Identifying a Knowledge Deficit among Pediatric and General Practitioner Trainees in Pediatric and Adolescent Gynecology in an Irish Hospital: A Pilot Study.

STUDY OBJECTIVE: We aim to show that there is a knowledge deficit among pediatric and general practitioner (GP) trainees in pediatric and adolescent gynecology (PAG) and that this has implications for increased morbidity in girls. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: In October 2019 in a tertiary Irish pediatric hospital 50 junior doctors were approached (of a possible 66) and were surveyed in their knowledge of PAG with a written 21-question questionnaire incorporating 10 topics. RESULTS: Forty candidates participated (n = 31 pediatric and 9 GP). Sixty percent (n = 24/40) incorrectly misdiagnosed vulvovaginitis as candida; 80% (n = 32/40) could not identify labial adhesions; 47.5% (n = 19/40) were unable to define heavy menstrual bleeding. All of the GP trainees (n = 9/9) said they would prescribe the oral contraceptive pill compared with 51.6% (n = 16/31) of pediatric trainees; 52.5% (n = 21/40) did not consider sexually transmitted infection screening; and 70% (n = 28/40) could not identify female genital mutilation. There was generally no statistically significant difference between GP and pediatric trainees. CONCLUSION: A knowledge deficit among trainees was evident in relation to PAG from common to rare, but serious PAG conditions. Misdiagnosis and delayed treatment could lead to increased morbidity for girls. We recommend the introduction of a standardized training program in PAG for trainees.

Benefit of Sequential Audit Cycles in Improving Management of Vitamin D Deficiency in the HIV Infected Paediatric Population

Aims Lifelong HIV infection has an unknown impact on bone health in children. In view of this, we aimed to improve management of vitamin D deficiency. Methods Three audits over 8 years (2009-2017) were performed with interventions introduced intermittently in an effort to improve vitamin D deficiency. The interventions included education, a change in vitamin D dose and brand to increase compliance and a shift to nursing led management. Results The most striking result was the eradication of patients with deficient vitamin D levels (<25nmol/L) in 2017. In 2009 and 2015, 15% and 9% were deficient. In the earlier two studies, only 15% had 'sufficient' (>50nmol) vitamin D levels. This increased to 71% in 2017. 10% of patients had levels greater than >120nmol/L, increasing risk of vitamin D toxicity. 67% of patients with insufficient vit D (25-50nmol/L) were prescribed a stat high dose vitamin D (120,000 IU) to help avoid adherence issues. Conclusions Sequential audits along with a shift to nurse led management were the most likely reasons for sustained improvement. Similar projects in all medical departments could improve clinical outcomes.

Evaluation and application potential of an accelerometer-based collar device for measuring grazing behavior of dairy cows.

The commercially available collar device MooMonitor+ was evaluated with regards to accuracy and application potential for measuring grazing behavior. These automated measurements are crucial as cows feed intake behavior at pasture is an important parameter of animal performance, health and welfare as well as being an indicator of feed availability. Compared to laborious and time-consuming visual observation, the continuous and automated measurement of grazing behavior may support and improve the grazing management of dairy cows on pasture. Therefore, there were two experiments as well as a literature analysis conducted to evaluate the MooMonitor+ under grazing conditions. The first experiment compared the automated measurement of the sensor against visual observation. In a second experiment, the MooMonitor+ was compared to a noseband sensor (RumiWatch), which also allows continuous measurement of grazing behavior. The first experiment on n = 12 cows revealed that the automated sensor MooMonitor+ and visual observation were highly correlated as indicated by the Spearman's rank correlation coefficient (rs) = 0.94 and concordance correlation coefficient (CCC) = 0.97 for grazing time. An rs-value of 0.97 and CCC = 0.98 was observed for rumination time. In a second experiment with n = 12 cows over 24-h periods, a high correlation between the MooMonitor+ and the RumiWatch was observed for grazing time as indicated by an rs-value of 0.91 and a CCC-value of 0.97. Similarly, a high correlation was observed for rumination time with an rs-value of 0.96 and a CCC-value of 0.99. While a higher level of agreement between the MooMonitor+ and both visual observation and RumiWatch was observed for rumination time compared to grazing time, the overall results showed a high level of accuracy of the collar device in measuring grazing and rumination times. Therefore, the collar device can be applied to monitor cow behavior at pasture on farms. With regards to the application potential of the collar device, it may not only be used on commercial farms but can also be applied to research questions when a data resolution of 15 min is sufficient. Thus, at farm level, the farmer can get an accurate and continuous measurement of grazing behavior of each individual cow and may then use those data for decision-making to optimize the animal management.

Review: Grass-based dairy systems, data and precision technologies.

Precision technologies and data have had relatively modest impacts in grass-based livestock ruminant production systems compared with other agricultural sectors such as arable. Precision technologies promise increased efficiency, reduced environmental impact, improved animal health, welfare and product quality. The benefits of precision technologies have, however, been relatively slow to be realised on pasture based farms. Though there is significant overlap with indoor systems, implementing technology in grass-based dairying brings unique opportunities and challenges. The large areas animals roam and graze in pasture based systems and the associated connectivity challenges may, in part at least, explain the comparatively lower adoption of such technologies in pasture based systems. With the exception of sensor and Bluetooth-enabled plate metres, there are thus few technologies designed specifically to increase pasture utilisation. Terrestrial and satellite-based spectral analysis of pasture biomass and quality is still in the development phase. One of the key drivers of efficiency in pasture based systems has thus only been marginally impacted by precision technologies. In contrast, technological development in the area of fertility and heat detection has been significant and offers significant potential value to dairy farmers, including those in pasture based systems. A past review of sensors in health management for dairy farms concluded that although the collection of accurate data was generally achieved, the processing, integration and presentation of the resulting information and decision-support applications were inadequate. These technologies' value to farming systems is thus unclear. As a result, it is not certain that farm management is being sufficiently improved to justify widespread adoption of precision technologies currently. We argue for a user need-driven development of technologies and for a focus on how outputs arising from precision technologies and associated decision support applications are delivered to users to maximise their value. Further cost/benefit analysis is required to determine the efficacy of investing in specific precision technologies, potentially taking account of several yet to ascertained farm specific variables.

Evaluation of the RumiWatchSystem for measuring grazing behaviour of cows.

Feeding behaviour is an important parameter of animal performance, health and welfare, as well as reflecting levels and quality of feed available. Previously, sensors were only used for measuring animal feeding behaviour in indoor housing systems. However, sensors such as the RumiWatchSystem can also monitor such behaviour continuously in pasture-based environments. Therefore, the aim of this study was to validate the RumiWatchSystem to record cow activity and feeding behaviour in a pasture-based system. The RumiWatchSystem was evaluated against visual observation across two different experiments. The time duration per hour at grazing, rumination, walking, standing and lying recorded by the RumiWatchSystem was compared to the visual observation data in Experiment 1. Concordance Correlation Coefficient (CCC) values of CCC=0.96 for grazing, CCC=0.99 for rumination, CCC=1.00 for standing and lying and CCC=0.92 for walking were obtained. The number of grazing and rumination bouts within one hour were also analysed resulting in Cohen's Kappa (κ)=0.62 and κ=0.86 for grazing and rumination bouts, respectively. Experiment 2 focused on the validation of grazing bites and rumination chews. The accordance between visual observation and automated measurement by the RumiWatchSystem was high with CCC=0.78 and CCC=0.94 for grazing bites and rumination chews, respectively. These results indicate that the RumiWatchSystem is a reliable sensor technology for observing cow activity and feeding behaviour in a pasture based milk production system, and may be used for research purposes in a grazing environment.

Acute intestinal failure in surgical patients: an audit of incidence, management and outcomes in an irish hospital, and compliance with ASGBI guidelines.

BACKGROUND: Acute intestinal failure (AIF) is defined as an inability to tolerate 80% of nutritional requirements delivered enterally for a minimum of 48 h. In surgical patients it commonly relates to abdominal sepsis, intestinal obstruction, or ileus. The prevalence of AIF in surgical units in Ireland has not previously been studied. METHODS: We retrospectively audited the general surgical and ICU departments in St James's Hospital over a 3-month period to identify patients with AIF and followed their management and outcomes focusing on the need for artificial nutrition and surgical intervention. RESULTS: Fifty-four surgical patients (11.4% of surgical emergency admissions) were diagnosed with AIF over the 3-month period. Of these, 30 (55.6%) required nutritional support; 26 (48.2%) had surgical ± radiological intervention and 6 (11.1%) had radiological intervention alone. Abdominal sepsis was present in 17 (31.5%) patients, a group that required significantly longer parenteral (14.6 vs. 6.7 days, p 0.029) and enteral (13.9 vs. 2.2 days, p 0.005) nutrition than AIF patients without abdominal sepsis. AIF also took longer to resolve in (5.8 vs. 4.2 days, p 0.024) in sepsis versus nonsepsis patients. The majority of patients (n = 43, 80%) were referred to clinical nutrition teams early after having symptoms for 3.77 days (range 1-21) and 72% had complete nutritional assessment clearly documented. CONCLUSION: AIF is common, and can often be treated conservatively. Early linkage with nutrition services is recommended. Early diagnosis of abdominal sepsis is important as this cohort of patients can be particularly difficult to manage.

Relationship between psychological stress and semen quality among in-vitro fertilization patients.

The purpose of this study was to determine the relationship between psychological stress and semen quality among men undergoing in-vitro fertilization (IVF). We assessed psychological variables, including self-reported stress, and sperm parameters in a group of 40 men undergoing IVF for the first time at a pre-IVF sampling period (T1) and at the time of egg retrieval (T2). Thirty-one patients completed the study. Results indicated that total and motile sperm concentration, total motile spermatozoa, and lateral head displacement decreased significantly from T1 to T2 in a high percentage of participants. In addition, the perceived importance of producing a semen specimen increased significantly (P = 0.001) from T1 to T2, and this change was significantly correlated (P < 0.05) with diminished semen quality at the time of oocyte retrieval. No decline in the semen quality or increase in perceived stress at egg retrieval was observed at T2 in male factor patients (n = 7). This study provides evidence for a significant decline in semen quality of male IVF patients at egg retrieval and demonstrates an inverse relationship between semen quality and specific aspects of psychological stress.

Prevention of ovarian cancer: a survey of the practice of prophylactic oophorectomy by consultant gynaecologists in Ireland.

The aim of this study was to investigate attitudes to prophylactic oophorectomy among practicing consultant gynaecologists in Ireland. An anonymous questionnaire was sent to 90 practicing consultants. A total of 68 replies were received (76%). Of these, the number who said they would remove apparently normal ovaries at the time of abdominal hysterectomy from premenopausal women in age groups < 35, 35-39, 40-44, 45-49 and > 49 years was 0 (0%), 0 (0%), 4 (6%), 29 (43%), and 46 (68%) respectively; and from postmenopausal women 60 (88%). Only 2 (3%) routinely considered oophorectomy when performing a vaginal hysterectomy. The majority of respondents said that (i) they would prescribe hormone replacement therapy in premenopausal oophorectomised women (98.5%); (ii) they did not consider unilateral oophorectomy to have a role in the prevention of ovarian cancer (84%); and (iii) they routinely discussed the question of prophylactic oophorectomy with their patients preoperatively (82%). Only 19 (27%) believed that the established figure of 10-15% of ovarian cancers could be prevented by oophorectomy at the time of hysterectomy for benign disease. 43 (63%) would perform prophylactic oophorectomy as a primary surgical procedure in women with a strong family history of ovarian carcinoma.

Prediction of functional capacities.

OBJECTIVE: This study explores the hypothesis that clients with low back injury can estimate their own functional capacities for waist-level lifting, lifting from the floor, and standing tolerance prior to formal functional capacity testing. SUMMARY OF BACKGROUND DATA: The frequent use of functional capacity evaluations for clients with industrial injuries and health care cost containment prompted research on the appropriateness and need for ohjective functional capacity evaluations. STUDY DESIGN/METHODS: All clients referred to the Sister Kenny Institute Work Injury Program for functional capacity evaluations from July 1991 to May 1992 were screened for eligibility and willingness to participate. Seventy-five subjects participated in the study. These subjects predicted their capacities prior to formal functional capacities testing; formal testing results were then compared to the predictions. RESULTS: RESULTS indicated the majority of low back injured clients' actual test scores were not within 20 tests. CONCLUSION: The outcome of this study indicates it is difficult for clients to accurately predict their own functional capacities following low back injuries. Therefore, when functional capacities remain in question, functional capacity evaluations continue to be a valuable and cost-effective route to promote a safe return to work.