A Case of Autoimmune Pancreatitis Presenting as a Deterioration in Glycaemic Control in a Patient with Pre-Existing Type 2 Diabetes.

We report a case of Type 1 autoimmune pancreatitis presenting as a rare cause of worsening hyperglycaemia in a patient with Type 2 diabetes and discuss the difficulties in differentiating this disease from pancreatic cancer

Protocol for a realist review of workplace learning in postgraduate medical education and training

Postgraduate medical education and training (PGMET) is a complex social process which happens predominantly during the delivery of patient care. The clinical learning environment (CLE), the context for PGMET, shapes the development of the doctors who learn and work within it, ultimately impacting the quality and safety of patient care. Clinical workplaces are complex, dynamic systems in which learning emerges from non-linear interactions within a network of related factors and activities. Those tasked with the design and delivery of postgraduate medical education and training need to understand the relationship between the processes of medical workplace learning and these contextual elements in order to optimise conditions for learning. We propose to conduct a realist synthesis of the literature to address the overarching questions; how, why and in what circumstances do doctors learn in clinical environments? This review is part of a funded projected with the overall aim of producing guidelines and recommendations for the design of high quality clinical learning environments for postgraduate medical education and training

Outcome in patients with cystic fibrosis liver disease

AbstractBackgroundLiver disease is an important complication in CF.AimsTo determine if CFLD is a risk factor for mortality in CF, and which baseline characteristics predict all-cause mortality.MethodsIrish children with CFLD, and their age and gender matched controls were enrolled at baseline and reviewed after 10years to determine which characteristics predict mortality.Results72/84 (85.71%) participants were followed, (mean age Cases 21.71yrs SD 6.5, CF controls 23.62 SD 5.6, 22 (61%) males), with no difference in duration of follow-up. Nineteen participants (26.4%) died, 38.9% (14/36) with CFLD and 13.89% (5/36) CF controls (Odds Ratio (OR) 3.94 95% CI:1.23–12.56 p=0.005). In logistic regression, liver disease (OR 4.28 95% CI 1.07–17.16) female gender (OR 12.25 95% CI 2.37–63.24), reduced pulmonary function, (OR 5.11 95% CI 1.09–23.81) were each independent risk factors for mortality in CF.ConclusionsLiver disease is an independent risk factor for mortality in CF

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

Medical Professionalism: Promoting Patient and Physician Safety.

Realisation of the importance of medical professionalism has been increasing over recent years as evidenced by publications by regulatory bodies, education bodies and the media. Multiple definitions exist in the literature with significant consistency1,2. The current working definition from the Irish Medical Council3 includes the set of intrinsic values, expressed as extrinsic behaviours which justify the trust between patients and good doctors and between the public and the medical profession. These values and behaviours include respect for patients, demonstrated by patient–centred practice; ethical standards including honesty, integrity, empathy and altruism; reflection/self-awareness demonstrated by reflective practice; personal responsibility for actions including safeguarding one’s own health and well-being; teamwork commitment demonstrated by effective communication and teamwork, leadership and social responsibility demonstrated by commitment to the health of the community. The primary aim of the practice of medical professionalism is patient centred care.</p

C5L2, a nonsignalling C5A receptor is uncoupled to G proteins

THESIS 8414The complement anaphylatoxins are prominent mediators of host defence and inflammation. The small subunit of the fifth component of complement, C5a has complex effects in vivo including potential anti- and pro-inflammatory effects in acute pancreatitis with associated lung injury, and sepsis respectively. Deletion of the classical C5a receptor C5aR, does not fully explain all these effects. Secondly, expression of receptors for C5a on parenchymal cells in the lung, liver, smooth muscle and endothelial cells serve as yet uncharacterised functions. We suspected that an additional receptor for C5a might exist. Ohno and colleagues (Ohno et al. 2000) had Just cloned a novel human gene encoding the putative orphan receptor ?C5a like 2 receptor?, C5L2, which they found on immature but not mature dendritic cells. We cloned C5L2 from man and mouse and characterised this receptor

A time of crisis, a time to re-evaluate

The Covid-19 pandemic demonstrated the strong culture of professionalism in healthcare that exists nationally and internationally. In excess of 40,000 responses to the HSE’s “be on call for Ireland” campaign were received. Healthcare workers came out of retirement and home from abroad to work frontline with student nurses and doctors.</p

Medical Professionalism, Critical for Good Practice and Clinician Wellbeing

Professionalism is a key component of good patient care. Research has shown that professionalism improves patient safety, patient experience, staff morale, recruitment and retention, healthcare institution reputation and health system productivity. In parallel it reduces clinical incidents, claims and costs. It must be inculcated in our medical students and doctors to ensure patient centred care is provided.</p

Medication related litigation in Ireland: a 6-year review.

AIMS: The primary aims of the study were to identify those medications most frequently associated with clinical litigation in Ireland and to quantify the cost of such litigation. Secondary aims were to identify where in the medication-use process claims were most likely to arise, the medication incident types involved and the primary injury alleged. METHODS: The National Incident Management System (NIMS) for incident and claims management was searched to identify all medication-related claims finalised from 2011 to 2016 (inclusive). The physical case files were obtained and additional data not available on NIMS was extracted in order to build a detailed picture of the incident and subsequent claim. RESULTS: The search identified 79 relevant claims, of which 48 closed with a payment to the plaintiff. These 48 claims involved 54 medications. Medication groups identified included general anaesthetics (n = 7), opioids (n = 6), penicillins, antithrombotics and local anaesthetics (all n = 5). The errors alleged occurred exclusively at the administration (58%) and prescribing (42%) stages of the medication-use process. Medication incident types included wrong dose/strength (n = 17), wrong drug (n = 7) and adverse drug reaction (n = 6). The most commonly pleaded primary injuries were allergic reaction (n = 9), deterioration in clinical status (n = 9) and post-traumatic stress disorder (n = 8). The median total cost of these claims was €60 991, including median damages of €33 858. CONCLUSIONS: This study links data on medication incidents, actual harm to patients and litigation costs. Thus, it presents a comprehensive picture of the consequences of medication error

Chest radiographs for outcome assessment in cystic fibrosis

We compare a chest radiographic scoring system developed by our group to spirometry in quantifying the longitudinal progression of lung disease among cystic fibrosis (CF) patients, and we evaluate the use of this radiographic scoring system in identifying the treatment effect of an inhaled antibiotic. Results suggest that longitudinally acquired chest radiographs, when scored using our scoring system, are at least as sensitive as lung function in detecting the progression of lung disease in CF patients