Tranexamic acid for major trauma patients in Ireland / 世界急诊医学杂志（英文）

@#BACKGROUND: The Clinical Randomisation of an Anti-fibrinolytic in Significant Hemorrhage-2 (CRASH-2) is the largest randomized control trial (RCT) examining circulatory resuscitation for trauma patients to date and concluded a statistically significant reduction in all-cause mortality in patients administered tranexamic acid (TXA) within 3 hours of injury. Since the publication of CRASH-2, significant geographical variance in the use of TXA for trauma patients exists. This study aims to assess TXA use for major trauma patients with hemorrhagic shock in Ireland after the publication of CRASH-2. METHODS: A retrospective cohort study was conducted using data derived from the Trauma Audit and Research Network (TARN). All injured patients in Ireland between January 2013 and December 2018 who had evidence of hemorrhagic shock on presentation (as defined by systolic blood pressure [SBP] <100 mmHg [1 mmHg=0.133 kPa] and administration of blood products) were eligible for inclusion. Death at hospital discharge was the primary outcome. RESULTS: During the study period, a total of 234 patients met the inclusion criteria. Among injured patients presenting with hemorrhagic shock, 133 (56.8%; 95% confidence interval [CI] 50.2%-63.3%) received TXA. Of patients that received TXA, a higher proportion of patients presented with shock index >1 (70.68% vs.57.43%) and higher Injury Severity Score (ISS >25; 49.62% vs. 23.76%). Administration of TXA was not associated with mortality at hospital discharge (odds ratio [OR] 0.86, 95% CI 0.31-2.38). CONCLUSIONS: Among injured Irish patients presenting with hemorrhagic shock, TXA was administered to 56.8% of patients. Patients administered with TXA were on average more severely injured. However, a mortality benefit could not be demonstrated.

An Exploratory Study of Medical Cover Policies Offered by the Travel Health Insurance Industry

Background: Travel insurance represents the most important safety measure for travellers in case of unfortunate events incurred during travel abroad. There are many travel insurance companies which offer services to residents of their state under a wide range of terms and regulations. Objective: This study attempts to explore the different types of medical coverage policies offered by travel insurance organizations operating in the Republic of Ireland. Methods: A web-based content analysis using the Google search engine was performed. Results: Total 16 travel insurance policies were identified for analysis. Each insurance policy identified provides a different travel health cover plans to policyholders, particularly tourists embarking on international journeys. The variance in medical coverage offered by the insurance companies depends on their business strategy and product differentiation. There were differences among the companies offering travel medical insurance. Total 6 out of 16 medical travel plans in the Irish market offer cover for pre-existing conditions provided that clients submit themselves for medical screening tests and pay higher premiums. Only 4 companies offer cover to older travellers and there are 2 travel insurers who specifically excluded acute mental illnesses in their basic cover plan. Conclusion: All the insurance firms within the Irish market insure unexpected illnesses or disorders, dental care, funeral services costs in the event of death, and medical evacuations. However, few policies consider covering unlisted medical conditions such as cancer, mental and heart disorders unless the traveller pays extra premiums.

Aproximando (d)o "Bicho de Sete Cabeças": Alteridade e Práticas de Segurança no Rio de Janeiro e Irlanda do Norte / Approaching the Seven Heads Monster: Alterity and Security Practices in Rio de Janeiro and Northern Ireland / Aproximando (d)el "Bicho de Siete Cabezas": Alteridad y Prácticas de Seguridad en Río de Janeiro e Irlanda del Norte

O presente trabalho visa problematizar o campo da segurança pública carioca no sentido de averiguar o quanto se constitui enquanto território de acolhida ou eliminação das diferentes formas de expressão psicossociais presentes na contemporaneidade. O intuito é o de averiguar como os desafios de se viver em comunidade produzem demandas relacionadas à alteridade, ora no sentido de segregação e exclusão, ora no sentido de integração e valorização da pluralidade social. Para tanto, a pesquisa se vale da ferramenta teórico-metodológica da cartografia psicossocial, discutida entre outros, por Deleuze, Guattari e Rolnik. Discute-se continuidades e transformações nos paradigmas de segurança, realizando breves articulações com a reforma policial norte-irlandesa. Por fim, a pesquisa procura problematizar as relações entre o aparato policial e a população, bem como defender a potencialização de práticas de segurança em que o encontro com o "outro" seja vivenciado não pela hierarquia que o coloca em termos de superioridade e inferioridade, mas a partir das possibilidades de mundo que a presença de outrem apresenta....(AU)

This research aims to problematize the Rio de Janeiro public security context, analyzing how it creates acceptance or elimination of different psychosocial expression forms. The purpose is to verify how the challenges of living in community have produced demands related to alterity, on one hand, related to segregation and exclusion and, on the other, to integration and respect of social diversity. In this sense, the theoretical and methodological concept of psychosocial cartography, discussed by Deleuze, Guattari, Rolnik and others, has been used.The research discusses the continuities and transformations in the public security paradigms, articulating specific points with the Northern Ireland security experience. Finally, this research seeks to problematize the relationship between police and citizens, defending that security practices occur based on diversity and human rights respect....(AU)

El presente trabajo pretende problematizar el campo de la seguridad pública carioca en el sentido de averiguar cuánto se constituye como territorio de acogida o eliminación de las diferentes formas de expresión psicosociales presentes en la contemporaneidad. El propósito es averiguar cómo los desafíos de vivir en comunidad producen demandas relacionadas con la alteridad, a veces en el sentido de segregación y exclusión, a veces en el sentido de integración y valorización de la pluralidad social. Para ello, la investigación se vale de la herramienta teóricometodológica de la cartografía psicosocial, discutida entre otros, por Deleuze, Guattari y Rolnik. Se discuten continuidades y transformaciones en los paradigmas de seguridad, realizando breves articulaciones con la reforma policial norte-irlandesa. Por último, la investigación busca problematizar las relaciones entre el aparato policial y la población, así como defender la potenciación de prácticas de seguridad en que el encuentro con el "otro" sea vivido no por la jerarquía que lo coloca en términos de superioridad e inferioridad, pero a partir de lasposibilidades de mundo que la presencia del otro presenta.....(AU)

Comparison of different scoring systems in patients undergoing colorectal cancer surgery for predicting mortality and morbidity.

BACKGROUND: Preoperative risk estimation evaluating mortality and morbidity might help surgical decision. AIMS: The aim of this study was to compare the sensitivities of physiologic and operative severity score for the enumeration of mortality and morbidity (POSSUM), portsmouth‑POSSUM (P‑POSSUM), colorectal‑POSSUM (CR‑POSSUM), the Association of Coloproctology of Great Britain and Ireland colorectal cancer model (ACPGBI CRC) and revised ACPGBI CRC scoring systems that are used for evaluating mortality and morbidity in colorectal surgery performed in third‑level healthcare centers. SETTINGS AND DESIGN: A retrospective analysis has been performed on 335 consecutive patients undergoing colorectal cancer surgery between 2002 and 2012. MATERIALS AND METHODS: Mortality and morbidity risks of 335 patients who underwent colorectal cancer were evaluated using these scoring systems and the results were compared with actual mortality and morbidity within postoperative 30‑day that extend the duration of hospital stay. STATISTICAL ANALYSIS USED: The receiver operating characteristic (ROC) curves were designed to identify the score values. RESULTS: Results of POSSUM and P‑POSSUM systems showed statistical differences compared with those of CR‑POSSUM, ACPGBI CRC and revised ACPGBI CRC systems (P < 0.05). P‑POSSUM was found to be the best scoring system for predicting mortality risk, although all scoring systems seem to be appropriate for this parameter. On the other hand POSSUM, which can predict morbidity, was found to have moderate differentiation ability due to the magnitude of the area under the ROC curve. CONCLUSIONS: Despite altering patient demographics and surgical conditions, POSSUM seems to lead as the best scoring system for predicting mortality and morbidity among others including those most‑recently proposed.

Ethnopharmacology in Ireland: an overview

The aim of this review was to extract information of the book Medicinal Plants in Folk Tradition: An Ethnobotany of Britain & Ireland published in 2004 by Allen and Hatfield, to give an overview of plants with medicinal potential and their applications. This study attempts to attest, observe and comment on the diversity of plants, as well as the accompanying information which inevitably is vital for the future development of herbal medicines for human therapy. Initially, the information in relation to medicinal plants in Ireland only was extracted from the above-mentioned book and organised in tables. Afterwards, it was analysed through the construction of maps and the positioning of each piece of information in specific geographical regions of the country. Its division into provinces was taken into consideration as well as into counties within the provinces. These maps and graphs illustrate the most predominantly reported botanical families identified and utilised (Asteraceae, Scrophulariaceae and Lamiaceae), and to the most frequently cited medicinal uses were attributed to topical applications. As a result we can see that the uses of traditional medicines vary among these different geographical areas of the country. Not only different uses were reported but also different plants used to treat the same condition, or different conditions treated with the same plant depending on the county. Various phytopharmaceuticals date back several decades and despite the existing evolving technology, without a doubt herbal medicines can and still do provide exceptional and efficacious outcomes like many of the conventional remedies available today.

Medical Student Experiences in Clinical Reproductive Medicine: Dual-Cohort Assessment of a New Learning Module at the Royal College of Surgeons in Ireland.

Aims: Exposure to a structured curriculum in reproductive medicine during medical school is helpful given the high frequency of fertility and pregnancy-related issues that future physicians will encounter. This study sought to evaluate a new reproductive medicine module for medical students. Study Design: Prospective cohort study. Place and Duration of Study: Dublin, Ireland; 2008-2010. Methodology: A new educational module in reproductive medicine for upper-level medical students was initiated in 2008 at the Royal College of Surgeons in Ireland (RCSI). The module included reproductive endocrinology lectures, laboratory sessions, and direct observation of clinical consultations as a required component of an obstetrics and gynaecology rotation. Students were assigned to this module on the basis of random allocation by departmental administration. The current investigation used an anonymous questionnaire and a MCQ exam to measure academic performance and student acceptance of this module, at launch and again two years later. The first sampling was from the pilot class in 2008 and a second group was evaluated in 2010. No student was in both groups. Results: 42 of 66 students completed the evaluation in 2008, and 71 of 98 did so in 2010. Mean±SD medical student age and average examination scores were comparable for the two groups. In both samples, most students (95.5%) had no prior lectures on reproductive endocrinology, and most indicated improvement in their level of understanding after the module. Both laboratory and clinical features were scored highly by students. Conclusion: At present, there is no standardised medical student curriculum for reproductive medicine in Ireland. This report is the first to describe a structured learning experience in this subspecialty area for medical students in Ireland. Additional studies are planned to track knowledge acquisition and career impact specific to reproductive medicine based on this module.

Irish public opinion on assisted human reproduction services: Contemporary assessments from a national sample / 대한생식의학회지

OBJECTIVE: To measure Irish opinion on a range of assisted human reproduction (AHR) treatments. METHODS: A nationally representative sample of Irish adults (n=1,003) were anonymously sampled by telephone survey. RESULTS: Most participants (77%) agreed that any fertility services offered internationally should also be available in Ireland, although only a small minority of the general Irish population had personal familiarity with AHR or infertility. This sample finds substantial agreement (63%) that the Government of Ireland should introduce legislation covering AHR. The range of support for gamete donation in Ireland ranged from 53% to 83%, depending on how donor privacy and disclosure policies are presented. For example, donation where the donor agrees to be contacted by the child born following donation, and anonymous donation where donor privacy is completely protected by law were supported by 68% and 66%, respectively. The least popular (53%) donor gamete treatment type appeared to be donation where the donor consents to be involved in the future life of any child born as a result of donor fertility treatment. Respondents in social class ABC1 (58%), age 18 to 24 (62%), age 25 to 34 (60%), or without children (61%) were more likely to favour this donor treatment policy in our sample. CONCLUSION: This is the first nationwide assessment of Irish public opinion on the advanced reproductive technologies since 2005. Access to a wide range of AHR treatment was supported by all subgroups studied. Public opinion concerning specific types of AHR treatment varied, yet general support for the need for national AHR legislation was reported by 63% of this national sample. Contemporary views on AHR remain largely consistent with the Commission for Assisted Human Reproduction recommendations from 2005, although further research is needed to clarify exactly how popular opinion on these issues has changed. It appears that legislation allowing for the full range of donation options (and not mandating disclosure of donor identity at a stipulated age) would better align with current Irish public opinion.

A luz não é para todos / The light is not for everyone

Este ensaio faz comparações entre as obras poéticas de Seamus Heaney e Dylan Thomas, relacionando-as aos temas da violência e ao modo como o poeta se reflete na sociedade onde vive.

This essay draws comparisons between the poetical works of Seamus Heaney and Dylan Thomas, relating them to the themes of violence and to the way how the poet reflects himself in the society where he lives.

Guerra, formação do estado e identidade nacional nas franjas do mundo Atlântico / Guerre, formation de l'état et identité nationale dans lês franges du monde Atlantique / War, state formation, and national identity on the fringes of the Atlantic world

This paper deals with the impact of war on state formation in Ireland and England, focusing on the period from 1590 to 1691, the key turning point for the future development of the state in both countries. War played a vital role, but in a number of different ways, including in the ideological sphere, in a complex process, rather than simply causing a long-term expansion in army size and subsequent growth of the state. The author further emphasizes the dynamic nature of the state itself.

Dans cet article, on étudie l'impact de la guerre sur la formation de l'État en Irlande et en Angleterre, surtout dans la période de 1590 à 1691, période-clé pour le développement de l'État dans ces deux pays. La guerre y a joué un rôle très important sous plusieurs formes, et en particulier dans la sphère idéologique, au long d'un processus très complexe, au-delà de son rôle d'expansion et d'augmentation des armées et de sa conséquence, la croissance de l'État, dont il faut souligner la nature dynamique.