15 research outputs found
The prevention of fractures in adults
Background General practitioners (GPs) encounter patients who have suffered a fracture or are at an increased risk. Fragility fractures cost Europe 32 billion Euros per year. Recognizing this challenge and understanding its management allows GPs to engage in primary and secondary prevention of fragility fractures. Aim To illustrate lifestyle and pharmacological management options offered by a general practitioner to an adult at increased risk of fractures or low bone mineral density (BMD). The National Osteoporosis Guideline Group (NOGG, 2016), World Health Organisation (WHO), International Osteoporosis Foundation (IOF, 2012), Kidney Disease Improving Global Outcomes (KDIGO, 2009), Scottish Intercollegiate Guidelines Network (SIGN) and National Institute for Health and Care Excellence (NICE) management guidelines are discussed in this regard. Objectives âą To provide key definitions in the management of osteoporosis. âą To identify groups at risk of developing low BMD, vitamin D deficiency and fragility fractures. âą To illustrate the current management options for an adult at increased risk of fractures or low bone mass by a general practitioner. âą To discuss current methods of investigation and measurement of low BMD, fracture risk assessment and vitamin D deficiency. âą To address dietary requirements of calcium and vitamin D and local formulations available. Method A literature search was conducted using Pubmed and Google search engines. Keywords included: osteoporosis; low bone mineral density; vitamin D; fragility fracture; postmenopausal. The NOGG (2016), WHO, IOF (2012), KDIGO (2009), SIGN and NICE management guidelines were included directly. Treatments ranging from fall prevention, dietary modification, anti-resorptive therapy and tailoring in subgroups were reviewed. Conclusion Guidelines can close the gap between physicians in primary and secondary care, institutions and private practice providing a multifaceted approach for the proper identification, prevention and management of fragility fractures.peer-reviewe
An evaluation of referral tickets for acute psychiatric admissions
Background
Tickets of referral assist in clerking and the enforcement
of the Mental Health Act. Initial reviewers of the patient
who may be more aware of his/her background may
provide this information when transferring a patient to
Mount Carmel Hospital, Maltaâs psychiatric hospital.
Objectives
The aims of this study were to assess whether key
information on referral tickets was lacking as well as to
justify the importance of such information when referring
a new case and raise awareness on appropriate referral.
Methods
Permission to review the tickets of referral for new
admissions from the community to Mount Carmel
Hospital during the month of June 2015 was obtained
from the Chairman of Psychiatry. The files of new
admissions were assessed to see if the following were
present: official referral ticket; drug history; next of kin
details; handover to staff at Mount Carmel Hospital. The
place of initial assessment was also noted. All data was
anonymised and data input was done using a prepared
proforma. Patients referred from the civil prison and by
the caring consultantâs firm were not included.
Results
Seventy admissions were assessed. Eighty-nine per cent
(n=62) of these admissions included an official ticket
of referral. Most referrals came from health centres: 31%
(n=22). Seventy-four per cent (n=51) had a drug history
present. Seventy-six per cent (n=53) were lacking next
of kin details. Forty per cent (n=28) of the cases had
documentation of a handover to a senior on call.
Conclusions
Poor quality referral tickets with missing information are
often present which makes it difficult for the on-call staff at Mount Carmel Hospital to clerk the patient and come
up with a provisional treatment plan.peer-reviewe
Fetal MRI : an essential step in interpreting complex ultrasound findings
Background: Fetal magnetic resonance imaging (MRI) allows for the interpretation of complex fetal anomalies detected on ultrasound (US). Locally it has been available since 2013 but has remained underused.
Method: In this paper we report the US and MRI findings of all cases of fetal MRI that were taken to date locally and how MRI can contribute to the clarification of malformations, management, counseling, evaluation of prognosis and ruling out of other possible malformations.
Results: The cases reported were: two cases of hydroureter; gastroschisis; ventriculomegaly; intracranial haemorrhage; splenic cyst; Arnold Chiari II malformation. In all seven cases MRI was able to add to or change the diagnosis.
Conclusion: Fetal MRI acts as an adjunct to US in interpreting abnormal fetal development. It is a safe non-invasive method of imaging that allows the clinician to take more informed decisions and better parental counselling.peer-reviewe
The cost of blood in paediatric oncology patients
Introduction: Consumption of blood products is significant aiming to treat low cell counts and improve quality of life however 9% to 44% of the total consumption in centres abroad are unjustified. We reviewed thresholds at which blood products were administered and costs incurred by administering blood products at the local paediatric oncology ward at Mater Dei hospital and assessed whether they were inkeeping with local guidelines.
Methods: Patient files were analyzed retrospectively for demographics, disease, type and amount of blood products used from January to May 2013. The costs involved were obtained from the Blood Bank at Mater Dei Hospital. The standards used were the protocol by HBB regarding administration on KURA and âSupportive care protocolsâ in paediatric oncology and haematology.
Results: Nine children were given blood products. Red cell products (RCP) use ranged from 0-10 units. and platelets derived products ranged 0- 12 units per patient. haemoglobin levels and platelet counts before transfusions ranged from 3.1 to 8.6g/dL and 9 to 60x109/L respectively. The total cost for the department was âŹ17,950 while the total amount spent for tests done prior to ordering products was âŹ3,276 out of 22 RCP requests for transfusion only once were RCPs transfused above the standard 7g/dL. Platelets were requested 26 times. Documentation regarding the reason for administration was lacking in patient files.
Conclusion: The use of blood products is dependent on patient needs and is not influenced by prices. Thresholds at which platelets and RCP are administered vary according to the clinical scenario. Rising costs and shrinking donor pools require blood products to be used judiciously.peer-reviewe
Updates in the prevention of fractures
BACKGROUND: The prevention of fractures is multifaceted and
relies on reorienting lifestyles and targeting
persons with increased fracture risk. Following
an earlier review in 2017, the International
Osteoporosis Foundation (IOF) has provided
several updates for fracture prevention.OBJECTIVES: This bibliographic review will provide family
doctors with the IOFâs updates published on
its website, noting changes to treatments and
guidelines, addressing the prevention of fractures
and discussing the new recommendations in the
context of the Maltese healthcare system.METHOD: The IOF website (https://www.osteoporosis.
foundation/) was reviewed for guidance on
preventing fractures from the 19th to the 27th
of February 2023. The Scottish Intercollegiate
Guidelines Network SIGN 2021 guidelines on
managing osteoporosis and the UK Steady,
Strong, Straight consensus statement were
included. Updates in fracture prevention
management were noted, and domestic practices
and services available in the community were
discussed.RESULTS: The IOF promotes bone health through
educational means, lobbying, and developing
strategies, such as the Scorecard for Osteoporosis
in Europe (SCOPE), which compares EU countries based on expenditure outcomes and accessibility
to fracture prevention and management services.
The review also emphasises using fracture risk
calculators and densitometry to determine
treatment and measure responses.CONCLUSION: Strategies can reduce the risk of fractures
by giving specific, measurable, and doable
objectives to different stakeholders. For family
doctors, this could involve community services
in assessing the domestic milieu and improving
access to social benefits and interventions. Home
improvement measures improve both the risk
and rate of falls while intervening on a personal
level by improving physical and mental attributes
to improve the rates of falls.peer-reviewe
National analyses on survival in Maltese adult patients on renal replacement therapy started during 2009â2012
Chronic kidney disease patients on maintenance dialysis (CKD 5D) experience major morbidity and
mortality. No data on survival in Maltese dialysis patients exist; therefore, the aim of this study was to
rigorously examine survival statistics in a complete cohort of Maltese CKD 5D patients.
The study population was comprised of all incident chronic patients (N=328) starting dialysis at the
renal unit, Mater Dei hospital, Msida, Malta, for 4 consecutive years (2009â2012). Each yearly cohort
was analysed in detail up to 31st December 2017, providing up to 8 years follow-up. Demographics
(male 65%; female 35%), aetiology of renal failure (diabetic kidney disease: n=191; 58.2%), comorbidities,
transplant status, and death were documented. Data collection and follow up were completed and
statistical analysis was performed on the aggregated cohorts with SPSS version 23 with censoring up
to 31st December 2017.
The cumulative adjusted 5-year overall survival in Maltese CKD 5D patients was 0.36 and 0.25 at 8
years. No statistical difference was observed according to the year of starting dialysis. Cox regression
analysis showed that age and transplant status influenced survival. The unadjusted hazard of death
increased by 3% for every 1-year increase in age and was increased by 7% if the patient did not receive
a transplant, and overall 22% (n=72) of the entire cohort eventually received transplants.
This study reports an approximate 65% mortality at 5 years in Maltese haemodialysis patients, a poor
prognosis that, despite optimal medical management, is consistent with worldwide reports.peer-reviewe
Preparing an interdisciplinary guidance for the management of generalised paediatric status epilepticus
BACKGROUND: A guidance was created to assist family doctors
in managing generalized paediatric status
epilepticus (GPSE) at Primary HealthCare (PHC)
clinics.AIM: The article aims to discuss the process by which
the GPSE guidance was prepared.OBJECTIVES: The authors intend to provide information on
how the literature review was carried out, what
clinical threshold was decided as appropriate
for the administration of rescue medication, and
what treatments may be used in PHC.METHOD: An initial search and guidance draft was
forwarded to a Joint Working Group (JWG)
composed of professionals working at PHC
and Mater Dei Hospital (MDH). The names of
benzodiazepines and their formulations available
at PHC clinics were forwarded to the JWG by the
clinical Chairperson of Primary HealthCare. A
Pubmed search was carried out for the terms
âstatus epilepticus,â âchildrenâ, and âprehospitalâ,
filtering for free full text publications, humans,
English language, and dating from 1999 to 2019, yielding seventeen results in the English
language. Eight were relevant. A second Pubmed
search for âdiazepam use in paediatric seizuresâ
and âmidazolam use in paediatric seizuresâ
yielded fifty-five results, filtering for English
and dating from 2010-2019. Two were relevant.
Several guidelines and literature were directly
referenced. The literature review process and
results were summarised and modified into a
flowchart.RESULTS: An interdisciplinary approach was used to
decide how GPSE should be treated. Consensus
was agreed that if a seizure lasts more than
five minutes, benzodiazepines midazolam and
diazepam available at PHC clinics, may be used.
Intramuscular, intranasal, buccal, or rectal routes
are preferred per the childâs weight; and time the
duration of seizure activity.CONCLUSION: GPSE may terminate during the first five minutes
of ictal activity. Midazolam and diazepam may be
administered by different methods if seizures
persist, depending on the clinical scenario.peer-reviewe
Geographical and temporal distribution of SARS-CoV-2 clades in the WHO European Region, January to June 2020
We show the distribution of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) genetic clades over time and between countries and outline potential genomic surveillance objectives. We applied three genomic nomenclature systems to all sequence data from the World Health Organization European Region available until 10 July 2020. We highlight the importance of real-time sequencing and data dissemination in a pandemic situation, compare the nomenclatures and lay a foundation for future European genomic surveillance of SARS-CoV-2
SMS SOS: A randomized controlled trial to reduce self-harm and suicide attempts using SMS text messaging
Background: Hospital-treated deliberate self-harm (DSH) is common, costly and has high repetition rates. Since brief contact interventions (BCIs) may reduce the risk of DSH repetition, we aim to evaluate whether a SMS (Short Message Service) text message Intervention plus Treatment As Usual (TAU) compared to TAU alone will reduce hospital DSH re-presentation rates in Western Sydney public hospitals in Australia. Methods/design: Our study is a 24-month randomized controlled trial (RCT). Adult patients who present with DSH to hospital emergency, psychiatric, and mental health triage and assessment departments will be randomly assigned to an Intervention condition plus TAU receiving nine SMS text messages at 1, 2, 3, 4, 5, 6, 8, 10 and 12-months post-discharge. Each message will contain telephone numbers for two mental health crises support tele-services. Primary outcomes will be the difference in the number of DSH re-presentations, and the time to first re-presentation, within 12-months of discharge. Discussion: This study protocol describes the design and implementation of an RCT using SMS text messages, which aim to reduce hospital re-presentation rates for DSH. Positive study findings would support the translation of an SMS-aftercare protocol into mental health services at minimal expense. Trial registration and ethics approval: This trial has been registered with the Australian and New Zealand Clinical Trials Registry (Trial registration: ACTRN12617000607370. Registered 28 April 2017) and has been approved by two Local Health Districts (LHDs). Western Sydney LHD Human Research Ethics Committee approved the study for Westmead Hospital and Blacktown Hospital (Protocol: HREC/16/WMEAD/336). Nepean Blue Mountains LHD Research Governance Office approved the study for Nepean Hospital (SSA/16/Nepean/170)
SMS SOS: a randomized controlled trial to reduce self-harm and suicide attempts using SMS text messaging
Abstract Background Hospital-treated deliberate self-harm (DSH) is common, costly and has high repetition rates. Since brief contact interventions (BCIs) may reduce the risk of DSH repetition, we aim to evaluate whether a SMS (Short Message Service) text message Intervention plus Treatment As Usual (TAU) compared to TAU alone will reduce hospital DSH re-presentation rates in Western Sydney public hospitals in Australia. Methods/design Our study is a 24-month randomized controlled trial (RCT). Adult patients who present with DSH to hospital emergency, psychiatric, and mental health triage and assessment departments will be randomly assigned to an Intervention condition plus TAU receiving nine SMS text messages at 1, 2, 3, 4, 5, 6, 8, 10 and 12-months post-discharge. Each message will contain telephone numbers for two mental health crises support tele-services. Primary outcomes will be the difference in the number of DSH re-presentations, and the time to first re-presentation, within 12-months of discharge. Discussion This study protocol describes the design and implementation of an RCT using SMS text messages, which aim to reduce hospital re-presentation rates for DSH. Positive study findings would support the translation of an SMS-aftercare protocol into mental health services at minimal expense. Trial registration and ethics approval This trial has been registered with the Australian and New Zealand Clinical Trials Registry (Trial registration: ACTRN12617000607370. Registered 28 April 2017) and has been approved by two Local Health Districts (LHDs). Western Sydney LHD Human Research Ethics Committee approved the study for Westmead Hospital and Blacktown Hospital (Protocol: HREC/16/WMEAD/336). Nepean Blue Mountains LHD Research Governance Office approved the study for Nepean Hospital (SSA/16/Nepean/170)