Irish Journal of Medical Science

Publisher: Springer Verlag

Description

Impact factor 0.51

  • 5-year impact
    0.62
  • Cited half-life
    6.20
  • Immediacy index
    0.08
  • Eigenfactor
    0.00
  • Article influence
    0.18
  • ISSN
    1863-4362
  • OCLC
    180074721
  • Material type
    Periodical, Internet resource
  • Document type
    Internet Resource, Computer File, Journal / Magazine / Newspaper

Publisher details

Springer Verlag

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Author's pre-print on pre-print servers such as arXiv.org
    • Author's post-print on author's personal website immediately
    • Author's post-print on any open access repository after 12 months after publication
    • Publisher's version/PDF cannot be used
    • Published source must be acknowledged
    • Must link to publisher version
    • Set phrase to accompany link to published version (see policy)
    • Articles in some journals can be made Open Access on payment of additional charge
  • Classification
    ​ green

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: With concerns that blind registration in Ireland due to diabetic retinopathy is continuing to rise, a structured retinopathy screening service is in the process of being rolled out nationally. To report on the validation process for creating a register of diabetics in the Mid-West of Ireland, and findings following retinopathy screening of a representative sample. National primary care databases were employed in generating provisional lists of diabetic patients in the Health Service Executive (HSE) Mid-West area. Subsequent engagement with the corresponding general practices over a three year period between 2010 and 2013 facilitated the validation of these lists. A summary of the retinopathy screening outcomes of 1,434 patients and pre-existing screening patterns is reported. The number of patients on the Mid-West diabetes register to date is 11,126. Of the 1,434 patients screened, 288 (20.1 %) had background retinopathy, while 117 (8.2 %) had sight-threatening retinopathy. Seventeen (19.8 %) of the 86 patients identified with maculopathy required treatment with intravitreal injections. Of the 610 patients questioned about previous screening events, 389 (63.8 %) said they had undergone an ocular examination within the previous 12 months. The HSE Mid-West has over 11,000 patients on its database ready to be screened by the national programme, with the treatment of maculopathy expected to have the largest impact on resources. Although the majority of patients are already undergoing screening in the community in an ad hoc fashion, the rates of sight-threatening retinopathy encountered highlight the timeliness of the full implementation of the national programme.
    Irish Journal of Medical Science 01/2015;
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    ABSTRACT: Management of axillary disease in breast cancer has evolved significantly over the last two decades with the introduction of SLNB and a trend towards less radical surgery. Data from the American College of Surgeons Oncology Group Z0011 trial proposes that not all patients with positive axillary lymph nodes require completion axillary dissection. The aim of this study was to determine whether there has been a change in practice patterns for axillary management in Ireland since the publication of this 'practice-changing' trial. A review of breast cancers managed in the 12 months prior to publication of Z0011 (pre-Z0011) and comparison with those managed in the following 12 months (post-Z0011) was undertaken in three tertiary referral breast cancer centres. Patients with a positive SLNB were identified, and clinicopathologic data and subsequent management was compared between the two cohorts. There were 708 SLNB performed during the study period; 326 pre-Z0011 and 382 post-Z0011. There was no difference in the rate of SLN positivity between the two cohorts: 29.1 % had a positive SLN pre-Z0011 and 29.3 % were positive post-Z0011. There were a significantly lower number of axillary clearances performed in SLN-positive patients in the post-Z0011 period (71.4 %) compared to the pre-Z011 period (93.7 %, p = 0.0022 Chi-square). Of the patients with tumour characteristics meeting the Z0011 inclusion criteria in the initial 12 months of the study, 92.3 % underwent ALND compared with 65.6 % in the final 12 months of the study (p = 0.0006 Chi-square). There has been a change in clinical practice since the publication of the Z0011 trial, illustrated by a decrease in the rate of axillary clearance in node-positive breast cancers.
    Irish Journal of Medical Science 01/2015;
  • Irish Journal of Medical Science 01/2015;
  • Irish Journal of Medical Science 01/2015;
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    ABSTRACT: It has been estimated that approximately 520,000 injury presentations are made to Irish accident and emergency departments each year. Fractures account for 20 % of these injuries. Circular external fixators (frames) have been shown to be a safe and effective method of treatment for long bone fractures where internal fixation is impossible or in-advisable. We present the outcomes of all frames applied at our institution for stabilisation of acute fractures over a 20-year period. We retrospectively reviewed a prospectively compiled database of all frames applied in our institution and identified all frames which were applied for acute lower limb trauma. We identified 68 fractures in 63 patients. There were 11 femoral fractures and 57 tibial fractures. All fractures were classified using the AO Classification system, and most fractures were Type C fractures. We used an Ilizarov frame for 53 fractures and a Taylor Spatial Frame for 15 fractures. The mean time in frame was 365 days for a femoral fracture and 230 days for a tibial fracture. There were five tibial non-unions giving an overall union rate of 93 %. Factors associated with non-union included high-energy trauma and cigarette smoking. The vast majority of lower limb fractures can be treated using 'conventional' methods. Complex fractures which are not amenable to open reduction and internal fixation or cast immobilisation can be treated in a frame with excellent results. The paucity of published reports regarding the use of frames for complex trauma reflects the under-utilisation of the technique.
    Irish Journal of Medical Science 12/2014;
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    ABSTRACT: Kidneys from extended criteria donors are associated with higher rates of delayed graft function (DGF). Hypothermic machine perfusion (MP) for storage is associated with more favourable outcomes. A retrospective analysis was performed in 93 patients where the kidney was stored using hypothermic MP (LifePort(®)) and compared to an age-matched control group where the kidney was stored in cold static storage (CSS) using University of Wisconsin solution. Median age was similar in both groups (59.2 years in MP vs 59.9 years in CSS, p = 0.5598). Mean cold storage time was 15.6 h in MP vs 17.9 h in CSS. Post transplant mean serum creatinine was as follows; MP group-144.7 μmol/L at 1 month; 138.3 μmol/L at 3 months and 129.5 μmol/L at 12 months. In the CSS group-163 μmol/L at 1 month; 154.9 μmol/L at 3 months and 140.2 μmol/L at 12 months. There was a statistically significant difference at 1 month (p = 0.0096) and 3 months (p = 0.0236). DGF was defined as the need for haemodialysis within 7 days post transplant. In the MP group, DGF occurred in 17.2 % patients with mean of 6 days (range 1-18). In the CSS group, 25.8 % patients with mean of 8.1 days (range 3-25). One-year graft survival rate was better in the MP group (97.85 vs 96.77 %). Our experience to date recommends the use of hypothermic MP for storage of kidneys from extended criteria deceased heart-beating donors.
    Irish Journal of Medical Science 12/2014;
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    ABSTRACT: Galway University Hospital provides a 24-h referral eye emergency service for patients triaged by a primary health network. A prospective study was designed to evaluate the profile of patients referred to the eye emergency service and an attempt was made to compare the data recorded to those of a walk-in eye casualty. All cases seen in Galway University Hospital eye emergency service over five consecutive weeks in 2012 were recorded and analyzed. Four hundred and eight cases were seen in total. 312 (76.5 %) were seen during normal working hours and 96 (23.5 %) after-hours. 33.3 % of cases were inflammatory and 31.9 % traumatic. Anterior uveitis [39 cases (9.6 %)] and corneal abrasion [37 cases (9.1 %)] were the most common diagnosis, while bacterial keratitis [9 cases (2.2 %)] and globe rupture/penetration [4 cases (1 %)] were the most serious. 85.6 % of patients were seen within 30 h from referral. A&E department was the main referral source (35 % of cases seen during normal hours and 70.8 % of those seen after-hours). 42.5 % of patients needed to be followed-up in the clinics. Seventy-two patients (17.6 %) were seen after 5 pm, Monday to Monday. Twenty-one were traumatic, 4 required admission and only 9 were deemed inappropriate after assessment. Serious eye pathology presents after normal working hours. The triage process results in lower number of minor complaints being referred to the service. Compared to a walk-in casualty, a triaged service manages greater percentage of complex pathology.
    Irish Journal of Medical Science 12/2014;
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    ABSTRACT: Ireland has the fourth highest incidence of asthma in the world, with an estimated 14.7 % of the population having asthma, making it the most common chronic disease in childhood and the most common respiratory illness in Ireland. The aim of this qualitative enquiry, involving participant focus groups, was to investigate the health and well-being of Irish adults who have asthma, with particular interest in the influences on their health and well-being. The study population was recruited from the Asthma Society of Ireland database of members. Data were collected in eight focus group interviews and analysed for themes. Asthma was found to have a significant impact on the health and well-being of participants due to symptom experience, treatments they had to undertake, and the repercussions of uncontrollable events or triggers. The unrelenting pressure of managing their asthma took a toll on many of the participants, who felt their lifestyle had changed dramatically and they had lost some or all of their control over their health and well-being.
    Irish Journal of Medical Science 11/2014;
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    ABSTRACT: Treatment of dental, craniofacial and orthopedic defects with bone graft substitutes has shown promising result achieving almost complete bone regeneration depending on product resorption similar to human bone's physicochemical and crystallographic characteristics. Among these, non-ceramic and ceramic hydroxyapatite being the main inorganic salt of bone is the most studied calcium phosphate material in clinical practices ever since 1970s and non-ceramic since 1985. Its "chemical similarity" with the mineralized phase of biologic bone makes it unique. Hydroxyapatite as an excellent carrier of osteoinductive growth factors and osteogenic cell populations is also useful as drug delivery vehicle regardless of its density. Porous ceramic and non-ceramic hydroxyapatite is osteoconductive, biocompatible and very inert. The need for bone graft material keeps on increasing with increased age of the population and the increased conditions of trauma. Recent advances in genetic engineering and doping techniques have made it possible to use non-ceramic hydroxyapatite in larger non-ceramic crystals and cluster forms as a successful bone graft substitute to treat various types of bone defects. In this paper we have mentioned some recently studied properties of hydroxyapatite and its various uses through a brief review of the literatures available to date.
    Irish Journal of Medical Science 11/2014;
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    ABSTRACT: This study aims to assess quality of life outcomes, continence, rates of pouchitis and predictors of pouchitis for patients undergoing laparoscopic versus open three-stage ileal pouch-anal anastomosis (IPAA) surgery in our institution. Forty-two patients having had three-stage (IPAA) surgery were identified. One was excluded as they had undergone pouchectomy. A postal questionnaire followed by telephone contact was undertaken. The questionnaire was based on The Gastrointestinal Quality of Life Index (GIQLI) and Wexner/Cleveland Clinic Faecal Incontinence Symptom Severity Scoring Systems. Our aim was to assess morbidity, quality of life, incidence of pouchitis and continence following restorative panproctocolectomy and IPAA. Thirty-five patients completed the response. The median age at colectomy of our patient population was 32 years. 57 % were male and 43 % were female. 54.3 % of cases were carried out laparoscopically. 8/19 patients who had laparoscopic surgery had pouchitis (42.1 %) versus 9/16 patients who had open surgery (56.3 %). The median Wexner score was 0. Nine patients (25.7 %) had a GIQLI score that was within or above the range reported for healthy controls. The rate of complications was 31.7 % for emergency cases and 25.7 % for elective cases. The rate of pouchitis in this group was 48.5 %. Overall pelvic sepsis rate was 12.8 %. Ileal pouch-anal anastomosis is a successful and well-tolerated procedure with 94 % of patients opting to have the surgery again. Preliminary results do not show any significant difference in the incidence of pouchitis following laparoscopic surgery.
    Irish Journal of Medical Science 11/2014;
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    ABSTRACT: The aim of this study is to review a cohort of cases with vaginal intraepithelial neoplasia (VAIN) in a Chinese tertiary centre and to analyze the relationship between VAIN and cervical neoplasm, the treatment of the disease, and the outcomes. We retrospectively reviewed patients undergoing treatment for VAIN from January 2007 to June 2013. All the data of demographics, history, histological information, and HPV testing results were recorded. Statistical analysis was performed with SPSS 10.0 software. The study comprised of 184 patients. 132 out of 184 cases were diagnosed with cervical cancer or cervical intraepithelial neoplasia (CIN). 19 cases occurred after treatment of cervical neoplasia, and 33 patients were without any cervical lesion at the time of diagnosis. The average age of total patients was 48.30 ± 11.58. There were no significant differences in age, parity, and HPV infection among different groups. No significant differences were found in age, parity, and HPV infection between low-grade VAIN1 and high-grade VAIN (VAIN2 and VAIN3). The main treatment was electrofulguration and focal resection. The primary remission rate was 87.62 %. Four patients of VAIN1 were observed with the result of no recurrence in three cases. VAIN is a disease which has a close relationship with cervical neoplasia. Electrofulguration treatment with local resection is a suitable treatment with a much lower recurrence rate. For VAIN 1, observation may be a good choice especially for younger patients.
    Irish Journal of Medical Science 11/2014;
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    ABSTRACT: Referrals to symptomatic breast clinics have increased significantly in recent years with unchanged numbers of detected cancers. The general practitioner (GP) referral information relating to this increased patient volume causes anxiety and potentially creates confusion and future medicolegal issues if inaccurate. To compare GP triage category requests and clinical findings with those determined by the breast centre. 1,014 consecutive referrals to a symptomatic breast service were included. GP triage request category and clinical findings were prospectively recorded and compared to cancer centre surgeon triage category, clinical findings and cancer detection rates. GPs requested urgent appointments for 49 % of referrals, only 22 % were considered urgent on triage at the cancer centre. The triage category request was downgraded in 56 % of referrals from urgent to routine. Thirty-three cancers were detected, representing 3 % of referrals. Eighty-eight percent of cancers were identified in the group with positive clinical findings at the breast clinic. 24 % of the new referrals were for mastalgia alone. In the 55 % of referred cases where GPs reported a clinical abnormality, only 39 % of these had a clinical finding confirmed by the breast surgeon. There is poor correlation between GP triage category request and those assigned by the breast unit. GP referrals indicating patients with a clinical abnormality was discordant with specialist findings in 61% of cases. The frequency of overstating of clinical findings by GPs is such that subsequent cancer diagnosis does not imply failure of a preceding triple assessment process.
    Irish Journal of Medical Science 11/2014;
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    ABSTRACT: Varicose veins are common and frequently cause patient distress. In recent years, Radiofrequency ablation (RFA) has emerged as a minimally invasive alternative to traditional open venous ligation surgery. The aim of this study was to directly compare RFA and open saphenofemoral ligation. This was a single-centre retrospective cohort study. Consecutive patients undergoing surgical management over a 2-year period commencing from January 2011 were studied. Radiological success, peri-operative serological testing and hospital length of stay were documented. Procedural cost was calculated. A focused cohort analysis was undertaken to compare the initial 50 RFA procedures performed with the last 50. During the study period, 296 patients underwent surgical intervention. A total of 204 patients underwent RFA. Sixty-six percent of all patients were female. RFA was associated with a reduction in overnight hospital stay (18 vs. 78 %, P = <0.001) when compared with open ligation with a success rate of 98 %. No significant inter-group difference was noted for 30-day readmission (p = 0.203). Focused cohort analysis identified an increase in hospital day case activity (74 vs. 90 %, p = 0.002), which contributed to a reduction in procedural cost ( 1,024 vs. 971, p = 0.003) over the study period. Radiofrequency ablation is a viable alternative to open repair offering excellent efficacy. It is however associated with a higher procedural cost than the open surgical option.
    Irish Journal of Medical Science 11/2014;
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    ABSTRACT: Remote ischemic perconditioning (RIPerC), remote ischemic postconditioning (RIPostC), and remote ischemic perconditioning + postconditioning (RIPerC + RIPostC) protect against renal ischemia reperfusion injury (IRI). However, the most beneficial approach among these is not known.
    Irish Journal of Medical Science 11/2014;
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    ABSTRACT: Planar bone scintigraphy (PBS) is a standard radiological technique to detect skeletal metastases from prostate cancer (PC), the addition of SPECT-CT to PBS improves its diagnostic accuracy. The aim of this study was to assess the additional value of targeted SPECT-CT with PBS in detecting skeletal metastasis form prostate cancer, considering resource implications in an Irish hospital setting.
    Irish Journal of Medical Science 11/2014;
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    ABSTRACT: Nuclear factor-erythroid 2-related factor-2 (Nrf2) acts as a defense system in the development of nonalcoholic steatohepatitis (NASH). Curcumin is a phenolic compound with lipid regulatory, anti-oxidative, anti-inflammatory and anti-tumorigenic properties that is beneficial in defending against NASH and was recently proved to be an Nrf2 activator. The aim of this study was to evaluate whether Nrf2 activation could be involved in NASH mitigation by curcumin.
    Irish Journal of Medical Science 11/2014;
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    ABSTRACT: Recent studies have shown that microRNA-21 (miR-21) is overexpressed in solid tumors and implicated in the modulation of drug-induced resistance.
    Irish Journal of Medical Science 11/2014;
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    ABSTRACT: Inappropriate or unnecessary paediatric inpatient admissions are sometimes unavoidable but are costly and increase pressure on services. Various measures, including paediatric observation units, have been undertaken in an attempt to reduce these admissions.
    Irish Journal of Medical Science 11/2014;
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    ABSTRACT: Increasing demand exists for blended approaches to the development of professionalism. Trainees of the Royal College of Physicians of Ireland participated in an online patient safety programme.
    Irish Journal of Medical Science 11/2014;