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PubMed1994

Palliative care services in Britain and Ireland--update 1991.

The objective of this study was to repeat part of a survey carried out the previous year and to describe and quantify the hospice and palliative care inpatient units throughout Great Britain and Ireland for the year 1991, this also to include a survey of palliative care day centres and hospital support services. Questionnaires were sent to 346 hospice and palliative care services in Great Britain and Ireland. Replies were analysed by the Hospice Information Service. A total of 293 replies were received (84% response). The report details bed usage, length of stay and admissions, deaths and discharges in inpatients units. It also describes provision of day centre places and types of services offered. An initial assessment is made of the different types of hospital palliative care support services available. An estimate of the number of patients receiving palliative care in inpatient units and in day care centres is made.

Day Care, Medical↗
PubMedDate not supplied

Concomitant HIV and mycobacterial infection in Ireland, 1987-92.

A six-year retrospective review of concomitant HIV and mycobacterial infection in the Republic of Ireland is presented. A total of 42 culture proven mycobacterial infections were seen in 40 different HIV-infected patients. There were 24 infections with Mycobacterium tuberculosis (M.tb) and 18 infections with mycobacteria other than tuberculosis (MOTT), a significantly higher rate of MOTT infections in Ireland compared to a study from 1962-1981. The detection rate for all mycobacterial infections had an annual upward trend with a 4-fold increase between 1987 and 1992. In homosexuals, MOTT infections occurred more frequently than M.tb, while the reverse was true for IVDUs. Twenty per cent of the infections were seen in patients recently incarcerated. Relapse of tuberculosis occurred in 42.9% (3/7) of non-compliant patients, 2 of whom developed rifampin-resistant strains of M.tb. No patient compliant to their regimen had a relapse in disease. The overall survival of patients after diagnosis of M.tb was significantly better than those with MOTT infections, with respective one-year survival rate of 79% and 36% (log rank test, P = 0.006).

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Brucellosis--a persistent occupational hazard in Ireland.

A cross-sectional seroprevalence study using the complement fixation technique (CFT) was carried out among technical and support staff of the Department of Agriculture in Ireland (n=375). A result CFT of < 1:8 was accepted as normal, i.e., no evidence of exposure to Brucella abortus. Results were compared with available medical records to differentiate new from old or established cases. The participation rate was 75% (n= 281). Of the 281 participants, ten [3.6% (95% CI 1.7-6.5%)] tested positive (titers > or = 1:8). Veterinarians, laboratory staff, and workers based in meat plants were at increased risk of exposure. 106 previous results were available. Eight of those who tested positive had previously been tested, and of these, four (3.8%, 1-9.4%) had converted from negative to positive in the intervening five years, a conversion rate of 8 (CI 2-20) per 1,000 employees per annum. Thus, exposure to B. abortus remains common among at-risk occupational groups in Ireland.

Agricultural Workers' Diseases↗
PubMed2003

vCJD risk in the Republic of Ireland.

BACKGROUND: The Republic of Ireland has the second highest incidence of BSE worldwide. Only a single case of vCJD has been identified to date. METHODS: We estimate the total future number of clinical cases of vCJD using an established mathematical model, and based on infectivity of bovine tissue calculated from UK data and on the relative exposure to BSE contaminated meat. RESULTS: We estimate 1 future clinical case (95% CI 0-15) of vCJD in the Republic of Ireland. Irish exposure is from BSE infected indigenous beef products and from imported UK beef products. Additionally, 2.5% of the Irish population was exposed to UK beef through residing in the UK during the 'at-risk' period. The relative proportion of risk attributable to each of these three exposures individually is 2:2:1 respectively. CONCLUSIONS: The low numbers of future vCJD cases estimated in this study is reassuring for the Irish population and for other countries with a similar level of BSE exposure.

Animals↗
PubMed2006

The epidemiology of severe sepsis in England, Wales and Northern Ireland, 1996 to 2004: secondary analysis of a high quality clinical database, the ICNARC Case Mix Programme Database.

INTRODUCTION: To evaluate the impact of recent evidence-based treatments for severe sepsis in routine clinical care requires an understanding of the underlying epidemiology, particularly with regard to trends over time. We interrogated a high quality clinical database to examine trends in the incidence and mortality of severe sepsis over a nine-year period. METHODS: Admissions with severe sepsis occurring at any time within 24 hours of admission to critical care were identified to an established methodology using raw physiological data from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme Database, containing data from 343,860 admissions to 172 adult, general critical care units in England, Wales and Northern Ireland between December 1995 and January 2005. Generalised linear models were used to assess changes in the incidence, case mix, outcomes and activity of these admissions. RESULTS: In total, 92,672 admissions (27.0%) were identified as having severe sepsis in the first 24 hours following admission. The percentage of admissions with severe sepsis during the first 24 hours rose from 23.5% in 1996 to 28.7% in 2004. This represents an increase from an estimated 18,500 to 31,000 admissions to all 240 adult, general critical care units in England, Wales and Northern Ireland. Hospital mortality for admissions with severe sepsis decreased from 48.3% in 1996 to 44.7% in 2004, but the total number of deaths increased from an estimated 9,000 to 14,000. The treated incidence of severe sepsis per 100,000 population rose from 46 in 1996 to 66 in 2003, with the associated number of hospital deaths per 100,000 population rising from 23 to 30. CONCLUSION: The population incidence of critical care admission with severe sepsis during the first 24 hours and associated hospital deaths are increasing. These baseline data provide essential information to those wishing to evaluate the introduction of the Surviving Sepsis Campaign care bundles in UK hospitals.

Databases, Factual↗
PubMed2001

An audit of the provision of environmental control systems in Northern Ireland, 1992-1997.

OBJECTIVE: To evaluate the provision of environmental control systems (ECS) in Northern Ireland with regard to assessment and prescription, installation and review and propose guidelines for future service delivery. DESIGN: Structured interview, physical examination, Barthel ADL Index, demonstration and assessment of suitability of ECS for patient. SUBJECTS: Prescriptions for ECS from April 1992 to 1997 were identified from centrally held records. Current users were assessed in their own homes. RESULTS: Forty-six out of 49 current users identified were assessed. All were severely disabled (Barthel 0-9); 24% were living alone; 7 (15%) were not utilizing the system; 96% were satisfied with their initial assessment. Prior to prescription 52% had information about ECS and 20% had a practical demonstration; 78% felt that this would have been useful; 52% of users were not under routine clinical review; 41% of ECS had been altered since installation. Repairs had taken longer than 7 days in 11% of cases. In 45 cases the ECS was essential and in 43 it was appropriate to the users' needs and abilities. CONCLUSIONS: ECS are a valuable tool for severely disabled persons and are appropriately prescribed in Northern Ireland. A multidisciplinary team should perform assessment and prescription. All patients should have a practical trial of the equipment to assist in prescriptions. Regular review by the team should be performed to identify changes in need and alter systems appropriately. Users who live alone should represent a priority for repairs.

Activities of Daily Living↗
PubMed2001

Regional variations in stroke care in England, Wales and Northern Ireland: results from the National Sentinel Audit of Stroke. Royal College of Physicians Intercollegiate Stroke Working Party.

STUDY OBJECTIVE: To identify the variations between regions in England, Wales and Northern Ireland in the case-mix, organization and process of care for stroke. DESIGN: Retrospective audit of case notes and service organization. SETTING: Two hundred and ten Trust sites from 197 Trusts in 10 Health Regions in England, Wales and Northern Ireland. PATIENTS: The 6894 consecutive stroke patients admitted between 1 January and 31 March 1998 (up to 40 per Trust). Audit tool: The Intercollegiate Stroke Audit. RESULTS: There are significant differences in stroke care between regions that cannot be explained by known case-mix or clinical variables. The proportion of patients spending more than half their hospital stay in stroke unit care varied between regions from 10% to 27%. Thirty-day mortality in different regions ranged between 21% and 33%. Institutionalization rates for those admitted from home varied between 6% and 19%. Similar variations existed in discharge disability and length of stay. CONCLUSIONS: There were widespread variations in specialist service provision for stroke in different regions. Regional variation in 30-day mortality and in institutionalization after stroke is not explained by clinical factors and therefore may represent different local health care policies and expectations.

Aged↗
PubMed1984

The impact of political violence on mild psychiatric morbidity in northern Ireland.

Evidence concerning the impact of the violence in Northern Ireland on psychiatric morbidity is limited to studies examining admission rates and psychotropic drug prescribing rates; their results varied from suggesting no effect to indicating that greater levels of violence are actually equated with higher levels of mental health. The present study is the first to use a community sample, in which respondents (797) from two towns, which have experienced contrasting levels of violence over the last ten years, completed the 30-item version of the General Health Questionnaire (GHQ), and also indicated their perception of the level of violence in their area and how safe they felt this was to live in. Those who lived in the more violent town scored higher on the GHQ, as did women compared to men and those who perceived that their area had experienced more violence. There was also a two-way interaction, such that the small number of people, who perceived much violence in their area and who also lived in the more violent town, scored more highly on the GHQ. It is possible that the majority of people in Northern Ireland deal effectively with stress generated by the political violence, but do so by denying the existence of this violence around them.

Adult↗
PubMed1997

Mental disorders and suicide in Northern Ireland.

BACKGROUND: The aim of this part of the Northern Ireland Suicide Study was to investigate the prevalence of DSM-III-R axis I (clinical syndrome) and axis II (personality) disorders among suicides (14 years and older) in Northern Ireland during a one-year period. METHOD: A psychological autopsy study based on a variety of documentary sources and interviews with bereaved informants and health care professionals. RESULTS: Ninety per cent of suicides (106/118) had a current axis I and/or an axis II mental disorder. At least one current axis I disorder was diagnosed in 86% of suicides (102/118), and at least one axis II disorder was diagnosed in 44% (52/118). Suicides under 30 years (92% male) were less likely to have a current axis I disorder (68%; 26/38) than those 30 years and older (95%; 76/80). Psychiatric comorbidity was present in 55% of suicides (65/118). The time between the last contact with a health care professional and death was greater among suicides under 30 years and male suicides. CONCLUSIONS: Notwithstanding the aetiological complexity of suicide, the prevention, recognition and treatment of mental disorder will continue to play key roles in suicide prevention.

Adolescent↗
PubMed1997

Guilty but insane: the insanity defence in Ireland, 1850-1995.

BACKGROUND: This is a retrospective study describing sociodemographic and clinical characteristics of an almost complete sample of insanity acquittees in Ireland between 1850-1995. METHOD: Case records and legal files were examined for each of the 437 patients admitted to the Central Mental Hospital under guilty but insane criteria, and a profile of sociodemographic, forensic and clinical data completed in each. RESULTS: The number of insanity acquittees has fallen five-fold since the 19th century. Acquittees were usually single males from rural areas, aged in their 30s, who had committed a violent crime while suffering from a major psychiatric illness. Female insanity acquittees were relatively few in number and were equally likely to have been charged with violent crime, especially against their own children. The mean length of detention was 14.5 years. CONCLUSIONS: The insanity defence is rarely used in Ireland, is largely confined to serious offences (especially homicide), and generally results in prolonged detention.

Crime↗
PubMed2004

PINK1 (PARK6) associated Parkinson disease in Ireland.

Mutations in the PINK1 gene have recently been shown to cause autosomal recessive Parkinson disease (PD). The authors assessed the prevalence of PINK1 gene mutations in 290 well-characterized early- and late-onset PD patients from Ireland. In a 51-year-old PD patient with a family history of PD, the authors identified a novel heterozygous mutation (R147H) in exon 2 of the PINK1 gene. Overall, these data indicate that PINK1 mutations are a rare cause of PD in Ireland.

Adolescent↗
PubMed2004

Equity of use of inpatient services by the two communities in Northern Ireland.

OBJECTIVE: There is concern about whether public services in Northern Ireland are equitably targeted across the religious divide. This study investigates whether use of acute hospital inpatient services differs by religious denomination, after adjusting for supply and for identified demographic, morbidity and socio-economic determinants of need for such services. METHODS: Hospital utilisation at small area level was modelled against a wide range of potential health and socioeconomic factors. Spatial interactive modelling was used to estimate the effect of supply of hospital beds and other facilities on hospital utilisation. Two-stage weighted least-squares regression was used to model utilisation against need and supply. RESULTS: There was a clear positive relationship between the proportion of Roman Catholics in a ward and both need for and utilisation of inpatient services. The higher levels of relative utilisation in wards with a greater proportion of Catholics persisted after controlling for needs but not when supply variables were also entered in the regression equation. The surviving needs drivers were: uptake levels of 'income maintenance' benefits, all-ages standardised mortality ratio, low birth weight and elderly people living alone. Most of these indicators of need are positively correlated with proportion of Catholics. CONCLUSIONS: When both need and supply factors are taken into account, there appears to be no significant effect of religion on inpatient hospital use in Northern Ireland. Efforts to ensure socio-economic equity between the two communities should focus on ensuring that hospital rationalisation does not lead to disadvantage and on reducing socio-economic differentials between the Catholic and Protestant communities.

Catchment Area, Health↗
PubMedDate not supplied

Development of nurse specialists/advanced practitioners in Ireland.

An Bord Altranais (Irish Nursing Board) published "Report of the Commission on Nursing: A Blueprint for the Future" in 1998. This report was the result of collaborative work among those involved in nursing in Ireland. It recommended the establishment of clinical career pathways, which would allow a nurse with extensive experience and advanced expertise, as well as an appropriate course, to be recognized as a clinical nurse specialist. Further advancement along this pathway could possibly enable the nurse to progress to an advanced practitioner grade. The report acknowledged that there are "various and differing interpretations" of the title "practitioner". This article explores the growth and development of the roles of the clinical nurse specialist and advanced nurse practitioners in Ireland over the past number of years. The literature reflects elements of confusion that exist in some areas about the role of a clinical nurse specialist and an advanced nurse practitioner. The "Review of the Scope of Nursing and Midwifery Practice" (An Board Altranais, 2000) recognized a lack of clear differentiation between the role of the clinical nurse specialist and the advanced nurse practitioner. Overall, some clear roles are identified for the nurse who advances or wishes to advance along clinical career pathways in nursing. However, there still appears to be a certain degree of confusion about the use of titles such as "nurse specialist" and/or "nurse practitioner". The guidelines about the level of practice and education/training required for the nurse moving along the pathways of clinical nurse specialism and/or advanced nursing practice is somewhat obscure and is interpreted in different ways in the literature.

Career Mobility↗
PubMed2006

Breast reduction surgery in the UK and Ireland - current trends.

INTRODUCTION: This paper reviews the current status of bilateral breast reduction surgery in the UK and Ireland. It examines the pre-operative, operative and postoperative management of women. PATIENTS AND METHODS: A questionnaire established information about surgeons' experience, bilateral breast reduction work-load, pre-operative assessment, selection criteria, issues of operative technique and postoperative management. This was sent to 230 consultant plastic surgeons working in the NHS in the UK and Ireland. RESULTS: There was a 61% response rate. Of respondent surgeons, 82% always perform pre-operative photography, 71% never do a mammogram even in patients above the age of 50 years. Body mass index (BMI) is the most commonly used criteria for patient selection (60%). Two-thirds of the surgeons use an inferior pedicle technique and 75% of surgeons work in health authorities that restrict breast reduction surgery. CONCLUSIONS: There was significant variation in practice among surgeons performing bilateral breast reduction. This may reflect a lack of evidence base for practise. Published literature focuses almost exclusively on the description of different techniques. Further work is required to evaluate the role of pre-operative mammography, specimen mammography, antibiotics and selection criteria for surgery.

Ambulatory Surgical Procedures↗
PubMed2001

Why is celiac disease so common in Ireland?

Celiac disease (gluten sensitive enteropathy) is a condition affecting the small bowel, characterized by permanent intolerance to dietary gluten, and giving rise to varying degrees of malabsorption and diarrhea. With the advent of sensitive screening tests, the condition is being increasingly diagnosed. Celiac disease is more common in the Irish and in those of Irish descent. Simoons (1978, 1981) hypothesized that the present-day prevalence of celiac disease across Europe is related to the interaction between genetic gradients, largely determined by the advance of agriculture, and historical patterns of cereal ingestion. This essay examines Simoons' hypothesis as it relates to Ireland, reviews the ethnic and genetic mix of those living on the island of Ireland and aspects of Irish dietary history, and considers how these factors may have combined to result in a high frequency of celiac disease.

Celiac Disease↗
PubMed1987

Natural and induced ovulation rate in prolific and non-prolific breeds of sheep in Ireland, Morocco and New Zealand.

Ovulation rate, in mixed-age groups of prolific and non-prolific ewe breed types, after administration of a range of doses of PMSG (0, 375, 750 and 1500 i.u.) during the follicular phase of the oestrous cycle, were compared in Ireland, Morocco and New Zealand. The ewes in Ireland and Morocco were from the Finnish Landrace and Galway, and D'Man and Timhadite breeds, respectively. In New Zealand Booroola Merino x Romney ewes which had been previously identified as heterozygous carriers (F+) of the Booroola high fecundity gene and purebred Romneys were used to represent the prolific and non-prolific genotypes respectively; in addition a group of Booroola Merino x Romney non-carriers (++) of the major gene were also included for comparison. Ovulation rate at the oestrus which preceded stimulation with PMSG was also measured in all animals. In all 3 locations the ewes of the prolific genotype had a greater ovulation rate after PMSG stimulation than did the non-prolific controls. However, this association between prolificacy and response to PMSG was removed when ovulation rate after PMSG was transformed by dividing by the ovulation rate observed before PMSG administration. Despite the differences in the genetic basis of their high prolificacy the pattern of response to PMSG over the range of dosages used was similar in Finnish Landrace, D'Man and Booroola Merino x Romney (F+) ewes and all breeds had means of about 10 ovulations in response to 1500 i.u. PMSG. Amongst the non-prolific breeds, the Timhadite was the most responsive to PMSG although it had the lowest natural ovulation rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2002

Control of foot and mouth disease: lessons from the experience of Ireland.

The authors outline the measures applied in Ireland to prevent the introduction of foot and mouth disease (FMD) from the United Kingdom, France and The Netherlands, to stamp out the disease in Ireland following confirmation of an outbreak on 22 March 2001 and to conduct serological surveillance in order to prove freedom from the disease. Successful control was the result of prompt action and extensive culling in the area around the infected premises. This was achieved by the State Veterinary Service operating with the assistance of the personnel and equipment resources of many Government departments, private industry and private veterinary practitioners, with the co-operation of the farming community and general public. In order to ensure effective use of these resources, good systems of communication and information technology are vital, as are the existence of detailed contingency plans and trained staff.

Animals↗
PubMed2004

The long march: the development of academic general practice in the UK and Ireland.

Academic general practice and primary care is thriving in both the UK and Ireland, as judged by the content and vibrancy of the main annual scientific meetings of the discipline in the two countries. Problems and challenges abound, but the long-term trend is one of steady growth, with gradual increases in capacity and activity. Contributions to undergraduate medical education and to multidisciplinary professional development, and achievements in the UK University Research Assessment Exercise (RAE) show what the discipline is capable of. A major challenge remains the creation and funding of appropriate academic career structures in academic general practice and primary care, removing the current financial disincentives, uncertainties and problems in acquiring both clinical and academic experience. With increased numbers of clinical and non-clinical academics working in general practice and primary care, the discipline is set to play an important role in health service development in both the UK and Ireland.

Biomedical Research↗