1,721,093 research outputs found
Neuro-muscular electrical stimulation for the treatment of orthostatic hypotension in an older community dwelling population
No full textOrthostatic hypotension (OH) is highly prevalent in older people and is associated with increased morbidity and mortality. Current treatment options include pharmacological and non-pharmacological approaches, although robust evidence regarding therapeutic efficacy is lacking. The overarching aim of this thesis is to investigate the potential benefit of neuromuscular electrical stimulation (NMES) in attenuating blood pressure (BP) reductions in community dwelling older subjects with OH. The first study incorporated two surveys to evaluate patient and physician practices and perceptions of using elastic compression stockings (ECS), which are currently frequently used for this indication. This study found that only one third of patients wear ECS daily, with practical difficulties limiting their use specifically in an older age group. The physician survey concluded that although ECS are prescribed frequently, there is significant discrepancy between physician prediction of patient compliance, and actual patient compliance which may reflect the current lack of convincing evidence regarding their efficacy. The second study incorporated a randomised crossover design investigating the use of both simultaneous and alternate leg calf muscle NMES during head-up tilt table testing. In this feasibility study, a trend toward benefit was demonstrated with alternate leg NMES setting. The third study evaluated the effect of both alternate and simultaneous NMES in a young, healthy population during head-up tilting and demonstrated a more favourable haemodynamic response and tolerability profile with alternate NMES. The final study compared the effect of alternate leg calf muscle NMES and ECS during both passive and active orthostatic challenges. Both NMES and ECS significantly attenuated BP reductions during orthostasis in comparison to control, with NMES resulting in significantly higher venous blood flow responses and demonstrated to be tolerable. There was no significant difference in systolic or diastolic BP between NMES and ECS interventions. In conclusion, NMES has been demonstrated to be as effective as ECS in attenuating BP reductions in an older subject group with OH during active and passive orthostatic challenges and is tolerable. Future study should evaluate the longer term efficacy and practicality of NMES for this indication
A model of continuous professional development for registered pre-hospital practitioners in Ireland
No full textThe introduction of a Regulatory body in Ireland with responsibility for ensuring high
standards of education and professionalism for ambulance, and other pre-hospital,
practitioners was a welcomed initiative in 2001 due to a need for improvement in care
delivered to patients before arrival at hospital.
This Regulatory body, the Pre-Hospital Emergency Care Council (PHECC), was
established under Statutory Instrument with an initial priority being to develop three
levels of pre-hospital practitioner: Emergency Medical Technician (EMT); Paramedic;
Advanced Paramedic (AP). The introduction of these three levels meant that only
such registered practitioners could practice in the pre-hospital environment. However
for practitioners to renew their registration, they had only to meet simple and minimal
criteria with no requirement to demonstrate any level of competence.
The Council’s 2011-2014 Strategic plan identified the need to introduce a system of
continuous professional development/competence as a priority.
The purpose of the studies in this thesis was to engage with the three levels of
practitioner in Ireland and to seek their views and opinions so as to identify factors
that would inform the implementation of a continuous professional competence (CPC)
framework for all pre-hospital practitioners. The expectation in when initiating this
work was that the results would assist in the introduction of a framework for one
group of registrants in particular, EMTs. In reality the outcomes from these studies
provided the evidence base when drafting the formal guidance document that was
subsequently issued officially to all EMTs in Ireland by the Regulator.
Following that introduction of CPC, a retrospective analysis was performed through
engagement with those registrants so to allow for further refinement of the process
before the framework would subsequently be introduced to the two remaining
registrant groups, paramedics and APs.
At a practical level, this thesis represents the first series of studies to engage with all
levels of pre-hospital emergency care registrants on a national level in Ireland and is
one of only very few to report nationwide pre-hospital research. Data were gathered
using qualitative and quantitative methods, in the form of on-line surveys and focus
groups. These data then formed the basis for the initial introduction of the CPC
model. After a six-month period, further engagement with registrants provided the
additional data to refine the process further. Therefore, this work represented a
meaningful process of consultation with practicing pre-hospital care providers that
would inform the information to be provided to them by their Regulator and the
format in which that would be delivered. To my knowledge, there is no previously
published example of such relationship between pre-hospital practitioners and
Regulators internationally.
Further, the design of this thesis allowed additional engagement with Irish pre-hospital
practitioners following the introduction of CPC. Through publication of the
outcomes, the thesis makes a contribution to both the international literature on
continuous professional competence (CPC) for pre-hospital practitioners specifically
and, in particular, the development of the profession in Ireland. The implementation
of CPC aligns Irish pre-hospital practitioners with other well established international
best practice models. This thesis, through substantial engagement with registrants, has
identified the factors which they believe are important for the successful
implementation of CPC and adds to the international literature on pre-hospital care
and, in particular, practitioner competence in this regard.
The model of CPC will have significant implications for all registrants; organisations
who operate in the pre-hospital environment; the Regulator; and will positively impact
on patient care by ensuring a national standard of competence exists for all relevant
practitioners. While Ireland has been the focus of this thesis, the publication of its
findings in peer-reviewed journals means that its relevance may extend beyond the
Irish setting to those working more broadly in the fields of continuous professional
development and professionalism internationally
The relationship between circadian integrity and delirium: a prospective study of an elderly population in an acute hospital setting
No full textno abstract availabl
The impact of healthcare-associated infections on patient care and the role of diagnostic molecular technology in infection prevention and control practice
No full textHealthcare-associated infections (HCAIs) are a public health challenge in Ireland and
pose a patient safety risk. The emergence of multi-drug resistant (MDR) Grampositive
organisms, such as methicillin-resistant Staphylococcus aureus (MRSA),
vancomycin-resistant Enterococci (VRE), Panton-Valentine leucocidin toxin-positive
S. aureus (PVL-SA), and Gram-negative organisms, such as extended-spectrum betalactamase
(ESBL)-producers and carbapenemase-producing Enterobacteriaceae
(CPE), have made HCAIs more complex and diverse. Clinical microbiologists are an
integral part of a hospital infection prevention and control (IPC) team, providing
clinical guidance and expertise, assisting with the implementation of national and
international IPC practices, managing outbreaks, and analysing rates of HCAIs. An
efficient microbiology laboratory is an integral component of a hospital’s IPC strategy
to facilitate the timely identification of pathogenic organisms from clinical specimens.
In order to provide this service, a combination of skilled scientists who can perform
traditional ‘bench’ tests and also utilise newer molecular diagnostics is required.
Matrix-Assisted Laser Desorption/Ionisation Time of Flight Mass Spectrometry
(MALDI-TOF MS) has facilitated the identification of bacteria, viruses and fungi in a
convenient and time efficient manner and negated the need to employ older
methodologies such as biochemical identification techniques. Faster identification of
multi-drug resistant organisms (MDROs) is crucial for the timely management of
HCAIs. Gradually, more laboratory work is becoming semi-automated and total
laboratory automation (TLA) has become reality in many laboratories in Europe. To
date, no Irish laboratory has installed a TLA system. Through greater public
awareness of HCAIs, patients are more informed than ever regarding the risks
associated with the acquisition of a HCAI and the concepts of patient safety and risk management have become key objectives for hospital management teams. As
presented in this thesis, HCAIs have occurred in the Mid-West of Ireland across all
age groups, despite the successful implementation of recommended IPC practices.
Between 2009 and 2015, two outbreaks of CPE, an ESBL outbreak in a neonatal
intensive care unit, the first reported case of neonatal mastitis secondary to PVL-SA,
the first Irish outbreak of linezolid-resistant S. epidermidis and a rare case of
daptomycin and vancomycin resistant enterococcal infective endocarditis have all
occurred in the region. The Mid-West of Ireland currently has the highest national
rates of CPE and higher than average national rates of ESBL-producing Escherichia
coli in blood cultures. Future work to track the progression of these trends is needed.
Infection prevention and control practices currently employed within the region are in
line with national and international guidelines but despite this the rates of HCAIs
remain problematic both clinically and practically, with regard to allocation of
isolation facilities in acute hospitals. Leadership and support are required from
hospital management to implement measures to reduce rates of HCAIs including
providing funding for the purchase of laboratory equipment that can facilitate the rapid
diagnosis of microorganisms, staff education and training including incentivising and
rewarding wards to reduce rates of HCAIs, thoroughly investigating outbreaks as they
occur and managing hospital beds in a safe and efficient manner. HCAIs have a
negative impact on patient care and staff morale. A hospital-wide approach with input
from all key stakeholders is needed for a sustained reduction in HCAI rates to be
achieved
Assessing need and advancing psychiatric care in Irish prisons
No full textThe mental healthcare of prisoners is seen as a public health challenge internationally.
Emerging research has highlighted higher rates of mental illness and intellectual disabilities
in prisons as compared to general population prevalence across multiple jurisdictions. This is
reflected in higher rates of adverse outcomes such as suicide rates amongst prisoners.
Psychiatrists visiting prisons play a key role in providing clinical guidance and expertise in
managing those with mental illness in prison, identifying those that need diversion from the
criminal justice system and highlighting those that may need additional support so as to
reduce suicide risk. This is done whilst operating in an environment with specific clinical, legal
and ethical challenges. As presented in this thesis, Irish prisons have higher rates of multiple
vulnerabilities including mental illness, substance misuse, homelessness and intellectual
disabilities as compared to the general population. Advances in screening practices and
service development are needed to facilitate diversion. This thesis describes the development
of care pathways to manage the care of prisoners with intellectual disabilities and prisoners
on hunger strike. These aim to advance care in prisons within Ireland and internationally
Hand hygiene and professional practice: comparative studies exploring attitudes and practice among healthcare students and among healthcare professionals
No full textHand hygiene is widely recognised as an effective measure in preventing the
transmission of healthcare-associated infection (HCAI). HCAI is a public health
challenge internationally and the emergence of antimicrobial resistance (AMR) and
multi-drug resistant organism-associated infections add to the complexity and
diversity of the challenge. Now, more than ever, the strategic and operational
implementation of infection prevention and control policies, including hand hygiene
improvement strategies, is a priority in managing the acute patient safety risk posed
by the transmission of pathogenic organisms.
Despite this, evidence shows that hand hygiene compliance among healthcare workers
(HCWs) internationally is low, while little is known about the hand hygiene practices
of HCWs in Ireland. Heretofore, a comprehensive independent study of hand hygiene
practice among HCWs in Ireland has not been published. This thesis presents an
independent study of hand hygiene in Ireland and includes the following
Mesenteric manifestations in Crohn’s disease
No full textBackground
Mesenteric manifestations are of pathobiologic relevance in Crohn’s disease.
Clarification of mesenteric morphology provides an opportunity to re-appraise their
pathogenic significance. Therefore, we examined the relationship between mesenteric,
mucosal and systemic manifestations in Crohn’s disease.
Methods
A multi-institutional study was conducted in which mesenteric disease was quantified
(mesenteric disease score) in patients undergoing resection (n=34) for CD. The
mesenteric disease score was correlated with a mucosal disease score, and Crohn’s
Disease Activity Index (CDAI). The relationship between mesenteric manifestations and
surgical recurrence was retrospectively determined in a second cohort (n=94). Local
mesenteric and systemic fibrocyte levels were determined using a combination of
histology, immunohistochemistry and flow cytometry. Mesenteric and mucosal gene
expressions were compared in Crohn’s disease patients, in silico using Chipster©, an R
based bio-informatic software.
Results
Mesenteric disease scores correlated with mucosal disease scores (r=0.8, p<0.0001) and
CDAI (r=0.7, p<0.0001) and were significantly increased in smokers (p<0.04).
Mesenteric disease manifestations independently predicted increased risk of surgical
recurrence (HR 4.7, 95% CI: 1.71-13.01, p=0.003) and reduced time to recurrence
(p<0.001). Mesenchymal abnormalities included fibrocytosis and adipocyte hyperplasia
and were contiguous between mesentery and adjacent intestine. The fibrocyte
proportion of circulating monocytes was increased in Crohn’s disease compared with
healthy controls (6.4 ± 2.82% vs. 2.0 ± 1.04%, p<0.001). Levels normalized following
ileocolic resection (5.7 ± 2.12% vs. 1.7 ± 1.20%, p=0.005), in patients with ileocolic
disease. Fibrocyte percentages correlated with mesenteric and mucosal disease scores as
well as with the CDAI (r=0.94, p<0.0001). Mesenteric, but not mucosal, gene
expression profiles were associated with connective tissue, immunologic and
inflammatory disorders.
Conclusions
Mesenteric manifestations are an important part of the pathogenesis of Crohn’s disease;
they are associated with smoking and disease severity, and have predictive value for
surgical recurrence. Therefore, they should be formally scored and recorded at the time
of surgery
Correlation of probiotic Lactobacillus salivarius growth phase with its cell wall-associated proteome
No full textLactobacillus salivarius subsp. salivarius UCC118 is a probiotic bacterium that was originally isolated from human intestinal tissues and was subsequently shown in a pilot study to alleviate symptoms associated with mild-moderate Crohn's disease. Strain UCC118 can adhere to animal and human intestinal tissue, and to both healthy and inflamed ulcerative colitis mucosa, irrespective of location in the gut. In this study, an enzymatic technique has been combined with proteomic analysis to correlate bacterial growth phase with the presence of factors present in the cell wall of the bacterium. Using PAGE electrophoresis, it was determined that progression from lag to log to stationary growth phases in vitro correlated with increasing prominence of an 84 kD protein associated with in vitro adherence ability. Isolated proteins from the 84 kD band region were further separated by two-dimensional electrophoresis, resolving this band into 20 individual protein spots at differing isoelectric points. The protein moieties were excised, trypsin digested and subjected to tandem mass spectrometry. The observed proteins are analogous to those reported to be associated with the Listeria monocytogenes cell-wall proteome, and include DnaK, Ef-Ts and pyruvate kinase. These data suggest that at least some of the beneficial attributes of probiotic lactobacilli, and in particular this strain, may be due to nonpathogenic mimicry of pathogens and potentially be mediated through a form of attenuated virulenc
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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