UCC Journals (Univ. College Cork)
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Acute exacerbation of congestive heart failure following intranasal cocaine use
Get PDFBackground: Most presentations of decompensated congestive heart failure occur in patients diagnosed with pre-existing heart failure. Decompensation presents as progressive dyspnea, abdominal and peripheral congestions, as well as neurological symptoms. It typically occurs following physiological stressors such as infection, arrhythmia, or medical non-adherence. Chronic heart failure may result from cardiovascular comorbid conditions, such as coronary artery disease, valvular disease, and long-standing hypertension.
Long term cocaine use also results in adverse cardiovascular health. Cocaine use can augment pre-existing risk factors for both chronic congestive heart failure and acute decompensations - namely, coronary artery disease, congestive heart failure, and peripheral vascular disease. It can also independently pose a cardiovascular risk by causing acute ischemia, vasoconstriction, tachycardia, systolic dysfunction, and cardiac remodeling.
The Case: the case of a 49-year-old Caucasian male, who presented with worsening dyspnea on exertion and bilateral peripheral edema extending to his abdomen. His symptoms worsened over the preceding week and began after three consecutive days of intranasal cocaine use. He presented with a background history of congestive heart failure, coronary artery disease, peripheral vascular disease, a 30 pack-year smoking history, and weekly cocaine use for the past 12 years.
Conclusion: Cocaine use can lead to decompensation of congestive heart failure in patients with extensive cardiac and vascular disease. Cocaine use can also acutely worsen systolic function and cause demand ischemia, on a background of chronic remodelling and atherosclerotic changes.
Patient Consent Obtained: Ye
The effects of postoperative delirium on outcomes in hip fracture patients
Get PDFBackground: Hip fractures have reached epidemic levels in an ever-ageing population. Based on this increase, the rate of postoperative delirium (POD) is simultaneously expected to rise as it seems to be a disproportionate hazard post-hip surgery. POD is purported to have detrimental effects, but prevention and screening efforts remain inadequate. Therefore, examination of recent evidence for negative outcomes, including decreased survival and increased complications, is critical if we seek best practice.
Objectives: This review examines the most recent evidence for the effect of POD on mortality of hip fracture patients and other outcomes such as length of stay, discharge destination and functional outcomes.
Methods: Two electronic database searches resulted in selection and critical appraisal of ten studies.
Results: Across the ten articles selected for review, the prevalence of POD ranged from 18-53.3%. Nine studies focused on mortality. In unadjusted analysis, mortality was found to have a significantly increased association with POD. However, several papers showed with effective adjustment for confounding or contributory variables, no independent association was observed. Medical complications was a focus in four of the articles, and the association with POD was observed following adjustment. Similar results were reported for increased non-home discharge and length of hospital stay.
Conclusion: POD has some effect on outcomes in hip surgeries but future research needs coherence of methods across the field and comprehensive accounting for the increased age and comorbidities of POD patients. Determining whether factors like increased length of stay are themselves the cause, rather than the result, is imperative. The lack of consistent high-quality research frustrates the validity of many of the papers conclusions on increased mortality. While we await such research an effort still needs to be made to prevent POD, especially given the more valid evidence of other less fatal effects
Palliative medicine during the pandemic: a medical student\u27s perspective
Get PDFTucked away in the outskirts of Cork City is Marymount University Hospital and Hospice. This facility with 44 beds houses the most frail, immunocom- promised and terminally ill patients from all across Munster. That being said, providing palliative care was significantly affected by the challenges brought on from the ongoing global pandemic
Severe maternal morbidity in high income countries
Get PDFIntroductionWith declining maternal mortality rates in high income countries (HICs), severe maternal morbidity (SMM) is becoming an important quality measure of maternal care. However, there is no international consensus on the definition and types of SMM. This study aims to critically analyze published literature on SMM in HICs.
ObjectivesTo compare definitions and criteria used to identify SMM, and to identify the main types and risk factors contributing to SMM in eight HICs.
MethodsThree databases were searched, results were filtered, and ten studies were critically appraised.
ResultsSix of the articles discussed SMM identification criteria and proposed definition modifications. Longer hospital stay and admission to intensive care unit were suggested as additional criteria. Disease-based criteria was shown to be superior to organ dysfunction criteria. Seven articles detailed common types of SMM as severe haemorrhage, hypertensive disorders, and pre-eclampsia/eclampsia. Six articles described SMM risk factors, of which advanced maternal age and caesarean delivery were most common.
DiscussionThis literature review identified disease-based criteria and Canadian study criteria as promising measures of SMM. It also identified several types and risk factors of SMM common between HICs. These findings can help physicians identify women at risk of SMM. The study is however limited to eight HICs and ten studies. Further research should aim to investigate how the measures compare with previous sources of criteria, and to discern the association of weight and race risk factors with SMM
Efficacy of the informed consent process for surgical procedures: a review of the literature
Get PDFBackground: Informed consent is a communication process between a patient and their healthcare team to acquire a patient’s approval to undergo a medical intervention. It is essential to the delivery of legal, safe, and patient-centred health care. Despite this, it is often inadequately implemented in clinical practice which frequently contributes to patients having little understanding and can lead to unfavourable outcomes. Furthermore, interventions to improve the consent process are not well recognized. Ultimately, the evaluation of these factors in this review will be of relevance in improving patient-centred care.
Objectives: Explore degree of understanding and retention of information amongst surgical patients during the informed consent process, identify outcomes of obtaining inadequate informed consent, and evaluate interventions that improve comprehension of surgical treatment.
Methods: The first electronic search was conducted through EBSCOhost to identify relevant literature on MEDLINE, Academic Search Complete, and CINAHL Plus. A second search was completed through PubMed. Exclusion and inclusion filters were applied, and duplicates removed, which yielded 200 articles. Title/Abstract screening yielded 15 articles which have then undergone full text review to assess for eligibility. This generated the 10 articles used in this review.
Results: Surgical patients have poor comprehension with regards to the benefits, risks, and alternatives of their procedure. Although most patients receive some information about their procedure, this was not suited to their personal goals and needs. Surgical patients also greatly benefited from interventions that were assessed to increase patient understanding and improve the informed consent process.
Conclusion: Informed consent is poorly delivered based on the analysis of patient understanding and outcomes. Further research on interventions to improve these elements are recommended as previous studies show notable improvement
Reviewing the effect of creative arts therapy on the development of cognitive and social skills in children and adolescents with autism spectrum disorder
Get PDFCreative art therapy has been utilized for many years as a treatment regimen for certain mental disorders. Overall, results of studies on creative art therapy show a positive trend, with general improvements in mental health and reduction of neurological symptoms in the majority of cases. The results regarding the effectiveness of creative art therapies in treating autism spectrum disorder are unclear and varied, due to the range of symptoms involved in autism spectrum disorder, the effect of age on therapy, and the variety of creative art therapies available for use. Of all the creative art therapies chosen to review, music was the most investigated. The studies performed on music therapy showed positive results, however, a large-scale randomized controlled trial refuted the positive benefits, leading to an inconclusive overall result on the effectiveness of music therapy. Research on the benefits of creative art therapies for children with autism spectrum disorder is inconclusive. Studies generally demonstrate a positive effect on many different types of creative art therapies. However, these studies have major limitations in generalizability due to small sample sizes and their descriptive nature. Future research should focus on developing randomized controlled trial protocols that can be used on a larger scale to generate more definitive results on the benefits, or lack thereof, of creative art therapies. Research should also be performed on the effect of adolescence on creative art therapies, and whether targeting it at younger children with autism spectrum disorder would be more or less beneficial than targeting it towards adolescents
Energy and presence: A journey from theatre lab to teacher training
Get PDFThis article narrates my journey through laboratory physical theatre, focusing on how actor presence emerges from physical training, imagination, intentionality and connection with the audience. It then argues for the significance of these elements in initial teacher training, exploring the concept of teacher presence and examining to create a more embodied and active engagement in the classroom, similar to the craft of an actor in performance. By integrating actor-training, I propose that presence is something developed through laboratory theatre training techniques. In my work with student teachers, I incorporate such techniques to work on their energetic presence, enabling them to create richer emotional connections with their students. Research indicates that strong teacher-student relationships significantly impact academic achievement, motivation, and engagement. These relationships flourish when teachers leverage their mental, physical, and emotional resources, suggesting that presence is not merely an innate quality but a skill that can be developed through specific actor-training exercises. Student logs of reflections on the drama module sessions will illustrate the transformative impact of this training on their confidence, teaching practices, and the relationships cultivated within the classroom. Ultimately, I posit that when educators engage their intellect, emotions, and creativity, they can create dynamic learning environments that resonate with authenticity and connection
How effective is 13-valent pneumococcal conjugate vaccine (PCV13) combined with 23-valent pneumococcal polysaccharide vaccine (PPSV23)?
Get PDFThe bacterium Streptococcus pneumoniae remains a major causeof morbidity and mortality worldwide. Currently, the 2 leading vaccines targeted against it are: 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13). It was only very recently, starting 22 November 2019, that the Advisory Committee on Immunisation Practices (ACIP) no longer recommends routine administration of PCV13 for all adults aged 65 and above. As such, this systematic review aims to investigate how the use of PCV13 combined with PPSV23 compares to using PPSV23 alone in older adults.
Relevant research papers were chosen through an electronic searchin PubMed. A set of selection criteria was then applied to ensure that the papers aligned with the objectives of this paper.
The majority of the studies included in this paper demonstrated that in adults aged 50 years and above, PCV13 had the ability to generate a strong immune response in adults, even more so than PPSV23 for all of the twelve serotypes common to both vaccines. The safety of PCV13 was also demonstrated in the studies as no PCV13-related serious adverse events (SAEs) had surfaced. Only one study included in this systematic review opposed the trend.While the evidence for both PCV13’s and PPSV23’s ability to generate an immune response have been persuasive, more research that focuses on the clinical endpoint in older adults, as well as the incidence of pneumococcal infections in the population, could be done to fully address the main question of this paper
Mixing Materials for Integrated Photonic Innovation
Get PDFPhotonics, an ever-growing field since the invention of lasers in the 1960s, has been applied in wide-ranging applications such as optical communications, sensing, imaging and more. Photonic integrated circuits (PIC) are the next step to take this technology and shrink it onto a semiconductor chip, leading to more compact, cheaper, and lower power consumption solutions. However, integrated photonics faces the challenge of lacking a single material platform that encompasses all the desired properties, unlike its more mature electronic integrated circuit counterpart which uses silicon with a standardised fabrication process known as complementary metal oxide semiconductor (CMOS). To overcome this limitation, researchers are exploring hybrid and heterogeneous integration techniques. By combining the strengths of different photonic platforms, such as III-V materials for light emission, silicon for strong light guidance, silicon-nitride for visible light guiding, and lithium niobate for its modulating capabilities, integrated photonic technologies can harness the collective advantages and unlock new possibilities.
“Light brings us the news from the universe.”
— Sir William Bragg