Medicine - Journal Articles

Permanent URI for this collection

https://hdl.handle.net/10468/849

Browse

Now showing 1 - 20 of 675

18-Fluorodeoxyglucose positron emission tomography/computed tomography in the management of aggressive non-Hodgkin's B-cell lymphoma
(Hindawi Publishing Corporation, 2012) Shelly, M. J.; McDermott, S.; O'Connor, Owen J.; Blake, M. A.
18-Fluorodeoxyglucose (FDG-PET/CT) is an established imaging modality that has been proven to be of benefit in the management of aggressive B-cell non-Hodgkin's lymphoma, such as diffuse large B-cell lymphoma and advanced stage follicular lymphoma. The combination of anatomic and functional imaging afforded by FDG-PET/CT has led to superior sensitivity and specificity in the primary staging, restaging, and assessment of response to treatment of hematological malignancies when compared to FDG-PET and CT alone. The use of FDG-PET/CT for post treatment surveillance imaging remains controversial, and further study is needed to ascertain whether this modality is cost effective and appropriate for use in this setting.
Accuracy of interpretation of nasogastric tube position on chest radiographs by diagnostic radiographers: A multi-case, multi-reader study
(Elsevier Ltd., 2024-11-14) Creeden, A.; McFadden, S.; Rainey, Clare; Campbell, S.; Ather, S.; Hajilou, A.; Bond, R.; McAllister, P.; Woznitza, N.
Introduction: Feeding via a misplaced nasogastric tube (NGT) is a common but preventable cause of patient harm. The aim of this study was to determine the accuracy of diagnostic radiographers’ assessment of NGT position on chest radiographs (CXRs) and safe-to-feed decisions. Methods: A multi-case, multi-reader study was conducted using an online image interpretation platform. A test bank consisting of 15 CXRs with an NGT in-situ was created. Diagnostic radiographers without formal qualifications in CXR interpretation were recruited via two international conferences. Participants placed an electronic marker on each CXR to identify the location of the tip of the NGT and indicated whether or not they believed that the tube was safely positioned. Results: 68 participants were recruited. Each participant reviewed 15 CXRs, providing 1020 unique image assessments. 76 % (n = 778/1020) image assessments were completely correct (both the position of the tip of the NGT was accurately located and an appropriate safe-to-use decision made). In 5 % (n = 56/1020) of cases the NGT was safely positioned and the location of the tip was correctly identified by the participant but the tube was erroneously determined to be unsafe for feeding. In a further 6 % (n = 59/1020) of cases the participant correctly located the tip of an NGT in an unsafe position but indicated that the tube was safe to use. Participants failed to correctly identify the tip of the NGT in the remaining 12 % (n = 127/1020) of cases. Conclusion: Consistent with previous studies involving other staff groups, diagnostic radiographers without formal qualification in CXR interpretation can assess NGT positioning on radiographs with moderate accuracy but require further training, including strategies for the identification of poorly-visualised tube tips, to achieve the 100 % accuracy necessary for this safety-critical task. Implications for practice: A bespoke training programme which includes teaching on image quality, tube tip identification and assessment of tube positioning using the National Patient Safety Agency (NPSA) four criteria, should be delivered prior to implementation of a radiographer-led NGT CXR evaluation service.
Active and healthy ageing and independent living 2016
(Hindawi Publishing Corporation, 2016-08) Illario, Maddalena; Vollenbroek-Hutten, Miriam M. R.; Molloy, D. William; Menditto, Enrica; Iaccarino, Guido; Eklund, Patrik
Acute hospital dementia care: results from a national audit
(BioMed Central, 2016-05-31) Timmons, Suzanne; O'Shea, Emma; O'Neill, Desmond; Gallagher, Paul F.; de Siún, Anna; McArdle, Denise; Gibbons, Patricia; Kennelly, Sean; Atlantic Philanthropies
Background: Admission to an acute hospital can be distressing and disorientating for a person with dementia, and is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland. Methods: Across all 35 acute public hospitals, data was collected on care from admission through discharge using a retrospective chart review (n = 660), hospital organisation interview with senior management (n = 35), and ward level organisation interview with ward managers (n = 76). Inclusion criteria included a diagnosis of dementia, and a length of stay greater than 5 days. Results: Most patients received physical assessments, including mobility (89 %), continence (84 %) and pressure sore risk (87 %); however assessment of pain (75 %), and particularly functioning (36 %) was poor. Assessment for cognition (43 %) and delirium (30 %) was inadequate. Most wards have access at least 5 days per week to Liaison Psychiatry (93 %), Geriatric Medicine (84 %), Occupational Therapy (79 %), Speech & Language (81 %), Physiotherapy (99 %), and Palliative Care (89 %) Access to Psychology (9 %), Social Work (53 %), and Continence services (34 %) is limited. Dementia awareness training is provided on induction in only 2 hospitals, and almost half of hospitals did not offer dementia training to doctors (45 %) or nurses (48 %) in the previous 12 months. Staff cover could not be provided on 62 % of wards for attending dementia training. Most wards (84 %) had no dementia champion to guide best practice in care. Discharge planning was not initiated within 24 h of admission in 72 % of cases, less than 40 % had a single plan for discharge recorded, and 33 % of carers received no needs assessment prior to discharge. Length of stay was significantly greater for new discharges to residential care (p < .001). Conclusion: Dementia care relating to assessment, access to certain specialist services, staffing levels, training and support, and discharge planning is sub-optimal, which may increase the risk of adverse patient outcomes and the cost of acute care. Areas of good practice are also highlighted.
Advanced glycation end product intake during pregnancy and offspring allergy outcomes: prospective cohort study
(John Wiley & Sons, Inc., 2021-10-05) Venter, Carina; Pickett, Kaci; Starling, Anne; Maslin, Kate; Smith, Pete K.; Palumbo, Michaela P.; O'Mahony, Liam; Ben Abdallah, Miriam; Dabelea, Dana; National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Diseases
Background: Associations have been shown between concurrent assessment of dietary intake of AGEs and childhood allergic outcomes. We examined the association between maternal AGEs intake and development of offspring asthma, wheeze, atopic dermatitis, allergic rhinitis, and food allergies, and sought to determine whether intake of AGEs was associated with cord sera cytokines/chemokines. Methods: Pregnant women ≥ 16 years were recruited in the Healthy Start study, a prospective pre-birth cohort from Colorado (N =1410). The analysis included 962 dyads with adequate diet (≥2 recalls) and allergy outcome details. AGEs intake was estimated for each mother by matching intakes reported using 24-hour dietary recalls during pregnancy to a reference database of commonly consumed foods’ AGEs values. Child diagnoses of asthma and allergies up to 8 years were obtained from electronic medical records. Cord sera cytokines and chemokines were analyzed in a subset (N = 462) of children. Results: The median [IQR] AGEs intake for the overall sample was 11919 kU/day [8293, 16573]. Unadjusted analysis showed a positive association between maternal AGEs intake in pregnancy and rhinitis up to 8 years of age (HR = 1.03; 95% CI: 1.01, 1.06), but the association was attenuated and no longer significant in adjusted models (HR = 1.01; 95% CI: 0.98, 1.04). Both adjusted and unadjusted models showed no associations between AGEs intake in pregnancy and any of the other outcomes (p>0.05). There were no significant associations between any cytokine or chemokine measured and AGEs intake or any of the outcomes studied (p>0.05). Conclusion: The study showed that maternal AGEs intake was not associated with offspring asthma and allergy outcomes. AGEs exposure during pregnancy may not have the same impact on child development to postnatal exposure.
Adverse childhood experiences (ACEs) and later-life depression: perceived social support as a potential protective factor
(BMJ Publishing Group, 2017) Cheong, E. Von; Sinnott, Carol; Dahly, Darren L.; Kearney, Patricia M.; Health Research Board
Objective: To investigate associations between adverse childhood experiences (ACEs) and later-life depressive symptoms; and to explore whether perceived social support (PSS) moderates these. Method: We analysed baseline data from the Mitchelstown (Ireland) 2010–2011 cohort of 2047 men and women aged 50–69 years. Self-reported measures included ACEs (Centre for Disease Control ACE questionnaire), PSS (Oslo Social Support Scale) and depressive symptoms (CES-D). The primary exposure was self-report of at least one ACE. We also investigated the effects of ACE exposure by ACE scores and ACE subtypes abuse, neglect and household dysfunction. Associations between each of these exposures and depressive symptoms were estimated using logistic regression, adjusted for socio-demographic factors. We tested whether the estimated associations varied across levels of PSS (poor, moderate and strong). Results: 23.7% of participants reported at least one ACE (95% CI 21.9% to 25.6%). ACE exposures (overall, subtype or ACE scores) were associated with a higher odds of depressive symptoms, but only among individuals with poor PSS. Exposure to any ACE (vs none) was associated with almost three times the odds of depressive symptoms (adjusted OR 2.85; 95% CI 1.64 to 4.95) among individuals reporting poor PSS, while among those reporting moderate and strong PSS, the adjusted ORs were 2.21 (95% CI 1.52 to 3.22) and 1.39 (95% CI 0.85 to 2.29), respectively. This pattern of results was similar when exposures were based on ACE subtype and ACE scores, though the interaction was clearly strongest among those reporting abuse. Conclusions: ACEs are common among older adults in Ireland and are associated with higher odds of later-life depressive symptoms, particularly among those with poor PSS. Interventions that enhance social support, or possibly perceptions of social support, may help reduce the burden of depression in older populations with ACE exposure, particularly in those reporting abuse.
Age-dependent differences in pulmonary host responses in ARDS: A prospective observational cohort study
(Springer Open, 2019-05-14) Schouten, Laura R.; van Kaam, Anton H.; Kohse, Franziska; Veltkamp, Floor; Bos, Lieuwe D.; de Beer, Friso M.; van Hooijdonk, Roosmarijn T.; Horn, Janneke; Straat, Marleen; Witteveen, Esther; Glas, Gerie J.; Wieske, Luuk; van Vught, Lonneke A.; Wiewel, Maryse A.; Ingelse, Sarah A.; Cortjens, Bart; van Woensel, Job B.; Bos, Albert P.; Walther, Thomas; Schultz, Marcus J.; Wösten-van Asperen, Roelie M.; Center for Translational Molecular Medicine
Background: Results from preclinical studies suggest that age-dependent differences in host defense and the pulmonary renin–angiotensin system (RAS) are responsible for observed differences in epidemiology of acute respiratory distress syndrome (ARDS) between children and adults. The present study compares biomarkers of host defense and RAS in bronchoalveolar lavage (BAL) fluid from neonates, children, adults, and older adults with ARDS. Methods: In this prospective observational study, we enrolled mechanical ventilated ARDS patients categorized into four age groups: 20 neonates (< 28 days corrected postnatal age), 29 children (28 days–18 years), 26 adults (18–65 years), and 17 older adults (> 65 years of age). All patients underwent a nondirected BAL within 72 h after intubation. Activities of the two main enzymes of RAS, angiotensin converting enzyme (ACE) and ACE2, and levels of biomarkers of inflammation, endothelial activation, and epithelial damage were determined in BAL fluid. Results: Levels of myeloperoxidase, interleukin (IL)-6, IL-10, and p-selectin were higher with increasing age, whereas intercellular adhesion molecule-1 was higher in neonates. No differences in activity of ACE and ACE2 were seen between the four age groups. Conclusions: Age-dependent differences in the levels of biomarkers in lungs of ARDS patients are present. Especially, higher levels of markers involved in the neutrophil response were found with increasing age. In contrast to preclinical studies, age is not associated with changes in the pulmonary RAS.
AllergoOncology: microbiota in allergy and cancer—A European Academy for Allergy and Clinical Immunology position paper
(Wiley, 2019-06-07) Untersmayr, Eva; Bax, Heather J.; Bergmann, Christoph; Bianchini, Rodolfo; Cozen, Wendy; Gould, Hannah J.; Hartmann, Karin; Josephs, Debra H.; Levi-Schaffer, Francesca; Penichet, Manuel L.; O'Mahony, Liam; Poli, Aurelie; Redegeld, Frank A.; Roth-Walter, Franziska; Turner, Michelle C.; Vangelista, Luca; Karagiannis, Sophia N.; Jensen-Jarolim, Erika; National Institute for Health Research; European Academy of Allergy and Clinical Immunology; Foundation for the National Institutes of Health; Deutsche Forschungsgemeinschaft; Aimwell Charitable Trust and Emailie Gutterman Memorial Endowed Fund; Departament de Salut, Generalitat de Catalunya; IGEM Therapeutics Ltd; Austrian Science Fund; Instytut Biologii Medycznej Polskiej Akademii Nauk; Cancer Research UK; Medical Research Council; Israel Science Foundation; Israel Cancer Association; American Society of Hematology; Breast Cancer Now; Stop Cancer; Israel Ministry of Science, Technology and Space “Personalized Medicine”
The microbiota can play important roles in the development of human immunity and the establishment of immune homeostasis. Lifestyle factors including diet, hygiene, and exposure to viruses or bacteria, and medical interventions with antibiotics or anti-ulcer medications, regulate phylogenetic variability and the quality of cross talk between innate and adaptive immune cells via mucosal and skin epithelia. More recently, microbiota and their composition have been linked to protective effects for health. Imbalance, however, has been linked to immune-related diseases such as allergy and cancer, characterized by impaired, or exaggerated immune tolerance, respectively. In this AllergoOncology position paper, we focus on the increasing evidence defining the microbiota composition as a key determinant of immunity and immune tolerance, linked to the risk for the development of allergic and malignant diseases. We discuss novel insights into the role of microbiota in disease and patient responses to treatments in cancer and in allergy. These may highlight opportunities to improve patient outcomes with medical interventions supported through a restored microbiome.
Altered cytokine profile, pain sensitivity, and stress responsivity in mice with co-disruption of the developmental genes Neuregulin-1 × DISC1
(Elsevier, 2016-12-01) O'Tuathaigh, Colm M. P.; Waddington, John L.; Harvey, Richard P.; Desbonnet, Lieve; Cox, Rachel; Tighe, Orna; Lai, Donna; Science Foundation Ireland; Health Research Board
The complex genetic origins of many human disorders suggest that epistatic (gene × gene) interactions may contribute to a significant proportion of their heritability estimates and phenotypic heterogeneity. Simultaneous disruption of the developmental genes and schizophrenia risk factors Neuregulin-1 (NRG1) and Disrupted-in-schizophrenia 1 (DISC1) in mice has been shown to produce disease-relevant and domain-specific phenotypic profiles different from that observed following disruption of either gene alone. In the current study, anxiety and stress responsivity phenotypes in male and female mutant mice with simultaneous disruption of DISC1 and NRG1 were examined. NRG1 × DISC1 mutant mice were generated and adult mice from each genotype were assessed for pain sensitivity (hot plate and tail flick tests), anxiety (light-dark box), and stress-induced hypothermia. Serum samples were assayed to measure circulating levels of pro-inflammatory cytokines. Mice with the NRG1 mutation, irrespective of DISC1 mutation, spent significantly more time in the light chamber, displayed increased core body temperature following acute stress, and decreased pain sensitivity. Basal serum levels of cytokines IL8, IL1β and IL10 were decreased in NRG1 mutants. Mutation of DISC1, in the absence of epistatic interaction with NRG1, was associated with increased serum levels of IL1β. Epistatic effects were evident for IL6, IL12 and TNFα. NRG1 mutation alters stress and pain responsivity, anxiety, and is associated with changes in basal cytokine levels. Epistasis resulting from synergistic NRG1 and DISC1 gene mutations altered pro-inflammatory cytokine levels relative to the effects of each of these genes individually, highlighting the importance of epistatic mechanisms in immune-related pathology.
The altered gut microbiota in adults with cystic fibrosis
(BioMed Central, 2017-03-09) Fouhy, Fiona; Burke, Daniel G.; Harrison, M. J.; Rea, Mary C.; Cotter, Paul D.; O'Sullivan, Orla; Stanton, Catherine; Hill, Colin; Shanahan, Fergus; Plant, Barry J.; Ross, R. Paul; Science Foundation Ireland; Seventh Framework Programme; European Commission
Background: Cystic Fibrosis (CF) is an autosomal recessive disease that affects the function of a number of organs, principally the lungs, but also the gastrointestinal tract. The manifestations of cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction in the gastrointestinal tract, as well as frequent antibiotic exposure, undoubtedly disrupts the gut microbiota. To analyse the effects of CF and its management on the microbiome, we compared the gut microbiota of 43 individuals with CF during a period of stability, to that of 69 non-CF controls using 454-pyrosequencing of the 16S rRNA gene. The impact of clinical parameters, including antibiotic therapy, on the results was also assessed. Results: The CF-associated microbiome had reduced microbial diversity, an increase in Firmicutes and a reduction in Bacteroidetes compared to the non-CF controls. While the greatest number of differences in taxonomic abundances of the intestinal microbiota was observed between individuals with CF and the healthy controls, gut microbiota differences were also reported between people with CF when grouped by clinical parameters including % predicted FEV1 (measure of lung dysfunction) and the number of intravenous (IV) antibiotic courses in the previous 12 months. Notably, CF individuals presenting with severe lung dysfunction (% predicted FEV1 ≤ 40%) had significantly (p < 0.05) reduced gut microbiota diversity relative to those presenting with mild or moderate dysfunction. A significant negative correlation (−0.383, Simpson’s Diversity Index) was also observed between the number of IV antibiotic courses and gut microbiota diversity. Conclusions: This is one of the largest single-centre studies on gut microbiota in stable adults with CF and demonstrates the significantly altered gut microbiota, including reduced microbial diversity seen in CF patients compared to healthy controls. The data show the impact that CF and it's management have on gut microbiota, presenting the opportunity to develop CF specific probiotics to minimise microbiota alterations.
Anakinra for recalcitrant pyoderma gangrenosum
(John Wiley & Sons, Inc., 2021-06-16) O'Connor, Cathal; Gallagher, Catriona; Hollywood, Aoife; Paul, Lindsay; O'Connell, Michael
Pyoderma gangrenosum (PG) is an autoinflammatory neutrophilic dermatosis characterized by rapidly enlarging, painful ulcers. Anakinra is a recombinant interleukin-1 (IL-1) receptor antagonist that blocks the activity of IL-1α and IL-1β by competitively inhibiting IL-1 binding to the IL-1 type I receptor. We present a series of two patients with recalcitrant PG, who had limited therapeutic options due to multiple previous treatment failures and multiple co-morbidities, who obtained 100% healing with anakinra. Compared to conventional first-line therapies for PG, the safety profile of anakinra may be preferable for patients with multiple co-morbidities. Further research is needed to assess the safety and efficacy of anakinra for PG.
Angiotensin-(1-7) counteracts the transforming effects triggered by angiotensin II in breast cancer cells
(Impact Journals, 2017) Cambados, Nadia; Walther, Thomas; Nahmod, Karen; Tocci, Johanna M.; Rubinstein, Natalia; Boehme, Ilka; Simian, Marina; Sampayo, Rocio; Del Valle Suberbordes, Melisa; Kordon, Edith C.; Schere-Levy, Carolina; Deutsche Forschungsgemeinschaft; Ministerio de Ciencia, Tecnología e Innovación Productiva; National Cancer Institute; Consejo Nacional de Investigaciones Científicas y Técnicas; Agencia Nacional de Promoción Científica y Tecnológica
Angiotensin (Ang) II, the main effector peptide of the renin-angiotensin system, has been implicated in multiple aspects of cancer progression such as proliferation, migration, invasion, angiogenesis and metastasis. Ang-(1-7), is a biologically active heptapeptide, generated predominantly from AngII by the enzymatic activity of angiotensin converting enzyme 2. Previous studies have shown that Ang-(1-7) counterbalances AngII actions in different pathophysiological settings. In this study, we have analysed the impact of Ang( 1-7) on AngII-induced pro-tumorigenic features on normal murine mammary epithelial cells NMuMG and breast cancer cells MDA-MB-231. AngII stimulated the activation of the survival factor AKT in NMuMG cells mainly through the AT1 receptor. This PI3K/AKT pathway activation also promoted epithelial-mesenchymal transition (EMT). Concomitant treatment of NMuMG cells with AngII and Ang-(1-7) completely abolished EMT features induced by AngII. Furthermore, Ang-(1-7) abrogated AngII induced migration and invasion of the MDA-MB-231 cells as well as pro-angiogenic events such as the stimulation of MMP-9 activity and VEGF expression. Together, these results demonstrate for the first time that Ang-(1-7) counteracts tumor aggressive signals stimulated by AngII in breast cancer cells emerging the peptide as a potential therapy to prevent breast cancer progression.
Angle-specific isokinetic shoulder rotational strength can be reliably assessed in collision and contact athletes
(Human Kinetics, 2022-07-23) Fanning, Edel; Falvey, Éanna; Daniels, Katherine; Cools, Ann
An increased understanding of rotational strength as a potential prognostic factor for injury in contact and collision athletes may be important in planning return to sport. The aim of this study was to (1) determine the testâ retest reliability of clinically relevant, angle-specific rotational and peak torque measurements in a cohort of uninjured collision and contact athletes; (2) develop a normal descriptive profile of angle-specific rotational torque measurements in the same cohort; and (3) examine the effects of direction and joint angle on shoulder rotational strength interlimb asymmetries. Twenty-three collision and contact athletes were recruited for the interday reliability substudy and 47 athletes were recruited for the remaining substudies. We used intraclass correlation coefficients with 95% confidence intervals to quantify interday reliability of all variables. We used a 2-way repeated-measures analysis of variance to analyze differences in absolute interlimb asymmetries. Interday reliability for the isokinetic strength variables was good to excellent (0.78â 0.90) on the dominant side and moderate to good (0.63â 0.86) on the nondominant side. Maximum angle-specific torque (as well as peak torque) can be measured reliably in internally and externally rotated positions. A normal profile of clinically relevant, angle-specific shoulder rotational torque measurements for collision and contact athletes has been established which provides a reference when assessing shoulder strength in this population.
An antitumorigenic role for the IL-33 receptor, ST2L, in colon cancer
(Nature Publishing Group, 2015-12-17) O'Donnell, Charlotte; Mahmoud, Amr; Keane, Jonathan; Murphy, Carola T.; White, Declan; Carey, Sinead; O'Riordain, Micheal G.; Bennett, Michael W.; Brint, Elizabeth K.; Houston, Aileen M.; Health Research Board; Pathological Society of Great Britain and Ireland
Background: Despite the importance of inflammation in cancer, the role of the cytokine IL-33, and its receptor ST2, in colon cancer is unclear. The aim of this study was to investigate the role of IL-33, and its receptor isoforms (ST2 and ST2L), in colon cancer. Methods: Serum levels of IL-33 and sST2 were determined with ELISA. ST2 and IL-33 expression was detected with quantitative real-time PCR (qRT–PCR), western blotting and immunohistochemistry. ST2 expression in CT26 cells was stably suppressed using ST2-specific shRNA. Cytokine and chemokine gene expression was detected with qRT–PCR. Results: Human colon tumours showed lower expression of ST2L as compared with adjacent non-tumour tissue (P<0.01). Moreover, the higher the tumour grade, the lower the expression of ST2L (P=0.026). Colon cancer cells expressed ST2 and IL-33 in vitro. Functional analyses showed that stimulation of tumour cells with IL-33 induced the expression of chemokine (C–C motif) ligand 2 (CCL2). Knockdown of ST2 in murine colon cancer cells resulted in enhanced tumour growth (P<0.05) in BALB/c mice in vivo. This was associated with a decrease in macrophage infiltration, with IL-33-induced macrophage recruitment reduced by antagonising CCL2 in vitro. Conclusion: The IL-33/ST2 signalling axis may have a protective role in colon carcinogenesis.
Aplasia cutis congenita in dizygotic twin infants
(John Wiley & Sons, Inc., 2021-05-28) Bowe, S.; O'Connor, Cathal; Kenosi, M.; Murphy, L. A.
Aplasia cutis congenita (ACC) is a rare heterogenous group of disorders characterized by the absence of a portion of skin in a localized or widespread area at birth. 1 ACC is often sporadic but familial cases have been reported. 1,2 We report a case of a dichorionic diamniotic (DCDA) twin pregnancy in which both the male and female twins had matching areas of aplasia cutis on their scalps.
Application of recent international epidemiological guidelines to a prospective study of the incidence of first seizures, newly-diagnosed epilepsy and seizure mimics in a defined geographic region in Ireland
(Karger Publishers, 2019-08-21) Maloney, Eimer M.; Chaila, Elijah; O'Reilly. Éilis J.; Costello, Daniel J.
Studies adherent to international guidelines and epilepsy classification are needed to accurately record the incidence of isolated seizures, epilepsy and seizure-mimics within a population. Because the diagnosis of epilepsy is largely made through clinical assessment by experienced physicians, seizures and epilepsy are susceptible to misdiagnosis. Previous epidemiological studies in epilepsy have not captured â seizure mimicsâ . We therefore sought to quantify the incidence of isolated seizures, epilepsy and seizure-mimics using the International League Against Epilepsy (ILAE) classification system. In this study multiple overlapping methods of case ascertainment were applied to a defined geographic region from January 1 to March 31, 2017 to identify all patients presenting with first seizures (provoked and unprovoked), new diagnoses of epilepsy and seizure mimics. Over a 3 month period, from a population of 542,869 adults and children, 442 potential presentations were identified, and 283 met the inclusion criteria. Radiology databases were the source of the largest number of individual cases (n = 153, 54%), while electroencephalogram (EEG) databases were the source of the highest number of unique-to-source cases (those not identified elsewhere, n = 60, 21%). No single case was picked up in every method of ascertainment. Among the 283 included presentations, 38 (13%) were classed as first provoked seizures, 27 (10%) as first unprovoked seizures, 95 (34%) as new diagnosis of epilepsy and 113 (40%) as seizure mimics. Ten (3%) presentations were indeterminate. We present and apply a rigorous study protocol for investigation of the incidence of first seizures, new diagnosis of epilepsy and seizure mimics in a geographically defined region which is adherent to recently published international guidelines for epidemiologic studies and epilepsy classification. We highlight the challenges in making a diagnosis of new-onset epilepsy in patients presenting with a first seizure using the current ILAE definition of epilepsy, when epilepsy can be diagnosed in situations where the treating physician anticipates the risk of further seizures exceeds 60%.
Are smoking cessation treatments associated with suicidality risk? An overview
(SAGE Journals, 2016-01-27) Penberthy, J. Kim; Penberthy, J. Morgan; Harris, Marcus R.; Nanda, Sonali; Ahn, Jennifer; Martinez, Caridad Ponce; Osika, Apule O.; Slepian, Zoe A.; Forsyth, Justin C.; Starr, J. Andrew; Farrell, Jennifer E.; Hook, Joshua N.
Risk of suicidality during smoking cessation treatment is an important, but often overlooked, aspect of nicotine addiction research and treatment. We explore the relationship between smoking cessation interventions and suicidality and explore common treatments, their associated risks, and effectiveness in promoting smoking reduction and abstinence. Although active smokers have been reported to have twofold to threefold increased risk of suicidality when compared to nonsmokers,14 research regarding the safest way to stop smoking does not always provide clear guidelines for practitioners wishing to advise their patients regarding smoking cessation strategies. In this article, we review pharmacological and cognitive behavioral therapy (CBT) options that are available for people seeking to quit smoking, focusing on the relationship between the ability of these therapies to reduce smoking behavior and promote abstinence and suicidality risks as assessed by reported suicidality on validated measures, reports of suicidal ideation, behaviors, actual attempts, or completed suicides. Pharmacotherapies such as varenicline, bupropion, and nicotine replacement, and CBTs, including contextual CBT interventions, have been found to help reduce smoking rates and promote and maintain abstinence. Suicidality risks, while present when trying to quit smoking, do not appear to demonstrate a consistent or significant rise associated with use of any particular smoking cessation pharmacotherapy or CBT/contextual CBT intervention reviewed.
Artificial intelligence and radiographer preliminary image evaluation: What might the future hold for radiographers providing x-ray interpretation in the acute setting?
(John Wiley and Sons Ltd, 2024) Rainey, Clare
In a stretched healthcare system, radiographer preliminary image evaluation in the acute setting can be a means to optimise patient care by reducing error and increasing efficiencies in the patient journey. Radiographers have shown impressive accuracies in the provision of these initial evaluations, however, barriers such as a lack of confidence and increased workloads have been cited as a reason for radiographer reticence in engagement with this practice. With advances in Artificial Intelligence (AI) technology for assistance in clinical decision-making, and indication that this may increase confidence in diagnostic decision-making with reporting radiographers, the author of this editorial wonders what the impact of this technology might be on clinical decision-making by radiographers in the provision of Preliminary Image Evaluation (PIE).
Artificial intelligence and training physicians to perform technical procedures
(American Medical Association, 2019-08-02) Shorten, George
Winkler-Schwartz et al have set out to determine if some combination of machine learning algorithms can differentiate participants according to their stage of practice (ie, neurosurgeon, fellow, senior or junior resident, or medical student) based on their performance of a complex simulated neurosurgical task. A total of 250 simulated surgical resections performed by 50 participants were studied using a prospective, observational case series design. The best-performing algorithm (K-nearest neighbor) had 90% accuracy for prediction and used 6 machine-selected metrics. Three of the 4 algorithms used in the study misclassified a medical student as a neurosurgeon.
Assessing fitness to drive after stroke: A survey investigating current practice among occupational therapists in Ireland
(Emerald Publishing Limited, 2018) Stack, Aisling Helen; Duggan, Orla; Stapleton, Tadhg
Purpose: The assessment of fitness to drive after stroke is an emerging area of occupational therapy practice in Ireland. Despite this, little is known about occupational therapists’ evaluation practices, and there are no internationally agreed clinical guidelines to inform best practice. The purpose of this paper is to investigate occupational therapy evaluation practices for fitness to drive after stroke in Ireland. Design/methodology/approach: This is a cross-sectional study design targeting occupational therapists working with people after stroke using an online survey. Summary and descriptive statistics were .used to analyse the returned surveys Findings: In total, 47 occupational therapists participated. Off-road driving assessment was completed by 68 per cent of respondents. Functional assessment and non-driving-specific assessments were most widely used and perceived to be the most useful in informing the off-road assessment. A total of 89 per cent referred clients for on-road assessments; however, some referred without first completing an off-road assessment. The therapists who completed formal post graduate education/training in driving assessment reported greater confidence and competence in their skills and ability to assess fitness to drive. A vast majority of participants agreed that clinical guidelines regarding best practice in this area would be beneficial. Research limitations/implications: A majority of occupational therapists are assessing fitness to drive after stroke in Ireland with non-driving-specific assessments and functional observations; however, there are many gaps and wide variations between services. Education/training in evaluating fitness to drive after stroke is recommended. The development of clinical guidelines to inform practice would facilitate a consistent approach nationally.

Browse

Browsing Medicine - Journal Articles by Title

Results Per Page

Sort Options