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Wilcz-Villega E.,Trinity Center for Health science | Mcclean S.,Institute of Technology Tallaght | O'Sullivan M.,St Jamess Hospital
Neurogastroenterology and Motility | Year: 2014

Background: Increased intestinal permeability and altered expression of tight junction (TJ) proteins may be implicated in the pathogenesis of irritable bowel syndrome (IBS). This study aimed to investigate the expression of adherens junction (AJ) protein E-cadherin and TJ proteins zonula occludens (ZO)-1 and claudin (CLD)-1 and associations with IBS symptoms. Methods: Junctional proteins were immunostained in cecal biopsy tissue of Rome II IBS patients (n = 34) comprising both alternating (IBS-A) and diarrhea predominant (IBS-D) subtypes, and controls (n = 12). IBS symptom duration, abdominal pain severity and stool frequency were assessed for IBS patients. Protein expression was determined by immunofluorescence. Key Results: E-cadherin and ZO-1 protein expression was significantly lower (p = 0.03 and p = 0.016, respectively) in the cecal surface epithelium of the IBS group comprising both IBS-A and IBS-D subtypes. CLD-1 expression was not significantly altered compared with controls. On subtype analysis, ZO-1 expression was significantly reduced in both IBS-A and IBS-D compared with controls, whereas E-cadherin was reduced only in IBS-A. Lower E-cadherin expression was associated with longer symptoms duration specifically in IBS-A patients (rs = -0.76, p = 0.004). Reduced E-cadherin associated with abdominal pain severity in the overall IBS group (rs = -0.36, p = 0.041), but this association was unrelated to IBS subtype. Conclusions & Inferences: E-cadherin protein expression in the cecum was significantly lower in IBS-A compared with controls and associated with longstanding symptoms. E-cadherin was further associated with abdominal pain severity in the IBS group overall, but unrelated to IBS subtype. Altered E-cadherin expression may provide novel insights into mechanisms underlying intestinal barrier dysfunction in IBS. In this study, comprising IBS-A and IBS-D subtypes, E-cadherin and ZO-1 protein expression was significantly lower in the cecal surface epithelium compared with controls. Furthermore, reduced E-cadherin expressed in the IBS group was associated with more severe abdominal pain, and in IBS-A with longer duration of symptoms. Altered E-cadherin expression may provide novel insights into mechanisms underlying intestinal barrier dysfunction in IBS. © 2013 John Wiley & Sons Ltd.

Richardson K.,Trinity College Dublin | Kenny R.A.,Trinity College Dublin | Kenny R.A.,St Jamess Hospital | Peklar J.,University of Ljubljana | Bennett K.,Trinity Center for Health science
Journal of Clinical Epidemiology | Year: 2013

Objectives: To estimate the agreement between interview-ascertained medication use and pharmacy records among the population aged older than 50 years, and to identify patient-level predictors of discordance. Study Design and Setting: The Irish Longitudinal study on Ageing is representative of community-dwelling adults aged 50 years and older in Ireland. Interview-ascertained medication data from 2,621 participants were linked to pharmacy dispensing records. The kappa statistics measured the agreement between the two sources for 19 therapeutic classes. Logistic regression assessed the effect of patient-level characteristics on survey under- and overreporting of regularly dispensed medications. Results: Agreement was good or very good (κ = 0.64-0.86) for 15 medication classes, and moderate or poor for antiinflammatory and antirheumatic products (κ = 0.54), analgesics (κ = 0.50), psycholeptics (κ = 0.59), and ophthalmologicals (κ = 0.37). Not reporting an indicated health condition, less frequent dispensing, older age, and more medications regularly dispensed were associated with survey underreporting, but results varied by therapeutic class. Memory and cognition were not associated with discordance. Conclusion: Ascertaining medication use via patient interview seems a valid method for most medication classes and also captures nonprescription and supplement use. However, medications applied topically and as needed may be underreported. The source of medication data should be carefully considered when performing pharmacoepidemiological studies. © 2013 Elsevier Inc. All rights reserved.

The objective was to systematically review the literature to identify and grade tools used for the end point assessment of procedural skills (e.g., phlebotomy, IV cannulation, suturing) competence in medical students prior to certification. The authors searched eight bibliographic databases electronically - ERIC, Medline, CINAHL, EMBASE, Psychinfo, PsychLIT, EBM Reviews and the Cochrane databases. Two reviewers independently reviewed the literature to identify procedural assessment tools used specifically for assessing medical students within the PRISMA framework, the inclusion/exclusion criteria and search period. Papers on OSATS and DOPS were excluded as they focused on post-registration assessment and clinical rather than simulated competence. Of 659 abstracted articles 56 identified procedural assessment tools. Only 11 specifically assessed medical students. The final 11 studies consisted of 1 randomised controlled trial, 4 comparative and 6 descriptive studies yielding 12 heterogeneous procedural assessment tools for analysis. Seven tools addressed four discrete pre-certification skills, basic suture (3), airway management (2), nasogastric tube insertion (1) and intravenous cannulation (1). One tool used a generic assessment of procedural skills. Two tools focused on postgraduate laparoscopic skills and one on osteopathic students and thus were not included in this review. The levels of evidence are low with regard to reliability - κ = 0.65-0.71 and minimum validity is achieved - face and content. In conclusion, there are no tools designed specifically to assess competence of procedural skills in a final certification examination. There is a need to develop standardised tools with proven reliability and validity for assessment of procedural skills competence at the end of medical training. Medicine graduates must have comparable levels of procedural skills acquisition entering the clinical workforce irrespective of the country of training.

Coffey M.,Trinity Center for Health science | Vaandering A.,Cliniques universitaires Saint Luc
Radiotherapy and Oncology | Year: 2010

PET/CT imaging modalities have been shown to be useful in the diagnosis, staging, and monitoring of malignant diseases. Its inclusion into the treatment planning process is now central to modern radiotherapy practice. However, it is essential to be cognisant of the factors that are necessary in order to ensure that the acquired images are consistent with the requirements for both treatment planning and treatment delivery. Essential parameters required in image acquisition for radiotherapy planning and treatment include consistencies of table tops and the use of laser light for patient set-up. But they also include the accurate definition of the patient's initial positioning and the use of proper immobilization devices in the radiotherapy department. While determining this optimum set-up, patient psychological factors and limitations that may be due to the subsequent use of PET/CT for planning purposes need to be taken into account. Furthermore, patient set-up data need to be properly recorded and transmitted to the imaging departments. To ensure the consistency of patient set-up, the radiation therapist should ideally be directly involved in informing and positioning the patient on the PET/CT. However, a proper exchange of patient-related information can also be achieved by a close liaison between the two departments and by the use of clear detailed protocols per type of patient set-up and/or per localization of tumour site. © 2010 European Society for Therapeutic Radiology and Oncology and European Association of Nuclear Medicine. Published by Elsevier Ireland Ltd. All rights reserved.

Machold C.,Trinity Center for Health science
Irish medical journal | Year: 2012

Social Networking Sites (SNSs) have grown substantially, posing new hazards to teenagers. This study aimed to determine general patterns of Internet usage among Irish teenagers aged 11-16 years, and to identify potential hazards, including; bullying, inappropriate contact, overuse, addiction and invasion of users' privacy. A cross-sectional study design was employed to survey students at three Irish secondary schools, with a sample of 474 completing a questionnaire. 202 (44%) (n = 460) accessed the Internet using a shared home computer. Two hours or less were spent online daily by 285(62%), of whom 450 (98%) were unsupervised. 306 (72%) (n = 425) reported frequent usage of SNSs, 403 (95%) of whom were Facebook users. 42 (10%) males and 51 (12%) females experienced bullying online, while 114 (27%) reported inappropriate contact from others. Concerning overuse and the risk of addiction, 140 (33%) felt they accessed SNSs too often. These patterns among Irish teenagers suggest that SNS usage poses significant dangers, which are going largely unaddressed.

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