Direct healthcare costs in the first 2 years of life: A comparison of screened and clinically diagnosed children with cystic fibrosis - The Irish comparative outcomes study of CF (ICOS).

BACKGROUND: In July 2011, Cystic Fibrosis (CF) was added to the Newborn Bloodspot Screening Programme in Ireland. The Irish Comparative Outcomes Study (ICOS) is a historical cohort study established to compare outcomes between clinically-detected and screen-detected children with CF. Here we present the results of economic analysis comparing direct healthcare costs in the first 2 years of life of children born between mid-2008 and mid-2016, in the pre-CF transmembrane conductance regulator modulator era. METHODS: Healthcare resource use information was obtained from Cystic Fibrosis Registry of Ireland (CFRI), medical records and parental questionnaire. Hospital admissions, emergency department visits, outpatient appointments, antibiotics and maintenance medications were included. Costs were estimated using the Health Service Executive Casemix, Irish Medicines Formulary and hospital pharmacy data, adjusted for inflation using Consumer Price Index data from the Central Statistics Office. A Negative Binomial regression was used, with time in the study as an offset. RESULTS: Overall participation was 93 %. After exclusion of those with meconium ileus, data from 139 patients, with follow-up to 2 years of age, were available. 72 (51.8 %) were from the clinically diagnosed cohort. In the final model (n=105), clinically diagnosed children had 2.62-fold higher costs per annum (p<0.0001), when adjusted for confounders, including homozygous ΔF508 or G511D mutation, socio-demographic factors and time between diagnosis and first CFRI interaction. CONCLUSIONS: There are few studies evaluating economic aspects of newborn screening for CF using routine care data. These results imply that the benefits of newborn screening extend to direct healthcare costs borne by the State.

A co-designed evaluation study to identify Breastfeeding Knowledge of General Practitioners' and Practice Nurses'.

The World Health Organization and American Academy of Paediatrics recommend exclusive breastfeeding until 6 months of age, with continued breastfeeding along with complementary solid foods for up to 2 years and beyond. Despite the well-established importance of breastfeeding, Irish rates remain the lowest in Europe. Healthcare professionals' breastfeeding knowledge and skills have a positive impact on increasing breastfeeding rates. There is limited evidence of the knowledge, attitudes or practices of general practitioners (GPs) and general practice nurses (GPNs), which is essential to breastfeeding in Ireland. The aim of this study was to evaluate the breastfeeding knowledge, attitudes and practices of GPs and GPNs in one community healthcare organisation (CHO) in Ireland. A co-designed evaluation study was used following low-risk ethical exemption (LS-LR-22-161). A modified version of a validated breastfeeding questionnaire was developed. A Project Steering Committee was established that included patient, and public involvement stakeholders. The anonymised survey was distributed via online Qualtrics platform (November 2022-February 2023). STROBE Guidelines were utilised. The overall response rate was 25.9% (n = 121) and valid responses were reported in the article. The total population size was n = 468 (GPs n = 290 and GPNs n = 178). Our pilot study identified that 42.7% (n = 47/110) of respondents never attended a breastfeeding education programme, and 53.9% (n = 55/102) identified that their knowledge could be improved. The majority of respondents, 92.9% (n = 92/99) wish to complete further education in breastfeeding. The results of this pilot study in one CHO in Ireland indicate a gap in knowledge and a need for specific breastfeeding and lactation theoretical and skills training for GPs and GPNs working in primary care to support, promote and protect breastfeeding.

Smoking Cessation Support: A Marathon, Not a Sprint; The Perspectives of Cancer Patients Who Smoke.

OBJECTIVES: Despite the unfavorable outcomes associated with continued smoking, a substantial proportion of patients with cancer continue to smoke after diagnosis. However, limited use of smoking cessation (SC) interventions has been reported. This study explored the perceptions of patients with cancer who continue to smoke/recently quit regarding SC. DATA SOURCES: Semistructured phone/Zoom/Webex interviews were conducted with 25 participants attending four Irish cancer hospitals who were current smokers or had quit at/after their cancer diagnosis. Thematic analysis was used to analyze the data. CONCLUSION: A total of four key themes emerged: (1) Diagnosis was a shock and a cue to action. (2) Brief and variable SC support: most participants did not feel stigmatized and reported receiving verbal or written information from oncology healthcare providers (HCPs) on SC supports. However, use of SC services was limited and largely ineffective. Some participants reported that SC discussions occurred earlier in their treatment with limited/no discussion later. (3) Facilitators vs barriers: the presence or absence of willpower and motivation was perceived as important. Family and HCP support helped while stress hindered SC. (4) SC support is a "marathon," not a "sprint." Patients with cancer who continue to smoke or recently quit want a sustained, tailored, nonjudgmental approach to SC incorporating pharmacological and behavioral interventions that span hospital-/community-based settings. IMPLICATIONS FOR NURSING PRACTICE: While consultants have been identified as the key HCP to initiate the SC discussion, oncology nurses can support patients with cancer who smoke/recently quit by advocating for comprehensive SC services and by using positive messaging and encouragement.

Specialist cancer hospital-based smoking cessation service provision in Ireland.

BACKGROUND: While much progress has been made in reducing tobacco use in many countries, both active and passive smoking remain challenges. The benefits of smoking cessation are universally recognized, and the hospital setting is an ideal setting where smokers can access smoking cessation services as hospital admission can be a cue to action. Consistent delivery of good quality smoking cessation care across health services is an important focus for reducing the harm of tobacco use, especially among continued smokers. AIMS: Our objective was to document the smoking cessation medication and support services provided by specialist adult cancer hospitals across Ireland, a country with a stated tobacco endgame goal. METHODS: A cross-sectional survey based on recent national clinical guidelines was used to determine smoking cessation care delivery across eight specialist adult cancer tertiary referral university hospitals and one specialist radiotherapy center. Survey responses were collected using Qualtrics, a secure online survey software tool. The data was grouped, anonymized, and analyzed in Microsoft Excel. RESULTS: All responding hospitals demonstrated either some level of smoking cessation information or a service available to patients. However, there is substantial variation in the type and level of smoking cessation information offered, making access to smoking cessation services inconsistent and inequitable. CONCLUSION: The recently launched National Clinical Guideline for smoking cessation provides the template for all hospitals to ensure health services are in a position to contribute to Ireland's tobacco endgame goal.

Systematic Review of Smoking Cessation Interventions for Smokers Diagnosed with Cancer.

The detrimental impact of smoking on health and wellbeing are irrefutable. Additionally, smoking is associated with the development of cancer, a reduction treatment outcomes and poorer health outcomes. Nevertheless, a significant number of people continue to smoke following a cancer diagnosis. Little is understood of the smoking cessation services provided to smokers with cancer or their engagement with them. This systematic review aimed to identify existing smoking cessation interventions for this cohort diagnosed with breast, head and neck, lung and cervical cancers (linked to risk). Systematic searches of Pubmed, Embase, Psych Info and CINAHL from 1 January 2015 to 15 December 2020 were conducted. Included studies examined the characteristics of smoking cessation interventions and impact on referrals and quit attempts. The impact on healthcare professionals was included if reported. Included studies were restricted to adults with a cancer diagnosis and published in English. No restriction was placed on study designs, and narrative data synthesis was conducted due to heterogeneity. A review protocol was registered on PROSPERO CRD 42020214204, and reporting adheres to PRISMA reporting guidelines. Data were screened, extracted in duplicate and an assessment of the quality of evidence undertaken using Mixed Methods Assessment Tool. 23 studies met the inclusion criteria, representing USA, Canada, England, Lebanon, Australia and including randomized controlled trials (9), observational studies (10), quality improvement (3), and one qualitative study. Hospital and cancer clinics [including a dental clinic] were the settings for all studies. 43% (10/23) of studies reported interventions for smokers diagnosed with head and neck cancer, 13% (3/23) for smokers diagnosed with lung cancer, one study provides evidence for breast cancer, and the remaining nine studies (39%) report on multiple cancers including the ones specified in this review. Methodological quality was variable. There were limited data to identify one optimal intervention for this cohort. Key elements included the timing and frequency of quit conversations, use of electronic records, pharmacotherapy including extended use of varenicline, increased counselling sessions and a service embedded in oncology departments. More studies are required to ensure tailored smoking cessation pathways are co-developed for smokers with a diagnosis of cancer to support this population.

Methotrexate Toxicity: A Case Series from a Tertiary Care Center in Northern India.

Methotrexate is widely prescribed by various specialists, including internists, dermatologists, rheumatologists, orthopedics, and oncologists. The clinical features of acute methotrexate toxicity vary and are influenced by the acute cumulative dose, duration of methotrexate, associated risk factors, comorbidities, and drug interactions. We present a series of six patients with acute methotrexate toxicity. The characteristics of their clinical presentation, diagnoses, and risk factors are highlighted. All patients were given intravenous leucovorin and other supportive treatments. This series highlights the importance of thorough counseling for patients regarding the course of disease for which methotrexate is prescribed and the dosing, schedule, and adverse effects that are associated with methotrexate. Physician awareness, diagnosis, and treatment are crucial for mitigating the complications of methotrexate toxicity. (SKINmed. 2022;20:274-281).

Acquired Trichorrhexis Nodosa Secondary to Trichoteiromania: Prompt Diagnosis Using Trichoscopy.

Trichorrhexis nodosa (TN) is a common hair shaft defect that develops as a result of excessive physical or chemical trauma. Microscopy is considered the gold standard for its diagnosis. Outpatient diagnosis thus becomes difficult in the absence of availability of microscope. Trichoscopy is emerging as an excellent tool in outpatient diagnosis of hair shaft defects. Here, we report a young girl with localized TN secondary to trichoteiromania where trichoscopy clinched the diagnosis. Classical appearance of nodes in hair shaft and transverse hair shaft fractures producing "two brooms stuck in opposite direction" was evident. This case is being reported to emphasize the advantages of trichoscopy in quick diagnosis of hair shaft defects with review of published literature.

Has the National Fall in Smoking Rates in Ireland Been Replicated in Cancer Patients? A 5-Year Report.

Smoking among cancer patients leads to poorer outcomes, yet many patients continue smoking. As part of a feasibility study of smoking cessation for cancer patients in Ireland, smoking rates were reviewed. Hospital Inpatient Enquiry (HIPE) data on the smoking status of discharges with a cancer diagnosis (overall, breast, lung, cervical and head and neck cancer) were used (2014-2018). During 2014-2017, current smoking increased for overall (10.5-11.7%) and lung cancer (24.7-27.2%), then decreased to 11.4% and 24.1%, respectively, in 2018. Current smoking increased for cervical during 2014-2018 (11-19.8%) and initially (2014-2016) for head and neck (3-12.7%) cancer, decreasing to 7.6% in 2018; breast cancer was stable at 6 ± 0.6%. These rates are lower than the Irish (23-20%) and European (29% (average)) general population. During 2014-2017, past smoking increased among overall (15.2-21%) and specific cancers, which was lower than the Irish general population (23-28%). Current smoking was highest among 50-59-year-olds (14-16%), which contrasts with the Irish general population (24-35 years at 32-28%). HIPE data are subject to potential duplicate episodes of care and under-documentation of smoking. However, trend analysis is useful, as these limitations should be stable. Rates remain high; therefore, robust documentation and smoking cessation referrals for cancer patients are important.

Dermoscopic findings of a congenital smooth muscle hamartoma in an infant.

Cutaneous smooth muscle hamartoma is an uncommon, benign tumor developing in the dermis as a result of disorganized hyperproliferation of arrector pili muscle fibers. We present a 1-month-old infant with a congenital smooth muscle hamartoma together with the dermoscopic findings of the case. Dermoscopy can be a helpful non-invasive tool in diagnosing congenital smooth muscle hamartoma due to its distinct findings that help to differentiate it from close mimickers like solitary mastocytoma.

Autoimmune progesterone dermatitis presenting as fixed drug eruption.

Autoimmune progesterone dermatitis (APD) is a rare disorder that presents as recurrent cyclical cutaneous eruptions during the premenstrual period when progesterone level is elevated. It does not have a specific cutaneous manifestation of its own and presents with a multitude of common cutaneous conditions, thus making it a diagnostic challenge. We describe the case of a young woman who presented with a hyperpigmented patch on her left thigh, over which she developed recurrent erythema, pain and itching, starting 2 days before her menstrual cycle and resolving within 2 days after menstruation. Intradermal progesterone sensitivity test was positive. Histopathology of hyperpigmented patch showed features of fixed drug eruption. A diagnosis of APD presenting as fixed drug eruption was made. She was treated with oral contraceptive pills with significant improvement. This case has been reported because of its rarity and to highlight the clinical implications this condition can pose if diagnosis is not sought timely.

Skin Disorders Among Geriatric Population at a Tertiary Care Center in Uttarakhand.

INTRODUCTION: Ageing results in decline of normal functioning in all organ systems including skin. This predisposes the elderly persons to develop various skin ailments. A thorough knowledge of different diseases prevalent in this population in different geographic regions help the health care providers in better health care policy making. AIM: This study was planned to know the common dermatological diseases prevalent in Uttarakhand region of India. MATERIALS AND METHODS: Hospital out patients records maintained in Department of Dermatology, Venereology & Leprosy were analysed and information regarding age, sex and diagnosis of patients were recorded. Descriptive statistics for prevalence of skin diseases in patients presenting to hospital were calculated. RESULTS: Out of the total 29,422 patients seen in dermatology department from August 2012 to 2014, 4.7% (1,380) were aged 60 years and above. Male to female ratio was 2:1. Erythemato-squamous disorders taken collectively constituted the major skin disorder seen in 38.9% patients. This was followed by infections and infestations (29.9%), senile pruritus (9.0%) and age related skin changes (3.7%). Benign neoplasms were seen in 1.1% patients followed by cutaneous malignancies in 0.8% and precancerous lesions in 0.4%. Fungal infections were the most common infections seen in 18% patients. CONCLUSION: This study strengthens the opinion that infections, senile pruritus and eczema-dermatitis are the major dermatological disorders in elderly population.