array of experiential and community-engaged learning opportunities.</p
Dispersion protocols have minimal impact on the biomolecular corona of advanced nanomaterials in cell culture assays
No full textIndustrial sectors have largely invested in the use of advanced nanomaterials (NMs), which are currently being implemented in a wide range of applications. However, the potential exposure to living beings and the environment still remains a concern. While some of these materials were not designed to be dispersible in aqueous media, the development of dispersion protocols to ensure compatibility with the in vitro and in vivo assays has become crucial for the correct assessment of the studies. NMs' identity in biological media is significantly influenced by the formation of a biomolecular corona on its surface. However, this corona might be affected by the dispersion method, altering their physicochemical characteristics and complicating the understanding of their interactions with biological systems. Therefore, understanding the efficiency of dispersion protocols and their influence on the biological identity of NMs is fundamental. However, systematic studies on the effects of dispersion protocols are still lacking, making this a crucial yet overlooked aspect in the field. This study aims to compare two standard dispersion protocols, commonly known as Harvard and Nanogenotox, and evaluate their impact on the biomolecular corona formation across a selection of advanced industrial NMs. To this aim, different techniques were used to assess particle size, colloidal stability and ion release, as well as protein and sialic acid content and abundance in the corona. Results show that the dispersion protocol modestly alters nanoparticle size and agglomeration state, and proteomics analysis revealed that each nanoparticle type forms a distinct corona, influenced by the distinct surface modifications. The presence of bovine serum albumin (BSA) in the Nanogenotox protocol minimally affected the overall trends in protein composition between the two protocols. These findings emphasize the significance of the dispersion protocol in nanotoxicology assays and demonstrate that variations between these methods do not play a decisive role in shaping the bio-identity and potential biological effects of advanced and multicomponent NMs.</p
Shoulder instability in an athletic population - role of the Latarjet procedure
No full textShoulder instability in collision athletes is a challenging issue with particular concern about the type of procedure performed and timing and success of return to play. In this thesis we examine a number of issues in relation to the Latarjet procedure particularly in an athletic population. We examine the results of arthroscopic stabilisation versus Latarjet procedure in both athletes who have had a single dislocation and also in those who recurrent instability episodes. We have demonstrated that the Latarjet procedure has a lower rate of recurrent instability and higher rate of return to play. The Latarjet procedure is frequently performed in patients who have had previous soft tissue surgery. We examine the rate of recurrent instability and rate of return to play in patients who have undergone a Latarjet procedure following previous soft tissue surgery in both a case-controlled series and in a systematic review. Haematoma formation is the most common complication following the Latarjet procedure. We performed a randomised double-blind prospective trial of the use of tranexamic acid in patients undergoing the Latarjet procedure and demonstrated significant reduction in haematoma formation, post-operative blood loss and post-operative pain. We examined the 90-day rate of complications following Latarjet procedure in a high volume practice and found the rate of complications to be lower than previously reported. Finally, we performed a systematic review of the long term outcome of the Latarjet procedure. This demonstrated that the results of the Latarjet procedure are durable with a low rate of recurrent dislocation and high return to sport. However, there was a significant number of patients who had persistent discomfort.</p
Chronic pancreatitis: insights into an orphan disease
No full textChronic pancreatitis (CP) is the paradigm orphan disease, infrequent, with uncertain pathogenesis, challenging clinical course, and deleterious effect on quality-of-life and longevity. Recurrent inflammatory episodes lead to pancreatic parenchymal replacement by fibrous connective tissue, progressing to progressive exocrine and endocrine failure. Patients often present with unremitting pain and nutrition-related diseases, including malnutrition, osteopathy, sarcopenia, and micronutrient deficiencies. A decade ago there was a dearth of literature concerning management, pathophysiology, and metabolic consequences of CP. Furthermore, there were no contemporary clinical guidelines available, and integration of care was non-existent. The work described in this thesis details endeavors to address those concerns. Papers presented for consideration have focused on the nutritional, genetic, and metabolic consequences of CP and its management. We noted that Irish patients present at a younger age, commonly have pancreatic exocrine insufficiency (PEI) resulting in malabsorption with nutrient and vitamin deficiencies. Osteopathy was common and associated with systemic inflammation. Small intestinal bacterial overgrowth (SIBO) was present in 15% of non-surgical CP patients and should be considered in those patients with PEI who have persistent symptomatology despite adequate enzyme replacement. Genetic mutations were demonstrated in a fifth of CP patients with idiopathic or alcohol-induced CP with a low/moderate intake. The most frequent mutation was in the SPINK-1 gene suggesting that such mutations may be a contributing aetiological factor. Endocrine dysfunction was common and the concept of pancreatogenic diabetes (type 3cDM) is often misunderstood. Examining the pathophysiology of post severe acute pancreatitis diabetes, we were able to better characterize the various diabetic subtypes and make recommendations regarding the diagnoses of type3c DM. As we further understood the complexity of the disease and its management, it became apparent that a clinical severity scoring system that could guide therapies would be helpful. Unfortunately, such a score was lacking, leading us to develop such a score which utilizes clinical data on the patient’s initial presentation to predict need for subsequent hospitalizations and help streamline care. The work presented has provided insights to the complexity of CP, resulting in improved multidisciplinary care, guideline development, and the creation of new integrated care pathways.</p
Placing human rights at the heart of nursing home care in Ireland
No full textConference flyer for: Placing human rights at the heart of nursing home care in Ireland.</p
Irish Paediatric Critical Care Audit summary report 2023
No full textThe Irish Paediatric Critical Care Audit (IPCCA) was established by the National Office of Clinical Audit (NOCA) and reports on the care of patients in paediatric critical care units (PCCUs). NOCA works with the Paediatric Intensive Care Audit Network (PICANet) in the UK to collect and monitor the data. The audit also reports on paediatric patients admitted to adult ICUs, using data from the Irish National ICU Audit.</p
Association of increased red blood cell distribution width with adverse cardiorenal outcomes after cardiac surgery
No full textPerioperative risk stratification remains an important and unmet need in adult cardiac surgery. Red blood cell distribution width (RDW) quantifies the variability in red blood cell (RBC) size and has gained recognition as a potential biomarker across a wide range of clinical conditions.1 RDW is calculated by dividing the standard deviation of RBC volume by the mean corpuscular volume, yielding a normal range of 11% to 15%. Elevated RDW values indicate anisocytosis, which may be reflective of disruptions in RBC production or increased RBC destruction. RDW is increasingly recognized as a marker of conditions associated with inflammation, anemia, and systemic stress, and recent studies highlight its potential role as a prognostic marker in coronary artery disease, atherosclerosis, acute coronary syndrome, heart failure, and congenital heart disease. Given the routine availability and cost-effectiveness of conducting RDW measurements, RDW may be a valuable tool for perioperative risk stratification. We evaluated the association of RDW with cardiorenal outcomes in adults undergoing cardiac surgery who were part of the large, contemporary Transfusion Requirements in Cardiac Surgery (TRICS) III trial.2,3</p
Current and emerging parenteral and peroral medications for weight loss: a narrative review
No full textObesity is a growing global health challenge, necessitating effective treatment options beyond lifestyle interventions. This narrative review explores established and emerging pharmacotherapies for weight management, including parenteral agents like Liraglutide, Semaglutide, Setmelanotide, and Tirzepatide, as well as peroral medications such as Phentermine, Phentermine/Topiramate, Bupropion/Naltrexone, Orlistat, and Metformin. Newer treatments like Cagrilintide and Bimagrumab show promise for enhancing weight loss outcomes. Parenteral GLP-1 receptor agonists demonstrate superior efficacy compared to traditional peroral medications, with gastrointestinal side effects being the most common. Artificial intelligence presents intriguing opportunities to enhance weight loss strategies; however, its integration into clinical practice remains investigational and requires rigorous clinical validation. While current anti-obesity medications deliver significant benefits, future research must determine the efficacy, safety, and cost-effectiveness of AI-driven approaches. This includes exploring how AI can complement combination therapies and tailor personalized interventions, thereby grounding its potential benefits in robust clinical evidence. Future directions will focus on integrating AI into clinical trials to refine and personalize obesity management strategies.</p