An Observational Research Study to Evaluate the Impact of Breakthrough Cancer Pain on the Daily Lives and Functional Status of Patients

Breakthrough cancer pain (BTcP) is common, resulting in significant physical and psychosocial morbidity. We assessed the impact of BTcP on 81 cancer patients attending Irish specialist palliative care services. BTcP occurred up to twice daily in 24 (30%) and 3-4 times daily in 57 (70%) of cases. Median scores for the 'worst' and 'least' pains in the previous 24 hours were 7 and 2/10 respectively. Pain lasted < 15 minutes in 19 (23.5%), 15-30 minutes in 25 (30.8%), 30-60 minutes in 18 (22.2%) and > 60 minutes in 19 (23.5%) of patients. BTcP had a negative impact on general activity, mood, walking ability, work, relations with others, sleep and overall enjoyment of life. BTcP increased anxiety, depression, anger, isolation, financial difficulties and an inability to undergo cancer treatments. Systematic assessment of BTcP should form an integral part of every oncology/palliative medicine assessment. Once identified, BTcP should be managed assiduously.

Efficient gene delivery to photoreceptors using AAV2/rh10 and rescue of the Rho(-/-) mouse

As gene therapies for various forms of retinal degeneration progress toward human clinical trial, it will be essential to have a repertoire of safe and efficient vectors for gene delivery to the target cells. Recombinant adeno-associated virus (AAV) serotype 2/2 has been shown to be well tolerated in the human retina and has provided efficacy in human patients for some inherited retinal degenerations. In this study, the AAV2/8 and AAV2/rh10 serotypes have been compared as a means of gene delivery to mammalian photoreceptor cells using a photoreceptor specific promoter for transgene expression. Both AAV2/8 and AAV2/rh10 provided rescue of the retinal degeneration present in the rhodopsin knockout mouse, with similar levels of benefit as evaluated by molecular, histological, and functional readouts. Transgene expression levels were significantly higher (fivefold) 1 week postsubretinal injection when employing AAV2/8 for rhodopsin gene delivery compared to AAV2/rh10, and were indistinguishable by 6 weeks postadministration of vector. This study reports the use of the AAV2/rh10 serotype to provide rescue in a degenerating retina and provides a comparative evaluation of AAV2/rh10 with respect to AAV2/8, a serotype regarded as providing efficient delivery to photoreceptors.

'They're not witches. …' Young children and their parents' perceptions and experiences of Child and Adolescent Mental Health Services

BACKGROUND

Recent initiatives have emphasized the ongoing need to include children in healthcare research, which is relevant to the development of both paediatric and mental healthcare services. Our aim was to contribute children and their parents' perceptions and experiences of Child and Adolescent Mental Health Services (CAMHS), with the objective of providing guidance for those wishing to improve inclusivity and empowerment.

METHOD

We performed a thematic analysis of interview data taken from 11 children (9 boys, 2 girls, aged 8-12) and their parents (12 mothers, 2 fathers), who had recently been referred to CAMHS for mental health and educational problems.

RESULTS

Three core themes emerged from the data. Fear of the unknown refers to emotional apprehension due to uncertainty of what happens in CAMHS. However children also provided useful reassurances for future service users. Therapeutic engagement refers to the importance of being listened to and building up good relationships with professionals. Finally making services acceptable was discussed in terms of issues of accessibility, session tolerances and suggestions for the development of child-centred services.

CONCLUSIONS

Children were able to provide potentially useful opinions of CAMHS. In a time of limited resources it is imperative that the voices of children and their parents are acknowledged in order to improve accessibility and experiences within CAMHS.

Urban and rural differences in out-of-hospital cardiac arrest in Ireland

BACKGROUND

More than a third of Ireland's population lives in a rural area, defined as the population residing in all areas outside clusters of 1500 or more inhabitants. This presents a challenge for the provision of effective pre-hospital resuscitation services. In 2012, Ireland became one of three European countries with nationwide Out-of-Hospital Cardiac Arrest (OHCA) register coverage. An OHCA register provides an ability to monitor quality and equity of access to life-saving services in Irish communities.

AIM

To use the first year of national OHCAR data to assess differences in the occurrence, incidence and outcomes of OHCA where resuscitation is attempted and the incident is attended by statutory Emergency Medical Services between rural and urban settings.

METHODS

The geographical coordinates of incident locations were identified and co-ordinates were then classified as 'urban' or 'rural' according to the Irish Central Statistics Office (CSO) definition.

RESULTS

1798 OHCA incidents were recorded which were attended by statutory Emergency Medical Services (EMS) and where resuscitation was attempted. There was a higher percentage of male patients in rural settings (71% vs. 65%; p = 0.009) but the incidence of male patients did not differ significantly between urban and rural settings (26 vs. 25 males/100,000 population/year p = 0.353). A higher proportion of rural patients received bystander cardiopulmonary resuscitation (B-CPR) 70% vs. 55% (p ≤ 0.001), and had defibrillation attempted before statutory EMS arrival (7% vs. 4% (p = 0.019), respectively). Urban patients were more likely to receive a statutory EMS response in 8 min or less (33% vs. 9%; p ≤ 0.001). Urban patients were also more likely to be discharged alive from hospital (6% vs. 3%; p = 0.006) (incidence 2.5 vs. 1.1/100,000 population/year; p ≤ 0.001). Multivariable analysis of survival showed that the main variable of interest i.e. urban vs. rural setting was also independently associated with discharge from hospital alive (OR 3.23 (95% CI 1.43-7.31)).

CONCLUSION

There are significant disparities in the incidence of resuscitation attempts in urban and rural areas. There are challenges in the provision of services and subsequent outcomes from OHCA that occur outside of urban areas requiring novel and innovative solutions. An integrated community response system is necessary to improve metrics around OHCA response and outcomes in rural areas.

Anorexia nervosa (AN) in inpatients at a children's hospital (2005-2011)

AN is a serious mental illness best treated in the community. Those with critically low weight require hospitalisation. There is little published research on AN in Ireland. The aim of this audit was to evaluate the Irish experience. The mean age on admission was 13.5 yrs which is 6 mo earlier than 2002 figures. Boys represented 6/20 (30%) of admissions. On admission girls were more underweight than boys (0.4th centile V 9th centile for BMI). This was despite girls presenting to hospital sooner than boys post onset of symptoms. Aside from low weight, over-exercising and food restricting were the most common presenting features. Inpatient weight restoration is successful with a mean weekly weight gain of 930g which is within the recommended range of 500-1000g/wk. Mean hospital stay was 38 days.

Diagnosing autistic spectrum disorder in the age of austerity

BACKGROUND

Diagnosing autistic spectrum disorder is a challenge, typically involving myriad professionals. In the current climate we explore how diagnosis is managed in the real world by professionals.

METHODS

Using semi-structured interviews we thematically analyse data from psychiatrists, paediatricians and educational psychologists.

RESULTS

While there is some consistency across and within these groups there are also a number of variances, and several important issues are highlighted. These include the problem of time and resources, the issue of location for diagnosis, the value of diagnostic tools and schedules, the need for supporting information, the difficulty of multi-agency working, the relevance of a physical examination and the eventual diagnostic label.

CONCLUSIONS

In the current economic climate and considering changes in guidelines there is a need to evaluate current service provision and enhance services. However, attention needs to be paid to the practical and realistic application of the suggested guidance.

Minimal genome encoding proteins with constrained amino acid repertoire

Minimal bacterial gene set comprises the genetic elements needed for survival of engineered bacterium on a rich medium. This set is estimated to include 300-350 protein-coding genes. One way of simplifying an organism with such a minimal genome even further is to constrain the amino acid content of its proteins. In this study, comparative genomics approaches and the results of gene knockout experiments were used to extrapolate the minimal gene set of mollicutes, and bioinformatics combined with the knowledge-based analysis of the structure-function relationships in these proteins and their orthologs, paralogs and analogs was applied to examine the challenges of completely replacing the rarest residue, cysteine. Among several known functions of cysteine residues, their roles in the active centers of the enzymes responsible for deoxyribonucleoside synthesis and transfer RNA modification appear to be crucial, as no alternative chemistry is known for these reactions. Thus, drastic reduction of the content of the rarest amino acid in a minimal proteome appears to be possible, but its complete elimination is challenging.

Universal antenatal screening for hepatitis C

The aims of this study were to pilot universal antenatal HCV screening and to determine the true seroprevalence of HCV infection in an unselected antenatal population. A risk assessment questionnaire for HCV infection was applied to all women booking for antenatal care over a 1-year period. In addition the prevalence of anti-HCV antibody positive serology in this population was determined. Over the course of the year, 9121 women booked for antenatal care at the Rotunda and 8976 women agreed to take part in the study, representing an uptake of 98.4%. 78 (0.9%) women were diagnosed as anti-HCV positive, the majority of whom were Irish (60.3%) or from Eastern Europe (24.4%). 73% of anti-HCV positive women reported one or more known risk factor with tattooing and a history of drug abuse the most commonly reported. 27% (n = 21) of anti-HCV positive women had no identifiable risk factors. Due to selective screening, seroprevalence of HCV is impossible to accurately calculate. However the universal screening applied here and the high uptake of testing has allowed the prevalence of anti-HCV among our antenatal population to be calculated at 0.9%. A significant proportion (27%) of anti-HCV positive women in this study reported no epidemiological risk factors at the time