• Warfarin use in hemodialysis patients: what is the risk?

      Phelan, P J; O'Kelly, P; Holian, J; Walshe, J J; Delany, C; Slaby, J; Winders, S; O'Toole, D; Magee, C; Conlon, P J; et al. (2011-03)
      Background: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. Methods: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. Results: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). Conclusions: This study confirms the higher bleeding risk associated with HD/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. Summary: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A secondary finding was that INR variability was significantly higher in HD patients than non-HD patients on warfarin.
    • Warfarin use in hemodialysis patients: what is the risk?

      Phelan, P J; O'Kelly, P; Holian, J; Walshe, J J; Delany, C; Slaby, J; Winders, S; O'Toole, D; Magee, C; Conlon, P J; et al. (2012-02-01)
      BACKGROUND: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. METHODS: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. RESULTS: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). CONCLUSIONS: This study confirms the higher bleeding risk associated with HD/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. SUMMARY: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A secondary finding was that INR variability was significantly higher in HD patients than non-HD patients on warfarin.
    • Warming preterm infants in the delivery room: polyethylene bags, exothermic mattresses or both?

      McCarthy, Lisa K; O'Donnell, Colm P F; The National Maternity Hospital, Dublin 2, Ireland. lisamac79@yahoo.com (2011-12)
      To compare the admission temperature of infants treated with polyethylene bags alone to infants treated with exothermic mattresses in addition to bags in the delivery room.
    • Wasted - the years waiting for an alcohol policy

      Murphy, JFA (Irish Medical Journal, 2012-12)
      Throughout his lecture Bedford portrayed the close and complex relationship between Irish society and alcohol. Alcohol is part of our image both nationally and internationally. Some of the most abiding images of US presidential visits to Ireland are of drinking pints in Irish pubs. There is Arthur’s day and jump into Ireland. Alcohol is intertwined with our great sporting occasions and achievements. The famous Ireland vs England rugby match at Croke Park was set against the backdrop of intensive Guinness advertising. All Ireland final day has a strong association with the drinks industry.
    • The way forward for the refractory asthmatic

      Kooblall, M; Moloney, E; Lane, SJ (Irish Medical Journal, 2015-07)
      Ireland has the fourth highest prevalence of asthma in the world. 7.1% of 18+ population and 18.9% of 13-15 year olds have asthma. 38.5% of 13-15 year olds reported wheezing. More than 1 person a week dies from asthma and 29% of asthma patients miss school or work. 1 Despite very safe and effective treatment 5-10% of patients with bronchial asthma do not respond well to their treatment. This group of patients are labelled as refractory asthmatics. Besides compliance, presence of psychogenic and trigger factors and comorbid illness, steroid insensitiveness or resistance may play a significant role in the poorly controlled/responding asthmatics. Type I Steroid resistance is due to lack of binding affinity of steroids to glucocorticoid receptors and may respond to higher doses of steroids while type II steroid resistance is because of reduced number of cells with glucocorticoid receptors, which is very rare and do not respond to even higher doses of systemic steroids and these cases require alternative/novel therapies. 2
    • A Web-Based Electronic Neurology Referral System: A Solution for anOverburdened Healthcare System

      Williams, L; O’Riordan, S; McGuigan, C; Hutchinson, M; Tubridy, N (Irish Medical Journal (IMJ), 2012-10)
    • Weight gain as a manageable side effect in psychiatric populations

      Cahill, Dr Michele; Noone, Dr Patricia; Eli Lilly & Co. (2003)
    • Weight management services for adults highlighting the role of primary care

      Hassan, SJ; O’Shea, D (Irish Medical Journal, 2012-12)
    • Westermark's sign of pulmonary embolism--well known but frequently overlooked.

      Tsvetanova, Z; Logan, H (Irish Medical Journal, 2015-01)
      Pulmonary embolism (PE) is frequently a difficult diagnosis because of non-specific symptoms that can lead to misdiagnosis 1 . We report a patient with PE successfully diagnosed and treated, whose CXR showed Westermark’s sign of pulmonary embolism. Westermark’s sign is distal oligaemia in the affected area of the lung due to a reduction in size of vessels distal to a PE 2 . It has a low sensitivity (14%) and high specificity (92%) for the diagnosis of pulmonary embolism 3 . Its high specificity for PE makes it a sign well worth being aware of and in this case described its early recognition may led to early treatment and to prevention of cardiovascular insult.
    • What are the spondyloarthropathies?

      FitzGerald, Oliver; Maksymowych, Walter P; Dept of Rheumatology, St. Vincents University Hospital, Elm Park, Dublin, 4, Ireland. oliver.fitzgerald@ucd.ie (2010-10)
    • What do gastroenterology trainees want: recognition, remuneration or recreation?

      Harewood, G C; Pardi, D S; Hansel, S L; Corr, A E; Aslanian, H; Maple, J; Department of Gastroenterology and Hepatology, Beaumont Hospital, Dublin, Ireland, harewood.gavin@gmail.com. (2010-07-27)
      BACKGROUND: Occupational psychologists have identified three factors important in motivating physicians: financial reward, academic recognition, time off. AIM: To assess motivators among gastroenterology (GI) trainees. METHODS: A questionnaire was distributed to GI trainees to assess their motivators: (1) work fewer hours for less lucrative rate, (2) reduction in salary/increase in hours for academic protected time, and (3) work longer hours for higher total salary, but less lucrative hourly rate. RESULTS: Overall, 61 trainees responded; 52% of trainees would work shorter hours for less lucrative rate; 60% would accept a disproportionate reduction in salary/increase in hours for academic protected time; 54% would work longer hours for more money but less lucrative rate. Most trainees (93%) accepted at least one scenario. CONCLUSIONS: Most GI trainees are willing to modify their job description to align with their personal values. Tailoring job descriptions according to these values can yield economic benefits to GI Divisions.
    • What do gastroenterology trainees want: recognition, remuneration or recreation?

      Harewood, G C; Pardi, D S; Hansel, S L; Corr, A E; Aslanian, H; Maple, J; Department of Gastroenterology and Hepatology, Beaumont Hospital, Dublin,, Ireland. harewood.gavin@gmail.com (2012-02-01)
      BACKGROUND: Occupational psychologists have identified three factors important in motivating physicians: financial reward, academic recognition, time off. AIM: To assess motivators among gastroenterology (GI) trainees. METHODS: A questionnaire was distributed to GI trainees to assess their motivators: (1) work fewer hours for less lucrative rate, (2) reduction in salary/increase in hours for academic protected time, and (3) work longer hours for higher total salary, but less lucrative hourly rate. RESULTS: Overall, 61 trainees responded; 52% of trainees would work shorter hours for less lucrative rate; 60% would accept a disproportionate reduction in salary/increase in hours for academic protected time; 54% would work longer hours for more money but less lucrative rate. Most trainees (93%) accepted at least one scenario. CONCLUSIONS: Most GI trainees are willing to modify their job description to align with their personal values. Tailoring job descriptions according to these values can yield economic benefits to GI Divisions.
    • What do you think of us? Evaluating patient knowledge of and satisfaction with a psychiatric outpatient service.

      Jabbar, F; Casey, P; Schelten, S L; Kelly, B D; Department of Adult Psychiatry, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin 7, Ireland. (2011-03)
      This study aimed to measure patient satisfaction with the care they were receiving; examine patients' knowledge of the psychiatric services in general; and identify variables associated with satisfaction.
    • What have shorter working hours for doctors achieved

      Murphy, J F A (Irish Medical Journal, 2011-04)
      The first years after qualification are difficult for all doctors. Itâ s a lot of responsibility for someone in their mid- twenties. The work is hard and complex and it takes time to acquire the ability to translate the theoretical knowledge acquired at medical school into clinical practice. Neal Chatterjee 1 has recently described the initial rawness and impact of hospital life on the new resident. There are ever-lit hallways, the cacophony of overhead pages, near constant bleeps and buzzes and the stale smell of hospital linen. Itâ s a foreign world in which the new doctor encounters daily stressful experiences. The question now being asked is whether it needs to be so daunting. Can the working conditions and the environment be improved?
    • What is my risk of developing cardiovascular disease?

      Graham, Ian M; Cooney, Marie-Therese; Dudina, Alexandra; Squarta, Sophie; Trinity College and Department of Cardiology, The Adelaide and Meath Hospital, Incorporating National Childrens' Hospital Tallaght, Dublin, Ireland., ian.graham@amnch.ie (2012-02-01)
    • What is new in obstetric antecedents of chronic disease? Best articles from the past year.

      Malone, Fergal D; Rotunda Hospital (2014-04)
      This month, we focus on current research in obstetric antecedents of chronic disease. Dr Malone discusses four recent publications, and each is concluded with a "bottom line" that is the take-home message. The complete reference for each can be found in on this page along with direct links to the abstracts.
    • What is the place of new risk markers in the prediction of cardiovascular disease

      DeBacker, G; Cooney, MT; Graham, IM (European Journal Cardiovascular Prevention Rehabilitation, 2011)
    • What is the role and value of extra-mural medical activity

      Murphy, JFA (Irish Medical Journal, 2013-08-20)
      Presently all Irish doctors, apart from trainees, are in the process of getting their educational activities for the past year in order for enrolment in the new medical competence scheme. The intra-mural component is understandable and makes common sense. It gives an existence to oneâ s daily professional life. It is about meeting with oneâ s colleagues at least once a week to discuss aspects of patient care, review of radiological findings and the presentation of data from recent medical papers. The process is cost neutral, time efficient and beneficial for both patients and doctors. It is an important driver for the audit programme. In addition to its educational value it is good for team building and personal professional development. It may not sound very glamorous but its potential is considerable
    • What is the value of ultrasound soft tissue measurements in the prediction of abnormal fetal growth?

      Farah, N; Stuart, B; Donnelly, V; Rafferty, G; Turner, M; UCD School of Medicine and Medical Science, Coombe Women and Infants University, Hospital, Dublin 8, Ireland. nadine.farah@ucd.ie (2012-02-01)
      Abnormal fetal growth increases the complications of pregnancy not only for the baby but also for the mother. Growth abnormalities also have lifelong consequences. These babies are at increased risk of insulin resistance, diabetes and hypertension later in life. It is important to identify these babies antenatally to optimise their clinical care. Although used extensively antenatally to monitor fetal growth, ultrasound has its limitations. Despite the use of more than 50 different formulae to estimate fetal weight, their performance has been poor at the extremes of fetal weight. Over the past 20 years there has been emerging interest in studying fetal soft tissue measurements to improve detection of growth abnormalities. This review paper outlines the value of soft tissue measurements in identifying fetal growth abnormalities, in estimating fetal weight and in managing diabetes mellitus in pregnancy.