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PubMed2004

Maternal brain death, pregnancy and the foetus: the medico-legal implications for Ireland.

This paper examines some of the medico-legal issues that arose as a result of a situation which occurred in May 2001 in Ireland when a woman who was a British citizen and who was fourteen weeks pregnant collapsed and suffered a brain haemorrhage. She was taken to hospital where she was placed on life support but declared brain-dead. As a result of the uncertainty regarding the hospital's obligation to the foetus, life-support was maintained until further opinion was sought. After two weeks the foetus died and life support was only then discontinued. In Ireland there currently exists neither medical guidelines nor legislation to regulate such areas of medical practice. Also, the courts have not had the opportunity to comment on this particular matter and thus there exists widespread concern as to how healthcare providers will act if such situation were to occur again in the future. This article examines the following difficult medico-legal implications that arise from the above situation and especially in light of the constitutional protection of the unborn child in Ireland.

Brain Death↗
PubMed2004

The burden of severe pneumococcal infection in Ireland: potential effectiveness and indirect benefits of the 7-valent pneumococcal conjugate vaccine.

This study attempts to overcome the problem of under-reporting of serious pneumococcal infection in the Republic of Ireland by adding a proportion of 'unspecified' disease to pneumococcal disease reports. ICD-9 data for all age groups was collected on meningitis (from the National Disease Surveillance Centre), and septicaemia and pneumonia (from the Hospital In-Patient Enquiry system) for the year 1999. A 7-valent pneumococcal conjugate vaccine (PCV) has been shown to have significant effectiveness in the target paediatric age group and also indirect herd effects on the US adult population. The implications of these direct and indirect effects were applied to the epidemiology of serious pneumococcal infection in Ireland. The annual reported incidence rates for laboratory confirmed severe pneumococcal disease in Ireland in 1999 may underestimate both the morbidity and mortality of disease by 21% and 28% respectively. In all age groups 1,183 cases and 132 deaths may be prevented annually by the introduction of the vaccine. In addition, the vaccine provides an effective new tool for reducing disease caused by antibiotic resistant pneumococci thus assisting in the control of anti-microbial resistance in humans.

Age Distribution↗
PubMed2005

The incidence of S. aureus bacteraemia in acute hospitals of the Mid-Western Area, Ireland, 2002-2004.

Concerns about healthcare-associated infections and the global crisis in antimicrobial resistance has combined to accentuate the fears around so-called "superbugs". In Ireland there is no single agreed indicator regarded as a true measure of the level of methicillin resistant Staphylococcus aureus (MRSA) in hospitals. The objective of this study was to compare two crude measures of MRSA--the percentage of bacteraemia caused by MRSA and the incidence rate (per 1000 bed days used) of MRSA bacteraemia in six acute hospitals. We examined all blood cultures positive for S. aureus (methicillin sensitive and resistant) from 2002 to 2004 in the Health Service Executive (HSE) Mid-Western Area of Ireland. Hospital In-Patient Enquiry (HIPE) data was used to determine monthly in-patient bed days used. Of 245 patient episodes of bacteraemia, 119 were MRSA. The trends in the percentage of isolates that were MRSA and the incidence rate calculated were compared. The incidence rate appears to be a more reliable and robust indicator of MRSA in hospitals than the percentage. Despite many difficulties in interpreting indicators of MRSA they should not preclude the regular publication of data at least at regional level in Ireland.

Acute Disease↗
PubMed2006

Substance abuse in pregnancy: opioid substitution in a northern Ireland maternity unit.

An increase in illicit drug use in Northern Ireland may well have links to the resolution of political conflict, which started in the mid 1990s. Social issues, heretofore hidden, have emerged into the limelight and may be worsened by paramilitary involvement. Registered addicts in the four Health Board areas have shown an increase from 1997 with the greatest number resident within the Northern Board Area. As the prevalence of heroin use in Northern Ireland increased, the Department of Health and Social Services and Public Safety (DHSSPS) commissioned a report, to recommend the development of substitute prescribing services. A case series of pregnancies was reviewed, within the Northern Board Area, where the mother was taking opioid substitution therapy. This resulted in baseline data of outcome for both mother and baby specific to a Northern Ireland population. The different medications for opioid substitution are also assessed. This information will guide a co-ordinated approach that involves obstetrician, anaesthetist, psychiatrist, midwife and social worker to the care of these high-risk pregnancies. Eighteen pregnancies were identified in the study period. Sixteen of these had viable outcomes. One was a twin pregnancy. Outcome data was therefore available for 17 infants. Information was obtained regarding patients' social and demographic background, drug taking behaviour and substitution regimen. Antenatal and intrapartum care was assessed and infants were followed up to the time of hospital discharge.

Adult↗
PubMed1991

Use of the autopsy in Northern Ireland and its value in perioperative deaths.

A report on the pilot study of the Confidential Enquiry into Perioperative Deaths was published recently in the United Kingdom. The scheme was designed as a specialized form of clinical audit relating to perioperative patient care. Because the report placed little emphasis on autopsy, we have looked at all autopsied perioperative deaths, as defined by the enquiry, over a three-year period (1986-88) in a defined catchment area of Northern Ireland. Class I major discrepancies of diagnosis between clinical and postmortem records were found in 21% of 213 autopsied perioperative deaths. By definition, these represented instances in which an adverse impact on patient survival had resulted from the discrepancy. In an additional 29% of cases, there were Class II major discrepancies, which were discrepancies in the primary diagnosis not relevant to life-saving treatment. In 30% of cases there was a discrepancy in a secondary diagnosis, which might have affected the eventual prognosis, had the patient survived, but which was not related directly to the cause of death; these were termed Class III discrepancies. In 47% of cases, there were Class IV discrepant secondary diagnoses, which were 'incidental' findings and had no bearing on prognosis. To put these findings in context, the autopsy rate in Northern Ireland was 12% in 1987, with a higher rate (23%) in the two main teaching hospitals and a lower rate (8%) in all other hospitals. The rate of coroner's autopsies, 6%, is uniform throughout Northern Ireland. Coroner's autopsies are carried out mostly by the salaried staff of the State Pathologist's department. The observed differences in the rates of hospital autopsies reflect local deficiencies of pathologists in relation to the work load. In a series of consecutive autopsies carried out at one of the main teaching hospitals, the highest autopsy rate (68%) was found for paediatric patients, with rates of 29% for surgical and 23% for medical cases. The proportion of hospital autopsies carried out in perioperative surgical patients was the same as that for medical patients, reflecting the fact that no particular emphasis is placed on use of the autopsy as a form of clinical audit for the perioperative group.

Adolescent↗
PubMed1990

Cardiac pacing in Northern Ireland 1979-1988.

The implantation rate of cardiac pacemakers in Northern Ireland rose from 55.8 per million population in 1979 to over 180 per million in 1988, with the emergence of a second pacemaker implantation centre. However, the implantation rate in Northern Ireland remains less than that of many other countries. Over the period complete heart block fell as an indication from 45% to 34% and sinus node disease rose from 16% to 28%. Symptoms necessitating pacing remained unchanged, syncope being the most common. Ventricular demand pacemakers constituted a lower proportion of implants than anywhere else in the world and more atrial demand and dual chamber pacemakers were implanted than in most other countries. Insufficient patients are being referred for pacing in Northern Ireland but a high proportion of those who are referred receive modern sophisticated pacemakers.

Heart Diseases↗
PubMed1987

Death rates from diabetes mellitus in Ireland 1833-1983: a historical commentary.

A world-wide increase in diabetic deaths and a varying rate of increase between one country and another over the past hundred years has long been recognised. During the nineteenth century, the incidence of diabetes was low in Ireland as measured by mortality. Nevertheless, the rising trend found elsewhere was also apparent in Ireland. Recorded deaths were 0.22/100,000 of the population in 1840, rising to 13.2 by 1972. Most of the increase occurred between the 1880s and 1911, but only 15% of this can be accounted for by an ageing population. It is, therefore, necessary to seek other explanations. During the period, sugar and fat consumption in Ireland rose sharply. It has not been possible precisely to relate dietary causes to the incidence of diabetes, but the Irish experience suggests that such a link may exist.

Diabetes Mellitus↗
PubMed1987

Radionuclide monitoring in Northern Ireland of the Chernobyl nuclear reactor accident.

Northern Ireland received higher radiation doses due to the radionuclide contamination from the Chernobyl nuclear reactor accident than did the south of England. Levels of radioactive iodine ((131)I) and caesium ((137)Cs) in cows' milk in Northern Ireland increased to 166 and 120 Bq/l respectively in May 1986, but had decreased by factors of one million, and of twenty-five, respectively, by 1 September 1986. The resultant radiation doses represent less than one per cent of those received by a Northern Ireland individual over a period of 40 years from natural background radiation sources. The added risk to any individual from the Chernobyl accident will therefore be very small and may best be judged in the context of the enormously greater risk of death due to potentially preventable diseases, such as smoking-related lung cancer, and coronary heart disease.

Adult↗
PubMed1980

Death anxiety among university students in Northern Ireland and Canada.

Male and female university students in Northern Ireland (n = 315) and Canada (n = 255) completed Templer's Death Anxiety Scale (DAS) and the Taylor Manifest Anxiety Scale (MAS). Results of a discriminant function analysis indicated that Canadian students showed more concern about being afraid to die and thoughts of death, while students from the North of Ireland were more concerned about getting cancer, the shortness of life, and the viewing of a corpse. However, total DAS scores failed to show significance between group differences (p greater than .10). Correlations between DAS and MAS total scores were r = .34 for Northern Ireland and r = .31 for Canadian students.

Adult↗
PubMed1995

Transplantation for chronic pulmonary disease: referral and outcome in Northern Ireland, 1986-1990.

Eighteen patients have been referred for lung transplantations from Northern Ireland in 1986-1990. Fourteen were accepted but only four achieved transplantation. These rates are lower than for comparable regions in the North of England. The lung donation rate from Northern Ireland during the same period was similar to that for the United Kingdom as a whole. The low referral and transplant rates for Northern Ireland require reassessment of the procedures involved.

Heart-Lung Transplantation↗
PubMed1993

Social and behavioural predictors of women's cancer screening practices in Northern Ireland.

The aim of this study was to describe the extent of cancer screening practices among women resident in Northern Ireland and to identify the social and behavioural characteristics associated with these practices. The study involved a survey of adults resident in the community in Northern Ireland. Contact was made with a sample of 1162 residents who were asked to complete a questionnaire about preventive health practices and attitudes. This produced a response rate of 65.1 per cent. Of these, 391 were women who were asked questions about breast self-examination (BSE), attendance for cervical screening, and certain social and behavioural factors. Approximately 28 per cent of the women performed BSE regularly, a further 28 per cent performed it occasionally, and the remainder rarely or not at all. Almost 20 per cent of the women had had a smear test once, 48 per cent several times, and the rest never. Performance of BSE and attendance for smear tests and BSE was more common among those women aged 35-54 years, who were married, worked outside the home, and whose religion was Church of Ireland (Anglican). The most frequent reason given for not performing BSE was fear of finding a lump and ignorance of the procedure. The most frequent reason given for non-attendance for a smear test was that it was not thought necessary at their age. Public health strategies designed to promote cancer screening need to consider the value of directing their campaigns at those who are most reluctant to perform these practices.

Adult↗
PubMed1996

The provision of adult intensive care in Northern Ireland with reference to the role of high dependency care.

In 1991 an audit of Intensive Care Services was carried out by the Northern Ireland Intensive Care Group. In conjunction with this regional overview, all patients in the Regional Intensive Care Unit, (RICU) in the Royal Victoria Hospital were assessed daily, over a 10 month period in 1990-91 and classified as conforming to either intensive care or high dependency status. These data were then used to compare adult intensive care service in Northern Ireland with recent national and international recommendations on intensive care. Ten units in Northern Ireland were surveyed. In regard to national or international guidelines, all ten were deficient to some degree. Four units had significant deficiencies; small patient numbers, lack of 'dedicated' 24 hr medical cover and or deficiencies in the provision of appropriate monitoring and or equipment. There was a large diversity in casemix among the ten units surveyed which suggested differing admission criteria. The bed occupancy of RICU was 100%. Refused admissions constituted a further 13% of unresourced workload. The lack of physically separate, dedicated high dependency unit facilities meant that 26% of bed days were devoted to HDU care (usually for "improved" intensive care unit patients not yet ready for discharge to a general ward. Achieving nationally recommended intensive care standards (on a regional basis) is probably only possible if a number of the smaller intensive care units are redesignated as high dependency units, and patients requiring intensive care are concentrated in a smaller number of larger ICUs. This will increase the frequency of interhospital transfer of critically ill patients.

APACHE↗
PubMed1997

Assaults against general practitioners in Ireland.

BACKGROUND AND OBJECTIVES: Violence directed at general practitioners (GPs) is on the increase in urban areas of Ireland. However, little information has been available on the incidence, effects, or precipitants of this violence. This study documents the frequency of the problem in Ireland's capital city, Dublin. METHODS: A survey was sent to all 634 GPs in the Eastern Health Board region of Ireland. The survey asked each GP to report an incident of violence or aggression using standardized definitions and reporting forms. The survey also requested that participants provide information on their practice and its staff and setting. RESULTS: We collected information from 622 of 634 doctors (98%). The overall incidence of violence or aggression in the sample was 21%. Of the 131 incidents reported, only 7% resulted in injury to the doctor; the remainder all involved verbal abuse and/or threats. The most frequent assailant characteristics identified were alcohol or opiate abuse. CONCLUSIONS: Violence and aggression against GPs are common. Several interventions are discussed.

Adult↗
PubMed1997

Nosological Inaccuracies in death certification in Northern Ireland. A comparative study between hospital doctors and general practitioners.

We aimed to audit nosological inaccuracies in death certification in Northern Ireland and to compare performance of hospital doctors and general practitioners. Nosology is the branch of medicine which treats of the classification of disease. 1138 deaths were registered in Northern Ireland in a 4-week period commencing 3/10/94. 195 of these were either registered by HM Coroners (HMC) or required further investigation by their staff; these cases were excluded from the study. The remaining 943 were analysed for wording and formulation inaccuracies according to the revised notes (1974), Northern Ireland Medical Certificate of Cause of Death. These are issued in book form by the Registrar of Births and Deaths. The commonest inaccuracies in death certification occur in the areas of poor terminology, sequence errors and unqualified mode. One or more inaccuracies were found in 317 (33.6%) of cases. In 13 of these (4%) cases, the inaccuracies were serious enough to warrant referral by the Registrar of Deaths to HM Coroner. The numbers of general practitioners and hospital doctors were recorded, with general practitioners being responsible for 122 (38%) and hospital doctors being responsible for 195 (62%) of inaccuracies.

Cause of Death↗
PubMed1997

Prescription of oxygen concentrators and survival in Northern Ireland.

Long-term oxygen therapy (LTOT) has been shown to prolong survival and to improve quality of life in patients with chronic obstructive pulmonary disease (COPD) and in respiratory failure. In Northern Ireland oxygen concentrators have been available on prescription since August 1986, initially on a restricted basis from hospital physicians only. This was followed by open prescribing from April 1989, when concentrators could be prescribed by general practitioners. This study examined prescribing habits of LTOT during both periods, and patient survival. Case notes of all prescriptions of oxygen concentrators in Northern Ireland (to April 1991) were reviewed. Prescription criteria and advice regarding usage during both periods were analysed. A questionnaire survey of subjects during open prescribing documented the advice given at the time of prescription and current usage. 164 charts of 178 total installations were available for review. During both periods many concentrators were installed without adherence to the prescribing criteria at the time (75% restricted, 48% open). The majority of these were on the advice of a consultant respiratory physician and only 14 were prescribed directly by GPs. 89 of 91 subjects receiving current LTOT during the study period completed questionnaires. Of the subjects prescribed LTOT during the restricted period, 2 subjects are still alive (median survival 19 m, range 0-104). From the open period, survival data was available on 107 of 129 subjects with 17 still alive (median survival 22 m, range 0-94). This study documents an inadequate rate of prescribing and a lack of conformity to guidelines in the provision of LTOT in Northern Ireland. We would suggest that familiarisation with the prescribing criteria, formal written advice at the time of prescription, appropriate follow up to ensure adequate supplementation and regular patient education on the use of LTOT would address these problems to a substantial degree.

Aged↗
PubMed1997

The Unlinked Anonymous HIV Prevalence Monitoring Programme in N. Ireland 1992-1995.

Previous evidence has suggested that Northern Ireland is a low seroprevalence area for HIV infection. The Unlinked Anonymous HIV Prevalence Monitoring Programme initiated in England and Wales in 1990 was extended to Northern Ireland in 1992. Patients attending the Genitourinary Medicine Clinic at the Royal Victoria Hospital have, with informed consent, been tested anonymously for HIV infection since that time. The results of the survey between 1992 and 1995 have shown an overall seroprevalence rate 3.01% for homosexual/bisexual men, 0.08% for heterosexual men, and 0.05% for heterosexual women. These results confirm the previous impression of low HIV seroprevalence in Northern Ireland and the survey provides an excellent longitudinal study by which changes may be monitored.

AIDS Serodiagnosis↗
PubMed1997

A survey of exercise based cardiac rehabilitation services in Northern Ireland.

A survey was undertaken to establish the extent of provision of phase III exercise-based cardiac rehabilitation in Northern Ireland. Detailed information was obtained on patient referral mechanisms, patient assessment, the exercise component of cardiac rehabilitation and the use of outcome measures. The results suggest that cardiac rehabilitation in Northern Ireland has developed on an ad hoc basis, and although most centres accept myocardial infarction and coronary artery bypass graft patients for cardiac rehabilitation, higher risk patients are generally excluded from these programmes. Currently, little in the way of standard outcome measures are being used to evaluate the effectiveness of existing cardiac rehabilitation services. This paper makes several recommendations to facilitate the development of a more standardised service within Northern Ireland.

Coronary Artery Bypass↗
PubMed1998

An audit of acute psychiatric admission bed occupancy in Northern Ireland.

The Northern Ireland Section (Irish Division) of the Royal College of Psychiatrists were requested to investigate apparent increasing pressures on acute psychiatric beds. Information on bed occupancy and associated service activity was collected by clinicians on site in every psychiatric unit in Northern Ireland over the past eight years. Three separate years (1987, 1991 and 1995) were studied. Bed occupancy rose across these three years. There was an associated reduction in the number of acute psychiatric beds, reduction in adult continuing care beds, increased recorded referrals to psychiatric units and evidence of considerable numbers of new long-stay patients and difficulties with community placements. Acute bed occupancy in Northern Ireland is high, frequently over 100% and rising. Occupancy rose between each of the years studied. The problem is not confined to urban areas and several associated service factors may be contributing. Without change, acute bed provision will inevitably fail to match mental health needs.

Adult↗