713 research outputs found
A qualitative study of undergraduate clerkships in the intensive care unit: It’s a brand new world
Exploring patient characteristics and barriers to Hepatitis C treatment in patients on opioid substitution treatment (OST) attending a community based fibro-scanning clinic.
Background and Objectives: Hepatitis C virus (HCV) infection is a major public health issue. There is substandard uptake in HCV assessment and treatment among people who inject drugs (PWID). Community fibroscanning is used to assess disease severity and target treatment. Methods: A survey was administered to a cohort of chronically HCV infected patients attending a community fibroscanning clinic. Questions targeted diagnosis of HCV, suitability, willingness and barriers to engagement in treatment. Descriptive and regression analysis, with thematic analysis of open-ended data was conducted. Results: There was high acceptance of community fibroscanning among this cohort with over 90% (68) attending. High levels of unemployment (90%) and homelessness (40%) were identified. Most patients were on methadone treatment and had been HCV infected for greater than 10 years with length of time since HCV diagnosis being significantly longer in patients with fibroscan scores > 8.5 kPa (P = 0.016). With each unit increase in methadone dose, the odds of the >8.5 fibroscan group increased by 5.2%. Patient identified barriers to engagement were alcohol and drug use, fear of HCV treatment and liver biopsy, imprisonment, distance to hospital and early morning appointments. Conclusion: The study highlights the usefulness of community fibroscanning. Identifying barriers to treatment in this cohort affords an opportunity to increase the treatment uptake. The availability of afternoon clinics and enhanced prison linkage are warranted
Inviscid SPH
In smooth-particle hydrodynamics (SPH), artificial viscosity is necessary for
the correct treatment of shocks, but often generates unwanted dissipation away
from shocks. We present a novel method of controlling the amount of artificial
viscosity, which uses the total time derivative of the velocity divergence as
shock indicator and aims at completely eliminating viscosity away from shocks.
We subject the new scheme to numerous tests and find that the method works at
least as well as any previous technique in the strong-shock regime, but becomes
virtually inviscid away from shocks, while still maintaining particle order. In
particular sound waves or oscillations of gas spheres are hardly damped over
many periods.Comment: 14 pages (15 in arXiv), 15 figures, accepted for publication in MNRA
Stringent neutron-star limits on large extra dimensions
Supernovae (SNe) are copious sources for Kaluza-Klein gravitons which are
generic for theories with large extra dimensions. These massive particles are
produced with average velocities ~0.5 c so that many of them are
gravitationally retained by the SN core. Every neutron star thus has a halo of
KK gravitons which decay into nu bar-nu, e^+e^- and gamma gamma on time scales
\~10^9 years. The EGRET gamma-flux limits (E_gamma ~ 100 MeV) for nearby
neutron stars constrain the fundamental scale for n=2 extra dimensions to M
>500 TeV, and M>30 TeV for n=3. The upcoming GLAST satellite is a factor ~30
more sensitive and thus may detect KK decays, for example at the nearby neutron
star RX J185635--3754. The requirement that neutron stars are not excessively
heated by KK decays implies M>1700 TeV for n=2, and M>60 TeV for n=3.Comment: Minor changes, matches version to appear in PR
A pilot study of performance among hospitalised elderly patients on a novel test of visuospatial cognition: the letter and shape drawing (LSD) test.
peer-reviewedObjectives. Conventional bedside tests of visuospatial function such as the clock drawing (CDT) and intersecting
pentagons tests (IPT) are subject to considerable inconsistency in their delivery and interpretation. We compared performance
on a novel test – the letter and shape drawing (LSD) test –with these conventional tests in hospitalised elderly patients.
Methods. The LSD, IPT, CDT and the Montreal Cognitive Assessment (MoCA) were performed in 40 acute elderly
medical inpatients at University Hospital Limerick The correlation between these tests was examined as well as the
accuracy of the visuospatial tests to identify significant cognitive impairment on the MoCA.
Results. The patients (mean age 81.0±7.71; 21 female) had a median MoCA score of 15.5 (range = 1–29). There was a
strong, positive correlation between the LSD and both the CDT (r = 0.56) and IPT (r = 0.71). The correlation between the
LSD and MoCA (r = 0.91) was greater than for the CDT and IPT (both 0.67). The LSD correlated highly with all MoCA
domains (ranging from 0.54 to 0.86) and especially for the domains of orientation (r = 0.86), attention (0.81) and
visuospatial function (r = 0.73). Two or more errors on the LSD identified 90% (26/29) of those patients with MoCA
scores of ⩽20, which was substantially higher than for the CDT (59%) and IPT (55%).
Conclusion. The LSD is a novel test of visuospatial function that is brief, readily administered and easily interpreted.
Performance correlates strongly with other tests of visuospatial ability, with favourable ability to identify patients with
significant impairment of general cognition.PUBLISHEDpeer-reviewe
Improving convergence in smoothed particle hydrodynamics simulations without pairing instability
The numerical convergence of smoothed particle hydrodynamics (SPH) can be
severely restricted by random force errors induced by particle disorder,
especially in shear flows, which are ubiquitous in astrophysics. The increase
in the number NH of neighbours when switching to more extended smoothing
kernels at fixed resolution (using an appropriate definition for the SPH
resolution scale) is insufficient to combat these errors. Consequently, trading
resolution for better convergence is necessary, but for traditional smoothing
kernels this option is limited by the pairing (or clumping) instability.
Therefore, we investigate the suitability of the Wendland functions as
smoothing kernels and compare them with the traditional B-splines. Linear
stability analysis in three dimensions and test simulations demonstrate that
the Wendland kernels avoid the pairing instability for all NH, despite having
vanishing derivative at the origin (disproving traditional ideas about the
origin of this instability; instead, we uncover a relation with the kernel
Fourier transform and give an explanation in terms of the SPH density
estimator). The Wendland kernels are computationally more convenient than the
higher-order B-splines, allowing large NH and hence better numerical
convergence (note that computational costs rise sub-linear with NH). Our
analysis also shows that at low NH the quartic spline kernel with NH ~= 60
obtains much better convergence then the standard cubic spline.Comment: substantially revised version, accepted for publication in MNRAS, 15
pages, 13 figure
Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care
<p>Abstract</p> <p>Background</p> <p>Although multimorbidity has important implications for patient care in general practice, limited research has examined chronic illness and health service utilisation among problem drug users. This study aimed to determine chronic illness prevalence and health service utilisation among problem drug users attending primary care for methadone treatment, to compare these rates with matched 'controls' and to develop and pilot test a valid study instrument.</p> <p>Methods</p> <p>A cross-sectional study of patients attending three large urban general practices in Dublin, Ireland for methadone treatment was conducted, and this sample was compared with a control group matched by practice, age, gender and General Medical Services (GMS) status.</p> <p>Results</p> <p>Data were collected on 114 patients. Fifty-seven patients were on methadone treatment, of whom 52(91%) had at least one chronic illness (other then substance use) and 39(68%) were prescribed at least one regular medication. Frequent utilisation of primary care services and secondary care services in the previous six months was observed among patients on methadone treatment and controls, although the former had significantly higher chronic illness prevalence and primary care contact rates. The study instrument facilitated data collection that was feasible and with minimal inter-observer variation.</p> <p>Conclusion</p> <p>Multimorbidity is common among problem drug users attending general practice for methadone treatment. Primary care may therefore have an important role in primary and secondary prevention of chronic illnesses among this population. This study offers a feasible study instrument for further work on this issue. (238 words)</p
Prevalence of problem alcohol use among patients attending primary care for methadone treatment
<p>Abstract</p> <p>Background</p> <p>Problem alcohol use is associated with adverse health outcomes among current or former heroin users and primary care is providing methadone treatment for increasing numbers of this population. This study aimed todetermine the prevalence of problem alcohol use among current or former heroin users attending primary care for methadone treatment and to describe the socio-demographic characteristics and health service utilisation characteristics associated with problem alcohol uses.</p> <p>Methods</p> <p>We conducted a cross sectional survey of patients sampled from a national database of patients attending general practice for methadone treatment. Participants were recruited by their general practitioner and data was collected using an interviewer-administered questionnaire, which included the Alcohol Use Disorders Identification Test ('AUDIT'), with a score of >7 considered abnormal (ie 'AUDIT positive cases') and socio-demographic, medical and substance use characteristics.</p> <p>Results</p> <p>We interviewed 196 patients (71% of those invited, 31% of those sampled, 11% of the national database). The median age was 32 years, 55% were hepatitis C positive, 79% had used illicit drugs in the previous month and 68% were male. Sixty-eight 'AUDIT positive' cases were identified (prevalence of 35%, 95% CI = 28–41%) and these were more likely to have attended a local Emergency Department in the previous year (p < 0.05) and less likely to have attended a hospital clinic in the previous year (p < 0.05). Twenty-seven (14%) scored 20 or higher indicating possible alcohol dependence.</p> <p>Conclusion</p> <p>Problem alcohol use has a high prevalence among current or former heroin users attending primary care for methadone treatment and interventions that address this issue should be explored as a priority. Interventions that address problem alcohol use in this population should be considered as a priority, although the complex medical and psychological needs of this population may make this challenging.</p
Integrating primary and secondary care to optimize hepatitis C treatment:development and evaluation of a multidisciplinary educational Masterclass series
[Background] It is increasingly being recognized that the elimination of HCV requires a multidisciplinary approach and effective cooperation between primary and secondary care.[Objectives] As part of a project (HepCare Europe) to integrate primary and secondary care for patients at risk of or infected with HCV, we developed a multidisciplinary educational Masterclass series for healthcare professionals (HCPs) working in primary care in Dublin and Bucharest. This article aims to describe and evaluate the series and examine how this model might be implemented into practice.[Methods] GPs and other HCPs working in primary care, addiction treatment services and NGOs were invited to eight 1 day symposia (HCV Masterclass series), examining the burden and management of HCV in key populations. Peer-support sessions were also conducted, to give people affected by HCV and community-based organizations working with those directly affected, an update on the latest developments in HCV treatment.[Results] One hundred percent of participants ‘strongly agreed’ or ‘agreed’ that the Masterclass helped them to appreciate the role of integrated services in ‘the management of patients with HCV’. One hundred percent of participants indicated the importance of a ‘designated nurse to liaise with hospital services’. An improvement of knowledge regarding HCV management of patients with high-risk behaviour was registered at the end of the course.[Conclusions] Integrated approaches to healthcare and improving the knowledge of HCPs and patients of the latest developments in HCV treatment are very important strategies that can enhance the HCV care pathway and treatment outcomes.This work was supported by the European Commission through its EU Third Health Programme (Grant Agreement Number 709844) and Ireland’s Health Services Executive.Peer reviewe
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