Kennedy GE, Craig J, McMahon SE
… +1 more, Cusick LA
Ulster Med J
· 2024 Dec · PMID 39669954
INTRODUCTION: Total hip arthroplasty (THA) for displaced intracapsular hip fracture is increasingly common. The aim of this project was to determine all-cause mortality rates, rates of significant complications and funct...INTRODUCTION: Total hip arthroplasty (THA) for displaced intracapsular hip fracture is increasingly common. The aim of this project was to determine all-cause mortality rates, rates of significant complications and functional outcomes following THA for fractures. METHODS: An inpatient database search identified all patients undergoing THA for displaced intracapsular fracture in Northern Ireland's regional trauma centre from 2010-2017. Regional electronic healthcare systems were reviewed for evidence of complications. RESULTS: After exclusions, 345 cases were identified. The median age was 70 years (31 - 91 years).Median follow-up was 4.3 years (1.6 - 9.3 years). The all-cause mortality rate was 0.3% at 30 days, 3.2% at one year, and 5.5% at two years.Seven patients (2.0%) experienced dislocations. Most occurred within 60 days; five patients underwent revision.Radiographic evidence of heterotopic ossification (HO) was seen in 48 patients (13.8%).Re-operation was required for 16 patients (4.6%). This included 5 dislocations, eight cases of periprosthetic fractures (in seven patients), two cases of infection, and one case of symptomatic HO.Pre-injury, 96.2% (332/345) were independently mobile, and after one year 78.9% (262/332) of those patients remained so. Pre-injury, 96.2% obtained the maximum functional score (Barthel Index, maximum score of 20), and after one year 78.9% (262/332) of these continued to report a maximum Barthel Index score. CONCLUSION: THA for hip fracture holds a 2.0% risk of dislocation and a 4.6% risk of re-operation. HO is common but seldom requires re-operation. All-cause mortality rates and functional levels compared favourably with current literature.
Millar BC, Alexander L, Bell J
… +15 more, Grieve E, McCabe CA, Wright E, Catney K, Toland D, Coyle B, Parkin A, Anderson HL, Benny C, Moore RE, O'Neill D, Jenkins L, Reid A, Rendall JC, Moore JE
Ulster Med J
· 2024 Dec · PMID 39669952
BACKGROUND: In Northern Ireland, approximately 550 people with cystic fibrosis (PwCF) attend the regional paediatric and adult centres within the Belfast Health and Social Care Trust. This autosomal recessive chronic con...BACKGROUND: In Northern Ireland, approximately 550 people with cystic fibrosis (PwCF) attend the regional paediatric and adult centres within the Belfast Health and Social Care Trust. This autosomal recessive chronic condition necessitates regular clinical monitoring and a high treatment burden, as well as time implications for the maintenance of respiratory devices. Development of health literacy skills at an early age and promoting children with CF (CwCF) to take an active role in their healthcare has many advantages relating to their long-term self-care in preparation for transition from paediatric to adult care, decision-making and partnership engagement with the CF-multidisciplinary team (CF-MDT). METHODS: This study comprised of four individual components, namely (i) an analysis of responses (n=24) to an anonymous questionnaire from the Northern Ireland CF community to determine where PwCF and their carers/families seek healthcare information; (ii) to co-produce paediatric-facing healthcare educational resources, namely colouring/ storybooks and animations, relating to the importance of microbiological sampling, nebuliser hygiene and pancreatic replacement therapy (PERT) in conjunction with the CF-MDT, CwCF, parents, students and animators and (iii) assess the readability of these new materials using Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), SMOG Index and Gunning Fog (GF) Index and compare these with paediatric and adult-facing materials available from CF charities, pharmaceutical companies and the scientific literature. The final component (iv) examined parents' and children's knowledge of PERT pre- and post-viewing the bespoke animation. RESULTS: (i) The findings showed that the CF community relied upon the CF-MDT as their primary source of healthcare information, most frequently consulting the Doctor/CF Consultant (61.5%), the physiotherapist (61.6%), the nurse (57.7%), followed by the CF dietitian (34.6%), as well as the Cystic Fibrosis Trust (38.4%). Pharmaceutical websites were least consulted with 69.2% of respondents never consulting such resources.(ii) Reflective learning points from this co-production of resources are provided to assist other healthcare teams preparing engaging and effective healthcare information for the paediatric service user.(iii) The readability of the new paediatric-facing materials prepared by the CF-MDT was appropriate for primary school aged-children and was not statistically different from paediatric-facing information prepared by charities or pharmaceutical companies. A statistical difference was noted in relation to the prepared materials in comparison with adult-facing charity information (p=0.04; 0.02; 0.03; 0.04) and scientific abstracts (p<0.0001), which were more complex in terms of readability parameters, FRE, FKGL, SMOG and GF, respectively.(iv) Following viewing the PERT animation, both parents' and children's knowledge had improved with 50% of children's understanding determined as moderate/little understanding (pre-animation) and 50% very good/ 42 % good (post-animation). CONCLUSIONS: Healthcare professionals are important custodians of healthcare information for their service user population. Paediatric healthcare teams have a responsibility to aid in the development of health literacy skills at an early age and promoting children to take an active role in their healthcare. The use of colouring/storybooks and animations are excellent media to initiate discussions and develop partnerships in paediatric healthcare in an engaging and informative manner. Whilst this study related to CwCF, the findings may be applicable to the health literacy of children of other disease states. For optimum impact, the healthcare team should (i) co-produce these media with the paediatric service user, their families and animation teams and (ii) ensure that the readability, legibility and formats are appropriate, informative and engaging for the target age-group.
Discussion of bioethical issues using the four principles approach proposed by Beauchamp and Childress is now standard practice in the UK. This paper first documents the history of principlism before considering its impa...Discussion of bioethical issues using the four principles approach proposed by Beauchamp and Childress is now standard practice in the UK. This paper first documents the history of principlism before considering its impact and reviewing some criticisms of the approach. A future paper will examine some of the philosophical difficulties arising from principlism in greater depth.
Dodds K, Curry D, Kelly P
… +2 more, O'Rourke D, McClements J
Ulster Med J
· 2024 Dec · PMID 39669950
UNLABELLED: Metastatic tumours to the pancreas are rare but most commonly arise from primary renal cell carcinoma (RCC). Contrary to other metastatic malignancies, metastatic RCC demonstrates indolent behaviour; with a l...UNLABELLED: Metastatic tumours to the pancreas are rare but most commonly arise from primary renal cell carcinoma (RCC). Contrary to other metastatic malignancies, metastatic RCC demonstrates indolent behaviour; with a long latency between primary tumour presentation and the development of metastasis, as well as a predilection to isolated pancreas-only disease. As such, pancreatic metastasectomy has evolved as a treatment option for patients with metastatic RCC; reported to associate with improved outcomes in selected patients. The aim of this study was to describe the clinicopathological characteristics and patient outcomes in a series of patients undergoing pancreatic resection for metastatic RCC in a high volume, regional hepatopancreatobiliary (HPB) centre. DESIGN: Retrospective review of all patients who underwent pancreatic metastasectomy for pathologically-confirmed metastatic RCC over an eighteen-year period. Clinicopathological characteristics and outcomes were collected and analysed. RESULTS: Fifteen patients underwent pancreatic resection for metastatic RCC between October 2004 and October 2022. Two patients underwent synchronous nephrectomy and pancreatectomy. In thirteen patients, the pancreas was the only site of metastatic disease. For those with metachronous metastases, the median disease-free interval (DFI) was 126 months from initial nephrectomy.Five-year disease-free and overall survival were 32.7 % and 63.3 %, respectively. No clinicopathological factor was found to associate with overall survival (OS); however, patients with synchronous metastatic disease had a significantly shorter disease-free survival (p = 0.029). Similarly, patients with a longer DFI (≥ ten years) between RCC primary and the development of pancreatic metastases had a trend towards improved OS (p = 0.074).Post-operative morbidity and mortality rates were comparable to that of pancreatic surgery for primary pancreatic pathology. CONCLUSION: This case series supports the role of pancreatic resection in patients with metastatic RCC, with acceptable rates of morbidity and mortality and favourable patient outcomes. The long DFI between nephrectomy and pancreatic metastases highlights the importance of long-term follow-up for patients diagnosed with RCC.
The integration of genomic medicine within mainstream patient care promises advances in healthcare and potential benefits for disease prediction and personalised treatment approaches. This paper explores the challenges o...The integration of genomic medicine within mainstream patient care promises advances in healthcare and potential benefits for disease prediction and personalised treatment approaches. This paper explores the challenges of integrating genomic medicine within the UK's National Health Service (NHS) and potential solutions for alignment with the NHS's proposed long-term plan and Genome UK strategy. Critical challenges and knowledge gaps have been identified, including a referral-dependent system, unclear eligibility criteria, lack of policies and guidelines, gaps in clinical genomic competence, genomic sequencing costs, equity issues for genomic testing access across the UK, and data management and patient privacy concerns. Proposed solutions and future directions include extending genetic test ordering authority to include mainstream clinicians and establishing unambiguous eligibility criteria, policies and guidelines through a developing trained workforce and appropriate patient engagement. Moreover, expanded Whole Genome Sequencing (WGS) and pharmacogenomic testing approaches through up-scaling genomic sequencing capacity and standardising genetic testing across the UK will lower consumable costs. Leveraging artificial intelligence (AI) and data warehousing approaches will improve data management, particularly in the context of integration within electronic health records. In summary, the successful integration of genomic medicine within mainstream patient care holds transformative potential for healthcare provision. By recognising the challenges identified and embracing the proposed solutions, healthcare systems can revolutionise patient outcomes, advancing precision medicine and shaping the future of genomic-driven healthcare.
McKinley N, Wilson R, Huddleston R
… +2 more, Kennedy R, Reid J
Ulster Med J
· 2024 Nov · PMID 39606142
BACKGROUND: Retroperitoneal sarcomas (RPS) are a heterogeneous group of rare tumours that require complex surgical management with outcomes tightly correlated to quality of surgery.This study aimed to examine the determi...BACKGROUND: Retroperitoneal sarcomas (RPS) are a heterogeneous group of rare tumours that require complex surgical management with outcomes tightly correlated to quality of surgery.This study aimed to examine the determine patient demographics, treatment approaches and outcomes for patients with primary RPS in this single center during the period 2010-2021. METHODS: All patients diagnosed with RPS from 2010 to 2021 that underwent surgical resection in a single trust in Northern Ireland were identified. Data was collated using histopathology records, electronic care records and retrospective chart review. RESULTS: Fifty-four resections were performed for RPS in a 10 year period. 30 day mortality rate was 3.7%, in-hospital mortality was 1.9% and 90 day mortality was 7.4%. 11.1% of patients were recorded as having a severe postoperative adverse event. 90.4% patients achieved an R0/R1 resection. The 1, 3, and 5-year overall survival were 80% [95% confidence interval (CI) 67-89), 69% (95% CI 53-79), and 62% (95% CI 48-75). The 1 and 5-year crude-cumulative-incidence (CCI) for local recurrence were 32% (95%CI 20, 46) and 55% (95%CI 32,77). 1 and 5-year CCI for distant metastases were 11% (95%CI 4, 23) and 35% (95%CI 15,59). Median overall survival was 6.3 years (IQR 5.0-7.6). CONCLUSION: Survival outcomes in this LVH are similar to those reported by a number of HVHs worldwide, with an additional low rate of severe postoperative complication. Given that there are only between 250 and 300 new diagnoses of retroperitoneal sarcoma (RPS) in the UK each year prospective data collection and participation in multi-institution studies, specifically a UK collaboration, is critical to expand upon current knowledge and further improve management, outcomes and follow-up of patients with this rare and complex surgical disease.
Assisted Dying (AD), the ending of a person's life pre-emptively under a legal criterion is widely debated, both in the United Kingdom (UK) and Ireland. The expectation is often those doctors closest to dying would be bo...Assisted Dying (AD), the ending of a person's life pre-emptively under a legal criterion is widely debated, both in the United Kingdom (UK) and Ireland. The expectation is often those doctors closest to dying would be both the proponents and facilitators of this action. A survey of Palliative Medicine in Northern Ireland (NI) on this topic has never been previously undertaken. The Regional Palliative Medicine Group (RPMG) a representative body of all the Palliative Medicine Consultants in NI organised an anonymous 'Google Forms' survey on AD from 3/6/24 to 17/6/24 of all doctors of all grades working within Specialist Palliative Medicine at the time. The survey had a 69% response rate (56/81) demonstrating 80% of all responding doctors working within Palliative Medicine and 100% of responding Palliative Medicine Consultants and Registrars in Northern Ireland do not favour a change in legislation allowing for AD. 91% (n=51) have concerns that AD will be influenced by a lack of availability of personal care at home. 93% (n=52) are concerned that AD will be influenced by cost-saving for the patient and their family and 82% (n=46) are concerned that AD will be influenced by cost savings for health and social care. 98% (n=55) stated if AD is legalised it should not be 'part of mainstream healthcare' with 45% (n=25) saying it should be 'via the legal system' and 46% (n=26) saying 'via a separate independent facility'. 53% (n=28) 'would not' and 40% (n=21) 'don't know', if they could remain working for an organisation that undertakes AD. These results clearly show that Palliative Medicine in Northern Ireland will not be part of an AD service model. The question is who will be? Healthcare leaders now need to support their Palliative Medicine workforce by stating there will be AD-free healthcare facilities if AD is legalised.
Vage A, Spence AD, McKeown G
… +2 more, Gormley GJ, Hamilton PK
Ulster Med J
· 2024 Nov · PMID 39606139
In recent years, simulation has come to prominence as an educational method within the healthcare professions, aiming to shield learners from real-world consequences. However, the associated risks of this educational met...In recent years, simulation has come to prominence as an educational method within the healthcare professions, aiming to shield learners from real-world consequences. However, the associated risks of this educational method have largely remained unaddressed. One of the most potent risks of simulation is felt to be the experience of psychological stress. Over the last two decades, researchers have suggested that an increase in simulation-related stress goes hand-in-hand with diminishing performance, but the evidence base for this claim is lacking. A medical educator thus has no robust scientific steering on which to gauge how 'hard to push' a trainee in a simulation environment to best assist their learning. In this review we systematically analyse the literature to further understand the impact of simulation-related stress on learner performance and report that inducing a high-stress environment during simulation is generally associated with impaired performance.
Discussion of bioethical issues using four principles approach proposed by Beauchamp and Childress is now standard practice in the UK. An earlier paper documented the history of principlism before considering its impact...Discussion of bioethical issues using four principles approach proposed by Beauchamp and Childress is now standard practice in the UK. An earlier paper documented the history of principlism before considering its impact and reviewing some criticisms of the approach. This paper will examine some of the philosophical difficulties in greater depth. A particular concern is that principlism leads to debate with consideration of means without due concern regarding their intended ends.
Patterson T, Reid G, Stewart S
… +1 more, Earley O
Ulster Med J
· 2024 Jan · PMID 38707980
BACKGROUND: The practice of immediate sequential bilateral cataract surgery (ISBCS) was more widely adopted in the UK during the COVID-19 pandemic, in response to limited surgical capacity and the risk of nosocomial infe...BACKGROUND: The practice of immediate sequential bilateral cataract surgery (ISBCS) was more widely adopted in the UK during the COVID-19 pandemic, in response to limited surgical capacity and the risk of nosocomial infection. This study reports on a single site experience of ISBCS in Northern Ireland. METHODS: Data was collected prospectively between 17 November 2020 and 30 November 2021. The ISBCS surgical protocol, recommended by RCOphth and UKISCRS, was followed. Primary outcomes measures were: postoperative visual acuity (VA), refractive prediction accuracy, intraoperative and postoperative complications. RESULTS: Of 41 patients scheduled, 39 patients completed ISBCS and two patients underwent unilateral surgery (n=80 eyes). Mean age at the time of surgery was 71.6 years (standard deviation (SD) ±11.8 years). Median preoperative VA was 0.8 logMAR (range: PL to 0.2 logMAR). Seventeen (20.9%) eyes were highly myopic and 9 (11.1%) eyes were highly hypermetropic. Median cumulative dissipated phacoemulsification energy was 15.7 sec (range: 1.8 sec to 83.4 sec). Median case time was 10.4 min (range: 4.3 min to 37.1 min).One eye (1.3%) developed iritis secondary to a retained tiny cortical fragment. Four eyes (5.0%, n=3 patients) developed cystoid macular oedema, with full resolution. On wide field imaging, an asymptomatic unilateral peripheral suprachoroidal haemorrhage was noted in two highly myopic patients (axial lengths of 27.01mm and 25.05mm respectively). The posterior pole was spared, and both resolved spontaneously without any visual impairment. CONCLUSIONS: In our initial experience, ISBCS was found to be a safe approach to cataract surgery. Our patient cohort included eyes with dense cataracts and high ametropia. Further studies are required to assess patient reported outcome measures and the possible economic benefits of ISBCS in our local population.