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3.
Ir Med J ; 117(2): 913, 2024 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-38446194
8.
BMC Pediatr ; 20(1): 505, 2020 11 03.
Artículo en Inglés | MEDLINE | ID: mdl-33143681

RESUMEN

BACKGROUND: A child's home and family environment plays a vital role in neuro-cognitive and emotional development. Assessment of a child's home environment and social circumstances is an crucial part of holistic Paediatric assessment. AIMS: Our aim is to achieve full compliance with comprehensive documentation of biopsychosocial history, for all children medically admitted to the children's inpatient unit in University Hospital Limerick. METHODS: We performed a retrospective chart review to audit documentation within our department. This was followed by teaching interventions and a survey on knowledge, attitudes and behaviour of paediatric non-consultant hospital doctors (NCHDs) towards the social history. We performed two subsequent re-audits to assess response to our interventions, and provided educational sessions to seek improvement in quality of care. RESULTS: Results showed a significant improvement in quality of documentation following interventions, demonstrated by a net increase of 53% in levels of documentation of some social history on first re-audit. Though this was not maintained at an optimum level throughout the course of the year with compliance reduced from 95% to 82.5% on second re-audit, there was nonetheless a sustained improvement from our baseline. Our qualitative survey suggested further initiatives and educational tools that may be helpful in supporting the ongoing optimisation of the quality of documentation of social history in our paediatric department. CONCLUSION: We hope this quality improvement initiative will ultimately lead to sustained improvements in the quality of patient-centred care, and early identification and intervention for children at risk in our community.


Asunto(s)
Documentación , Mejoramiento de la Calidad , Niño , Hospitalización , Hospitales Pediátricos , Humanos , Estudios Retrospectivos
10.
Acta Psychiatr Scand ; 142(1): 52-57, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32474904

RESUMEN

OBJECTIVE: The gold standard for diagnosing anti-NMDAR encephalitis is demonstration of the antibody in CSF. Clinical diagnostic criteria have been proposed for when this is not available in a timely manner which is evaluated, in this study, for a psychiatric population. METHODS: This study retrospectively assessed the proposed criteria in patients presenting to psychiatric services for the first time with known anti-NMDAR antibody status. Antibody-positive cases were derived from the literature (conception to December 2019) and a state-wide (Queensland, Australia) cohort. Antibody-negative cases were derived from a service-wide (Metro South, Queensland, Australia) cohort of psychiatric cases which underwent antibody testing for routine organic screening. Sensitivity and specificity were calculated at 1 week following admission and the point of discharge. RESULTS: The proposed criteria were applied to 641 cases (500 antibody-positive and 141 antibody-negative), demonstrating a sensitivity which increased from around 19% after 1 week to 49% by the point of discharge. Specificity was 100% at both time points. The mean average time to become positive using the proposed criteria was 19.5 days compared to 34.9 days for return of antibody testing. CONCLUSIONS: High specificity of the proposed criteria, seen in this study, suggests that cases which are positive can be considered for expedited commencement of treatment. However, if clinical suspicion is high despite criteria being negative, it is essential to test CSF for anti-NMDAR antibody.


Asunto(s)
Encefalitis Antirreceptor N-Metil-D-Aspartato/diagnóstico , Adulto , Encefalitis Antirreceptor N-Metil-D-Aspartato/inmunología , Femenino , Humanos , Masculino , Servicios de Salud Mental , Queensland , Receptores de N-Metil-D-Aspartato/inmunología , Estudios Retrospectivos , Sensibilidad y Especificidad
11.
Ir Med J ; 112(4): 910, 2019 04 11.
Artículo en Inglés | MEDLINE | ID: mdl-31241277

RESUMEN

Introduction Weight measurement is fundamental in the management of paediatric patients. Many methods have been described for estimating a patient's weight. The aim of this study was to assess the accuracy of the APLS 2017 estimated weight guidelines. Methods 100 patient charts were analysed in University Hospital Limerick's Paediatric unit. Measured weights were recorded, and estimated weights were calculated using the APLS 2017 charts. Estimated and measured weight was compared using Bland Altman plots. Results Of 100 subjects, 53 (53%) were female and 47 (47%) male. Fifty subjects (50%) were Pre-School, 32 (32%) Primary School and 18 (18%) Secondary School. Estimated weight was a good predictor for measured weight, however weight was underestimated by between 2.34% and 16.39% of measured weight. Discussion The current APLS guidelines are reasonably accurate; but accuracy decreases with increasing age. Estimation cannot replace an accurate measurement, which is not always feasible in the acute setting.


Asunto(s)
Peso Corporal , Pediatría , Factores de Edad , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios Prospectivos
13.
Ir Med J ; 111(9): 819, 2018 10 11.
Artículo en Inglés | MEDLINE | ID: mdl-30556667

RESUMEN

Aim To describe the healthcare needs of adolescent patients inhabiting the 'seventh age of childhood' in our region with a view towards future workforce and infrastructure planning. Methods This is a retrospective descriptive study of patients aged between 14 and 16 years presenting to each of the six hospitals in our hospital group over a 10 year period (01.07.2006-1.07.2016) using electronic databases. Results There were 10,992 hospital admissions, 41,456 outpatient appointments and an average of 1,847 attendances per year at our Emergency Department in this age group. Seventeen percent (n=1,873) of patients were admitted to age appropriate wards. Only 11.3% (n=1,242) of our cohort were admitted under the care of a Paediatrician. Conclusion The Irish healthcare agenda needs to be advanced to ensure the optimal health for this valuable, yet vulnerable generation. Further investment will help shape the fledgling discipline of 'adolescent health' in Ireland.


Asunto(s)
Salud del Adolescente , Atención Ambulatoria/estadística & datos numéricos , Atención a la Salud , Necesidades y Demandas de Servicios de Salud , Pacientes Ambulatorios/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Atención al Paciente/estadística & datos numéricos , Adolescente , Factores de Edad , Estudios de Cohortes , Bases de Datos Factuales , Servicios Médicos de Urgencia/estadística & datos numéricos , Femenino , Humanos , Irlanda/epidemiología , Masculino , Pediatras , Estudios Retrospectivos , Factores de Tiempo
15.
Obes Sci Pract ; 4(5): 455-467, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30338116

RESUMEN

BACKGROUND/AIM: Exercise can be used as a strategy to attenuate hyperglycaemia experienced during gestational diabetes mellitus (GDM). To maximize its use for clinical management, the most effective modality should be identified. The purpose of this review is to elucidate the most effective modality of exercise on insulin sensitivity and blood glucose control in pregnant women with or at risk of GDM. METHODS: A search was undertaken in MEDLINE, PubMed, Scopus, CINAHL, the Cochrane Library, Embase and the Maternity & Infant Healthcare Database. Studies that met inclusion criteria were randomized controlled trials and case-controlled studies, which compared exercise interventions with standard care during pregnancy in women with or at risk of GDM. RESULTS: Two interventions using resistance training, eight using aerobic exercise and two using a combination of both modalities were included. The interventions showed consistently that requirements of insulin therapy, dosage, and latency to administration were improved in the exercise groups. Less consistent results were observed for capillary blood glucose measurements; however, both modalities and combination of modalities were effective at improving blood glucose control in already diagnosed patients and pregnant women with obesity. Discrepancies in the timing of intervention, GDM diagnostic criteria, and the different measures used to assess glucose metabolism make it difficult to draw clear recommendations. CONCLUSION: Exercising three times per week for 40-60 min at 65-75% age-predicted heart rate maximum using cycling, walking or circuit training as a modality improved glycaemic control in GDM patients and reduced incidence of GDM in pregnant women with obesity. Further studies looking specifically at the effects of different modalities of exercise on glucose metabolism with combined strategies to enhance insulin sensitivity should be explored to maximize benefits for GDM pregnancies. Consistency in design and delivery of exercise-only interventions is required to make recommendations on a suitable exercise prescription in this population. In practice, adherence to consensus in diagnostic cut-offs for GDM diagnosis is fundamental for standardizing future research.

16.
Acta Psychiatr Scand ; 138(5): 401-408, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-29992532

RESUMEN

OBJECTIVE: To review the psychiatric symptoms of anti-N-methyl-d-aspartate (NMDA) receptor encephalitis, in an attempt to differentiate the presentation from a primary psychiatric disorder. METHOD: A systematic literature review of PubMed and EMBASE of all published cases of anti-NMDA receptor encephalitis was performed from inception to January 2018. RESULTS: There were 706 cases of anti-NMDA receptor encephalitis identified. Cases were typically young (mean age 22.6 years, SD 14.8), female (F : M ratio 3.5 : 1) and presented with significant behavioural disturbance. Reported behaviour was most commonly severe agitation and aggression, abnormal speech, and catatonia. Psychosis occurred in 45.8% of cases. Investigation results were inconsistent (MRI abnormal in 35.6%, EEG abnormal in 83.0%) and non-specific. Psychiatric treatment often required multiple psychotropics, and there may be increased risk of significant side-effects such as neuroleptic malignant syndrome. Prognosis was usually good; however, cognitive and behavioral symptoms remained prominent during recovery, and psychiatrist involvement was required in this period. CONCLUSION: The presentation of anti-NMDA receptor encephalitis is variable. However, there are often psychiatric features which are atypical to a primary psychiatric illness, such as severe agitation, speech abnormalities, and catatonia, which may help early identification.


Asunto(s)
Agresión/fisiología , Encefalitis Antirreceptor N-Metil-D-Aspartato/fisiopatología , Síntomas Conductuales/fisiopatología , Agitación Psicomotora/fisiopatología , Trastornos Psicóticos/fisiopatología , Trastornos del Habla/fisiopatología , Adolescente , Adulto , Encefalitis Antirreceptor N-Metil-D-Aspartato/complicaciones , Síntomas Conductuales/etiología , Femenino , Humanos , Masculino , Agitación Psicomotora/etiología , Trastornos Psicóticos/etiología , Trastornos del Habla/etiología , Adulto Joven
17.
Ir Med J ; 111(2): 686, 2018 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-29952435

RESUMEN

INTRODUCTION: Nineteen percent of 9 years old Irish children are overweight; seven percent are obese. Our aims were: to examine whether differences exist between paternal self-reported and measured height, weight and BMI in a population representative sample; and to explore paternal perceptions of their own weight status. METHODS: Measures of height and weight for fathers and for their children from the National Longitudinal Study of Children Growing Up in Ireland were obtained using validated methods. RESULTS: Three quarters of fathers (6,263 of 8,568 study children) with a mean age of 42 years (SD 5.04) responded. The mean difference between self-reported and measured weight was -1.03kg (SD=4.52), indicating that weight was underestimated. Obese fathers were more likely to have an obese son (9.4% compared to 5.3% for the full cohort) and an obese daughter (12.4% compared to 7.7%). DISCUSSION: These data suggest that there is a strong relationship between fathers' weights and his childrens' weights. A leading factor in the development of childhood obesity is parental obesity. Targeting overweight and obesity in the child should occur simultaneously with tackling overweight and obesity in the parents; in this study, the fathers.


Asunto(s)
Índice de Masa Corporal , Peso Corporal , Autoevaluación Diagnóstica , Padre , Obesidad , Adulto , Estatura , Niño , Humanos , Irlanda , Estudios Longitudinales , Masculino , Sobrepeso , Obesidad Infantil
18.
Ir J Med Sci ; 186(2): 427-432, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-27083452

RESUMEN

BACKGROUND: Type 1 diabetes mellitus (T1DM) is a recognised risk factor for cardiometabolic disease. Other risk factors include age, gender, family history, glycaemic control, dyslipidaemia, weight, and activity levels. AIMS: To estimate the point prevalence of cardiometabolic risk factors in a paediatric population with T1DM. METHODS: Eighty-one patients with T1DM aged between 10 and 16 years attended during the study and 56 (69.1 %) patients agreed to participate. Mixed methods data collection included a questionnaire developed for this study, supplemented by retrospective and prospective data collected from the patient records. RESULTS: Of 56 subjects with T1DM, aged 12.7 ± 1.7 years (10-16 years) 26 were male and 30 were female. Mean HbA1c was 72 ± 14 mmol/mol. 53 subjects (94.6 %) had at least one additional cardiometabolic risk factor. CONCLUSIONS: Cardiometabolic risk factors are present in this population with T1DM. Identifying cardiometabolic risk factors in adolescent T1DM patients is the first step in prevention of future morbidity and mortality.


Asunto(s)
Glucemia , Enfermedades Cardiovasculares/etiología , Diabetes Mellitus Tipo 1/complicaciones , Dislipidemias/epidemiología , Adolescente , Niño , Femenino , Humanos , Masculino , Prevalencia , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo
19.
20.
Ir Med J ; 109(5): 404, 2016 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-27685875

RESUMEN

The safest way for children to travel within a car is by provision of a weight-appropriate safety-seat. To investigate this, we conducted a cross-sectional study of adult parents who had children under 12 years, and collected information related to: car use, safety-seat legislation, and type of safety-seat employed. Data were reviewed on 120 children from 60 respondents. Ninety-eight (81.7%) children were transported daily by car. Forty-eight (81.4%) respondents were aware that current safety-seat legislation is based on the weight of the child. One hundred and seven (89.9%) children were restrained during travel using a car safety-seat. One hundred and two (96.2%) safety seats were newly purchased, installed in 82.3% (88) cases by family members with installation instructions fully read in 58 (55.2%) cases. Ninety-nine (83.2%) children were restrained using an appropriate safety-seat for their weight. The results show that four out of five families are employing the most appropriate safety-seat for their child, so providing an effective mechanism to reduce car-related injury. However, the majority of safety-seats are installed by family members, which may have child safety consequences.

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