Irish Endocrine Society 43 rd Annual Meeting

44th Sir Peter Freyer Memorial Lecture & Surgical Symposium 2019

Patients referred for arteriovenous fistula construction: a retrospective outcome analysis Abstract Objectives With lower rates of sepsis and re-interventions, arteriovenous fistula (AVF) is the preferred vascular access modality. The aim of this study is to evaluate the outcomes of patients referred for AVF construction at a single center in Cork, Ireland. Methods The current study is a single-center retrospective review of all patients who underwent AVF creation between 2015 and 2017. Additionally, the kidney disease clinical patient management system was used to provide statistics on AVF use in Ireland. Results 39.3% of hemodialysis patients in Ireland use an AVF for vascular access. Regional use ranged from 50 to 20% across Irish hemodialysis centers. At Cork University Hospital, 192 AVFs were created. The population was 69.3% male (n = 133), 30.7% female (n = 59) with a mean (±SEM) age of 58.8 ± 1.03 years. 69.5% of females received a brachiocephalic AVF (BCAVF) while 13.6% had a radiocephalic AVF (RCAVF) constructed. Significance was seen when comparing gender and AVF type (p < 0.001). Fifty-four percent of the fistulae were brachiocephalic (n = 103), 33% were radiocephalic (n = 63), and 4% were brachiobasilic (n = 8). BCAVF patients (62.7 ± 1.2 years) were significantly older than patients receiving a RCAVF (54.5 ± 1.9 years, p < 0.001). A post-operative thrill or continuous flow on Doppler was present in 99% of patients (n = 190) with maturation and complication rates of 82.7% (n = 153) and 5.7% (n = 11) respectively. 69.9% of AVFs were needled for hemodialysis (n = 114). Conclusions AVF outcomes at this center are consistent with reported statistics in the literature. Patient age, sex, and diabetic status may influence the use of proximal AVF. AVF creation rates in Ireland are below international reported recommendations.

Professional burnout, work patterns and career satisfaction in medical oncologists in Ireland Abstract Background Burnout is an occupational syndrome frequently encountered within the healthcare profession. It is characterised by emotional exhaustion (EE), depersonalisation (DP) and a low sense of personal accomplishment (PA). Its negative impact extends to the physician, patient and overall service provision. Aims The aim of this study was to evaluate work patterns, the prevalence of burnout and its associations in medical oncology consultants and specialist registrars (SpRs) in Ireland. Methods Participants were invited to partake in an anonymised online survey. Burnout domains were measured using the validated Maslach Burnout Inventory. Associations between variables were evaluated using the Mann-Whitney U and Kruskal-Wallis tests (continuous), and chi-square and Fisher’s exact testing (categorical). Results Seventy-four physicians were contacted to participate, 44 (59%) completed the survey. The majority (71%) work ≥ 50 h a week, with 57% having additional on-call commitments of ≥ 5 days/month. Burnout is defined by a high score in EE combined with a high DP and/or low PA was identified in 45% of consultants and 20% of SpRs. Longer working hours (≥ 60 h/ week) were found to be associated with both high EE (p = 0.049) and DP (p = 0.019). Higher EE scores were demonstrated in those ≥ 40 years (p = 0.04). The majority (86%) reported they would become an oncologist again. Conclusion One or more of the symptoms of burnout is highly prevalent in medical oncologists in Ireland. With increasing pressure on resources, burnout is expected to increase. Attention to strategies for prevention needs to be prioritised within our healthcare system.

Association between vitamin D status in early pregnancy and atopy in offspring in a vitamin D deplete cohort Abstract Background Vitamin D status may play a role in the development of atopic diseases due to its action on lung development and immune system development and function. Aims Our objective was to assess whether 25-hydroxyvitamin D (25OHD) levels in maternal blood in pregnancy were associated with atopy in children. Methods We analysed 279 mother-child pairs from the ROLO study conducted in Dublin, Ireland. Serum 25OHD was measured at 13 and 28 weeks of pregnancy. Development of childhood atopy was self-reported by mothers at follow-up appointments at 6 months, 2 years or 5 years. Logistic regression analysis was used to evaluate associations between maternal 25OHD status and development of atopy. Results The mean (SD) 25OHD levels in early and late pregnancy were 41.9 (19.2) nmol/L and 40.2 (21.6) nmol/L, respectively. Maternal 25OHD status in early pregnancy, but not in late pregnancy, was associated with a reduced risk of atopy at 2 years (OR 0.972, CI 0.946–0.999). In early pregnancy, those with serum 25OHD levels < 30 nmol/L compared with those with 25OHD > 50 nmol/L had significantly greater risk of developing atopy at 2 years (OR 4.76, CI 1.38–16.47). Conclusions The development of childhood atopy may be associated with maternal vitamin D deficiency in early pregnancy among a cohort of women at risk of vitamin D deficiency. Further research is required to explore the relationship between vitamin D and atopy, particularly among women with poor vitamin D status, and whether supplementation should be prioritised in early pregnancy to reduce childhood atopy.

“A breath of fresh air” for tackling chronic disease in Ireland? An evaluation of a self-management support service for people with chronic respiratory diseases Abstract Objective To describe the impact of a nurse-led telephone self-management support (SMS) service for people with asthma and COPD in Ireland. Methods A cross-sectional survey of all (442) SMS users, July 2016 to May 2017, described user demographics, self-reported experience, process and outcome. Population utilisation was estimated and compared across groups. Factors associated with key outcomes were identified. Results The response rate was 162 (36.7%). Utilisation varied across population groups. Reported satisfaction was high, and 56.0% of users without a written action plan reported developing one. Most users reported positive cognitive and affective outcomes indicating effective patient activation. Information pack receipt was independently associated with better outcomes (odds ratio = 11.4 (95% CI, 2.0, 216.6), p < 0.05). Conclusion A nurse-led telephone SMS intervention positively impacted self-management for people with asthma and COPD in Ireland. Practice implications Roll-out of SMS should include staff training to promote positive service user experience and should include routine monitoring and evaluation to assure equitable reach and quality of key evidence-based care processes.

Clinical outcomes of patients with pure small cell carcinoma of the urinary bladder Abstract Objectives There is not yet a standardized approach to treat patients with small cell carcinoma of the bladder (SmCCB). This study aims to investigate the clinical features, treatment, and survival outcomes of patients with pure SmCCB. Materials and methods Patients diagnosed with SmCCB between January 2006 and September 2015 were retrospectively evaluated. Results A total of 34 patients with a median age of 63.0 years were included in the study, with a male to female ratio of 4.6:1.0. At the time of diagnosis, 22 patients (64.7%) had stage IV disease. At a median follow-up time of 12.7 months, 67.6% of patients died of bladder carcinoma, with an overall survival (OS) of 15.7 months for all patients. In the patients with stages I–III, nodal involvement, and distant metastases, the median OS was 31.8, 15.7, and 8.4 months, respectively (P = 0.005). Considering the survival rates of the patients (stages I–III) treated with surgery vs. local therapy, there was not a statistically significant difference (26.6 months and 31.8 months, P = 0.97, respectively). A multivariate analysis revealed that stage IV disease and poor ECOG performance status were associated with OS. Conclusion The optimal treatment of SmCCB has been under debate. For the patients with advanced stage of disease (T4b, N+, M+), platinum containing chemotherapeutic agents should be preferred. Stage IV disease and poor ECOG performance status were associated with shorter OS.

Serum lipase as a biomarker for early prediction and diagnosis of post-endoscopic retrograde cholangiopancreatography pancreatitis Abstract Background Lipase is one of the diagnostic criteria for acute pancreatitis; however, the value of serum lipase in the early prediction and diagnosis for post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis remains controversial. Aims We evaluate the 3-h post-ERCP serum amylase and lipase activities for early prediction of postoperative pancreatitis (PEP) and compare the 24-h post-ERCP serum amylase and lipase activities in the diagnosis of PEP. Methods Clinical information of patients who underwent ERCP from January 2017 to December 2018 at our hospital were retrospectively reviewed. Receiver operating characteristic (ROC) curves were performed for 3-h and 24-h post-ERCP serum amylase and lipase activities to evaluate predictive and diagnostic values, respectively. Results A total of 498 cases with ERCP were finally enrolled, in which 36 cases of PEP were confirmed. ROC curves for 3-h post-ERCP amylase and lipase activities depicted areas under the curve (AUCs) of 0.88 (P < 0.001, 95% confidence intervals [CI] 0.82–0.93) and 0.90 (P < 0.001, 95% CI 0.86–0.93), respectively. The difference showed no significance using Z test (Z = 0.69, P > 0.05). AUCs for 24-h amylase and lipase activities were 0.83 (P < 0.001, 95% CI 0.77–0.89) and 0.94 (P < 0.001, 95% CI 0.90–0.99), respectively, and the difference was significant (Z = 3.04, P < 0.05). Conclusions For early prediction of PEP, 3-h post-ERCP serum lipase activity is at least as good as that of amylase. For diagnosis of PEP, 24-h post-ERCP serum lipase is a much better indicator than that of amylase. Together, this study suggests that serum lipase should be given priority in the early prediction and diagnosis of PEP.

Participation of the hospitals in the Republic of Ireland in international research over more than a decade: a bibliometric analysis Abstract Background This study provides an accurate awareness of the present situation of health research in Irish hospitals both public and private. We aimed to analyze factors that may influence it and provide recommendations for active steps to improve the current situation of Irish health research based on our findings. Methods We performed a bibliometric analysis to assess qualitatively and quantitatively the publications from Ireland over a period between 2007 and 2018. We also investigated the associated variables with the quality of research. Furthermore, we conducted a Joinpoint analysis to see the trends in Irish research over these years. Results From 12,828 included peer-reviewed articles, the average citation count per article was 19.98. Furthermore, we showed that a higher impact factor (IF) and institutions number, present per article, were significantly associated with more citations. Also, the publication count and the mean IF showed an increase over the years according to the Joinpoint analysis. Moreover, the oncology research had the highest output, followed by pediatrics, then neurology while the specialties with least publications were ear, nose, and throat (ENT), urology, plastic surgery, and dentistry. Additionally, cardiovascular, obstetrics and gynecology, oncology, pediatrics, pulmonology, dermatology, ophthalmology, dentistry, and radiology research showed an increased publication count trend in recent years. While anesthesiology, ENT, general surgery, gastroenterology and hepatology, infection and tropical medicine, nephrology, neurology, orthopedics, plastic surgery, and urology showed a decrease in the publications trend. Conclusions Our findings may serve as a useful approach to benchmark scientific output from hospitals and guide the future allocation of research spending.

Dorsal root ganglion pulsed radiofrequency treatment for chronic cervical radicular pain: a retrospective review of outcomes in fifty-nine cases Abstract Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is used to treat persistent cervical radicular pain that has not responded to conservative therapies. This technique has gained popularity in years for both cervical and lumbosacral radicular pain. The evidence to support its use is still evolving. Methods We performed a retrospective review of outcomes in 59 patients who underwent this therapy over a 3-year period in our institution. We evaluated a reduction in pain, duration of pain relief, reduction in use of analgesics and progression to surgery. Results Our results demonstrated 49 patients experienced some relief. Forty patients of the 59 experienced an improvement in pain of 50% or more. The mean duration of relief in this group was 37 weeks. Seven patients experienced complete resolution of their pain. In this group, the mean duration of relief was 39 weeks. Regarding the 53 patients who were taking medication for pain prior to the procedure, 37 patients reduced or discontinued their usage after the procedure. Conclusion Despite the limitations of a retrospective study, we feel our study adds to the growing evidence base that pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion has a role in the treatment of chronic cervical radicular pain.