Acute Hospital Bed Capacity - A National Review

The Programme for Prosperity and Fairness outlined the commitment of the Government to a review of hospital bed capacity in both acute and non-acute settings, to be carried out by the Department of Health and Children in conjunction with the Department of Finance and in consultation with the Social Partners. The focus of this report is on bed capacity in publicly-funded acute hospitals in Ireland. The capacity needs of the sub-acute sector have been assessed separately in the context of the Health Strategy, Quality and Fairness: A Health System for You. Download document here

Value for Money and Policy Review of the Economic Cost and Charges Associated with Private and Semi-Private Treatment Services in Public Hospitals - Final Report

This Value for Money and Policy Review (VFM&PR) of the Economic Cost and Charges Associated with Private and Semi-Private Treatment Services in Public Hospitals was initiated by the Department of Health and Children in June 2009 and was conducted under the auspices of the Governmentâ?Ts Value for Money & Policy Review Initiative 2009-2011. The Review was overseen by an independently chaired National Steering Group comprised of senior representatives from the Department of Health and Children, the Department of Finance, and the Health Service Executive (HSE). Download document here Download Explanatory Note  

Value for Money and Policy Review of the Economic Cost and Charges Associated with Private and Semi-Private Treatment Services in Public Hospitals - Interim Report

This report sets out a revised costing methodology and an estimate of the gap which currently exists between private and semi-private bed charges and the average economic cost. While the Steering Group considers the costing methodology proposed as an improvement on the approach taken in previous years and a good overall approximation of the difference on average between economic costs and current charges, it recognises that the current charging regime does not take sufficient account of the variation between different categories of patient. Download document here Note to Readers

Discrepancy between antihypertensive effect and angiotensin converting enzyme inhibition by captopril

Captopril, an inhibitor of angiotensin converting enzyme, was administered twice daily to 13 hypertensive patients for a mean period of 9 weeks. Continuous blood pressure control in the ambulatory patients was established with a portable blood pressure recorder. Notwithstanding, in eight patients with normal renal function, plasma converting enzyme was found to resume normal activity before administration of the morning dose of captopril. Only in 5 patients with impaired renal function did some blockade of plasma converting enzyme persist for more than 12 hours. Measured plasma converting enzyme activity seemed to reflect total conversion of angiotensin I, including conversion in the pulmonary vascular bed, since changes in its activity were closely paralled by changes in plasma aldosterone levels. Bradykinin accumulation seems unlikely when converting enzyme and thus, presumably, kininase II has resumed normal activity. Captopril administration does not seem to alter plasma epinephrine or norepinephrine levels. Blood pressure reduction in the face of normal angiotensin converting enzyme activity is probably due to hyporesponsiveness of the arterioles to pressor hormones, which may be due to specific renin-related and/or nonspecific effects of captopril.

A Happy and a Healthy 2012

Many of us start the New Year with the best of intentions to lose weight, get fitter and eat well. It's that sense of new possibilities and fresh beginnings that can also help motivate changes in lifestyle. The Public Health Agency advises that making small changes to your own and your family's lifestyle can have a significant impact on improving overall health. Taking time to reflect, and making a plan, can all help. Choosing healthier food and increasing your physical activity will help maintain a healthy weight and prevent unwanted weight gain, which can have serious implications for a person's physical and mental health as it is associated with an increased risk of heart disease, stroke, type 2 diabetes, some cancers, respiratory problems, joint pain and depression.What can I do to improve my health?Make 1 or 2 small changes at a time - don't try to change your lifestyle radically or all at once as you're more likely to fail. Small changes in what you eat, or how active you are, are easier to make and more likely to be maintained.Mary Black, Assistant Director of Health and Wellbeing Improvement, PHA, said: "The New Year brings a time when many people reflect on their lives and very often eating more healthily is one of things they identify for change. I recommend setting a couple of small, achievable targets that can then be continued in the long term, for example:Eat breakfast everyday;Eat an extra portion of vegetables every day;Swap deep fried chips for oven chips;Choose fruit for between-meal snacks instead of a biscuit or bun;Begin to enjoy a hot drink on its own without feeling the need to have something sweet at the same time.Be active. Any sort of activity will be good for you. Think about how you can be more active each day. This doesn't have to involve running a marathon or joining a gym. Some suggestions include:· Go for walks with the children/family or friends. It's free! Walk on your lunch break;· Take the stairs instead of the elevator or escalator;· Park further away and walk to work/school;· Get off the bus a stop earlier and walk the rest;· Minimise the amount of time you are sitting down - take breaks from the computer at work or watching TV at home and walk around;· Children and adults can build up to the recommended daily activity levels in 10 minute sessions rather than doing it all in one session.Adults need at least 30 minutes, five days a week of moderate physical activity and children need 60 minutes of physical activity every day.Mary continued "It's easy for people to get into the habit of spending their spare time sitting down - watching TV, playing computer games, listening to their MP3 players - but being active will help you maintain a healthy weight and generally make you feel better. It can also improve your mood, reduce anxiety and protect against depression."It is what you do most of the time that really matters, so if you eat too much or don't exercise on any one day, don't worry too much - just accept it and get back to your new way of eating and being more active as soon as possible.

The functional outcome and recovery of patients admitted to an intensive care unit following drug overdose: a follow-up study.

Patients who have overdosed on drugs commonly present to emergency departments, with only the most severe cases requiring intensive care unit (ICU) admission. Such patients typically survive hospitalisation. We studied their longer term functional outcomes and recovery patterns which have not been well described. All patients admitted to the 18-bed ICU of a university-affiliated teaching hospital following drug overdoses between 1 January 2004 and 31 December 2006 were identified. With ethical approval, we evaluated the functional outcome and recovery patterns of the surviving patients 31 months after presentation, by telephone or personal interview. These were recorded as Glasgow outcome score, Karnofsky performance index and present work status. During the three years studied, 43 patients were identified as being admitted to our ICU because of an overdose. The average age was 34 years, 72% were male and the mean APACHE II score was 16.7. Of these, 32 were discharged from hospital alive. Follow-up data was attained on all of them. At a median of 31 months follow-up, a further eight had died. Of the 24 surviving there were 13 unemployed, seven employed and four in custody. The median Glasgow outcome score of survivors was 4.5, their Karnofsky score 80. Admission to ICU for treatment of overdose is associated with a very high risk of death in both the short- and long-term. While excellent functional recovery is achievable, 16% of survivors were held in custody and 54% unemployed.This resource was contributed by The National Documentation Centre on Drug Use.

Contact tracing investigation after professional exposure to tuberculosis in a Swiss hospital using both tuberculin skin test and IGRA.

SETTING: A 950 bed teaching hospital in Switzerland. AIM: To describe the result of a contact investigation among health care workers (HCW) and patients after exposure to a physician with smear-positive pulmonary tuberculosis in a hospital setting using standard tuberculin skin tests (TST) and Interferon-gamma release assay (IGRA). METHOD: HCW with a negative or unknown TST at hiring had a TST two weeks after the last contact with the index case (T0), repeated six weeks later if negative (T6). All exposed HCW had a T-SPOT.TB at T0 and T6. Exposed patients had a TST six weeks after the last contact, and a T-SPOT.TB if the TST was positive. RESULTS: Among 101 HCW, 17/73 (22%) had a positive TST at T0. TST was repeated in 50 at T6 and converted from negative to positive in eight (16%). Twelve HCW had a positive T-SPOT.TB at T0 and ten converted from negative to positive at T6. Seven HCW with a positive T-SPOT.TB reverted to negative at T6 or at later controls, most of them with test values close to the cut-off. Among 27 exposed patients tested at six weeks, ten had a positive TST, five of them confirmed by a positive T-SPOT.TB. CONCLUSIONS: HCW tested twice after exposure to a case of smear-positive pulmonary TB demonstrated a possible conversion in 10% with T-SPOT and 16% with TST. Some T-SPOT.TB reverted from positive to negative during the follow-up, mostly tests with a value close to the cut-off. Due to the variability of the test results, it seems advisable to repeat the test with values close to the cut-off before diagnosing the presence of a tuberculous infection.

Wake Up, Shake Up Breakfast Club

The Wake Up, Shake Up club was first set up in February 2013. The aim of the club is to support working parents and offer an affordable alternative to local childcare options. It is also an opportunity to re-enforce school healthy eating guidelines and explore different food options with children.The club is run by staff members of Holywell Childcare. 33 children attend each morning. There is a charge of €1 per child per day to cover staff costs. A selection of cereals is served each morning along with toast, fruit and fruit juice. Children can take part in different activities after breakfast, such as crafts, games, and even yoga ! Part of theBreakfast Clubs Pilot Programme Initiative Type Breakfast Clubs Location Dublin Target Groups Children ( 4-12 years) Start 18th Feb 2013

Rise & Shine Breakfast Club

The Rise ‘n’ Shine club was set up in January 2013. The main aims of the club are to improve attendance, increase participation in class, and reinforce healthy eating policy in pupils. The club is run each morning by a group of volunteers which includes teachers, parents and 6th class children. The Home School Community Liaison Officer co-ordinates the club. On average, 20 – 25 girls attend each morning. A selection of cereals is served each morning along with toast and fruit juice. Different foods are served for special occasions, such as pancakes on Pancake Tuesday. This club is part of the Pilot Programme of Breakfast Clubs which is funded through Kellogg's Corporate Citizenship Fund. Part of theBreakfast Clubs Pilot Programme Initiative Type Breakfast Clubs Location Dublin 5 Target Groups Children ( 4-12 years) Funding This club is part of the Pilot Programme of Breakfast Clubs which is funded through Kellogg's Corporate Citizenship Fund. Start 13th Jan 2013

The Breakfast Club

The Breakfast Club was set up in January 2013. The aim of the breakfast club is to provide pupils with breakfast in a safe, structured and warm environment at the beginning of each school day so as to enhance their - Concentration- Attendance and punctuality- Nutrition- Social and personal development- Communication skills. The club is run by two parents and co-ordinated by the school principal. On average, 15 children attend the breakfast club each morning. A selection of cereals, fruit, toast and fruit juice are served each morning. All food is laid out in a buffet-style and children can serve themselves (with a little help from staff if needed). The breakfast club is part of the Pilot Programme of Breakfast Clubs which is funded through the Kellogg's Corporate Citizenship Fund. Part of theBreakfast Clubs Pilot Programme Initiative Type Breakfast Clubs Location Dublin 7 Target Groups Children ( 4-12 years) Funding The breakfast club is part of the Pilot Programme of Breakfast Clubs which is funded through the Kellogg's Corporate Citizenship Fund. Start 20th Jan 2013

WTID Nutrition and Cooking Classes

In partnership with the VEC WTID has delivered Nutrition Level 5 FETAC to a group of 24 learners, 4 being members of the Travelling community.  This module was also delivered to 5 Childcare staff at WTIDs pre-school service. Staff of the Harmony Afterschool Service undertakes baking activities each week with the children. Group work has been facilitated with 16 men who were on a BTEI on salt, sugar, caffeine and fibre, as well as with a young girls group on food tasting of various fruits, cheeses and how to make healthy potato wedges and other healthy snacks. WTID as part of the local Traveller Interagency Group are writing a well-being manual to be used with community groups working with Travellers- Healthy Eating is a module of this manual. Plans are in place to run a First Instincts Men's Health programme which will run over an 8 week period with workshops, weigh ins and provision of a healthy breakfast on each morning. HSE West; FAS CE scheme; Involve: Senior Youth Worker; Department of Children and Youth Affairs: Childcare Service; Pobal Initiative Type Community Food Centres Nutrition Education and Training Programmes Location Galway Target Groups At risk youth Children ( 4-12 years) Children (0-4 years) Children (13-18 years) Families Lone parents Men Older people People with mental health difficulties Travellers Unemployed Women Funding HSE West; FAS CE scheme; Involve: Senior Youth Worker; Department of Children and Youth Affairs: Childcare Service; Pobal Partner Agencies Equal Ireland FÁS Galway County Council GCCCC GRD HSE Involve RAPID VEC Adult Education Service

The balance between the production of tumor necrosis factor-alpha and interleukin-10 determines tissue injury and lethality during intestinal ischemia and reperfusion

A major goal in the treatment of acute ischemia of a vascular territory is to restore blood flow to normal values, i.e. to "reperfuse" the ischemic vascular bed. However, reperfusion of ischemic tissues is associated with local and systemic leukocyte activation and trafficking, endothelial barrier dysfunction in postcapillary venules, enhanced production of inflammatory mediators and great lethality. This phenomenon has been referred to as "reperfusion injury" and several studies demonstrated that injury is dependent on neutrophil recruitment. Furthermore, ischemia and reperfusion injury is associated with the coordinated activation of a series of cytokines and adhesion molecules. Among the mediators of the inflammatory cascade released, TNF-alpha appears to play an essential role for the reperfusion-associated injury. On the other hand, the release of IL-10 modulates pro-inflammatory cytokine production and reperfusion-associated tissue injury. IL-1beta, PAF and bradykinin are mediators involved in ischemia and reperfusion injury by regulating the balance between TNF-alpha and IL-10 production. Strategies that enhance IL-10 and/or prevent TNF-alpha concentration may be useful as therapeutic adjuvants in the treatment of the tissue injury that follows ischemia and reperfusion.

Clinical characteristics, prognosis, and treatment of pelvic cryptorchid seminoma.

PURPOSE: To analyze the clinical characteristics, prognosis, and treatment outcome of pelvic cryptorchid seminoma (PCS), and to determine whether whole abdominal-pelvic irradiation for Stage I disease is necessary. METHODS AND MATERIALS: From 1958 to 1991, 60 patients with PCS were treated at the Cancer Hospital of Chinese Academy of Medical Sciences, Beijing. They presented with a lower abdominal mass and showed a predominance for the right side. A high proportion of patients with PCS [26 of 60 (43%)] had metastatic disease, compared to 20% of those with scrotal seminoma, and there was a tendency toward a higher frequency of pelvic nodal metastases. There were 34 Stage I, 6 Stage IIA, 11 Stage IIB, 5 Stage III, and 4 Stage IV patients. Of these 60 patients, 56 underwent laparotomy with or without cryptorchiectomy (37 radical orchiectomy, 7 partial orchiectomy, and 12 biopsy of the primary or cervical node), and 4 cervical node biopsy only. All patients were further treated with radiotherapy, chemotherapy, or a combination of both. Patients with Stage I and II disease received radiotherapy, whereas patients with Stage III and IV were treated with chemotherapy. RESULTS: The overall and disease-free survivals at 5 and 10 years were 92% and 87%, and 88% and 84%, respectively. The 5- and 10-year survivals were 100% for Stage I, 94% and 87% for Stage II, and 56% and 42% for Stage III/IV, respectively (p < 0.05). Volume of irradiation, i.e., whole abdominal-pelvic radiotherapy (10 patients), versus hockey-stick encompassing paraaortic, ipsilateral iliac nodes and the primary tumor or tumor bed (17) did not influence outcome in Stage I patients. Five patients relapsed within 2-12 years after treatment, and four of these patients were successfully salvaged. Four patients developed a second malignant tumor and died. CONCLUSION: Stage I and II PCS can be adequately controlled by radiotherapy regardless of the surgical procedure. Whole abdominal-pelvic irradiation for Stage I and IIA disease is not required, and fields can be limited to the paraaortic, ipsilateral iliac nodes and primary tumor or tumor bed. We recommend platinum-based chemotherapy for Stage IIB-IV PCS.

Anopheles darlingi bionomics and transmission of Plasmodium falciparum, Plasmodium vivax and Plasmodium malariae in Amerindian villages of the Upper-Maroni Amazonian forest, French Guiana

French Guiana is one of the areas in South America most affected by malaria and where the disease has become a serious public health problem. In spite of this situation, little recent entomological data are available from the main localities where the disease occurs, even though they are crucial for development of an effective vector control strategy. A longitudinal entomological survey was carried out from March 2000-February 2002 in three Amerindian villages, namely Twenké, Taluène and Cayodé, located in the Amazonian forest of the Upper-Maroni area, to assess anopheline mosquitoes and malaria transmission dynamics. Anopheles darlingi (Diptera: Culicidae) was the most abundant mosquito species caught during the study. This efficient American malaria vector was active the entire year, but showed an evident peak of abundance during the main rainfall season, from April-June, with an average human biting rate of 255.5 bites per person per night. Parity rates were homogeneous all year, indicating no significant seasonal variability in female survival rates. Estimated vectorial capacity indices were higher during the rainy season, even though the risk of transmission was present throughout the year (VCI > 1). A total of 14 An. darlingi were found infected with Plasmodium falciparum, Plasmodium vivax or Plasmodium malariae. The annual circumsporozoite indices were 0.15, 0.14 and 0.05, and the entomological inoculation rates were 22.8, 27.4 and 14.4 infected bites per person per year in Twenké, Taluène and Cayodé, respectively. An. darlingiwas endo-exophagic and rather exophilic in these localities. The species was collected throughout the night but was more aggressive between 21:30-03:30 h and after 05:30 h. Parity rates were homogeneous during the entire night. Impregnated hammock and/or bed nets, coupled with the use of mosquito repellents, as well as the early treatment of malarial cases, appear to be the most suitable tools for fighting malaria in these Amerindian villages since the spraying of residual insecticides is inefficient because of vector biology and the housing structure.

Long-Term Control of Endemic Hospital-Wide Methicillin-Resistant Staphylococcus aureus (MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers

To evaluate the long-term impact of successive interventions on rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide situation. DESIGN:Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel electrophoresis. SETTING:A 950-bed teaching hospital in Seville, Spain. PATIENTS:All patients admitted to the hospital during the period from 1995 through 2008. METHODS:Three successive interventions were studied: (1) contact precautions, with no active surveillance for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards, prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients admitted from other medical centers. RESULTS:Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patient-days [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of MRSA colonization or infection changed significantly after the first intervention. The rate decreased significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patient-days) after the third intervention, and the rate remained at a similar level for 8 years. The MRSA bacteremia rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptible S. aureus did not change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates obtained from healthcare workers were clonally related to those recovered from patients who were in their care. CONCLUSION:Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers. The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards (identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the success of the program.