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PubMedDate not supplied

Establishing an intracytoplasmic sperm injection (ICSI) programme for the treatment of male factor infertility in Ireland.

This paper chronicles the introduction and initial experiences of Intra Cytoplasmic Sperm Injection (ICSI) as a treatment for severe male factor infertility in Ireland. Following initial development of the technique using a bovine model, therapy was offered clinically from September 1995. Up to March 1996 a total of 60 couples underwent the procedure. Fertilisation and embryo transfers were achieved in 50 of these (83.3 percent). Fourteen (23 percent) became clinically pregnant per cycle commenced, 28 percent per embryo transfer. Despite a drop in the total number of oocytes available, fertilisation rates rose over the 6 months of the study from 22 percent to 54 percent. There were 2 miscarriages (14.2 percent) and the multiple pregnancy rate was 28.5 percent. Eight singletons, 2 twins and 2 triplet sets have been successfully delivered. Provided there is proper patient selection, ICSI should prove a valuable addition to treatment options available to infertile couples in Ireland.

Adult↗
PubMedDate not supplied

Prevalence of rheumatoid arthritis in Dublin, Ireland: a population based survey.

The prevalence of Rheumatoid Arthritis (RA) in Ireland has never been established. Studies from different countries show varying rates, being almost 100 per cent greater in the highlands of Scotland (10/1,000) than in rural Lesotho (6/1,000). A recent study also suggests a fall in the prevalence of RA among women in the London urban area. Given these variations the validity of extrapolating prevalence rates established for other countries to Ireland is questionable. This study aimed to establish a prevalence rate for RA in a defined Dublin population. A self-administered questionnaire was sent to 2,500 people chosen at random from the electoral register. The questionnaire was designed to select out both undiagnosed patients and those with definite arthritis. Respondents whose replies indicated an arthritic process, but in whom no diagnosis had been made, were asked to attend for further assessment and investigations as appropriate. Those who responded that they had been diagnosed with arthritis were asked for consent to inspect their hospital or general practitioner records. A diagnosis of RA was based on American Rheumatism Association (ARA) criteria. Valid responses were received from 1,227 people surveyed (response rate = 49 per cent). Six cases of RA were identified including 2 previously undiagnosed cases. A prevalence rate of 5/1,000 has been estimated based on these findings.

Adult↗
PubMed1995

The relationship between the tuberculin test and the Kveim test in sarcoidosis in Ireland.

The aim of this study was to correlate tuberculin reactivity with the Kveim test in sarcoidosis. Case records 1983-91 inclusive, of those patients with positive Kveim tests and recorded tuberculin tests in an acute regional general hospital serving south-west Ireland (counties Cork and Kerry) were reviewed. Of 39 patients with positive Kveim tests 28 (72%) were tuberculin negative to a test dose of 10 tuberculin units or more. The group was slightly though significantly younger (p < 0.05) in age than the corresponding group (n = 11; 28%) with positive tuberculin tests. The incidence of tuberculin reactivity in the presence of Kveim reaction is higher than that expected for sarcoidosis. Corresponding studies in Britain and Scandinavia show a considerably lower tuberculin positive rate, which may be due to a lower prevalence of tuberculosis in these countries. However the younger age of the tuberculin negative group in our study may reflect a continuing decline in tuberculosis prevalence in south-west Ireland.

Adult↗
PubMed1993

Decompression sickness in Ireland--a review.

In the last decade there has been an increase in the incidence of decompression sickness in Ireland. The modern diver, equipped with specially developed diving equipment, is exposed to abnormal physiological conditions. This has resulted in a spectrum of medical conditions, which need to be recognised, diagnosed and treated. The department of Underwater Medicine at University College Hospital, Galway, is the only referral centre in the Republic of Ireland for patients suffering from decompression sickness. Early recognition and referral for treatment dramatically improves patient outcome. A one year's review of patients referred for treatment is presented.

Adult↗
PubMedDate not supplied

Prevalence and aetiology of leg ulcers in Ireland.

BACKGROUND: The prevalence of leg ulcer disease in Ireland has been poorly documented. AIMS: This study aimed to investigate the aetiology and prevalence of leg ulcers in one health district. METHODS: All patients receiving healthcare for an active leg ulcer in the Mid-Western Health Board (MWHB) region of Ireland (population: 317,069) were identified in a defined two-month period. A cross-sectional survey of all healthcare workers providing care to patients with leg ulceration was carried out. Patients with leg ulcers of uncertain cause were invited for follow-up assessment to establish the underlying cause. RESULTS: There were 389 patients with leg ulcers with a mean (standard deviation [SD]) age of 72.3 (11.1) years. The prevalence was 0.12% but it was 1.03% in patients aged 70 years and over. Women were twice as likely to be affected. Venous disease accounted for 81% of ulcers, and arterial disease for 16.3%, while ulceration due to diabetic neuropathy and rheumatoid vasculitis was unusual. CONCLUSION: Leg ulcers are an important source of morbidity in our ageing population. Effective treatment programmes could diminish the impact of this debilitating disease on the health service.

Adult↗
PubMedDate not supplied

Has there been a turning point in the numbers of AIDS and HIV antibody positive cases in Ireland?

BACKGROUND: Major developments in the prevention and treatment of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) have taken place in recent years. Changes in the size of the HIV and AIDS epidemic need to be monitored to assess these developments and plan future services. AIMS: To describe temporal trends in the incidence of HIV and AIDS in Ireland, describing separately the major risk groups, and to explore possible associations between these trends with developments in care. METHODS: The annual numbers of HIV and AIDS in Ireland were analysed to determine whether there has been a turning point in incidence. RESULTS: For AIDS, there has been an overall decrease in numbers since 1993, with both homosexual and intravenous drug users (IDU) risk groups exhibiting a decrease. For HIV antibody positive individuals, overall numbers have remained constant. However, there has been an upward trend in the heterosexual risk group and a downward trend in the IDU risk group. Thus both AIDS and HIV numbers exhibit turning points. CONCLUSIONS: Declines in HIV and AIDS incidence in the homosexual and IDU risk groups are indirectly attributable to health safety and treatment programmes. The increase in HIV antibody positive cases among heterosexuals may reflect a relapse in safe sex behaviour.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The first 20 years of heart transplantation in Ireland.

BACKGROUND: The first Irish heart transplant was performed on the 10th of September 1985. Over the next 20 years, 229 transplants were performed in 228 recipients. AIMS: To evaluate the success of the first generation of cardiac transplantation in Ireland. METHODS: Analysis of clinical outcomes and survival statistics for patients undergoing heart transplantation in Ireland and comparison with international standards. RESULTS: There has been a steady improvement in transplant outcome over this time and survival figures for recipients between 2000 and 2004 show a hospital, 1-year and 5-year survival rate of 85.7%, 84.1% and 76.8% respectively. Thirty-eight of the 99 heart transplants performed between 1985 and 1994 are still alive more than 10 years later and the longest survivor is now 19 years post transplantation. CONCLUSIONS: The results compare favourably with international figures. Heart transplantation offers excellent longterm survival and quality of life but remains challenged by a shortage of suitable donor organs.

Adolescent↗
PubMedDate not supplied

Trends in ophthalmic surgery in Ireland.

AIMS: This study was designed to document the changing trends in ophthalmic surgery in acute public hospitals in the Republic of Ireland over the years 1994 to 2001. METHOD: We obtained Hospital In-Patient Enquiry (HIPE) data returned from the major acute public hospitals to the Economic and Social Research Institute. We searched for cataracts, glaucoma, retinal detachment, strabismus, corneal transplant and repair of perforating injuries of the globe. RESULTS: There was a 24% increase in the total number of the searched operations occurring during the study period, from 8,857 procedures in 1994 to 11,005 in 2001. In 2001, cataract surgery alone counted for 82% of all procedures performed. There was a large increase in cataract (49%) and vitreo-retinal procedures (41%) reported between 1994 and 2001. Conversely, a large fall in trabeculectomy (67%), strabismus (63%) and corneal transplant (52%) procedures occurred during the study period. CONCLUSION: These data suggest that surgical numbers in ophthalmology in Ireland are increasing and the relative proportions are changing.

Hospitals, Public↗
PubMedDate not supplied

The increasing prevalence of childhood sickle-cell disease in Ireland.

BACKGROUND: Ireland has been relatively free of sickle-cell disease (SCD) and a care policy for the disease has not been established. AIM: To determine the prevalence of childhood SCD in Ireland and to predict requirements for a comprehensive care and assessment programme. METHODS: We retrospectively analysed the data of children with SCD presenting with sickle-cell crisis to one institution from January 1999 to April 2001. We also determined the nature and severity of the presenting haemoglobinopathy phenotype. RESULTS: Ninety-two patients with haemoglobinopathy have been registered with the Paediatric Haematology Service. The majority are from Nigeria with a smaller number from Angola and the Congo. Sixty have sickle-cell trait, 23 SCD, four haemoglobin SC disease and two haemoglobin E (HbE). There have been 32 sickle-cell crises. The majority were haemolytic or splenic sequestration events with a smaller number of aplastic and vaso-occlusive events and one osteomyelitis. CONCLUSION: The increasing number of children presenting with SCD as a result of the increasing refugee numbers requires a comprehensive care approach similar to that required for paediatric haemophilia to ensure optimum care.

Adolescent↗
PubMed1991

The development of a programme of care for elderly people in Northern Ireland.

This paper describes the development of a Programme of Care for elderly people in Northern Ireland. The problems of the elderly were previously identified, and a classification system was designed in key areas which allocated groups of individuals with similar needs to particular services. It was thus possible to quantify the resources required to meet the future needs of elderly people in Northern Ireland. The major implications for the Health and Social Services were then stressed on the basis of certain assumptions. Generally, resources are currently being channelled in the right direction but considerable expansion of resources is necessary in the future especially in community care. In showing one method of planning services for the elderly people and the possible results, this study also offers a methodology to assist the planning process in general.

Aged↗
PubMed2004

A study of bone mineral density in women with forearm fracture in Northern Ireland.

A group of Northern Ireland women aged 40-75 years of age with low-trauma forearm fracture were studied to determine the incidence of such fractures and the prevalence of osteoporosis in this fracture population. A total of 1,147 subjects were identified in 1997 and 1998 throughout Northern Ireland following low-trauma forearm fractures, as well as 699 residents in the Eastern Health and Social Services Board (EHSSB), enabling calculation of the annual incidence rate of new low-trauma forearm fractures at 2.69/1,000 population aged 40-75. A total of 375 participants consented to have bone mineral density (BMD) measurements undertaken at the femoral neck, spine, and forearm using a Lunar Expert bone densitometer. Osteoporosis at the femur was present in 14% of women, at the spine in 29%, and at the forearm in 32%. A total of 45% were osteoporotic at one or more measured sites, but only 18% were on treatment for osteoporosis. Additional significant risk factors identified included an early menopause in 24.5% and current or previous corticosteroid use in 13%. Only 1.6% received information on treatment of osteoporosis at the time of fracture. Increased awareness is needed in both primary and secondary care including fracture services to improve treatment of women with low-trauma fracture.

Adult↗
PubMed2006

Effect of clinical trial publicity on HRT prescribing in Ireland.

OBJECTIVE: To evaluate the effect of publicity surrounding the Women's Health Initiative (WHI) and Million Women (MW) studies on prescribing of all hormone replacement therapy (HRT) preparations and bisphosphonates in Ireland. METHODS: The General Medical Services (GMS) prescription database was used to identify the study population. Prescriptions were identified for HRT and bisphosphonate preparations [using WHO Anatomical Therapeutic Chemical (ATC) classification codes] in female patients aged 45-69 years in Ireland during a 4-year study period (January 2001-December 2004). Prescription rates were calculated monthly. Prevalence and incidence of HRT use was examined. RESULTS: There was a significant reduction in prevalence for all HRT preparations following the WHI trial (test for change in trend p<0.0001), which persisted after the MW study. The incidence of combined oestrogen/progestogen HRT declined after the WHI trial (test for change in trend p=0.004). Bisphosphonate prescribing showed a significant increase throughout the study period (p<0.0001). CONCLUSION: The findings suggest that coverage surrounding the publication of clinical trials appears to have had a negative impact on the rate of HRT prescribing. The findings regarding the coincident increase in use of bisphosphonates may suggest that prescribers and users were less likely to regard HRT as an appropriate therapy in the management of osteoporosis for some time before guidance was issued by the regulatory authorities.

Advertising↗
PubMed2005

Population frequency of HLA haplotypes contributes to the prevalence difference of multiple sclerosis in Ireland.

BACKGROUND: A recent epidemiological study of multiple sclerosis in County Donegal in the northwest of Ireland and County Wexford in the southeast found a significant prevalence difference of 63.9/100,000 (95% CI 49.3-82.7/100,000) between the two regions (Z = 3.94, p <or= 0.001). County Donegal had a higher prevalence rate than County Wexford (184.6/100,000 vs. 120.7/ 100,000). The aim of this paper is to examine whether the MS prevalence difference between the two counties is due to population differences in the genetic predisposition to MS. METHODS: Seventy-three MS patients from County Donegal and 45 from County Wexford participated in the study and 200 control subjects were enrolled from each county. Blood samples from both MS populations and control populations were HLA typed for DRB1 and DQB1 alleles. RESULTS: The strong association with the development of MS and the HLA DRB1*1501 and DQB1*0602 phenotypes was confirmed in both patient populations relative to controls. The Donegal sample control population also had a significantly higher carriage rate of the HLA DRB1*1501 - DQB1*0602 haplotype relative to the Wexford sample control population (chi(2) = 5.02, p <or= 0.05,OR = 1.616, CI 1.060-2.464, p = 0.05). CONCLUSION: Although the numbers tested in this study were small the results suggest one of the factors accounting for the difference in MS prevalence across the island of Ireland is likely to be variation in the genetic predisposition to MS within the Irish population.

Alleles↗
PubMed2006

A study of male patients with forearm fracture in Northern Ireland.

Osteoporosis, although considered less common, still occurs in men. We present a cross-sectional study of a group of Northern Ireland men with low-trauma forearm fractures to determine the presence of osteoporosis and screen for secondary causes of low bone mineral density. Male patients aged 30-75 years, presenting with distal forearm fracture in 2000-2001 in Northern Ireland, were identified through a Colles fracture database. A total of 37 subjects consented to have bone mineral density measurements undertaken at the femoral neck, spine and forearm using a Lunar expert bone densitometer. Twenty-seven percent of the men had osteoporosis at the spine, femoral neck or forearm, as defined by a bone mineral density score of less than -2.5. We also found that 49% of patients had vitamin D insufficiency or deficiency, 27% had low serum testosterone, 14% had abnormal liver function test results, and 14% had raised parathyroid hormone. Only one patient received advice or treatment regarding osteoporosis at the time of fracture. Increased awareness of male osteoporosis and the need for screening for potential secondary causes in this group of patients is required, both at primary and secondary care level.

Adult↗
PubMed2005

Impact of the European Antimicrobial Resistance Surveillance System on the development of a national programme to monitor resistance in Staphylococcus aureus and Streptococcus pneumoniae in Ireland, 1999-2003.

Presented here is the 5-year impact of a national antimicrobial resistance surveillance system in Ireland, which was introduced in accordance with the European Antimicrobial Resistance Surveillance System (EARSS). Participation in EARSS began in Ireland in 1999. Initially, 12 laboratories serving a mix of general and tertiary hospitals participated, but by 2003, participation had increased to 28 laboratories with a population coverage of 89%. During 1999-2003, 4,146 episodes of Staphylococcus aureus bacteraemia were reported, and methicillin resistance was detected in 1,709 (41.2%) of these isolates. Over the same period, 1,245 invasive (blood or cerebrospinal fluid) episodes of Streptococcus pneumoniae infection were reported, and 160 (12.9%) isolates were found to be non-susceptible to penicillin, with 23 (1.8%) demonstrating high-level penicillin resistance. By 2003, most Irish hospitals were participating in EARSS, which has been a catalyst for the development of a national antimicrobial resistance surveillance programme.

Drug Resistance, Bacterial↗
PubMed2004

Pricing and reimbursement of drugs in Ireland.

Expenditure on healthcare in Ireland, which is mainly derived from taxation, has increased considerably in recent years to an estimated 9.2 billion euro in 2003. Pharmaceuticals account for approximately 10% of total healthcare expenditure. Approximately one-third of patients receive their medications free of charge whilst the remaining two-thirds are subject to a co-payment threshold of 78 euro per month, i.e. 936 euro per year. The price of medications in Ireland is linked to those of five other member states where the price to the wholesaler of any medication will not exceed the lesser of the currency-adjusted wholesale price in the United Kingdom or the average of wholesale prices in Denmark, France, Germany, The Netherlands and the United Kingdom. A price freeze at the introduction price has been in existence since 1993. Despite the price freeze, expenditure on medicines on the community drugs scheme has increased from 201 million euro in 1993 to 898 million euro in 2002. The two main factors contributing to the increased expenditure on medicines include "product mix", the prescribing of new and more expensive medication, and "volume effect" comprising growth in the number of prescription items. Changing demographics and the extension of the General Medical Services (GMS) Scheme to provide free medicines for all those over the age of 70 years have also contributed. Prior to reimbursement under the community drugs schemes, a medicine must be included in the GMS code book or positive list. A demonstration of cost-effectiveness is not a pre-requisite for reimbursement.

Costs and Cost Analysis↗
PubMed2004

The high cost of medicines in Ireland. Is it time to change the pricing mechanism?

This study compared the prices of prescription medicines in Ireland to those in other countries to determine potential cost savings on the largest community drug scheme if an alternative pricing mechanism were adopted. The analysis covered a sample of 39 drugs (44.8% of the total ingredient cost) selected from the top 70 drugs in order of total ingredient cost. Potential cost savings ranged from Euro 20.73 million if a Danish price were adopted, to Euro 16.23 million for the average European price, to Euro 6.82 million for the UK price. The estimated savings were statistically significant for the Danish and average European price but not for the UK price. This study demonstrates the high ex-wholesale price of prescription medications in Ireland.

Cost Control↗
PubMed2004

Providing pharmacy services to care homes in Northern Ireland: a survey of community pharmacists' views.

OBJECTIVE: This study sought to explore the views of community pharmacists as to their present and potential role in providing care to the residents of nursing and residential home in Northern Ireland. METHOD: A structured questionnaire was developed and mailed to all community pharmacists in Northern Ireland (n = 508) on 2 occasions. RESULTS: A response rate of 50% was achieved. Over 40% of responding pharmacists (42.1%) were currently providing medication-related services to care homes for the elderly and 57.9% were not. Of those who were providing services, 50 to 80% were already providing advice to care homes regarding record-keeping, compliance devices, storage and administration of medicines and the use of more appropriate formulations. More than 75% of pharmacists who were not providing services to care homes for the elderly supported all services detailed in a checklist provided on the questionnaire. For pharmacists who were providing services to care homes, 89% agreed that they required access to an up-to-date medical history of care home residents. Over 60% of pharmacists who worked with care homes had experienced difficulties when ordering prescriptions from general practice surgeries. Just over 75% of all respondents stated that they wanted to be more involved in providing pharmaceutical services to care homes to the elderly. CONCLUSION: Community pharmacists expressed enthusiasm for provision of services to care home residents. On-going developments in community pharmacy practice in the UK may facilitate the development of this role and may guide policy development for long-term care in other countries.

Aged↗