Irish medical journal
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Irish medical journal · Jul 2006
Dissatisfaction with Do Not Attempt Resuscitation Orders: A nationwide study of Irish consultant physician practices.
The legal/ethical status of Do Not Attempt Resuscitation (DNAR) orders in Ireland has not been clarified, nor have national policies been formulated. We questioned 298 consultant physicians in the Republic of Ireland about DNAR orders. 173 replies were received (58%). 85 expressed unsatisfactory understanding of issues relating to Irish DNAR orders (49%). 116 physicians felt that alert patients preferred not to discuss their own resuscitation (67%). 55 physicians felt that if a competent adult patient is the subject of a DNAR order without the patient's knowledge, the reasons for this decision are "almost never" documented in the patient's medical record (32%). 75 consultants "almost never" had advance discussion of resuscitation preferences with the patient (43%). 47 physicians had experienced advance directives for Irish patients (27%). 102 physicians felt that both they and the patient's next of kin had joint responsibility for deciding resuscitation status for an incapacitated patient with no advance directive (59%). 37 respondents described a formal resuscitation policy in their place of work (21%). We feel that physicians require greater national guidance regarding DNAR order-making, and we advocate more widespread use of resuscitation policies.
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Irish medical journal · Jul 2006
Application of the Ottawa Knee Rules in assessing acute knee injuries.
The Ottawa Knee Rules (OKR) were established to identify which adults with acute knee injuries require knee x-rays as part of their assessment. This study evaluates the compliance of non-consultant hospital doctors (NCHDs), working in an Irish Emergency Dept., with these guidelines and assesses the impact of raising the profile of these rules on their implementation. Emergency Dept. (ED) notes of all adults who presented with an acute knee injury in a 3-month period were analysed retrospectively and compliance with the OKR was assessed. ⋯ This study highlights a lack of awareness of and compliance with the OKR in the assessment of acute knee injuries in adults. It shows how the implementation of simple measures, which raised the profile of the OKR among ED staff, significantly improved compliance with the rules, thus cutting patient waiting times and cutting hospital costs. Futhermore, this study revealed that patients, when injured, expect to get x-rayed and ofter doctors comply with these expectations even if no indication exists.
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All acute hospitals have a cardiac arrest team. A retrospective study of cardiac arrest calls prospectively recorded over a 24-month period was performed. 174 cardiac arrest calls were analyzed with 76 of these calls being false alarms. ⋯ A pilot study to determine physiological deterioration in the 24 hours prior to cardiac arrest was also performed. 45% of patients demonstrated a physiological deterioration over this time. Recommendations are made regarding the management of in-hospital cardiac arrests.
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Irish medical journal · Jun 2006
Oxegen 2004: the impact of a major music festival on the workload of a local hospital.
This prospective observational study was undertaken to assess the impact of a major music festival on the workload of a local hospital. Data were collected on all attendances at Naas General Hospital from the nearby Oxegen 2004 music festival. Patient demographics, disposition and diagnoses were recorded. ⋯ Thirty-seven of these attendees (51%) required inpatient or tertiary centre services. Thirty-four attendees (47%) were noted as having consumed alcohol and/or used illicit substances. We conclude that despite the provision of on-site medical facilities, major music events are associated with a significant increase in local health care activity and expenditure.
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Irish medical journal · May 2006
Letter Case ReportsThe aetiology of brachial plexus injury: what the paediatrician and obstetrician need to know.
The recognition of brachial plexus injury (BPI) after childbirth suggests to parents a causative rather than temporal relationship. This view is supported by textbooks of paediatrics, which state that: 1. "the mechanism of injury is a forceful separation of the head from the shoulder by lateral bending of the neck with simultaneous shoulder depression, during vaginal delivery"; and 2. "these injuries are due to traction on the brachial plexus during delivery."2 Although an obstetrician will talk to a parent when BPI occurs, the ongoing care of the child is within a mutidisciplinary team, where the paediatrician and obstetrician play leading roles. Parents will ask about aetiology, treatment and prognosis; but is the textbook explanation adequate? We illustrate the potential dilemma for the paediatrician and obstetrician through 2 cases of BPI and outline some data on BPI, which is not congruent with current paediatric texts.