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A genetic perspective on the recent demographic history of Ireland and Britain
No full textWhile subtle yet discrete clusters of genetic identity across Ireland and Britain have been identified, their demographic history is unclear. Using genotype data from 6,574 individuals with associated regional Irish or British ancestry, we identified genetic communities by applying Leiden community detection. Using haplotype segments segregated by length as proxy for time, we inferred regional Irish and British demographic histories. For a subset of the Irish communities, we provide genealogical context by estimating the enrichment/depletion of surnames.Through patterns of haplotype sharing, we find evidence of recent population bottlenecks in Orcadian, Manx and Welsh genetic communities. We observed temporal changes in genetic affinities within and between genetic communities in Ireland and Britain. While structure in Ireland is subtler when compared to British communities, the Irish groups share relatively more short haplotype segments. In addition, using effective population size estimates and levels of haplotype-sharing, we detected varying degrees of genetic isolation in some Irish and British genetic communities across time. Further, we observe a stable migration corridor between north-east Ireland and south-west Scotland while there is a recent migration barrier between south-east and west Ireland. Genealogical analysis of surnames in Ireland reflects history - Anglo-Norman surnames are enriched in the Wexford community while Scottish and Gallowglass surnames were enriched in the Ulster community.Using these new insights into the regional demographic history of Ireland and Britain across different time periods, we hope to understand the driving forces of rare allele frequencies and disease risk association within these populations.</p
That's a wrap – the use of an Esmarch bandage to treat compartment syndrome of the forearm in a paediatric patient
No full textA 13 year old boy presented to our emergency department after a fall from his bicycle and sustained a left radius & ulna fracture. The boy had paraesthesia and reduced sensation in his digits. AIN and PIN were intact. He underwent MUA & casting in theatre. He had significant swelling, paraesthesia and severe pain with passive movement of his digits post-op. A diagnosis of compartment syndrome with suspected acute carpal tunnel syndrome was made. Flexor compartment pressure was 68 mmHg and 16 mmHg in the extensor compartment. An Esmarch bandage was temporarily applied in a retrograde fashion from distal to proximal on the elevated limb. The technique was repeated 4 times and final flexor compartment pressure was 23 mmHg. Based on these measurements, carpal tunnel release and distal radius fixation was performed, but no fasciotomy. He remained asymptomatic throughout follow-up and was subsequently discharged from the fracture clinic. We have described a successful case of treating forearm compartment syndrome in the setting of a paediatric forearm fracture conservatively, without the need for a fasciotomy. We demonstrated an objective improvement in compartment pressures with repeated applications of the Esmarch bandage technique. It is quick to implement and safe for the patient. We advocate its use in those patients where a fasciotomy is already planned as that remains the gold standard treatment. This technique should be used to potentially avoid a fasciotomy and the subsequent morbidity associated with that surgical procedure. It should be used in conjunction with sound clinical judgment and examination technique.</p
Exploring the barriers and enablers of oral health care utilisation and safe oral sex practices among transgender women in Malaysia: a qualitative study
No full textBackground: Transgender women in Malaysia face social and healthcare marginalisation. Research about their oral health and oral health care utilisation is sparse. Despite growing clinical evidence highlighting the risk of transmission of sexually transmitted infections (STIs) through oral sexual practices, research in this area remains less explored. This study aimed to understand the experiences of transgender women in Malaysia by exploring oral health care needs and the barriers and enablers of oral health care utilisation as well as safe sexual practices relating to oral transmission of STIs.
Methods: Participants were recruited through a snow-balling method of sampling with the help of community workers. Semi-structured in-depth interviews (IDIs) with transgender women in northern Malaysia and Focus group discussion (FGD) with a mixed group of transgender women and health care professionals were conducted to gain insights into the needs of the community. Data obtained from IDIs and FGD were coded, transcribed, and thematically analysed to derive codes and themes through the interpretative lens of the Information, Motivation and Behavioural skills (IMB) theory.
Results: Participants of the IDIs were transgender women (n = 20, median age 39.8 (9.75 IQR) years). Aesthetic dental needs were prioritised, yet poor utilisation of dental services was reported, with many opting for self-medication or care from a non-qualified dental practitioner. Routine engagement in oral sex practices, primarily receptive fellatio with or without ejaculation with multiple cis-gender male partners, was reported. Low awareness of oral STIs, along with a perceived low risk of transmission of STIs through oral sex, was reported, with most (18, 90%) not using condoms for clients/partners or inconsistently using them during oral sexual practices. The themes identified from IDIs and FGD included: ‘Place in the society’ ‘Attitudes and beliefs linked with dental care’, ‘Access to dental care’, ‘Lack of trans-specific health care’ and ‘Use of condoms for oral sex’.
Conclusion: The study’s findings report poor dental service utilisation among transgender women despite aesthetics being prioritised. Gaps in knowledge regarding the oral transmission of STIs were also noted. These insights underscore the need for trans-specific health campaigns designed to address these concerns and enhance awareness through an integrated approach to improve access to inclusive oral health care and sexual health care for this vulnerable population.</p
Emergency department care experiences among 2SLGBTQQIA+ patients: a mixed methods study
No full textBackground: Equity-deserving groups (EDG), including those who identify as two-spirit, lesbian, gay, bisexual, transgender, queer, questioning, intersex, and/or asexual (2SLGBTQQIA+), are disproportionately treated in the Emergency Department (ED). This study aimed to understand ED care experiences of 2SLGBTQQIA+ individuals compared to those who do not identify with an equity-deserving group in Kingston, Canada, ultimately aiming to enhance inclusivity and better meet healthcare needs.Methods: Data were collected through a mixed qualitative/quantitative cross-sectional study using a novel electronic survey tool (Spryng.io), which purposely integrates qualitative and quantitative data, while minimising researcher bias. A community-based participatory approach was employed to involve community stakeholders. Participants were recruited from the Kingston Health Sciences Centre's ED, Urgent Care Centre, and at community-based organisations. Quantitative data were analysed using chi-squared tests, while qualitative data underwent thematic analysis. Results were triangulated. Focus group discussions with community partners were then undertaken to contextualise findings.Results: Compared to persons who did not identify as belonging to an EDG (n = 949), 2SLGBTQQIA+ individuals (n = 118) felt their identity had a more negative impact on their care (p p Conclusions: 2SLGBTQQIA+ individuals often face unmet mental health care needs, requiring tailored mental health care provision in the ED. Intersectionality within the 2SLGBTQQIA+ population underscores the importance of trauma-informed care. Strategies to improve 2SLGBTQQIA+ healthcare include implementing safer spaces, clear feedback mechanisms, referrals to gender-affirming specialists, and privacy in triage. Further research should assess the impact of educational interventions on HCP knowledge and patient experiences in the ED.</p
Society for Endocrinology Clinical Practice Guideline for the evaluation of androgen excess in women
No full textContext: Androgen excess is common in women and refers to clinical or biochemical evidence of elevated androgenic steroids such as testosterone. It is associated with underlying polycystic ovary syndrome in the majority of cases. However severe androgen excess is less common and may indicate the presence of underlying adrenal or ovarian neoplasms, genetic disorders or severe insulin resistance syndromes. Currently there are few consensus guidelines to assist clinicians with a standardised management approach to the patient with severe androgen excess.Design: Clinical practice guideline.Methods: This guideline has been developed with expertise from colleagues in endocrinology, gynaecology, clinical biochemistry and nursing, and furthermore provides a unique patient perspective to guide clinicians.Results: The Society for Endocrinology commissioned this new guideline to collate multi-disciplinary guidance for clinical practitioners in the investigation of severe androgen excess. Recommendations have been made in the areas of clinical assessment, biochemical work up, dynamic testing and imaging, informed where possible by the best available evidence.Conclusion: This guideline will provide guidance for clinicians in their approach to patients with severe androgen excess.</p
Navigating mental health challenges in international university students: adapting to life transitions
No full textChange is an inevitable part of life yet navigating it can be challenging. Students transitioning from school to higher education encounter unique stressors that can significantly impact their mental health. International students face compounded difficulties as they adapt to life abroad, often for the first time, without immediate support from family and friends. This transition introduces independent living, which demands new responsibilities such as managing finances, academics, and personal well-being-tasks that are frequently underestimated. These challenges are exacerbated by cultural adjustments, language barriers, and the isolation that accompanies being far from familiar support systems. Combined, these factors contribute to heightened stress levels and increased risk of mental health concerns in this population. However, the ability to build resilience and adopt effective coping mechanisms plays a crucial role in mitigating these challenges. Among these, social support and culturally tailored university programs consistently emerge as the most effective for enhancing resilience. Further strategies such as developing strong social networks, practicing self-care, and seeking institutional support can enhance students' ability to manage stress and adapt to their new environment. Additionally, fostering cultural competence, promoting mental health awareness, and providing tailored resources for international students can further bolster their mental well-being. Effective coping strategies identified in the literature include social support, self-compassion, culturally sensitive university programs, and mental health literacy initiatives. This paper explores the unique mental health challenges faced by international university students and highlights coping strategies aimed at promoting resilience and improving students' capacity to thrive during this pivotal life transition.</p
Using Hofstede's framework to explore surgical cultures and their impact on female surgeons
No full textContext: Workplace diversity improves outcomes, yet surgical cultures have long been identified as a deterrent for women considering surgical careers due to male-dominated traditions. Our study explores the impact of surgical cultures and their influence on gender through the analytical lens of Hofstede's cultural dimensions framework. We apply this in a novel way to gain deeper insights into how masculinity and other cultural dimensions intersect.Methods: For this qualitative study-part of a larger study exploring gender in surgery-we conducted semi-structured interviews with 29 female surgeons, 18 male and female colleagues of female surgeons (surgeons, anaesthetists, nurses and physician associates) and 13 patients of female surgeons. We analysed the data using framework analysis, with surgical cultures being identified as a central theme. We drew on Hofstede's cultural dimensions theory to deeply interrogate how cultural dimensions intersect to shape the surgical environment, thereby disadvantaging women.Results: Competition, achievement and heroism associated with masculinity were thought to be pervasive and hindered progression, particularly for female surgeons. Unequal power distributions were reported to lead to female surgeons working harder to earn respect. Female overseas doctors narrated the challenges of being respected by male colleagues from their own collectivist countries. Long-standing 'old boys' club' traditions associated with uncertainty avoidance were thought to maintain the gendered status quo. Long-term orientation and restraint were reported to impact female surgeons with career breaks. However, our analysis indicated novel interplays between masculinity and the other five cultural dimensions, with some dimensions overlapping (e.g., long-term orientation and restraint) and others contradicting (e.g., power distance and collectivist values).Conclusion: This study, drawing on Hofstede's cultural dimensions, illustrates the complexity of interacting cultural dimensions, serving to maintain inequities for female surgeons. We therefore provide recommendations for multiple interventions to enable surgical culture change, based on these intersecting six cultural dimensions.</p
An insight into the implications of the NCCP 2024 guideline on the staging & surveillance of melanoma
No full textAim: In 2024, the NCCP introduced changes to the staging and surveillance of cutaneous melanoma. This study aims to evaluate the cost-effectiveness of this proposed change and the impact on future modelling of services.Methods: Patients diagnosed with melanoma (Clinical Stage Ib and above) treated between 2017 and 2023 at Beaumont Hospital were identified from a prospectively maintained database. Data were analysed for their journey on an idealized pathway modelled over a 5-year follow-up period according to new guidelines. The increased number and cost of surveillance imaging required was estimated and compared with previous best practice.Results: According to new guidelines, based on our patient population, an additional 110 surveillance whole-body CT and brain-CT scans could be required annually for stage IIb and IIc melanoma. Regarding PET-CT scans, this could lead to a potential additional annual expense of €176,000. An additional 390 surveillance MRI-Brain scans could potentially be required annually for stage III and IV melanoma patients.Discussion: This study identifies cost and service access implications with the implementation of these guidelines. The clinical utility of increased surveillance imaging is yet to be determined. This provides key information for planning future service delivery in the context of an aging population and increased prevalence of melanoma.</p
A rare cause of neonatal seizures - a case report
No full text1 Case/IntroductionA male term infant with an uncomplicated perinatal background presented on day of life 13 with a brief history of isolated jerking of the right lower limb at home. On review, a witnessed event in clinic showed non-suppressible tonic–clonic movement of the right lower limb with secondary generalisation.</p
Assessing the statistical fragility of randomized controlled trials in hip and knee arthroplasty: a methodological review.pdf
No full textIntroduction: Randomized controlled trials (RCTs) are considered the gold standard in evidence-based medicine, providing high-quality evidence for the effectiveness of interventions in healthcare. However, the quality of RCTs can vary substantially. One aspect of methodological quality that has recently garnered interest is the fragility index (FI) which is a metric indicating how many event changes would lead to a change the significance of a study's results. Surgical RCTs, especially in orthopedic fields like hip and knee arthroplasty, have been shown to have high fragility, raising concerns about their reliability. This methodological study aims to describe the statistical fragility of RCTs in hip and knee arthroplasty over the past decade, with a secondary objective of determining the study characteristics associated with fragility.Methods: We conducted a systematic search of Medline and Embase databases for RCTs published between 2012 and 2022, focusing on hip and knee arthroplasty. Trials were included if they had a 1:1 parallel design and reported at least one statistically significant outcome. FI were calculated for both dichotomous and continuous outcomes using established methods. We extracted data such as sample size, study characteristics, and statistical measures. Multivariable regression was used to explore relationships between FI and study characteristics such as sample size, intervention type, and region.Results: From 16,214 records, 140 studies met the inclusion criteria. The median FI for dichotomous outcomes was 2, interquartile range (IQR) = 4, while the median continuous FI (CFI) was 8.85 (IQR 14.4), indicating higher robustness for continuous outcomes. No significant associations were found between FI and variables like region, year of publication, or sample size.Conclusions: Hip and knee arthroplasty trials often exhibit statistical fragility, particularly those reporting dichotomous outcomes. These fragile findings suggest the need for more robust RCT designs in orthopedic research. Incorporating FI into sample size calculations could improve trial stability and ensure more reliable outcomes that better inform clinical guidelines and patient care.</p