An Analysis of Antenatal Care Pathways to Mode of Birth in Ireland

This paper explores the role of antenatal care in determining mode of birth in the Irish healthcare system using data from the Growing Up in Ireland study. Results indicate that midwifery-led antenatal care is independently associated with significantly higher rates of normal delivery and significantly lower rates of elective caesarean section relative to consultant-led care in both the public and private sectors. Given concerns over increasing rates of caesarean section, our results are consistent with calls nationally and internationally for further investment in midwifery-led antenatal care services, and for stricter regulation of the actors, both providers and patients, engaged in the private antenatal care pathway

Global Journalist: Benazir Bhutto’s assassination and sympathy votes for her political party

On Jan. 10, 2008, Stuart Loory and his guests reflect on the ramifications of the assassination of former Pakistani Prime Minister Benazir Bhutto. She was campaigning when her life was taken and now, her 19-year-old son and her widower are named to lead Bhutto’s party. Are they qualified? And how can this affect US-Pakistan relations and joint war against terrorism

What is the Effect of Frequent Basic Life Support Refresher Sessions on Health Care Professionals’ Retention of Cardiopulmonary Resuscitation Skills? A Systematic Review

Abbreviations: AED, Automated External Defibrillator; AHA, American Heart Association; BLS, Basic Life Support; CPR, Cardiopulmonary Resuscitation; EBL, Evidence Based Librarianship; IDG, Instructor Directed Group; NHMRC, National Health and Medical Research Council; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta- Analyses; RCT, Randomised Control Trial; RFST, Repetitive Sessions of Formative Self Testing; RFSTAP, Repetitive Sessions of Formative Self Testing with Additional Practice ROSC, Return of Spontaneous Circulation; SDG, Student Directed Group. Abstract Background: Cardiopulmonary resuscitation training is currently provided to health care professionals at biannual intervals to meet mandatory recertification in accordance with guidelines.  However, literature reports that resuscitation skills decline rapidly and sometimes long before recertification. Inadequate CPR may result in a decrease in the incidence of achieving return of spontaneous circulation and other devastating outcomes. Good quality training and education in cardiopulmonary resuscitation is paramount to patient survival. Brief refresher sessions may prevent skill decay among health care professionals, improving skill retention over time and improving patient outcomes. Objective: The aim of this systematic review is to determine the effect of frequent basic life support refresher sessions on health care professionals’ retention of cardiopulmonary resuscitation skills. Methods: A systematic review using narrative analysis was completed.  A database search was conducted to identify relevant studies for inclusion.  Databases searched include Medline, Embase, CINAHL and The Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to guide the review. Results: Ten of the 11 studies in this paper concluded that basic life support refresher sessions may increase retention of cardiopulmonary resuscitation skills.  Two of the included studies discussed self-perceived confidence as a secondary outcome.  One of these two studies demonstrated a significant correlation between higher self-confidence and improved retention of cardiopulmonary resuscitation skills. Conclusion: Basic life support refresher sessions can have a positive impact on cardiopulmonary resuscitation skill retention among health care professionals.  However, the most effective method of delivering refresher sessions must be further clarified.  The optimal duration of these sessions as well as the optimal timing of delivering these sessions also requires further clarification through further research

Virtue and Video Games: False Pleasure in the Digital Age

This thesis examines video games as objects of pleasure and assesses the negative claim that certain video games can detract from the good life. It argues against the claim that all video games are 'wastes of time' or that they provide a kind of false pleasure, while recognising the heterogeneous nature of modern video games. To do so, this work focuses on the pleasure derived from these objects. It questions the nature of pleasure itself arguing that while some pleasures are essential for the good life, other pleasures can be detrimental to its pursuit. It argues that certain pleasures that detract from the good life can be considered false pleasures. Drawing on an analysis of the writings of Plato and Aristotle, this work proposes an original taxonomy of false pleasure. The taxonomy proposes four broad categories of false pleasure, they are: false pleasure of belief, false pleasure of experience, false pleasure of negative consequence, and false immoral pleasures. These categories are applied to video games to discover whether certain video games provide false pleasure. It is argued that while some video games in certain circumstances can be considered false pleasures, it does not hold that all video games are false pleasures. This thesis also questions the broader role mass media and technology has on the experience of pleasure in the modern world. It draws upon the writings of the Frankfurt School theorist who provided arguments critical of modern mass culture. I argue that these theorists considered mass media to systematically mislead individuals into making mistakes regarding pleasure and that these mistakes serve a political and social function. It is argued that the Frankfurt School critiques provide useful examples of the political and social function of false pleasure. However, it is shown that the some of their concerns are not new, rather they echo the concerns of Plato and Aristotle and can be accommodated within the proposed taxonomy of false pleasure. This work concludes that the notion of false pleasure is important when considering what makes the good life. However, the argument that all video games are false pleasures does not stand up to philosophical rigour. Moreover, it is shown that some video games, rather than being impediments to the good life, have a beneficial role to play in its pursuit

Cancer Pain Management at a Specialist Palliative Care Inpatient Unit: An Audit

Cancer pain is prevalent and burdensome in a palliative care setting and managed pharmacological and through non-pharmacological means. There is variance in how effectively cancer pain is managed, and to address this the ‘Pharmacological Management of Cancer Pain in Adults’ was published by the Department of Health in November 2015. To assess adherence to the standards defined by the ‘Pharmacological management of Cancer Pain in Adults’. Our study audited the implementation of these guidelines regarding recording pain, administering analgesics, dealing with side effects and opioid toxicity. Three researchers reviewed the charts of 100 consecutive cancer admissions between 01/09/17 and 31/12/17 in a Dublin hospice. This Information was used to assess adherence to 15 audit standards. Of the 15 audit standards examined, 9 met this goal of 100% compliance. 3 of the remaining 6 standards had a compliance equal or greater than 90%. There is a high degree of compliance in the assessment and management of cancer pain. Where compliance is not 100% clinical practice should be reviewed or feedback given on the audit tool. Future research should focus on completing the audit cycle, and further audit in a community or acute hospital setting

Development of core outcome sets for studies relating to awareness and clinical management of reduced fetal movement

Objective: This study aimed to create core outcome sets (COSs) for use in research studies relating to the awareness and clinical management of reduced fetal movement (RFM). Design: Delphi survey and consensus process. Setting: International. Population: A total of 128 participants (40 parents, 19 researchers and 65 clinicians) from 16 countries. Methods: A systematic literature review was conducted to identify outcomes in studies of interventions relating to the awareness and the clinical management of RFM. Using these outcomes as a preliminary list, stakeholders rated the importance of these outcomes for inclusion in COSs for studies of: (i) awareness of RFM; and (ii) clinical management of RFM. Main outcome measures: Preliminary lists of outcomes were discussed at consensus meetings where two COSs (one for studies of RFM awareness and one for studies of clinical management of RFM). Results: The first round of the Delphi survey was completed by 128 participants, 66% of whom (n = 84) completed all three rounds. Fifty outcomes identified by the systematic review, after multiple definitions were combined, were voted on in round one. Two outcomes were added in round one, and as such 52 outcomes were voted on in two lists in rounds two and three. The COSs for studies of RFM awareness and clinical management are comprised of eight outcomes (four maternal and four neonatal) and 10 outcomes (two maternal and eight neonatal), respectively. Conclusions: These COSs provide researchers with the minimum set of outcomes to be measured and reported in studies relating to the awareness and the clinical management of RFM.</p

Early Satiety in Cancer: A Clinical Review of Definition and Therapeutic Management

Early satiety is defined as the desire to eat with the inability to eat appropriate amounts due to premature fullness. Although a common symptom of cancer, it is rarely recognised in medical practice and poorly elucidated in the literature.&nbsp; This review highlights the importance of early satiety in cancer, and outlines appropriate treatment. A literature search was conducted using EMBASE, CINAHL and SCOPUS. The search was limited to articles available in English and peer-reviewed journals. Articles were screened in four stages by two independent reviewers and the Preferred Reporting Items for Systematic Reviews (PRISMA) was used. 486 articles were identified, of which, five full-text articles were included in the study. The literature outlined that targeting central and peripheral mechanisms are key to symptom management. Peripherally-acting prokinetics such as metoclopramide are considered first line therapy. Agents that target gastric accommodation such as clonidine, sumatriptan and sildenafil may also be useful. Centrally acting pharmacological agents associated with digestion may be effective. Centrally acting agents include: progesterone receptor agonists, cannabinoids and ghrelin agonists. Overall, early satiety is an under-recognised, but important symptom in cancer. Due to the limited studies available, the efficacy of treatments are not well established.&nbsp; High quality studies outlining appropriate therapeutic management are necessary to establish standardised treatment protocols