The epidemiology of assault-related hospital in-patient admissions and ED attendances.

The aim of this study was to describe the epidemiology and impact of serious assault warranting in-patient care over six years and its impact on ED attendances in a large teaching hospital in Dublin over 2 years. There were 16,079 emergency assault-related inpatient hospital discharges reducing from 60.1 per 100,000 population in 2005 to 50.6 per 100,000 population in 2010. The median length of stay was 1 day (1-466) representing 49,870 bed days. The majority were young males (13,921, 86.6%; median age 26 years). Overall crime figures showed a similar reduction. However, knife crimes did not reduce over this period. Data on ED attendances confirmed the age and gender profile and also showed an increase at weekends. Alcohol misuse was recorded in 2,292/16079 (14%) of in-patient cases and 242/2484 (10%) in ED attendances. An inter-sectoral preventative approach specifically targeting knife crime is required to reduce this burden on health services.

A budget impact analysis of natalizumab use in Ireland.

BACKGROUND: Multiple sclerosis is the commonest cause of disability in young Irish adults. Natalizumab reduces disability progression in those patients with relapsing remitting multiple sclerosis who are suitable for it. First line disease modifying therapies are given in the community and are paid for by the hi-tech drug scheme. Natalizumab is given in hospital and is paid for from the hospital's budget. Access to natalizumab has been problematic in some Irish hospitals. A budget impact analysis was performed to look at the overall cost to the Health Service Executive of giving natalizumab. METHODS: A budget impact analysis was performed from the perspective of the Health Service Executive comparing the use of natalizumab with first line disease modifying therapies for 2009-2011. RESULTS: The study showed that currently, the use of natalizumab is likely to be cost saving to the Health Service Executive overall, because some of the costs for natalizumab are borne by private insurers, whereas, all of the costs of disease modifying therapies are borne by the Health Service Executive. CONCLUSIONS: Although the use of natalizumab is cost saving, current funding arrangements in the Health Service Executive do not allow for the transfer of money saved from drugs paid for in the hi-tech scheme, to hospitals who are supplying alternative treatments.

Trends in COPD mortality and in-patient admissions in men & women: evidence of convergence.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality. Although more prevalent in men, it is anticipated that, due to the convergence in smoking rates, the prevalence rate in women will surpass that of men. There were 14,519 deaths attributable to COPD in the period 2000-2009. Although deaths decreased for both sexes, reduction in deaths was significantly higher among men (test for trend, p<0.01 for men vs. p=0.06 for women). Smoking rates decreased for both sexes from 1980-2009 with the percentage reduction in smoking significantly greater in men (11.5% vs. 7.0%, p<0.001). There has been a convergence in COPD deaths and COPD hospital in-patient discharges for men and women that mirrors the trend in the convergence of male and female smoking rates. This study provides evidence of the need for effective smoking cessation programmes that are targeted at women as well as men.

Folic acid supplement use in the prevention of neural tube defects.

In 2008, planned folic acid fortification for the prevention of Neural Tube Defects (NTD) was postponed. Concurrently, the economic recession may have affected dietary folic acid intake, placing increased emphasis on supplement use. This study examined folic acid supplement use in 2009. A cross-sectional survey of 300 ante-natal women was undertaken to assess folic acid knowledge and use. Associations between demographic, obstetric variables and folic acid knowledge and use were examined. A majority, 284/297 (96%), had heard of folic acid, and 178/297 (60%) knew that it could prevent NTD. Most, 270/297 (91%) had taken it during their pregnancy, but only 107/297 (36%) had used it periconceptionally. Being older, married, planned pregnancy and better socioeconomic status were associated with periconceptional use. Periconceptional folic acid use in 2009 was very low, little changed from economic status were associated with periconceptional use. Periconceptional folic acid use in 2009 was very low, little changed from earlier years. Continuous promotion efforts are necessary. Close monitoring of folic acid intake and NTD rates is essential, particularly in the absence of fortification.

Hepatitis B reactivation in an Irish dialysis unit, 2005.

In April 2005, a case of reactivation of hepatitis B virus (HBV) infection occurred in a patient undergoing haemodialysis in an Irish hospital. This incident potentially affected patients attending hospitals throughout the country, so a national incident team was set up coordinate the response to the incident.A total of 306 dialysis patients, attending 17 different dialysis centres (14 in Ireland), were identified as having been potentially exposed to HBV as a result of this incident. A programme of HBV serological testing and HBV vaccination was instituted. There was no evidence that any patient acquired HBV infection as a result of cross-infection from the index patient, although 11 patients (3.6%) had evidence of past infection (anti-HBc positive, HBsAg negative). The majority of patients in this cohort were of unknown HBV vaccination status (62.7%), 13.4% were fully vaccinated, 4.6% partially vaccinated and 15.7% unvaccinated. Of 239 tested for anti-HBs, 183 (76.6%) had a titre <10 mIU/ml. Local incidents in dialysis units can have national implications due to the frequent patient transfer between units. This incident highlighted serious deficiencies in current structures and practices, and a lack of appropriate guidelines. However, there were positive outcomes from this incident. The majority of Irish dialysis patients have now been vaccinated against HBV, and lessons learned have been used to develop national guidelines on HBV vaccination and testing and on the management of incidents of blood-borne viral infections in dialysis units.

Increase in observed mental health difficulties one year after acute coronary syndrome: general practitioner survey.

BACKGROUND: General practitioners (GPs) are often the first to assess mental health difficulties after acute coronary syndrome (ACS). AIMS: To determine whether GPs observed an increase in mental health difficulties one-year post-hospitalisation for ACS. METHODS: Postal survey. RESULTS: GPs rated patients (n = 442) as having probable (GP assessed 10%) or definite (formally assessed 7%) mental health difficulties pre-hospitalisation. Post-hospitalisation the prevalence of probable cases increased significantly to 19% (OR = 4.3, 95% CI 2.1-10.2, P < 0.001). In multivariate analysis, only smoking at index hospitalisation was associated with being assessed as a new case of probable/formal mental health difficulties (RR = 2.1, 95% CI 1.3-3.4, P = 0.003). Forty-seven percent of cases were prescribed some medication for this problem. CONCLUSIONS: GPs recorded a significant increase in mental health difficulties in ACS patients 12 months after hospitalisation, with smoking used as an indicator of new cases.

Cardiac rehabilitation services in Ireland: the impact of a coordinated national development strategy.

BACKGROUND: The national Cardiovascular Health Strategy including specific plans for cardiac rehabilitation was launched in Ireland in 1999. A survey of cardiac rehabilitation services was conducted in 2003 to evaluate progress on service provision. AIM: To establish levels of service provision, service formats and geographic distribution of cardiac rehabilitation services in 2003 and compare them with the status pre-Strategy (1998). METHOD: All hospitals in Ireland (n = 39) admitting cardiac patients to a coronary or intensive care unit were surveyed by postal questionnaire. RESULTS: All hospitals provided information and all reported providing Phase I cardiac rehabilitation. Seventy-seven per cent (30 of 39) provided Phase III rehabilitation in 2003 (i.e. outpatient cardiac rehabilitation services) compared with 29% (12 of 41) in 1998. Of those hospitals currently without programmes, 78% (seven of nine) had plans in place for programme establishment. All programmes had trained cardiac rehabilitation coordinators, multidisciplinary teams and multiple components as recommended in the Strategy. In 82% of hospitals, intervention was provided at Phase II (immediate post-discharge period) while 26% of hospitals provided intervention at Phase IV (long-term maintenance period). CONCLUSIONS: There have been substantial achievements towards the Cardiovascular Health Strategy target of providing cardiac rehabilitation services for all relevant hospitals in Ireland over the past five years. Service provision of cardiac rehabilitation can benefit from collective efforts made across centres to encourage the prioritisation of cardiac rehabilitation in national health policy initiatives.

Ethical approval for national studies in Ireland: an illustration of current challenges.

BACKGROUND: Ethical approval of research projects is, appropriately, an essential prerequisite in health settings. AIMS: This paper outlines difficulties encountered with procedures for gaining ethical approval for two multicentre surveys in Ireland. METHODS: The experiences of two national surveys were documented. RESULTS: Delays in processing ethics applications led to substantial delays in both surveys. Research ethics committees (RECs) assessed applications in an idiosyncratic manner. CONCLUSION: In Ireland, there is currently no accepted mechanism for single location ethical approval for multicentre studies. Instead, they require separate approval from all participating centres. The challenges of this system of application to multiple committees are outlined in this paper, and possible solutions presented.

Clinical outcome and return to sport after the surgical treatment of spondylolysis in young athletes.

We studied prospectively 22 young athletes who had undergone surgical treatment for lumbar spondylolysis. There were 15 men and seven women with a mean age of 20.2 years (15 to 34). Of these, 13 were professional footballers, four professional cricketers, three hockey players, one a tennis player and one a golfer. Preoperative assessment included plain radiography, single positron-emission CT, planar bone scanning and reverse-gantry CT. In all patients the Oswestry disability index (ODI) and in 19 the Short-Form 36 (SF-36) scores were determined preoperatively, and both were measured again after two years in all patients. Three patients had a Scott's fusion and 19 a Buck's fusion. The mean duration of back pain before surgery was 9.4 months (6 to 36). The mean size of the defect as determined by CT was 3.5 mm (1 to 8) and the mean preoperative and postoperative ODIs were 39.5 (SD 8.7) and 10.7 (SD 12.9), respectively. The mean scores for the physical component of the SF-36 improved from 27.1 (SD 5.1) to 47.8 (SD 7.7). The mean scores for the mental health component of the SF-36 improved from 39.0 (SD 3.9) to 55.4 (SD 6.3) with p < 0.001. After rehabilitation for a mean of seven months (4 to 10) 18 patients (82%) returned to their previous sporting activity.

Adult service refusers in the greater Dublin area.

The reclusive behaviour and living conditions of people living in the community can be a source of concern to others, especially when statutory and voluntary support are refused. A cross-sectional observational study of service providers was carried out to profile 'service refusers' in the greater Dublin area and to describe the support offered. Two hundred and thirty three subjects were identified. Most were female (127, 54.5%) and 65 years of age or older (162, 69.5%). Approximately 50% (117, 50.2%) were living in private accommodation. The majority of subjects were considered to exhibit traits of poor personal hygiene (171, 73.4%), suspiciousness (160, 68.7%), secrecy (144, 61.8%) or hoarding (126, 54.1%). Forty-seven per cent of subjects (110) identified met the criteria for 'Diogenes Syndrome'. A wide variety supports had been offered including meals-on-wheels, home-helps and house cleaning. Respondents considered that 51.9% (121) of subjects had not been offered a service which proved successful. Despite the best efforts of agencies, service refusers can remain steadfast in not availing of the help that is on offer.

Focal tenosynovial amyloid deposition as a rare cause of median nerve compression at the wrist.

Although certain local and systemic aetiologies for the carpal-tunnel syndrome are known, a large number of cases of this syndrome do not have a conclusive aetiology. We present a case of histologically proven focal tenosynovial deposition of amyloid presenting as a rare cause of median nerve compression at the wrist.