The Ulster Medical Journal[JOURNAL]
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200 papers
Eugenics.
Trimble M
Ulster Med J · 2023 May · PMID 37649922
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The Anger of Achilles.
Ulster Med J · 2023 May · PMID 37649921
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The effect of COVID-19 on the cervical screening programme within a Northern Irish Health and Social care trust.
McMullan JC, Rainey L, Morgan D … +1 more , Johnston L
Ulster Med J · 2023 May · PMID 37649920
PRECIS: COVID-19 has had a significant impact on the waiting times for cervical screening and colposcopy but no impact on the severity of disease outcomes. ABSTRACT: To assess the impact of the COVID-19 pandemic on the...
PRECIS: COVID-19 has had a significant impact on the waiting times for cervical screening and colposcopy but no impact on the severity of disease outcomes. ABSTRACT: To assess the impact of the COVID-19 pandemic on the cervical screening programme and colposcopy services in Northern Ireland. All new patients referred to colposcopy following an abnormal cervical smear result from September to November 2019 and 2020 were included. Review patients and those referred to colposcopy for another indication in the same time frame were excluded. Data collected included the presenting smear result and the time to report, time interval to colposcopy review, cervical biopsy method, result and the time to report. Statistical analysis was performed using JASP (JASP V.0.16.1, 2022) and included Shapiro-Wilk normality test and Mann-Whitney U test to compare means. There was an 11% reduction in the number of presenting cervical smears (7155 vs 6379) in 2020 with a 46% reduction (158 vs 85) in the number of colposcopy referrals. In 2020 there was a mean increase of 6 days to report the presenting smear (P<0.01), mean decrease of 49 days to attend colposcopy (P<0.01) and a mean decrease of 36 days to report the cervical biopsy result (P<0.01). An increase of 14 days (P= 0.01) and 15 days (P=0.01) respectively to attend colposcopy for moderate and severe dyskaryosis in 2020. No statistical difference was seen in the frequency of presenting smear results, method of cervical biopsy and cervical biopsy results in 2020. COVID-19 has had a significant impact on the number of patients referred to colposcopy and the time intervals in cervical screening but no significant short term impact on the severity of disease outcomes.
A Six Year Experience of a National Leadership Fellowship in Northern Ireland: Achieve, Develop, Explore Programme for Trainees (ADEPT).
Evans RM, Davidson S, Taylor A … +6 more , Macartney M, Small S, Elbaroni W, McCartney T, McMurray P, Steele I
Ulster Med J · 2023 May · PMID 37649919
INTRODUCTION: The Achieve, Develop, Explore Programme for Trainees (ADEPT) Clinical Leadership Fellowship Programme was established in response to growing recommendations to underpin healthcare reconfiguration in Norther...
INTRODUCTION: The Achieve, Develop, Explore Programme for Trainees (ADEPT) Clinical Leadership Fellowship Programme was established in response to growing recommendations to underpin healthcare reconfiguration in Northern Ireland with a collective leadership strategy. The fellowship combines a leadership development programme with a project carried out within a host organisation. With the fellowship now in its sixth year, a need was identified to assess its impact on the fellows' leadership skills, career choices, achievements, and views on both the fellowship and how to develop future leaders. METHODS: Demographic data for all ADEPT fellows was held centrally through Northern Ireland Medical and Dental Training Agency (NIMDTA) and assessed anonymously. A mixed-methods questionnaire was composed using Smart Survey. Likert scale questions were designed to determine the extent to which participants believed ADEPT supported their development of strong and exemplary elements of the nine dimensions of the NHS Healthcare Leadership Model. The questionnaire was distributed electronically to all ADEPT alumni in November 2021 and remained open for 4 weeks. RESULTS: There have been 46 ADEPT fellows to date (72% female; all fellows were white). ADEPT fellows were most commonly from Psychiatry (33%), Paediatrics (17%) and Obstetrics and Gynaecology (15%). There were 19 responses from the alumni cohort of 46 (41%). 75% of respondents reported that their project resulted in publication, presentation or award. Leadership skill development was identified as best in "Evaluating Information" and "Engaging the Team", whereas skills in "Sharing the Vision" and "Developing Capability" saw less improvement. The majority felt that the fellowship had been useful in securing their position as a consultant or general practitioner and 50% went on to pursue senior leadership positions. CONCLUSION: The ADEPT Clinical Leadership Fellowship delivers effective leadership training as measured by the nine domains of the NHS Healthcare Leadership Model. It provides value for host organisations through the projects undertaken and by developing doctors who are more likely to engage in future formal leadership roles. ADEPT alumni saw the value in their leadership experience and felt it should be embedded in standard postgraduate training schemes to reach a wider audience.
Curiositas.
Ulster Med J · 2023 May · PMID 37649918
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Ask an FY1 'Expert' - Peer Assisted Learning in Smoothing the Transition from Medical School to Clinical Practice.
Eves P, Guo Q, Doherty M … +2 more , Fergie R, Gardiner P
Ulster Med J · 2023 May · PMID 37649916
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The Long-Term and Late Effects of the Diagnosis and Treatment of Colorectal Cancer.
Carlile A, McAdam T
Ulster Med J · 2023 May · PMID 37649914
BACKGROUND: Colorectal cancer is the 3rd most common cancer in the UK. Through early detection and improved treatments more people than ever are surviving this disease. Surgery, chemotherapy and radiotherapy are the corn...
BACKGROUND: Colorectal cancer is the 3rd most common cancer in the UK. Through early detection and improved treatments more people than ever are surviving this disease. Surgery, chemotherapy and radiotherapy are the cornerstones of management, but these invasive treatments can cause a number of long-term and late effects. Using qualitative methods this study aimed to; explore peoples experiences with long-term and late effects of colorectal cancer, how these effects impacted on their lives and how participants managed them. METHOD: Semi-structured qualitative interviews were conducted with 15 participants who had completed curative treatment. Interviews were transcribed and analysed using the Framework approach to identify themes and categorise text data. RESULTS: Many long-term and late effects of colorectal cancer were explored including bowel dysfunction, sexual dysfunction, pain, metastatic disease and cognitive dysfunction. These effects caused distress for many and were linked to depression and social limitation. Previously unidentified long-term effects included decreased libido and joint pain which respondents attributed to chemotherapy. Anxiety and depression were found predominantly to be late effects. Management of long-term and late effects was varied with healthcare services often ineffective. CONCLUSION: Insight gained into long-term and late effects and their treatment, indicated that many participants suffered because of their after-effects and had unmet health needs. It adds a qualitative insight into an area where quantitative research has already been conducted. Improvements in cancer follow-up could offer opportunities to effectively identify, manage and monitor these effects. Further interventional studies are required to develop effective care pathways to achieve optimal care.
Northern Ireland Healthcare Crisis.
Ulster Med J · 2023 May · PMID 37649913
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'Factors influencing future career choices of Queen's University Belfast Medical students.'.
Madden S, Martin N, Clements JM … +1 more , Kirk SJ
Ulster Med J · 2023 May · PMID 37649912
INTRODUCTION: Decisions made by medical students on future career choice have demonstrated concordance with subsequent postgraduate career path. This study aimed to understand the factors that impact undergraduate career...
INTRODUCTION: Decisions made by medical students on future career choice have demonstrated concordance with subsequent postgraduate career path. This study aimed to understand the factors that impact undergraduate career decision making. METHODS: An anonymous voluntary survey consisting of binominal, Likert and free text responses was distributed to all medical students registered at Queen's University Belfast (QUB). Data was collected over 6 weeks in April-May 2021. The primary outcome was future career aspirations. The secondary outcomes were the impact of mentorship on career choice, the likelihood of students completing their medical degree and practicing medicine upon graduation. Local ethical approval was obtained. RESULTS: 202 responses were received (response rate 15%). 67% (n = 135) were female. One third of respondents remained undecided about their future career choice. Surgery was both the most popular definite career choice (16.3%) of respondents, butalsothespecialtymarkedmostoftenas'Least preferred Specialty' (33%). Factors positively influencing career choice were academic interest and flexibility in working hours. Negative predictors of career choice were lack of interest in the area, perceived workload, and duration of training schemes. 71% (n=144) of respondents reported that a subspecialty mentor would positively influence their career choice and two-thirds of respondents reported that financial factors would influence their career decision. 11% (n= 22) of respondents were unsure or undecided if they would continue medicine as a career upon graduation. CONCLUSION: Uncertainty over future career intention remains common with surgery the least popular speciality. Mentorship, integrating flexibility in training and enhancing academic interest should be considered by educational stakeholders as mechanisms to generating undergraduate interest in a subspecialty. Furthermore, the reported rate of students intention to leave their medical degree prior to graduation by this cohort is concerning, warranting further investigation.
Mapping Two Decades of Paediatric Down Syndrome Research Literature.
McKenna C, Schilder A, Lee RXN … +3 more , Manikam L, Venekamp R, Lakhanpaul M
Ulster Med J · 2023 May · PMID 37649911
BACKGROUND: While research has led to significant advancements in the health and life expectancy of children with Down Syndrome (DS), there remains a significant burden of disease and health inequity. Further research, f...
BACKGROUND: While research has led to significant advancements in the health and life expectancy of children with Down Syndrome (DS), there remains a significant burden of disease and health inequity. Further research, focused on areas of greatest need, is imperative to address this. An understanding of what research has been undertaken, and any existing gaps, helps to guide future academic efforts. METHODS: We utilised an epistemological approach to summarise two decades of paediatric DS literature. Publications were categorised according to the country of origin, methodology, primary health themes and subcategory research themes. RESULTS: Across 5,800 paediatric DS publications we demonstrate a general increase in the number of publications in this field between 2000 and 2014, with a trending decline thereafter. The majority of publications were affiliated with Institutions based in Western countries. The majority of studies utilised a cross-sectional methodology (33.3%), while relatively few were interventional (5.6%), qualitative (2.7%) or mixed-method studies (1.6%). Most publications focused on development & cognition (13.1%), neurology (9.9%) and oncology (9.8%), with fewer focusing on genitourinary health (0.9%), growth (0.9%), mortality (0.9%) and child protection (0.2%). CONCLUSION: These findings highlight areas of relative paucity within the paediatric DS literature which may warrant increased academic attention.
NHS Trust Boards and Health and Well-being Boards: Do they play any role in the management of disparate levels of care for South Asian patients with Inflammatory Bowel Disease?
Farrukh A, Mayberry JF
Ulster Med J · 2023 Jan · PMID 36762141
AIMS: There is evidence of disparate levels of care for members of ethnic minority communities with inflammatory bowel disease in various NHS Trusts and Health Boards in England and Scotland. The purpose of this study wa...
AIMS: There is evidence of disparate levels of care for members of ethnic minority communities with inflammatory bowel disease in various NHS Trusts and Health Boards in England and Scotland. The purpose of this study was to investigate whether there was any association between the existence of disparate levels of care and the ethnic composition of the management boards of NHS Trusts and Health Boards. It also examined the ethnic composition of Health and Wellbeing Boards associated with these Trusts in England. METHOD: NHS Trusts in England and Health Boards in Scotland, which had been involved in previous studies of disparate levels of care, were identified through a review of the relevant published papers. Health and Wellbeing Boards associated with these Trusts were then identified. Executive and non-executive membership of the NHS Trust, Health Boards and Health and Wellbeing Boards was determined through scrutiny of their web pages. RESULTS: The proportion of Asians, who were executive officers, was significantly lower than the proportion who were non-executive board members both for trusts who offered disparate care (z = 2.22; p < 0.03) and those which did not (z = 2.24; p < 0.03). There was no significant difference in the proportion of Asians who were non-executive board members between the two types of trust. The proportion of ethnic minority members of English Health and Well-Being Boards, where there was evidence of disparate levels of care received by South Asian patients was significantly greater than on Boards where this was not the case. (z = 2.8. p < 0.005). CONCLUSIONS: The relation of these findings to disparate levels of care is unclear. However, it may point to a culture of tokenism, where either the members are not truly representative of underserved communities or they are unable to have any influence on local policy decisions. In either case there is an urgent need to develop better links with minority communities who are underserved so that issues can be effectively identified and remedied.
A Neurology Advanced Referral Management System (NARMS) Reduces Face-to-Face Consultations By Over Sixty Percent.
McConville J, Hunter A, Fulton A … +3 more , Gray O, Kerr A, Patterson V
Ulster Med J · 2023 Jan · PMID 36762140
BACKGROUND: The COVID-19 pandemic has made neurology clinic waiting times longer. To prevent a build-up of patients waiting, we introduced a neurology advanced referral management system (NARMS) to deal with new referral...
BACKGROUND: The COVID-19 pandemic has made neurology clinic waiting times longer. To prevent a build-up of patients waiting, we introduced a neurology advanced referral management system (NARMS) to deal with new referrals from GPs, using advice, investigations, or the telephone, as alternatives to face-to-face (FF) assessment. METHODS: For six months, electronic referrals from GPs were triaged to the above categories. We recorded the numbers in each category, patient satisfaction, inter-consultant triage variation, re-referrals, and calculated CO2 emissions. RESULTS: There were 573 referrals. Triage destinations were advice 33%, investigations 27%, telephone 17%, and FF 33%. Of patients referred for MRI, 95% were happy not to be seen if their investigation was normal. Less-experienced consultants triaged 20% and 30% respectively, to advice or investigations, compared with 40% by a triage-experienced neurologist. Four percent were re-referred. Numbers on the waiting list did not increase. CO2 emissions were reduced by 50%. DISCUSSION: Two thirds of neurological referrals from GPs did not need to be seen FF and 50% were dealt with without the neurologist meeting the patient. Carbon emission was halved. This system should be employed more, with FF examination reserved for those patients who need a neurological examination for diagnosis and management.
Assisted suicide a 20 century problem, Palliative care a 21 century solution.
Doré M
Ulster Med J · 2023 Jan · PMID 36762139
Assisted suicide and euthanasia are two forms of what is being called 'assisted dying', and they are touted by proponents as "progressive" and "compassionate". In fact, they are, on the contrary, relics from the last cen...
Assisted suicide and euthanasia are two forms of what is being called 'assisted dying', and they are touted by proponents as "progressive" and "compassionate". In fact, they are, on the contrary, relics from the last century: today, in the 21 century, we have moved beyond such archaic solutions - we now have, instead, proper evidence-based palliative care. It is this that should be demanded for all. This article will dispel the myths around dying that are often cited. It will also explore the oft-overlooked tragedies generated by assisted suicide, in the hope you, the reader, can be better informed about this retrogressive practice.
Curiositas.
Ulster Med J · 2023 Jan · PMID 36762138
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Management of symptomatic Baker's cysts with ultrasound and fluoroscopic-guided aspiration followed by therapeutic injection with Depomedrone and Bupivacaine leads to a durable reduction in pain symptoms in a majority of patients; A case series and literature review.
Stroiescu AE, Laurinkiene J, Courtney K … +3 more , Moriarty HK, Kelly IP, Ryan AG
Ulster Med J · 2023 Jan · PMID 36762137
PURPOSE: To evaluate the efficacy of ultrasound and fluoroscopic-guided aspiration and therapeutic injection of Baker's cysts in the relief of pain and pressure symptoms. METHODS: A retrospective, observational, single-a...
PURPOSE: To evaluate the efficacy of ultrasound and fluoroscopic-guided aspiration and therapeutic injection of Baker's cysts in the relief of pain and pressure symptoms. METHODS: A retrospective, observational, single-arm study of consecutive patients referred from the Orthopaedic service for image-guided aspiration followed by therapeutic injection of symptomatic Baker's cysts was performed with institutional approval in the context of a Quality Improvement project. Patients' pain was graded using a 10-point Likert scale. Under standard sterile conditions, a 10 cm 5 Fr Yueh centesis needle was advanced into the cyst under direct ultrasound guidance, septae disrupted as necessary, the contents of the cyst aspirated, and a sample sent for microbiological analysis. Bursography was performed in an attempt to identify the expected communication with the knee joint, the contrast was aspirated and 40 mg of DepoMedrone and 5 ml of Bupivacaine were injected. RESULTS: Thirteen patients were referred, nine of whom satisfied the inclusion criteria (all female, average age 63.8 years). Over a 35-month period, 11 procedures were performed (bilateral in 1, repeated in another) yielding an average volume of 20.1 ml (range 10 - 50 mls). In 2/11 procedures the communication with the knee joint was outlined. The average follow up post-procedure was 8.3 months. The average patient's pain score reduced to zero from 5.7 for an average period of 5.96 months. After this period patients reported a gradual return of an ache, but none returned to the pre-procedure severity which, in some cases, had prevented them from sleeping. CONCLUSION: Aspiration of symptomatic Baker's cysts under Ultrasound and fluoroscopic guidance followed by therapeutic injection of DepoMedrone and Bupivacaine leads to a durable reduction in pain symptoms in a majority of patients.
Prescribing exercise and physical activity to treat and manage health conditions.
Rooney D, Gilmartin E, Heron N
Ulster Med J · 2023 Jan · PMID 36762135
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From a Vintage Journal (1890): Dr. Whitla's Urticaria Case and Dr. J.A. Lindsay's Notes on Asthma.
Freudenthaler T
Ulster Med J · 2023 Jan · PMID 36762134
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