An analysis of inpatient dermatologic consultations at University Hospital Limerick: inadequate infrastructure leads to acute skin failure.

BACKGROUND: Approximately 15-20 % of the general population have skin diseases and it is therefore clear that inpatients can also present with various skin conditions that require dermatology input and in some cases the primary reason for admission to hospital. Inpatient hospital care is more expensive than outpatient care. Recent trends are moving towards outpatient care, as there is huge pressure on hospital bed availability. AIMS: The main aim of this study was to analyse patients referred with dermatological complaints and how soon after admission, were patients assessed by the dermatology team. Most dermatologic work is outpatient based and inpatient workload can be underestimated. METHODS: We retrospectively reviewed our inpatient consultations with a total of 220 consultations (males 113, females 107) between August 2014 and April 2015, to document this significant area of work over an eight-month period. RESULTS: The services requesting consultations were mostly general medicine 45.9 % (101/220), surgery 25.4 % (56/220) and paediatrics 24 % (53/220). Dermatologist's diagnosis was different from the referral team diagnosis in 60 % (132/220) of consults, with prompt inpatient assessment by the dermatologist within 24 h of admission. Most common dermatoses diagnosed included eczema 21.8 % (48/220) and psoriasis 7.3 % (16/220). CONCLUSION: Timely diagnosis and inpatient care has important implications on appropriate treatment, duration of hospital stay and patient outcome.

A randomised controlled study of mindfulness meditation versus relaxation therapy in the management of tinnitus.

OBJECTIVE: Psychotherapeutic interventions have been adopted effectively in the management of tinnitus for a long time. This study compared mindfulness meditation and relaxation therapy for management of tinnitus. METHODS: In this randomised controlled trial, patients were recruited for five sessions of mindfulness meditation or five sessions of relaxation therapy. Patients' responses were evaluated using the Tinnitus Reaction Questionnaire as a primary outcome measure, and the Hospital Anxiety and Depression Scale, visual analogue scale and a health status indicator as secondary outcome measures. RESULTS: A total of 86 patients were recruited. Thirty-four patients completed mindfulness meditation and 27 patients completed relaxation therapy. Statistically significant improvement was seen in all outcome measures except the health status indicator in both treatment groups. The change in treatment scores was greater in the mindfulness meditation group than in the relaxation therapy group. CONCLUSION: This study suggests that although both mindfulness meditation and relaxation therapy are effective in the management of tinnitus, mindfulness meditation is superior to relaxation therapy.

Circumferential mural bands in the small intestine causing simple obstructive colic: a case series.

REASONS FOR PERFORMING STUDY: Circumferential mural band (CMB) in the small intestine is an emerging condition in Ireland. The clinical presentation is a simple obstruction of the small intestine of unknown aetiology. HYPOTHESIS: Horses affected with CMB in the small intestine have a good prognosis following surgical decompression into the caecum. METHODS: A retrospective study was carried out and 28 cases identified from 559 colic surgeries performed over a 5.5 year period. An exploratory celiotomy was performed in every case. A simple obstruction at the mid or distal jejunum was identified caused by a CMB, which was multiple in some cases. All of the horses except 2 had undergone a regular anthelmintic programme. RESULTS: Manual decompression of the small intestine into the caecum resulted in resolution of the simple jejunal obstruction. A constricted segment of small intestine was resected in one case, as the degree of constriction was severe. A full thickness biopsy was taken from another case. Histopathology was performed on both samples. All horses recovered from surgery and were discharged from the hospital 7-32 days post operatively. Short-term complications were observed. Survival rate was 100% at long-term follow-up. Histopathology showed inflammatory infiltration in the submucosa, muscularis and serosa with eosinophils predominating. Parasites were not detected. CONCLUSION AND POTENTIAL RELEVANCE: Small intestine circumferential mural bands have a good prognosis after surgical decompression of the small intestine into the caecum.

An approach to the audit of tinnitus management.

This study examines the advantages and internal consistency of an open-ended questionnaire (Benefit-problem questionnaire), over the Tinnitus questionnaire used by Jakes et al. (1985) in the auditing of a stress management programme. The Tinnitus questionnaire showed very little difference pre- and post-treatment, while the Benefit/problem questionnaire showed good improvement over a number of variables. This included some of the more traditional orthogonal values of tinnitus complaint. The clinical assessment made blindly and over a different time scale to the Benefit/problem questionnaire matched these positive results quite closely.

Intra-aortic mural thrombosis and splenic infarction in association with ulcerative colitis.

BACKGROUND: Arterial thrombosis is a very rare, but recognised complication of inflammatory bowel disease that can result in significant morbidity and mortality. CASE PRESENTATION: We present the case of a 48-year-old female with previously well-controlled ulcerative colitis who presented with severe left upper quadrant abdominal pain. Imaging investigations subsequently revealed a large intra-aortic mural thrombus extending into the coeliac axis complicated by splenic infarction. This occurred in the absence of other prothrombotic states such as thrombophilias or vasculitis. CONCLUSION: This case highlights the frequently overlooked association between inflammatory bowel disease and arterial thrombosis.

Tinnitus rehabilitation: a mindfulness meditation cognitive behavioural therapy approach.

BACKGROUND: Chronic tinnitus is a frequent symptom presentation in clinical practice. No drug treatment to date has shown itself to be effective. The aim of the present study was to investigate the effects of cognitive behavioural therapy and meditation in tinnitus sufferers. METHODOLOGY: Patients were selected from a dedicated tinnitus clinic in the Welsh Hearing Institute. A waiting list control design was used. Twenty-five chronic tinnitus sufferers were consecutively allocated to two groups, one receiving a cognitive behavioural therapy/meditation intervention of four one hour sessions with the other group waiting three months and subsequently treated in the same way, thereby acting as their own control. The main outcome was measured using the Hallam tinnitus questionnaire. A four to six month follow up was conducted. RESULTS: These showed significant statistical reductions in tinnitus variables both in the active and also in the control group. Post-therapy, no significant change was found after the waiting list period. The improvement was maintained at the four to six month period. CONCLUSION: The positive findings give support for the use of cognitive behavioural therapy/meditation for chronic tinnitus sufferers.

Stress management for irritable bowel syndrome: a controlled trial.

Thirty-five patients with irritable bowel syndrome were randomized to receive treatment in a stress management programme or conventional therapy which included the antispasmodic Colpermin. The stress management programme involved a median of six 40-min sessions with a physiotherapist during which patients were helped to understand the nature of their symptoms, their relationship to stress and were taught relaxation exercises. Two thirds of those in the stress management programme found the programme effective in relieving symptoms and experienced fewer attacks of less severity. This benefit was maintained for at least 12 months. Few of those given conventional management had any benefit. A stress management programme would appear to be of value for patients with irritable bowel syndrome.