Irish medical journal
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Irish medical journal · Nov 2007
Case ReportsEx utero intrapartum treatment (EXIT) procedure and simultaneous excision of oral teratoma.
We report a case of a large oral teratoma in a foetus diagnosed on antenatal ultrasound. Due to the anticipated difficulty in securing the airway at birth an ex-utero intrapartum treatment (EXIT) procedure was planned. In this case simultaneous excision of the tumour mass was carried out while on placental support this allowed safe procurement of the airway and successful delivery of an otherwise healthy infant. This case highlights the challenge presented by such unusual cases and illustrates the successful treatment of this condition.
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Irish medical journal · Nov 2007
Why are we waiting? A study of the patients' perspectives about their protracted stays in an emergency department.
The overcrowding of Emergency Departments compromises their critical function and the safety of patients and staff. This study asked the patients how the wait in overcrowded conditions impacted on them and the care they received and what they believed the reasons for the overcrowding were. ⋯ An overwhelming 85.9% felt that the Health Authorities were not doing enough to address the overcrowding issue. Overcrowding of Emergency Departments has been identified as a major problem the solution is to be found in increasing the capacity of the acute hospital system according to the majority of our study population.
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Convulsive status epilepticus is a relatively common life-threatening illness requiring prompt intervention. There has been much debate about the appropriate protocol for management of convulsive status epilepticus. Published data on the management of this condition in Ireland is limited. ⋯ The drugs of first choice varied between diazepam and lorazepam in most cases. Although phenytoin was used as second line drug, the dose used was frequently suboptimal. We have developed a protocol for the management for convulsive status in our centre.
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Irish medical journal · Sep 2007
Consensus statements on the borderlands of neonatal viability: from uncertainty to grey areas.
The gestational age and birth weight cut off for intact survival in extremely preterm infants is unclear. There is uncertainty among obstetricians and neonatologists about when it is inadvisable to institute intensive care. The suggested definition in relation to viability is when mortality does not exceed 50% but the corresponding figure for disability is undetermined. ⋯ Girls have approximately 1 week advantage over boys, every day increases survival by 3%, the benefits of a full course of antenatal steroids, the problem of multiple birth, the baby's condition at delivery. Also concerns have been expressed about basing policy on short-term follow-up only. Extreme prematurity is both uncommon and complex and should be managed in high volume tertiary centres that are familiar with the necessary facets for decision making.
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Irish medical journal · Sep 2007
Medical students in the emergency department: how do patients view participation in clinical teaching?
A survey was carried out in the Emergency Department (ED) of a single urban Irish teaching hospital to determine patients' acceptability towards medical students and their attitudes towards participating in clinical teaching. We analysed 145 patient replies and found 45 (31%) patients with previous ED medical student contact. ⋯ When patients who did not have previous contact with medical students were included in the analysis, receptiveness to student examination and procedures remained high [119 (82%) and 102 (70%) respectively] despite almost none of the patients recalled reading information about participating in medical teaching. Up to 52% patients would vary their consent depending on the severity of their clinical complaint but the majority, 104 (81%) patients were satisfied that involving medical students would not alter their clinical care.