Irish journal of medical science
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Hip fracture is a growing healthcare challenge, with 6-8% 30-day mortality and 20-30% of patients incurring major morbidity, including impaired mobilisation and ability to live independently. While observational studies have shown no benefit of general versus spinal anaesthesia on 30-day mortality, intraoperative hypotension during hip fracture surgery is associated with increased 30-day mortality regardless of anaesthetic technique. Although a recent trial on younger patients demonstrated reduced postoperative complications by maintaining intraoperative arterial blood pressure close to preoperative baseline, there are no data correlating intraoperative hypotension during hip fracture surgery with postoperative morbidity. ⋯ In this exploratory retrospective analysis, the cumulative time of hypotension during hip fracture surgery correlated with extensive postoperative morbidity when adjusting to other known predictors. Intraoperative cumulative time of hypotension may be a good candidate for larger prediction studies as a predictor of postoperative complications. A randomised controlled trial evaluating the effect of actively minimising intraoperative hypotension on postoperative morbidity in hip fracture patients seems warranted.
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The traditional outpatient paradigm of seeing patients prior to diagnostic tests and treatment is unsustainable without additional funding. New models of service delivery such as "one-stop clinics", direct access to diagnostics and advanced nurse practitioner (ANP)-led clinics have the potential to improve the efficiency of existing services. ⋯ New models of outpatient service delivery have the potential to reduce existing waiting lists and could be implemented in other Irish hospital groups.
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Quality of life of out-of-hospital cardiac arrest (OHCA) survivors is believed to be as important as a factor in resuscitation outcome as the survival rate. The aim of this investigation is to assess the quality of life outcomes of survivors of out-of- hospital cardiac arrest in the Munster region. OHCAR was used to identify survivors who were contacted in writing to invite their participation. ⋯ The mean age of participants was 63.5 years with 85% male and 15% female. Eighty percent (n = 16) had no issues with mobility, 90% (n = 18) had no issues with personal care, 90% could undertake all usual activities, and 90% (n = 18) experienced no anxiety or depression. In conclusion, survivors of OHCA in the Munster area, who participated in this study, survive at a very high functional level.
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Potential drug-drug interactions (pDDIs) are especially frequent in patients with chronic obstructive pulmonary disease (COPD) who, if hospitalized, experience, on average 6.5 pDDIs on admission, and 7.2 on discharge. The aim of our study was to identify and analyze risk and/or protective factors for occurrence of pDDIs in hospitalized patients with COPD. ⋯ The COPD patients who were prescribed more drugs (especially antiarrhythmic and anticoagulants), by several independent prescribers, and having more comorbidities, were more prone to experience a pDDI; the only protective factor against pDDIs was age of the patients. In conclusion, COPD patients with the abovementioned risk factors should have their therapy more intensely monitored for pDDIs.