Irish journal of medical science
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Direct oral anticoagulants (DOACs) are widely marketed as medicines that do not require routine laboratory monitoring. However, they do have complex pharmacological properties and side effects; hence prescribing and monitoring guidelines, such as the European Heart Rhythm Association (EHRA) guidelines, have emerged. These advocate monitoring for renal and hepatic impairment; bleeding episodes; liver function; co-medication; circulation, and occurrence of side effects. Though 3 to 6 month follow-up is advocated, this is currently not routine, and its implementation creates a potential obligation for general practitioners (GPs) managing atrial fibrillation (AF) patients in the community. ⋯ Results show that there was incomplete adherence to the 2013 EHRA prescribing guidelines with only 24% adhering to all seven guidelines, and patient follow-up was less frequent than has been suggested.
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Lung cancer is a disease that severely endangers human health. Non-small cell lung cancer (NSCLC) accounts for approximately 4/5 of lung cancers. ⋯ Early combination of local radiotherapy and GM-CSF has a significant efficacy for advanced NSCLC accounts for approximately 4/5 of lung cancers treated with icotinib, and it can improve patients' autoimmunity and lengthen progression free survival.
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Historical Article
Irish Medical Organisation Doolin Memorial Lecture 2019: rhetoric and reality in mental health-Ireland and the world.
This Doolin Memorial Lecture presents six suggestions for positive change in Ireland's mental health services, focused on legislation and rights: (a) revision of the Mental Health Act 2001 in line with existing recommendations, to better protect and promote a broad range of rights, including rights to treatment and liberty (which are related); (b) enhanced forensic mental health care to better protect and promote both treatment and liberty in this population; (c) prompt full implementation of the Public Health (Alcohol) Act 2018 to reduce alcohol-related harm and the opportunity cost of alcohol problems in the health service; (d) implementation of the Assisted Decision-Making (Capacity) Act 2015 to provide decision-making supports to the 29.4% of medical/surgical inpatients and 52.6% of psychiatry inpatients who lack full decision-making capacity for treatment decisions; (e) judicious medicalisation of our response to individual cannabis use (although legalisation is not advised); and (f) enhanced recognition of the social rights of the mentally ill, especially the right to housing. Attention to these areas would improve the quality of life and quality of liberty of people with mental illness and their families. ⋯ Enhanced attention to these areas would also help advance Ireland's national mental health policy, "A Vision for Change", which has yet to be implemented in full. That, too, would help.
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Gender differences have been noted in patients presenting with ST segment elevated myocardial infarction (STEMI) but the reason remained poorly defined. We hypothesize that women presenting with STEMI are associated with poor reperfusion strategies which leads to worse in-hospital outcomes. Our goal is to identify age-stratified gender differences in revascularizations and in-hospital outcomes in patients presented with STEMI. ⋯ Regardless of age, women presenting with STEMI are less likely to receive revascularization and have higher in-hospital mortality, longer length of stay, and more likely to be discharged to other acute care facility.
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In Europe, adverse drug reactions and drug interactions are the cause of considerable morbidity and mortality. In over 75s, hospital access due to adverse drug reactions can be as high as 1 in every 3. ⋯ Focusing on patients with at least 4 drugs in therapy is the right strategy to reduce the risks associated with polypharmacy.