Open Journal Systems Trinity College Dublin
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Editors’ Notes
Get PDFThis year marked the twentieth anniversary since the founding of the Trinity Student Medical Journal in 1999 under the guidance of Professor Conleth Feighery and Professor Moira O’Brien. The vast progress made in publication, education and research since then and the speed at which research makes it from the bench to print (with early releases online) and then to the patient’s bedside is phenomenal.
The TSMJ has been on a journey involving twenty committees, and a mix of conferences, study days, poster competitions, medical art awards, interviews, publication crash courses and journal clubs throughout its time. It has always delivered with physical journal copies being ferried to libraries, lecture theatres and the Trinity College teaching hospitals, as well as the legal deposit libraries.
This years journal highlights some interesting and topical articles; Hazeem Ahmayuddin’s case report (completed during an elective) on the management of a primary small cell carcinoma in the subglottis highlights a rare condition, and discusses the urgent need for further trials in the area, and Fátimah Alaya’s feature article on the reach of the GDPR that highlights and reflects on the limbo experienced in healthcare research for the last two years. There are two comprehensive reviews; one on the current research in the prodromal phases of Alzheimer’s Disease by Tristram Ryan, and the other on the balance between cost and efficacy of the new immune checkpoint inhibitor drugs in cancer therapeutics by now final year student Michael McKenna. And there are many other fascinating reads on reproductive rights, audits based in general practice, palliative care research and approaches and the need to sedating children during MRI studies.
As medicine evolves rapidly, so too does the world of publishing. We are evolving too in the TSMJ and are moving towards online platforms for that last few years. While print editions are key, accessibility and relevance of research relies on online presence and we too must move with the times. Our new website using the Open Journal Systems is soon to go live and will revolutionise the submission process and the ease with which the journal can be accessed, dispersed and referenced.
We are delighted to continue to provide a platform for students in medicine, dentistry and health science fields to publish their research, reviews, case reports and academic efforts that they devote their time to during their undergraduate studies. We are also student run which means that the entire production is a culmination of hard work and volunteered time by students from first year through to final year that are giving of their time and energy to foster others, teaching through editing, providing through production, learning through guiding others and yourself to deliver a product as a team.
The journal would not be here without students to research, authors to write, editors to review, designers to produce, and the numerous researchers, consultants and academics that together support student ventures. We are deeply grateful to all those involved in the Trinity Student Medical Journal, this year, and for every year that has gone before us.
We are pleased to present you with the twentieth edition of the Trinity Student Medical Journal. The topics are varied, thought-provoking and are produced by the talent of the upcoming health scientists, dentists and doctors. We are proud as ever to continue to serve as a platform for student research, student editorial work and student collaboration. Thank you to all our sponsors, supporters, and the School of Medicine for the constant support
The Artist in the Suit
Get PDFA reflection on the challenge of maintaining an artistic practice while pursuing a career as an arts manager in healthcare.
Mary Grehan has spent most of her career as an arts manager bringing arts experiences into hospitals. Although an art college graduate, the demands of her early career quickly overtook her fledgling visual arts practice. Twelve years into her career she resurrected a creative practice in visual art before turning to writing and since that point has juggled the demands of both practices – the day job as an arts manager working in healthcare and the artist in the attic. In this article, she reflects on the different rhythms, cultures and challenges of both practices and how as an arts manager she brokers the relationship between artists and healthcare professionals. She also questions whether her creative practice shapes her as an arts manager
Ireland’s Fiscal Spending Multipliers
Get PDFThis paper estimates government spending multipliers for Ireland. We add to the existing literature on Ireland-specific fiscal spending multipliers in two key ways. First, we focus on measures of economic activity that remove distortions caused by foreign-owned multinational enterprises, thus allowing us to derive truer estimates of the impact on the domestic economy of changes in fiscal policy. Second, we employ a number of statistical approaches in order to sense-check the multiplier estimates we derive, including standard SVAR approaches, an expectations-augmented VAR (EVAR) approach, and estimates based on a large-scale structural model. Our results show that government investment can have positive and significant initial impacts on Irish output, though these effects tend to disappear and/or become statistically insignificant over the longer term. Other forms of fiscal spending do not have a statistically significant effect
A General Practice Audit Comparing the Rate of Pneumococcal Vaccine Uptake Among Patients with Diabetes Mellitus, Before and After Intervention
Get PDFThe pneumococcal polysaccharide vaccine was introduced for at-risk groups in Ireland in 1996 and it has been demonstrated that increased vaccination rates result in fewer hospital visits in at-risk groups. An audit was carried out from October 2017 until January 2018 in a rural general practice catering for just over 2,000 patients. It was hypothesised that, from direct observation, there was a lack of uptake of the pneumococcal vaccine in certain at-risk patient groups, such as patients with diabetes mellitus. The findings from this were used to guide intervention aimed at encouraging uptake of the pneumococcal vaccine. Data was collected to include the vaccination status of all patients with diabetes mellitus in the practice. The results showed 89 patients (59.3%) had never received the vaccine. In addition, a further 23 (15.3%) patients were due a booster. From the re-audit, following intervention to encourage uptake, which included direct advice and encouragement from the practice doctors and nurses, in addition to a text message reminder sent to patients, 22 patients attended for vaccination, giving an uptake rate of 19.6%. The ideal scenario is for all patients with diabetes mellitus to be vaccinated which would amount to improved quality of life for patients. Whilst a target of 100% is difficult to achieve, the expectation would be to have the majority of patients vaccinated according to current guidelines. In addition, the practice would ensure compliance with those guidelines and recommendations regarding vaccination and would also generate revenue, which is important in order to maintain a viable business model within general practice
Managing Anxious Patients Undergoing Magnetic Resonance Imaging: Evidence Versus Common Practice in Ireland
Get PDFAim: Adult patients undergoing Magnetic Resonance Imaging (MRI) often experience anxiety prior to and during scanning. While NICE guidelines exist for anxious paediatric patients undergoing MRI procedures, no formal guidelines have been developed for adults. The aim of this study was to compare current practices of managing anxious adult patients undergoing MRI procedures in a selection of Irish hospitals with a reviewed international evidence base.
Methods: A comprehensive literature review was conducted once search terms, the Boolean operators with which to pair them, and the parameters of our search were defined. The Cochrane Database, PubMed, Google Scholar and eMedicine databases were all utilised for the literature review. This knowledge base was then used to create a comprehensive survey, which our team used to conduct phone interviews with nine hospitals throughout Ireland regarding their existing protocols.
Results: The literature demonstrates the benefits of utilising oral, or if necessary, intravenous sedation in anxious patients, despite the potential adverse effects of such. However, no universally-approved or utilised protocols have been established in Ireland. Our survey of nine Irish hospitals found three hospitals with vague and open-ended departmental protocols. The remainder of surveyed hospitals referred anxious patients to their general practitioner for review prior to repeat scans on a case-by-case basis.
Discussion: Our study demonstrates the lack of a nationally implemented formal protocol in Ireland for anxious patients undergoing MRI procedures. Without a formal protocol in place, vague protocols prevail, costing the healthcare system and individual patients time and money. We would aim to build upon this research, consulting with international hospitals to create a formal and robust protocol
Bonding and Bridging Social Capital: The Determinants of English Language Fluency and Its Effects on the Labour Market Outcome of International Students in Ireland
Get PDFThis study investigates the extent to which social capital influences the English fluency ofinternational students in Ireland and how language skills affect their earnings in the Irish labour market upon graduation. Two different forms of social capital are identified: ‘Bonding’ refers to the connections within international students’ co-national groups; ‘Bridging’ is used in reference to the ties these students create with those beyond their national communities, such as with the host country’s locals or other international students. The main findings suggest that: (1) Bridging social capital with Irish people is found to have a significant positive effect on international students’ English fluency. (2) English fluency, bonding social capital with co-nationals, as well as bridging social capital with Irish are all found to have positive effects on graduates’ monthly salary after correcting for endogeneity. In closing, implications are discussed
Estimating Ireland’s Tax Elasticities: a Policy-Adjusted Approach
Get PDFThis paper estimates tax elasticities for Ireland. We compile a new dataset on tax policy changes in Ireland. This allows us to use policy-adjusted revenue when estimating tax elasticities. This gives us a cleaner estimate of the relationship between government revenue and its economic drivers. We find that income tax elasticity estimates are significantly above one when policy-adjusted revenue is used, as opposed to significantly below one when unadjusted revenue is used. This highlights the importance of using policy-adjusted revenue when estimating elasticities. We also estimate elasticities of Pay Related Social Insurance and Value-Added Tax, which have previously received little attention in the Irish literature
Distributional Consequences of Technology, Trade Globalisation and Financialisation in the US
Get PDFIn this paper, we examine the dynamic contributions of technology, trade globalisation, and financialisation to the functional-personal income distribution nexus. We estimate a two-equation model for the income distribution in the US over the 1968-2014 period. We show that the labour share is affected negatively by personal inequality and trade, and it is also determined by tax and technology related variables. In turn, income inequality is fuelled by the falling labour share and increasing financial assets and financial payments. Our empirical model accounts for 67 per cent of the fall in the labour share and 85 per cent of the rise in income inequality. Using counterfactual simulations, we show that the net distributional impact of technology and trade globalisation is scarce; in contrast, our indicators of the financialisation process are prominent drivers of the falling labour share and rising personal inequality. In the post-Great Recession years of tense socio-economic conditions, we claim that the scope of financial institutions and corporate strategies needs to be revised
Macroprudential Policy and the Irish Crisis
Get PDFThe interaction between the banking and property sectors has been the source of considerable volatility in the case of Ireland. The Central Bank of Ireland has recently introduced macroprudential instruments that aim to enhance banks’ balance sheet resilience and mitigate the build-up of system risk. We use a new model of the Irish banking and property sectors to examine how both borrower- and lender-based instruments of macroprudential policy may have been effective in countering the extreme macrofinancial dynamics of the boom-bust period. Our simulation results suggest that, while instruments that work through the intermediary may help insulate banks against liquidity risk and portfolio losses, those that target credit demand are significantly more effective in dampening the Irish financial cycle