Irish journal of medical science
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To compare patients with active and inactive fibromyalgia to better understand the impact of physical inactivity on quality of life and symptoms in these patients. ⋯ Our results reinforce the understanding that exercise can reduce symptoms of fibromyalgia and suggests that patients who practice physical exercise have a better quality of life, with fewer depressive symptoms and absences from work, and better sense of well-being.
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Following oesophagectomy, the most concerning complication is that of anastomotic leak (AL). Prompt diagnosis and intervention are crucial to facilitate an optimal outcome. Other complications, particularly respiratory, are not infrequent. Early identification of AL versus other sources of the inflammatory response can be problematic. ⋯ Elevated CRP may be a useful marker in facilitating the prompt diagnosis of AL following oesophagectomy. Serial CRP may not contribute to identifying lower respiratory tract infections, partly as a result of the pro-inflammatory response following surgery.
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Application of evidence-based guidelines in the management of cellulitis is poorly studied in Ireland and it is observed that current admission and prescription practices in this country vary widely from internationally accepted standards of care. We aimed to examine the management of cellulitis with regard to hospital admission and initial antibiotic therapy. ⋯ There is a significant discrepancy between current clinical practice and international guidelines for the management of cellulitis in Ireland; local guidelines are not in keeping with newer evidence and there is a lack of national guidelines for this common condition. Closer adherence to international guidelines would significantly reduce costs by reducing unnecessary admissions and initial monotherapy would improve antibiotic stewardship. This study shows a clear need for local institutions to re-examine antibiotic guidelines to ensure the HSE provides effective evidence-based treatment in the correct setting.
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Oropharyngeal dysphagia (OPD) is a common but under-recognized problem among older residents in nursing homes. If not detected and properly managed, it is a risk factor for failure to thrive and aspiration pneumonia. Discharge to nursing home from hospital may provide an opportunity for detection and subsequent management. ⋯ OPD is present at discharge in over one-third of patients newly discharged to nursing home following a hospital admission, and this may be an under-estimate. This is significant in terms of planning of future care of management in nursing homes. It is important that the syndrome is duly noted in transfer documentation and that appropriate multi-disciplinary support arranged for residents in nursing homes with OPD.
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Doctors' continuing medical educational and professional development (CME and CPD) needs are known to be strongly influenced by national and local contextual characteristics. A crucial step in the development of effective education and training programmes is the assessment of learner needs. ⋯ Our findings identified priority areas where CME and CPD for GPs in Ireland should focus. The topics selected may reflect the changing nature of general practice, which increasingly requires delivery of care to an ageing population with more multi-morbidity and chronic disease management, while trying to apply evidence-based medicine and consider patient safety issues. CME/CPD programmes need to adapt accordingly.