The need for palliative care in Ireland: a population-based estimate of palliative care using routine mortality data, inclusive of nonmalignant conditions.

Context: Over the history of palliative care provision in Ireland, services have predominantly provided care to those with cancer. Previous estimates of palliative care need focused primarily on specialist palliative care and included only a limited number of nonmalignant diseases.

Objectives: The primary aim of this study was to estimate the potential population with generalist and/or specialist palliative care needs in Ireland using routine mortality data inclusive of nonmalignant conditions.

Effects of multidimensional treatment foster care on psychotic symptoms in girls.

Objective: Neurodevelopmental theories of psychosis highlight the potential benefits of early intervention, prevention, and/or preemption. How early intervention should take place has not been established, nor whether interventions based on social learning principles can have preemptive effects. The objective was to test whether a comprehensive psychosocial intervention can significantly alter psychotic symptom trajectories during adolescence-a period of heightened risk for a wide range of psychopathology.

Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID).

Background: Variations in testing for Clostridium difficile infection can hinder patients' care, increase the risk of transmission, and skew epidemiological data. We aimed to measure the underdiagnosis of C difficile infection across Europe.

Methods: We did a questionnaire-based study at 482 participating hospitals across 20 European countries.

Controlling the spread of vancomycin-resistant enterococci. Is active screening worthwhile?

Vancomycin-resistant enterococci (VRE) are significant causes of healthcare-acquired infections. Active screening, i.e.

Common versus psychopathology-specific risk factors for psychotic experiences and depression during adolescence.

Background: An argument often used to support the view that psychotic experiences (PEs) in general population samples are a valid phenotype for studying the aetiology of schizophrenia is that risk factors for schizophrenia show similar patterns of association with PEs. However, PEs often co-occur with depression, and no study has explicitly tested whether risk factors for schizophrenia are shared between PEs and depression, or are psychopathology specific, while jointly modelling both outcomes.

Method: We used data from 7030 subjects from a birth cohort study.

Air and surface contamination patterns of meticillin-resistant Staphylococcus aureus on eight acute hospital wards.

Background: Meticillin-resistant Staphylococcus aureus (MRSA) can be recovered from hospital air and from environmental surfaces. This poses a potential risk of transmission to patients.

Aim: To investigate associations between MRSA isolates recovered from air and environmental surfaces with those from patients when undertaking extensive patient and environmental sampling.

Dabigatran versus warfarin anticoagulation before and after catheter ablation for the treatment of atrial fibrillation.

Background: Systemic thromboembolism and bleeding remain the two most common and serious complications of catheter ablation of atrial fibrillation. A variety of periprocedure anticoagulation strategies have been proposed to mitigate these risks. Although operators are now routinely administering dabigatran for anticoagulation in this setting, its relative safety and effectiveness compared to warfarin are unknown.

Safety of drugs used in the treatment of osteoporosis.

A number of drug classes are licensed for the treatment of osteoporosis including bisphosphonates, recombinant human parathyroid hormone (PTH), strontium, hormone replacement therapy (HRT), selective oestrogen receptor modulators (SERMS) and denosumab. This review discusses the safety of osteoporosis treatments and their efficacies. Recent concerns about the safety of calcium and high-dose vitamin D are discussed.

Analysis of APC allelic imbalance/loss of heterozygosity and APC protein expression in cutaneous squamous cell carcinomas.

Background: The adenomatous polyposis coli (APC) gene is a tumor suppressor gene which is mutated in the hereditary disease, familial adenomatous polyposis (FAP). Somatic mutations of the APC gene have also been identified in the majority of sporadic colorectal carcinomas, and mutation of the APC gene appears to be an early step in the initiation of colon cancer. Loss of heterozygosity (LOH) of APC has been described in a variety of other cancer types, including renal cell carcinoma, gastric cancer, non-small cell lung cancer, endometrial cancer and oral squamous cell carcinomas (SCC).

The role of topical antibiotics used as prophylaxis in surgical site infection prevention.

Compared with systemic antibiotic therapy, the topical or local delivery of an antibiotic has many potential advantages. However, local antibiotics at the surgical site have received very limited approval in any of the surgical prophylaxis consensus guidelines that we are aware of. A review of the literature was carried out through searches of peer-reviewed publications in PubMed in the English language over a 30 year period between January 1980 and May 2010.

Neuroanatomical correlates of psychosis in temporal lobe epilepsy: voxel-based morphometry study.

Background: Temporal lobe epilepsy is associated with a significant risk of psychosis but there are only limited studies investigating the underlying neurobiology.

Aims: To characterise neuroanatomical changes in temporal lobe epilepsy and comorbid psychosis.

Method: The study population comprised all individuals with temporal lobe epilepsy on the epilepsy database at the National Centre for Epilepsy and Epilepsy Neurosurgery in Ireland (Beaumont Hospital) between 2002 and 2006.

Management of respiratory symptoms in ALS.

Respiratory insufficiency is a frequent feature of ALS and is present in almost all cases at some stage of the illness. It is the commonest cause of death in ALS. FVC is used as important endpoint in many clinical trials, and in decision-making events for patients with ALS, although there are limitations to its predictive utility.

A quantitative assessment of changing trends in internet usage for cancer information.

Background: The internet is an important source of healthcare information. To date, assessment of its use as a source of oncologic information has been restricted to retrospective surveys.

Methods: The cancer-related searches of approximately 361,916,185 people in the United States and the United Kingdom were examined.

The Modified Rivermead Mobility Index: reliability and convergent validity in a mixed neurological population.

Purpose: To assess the inter-rater reliability, internal consistency and convergent validity of the Modified Rivermead Mobility Index (MRMI) in a mixed neurological population.

Method: The MRMI was scored for 30 consecutive patients (mean age 54.5+/-15.

Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence.

Background: Adolescent cannabis use has been shown in many studies to increase the risk of later psychosis. Childhood trauma is associated with both substance misuse and risk for psychosis. In this study our aim was to investigate whether there is a significant interaction between cannabis use and childhood trauma in increasing the risk for experiencing psychotic symptoms during adolescence.

Do guidelines for the prevention and control of methicillin-resistant Staphylococcus aureus make a difference?

Many countries have national guidelines for the prevention and control of methicillin-resistant Staphylococcus aureus (MRSA) that are similar in approach. The evidence base for many recommendations is variable, and often, in the drafting of such guidelines, the evidence is either not analysed or not specifically reviewed. Guidelines usually recommend screening and early detection, hand hygiene, patient isolation or cohorting, and decolonization.

Evolving issues in the prevention of surgical site infections.

Surgical site infection is one of the more common causes of post-operative morbidity. Such infections contribute to prolonged recovery, delayed discharge and increasing costs to both patients and the health service. In the current climate increased emphasis is being placed on minimising the risks of acquiring or transmitting these nosocomial infections.

Prevention and control of methicillin-resistant Staphylococcus aureus.

Recent efforts to combat infections have focused on pharmaceutical interventions. However, the global spread of antimicrobial resistance calls for the reappraisal of personal and institutional hygiene. Hygiene embodies behavioural and procedural rules that prevent bacterial transmission.

Contrasting effects of maternal and paternal age on offspring intelligence: the clock ticks for men too.

Mary Cannon discusses the implications of a new cohort study showing an association between increasing paternal age and poorer cognitive abilities in the offspring.

Severe abdominal injuries sustained in an adult wearing a pelvic seatbelt: a case report and review of the literature.

In automobile accidents, the "seatbelt syndrome" (SBS) consists of a constellation of injuries, predominantly involving thoraco-lumbar vertebral fractures and intraabdominal organ injury. A recent amendment to Irish legislation has made the wearing of seatbelts mandatory for all rear seated passengers in an effort to protect children. Whilst rear seatbelts result in a significant reduction in morbidity and mortality following road traffic accidents (RTA), we present a case in which the rear lap seatbelt caused severe abdominal injuries.

Future of academic medicine in Ireland: no change is not an option.

There has been much concern internationally in recent years on the direction and future of academic medicine. Furthermore, there is uncertainty for medical consultants over academic contracts in Ireland, given recent changes in the health service and the slow pace of negotiations on a new contract. Reports from North America indicate that academics often spend more time in training but do not necessarily have more protected time for academic activities than their non-academic counterparts.

Molecular genetic analysis of the BRCA2 tumor suppressor gene region in cutaneous squamous cell carcinomas.

Background: Germ line mutations of the BRCA2 tumor suppressor gene with subsequent loss of the remaining wild-type BRCA2 allele have been identified in up to 35% of familial breast cancer cases. A high frequency of allelic loss at the BRCA2 gene locus has also been reported in a variety of sporadic epithelial tumors including oesophageal squamous cell carcinomas (SCC), and sporadic head and neck SCC.

Aim: The present study aimed to examine the integrity of the BRCA2 gene in cutaneous SCC.

Risk-based evaluation of thromboprophylaxis among surgical inpatients: are low risk patients treated unnecessarily?

Background: Venous thromboembolism is a common source of morbidity and mortality but a variety of preventative measures are available.

Aims: To audit the current practice of thromboprophylaxis and compare against published protocols.

Methods: Three-hundred and seventy-six (376) surgical patients were surveyed prospectively.

The Allergic Rhinitis and its Impact on Asthma system: a new classification of allergic rhinitis and nasal responsiveness.

Objectives And Hypothesis: Allergic rhinitis has traditionally been classified into seasonal and perennial rhinitis. However, many subjects with dual sensitisation do not fit neatly into either category. Recently, the Allergic Rhinitis and its Impact on Asthma workshop has proposed a new allergic rhinitis classification, into intermittent and persistent forms.