Wexford General Hospital

BACKGROUND: Surgical site infection (SSI) is an infection occurring in an incisional wound within 30 days of surgery and significantly effects patient recovery and hospital resources. OBJECTIVE: This study sought to determine the relationship between preoperative serum albumin and SSI. METHODS: A study of 524 patients who underwent gastrointestinal surgery in 4 institutions was performed. Patients were identified using a prospective SSI database and hospital records. Serum albumin was determined preoperatively in all patients. Hypoalbuminemia was defined as albumin <30 mg/dL. Data are presented as median (interquartile range) and a difference between groups was examined using Mann-Whitney U and Fisher exact test and multiple logistic regression analysis. RESULTS: A total of 105 patients developed a SSI (20%). The median time to the development of SSI was 7 (5-10) days. Having an emergency procedure (P = 0.003), having a procedure over 3 hours in duration (P = 0.047), being American Society of Anaesthetics grade 3 (P = 0.03) and not receiving preoperative antibiotics (P = 0.007) were associated with SSI while having a laparoscopic procedure reduced the likelihood of SSI (P = 0.004). Patients who developed a SSI had a lower preoperative serum albumin (30 [25-34.5] vs. 36 [32-39], P < 0.001). On multivariate analysis, hypoalbuminemia was an independent risk factor for SSI development (relative risk, RR = 5.68, 95% confidence interval: 3.45-9.35, P < 0.001). Albumin <30 mg/dL was associated with an increased rate of deep versus superficial SSI (P = 0.002). The duration of inpatient stay was negatively correlated with preoperative albumin (R = -0.319, P < 0.001). CONCLUSIONS: Hypoalbuminemia is an independent risk factor for the development of SSI following gastrointestinal surgery and is associated with deeper SSI and prolonged inpatient stay.

Abstract A method for the determination of carbohydrates in plant samples is described, in which the plants are frozen in dry ice as soon as they are cut and portions extracted with 80% alcohol in an Elco Homogenizer and the carbohydrate estimated by the anthrone reaction. A few results are given for the uptake of sucrose by plant roots from a culture solution.

Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.

Abstract Background We aimed to describe the clinical presentation of individuals presenting with prolonged recovery from coronavirus disease 2019 (COVID-19), known as long COVID. Methods This was an analysis within a multicenter, prospective cohort study of individuals with a confirmed diagnosis of COVID-19 and persistent symptoms &amp;gt;4 weeks from onset of acute symptoms. We performed a multiple correspondence analysis (MCA) on the most common self-reported symptoms and hierarchical clustering on the results of the MCA to identify symptom clusters. Results Two hundred thirty-three individuals were included in the analysis; the median age of the cohort was 43 (interquartile range [IQR], 36–54) years, 74% were women, and 77.3% reported a mild initial illness. MCA and hierarchical clustering revealed 3 clusters. Cluster 1 had predominantly pain symptoms with a higher proportion of joint pain, myalgia, and headache; cluster 2 had a preponderance of cardiovascular symptoms with prominent chest pain, shortness of breath, and palpitations; and cluster 3 had significantly fewer symptoms than the other clusters (2 [IQR, 2–3] symptoms per individual in cluster 3 vs 6 [IQR, 5–7] and 4 [IQR, 3–5] in clusters 1 and 2, respectively; P &amp;lt; .001). Clusters 1 and 2 had greater functional impairment, demonstrated by significantly longer work absence, higher dyspnea scores, and lower scores in SF-36 domains of general health, physical functioning, and role limitation due to physical functioning and social functioning. Conclusions Clusters of symptoms are evident in long COVID patients that are associated with functional impairments and may point to distinct underlying pathophysiologic mechanisms of disease.

Digital elevation models (DEMs) generated from unmanned aerial vehicle (UAV) photogrammetry offer opportunities for on-demand DEM production in environmental modelling and flood risk prediction applications. The DEM and orthoimage accuracies that can be achieved using lightweight UAV on-board sensors only, are compared with cases where progressively higher numbers of Global Navigation Satellite System (GNSS) referenced ground targets are utilized. Unacceptably large 95% planimetric orthoimage errors of 5.22 m (root mean square error (RMSE) 3.27 m), and DEM 95% elevation errors of 5.03 m (RMSE 2.2 m) are observed when using the on-board positioning and orientation sensors only. Introducing GNSS ground control points (GCPs) in increasing numbers progressively and substantially improves data accuracy. Remarkably small xy orthoimage errors of 0.076 m (RMS) and DEM elevation errors of 0.08 m (RMS) are achieved using 1 GCP for every 2 ha of ground area and utilizing more GCPs produced more or less identical results. These accuracies compare very favourably with the best commercial airborne survey DEMs, suggesting strong potential for the application of lightweight UAV photogrammetric DEMs in local environmental modelling and flood risk prediction applications. The potential of these DEMS for flood prediction is subsequently assessed and demonstrated by comparison with published flood risk maps and flood depth data, and by cross-comparing the outputs of the UAV DEM flood model predictions.

The electric grid is a highly complex, interconnected machine, and changing one part of the grid can have consequences elsewhere. Adding wind and solar affects the operation of the other power plants and adding high penetrations can induce cycling of fossil-fueled generators. Cycling leads to wear-and-tear costs and changes in emissions. Phase 2 of the Western Wind and Solar Integration Study (WWSIS-2) evaluated these costs and emissions and simulated grid operations for a year to investigate the detailed impact of wind and solar on the fossil-fueled fleet. This built on Phase 1, one of the largest wind and solar integration studies ever conducted, which examined operational impacts of high wind and solar penetrations in the West(GE Energy 2010).

BACKGROUND: The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all-cause 30-day readmissions and complications in a prospective population-based cohort. METHODS: Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all-cause 30-day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2). RESULTS: Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. CONCLUSION: Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics.

Abstract Objective Despite the high prevalence of hospitalization for left iliac fossa tenderness, there is a striking lack of randomized data available to guide therapy. The authors hypothesize that an oral antibiotic and fluids are not inferior to intravenous (IV) antibiotics and ‘bowel rest’ in clinically diagnosed acute uncomplicated diverticulitis. Method A randomized controlled trial was constructed in two District General Hospitals. All clinically diagnosed patients presenting with acute uncomplicated diverticulitis were eligible for the study. Oral and IV regimens utilizing ciprofloxacin and metronidazole were compared. The primary outcomes studied were surrogates for resolution of symptoms (including tenderness on day 3 and length of stay) and failure of oral therapy. Secondary endpoints studied were serial constitutional and biomarker trends. Results There were 41 patients in the oral arm and 38 in the IV arm ( n = 79). No patient had to be converted to IV antibiotics from the oral group. There was a complete resolution of symptoms in both groups. Tenderness was equivalent in both groups on day 3. Among secondary endpoints, a serial decrease in C reactive protein was the best serological predictor of resolution for both groups. Conclusion Oral antibiotics are not inferior to intravenous antibiotics in achieving resolution of clinically diagnosed diverticulitis.

BACKGROUND: Heterogeneity in type 2 diabetes presentation and progression suggests that precision medicine interventions could improve clinical outcomes. We undertook a systematic review to determine whether strategies to subclassify type 2 diabetes were associated with high quality evidence, reproducible results and improved outcomes for patients. METHODS: We searched PubMed and Embase for publications that used 'simple subclassification' approaches using simple categorisation of clinical characteristics, or 'complex subclassification' approaches which used machine learning or 'omics approaches in people with established type 2 diabetes. We excluded other diabetes subtypes and those predicting incident type 2 diabetes. We assessed quality, reproducibility and clinical relevance of extracted full-text articles and qualitatively synthesised a summary of subclassification approaches. RESULTS: Here we show data from 51 studies that demonstrate many simple stratification approaches, but none have been replicated and many are not associated with meaningful clinical outcomes. Complex stratification was reviewed in 62 studies and produced reproducible subtypes of type 2 diabetes that are associated with outcomes. Both approaches require a higher grade of evidence but support the premise that type 2 diabetes can be subclassified into clinically meaningful subtypes. CONCLUSION: Critical next steps toward clinical implementation are to test whether subtypes exist in more diverse ancestries and whether tailoring interventions to subtypes will improve outcomes.

Recently, considerable efforts have been made in the attempt to map quick clay areas using electrical resistivity measurements. However there is a lack of understanding regarding which soil parameters control the measured resistivity values. To address this issue, inverted resistivity values from 15 marine clay sites in Norway have been compared with basic geotechnical index properties. It was found that the resistivity value is strongly controlled by the salt content of the pore fluid. Resistivity decreases rapidly with increasing salt content. There is also a relatively clear trend of decreasing resistivity with increasing clay content and plasticity index. Resistivity values become very low (≈5 Ω·m) for high clay content (&gt;50%), medium- to high-plasticity (I p ≈ 20%) materials with salt content values greater than about 8 g/L (or corresponding remoulded shear strength values greater than 4 kPa). For the range of values studied, there is poor correlation between resistivity and bulk density and between resistivity and water content. The data studied suggest that the range of resistivity values corresponding to quick clay is 10 to 100 Ω·m, which is consistent with other published limits. A comparison is made between two-dimensional electrical resistivity tomography (ERT) and resistivity cone penetration test (RCPTU) data for two of the sites and the two sets of data show similar trends and values irrespective of scale effect.

PURPOSE: Colorectal cancer commonly presents first as an emergency and is likely to be complicated by bowel obstruction/perforation requiring more difficult procedures, with poorer outcomes. Analysis of all of the procedures performed on patients diagnosed in Wexford General Hospital, Ireland, during the period 2000 to 2006 was carried out to validate this hypothesis in our western European population. METHODS: Retrospective analysis of a prospectively maintained database of patient demographics, diagnosis, procedures, and mode of presentation (elective, emergency) was undertaken. RESULTS: A total of 356 patients with colorectal cancer underwent 498 procedures during the years 2000 to 2006. Eighty-four emergency endoscopies and 100 emergency bowel resections were performed. Obstructive lesions were more likely to require emergency resection (P < 0.001). Median survival time for patients treated electively was 82 months vs. 59 months for patients treated on an emergency basis. CONCLUSIONS: Of all colonic resections, 34 percent were carried out as emergencies and were significantly more likely to be complicated by obstruction or perforation (P < 0.001). Emergency resections were associated with a significantly poorer perioperative mortality and five-year survival rate (P < 0.001). Forty-one percent of colorectal cancers diagnosed at endoscopy were first seen emergently. These data raise concerns regarding public awareness of colorectal cancer and resource allocation and reemphasize the need for a national colorectal screening program.

Demographic links among fragmented populations are commonly studied as source-sink dynamics, whereby source populations exhibit net recruitment and net emigration, while sinks suffer net mortality but enjoy net immigration. It is commonly assumed that large, persistent aggregations of individuals must be sources, but this ignores the possibility that they are sinks instead, buoyed demographically by immigration. We tested this assumption using Bayesian integrated population modelling of Greenland white-fronted geese (Anser albifrons flavirostris) at their largest wintering site (Wexford, Ireland), combining capture-mark-recapture, census and recruitment data collected from 1982 to 2010. Management for this subspecies occurs largely on wintering areas; thus, study of source-sink dynamics of discrete regular wintering units provides unprecedented insights into population regulation and enables identification of likely processes influencing population dynamics at Wexford and among 70 other Greenland white-fronted goose wintering subpopulations. Using results from integrated population modelling, we parameterized an age-structured population projection matrix to determine the contribution of movement rates (emigration and immigration), recruitment and mortality to the dynamics of the Wexford subpopulation. Survival estimates for juvenile and adult birds at Wexford and adult birds elsewhere fluctuated over the 29-year study period, but were not identifiably different. However, per capita recruitment rates at Wexford in later years (post-1995) were identifiably lower than in earlier years (pre-1995). The observed persistence of the Wexford subpopulation was only possible with high rates of immigration, which exceeded emigration in each year. Thus, despite its apparent stability, Wexford has functioned as a sink over the entire study period. These results demonstrate that even large subpopulations can potentially be sinks, and that movement dynamics (e.g. immigration) among winters can dramatically obscure key processes driving subpopulation size. Further, novel population models which integrate capture-mark-recapture, census and recruitment data are essential to correctly ascribing source-sink status and accurately informing development of site-safeguard networks.

Management of agricultural diffuse pollution to water remains a challenge and is influenced by the complex interactions of rainfall-runoff pathways, soil and nutrient management, agricultural landscape heterogeneity and biogeochemical cycling in receiving water bodies. Amplified cycles of weather can also influence nutrient loss to water although they are less considered in policy reviews. Here, we present the development of climate-chemical indicators of diffuse pollution in highly monitored catchments in Western Europe. Specifically, we investigated the influences and relationships between weather processes amplified by the North Atlantic Oscillation during a sharp upward trend (2010-2016) and the patterns of diffuse nitrate and phosphorus pollution in rivers. On an annual scale, we found correlations between local catchment-scale nutrient concentrations in rivers and the influence of larger, oceanic-scale climate patterns defined by the intensity of the North Atlantic Oscillation. These influences were catchment-specific showing positive, negative or no correlation according to a typology. Upward trends in these decadal oscillations may override positive benefits of local management in some years or indicate greater benefits in other years. Developing integrated climate-chemical indicators into catchment monitoring indicators will provide a new and important contribution to water quality management objectives.

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use.

The COVID-19 pandemic has resulted in significant clinical and economic consequences for medical practices of all specialties across the nation. Although the clinical implications are of the utmost importance, the economic consequences have also been serious and resulted in substantial damage to the US healthcare system, including pain practices. Outpatient pain practices have had to significantly change their clinical care pathways, including the incorporation of telemedicine. Elective medical and interventional care has been postponed. For the most part, ambulatory surgical centers have had to cease operations. As patient volumes have decreased for non-emergent elective care, the financial indicators have deteriorated. This review article will provide insight into solutions to mitigate the clinical and economic challenges induced by COVID-19. Undoubtedly, the COVID-19 pandemic will have short-term and long-term implications for all medical practices and facilities. In order to survive, medical practices will need dynamic, operational, and creative strategic plans to mitigate the disruption in medical care and pathways for successful reintegration of clinical and surgical practice.

BACKGROUND: Opportunities to improve emergency surgery outcomes exist through guided better practice and reduced variability. Few attempts have been made to define optimal care in emergency surgery, and few clinically derived key performance indicators (KPIs) have been published. A summit was therefore convened to look at resources for optimal care of emergency surgery. The aim of the Donegal Summit was to set a platform in place to develop guidelines and KPIs in emergency surgery. METHODS: The project had multidisciplinary global involvement in producing consensus statements regarding emergency surgery care in key areas, and to assess feasibility of producing KPIs that could be used to monitor process and outcome of care in the future. RESULTS: Forty-four key opinion leaders in emergency surgery, across 7 disciplines from 17 countries, composed evidence-based position papers on 14 key areas of emergency surgery and 112 KPIs in 20 acute conditions or emergency systems. CONCLUSIONS: The summit was successful in achieving position papers and KPIs in emergency surgery. While position papers were limited by non-graded evidence and non-validated KPIs, the process set a foundation for the future advancement of emergency surgery.

Stormflow and baseflow phosphorus (P) concentrations and loads in rivers may exert different ecological pressures during different seasons. These pressures and subsequent impacts are important to disentangle in order to target and monitor the effectiveness of mitigation measures. This study investigated the influence of stormflow and baseflow P pressures on stream ecology in six contrasting agricultural catchments. A five-year high resolution dataset was used consisting of stream discharge, P chemistry, macroinvertebrate and diatom ecology, supported with microbial source tracking and turbidity data. Total reactive P (TRP) loads delivered during baseflows were low (1–7% of annual loads), but TRP concentrations frequently exceeded the environmental quality standard (EQS) of 0.035 mg L− 1 during these flows (32–100% of the time in five catchments). A pilot microbial source tracking exercise in one catchment indicated that both human and ruminant faecal effluents were contributing to these baseflow P pressures but were diluted at higher flows. Seasonally, TRP concentrations tended to be highest during summer due to these baseflow P pressures and corresponded well with declines in diatom quality during this time (R2 = 0.79). Diatoms tended to recover by late spring when storm P pressures were most prevalent and there was a poor relationship between antecedent TRP concentrations and diatom quality in spring (R2 = 0.23). Seasonal variations were less apparent in the macroinvertebrate indices; however, there was a good relationship between antecedent TRP concentrations and macroinvertebrate quality during spring (R2 = 0.51) and summer (R2 = 0.52). Reducing summer point source discharges may be the quickest way to improve ecological river quality, particularly diatom quality in these and similar catchments. Aligning estimates of P sources with ecological impacts and identifying ecological signals which can be attributed to storm P pressures are important next steps for successful management of agricultural catchments at these scales.

BACKGROUND: Effective preparedness to respond to mass casualty incidents and disasters requires a well-planned and integrated effort by all involved professionals, particularly those who are working in healthcare, who are equipped with unique knowledge and skills for emergencies. This study aims to investigate and evaluate the level of knowledge and skills related to mass casualty and disaster management in a cohort of healthcare professionals. METHODS: A cross-sectional brief study was conducted using a validated and anonymous questionnaire, with a sample of 134 employees at a clinical hospital in Lublin, Poland. RESULTS: The findings of this study may indicate a need for standardization of training for hospitals employees. It also suggests a knowledge gap between different professional groups, which calls for adjusting such general training, to at least, the weakest group, while special tasks and mission can be given to other groups within the training occasion. CONCLUSION: Pre-Training gap analyses and identification of participants' competencies and skills should be conducted prior to training in mass casualty incidents and disasters. Such analyses provides an opportunity to develop training curriculum at various skill and knowledge levels from basic to advance. All training in mass casualty incidents and disasters should be subject to ongoing, not just periodic, evaluation, in order to assess continued competency.

In a double blind trial, 25 patients with twin pregnancy were given 40 mg of ritodrine hydrochloride by mouth daily and 24 similar patients received a placebo. The ritodrine group had no significant prolongation of pregnancy nor increase in birth weight, and a high incidence of side effects occurred.

UNLABELLED: Bovine tuberculosis is an ongoing problem in Ireland, and herd incidence has remained at approximately 5% for some years. Spillover of infection from cattle to people remains an ever-present possibility, given the ongoing pool of infection in the Irish cattle population. This paper describes an outbreak of tuberculosis affecting cattle and people on a dairy farm in southeastern Ireland following the consumption of milk from a seven-year-old cow with tuberculous mastitis. Twenty-five of 28 calves born during autumn 2004 and spring 2005 were subsequently identified as TB reactors, and five of six family members were positive on the Mantoux test. During 2005, milk from this cow had mainly been used to feed calves, and was added only occasionally to the bulk tank. Therefore, the calves each received infected milk on an almost continuous basis between birth and weaning. The family collected milk from the bulk milk tank, and consumed it without pasteurisation. This case highlights the risks associated with the consumption of raw milk. In this family, TB has had a very significant impact on the health of two young children. These risks are well recognised, and relevant information for farmers is available. It is of concern, therefore, that raw milk consumption remains prevalent on Irish farms. New strategies are needed, in partnership with industry, to address this important issue. KEYWORDS: bovine tuberculosis, Ireland, mastitis, milk, Mycobacterium bovis, pasteurisation, TB, zoonosis.