Irish journal of medical science
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A feature of contemporary obstetrics in wealthy countries has been both the continuing increase in caesarean section (CS) rates and the emergence of high levels of maternal obesity. ⋯ The study found that although the prevalence of being overweight or obese changed little over the period, the odds of having a CS if a woman is obese have increased for multiparas. For nulliparas, increasing CS rates were found to be strongly associated with an increase in maternal age over the period which is important because of the evidence that Irish women are choosing to defer having their first baby until later in life.
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Methadone maintenance is currently the predominant form of opioid substitution treatment available in the Republic of Ireland. Prescribing decisions currently involve urine testing for drug use. Urine testing may involve provision of a supervised sample in some circumstances, despite recommendations made in 2010 to abandon this practice. ⋯ This study presents evidence that oral fluid testing is acceptable to most patients. While oral fluid testing was inferior to urine testing for benzodiazepines, it may have an adjunctive role to play in methadone maintenance provision. Patients reported more negative than positive aspects of methadone maintenance.
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The Acute Surgical Assessment Unit (ASAU) in University Hospital Limerick (UHL) has provided a solution to overcrowding and long waiting times since centralization of emergency services to UHL. Recognising the importance of its evolving role, the ASAU in UHL has recently undergone a major revamp to ease the pressure in the overcrowded emergency department (ED). This included a new purpose state-of-the-art-built unit and equipment, improved staffing levels and use of a Kaizen Lean system to identify key area of delays and inefficiency with subsequent implementation of suggestions derived after Kaizen Lean. Patient satisfaction reporting was analysed in the older building and subsequently in the new site post Kaizen Lean to complete a closed-loop audit. The aim of the study was to examine patient satisfaction response rates with the ASAU prior to and following Kaizen Lean implementation and transfer to a new purpose-built unit. ⋯ A Kaizen Lean approach improved the transition of an ASAU to a new purpose-built unit and further improved overall patient satisfaction with services of the ASAU.
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To explore the value of the right hemi-diaphragmatic excursion (DE) and its variation in predicting extubation outcome in mechanically ventilated patients with COPD. ⋯ The combination of DE30 and ∆DE30-5 could improve the predictive value and could be used as the predictor of extubation outcome in mechanically ventilated patients with COPD.