Cannabis versus combination chemotherapy; n  = 1 trial in Hodgkin’s lymphoma

Implementation of day of surgery admission for rectal cancer surgery in Ireland following a national centralisation programme Abstract Background Centralisation of rectal cancer surgery has altered the delivery of colorectal cancer care in Ireland. This has resulted in an increased demand for elective surgical beds in designated centres. Aim This study aimed to assess if day of surgery admission (DOSA), in conjunction with implementation of a coordinated enhanced recovery pathway can reduce length of stay following elective rectal cancer resection. Methods This is a retrospective review from a single institution. Our prospectively maintained Dendrite® Database was interrogated. Three time points were analysed across a 7-year period (2011, 2012, 2016). The first predates the introduction of a dedicated DOSA programme, the next was directly thereafter, and the final was 5-years post-implementation. These dates coincide with the centralisation of rectal cancer surgery to this centre. Outcomes included unadjusted length of stay and rates of DOSA pre-and post-implementation of the programme. Results The introduction of a DOSA pathway resulted in a fivefold increase in day of surgery admissions and a related 3-day reduction in average length of stay within a single year of implementation. This further improved in 2016, showing an almost 83% increase (15.90–98.50%) in day of surgery admission and a reduction in average length of stay from 16.4 to 12.4 days when compared to 2011. Conclusions Despite an increase in caseload of 54%, an estimated 272 bed days were saved. This demonstrated that DOSA is sustainable and highly effective in tackling the increased inpatient bed demands associated with the growing requirement for elective surgery.

Transmission electron microscopy and histological analysis of the peridural membrane Abstract Introduction While first described in 1904, the characterisation of the peridural membrane, which is frequently encountered, yet usually unnoticed, during lumbar decompression surgery, remains inconclusive. This relatively little known membrane is continuous with the posterior longitudinal ligament and lines the epidural space. In this study, we are comparing the membrane and ligamentum flavum from patients to analyse the variations of the histological and ultrastructural compositions. Materials and methods We took samples of the membrane and ligamentum flavum from five separate patients who were undergoing lumbar spine decompression surgery for herniated discs which were then analysed with transmission electron microscopy and stained with H&E (morphology), trichrome (collagen content), and Verhoeff-Van Gieson (elastin content). Results Upon analysis of the peridural membrane, we observed tightly packed collagen fibres, interspaced with elastin fibres and very few fibroblasts. While the ligamentum flavum showed a significantly higher elastin to collagen ratio and looser arrangement of collagen fibres with a larger extracellular matrix. The peridural membrane was similar in appearance and constituent parts to the dura mater. Conclusion The peridural membrane is a distinctive and important membrane in the spinal canal, and given its high collagen to elastin ratio and it tightly packed nature, we conclude that it forms a protective layer around the spinal cord which may help in minimising the compressive nature of intervertebral disc herniation.

The purpose of ward rounds Abstract Ward rounds are a highly important forum for collaborative medical reasoning. Despite being prevalent for over a century, they are under-researched. In particular, no clear and comprehensive statement of the purpose of ward rounds exists in the literature. This letter provides such a statement. Having the purpose of ward rounds clearly described helps to provide a foundation for evaluating the effectiveness of rounds and suggesting ways in which rounds can be improved.

Migration to aphakia and contact lens treatment is the trend in the management of unilateral congenital cataract in Britain and Ireland Abstract Background The Infant Aphakia Treatment Study (IATS) compared the treatment of unilateral cataract in infants aged 1–6 months with primary intraocular lens (IOL) implantation vs aphakia with contact lens (CL) correction. Aims This study aims to assess the current trends in the treatment of unilateral congenital cataract in infants less than 6 months at surgery in the UK and Ireland. Methods An anonymous survey was emailed to the 200 members of the BIPOSA mailing list with 14 questions to assess treatment choice (primary intraocular lens (IOL) vs aphakia with contact lens (CL)), reasons for this choice, and assessment of local CL services. Results There were 56 respondents, 39 of whom completed the entire survey. Aphakia with CL was the treatment choice for 74.4% of respondents. A quarter (25.6%) of respondents said they were performing primary IOL implantation prior to the publication of the Infant Aphakia Treatment Study (IATS), but now choose aphakia with CL. Amongst the 20.5% (n = 8) of respondents who chose primary IOL implantation, 5 attributed their choice to “inadequate CL service”. The majority (84.6%) of respondents rated their infant CL service as either “good” or “very good”. Conclusion Aphakia with CL rehabilitation was the most common approach to the treatment of unilateral congenital cataract in infants less than 6 months in this study. The results of the IATS appear to have influenced a change in practice from primary IOL implantation to aphakia and CL visual rehabilitation in approximately one quarter of those surveyed.

Parental awareness of newborn bloodspot screening in Ireland Abstract Background There is little known regarding how familiar parents are with the newborn bloodspot screening (NBS) test or how well parents of a child with a screen-detected condition understand that condition initially. Aim The study aim was to examine parental NBS awareness and conditions screened. Methods Two studies were conducted: [1] Parents of children with cystic fibrosis (CF) detected via NBS and subsequently, diagnosed (n = 124) completed a telephone questionnaire regarding information they received at the time of NBS. [2] A cross-sectional study of women (n = 662 (58%) antenatal; n = 480 (42%) postnatal) attending three large maternity hospitals completed a questionnaire addressing NBS awareness. Results Mothers incorrectly identified diabetes/asthma (35% postnatal; 70% antenatal) and sickle cell disease (26%) as conditions on NBS in Ireland. Phenylketonuria was correctly identified by 48/26%, CF by 82/64%, and congenital hypothyroidism by 35/13% postnatal and antenatal women respectively. Of parents of children screen-detected and subsequently, diagnosed with CF, only half (n = 63; 51%) reported awareness at the time of NBS that CF was included. These results should be used to improve the information provided to expectant mothers and to inform health professionals’ initial discussions with parents about their child’s diagnosis, building on parents’ pre-existing knowledge.

Dialysis independence following single-agent daratumumab in refractory myeloma with renal failure

Critical biochemistry values and patient safety in primary care

The inclusion health awareness month at University College Hospital Galway (UCHG)

An investigation into nature and extent of errors within the Irish Vital Statistics mortality database