Irish journal of medical science
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Observational Study
Prediction of postoperative delirium by comprehensive geriatric assessment among elderly patients with hip fracture.
The purpose of this study is to investigate whether the preoperative comprehensive geriatric assessment (CGA) would predict postoperative delirium (POD) in elderly patients with hip fracture. ⋯ The comprehensive geriatric assessment before hip fracture surgery can predict the occurrence of POD in elderly patients.
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Sacubitril-valsartan has been shown by the PARADIGM-HF trial to decrease hospital admissions and improve mortality in patients with heart failure with reduced ejection fraction. The PARADIGM trial had stringent exclusion criteria. It is not known how applicable these trial criteria are to real-life practice. In this study, we sought to determine the percentage of patients eligible for sacubitril-valsartan therapy in a level 3 hospital without a dedicated heart failure service. ⋯ Our study showed that a smaller than expected proportion of our patients in real-world practice are suitable for sacubitril-valsartan therapy at discharge. Most patients were in the HFPEF cohort which does not currently have evidence for treatment with sacubitril-valsartan. Low rates of prescribing of basic heart failure medicatons and the absence of dedicated heart failure services in a non-tertiary centre may explain the poor compliance observed. Improving guideline adherence and increasing awareness of evidence-based medication use at primary and secondary care levels would be of benefit to Irish heart failure patients.
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Mid-adolescence, that twilight era when the human child transitions to adulthood, is an often overlooked developmental age yet harbours a subpopulation of patients with their own myriad of medical problems somewhat unique to their age group. ⋯ The results highlight the most common presentations of this subgroup of patients, with trauma, in keeping with recent international data, being the most common presentation. The noted high frequency in the number of mental health/intoxication/self-harm presentations among the Irish teenagers in our region is consistent with trends reported in world literature and serves to emphasise one of the main challenges facing those working in paediatrics in Ireland over the next 10 years.
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Shoulder instability following traumatic glenohumeral dislocation is a common injury sustained by athletes particularly in contact and collision sports. Overhead contact sports such as gaelic football and hurling pose a unique hazard to the glenohumeral joint, increasing the risk of dislocation. ⋯ Favourable outcomes can be expected for overhead contact sport athletes undergoing anterior arthroscopic stabilisation for recurrent instability. Players from these groups returned to sport sooner than those from other sports and no difference in recurrence was noted. The level at which they can expect to return to is favourable with most athletes reaching their pre-injury level.
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The demand for intensive care unit (ICU) beds in the surgical population has increased in recent years. This is due to increased complexity of operative interventions, development of critical care services and improved availability of technologies. The number of beds in ICUs nationwide remains limited. In model three hospitals, this is further impacted by a lack of high dependency unit (HDU) facilities and difficulty with transfer of patients to tertiary centres. ⋯ This study demonstrates the need to protect sufficient numbers of ICU beds for delivery of emergency surgical care. It highlights the potential utility of an HDU in this setting. The introduction of such a facility would impact cost savings and increase access for those requiring definitive ICU level care.