Irish medical journal
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Irish medical journal · May 2014
Comparative StudyIntroduction of oesophageal Doppler-guided fluid management in a laparoscopic colorectal surgery enhanced recovery programme: an audit of effect on patient outcome.
Morbidity after colorectal surgery can be reduced with intraoperative oesophageal Doppler monitor (ODM) guided fluid therapy. We audited the effect of introducing ODM-guided fluid therapy in enhanced recovery laparoscopic colorectal surgery. ⋯ The ODM group had a lower mean (SD) POMS score on post-operative day 1 (2 (1.4) vs 4 (1.1), p = 0.001), fewer postoperative complications (14 patients vs 20, p = 0.009) and a lower rate of unplanned critical care area admission (1 vs 6, p= 0.001). Introduction of intraoperative ODM-guided stroke volume optimization was associated with improved outcomes in patients undergoing enhanced recovery laparoscopic colorectal surgery.
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Irish medical journal · May 2014
Case ReportsInfants with FPIES to solid food proteins--chicken, rice and oats.
We present two cases of Food Protein Induced Enterocolitis Syndrome (FPIES), a non-IgE mediated food hypersensitivity. FPIES induces severe vomiting 1.5-to-3 hours post ingestion of the offending food, and may be associated with diarrhoea, hypovolemic shock and acidosis. Avoidance of that food will lead to resolution of symptoms and prevents further episodes.
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Irish medical journal · Apr 2014
Case ReportsSpinal cord stimulation in pregnancy with failed back surgery syndrome.
Women of child-bearing age who are candidates for trial and possible implantation of a spinal cord stimulator (SCS) may express concerns regarding its effect on their ability to become pregnant, to maintain a pregnancy and to breastfeed. Despite the large number of SCS implanted worldwide there is a paucity of data regarding its effect on fertility and the course of the pregnancy. We describe a case of 32 year old lady in our centre who became pregnant after SCS implantation and had an uneventful pregnancy with delivery of a healthy baby which was breastfed.
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Irish medical journal · Apr 2014
Arrest in hospital: a study of in hospital cardiac arrest outcomes.
The effect of advances in cardiac arrest management over the last five decades on in-hospital cardiac arrest survival rates is not clear. Data on 212 arrests between January 2010 and May 2013 were retrospectively analyzed by means of an audit form based upon the Utstein template for in-hospital cardiac arrest, with a view to identifying significant associations between arrest characteristics and return of spontaneous circulation or survival to discharge. Significant associations were identified between return of spontaneous circulation and location (ward, 36 patients (38%) vs. ICU, 33 Patients (56%); P = 0.032), whether an arrest was witnessed or not (82 patients (52%) vs. 9 patients (30%); P = 0.029), whether the initial rhythm was shockable or non-shockable (28 patients (85%) vs. 38 patients (31%); P < 0.001), whether the first dose of adrenaline was administered within 2 minutes of arrest onset or later (13 patients (54%) vs. 12 patients (28%); P = 0.04).
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Irish medical journal · Mar 2014
Electronic discharge summaries--are they being done and do they have the required information?
A retrospective audit was conducted to evaluate the completeness of the available electronic discharge summaries. Forty-five randomly selected patients had their respective electronic discharge summaries reviewed including criteria such as length of stay; discharge summary availability; documentation of discharge medications; medication changes; medical co-morbidities and follow-up arrangements. ⋯ The readmission rate was found to be high when compared to published numbers with a quarter of the discharged patients being readmitted within 28 days. The recommendations resulting from this audit include the need for improved education on the requirements of the electronic dischange summary, appropriate documentation and possible implementation of out-of-hour discharge summary availability.