This Month’s IMJ October 2016 Vol 109 Number 9


The Epidemiology of Emergency Inpatient Hospitalisations Among Those with ‘No Fixed Abode’ (Homeless) 2005-2014: What Lessons Can be Learnt: 

O’Farrell et al have studied the inpatient hospitalization patterns among homeless people.  In the 9 year study period there were 2,051 admissions.  There has been a fourfold increase between 2005 and 2014.  The mean age was 40.6 years.  Over half of the cases had mental/ behavioural diagnosis.




An Approach to Optimize Therapeutic Vancomycin Dosage in a Haemodialysis Population

Gunning et al have addressed the complex issue of vancomycin dosing in renal patients.  A new protocol with fixed weight-based loading and subsequent dosing guided by pre-dialysis levels.  There was a significant improvement in the levels in the therapeutic range.





A Direct Oral Anticoagulant as a Cost Effective Alternative to Warfarin for Treatment of Provoked Venous Thrombosis

Courtney et al have undertaken a cost analysis between Rivaroxaban and Warfarin in the treatment of provoked venous thrombosis.  The Warfarin patients attended clinic 14.58 times compared with 2.92 times in the Rivaroxaban group.  The overall costs were the same.




Neonatal Bacteraemia Among 112,360 Live Births

Huggart et al have examined the rates of early onset sepsis (EOS) and late onset sepsis (LOS) in new born infants.  The EOS rate was 1.19/1000 births and the LOS rate was 1.88/1000 births.




Cocaine Use in Young Adults: Correlation with Early Onset Cannabis, Alcohol and Tobacco Use: 

Smyth et al found that among 1897 study participants the lifetime use of the following was- tobacco 62%, alcohol 96%, cannabis 31%, and cocaine 7.0%.  Earlier age of alcohol and a history of cannabis use were predictors of cocaine use.




Maternal Mortality in Women with Epilepsy

Holohan et al report that in a 9 year period there were 3 maternal deaths in women with epilepsy.  There were associated concerns in relation to the risks to the fetus from anti-epileptic drugs, and with access to neurology services before pregnancy. 




Audit of GP Referrals for Tonsillectomy to the ENT Clinic Using Present HIQA Guidelines

Hasan et al studied 58 patients referred to the ENT clinic for possible tonsillectomy.  A total of 62% met the HIQA guidelines for tonsillectomy.  Of those who met the criteria, 91.6% were listed for surgery at the first consultation.  The mean waiting time from referral to first OPD consultation was 19.2 months.



Knowledge, Skills and Experience Managing Tracheostomy Emergencies:  A survey of Critical Care Medicine trainees

Nizam report on a survey of 34 NCHD trainees regarding tracheostomy management.  Specific tracheostomy training and previous experience with tracheostomies increased the doctors’ confidence.




Arachnoid Cyst: An Unusual Cause for Increased Alkaline Phosphatase.

Sanneerappa et al report a toddler who presented with a bulge on the left side of her head.  Blood tests revealed serum alkaline phosphatase 2843 U/L.  A brain CT scan showed a large left sided arachnoid cyst.