Le syndrome hépatorénal chez le patient cirrhotique [Hepatorenal syndrome in patients with liver cirrhosis].

Hepatorenal syndrome is a particular form of functional renal failure which may develop in patients with liver cirrhosis. On a clinical standpoint, precise diagnostic criteria have been established to clearly define this entity, whereas recent advances in the understanding of the biology of vasoactive mediators and the physiology of microcirculation have allowed to better anticipate its pathophysiological mechanisms. During the course of cirrhosis, sinusoidal portal hypertension leads to splanchnic and systemic vasodilation, responsible for a reduction of effective arterial blood volume. As a result, a state of intense renal vasoconstriction develops, leading to renal failure in the absence of any organic renal disease. At this stage, liver transplantation is the only definitive therapy able to reverse renal dysfunction. In recent years, innovative therapies have shown promise to prolong survival in patients with hepatorenal syndrome, including the administration of analogs of vasopressin (mainly terlipressin), the insertion of transjugular intrahepatic portosystemic shunts and the use of novel techniques of dialysis. On a preventive viewpoint, several simple measures have been shown to reduce the risk of hepatorenal syndrome in cirrhotic patients, including the appropriate use of diuretics, the avoidance of nephrotoxic drugs, the prophylaxis of spontaneous bacterial peritonitis and optimal fluid management in patients undergoing large volume paracentesis.

First Annual Report of the Alcohol Marketing Communications Monitoring Body (2006)

First Annual Report of the Alcohol Marketing Communications Monitoring Body (2006) In December 2005 the Minister for Health and Children set up the Alcohol Marketing Communications Monitoring Body (the Monitoring Body) to oversee the implementation of and adherence to the Voluntary Codes of Practice to limit the exposure of young people to alcohol advertising. These Codes were agreed between the Department of Health and Children and representatives of the advertising, drinks and mediacommunications industries. Click here to download PDF 139kb

Building a Culture of Patient Safety - Report of the Commission on Patient Safety and Quality Assurance

The Commission on Patient Safety and Quality Assurance was established in January 2007 and reported to the Minister in July 2008. The report was considered by government in January 2009 which agreed the implementation process. The overall objective of the Commission was to develop clear and practical recommendations to ensure that safety and quality of care for patients is paramount within the healthcare system. The Commission’s report set out a wide range of policy measures that will drive the safety and quality agenda in Irish healthcare in the coming years. The establishment of the Commission was prompted by an increasing awareness of patient safety issues in general and high profile health service system failures at home and abroad and in particular by the Lourdes Hospital Inquiry. These have underlined the need for an increased focus on patient safety and quality. Download document here Download summary document on the Report

Second Report of the Alcohol Marketing Communications Monitoring Body (2007)

In December 2005, the Minister for Health and Children set up the Alcohol Marketing Communications Monitoring Body (the Monitoring Body) to oversee the implementation of and adherence to the Voluntary Codes of Practice to limit the exposure of young people to alcohol advertising. These Codes were agreed between the Department of Health and Children and representatives of the advertising, drinks and media communications industries. Click here to download PDF 146kb

Alcohol Marketing, Communications and Sponsorship Codes of Practice

In 2002 the Minister for Health and Children met with representative organisations from the Advertising Industry, the Association of Advertisers in Ireland (AAI), representing advertisers, the Institute of Advertising Practitioners in Ireland (IAPI), representing the advertising agencies and Drinks Industry Group Ireland (DIGI) representing the Alcohol Drinks Industry. The discussions centred on the Ministerâ?Ts concerns about some of the content, weight of exposure and placement of alcohol advertising. In addition, issues were discussed on activities involved in the sponsorship of, and activities surrounding, music and sports events. Download document here

First Quarterly Progress Report of the Implementation Steering Group on recommendations of the Report of the Commission on Patient Safety and Quality Assurance

First Quarterly Progress Report of the Implementation Steering Group on recommendations of the Report of the Commission on Patient Safety and Quality Assurance Click here to download PDF 56kb

2008 Annual Report of the Alcohol Marketing Communications Monitoring Body

2008 Annual Report of the Alcohol Marketing Communications Monitoring Body Click here to download PDF 158kb

Limiting the Exposure of Young People to Alcohol Advertising: 4th Annual report of the Alcohol Marketing Communications Monitoring Body

Limiting the Exposure of Young People to Alcohol Advertising: 4th Annual report of the Alcohol Marketing Communications Monitoring Body Click here to download PDF 156KB

Strategic Framework for Role Expansion of Nurses and Midwives: Promoting Quality Patient Care

This strategic document sets policy direction for the enhancement of nursing and midwifery roles. It builds on the achievements of the past ten years for nursing and midwifery and is set within the context of clinical and regulatory standards. The Programme for Government 2011 and policy initiatives such as legislative changes for the introduction of nurse and midwife medication prescribing create significant opportunities toexpand the role of nurses and midwives in a proactive manner.   Click here to download   PDF 1.12MB

Limiting the Exposure of Young People to Alcohol Advertising: 5th Annual report of the Alcohol Marketing Communications Monitoring Body

Limiting the Exposure of Young People to Alcohol Advertising: 5th Annual report of the Alcohol Marketing Communications Monitoring Body Click here to download PDF 173KB

Final Report of the Implementation Steering Group (ISG) on the recommendations of the Report of the Commission on Patient Safety and Quality Assurance

Final Report of the Implementation Steering Group (ISG) on the recommendations of the Report of the Commission on Patient Safety and Quality Assurance Click here to download PDF 235KB

Mutation screening of patients with Alzheimer disease identifies APP locus duplication in a Swedish patient.

BACKGROUND: Missense mutations in three different genes encoding amyloid-β precursor protein, presenilin 1 and presenilin 2 are recognized to cause familial early-onset Alzheimer disease. Also duplications of the amyloid precursor protein gene have been shown to cause the disease. At the Dept. of Geriatric Medicine, Karolinska University Hospital, Sweden, patients are referred for mutation screening for the identification of nucleotide variations and for determining copy-number of the APP locus. METHODS: We combined the method of microsatellite marker genotyping with a quantitative real-time PCR analysis to detect duplications in patients with Alzheimer disease. RESULTS: In 22 DNA samples from individuals diagnosed with clinical Alzheimer disease, we identified one patient carrying a duplication on chromosome 21 which included the APP locus. Further mapping of the chromosomal region by array-comparative genome hybridization showed that the duplication spanned a maximal region of 1.09 Mb. CONCLUSIONS: This is the first report of an APP duplication in a Swedish Alzheimer patient and describes the use of quantitative real-time PCR as a tool for determining copy-number of the APP locus.

Efavirenz in an obese HIV-infected patient - a report and an in vitro-in vivo extrapolation model indicate risk of underdosing.

Here, we report suboptimal efavirenz exposure in an obese patient treated with the standard 600 mg dose. Tripling the dose allowed attainment of therapeutic efavirenz concentrations. We developed an in vitro-in vivo extrapolation model to quantify dose requirements in obese individuals. Obesity represents a risk factor for antiretroviral therapy underdosing.

Evolution des transferts interhospitaliers au départ d'un centre hospitalier universitaire suisse [Trends in interhospital transfers from a Swiss university hospital center].

OBJECTIVE: Research on interhospital transfers provides a basis for describing and quantifying patient flow and its evolution over time, offering an insight into hospital organization and management and hospital overcrowding. The purpose of this study was to conduct a qualitative and quantitative analysis of patient flow and to examine trends over an eight-year period. METHODS: A retrospective descriptive study of interhospital transfers was conducted between 2003 and 2011 based on an analysis of demographic, medical and operational characteristics. Ambulance transfers and transfers requiring physician assistance were analyzed separately. RESULTS: The number of interhospital transfers increased significantly over the study period,from 4,026 in 2003 to 6,481 in 2011 (+60.9%). The number of ambulance transfers increased by almost 300% (616 in 2003 compared to 2,460 in 2011). Most of the transfers (98%) were to hospitals located less than 75 km from the university hospital (median: 24 km, 5-44). In 2011, 24% of all transfers were to psychiatric institutions. 26% of all transfer cases were direct transfers from the emergency department. An increasing number of transfers required physician assistance. 18% of these patients required ventilatory support, whole 9.8% required vasoactive drugs. 11.6% of these transfers were due to hospital overcrowding. Conclusion: The study shows that there has been a significant increase in interhospital transfers. This increase is related to hospital overcrowding and to the network-based systems governing patient care strategies.