Irish journal of medical science
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Following oesophagectomy, the most concerning complication is that of anastomotic leak (AL). Prompt diagnosis and intervention are crucial to facilitate an optimal outcome. Other complications, particularly respiratory, are not infrequent. Early identification of AL versus other sources of the inflammatory response can be problematic. ⋯ Elevated CRP may be a useful marker in facilitating the prompt diagnosis of AL following oesophagectomy. Serial CRP may not contribute to identifying lower respiratory tract infections, partly as a result of the pro-inflammatory response following surgery.
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Hereditary haemochromatosis is often not diagnosed until adulthood. Iron overload cardiomyopathy initially results in diastolic dysfunction and can result in arrhythmias and irreversible cardiac failure if untreated. The aim of this study was to investigate whether patients with newly diagnosed hereditary haemochromatosis without signs of heart failure exhibit subclinical alterations of cardiac function and to determine if cardiac function improved after 1 year of venesection. ⋯ Among all measurements, radial strain, IVRT and left atrial force were shown to significantly improve following a 1-year course of venesection, suggesting that these parameters could be used to identify subclinical cardiac dysfunction in patients with iron overload secondary to hereditary haemochromatosis and to guide intensification of venesection therapy.
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Doctors' continuing medical educational and professional development (CME and CPD) needs are known to be strongly influenced by national and local contextual characteristics. A crucial step in the development of effective education and training programmes is the assessment of learner needs. ⋯ Our findings identified priority areas where CME and CPD for GPs in Ireland should focus. The topics selected may reflect the changing nature of general practice, which increasingly requires delivery of care to an ageing population with more multi-morbidity and chronic disease management, while trying to apply evidence-based medicine and consider patient safety issues. CME/CPD programmes need to adapt accordingly.
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Early Warning Systems (EWS) track the physiological parameters of individual patients and trigger a response when the parameter threshold has been reached. The use of early warning scores in adult hospital medicine has been shown to be beneficial in facilitating the early recognition of the deteriorating patient, thereby enabling prompt treatment. In 2012, a standardised National Early Warning Score was introduced in Ireland for all non-pregnant patients. ⋯ However, the scoring system is only part of the package, once triggered it needs to be effectively communicated and acted upon promptly by appropriately trained clinicians. Despite undoubted shortcomings, the international evidence to date is supportive of the beneficial role of the OEWS in preventing maternal morbidity. Further research is needed to improve the sensitivity and specificity of the OEWS and how to better integrate it into every-day clinical practice.
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Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is used to treat persistent cervical radicular pain that has not responded to conservative therapies. This technique has gained popularity in years for both cervical and lumbosacral radicular pain. The evidence to support its use is still evolving.