This Month’s IMJ
March 2019, Vol 112, No. 3
Tatum et al report that the rate of polypharmacy among patients over 45 years receiving medication was 64.3%. The authors recommend research into the mechanisms that drive polypharmacy.
Table 1: Polypharmacy in 2013 by age and sex
|% of study population||44.8||55.2||22.8||20.3||12.0||14.7||30.1||100|
|% with polypharmacy||60.8||67.0||38.6||58.1||68.2||71.8||82.6||64.3|
Is It Time To Review The Vaccination Strategy To Protect Adults Against Invasive Pneumococcal Disease?
M. Corcoran, J. Mereckiene, S. Murchan, M. McElligott, D. O’Flanagan, S. Cotter, R. Cunney, H. Humphreys
Corcoran et al state that since the introduction of PCV7 and PCV13 into the childhood immunisation programme there has been a decline in these serotypes in adults aged 65 years and older. PCV7 has decreased by 85%. However the authors report that the number of PPV23-PCV13 and non-vaccine types are rapidly increasing. Increasing PPV23 uptake could still reduce the burden of disease for this population.
Table 1: Incidence and number of serotypes from adults aged ≥65 years of age in Ireland with invasive pneumococcal disease, according to vaccine serotypes, 2007/08 to 2016/17.
Figure 1: Number of penicillin susceptible and non-susceptible isolates causing invasive pneumococcal disease from adults aged ≥65 years of age in Ireland, from 2007/08 to 2016/17
The Profile of Women Attending the National Maternity Hospital Emergency Out Of Hours Service – Two Decades On. A Retrospective Review
O.F. O’Brien, S. Lee, A. Baby, F.M. McAuliffe, M.F. Higgins
O’Brien et al report that in 2017 a total of 9,020 women attended the out of hours service. The commonest reason was first trimester bleeding. The current admission rate is 16%.
Table 1: Indications for women’s presentation to the Out of Hours Emergency Service in 1993 compared to February-April 2017. “Other” included vomiting, hypertension, suspected pre-eclampsia, an outside ultrasound suggestive of miscarriage or ectopic pregnancy
Scope and Safety of Paediatric Surgery in a Model III Hospital
D.P. Joyce, R. Craig, A. Dakin, H. Elsheik, T. Ejaz, S. Mansoor, D.P. Toomey
Joyce et al report that in 2015-2016 there were 2,079 paediatric surgical admissions. 575 were elective and 1504 were emergencies. Laparoscopic appendicectomy accounted for almost 25% of the procedures undertaken. Male circumcision was the second commonest procedure, 15.5%.
Table 2. Most commonly performed procedures across 2015 and 2016
Continuous Glucose Monitoring in the Management of Neonatal Hypoglycaemia
S.M. McGlacken-Byrne, R. O’Neill, A. Jenkinson, J.F.A. Murphy
McGlacken-Byrne et al a quality initiative programme using continuous glucose monitoring in the newborn. The process illustrates the efficacy of PDSA cycling in the introduction of new methodologies.
Graph 2: Project runchart
High Rates of Diabetic Ketoacidosis in Patients with New and Known Type 1 Diabetes over a Six-Year Period
B.P. Finn, J. Trayer, C. Cronin, S.M. O’Connell
Finn et al report 133 cases of paediatric ketoacidosis over a 5 year period. 61% were new cases and 39% were known cases of diabetes. The precipitating factors were suboptimal control, psychosocial factors, acute illness, and pump failure.
Rana et al report on a 3 years old girl with a retropharyngeal abscess. She presented with irritability and neck flexion. A retropharyngeal abscess was diagnosed on MRI. It was treated with incision and antibiotics.
Arrow = Abscess
Meconium Ileus in Two Irish Newborns: The Presenting Feature of Cystic Fibrosis
A.Smith, E. Ryan, D. O’Keeffe, D. O’Donovan
Smith et al describe 2 infants with meconium ileus. Both were treated surgically. A subsequent diagnosis of cystic fibrosis was made for both infants.
Infliximab Induced Cardiac Tamponade
N. O’Morain, L. Kumar, C. O’Carroll-Lolait, A. Alakkari, B. Ryan
O’Morain et al report a case of cardiac tamponade following infliximab induction therapy. The patient had ulcerative colitis. The tamponade was treated with pericardiocentesis.
Image 1: Chest X-Ray pre and post first dose infliximab infusion.
Letters to the Editor
Widening the Net for Pre-Exposure Prophylaxis for HIV
L. Townsend, H. Tuite
Weight Status in Children with Autism Spectrum Disorder
L. McCarron, M. Fitzgerald, S. Gallagher, C.S. O’Gorman
Gastroschisis: What can the Neonate and Parents Expect?
I. Mc Donald, M. Doyle, J. Murphy
Characteristics, Management and Mortality Associated with Bacteremic Patients Presenting to an Acute Medical Unit
T. Dahab, S. Farrelly, C. Sadlier
Continual Professional Development
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