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Nally D.M.,University of Limerick | Kelly E.G.,RCSI | Clarke M.,RCSI | Ridgway P.,Trinity College Dublin
British Journal of Nutrition | Year: 2014

In patients with severe acute pancreatitis (AP), enteral nutrition is delivered by nasojejunal (NJ) tube to minimise pancreatic stimulation. Nasogastric (NG) feeding represents an alternative route. The primary objective of this systematic review and meta-analysis was to evaluate the efficacy of NG feeding. Secondary objectives were to compare the NG and NJ routes and assess the side effects of the former. The primary endpoint was exclusive NG feeding with delivery of 75 % of nutritional targets. Additional outcomes included change to total parenteral nutrition (TPN), increased pain or disease severity, vomiting, diarrhoea, delivery rate reduction and tube displacement. Among the retrieved studies, six were found to be eligible for the qualitative review and four for the meta-analysis. NG nutrition was received by 147 patients; exclusive NG feeding was achieved in 90 % (133/147). Of the 147 patients, 129 (87 %) received 75 % of the target energy. In studies where all subjects received exclusive NG nutrition, 82 % (seventy-four of the ninety patients) received >75 % of the intended energy. Compared with NJ nutrition, there was no significant difference in the delivery of 75 % of nutritional targets (pooled risk ratio (RR) 1.02; 95 % CI 0.75, 1.38.) or no increased risk of change to TPN (pooled RR 1.05; 95 % CI 0.45, 2.48), diarrhoea (pooled RR 1.28; 95 % CI 0.62, 2.66), exacerbation of pain (pooled RR 1.10; 95 % CI 0.47, 2.61) or tube displacement (pooled RR 0.44; 95 % CI 0.11, 1.73). Vomiting and diarrhoea were the most common side effects of NG feeding (13.3 and 12.9 %, respectively). With respect to the delivery of nutrition, 11.2 % of the patients required delivery rate reduction and 3.4 % dislodged the tube. Other side effects included elevated levels of aspirates (9.1 %), abdominal distension (1.5 %), pain exacerbation (7.5 %) and increased disease severity (1.6 %). In conclusion, NG feeding is efficacious in 90 % of patients. Further research is required to optimise the delivery of NG nutrition and examine 'gut-rousing' approaches to nutrition in patients with severe AP. Copyright © 2014 The Authors. Source


News Article | September 9, 2016
Site: http://www.rdmag.com/rss-feeds/all/rss.xml/all

Chemists from Trinity College Dublin, in collaboration with RCSI, have devised a revolutionary new scanning technique that produces extremely high-res 3D images of bones -- without exposing patients to X-ray radiation. The chemists attach luminescent compounds to tiny gold structures to form biologically safe 'nanoagents' that are attracted to calcium-rich surfaces, which appear when bones crack - even at a micro level. These nanoagents target and highlight the cracks formed in bones, allowing researchers to produce a complete 3D image of the damaged regions. The technique will have major implications for the health sector as it can be used to diagnose bone strength and provide a detailed blueprint of the extent and precise positioning of any weakness or injury. Additionally, this knowledge should help prevent the need for bone implants in many cases, and act as an early-warning system for people at a high risk of degenerative bone diseases, such as osteoporosis. The research, led by the Trinity College Dublin team of Professor of Chemistry, Thorri Gunnlaugsson, and Postdoctoral Researcher, Esther Surender, has just been published in the leading journal Chem, a sister journal to Cell, which is published by CellPress. Professor Gunnlaugsson said: "This work is the outcome of many years of successful collaboration between chemists from Trinity and medical and engineering experts from RCSI. We have demonstrated that we can achieve a three-dimensional map of bone damage, showing the so-called microcracks, using non-invasive luminescence imaging. The nanoagent we have developed allows us to visualise the nature and the extent of the damage in a manner that wasn't previously possible. This is a major step forward in our endeavour to develop targeted contrast agents for bone diagnostics for use in clinical applications." The work was funded by Science Foundation Ireland and by the Irish Research Council, and benefited from collaboration with scientists at RCSI (Royal College of Surgeons in Ireland), led by Professor of Anatomy, Clive Lee. Professor Lee said: "Everyday activity loads our bones and causes microcracks to develop. These are normally repaired by a remodelling process, but, when microcracks develop faster, they can exceed the repair rate and so accumulate and weaken our bones. This occurs in athletes and leads to stress fractures. In elderly people with osteoporosis, microcracks accumulate because repair is compromised and lead to fragility fractures, most commonly in the hip, wrist and spine. Current X ray techniques can tell us about the quantity of bone present but they do not give much information about bone quality." He continued: "By using our new nanoagent to label microcracks and detecting them with magnetic resonance imaging (MRI), we hope to measure both bone quantity and quality and identify those at greatest risk of fracture and institute appropriate therapy. Diagnosing weak bones before they break should therefore reduce the need for operations and implants - prevention is better than cure." In addition to the unprecedented resolution of this imaging technique, another major step forward lies in it not exposing X-rays to patients. X-rays emit radiation and have, in some cases, been associated with an increased risk of cancer. The red emitting gold-based nanoagents used in this alternative technique are biologically safe - gold has been used safely by medics in a variety of ways in the body for some time. Dr Esther Surender, Trinity, said: "These nanoagents have great potential for clinical application. Firstly, by using gold nanoparticles, we were able to lower the overall concentration of the agent that would have to be administered within the body, which is ideal from a clinical perspective. Secondly, by using what is called 'two-photon excitation' we were able to image bone structure using long wavelength excitation, which is not harmful or damaging to biological tissues." She added: "These nanoagents are similar to the contrast agents that are currently being utilised for MRI within the clinic, and hence have the potential to provide a novel means of medical bone diagnosis in the future. Specifically, by replacing the Europium with its sister ion Gadolinium, we can tune into the MRI activity of these nanoagents for future use alongside X-ray and computed tomography (CT) scans." Professor Gunnlaugsson and his research team are based in the Trinity Biomedical Sciences Institute (TBSI), which recently celebrated its 5-Year anniversary. Professor Gunnlaugsson presented his research at a symposium to mark the occasion, along with many other world-leaders in chemistry, immunology, bioengineering and cancer biology.


Malone A.,Beaumont Hospital | Malone A.,Royal College of Surgeons in Ireland | Meldrum D.,Royal College of Surgeons in Ireland | Gleeson J.,RCSI | Bolger C.,Beaumont Hospital
Journal of Electromyography and Kinesiology | Year: 2011

The aims of this study were to validate a computerised method to detect muscle activity from surface electromyography (SEMG) signals in gait in patients with cervical spondylotic myelopathy (CSM), and to evaluate the test-retest reliability of the activation times designated by this method. SEMG signals were recorded from rectus femoris (RF), biceps femoris (BF), tibialis anterior (TA), and medial gastrocnemius (MG), during gait in 12 participants with CSM on two separate test days. Four computerised activity detection methods, based on the Teager-Kaiser Energy Operator (TKEO), were applied to a subset of signals and compared to visual interpretation of muscle activation. The most accurate method was then applied to all signals for evaluation of test-retest reliability. A detection method based on a combined slope and amplitude threshold showed the highest agreement (87.5%) with visual interpretation. With respect to reliability, the standard error of measurement (SEM) of the timing of RF, TA and MG between test days was 5.5% stride duration or less, while the SEM of BF was 9.4%. The timing parameters of RF, TA and MG designated by this method were considered sufficiently reliable for use in clinical practice, however the reliability of BF was questionable. © 2011 Elsevier Ltd. Source


Humphries N.,Royal College of Surgeons in Ireland | Brugha R.,RCSI | McGee H.,Dean
Health Policy | Year: 2012

Ireland began actively recruiting nurses internationally in 2000. Between 2000 and 2010, 35% of new recruits into the health system were non-EU migrant nurses. Ireland is more heavily reliant upon international nurse recruitment than the UK, New Zealand or Australia.This paper draws on in-depth interviews (N= 21) conducted in 2007 with non-EU migrant nurses working in Ireland, a quantitative survey of non-EU migrant nurses (N= 337) conducted in 2009 and in-depth interviews conducted with key stakeholders (N= 12) in late 2009/early 2010.Available primary and secondary data indicate a fresh challenge for health workforce planning in Ireland as immigration slows and nurses (both non-EU and Irish trained) consider emigration. Successful international nurse recruitment campaigns obviated the need for health workforce planning in the short-term, however the assumption that international nurse recruitment had 'solved' the nursing shortage was short-lived and the current presumption that nurse migration (both emigration and immigration) will always 'work' for Ireland over-plays the reliability of migration as a health workforce planning tool. This article analyses Ireland's experience of international nurse recruitment 2000-2010, providing a case study which is illustrative of health workforce planning challenges faced internationally. © 2012 Elsevier Ireland Ltd. Source


Delany C.,RCSI
Irish medical journal | Year: 2011

In 2008, planned folic acid fortification for the prevention of Neural Tube Defects (NTD) was postponed. Concurrently, the economic recession may have affected dietary folic acid intake, placing increased emphasis on supplement use. This study examined folic acid supplement use in 2009. A cross-sectional survey of 300 ante-natal women was undertaken to assess folic acid knowledge and use. Associations between demographic, obstetric variables and folic acid knowledge and use were examined. A majority, 284/297 (96%), had heard of folic acid, and 178/297 (60%) knew that it could prevent NTD. Most, 270/297 (91%) had taken it during their pregnancy, but only 107/297 (36%) had used it periconceptionally. Being older, married, planned pregnancy and better socioeconomic status were associated with periconceptional use. Periconceptional folic acid use in 2009 was very low, little changed from economic status were associated with periconceptional use. Periconceptional folic acid use in 2009 was very low, little changed from earlier years. Continuous promotion efforts are necessary. Close monitoring of folic acid intake and NTD rates is essential, particularly in the absence of fortification. Source

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