Development of an observational protocol for reducing and mitigating workload and the risk of Retained Foreign Objects

Retained Foreign Objects are an uncommon but costly problem in today's healthcare. It regards the outcome after an unintended item is left behind in a patient after an invasive procedure. This paper presents the development of an observational protocol used for surgical observations in the FOR_RaM Project. The FOR_RaM or Foreign Object Retention - Reduction and Mitigation project aims to analyze and understand the problem of retained foreign objects in surgery and maternity settings in Ireland, develop hospital specific foreign object management processes and implementation roadmaps, with a focus on reducing and mitigating the risk of foreign object retention. This paper discusses the methodology used for developing an observational protocol as part of a socio-technical multi-methods approach in order to gain a better understanding of the existing practices that take place in these settings, including workload, operational processes and collaboration. Emphasis is placed on the observational template development and design, observational tasks, critical points, procedures and protocols followed throughout. This observation protocol has facilitated the collection of critical data and been successful in identifying good practices and potential areas for improvement

The MyD88+ phenotype is an adverse prognostic factor in epithelial ovarian cancer

The prognosis of epithelial ovarian cancer is poor in part due to the high frequency of chemoresistance. Recent evidence points to the Toll-like receptor-4 (TLR4), and particularly its adaptor protein MyD88, as one potential mediator of this resistance. This study aims to provide further evidence that MyD88 positive cancer cells are clinically significant, stem-like and reproducibly detectable for the purposes of prognostic stratification. Expression of TLR4 and MyD88 was assessed immunohistochemically in 198 paraffin-embedded ovarian tissues and in an embryonal carcinoma model of cancer stemness. In parallel, expression of TLR4 and MyD88 mRNA and regulatory microRNAs (miR-21 and miR-146a) was assessed, as well as in a series of chemosensitive and resistant cancer cells lines. Functional analysis of the pathway was assessed in chemoresistant SKOV-3 ovarian cancer cells. TLR4 and MyD88 expression can be reproducibly assessed via immunohistochemistry using a semi-quantitative scoring system. TLR4 expression was present in all ovarian epithelium (normal and neoplastic), whereas MyD88 was restricted to neoplastic cells, independent of tumour grade and associated with reduced progression-free and overall survival, in an immunohistological specific subset of serous carcinomas, p<0.05. MiR-21 and miR-146a expression was significantly increased in MyD88 negative cancers (p<0.05), indicating their participation in regulation. Significant alterations in MyD88 mRNA expression were observed between chemosensitive and chemoresistant cells and tissue. Knockdown of TLR4 in SKOV-3 ovarian cells recovered chemosensitivity. Knockdown of MyD88 alone did not. MyD88 expression was down-regulated in differentiated embryonal carcinoma (NTera2) cells, supporting the MyD88+ cancer stem cell hypothesis. Our findings demonstrate that expression of MyD88 is associated with significantly reduced patient survival and altered microRNA levels and suggest an intact/functioning TLR4/MyD88 pathway is required for acquisition of the chemoresistant phenotype. Ex vivo manipulation of ovarian cancer stem cell (CSC) differentiation can decrease MyD88 expression, providing a potentially valuable CSC model for ovarian cancer

A phase II study of Caelyx, liposomal doxorubicin : lack of activity in patients with advanced gastric cancer

Purpose A phase II study was designed to assess the efficacy and safety of Caelyx (liposomal doxorubicin) in patients with advanced or metastatic gastric cancer. Methods A total of 25 patients with gastric adenocarcinoma were treated with Caelyx 45 mg/m2 every 28 days as first-line therapy for advanced disease. Patients were treated until tumour progression or unacceptable toxicity. Results One patient was withdrawn from the study after experiencing a severe infusion reaction. Of the 24 evaluable patients, 1 had a partial response, 7 had stable disease and the others progressed. Side effects, in particular palmar-plantar erythrodysaesthesia and haematological toxicity, were minor. Conclusions We conclude that while this dose and schedule of Caelyx in this patient group is acceptable, further studies with this regimen cannot be recommended due to the lack of antitumour activity seen

Interventions for the treatment of persistent post-viral olfactory dysfunction

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effects (benefits and harms) of interventions that have been used to treat post-viral olfactory dysfunction

Interventions for the treatment of persistent post‐COVID‐19 olfactory dysfunction

Background: Olfactory dysfunction is an early and sensitive marker of COVID-19 infection. Although self-limiting in the majority of cases, when hyposmia or anosmia persists it can have a profound effect on quality of life. Little guidance exists on the treatment of post-COVID-19 olfactory dysfunction, however several strategies have been proposed from the evidence relating to the treatment of post-viral anosmia (such as medication or olfactory training). Objectives: To assess the effects (benefits and harms) of interventions that have been used, or proposed, to treat persisting olfactory dysfunction due to COVID-19 infection. A secondary objective is to keep the evidence up-to-date, using a living systematic review approach. Search methods: The Cochrane ENT Information Specialist searched the Cochrane COVID-19 Study Register; Cochrane ENT Register; CENTRAL; Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished studies. The date of the search was 16 December 2020. Selection criteria: Randomised controlled trials including participants who had symptoms of olfactory disturbance following COVID-19 infection. Only individuals who had symptoms for at least four weeks were included in this review. Studies compared any intervention with no treatment or placebo. Data collection and analysis: We used standard Cochrane methodological procedures. Primary outcomes were the recovery of sense of smell, disease-related quality of life and serious adverse effects. Secondary outcomes were the change in sense of smell, general quality of life, prevalence of parosmia and other adverse effects (including nosebleeds/bloody discharge). We used GRADE to assess the certainty of the evidence for each outcome. Main results: We included one study with 18 participants, which compared the use of a 15-day course of oral steroids combined with nasal irrigation (consisting of an intranasal steroid/mucolytic/decongestant solution) with no intervention. Psychophysical testing was used to assess olfactory function at baseline, 20 and 40 days. Systemic corticosteroids plus intranasal steroid/mucolytic/decongestant compared to no intervention. Recovery of sense of smell was assessed after 40 days (25 days after cessation of treatment) using the Connecticut Chemosensory Clinical Research Center (CCCRC) score. This tool has a range of 0 to 100, and a score of ≥ 90 represents normal olfactory function. The evidence is very uncertain about the effect of this intervention on recovery of the sense of smell at one to three months (5/9 participants in the intervention group scored ≥ 90 compared to 0/9 in the control group; risk ratio (RR) 11.00, 95% confidence interval (CI) 0.70 to 173.66; 1 study; 18 participants; very low-certainty evidence). Change in sense of smell was assessed using the CCCRC score at 40 days. This study reported an improvement in sense of smell in the intervention group from baseline (median improvement in CCCRC score 60, interquartile range (IQR) 40) compared to the control group (median improvement in CCCRC score 30, IQR 25) (1 study; 18 participants; very low-certainty evidence). Serious adverse events andother adverse events were not identified in any participants of this study; however, it is unclear how these outcomes were assessed and recorded (1 study; 18 participants; very low-certainty evidence). Authors' conclusions: There is very limited evidence available on the efficacy and harms of treatments for persistent olfactory dysfunction following COVID-19 infection. However, we have identified other ongoing trials in this area. As this is a living systematic review we will update the data regularly, as new results become available. For this (first) version of the living review we identified only one study with a small sample size, which assessed systemic steroids and nasal irrigation (intranasal steroid/mucolytic/decongestant). However, the evidence regarding the benefits and harms from this intervention to treat persistent post-COVID-19 olfactory dysfunction is very uncertain

Interventions for the prevention of persistent post‐COVID‐19 olfactory dysfunction

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effects (benefits and harms) of interventions that have been used, or proposed, to prevent persisting olfactory dysfunction due to COVID-19 infection. A secondary objective is to maintain the currency of the evidence, using a living systematic review approach

Research update: celebrating a passion for research

RCSI’s Research Strategy focuses on translational health research – ‘from bench to bedside to population’ – because ultimately ‘Today’s research is tomorrow’s healthcare’. We work to ensure that you, our undergraduate students, get a sense of the research culture of RCSI during your education here. The passion for research, and the great strides being made in their specialties, are evident from the testimonials of some of your senior professors in the following pages of this special 10th anniversary volume of the RCSIsmj. Alongside their commentaries, I can add from my experience that the best research is conducted when differing disciplines bring their collective expertise together to address a specific health problem. The Department of Psychology, among others, has focused on researching the patient’s perspective on health, illness and healthcare. Topics such as patient quality of life and family burden have become increasingly important research themes in many health conditions. RCSI has led on many Irish population health surveys – on general lifestyle, on sexual health and on ageing. We are also proud to co-host a national postgraduate PhD training programme in health services and population health (SPHeRE). Student research is supported in numerous ways in the RCSI – in particular through the Research Summer School, where over 120 students annually get an opportunity to join research teams here. The student conference (ICHAMS: International Conference of Health and Medicine Students), now in its sixth year, is an example of RCSI student-led showcasing of undergraduate research work. The RCSIsmj is the perfect closing point to that triangle of opportunities to ‘conduct, present and publish’ research as a student. Since its inception in 2008 the RCSIsmj has provided a great platform for undergraduate students to showcase and publish your research. The success of the RCSIsmj comes from the skill, enthusiasm, and dedication of fellow students who serve as the RCSIsmj Executive Committee, the staff writers and the peer review team. The RCSIsmj has gone from strength to strength. It has been wonderful to witness its growth over the last 10 years. As staff, we proudly and regularly present copies to external visitors – who (almost) don't believe such a quality publication could be student produced! We are happy to pass on the credit to you as student teams and contributors who have made this reputation of RCSIsmj possible. We celebrate the 10th anniversary edition. Well done to all who have been involved over the last 10 years; your contribution to the RCSI’s overall research profile and reputation has been invaluable. Happy 10th birthday!</p