Irish journal of medical science
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Obstetric anal sphincter injury (OASI) is the most common cause of anal incontinence. Identifying risk factors may facilitate change in labour and delivery practice, potentially reducing the risk. The objective of this study is to identify maternal, foetal and intrapartum risk factors for OASI in a regional hospital. ⋯ Maternal age ≥ 35 years confers a protective effect after adjusting for parity, birth weight and mode of delivery. Given the context of an ageing reproductive population, additional research is required to investigate the impact of maternal age on anal sphincter injury.
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The aim of this study was to determine the difference in proportion of shoulder MRIs that influence the management plan of shoulder patients based on whether MRI was ordered by a shoulder specialist, orthopaedic surgeon or primary care provider prior to referral to a specialist. ⋯ With less than 25% of primary care-ordered shoulder MRIs influencing clinical management, questions must be raised about the indications for MRI. Greater than 50% of referrals contained no documented physical examination, suggesting that MRI is being relied upon for assessment. If access to private MRI was to be rationalized, perhaps shoulder specialist-ordered CT and X-ray could be covered by insurance providers. Currently, they are not covered in our system, yet are more likely to influence clinical management than primary care-ordered MRIs, which are currently covered by insurance without restriction on indications.
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It is increasingly recognised that older patients may not present with typical symptoms of COVID-19. ⋯ Older patients with atypical presentation of COVID-19 in the community are equally susceptible to poor outcomes. Early detection may improve outcomes and limit community transmission. Primary care practitioners should be vigilant and consider prompt onward referral.
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Despite their adverse effects, antipsychotics are frequently prescribed to manage behavioural and psychological symptoms of dementia (BPSD). At present, we do not have a good understanding of general practitioners' (GPs) current management of BPSD. ⋯ This study identified several factors influencing the prescription of antipsychotics for patients with BPSD as well as the prescribing dilemmas faced by GPs in their daily practice. These findings can be used to guide future interventions aimed at reducing inappropriate prescribing in dementia care.