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McCarron M.O.,Altnagelvin Hospital | Stevenson M.,Queen's University of Belfast | Loftus A.M.,Aberfoyle Medical Practice | McKeown P.,Queen's University of Belfast
Clinical Neurology and Neurosurgery | Year: 2014

Introduction As general practice (GP) is the main source of referrals to neurologists, neurology education for GP trainees is important. We investigated the existence of neurophobia, contributing factors and potential prevention strategies among GP trainees. Methods In a questionnaire survey interest, knowledge, confidence and perceived difficulty in neurology were compared with different medical specialties. Reasons for difficulty with neurology, postgraduate neurology education experience, learning methods and suggested teaching improvements were examined. Results Of 205 GP trainees, 118 (58%) completed the questionnaire. Threshold analyses justified categorical intervals for the Likert responses. Trainees recorded poorer knowledge (p < 0.001), less confidence (p < 0.001) and more perceived difficulty (p < 0.001) with neurology than with any other medical specialty. GP trainees had less interest in neurology than any other medical specialty (Duncan test, p < 0.001). There was a similar gradation in difficulty and confidence perception across medical specialties. Hospital and community-based neurology teaching was graded as "poor" or "very poor" by over 60% of GP trainees. There were multiple perceived causes of neurophobia, including neuroanatomy and poor quality teaching. More organised clinical teaching and referral guidance were suggested to address GP neurophobia. Conclusions Neurophobia is common among GP trainees in Northern Ireland. GP trainees have clear and largely uniform ideas on improving their neurology education. GP training posts should reflect the importance of neurology within the GP curriculum. © 2014 Elsevier B.V.


Todd S.,Altnagelvin Hospital | Barr S.,South West Acute Hospital | Roberts M.,Royal Victoria Hospital | Passmore A.P.,Queen's University of Belfast
International Journal of Geriatric Psychiatry | Year: 2013

Objective Dementia is an important cause of mortality and, with the ageing population and increasing prevalence of dementia, reliable data on prognosis and survival will be of interest to patients and caregivers as well as providers and commissioners of health and social care. A review of the literature was undertaken to determine the rates of survival in dementia and Alzheimer's disease (AD) and to identify factors that are or are not predictive of mortality in dementia and AD. Methods Relevant articles on mortality in dementia were identified following a search of several electronic databases from 1990 to September 2012. Inclusion criteria were reports on prospective community or clinic based cohorts published in English since 1990, to reflect more recent recognition of possible predictors. Results Median survival time from age of onset of dementia ranges from 3.3 to 11.7 years, with most studies in the 7 to 10-year period. Median survival time from age of disease diagnosis ranges from 3.2 to 6.6 years for dementia or AD cohorts as a whole. Age was consistently reported as a predictor of mortality, with male gender a less consistent predictor. Increased disease severity and functional impairment were often associated with mortality. Conclusions Substantial heterogeneity in the design of included studies limits the ability to prognosticate for individual patients. However, it is clear that dementia and AD are associated with significant mortality. Reasons for the increased mortality are not established. Copyright © 2013 John Wiley & Sons, Ltd.


Mccolgan P.,University College London | Mckeown P.P.,Queen's University of Belfast | Selai C.,University College London | Doherty-Allan R.,Altnagelvin Hospital | Mccarron M.O.,Altnagelvin Hospital
European Journal of Neurology | Year: 2013

A fear of neurology and neural sciences (neurophobia) may have clinical consequences. There is therefore a need to formulate an evidence-based approach to neurology education. A comprehensive systematic review of educational interventions in neurology was performed. BEI, Cochrane Library, Dialog Datastar, EBSCO Biomedical, EBSCO Psychology & Behavioral Sciences, EMBASE, ERIC, First Search, MDConsult, Medline, Proquest Medical Library and Web of Knowledge databases were searched for all published studies assessing interventions in neurology education among undergraduate students, junior medical doctors and residents up to and including July 2012. Two independent literature searches were performed for relevant studies, which were then classified for level of evidence using the Centre of Evidence-based Medicine criteria and four levels of Kirkpatrick educational outcomes. One systematic review, 16 randomized controlled trials (RCTs), nine non-randomized cohort/follow-up studies, 33 case series or historically controlled studies and three mechanism-based reasoning studies were identified. Educational interventions showed favourable evaluation or assessment outcomes in 15 of 16 (94%) RCTs. Very few studies measured subsequent clinical behaviour (two studies) and patient outcomes (one study). There is very little high quality evidence of demonstrably effective neurology education. However, RCTs are emerging, albeit without meeting comprehensive educational criteria. An improving evidence base in the quality of neurology education will be important to reduce neurophobia. © 2013 EFNS.


Mcmenamin M.,Altnagelvin Hospital | Mckenna M.,Altnagelvin Hospital
Cytopathology | Year: 2013

Background: Cytology laboratories in the UK routinely treat unsatisfactory cervical liquid-based cytology (LBC) specimens with glacial acetic acid (GAA) to reduce the unsatisfactory rate. However, there is limited published data on the effect of GAA reprocessing on the molecular detection of human papillomavirus (HPV). The aim of this study was to assess the impact of GAA treatment of cervical ThinPrep® samples on HPV detection with the cobas® 4800 HPV Test (Roche Molecular Systems, Pleasanton, CA, USA). Methods: Residual ThinPrep samples (n = 121) were selected to provide a range of typical cytology results and enrich the study samples for HPV positivity. Specimens were equally split into two fractions: one part treated with 10% GAA and the other part left untreated. All samples were HPV tested using the cobas 4800 HPV Test, which simultaneously detects a total of 14 high-risk HPV (hrHPV) genotypes and individually identifies HPV16 and HPV18. The HPV positive/negative status of tested samples determined the level of agreement between treated and untreated fractions; one sample failed owing to detection of a clot by the instrument during pipetting, leaving 120 samples in the study. Statistical analysis was performed using an unweighted kappa. Results: Analysis of overall HPV positivity showed 97.5% (117/120) agreement between the treated and untreated fractions with a kappa value of 0.95. There were 63/65 (96.9%) concordant HPV positive and 54/55 (98.2%) concordant HPV negative results. In addition to the three discordant results for overall HPV positivity, there were three HPV type-specific discrepancies giving a total of 114/120 concordant HPV results (95% agreement). Conclusions: Glacial acetic acid (GAA) treatment of cervical ThinPrep specimens does not have significant adverse affects on HPV detection with the cobas 4800 HPV Test. © 2013 John Wiley & Sons Ltd.


O'Kane M.J.,Altnagelvin Hospital | McManus P.,Altnagelvin Hospital | McGowan N.,Altnagelvin Hospital | Lynch P.L.M.,Altnagelvin Hospital
Clinical Chemistry | Year: 2011

BACKGROUND: Although a theoretical consideration suggests that point-of-care testing (POCT) might be uniquely vulnerable to error, little information is available on the quality error rate associated with POCT. Such information would help inform risk/benefit analyses when one considers the introduction of POCT. METHODS: This study included 1 nonacute and 2 acute hospital sites. The 2 acute sites each had a 24-h central laboratory service. POCT was used for a range of tests, including blood gas/electrolytes, urine pregnancy testing, hemoglobin A 1c (Hb A 1c), blood glucose, blood ketones, screening for drugs of abuse, and urine dipstick testing. An established Quality Query reporting system was in place to log and investigate all quality errors associated with POCT. We reviewed reports logged over a 14-month period. RESULTS: Over the reporting period, 225 Quality Query reports were logged against a total of 407 704 POCT tests. Almost two-thirds of reports were logged by clinical users, and the remainder by laboratory staff. The quality error rate ranged from 0% for blood ketone testing to 0.65% for Hb A1c testing. Two-thirds of quality errors occurred in the analytical phase of the testing process. These errors were all assessed as having no or minimal adverse impact on patient outcomes; however, the potential adverse impact was graded higher. CONCLUSIONS: The quality error rate for POCT is variable and may be considerably higher than that reported previously for central laboratory testing. © 2011 American Association for Clinical Chemistry.


Purvis J.A.,Altnagelvin Hospital | Smyth S.,Altnagelvin Hospital | Barr S.H.,Altnagelvin Hospital
Journal of the American Society of Echocardiography | Year: 2011

A parachute abnormality of the mitral valve is an extremely rare finding in adults. It is usually seen as part of Shone's complex. The authors present multimodality imaging from a case of adult parachute abnormality of the mitral valve to illustrate and explain features such as the characteristic "pear" shape of the valve and "doming" of the subvalvular apparatus. The solitary papillary muscle that defines the condition may be difficult to identify on transthoracic echocardiography, but redundancy of the chordae is a key echocardiographic feature in the adult form of the condition. Copyright 2010 by the American Society of Echocardiography.


Henry M.S.,Queen's University of Belfast | Passmore A.P.,Queen's University of Belfast | Todd S.,Altnagelvin Hospital | McGuinness B.,Queen's University of Belfast | And 2 more authors.
International Journal of Geriatric Psychiatry | Year: 2013

Objective There is a widely recognised need to develop effective Alzheimer's disease (AD) biomarkers to aid the development of disease-modifying treatments, to facilitate early diagnosis and to improve clinical care. This overview aims to summarise the utility of key neuroimaging and cerebrospinal fluid (CSF) biomarkers for AD, before focusing on the latest efforts to identify informative blood biomarkers. Design A literature search was performed using PubMed up to September 2011 for reviews and primary research studies of neuroimaging (magnetic resonance imaging, magnetic resonance spectroscopy, positron emission tomography and amyloid imaging), CSF and blood-based (plasma, serum and platelet) biomarkers in AD and mild cognitive impairment. Citations within individual articles were examined to identify additional studies relevant to this review. Results Evidence of AD biomarker potential was available for imaging techniques reflecting amyloid burden and neurodegeneration. Several CSF measures are promising, including 42 amino acid β-amyloid peptide (Aβ42); total tau (T-tau) protein, reflecting axonal damage; and phosphorylated tau (P-tau), reflecting neurofibrillary tangle pathology. Studies of plasma Aβ have produced inferior diagnostic discrimination. Alternative plasma and platelet measures are described, which represent potential avenues for future research. Conclusions Several imaging and CSF markers demonstrate utility in predicting AD progression and determining aetiology. These require standardisation before forming core elements of diagnostic criteria. The enormous potential available for identifying a minimally-invasive, easily-accessible blood measure as an effective AD biomarker currently remains unfulfilled. © 2012 John Wiley & Sons, Ltd.


Sheiman R.G.,Beth Israel Deaconess Medical Center | Mullan C.,Altnagelvin Hospital | Ahmed M.,Beth Israel Deaconess Medical Center
International Journal of Hyperthermia | Year: 2012

Purpose: To calculate a modified heat capacity (mHC) of small hepatocellular carcinomas (HCCs) in vivo during radio frequency ablation (RFA) and to determine if (mHC) correlates with tumour vascularity, adjacent vessels or local recurrence. Patients and methods: This study was IRB approved and informed consent was obtained from all patients. Before formal RFA, ambient HCC temperature and temperature 1min after heating at constant wattage were measured in 29 patients. From temperature change and wattage, individual mHCs (joules required to increase tumour temperature by 1° Celsius) were calculated. PreRFA, threephase computerised tomography (CT) scans were reviewed blindly for hepatic arteries, hepatic veins and portal veins abutting or within 3mm of tumour edge from which twelve vascular parameters were quantified. Tumour enhancement (homogeneous or heterogeneous on arterial phase) was also assessed. Multiple regression was used to correlate mHC with vascular parameters and tumour enhancement. Cox proportional hazard model was used to examine the relationship of mHC to local recurrence. Results: There was significant correlation of mHC with lesion enhancement (P=0.0018), length of hepatic arteries (P<0.0001) and total hepatic vein volume in contact with tumour (P=0.016). No correlation was found with any nonabutting vessel or portal vein parameter. The chance of local recurrence increased with increasing mHC. Conclusion: Because the modified heat capacity of small HCCs in our study population correlated with HCC enhancement, abutting hepatic arteries, the volume of abutting hepatic veins and local recurrence, it may be an indicator of the heat sink effect (HSE) and supports the HSE as a risk factor for local recurrence. © 2012 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.


Purvis J.A.,Altnagelvin Hospital | Hughes S.M.,Altnagelvin Hospital
British Journal of Cardiology | Year: 2011

The National Institute for Health and Clinical Excellence (NICE) has issued guidance on the investigation of patients with recent onset of chest pain, recommending CT calcium scoring (CAC) as the preferred test in some low-risk groups. This reflects concern about the low sensitivity (high false positive rate) of exercise stress tests (EST). This represents a major shift away from traditional rapidaccess EST clinics and has generated concern. We looked at 125 consecutive ungraded patients with equivocal ESTs referred for CAC, and CT coronary angiography (CTA), if required. We found that 53% of patients had a CAC = 0 and would need no further testing under the NICE protocol. We estimate this would rise up to 70-80% if only low likelihood patients were studied. Two per cent of patients with a CAC = 0 required coronary intervention. As per NICE protocol, all patients with a CAC between 1 and 400 underwent CTA, and, of these, 25% required invasive coronary angiography (ICA) and 17% underwent coronary intervention. The overall strategy of CAC followed by CTA (if CAC between 1 and 400) and ICA (if CAC >400) produced a final sensitivity of 88% (higher than EST) and a negative predictive value of 98% (similar to EST). We believe the strategy is a useful way to assess recent onset chest pain but concerns about radiation dose, availability and patients with obstructive non-calcific plaque remain.


McMenamin M.,Altnagelvin Hospital | McKenna M.,Altnagelvin Hospital
Cancer Cytopathology | Year: 2014

The authors previously demonstrated that lysing samples with glacial acetic acid (GAA) before human papillomavirus (HPV) testing does not adversely affect HPV detection with the cobas 4800 HPV Test. However, the longterm impact of GAA on HPV DNA was not explored in that study, and inherent cell loss with the lysing protocol used also was observed. The current study considered the long-term effects of GAA treatment of cervical ThinPrep samples on HPV detection with the cobas 4800 HPV Test. They also modified the manufacturer's lysing procedure for ThinPrep specimens to help prevent cell loss. METHODS: Seventy-eight ThinPrep samples, including previously lysed, archived specimens, were split; then, 1 part was treated with GAA according to the manufacturer's protocol or using a modified protocol, and the other part was left untreated. All samples were tested for HPV using the cobas 4800 HPV Test. The HPV-positive/HPV-negative status of tested samples was used to determine the level of agreement between treated and untreated fractions. Performance of the modified lysing procedure was assessed relative to the manufacturer's protocol. RESULTS: Positive HPV status produced 97% agreement between the GAA-treated/untreated fractions. Concordance between the GAA-treated/untreated fractions did not differ between the 2 lysing methods; however, the average percentage increases in b-globin and HPV cycle threshold values after lysing were less discernible for the modified lysing method. CONCLUSIONS: GAA treatment of cervical ThinPrep specimens does not have long-term adverse effects on HPV detection with the cobas 4800 HPV Test. The manufacturer's GAA lysing procedure for ThinPrep specimens can be reliably modified for specimens that may subsequently undergo HPV testing. © 2013 American Cancer Society.

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