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Cardiology initiatives from the West

By sa | Mar 23, 2018 |

The heart and stroke charity Croí, which is based in Gal­way, has recently expanded its multidisciplinary health team at the Heart and Stroke Cen­tre in the city. The charity, which was founded in 1985 and continues to support the development of cardiac and stroke services in the region, is leading the way in designing and test­ing lifestyle and behaviour change models of care focused on disease prevention and rehabilitation.

As an example of this, Croí is en­gaged in developing a model of community cardiac rehabilita­tion, which could supplement ex­isting programmes that are hospi­tal-based. This is a HSE Health and Wellbeing Division-funded initia­tive to address the identified need for increased and standardised provision of cardiac rehabilitation, which is a priority of the Health and Wellbeing Division, for imple­mentation under the HSE’s Nation­al Framework for Self-Management Support for Chronic Conditions. This project aims to examine the feasibility of providing community-based cardiac rehabilitation and de­termining the effectiveness and scal­ability of such a programme in an Irish setting. The initiative, which is based on the Croí MyAction Pro­gramme, meets the British Asso­ciation of Cardiac and Pulmonary Rehabilitation (BACPR) standards and core competencies.

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Mr Neil Johnson, CEO, Croi

A needs assessment of cardiac re­habilitation (phase 3) in Ireland, car­ried out in 2016, found that only 39 per cent of the need for cardiac re­habilitation is met by current capac­ity nationally, at the narrowest defi­nition of need (ie, patients admitted to hospital with acute coronary syn­drome; post-revascularisation; or heart failure). The gap in provision is variable around the country and similar in the Saolta Hospital Group to the national picture. When you broaden the criteria for referral to in­clude patients with a wider range of conditions for which cardiac rehab is recommended, the deficit is even greater. Expansion of current capac­ity by a minimum of 61 per cent is re­quired nationally.

Ideally, the development of a community-based cardiac rehabil­itation programme should contrib­ute to increased access and availa­bility of cardiac rehab for the pop­ulation and support current hospi­tal provision, which is delivered by excellent cardiac rehab co-ordina­tors and staff who have been oper­ating against a backdrop of signifi­cant cutbacks in recent years.

Leadership in prevention and recovery

In 2014, Croí launched the Na­tional Institute for Preventive Car­diology (NIPC), affiliated to the College of Medicine, Nursing and Health Sciences at NUI Galway. The aims of the Institute are to pro­vide leadership through discovery, training and applied programmes in the prevention and control of cardiovascular disease; promote healthier living; raise the standards of preventive cardiology practice; and prepare leaders to advance pre­ventive healthcare in Ireland. Cur­rently, over 1,200 healthcare pro­fessionals, educators and research­ers have joined the NIPC Alliance, which provides regular updates on latest research, highlights hot top­ics, and profiles upcoming training and education opportunities. Mem­bership of the NIPC Alliance is free — see www.nipc.ie for further de­tails and to sign-up for the month­ly e-bulletin.

NIPC education and training op­portunities include an MSc Degree and Postgraduate Diploma in Pre­ventive Cardiology at NUI Galway, associated with the founding pro­gramme at Imperial College Lon­don. Applications are now open for the fifth year of this programme, which commences in September 2018. This level 9 course, which uses blended learning, is available as a one-year, full-time, in-service programme leading to an MSc, or a nine-month, full-time, in-service programme leading to a PG Diplo­ma. Further details are available at www.nuigalway.ie/medicine.

Other upcoming NIPC education and training opportunities include a ‘Cholesterol Masterclass’, which takes place in the Herbert Park Ho­tel, Dublin, on Friday, 27 April. Key sessions include: Updates on ‘Li­pid Guidelines for Optimal Man­agement’ by Dr Patricia O’Connor, Consultant Physician and Clinical Pharmacologist, St James’s Hospi­tal, Dublin; ‘Management of Lipids in Special Populations’ by Dr Der­mot Neely, Consultant in Clinical Bi­ochemistry and Metabolic Medicine, Newcastle upon Tyne NHS Trust; ‘Statin Intolerance — the Contro­versies’ by Dr Susan Connolly, Con­sultant Cardiologist, Western Health and Social Care Trust, Northern Ire­land; ‘Familial Hypercholesterolae­mia in Ireland’ by Dr Vivion Crow­ley, Consultant Chemical Pathol­ogist, St James’s Hospital, Dub­lin; and ‘Challenges to Adherence’ with Dr Joe Gallagher, GP, Wex­ford. Register for free at www.nipc. ie/conferences.html.

Another upcoming NIPC course which may be of interest to GPs, hospital doctors, nurses and other healthcare professionals is a one-day workshop, ‘Demystifying the ECG’, which takes place in the Croí Heart and Stroke Centre, Galway, on Saturday, 24 March. This excel­lent training course is delivered by Dr Paul Nolan, BSc ASCST, Chief Cardiac Physiologist at Galway University Hospital. Registration is now open at www.nipc.ie.

Asthma and fertility in women

By sa | Mar 14, 2018 |

Women with asthma who only use short-acting asthma relievers take longer to become pregnant than other women, according to a new study published in the European Respiratory Journal.

However, the study of more than 5,600 women in Ireland, Australia, New Zealand and the UK also shows that women with asthma who use long-acting asthma preventers conceive as quickly as other women.

While maternal asthma has been consistently associated with significant perinatal morbidities and mortality, impacts on fertility are conflicting, according to the study authors. In light of limited and conflicting evidence, the aim of the study (‘Asthma treatment impacts time to pregnancy: Evidence from the international SCOPE study’) was to examine the impact of asthma and asthma medication use on fecundability and time to pregnancy.

The researchers examined data from the international Screening for Pregnancy Endpoints (SCOPE) study, which recruited more than 5,600 women expecting their first babies in the early stages of pregnancy.

Ten per cent of women in the study said they had asthma and, overall, these women took longer to get pregnant.

When researchers separated this group according to the types of asthma treatments they were using, they found no difference in fertility between women using long-acting asthma treatments and women without asthma.

Women using short-acting reliever medication (beta-agonists) took 20 per cent longer to conceive on average. They were also 30 per cent more likely to have taken more than a year to conceive, which the researchers defined as the threshold for infertility.

This difference remained even after researchers took other factors known to influence fertility, such as age and weight, into account.

The study was led by Dr Luke Grzeskowiak from the University of Adelaide’s Robinson Research Institute, who said that the results provide reassurance for asthmatic women that using inhaled corticosteroids to prevent symptoms does not appear to reduce fertility.

“Five-to-10 per cent of all women around the world have asthma and it is one of the most common chronic medical conditions in women of reproductive age. Several studies have identified a link between asthma and female infertility, but the impact of asthma treatments on fertility has been unclear,” Dr Grzeskowiak said.

“Studying the effect of asthma treatments in women who are pregnant or trying to get pregnant is important, as women often express concerns about exposing their unborn babies to [the] potentially harmful effects of medications.”

While the study showed that women using short-acting asthma relievers take longer to get pregnant, “on the other hand, continued use of long-acting asthma preventers to control asthma seems to protect fertility and reduce the time it takes women with asthma to become pregnant. This could lead to a reduction in the need for fertility treatments”.

“There is plenty of evidence that maternal asthma has a negative impact on the health of pregnant mothers and their babies, and so our general advice is that women should take steps to get their asthma under control before trying to conceive,” he said.

“What we don’t yet know is exactly how asthma or asthma treatments lead to fertility problems. As well as affecting the lungs, asthma could cause inflammation elsewhere in the body, including the uterus. It could also affect the health of eggs in the ovaries.

“Inhaled corticosteroids suppress the immune system, whereas short-acting asthma treatments do not alter immune function. In women who are only using relievers, it’s possible that, while their asthma symptoms may improve, inflammation may still be present in the lungs and other organs in the body.”

The researchers plan further studies involving women with asthma who are undergoing fertility treatments, to see whether improving asthma control could also improve fertility outcomes.

Meanwhile, a separate study presented at the 2017 European Respiratory Society International Congress in Milan found that women with asthma are more likely to have fertility treatment before giving birth than non-asthmatic women.

Among 744 pregnant asthmatic women enrolled in the ‘Management of Asthma During Pregnancy’ programme at the Hvidovre Hospital, Hvidovre, Denmark, and who gave birth between 2007 and 2013, 12 per cent had received fertility treatment compared to 7 per cent of the 2,136 non-asthmatic women in the control group.

Although the study does not prove that asthma played a role in reducing fertility in some women, the researchers said it suggests that improving women’s asthma control might help them to become pregnant more easily.

Prof Charlotte Suppli Ulrik, from the Department of Respiratory Medicine at Hvidovre Hospital, who supervised the study, said: “We don’t have the hard-core evidence but based on what we know, it seems very likely that good asthma control will improve fertility in women with asthma by reducing the time it takes to become pregnant and, therefore, the need for fertility treatment.

“However, when it comes to fertility for women, age is a crucial factor — so the message, particularly for women with asthma, is don’t wait too long, as it might reduce your chances of having children.”

Prof Suppli Ulrik and colleagues are setting up studies to investigate further the association between asthma and fertility, including a study addressing the impact of good asthma control on fertility. “Further studies are needed to confirm our findings,” she said.

Unravelling the genetics of rheumatoid arthritis

By sa | Jan 24, 2018 |

Dr Una Lannin and Dr Sinead Harney examine the role genetics play in rheumatoid arthritis disease susceptibility and progression

Tackling venous thromboembolism

By sa | Dec 6, 2017 |

Paul Mulholland reports on the diagnostic and therapeutic advances in venous thromboembolism (VTE) highlighted at the VTE Dublin 2017 meeting

Irish blood cancer research making a real impact

By sa | Dec 6, 2017 |

The Medical Independent speaks to Prof Michael O’Dwyer about exciting new Irish blood cancer research data to be presented at the upcoming 2017 American Society of Haematology (ASH) Annual Meeting

Increasing evidence that vitamin D has anti-cancer properties

By sa | Nov 15, 2017 |

Prof Joe Duffy highlights the evidence to date on the role vitamin D has in cancer prevention and treatment and ongoing Irish research in the area

Irish study reveals under-detection and treatment of anaemia in CKD patients

By sa | Nov 15, 2017 |

Recent research on management of anaemia and iron deficiency at specialist nephrology clinics in Ireland identified much room for improvement. Lead author Prof Austin Stack discussed the findings with Catherine Reilly

Targeted therapy for lung cancer

By sa | Nov 15, 2017 |

Dr Susan Heavey outlines recent positive advances in the treatment and research of lung cancer, which is the most common cause of cancer-related death in Ireland

Lighting a candle in the darkness

By sa | Nov 2, 2017 |

A three-day international ophthalmology gathering, RETINA 2017, took place in Dublin recently and featured a unique mix of medical, scientific and patient research presentations. Priscilla Lynch reports

Metastatic breast cancer

By sa | Oct 4, 2017 |

Dr Scheryll Alken and Prof John Kennedy review the evolving landscape of metastatic breast cancer treatment and the latest research

Assessing the evidence on cryotherapy

By sa | Sep 21, 2017 |

Dr Adam Grainger examines the evidence to date on the use of whole body and partial body cryotherapy in medicine

Type 1 diabetes and kidney disease

By sa | Sep 1, 2017 |

Dr Ross Doyle and Prof Catherine Godson give a thorough overview of the relationship between type 1 diabetes and nephropathy and how Irish research is seeking to address the issue

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