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Introduction: The Achieve, Develop, Explore Programme for Trainees (ADEPT) Clinical Leadership Fellowship Programme was established in response to growing recommendations to underpin healthcare reconfiguration in Northern Ireland with a collective leadership strategy. The fellowship combines a leadership development programme with a project carried out within a host organisation. With the fellowship now in its sixth year, a need was identified to assess its impact on the fellows' leadership skills, career choices, achievements, and views on both the fellowship and how to develop future leaders., Methods: Demographic data for all ADEPT fellows was held centrally through Northern Ireland Medical and Dental Training Agency (NIMDTA) and assessed anonymously. A mixed-methods questionnaire was composed using Smart Survey. Likert scale questions were designed to determine the extent to which participants believed ADEPT supported their development of strong and exemplary elements of the nine dimensions of the NHS Healthcare Leadership Model. The questionnaire was distributed electronically to all ADEPT alumni in November 2021 and remained open for 4 weeks., Results: There have been 46 ADEPT fellows to date (72% female; all fellows were white). ADEPT fellows were most commonly from Psychiatry (33%), Paediatrics (17%) and Obstetrics and Gynaecology (15%). There were 19 responses from the alumni cohort of 46 (41%). 75% of respondents reported that their project resulted in publication, presentation or award. Leadership skill development was identified as best in "Evaluating Information" and "Engaging the Team", whereas skills in "Sharing the Vision" and "Developing Capability" saw less improvement. The majority felt that the fellowship had been useful in securing their position as a consultant or general practitioner and 50% went on to pursue senior leadership positions., Conclusion: The ADEPT Clinical Leadership Fellowship delivers effective leadership training as measured by the nine domains of the NHS Healthcare Leadership Model. It provides value for host organisations through the projects undertaken and by developing doctors who are more likely to engage in future formal leadership roles. ADEPT alumni saw the value in their leadership experience and felt it should be embedded in standard postgraduate training schemes to reach a wider audience., (Copyright © 2023 Ulster Medical Society.)

Abstract: After ileostomy surgery, patients require nutrition and hydration modifications to maintain electrolyte balances and prevent postoperative complications. In addition to becoming dehydrated, patients who have ileostomies can develop obstructions if care isn't taken to avoid certain kinds of foods. Moreover, changes to medications may be needed to manage ileostomy output or account for altered absorption. This article provides information on postoperative hydration, medication, and nutritional management to nurses caring for patients after ileostomy surgery., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The objective of this study was to evaluate our experience using cyclosporine A (CyA) in the treatment of Hunner lesion interstitial cystitis (HLIC)., Methods: Retrospective chart review was performed on patients with HLIC treated with CyA from August 2012 to September 2019. Demographic and clinical variables, number of interstitial cystitis therapies, frequency, nocturia, and bladder pain visual analog scores before and after CyA treatment were collected, as well as the Global Response Assessment (GRA) and the Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index. CyA responders were defined as those with moderately or markedly improved GRA scores., Results: A total of 51 patients with HLIC treated with CyA were identified. Mean follow-up was 3 years (0.36-6.8 years). Seventy-six percent (28 of 37) were female; mean age was 68 years (51-84 years). Before CyA treatment, an average of 8 previous therapies were tried and patients reported an average of 8 of 10 bladder pain. Daytime frequency was 11-20 times per day, and nocturia was 7 times per night. Per the GRA, 84% (31 of 37) were considered CyA responders. Posttherapy Interstitial Cystitis Symptom Index and Interstitial Cystitis Problem Index scores were lower in responders compared with nonresponders (8.9 ± 5.7 vs 21.3 ± 7.0, P = 0.001). Bladder pain, number of hydrodistentions/fulgurations, nocturia, and daytime frequency improved significantly after CyA treatment., Conclusions: The cyclosporine A response rate was 84%, with most of these patients reporting marked improvement. Bladder pain, daytime frequency, and nocturia were significantly improved after CyA treatment, and the number of interventions after CyA treatment decreased. Cyclosporine A should be considered earlier than fifth-line therapy in HLIC., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 American Urogynecologic Society. All rights reserved.)

Background: Mycobacterium wolinskyi is a rare, fast-growing, painful bacterium causing soft tissue infections. Sparse case reports focus on long-term intravenous antibiotic therapy and surgical interventions. We searched the literature and found almost no discussion about treatment from a nursing and wound care perspective., Case: Ms P, a 30-year-old Arabic female patient, underwent cosmetic surgery in Iraq including liposuction, abdominoplasty, and herniorrhaphy. One month postoperatively, she presented with an infection identified as M. wolinskyi resulting in multiple hospital admissions. Ms P received treatment with long-term antibiotic therapy and underwent multiple surgical debridements with extensive wound care management., Conclusion: Mycobacterium wolinskyi is an exceedingly rare bacterium not typically seen in the clinical setting and requires prolonged and aggressive treatment. It is painful and fast-growing, as evidenced by multiple abscess formations and tissue necrosis in this case. Daily assessments and wound management using a collaborative approach were important to promote optimal healing., Competing Interests: There is no conflict of interest or source funding from any of the authors., (Copyright © 2021 by the Wound, Ostomy and Continence Nurses Society.)

Aims: In patients with pudendal neuralgia, prior studies have shown efficacy in chronic stimulation with Interstim® (Medtronic, Inc.). This feasibility study reports on the initial experience of using a wireless system to power an implanted lead at the pudendal nerve, StimWave®, to treat pudendal neuralgia., Methods: Retrospective chart review identified patients with a lead placed at the pudendal nerve for neuralgia and powered wirelessly. Clinical outcomes were assessed at Postoperative visits and phone calls. Administered non-validated follow-up questionnaire evaluated the Global Response Assessment, percentage of pain improvement, satisfaction with device, and initial and current settings of the device (h/day of stimulation)., Results: Thirteen patients had the StimWave® lead placed at the pudendal nerve, 12 (92%) female and 1 (7.6%) male. Mean age was 50 years (range: 20-58). Failed prior therapies include medical therapy (100%), pelvic floor physical therapy (92%), pudendal nerve blocks (85%), pelvic floor muscle trigger point injections (69%), neuromodulation (30.7%), or surgeries for urogenital pain (23.1%). After the trial period, 10/13 (76.9%) had >50% improvement in pain with 6/13 (46.1%) reporting 100% pain improvement. Nine underwent permanent lead placement. At last postoperative visit (range, 6-83 days), 5/9 patients reported >50% pain improvement. Seven patients reached for phone calls (22-759 days) reported symptoms to be "markedly improved" (n = 2), "moderately improved" (n = 4), or "slightly improved" (n = 1). At follow up, complications included lead migration (n = 2), broken wire (n = 1), or nonfunctioning antenna (n = 2)., Conclusion: Complex patients with pudendal neuralgia may benefit from pudendal nerve stimulation via StimWave®., (© 2021 Wiley Periodicals LLC.)

The double-stranded RNA mimetic poly(I:C) and lipopolysaccharide (LPS) activate Toll-like receptors 3 (TLR3) and TLR4, respectively, triggering the activation of TANK (TRAF family member-associated NF-κB activator)-binding kinase 1 (TBK1) complexes, the phosphorylation of interferon regulatory factor 3 (IRF3) and transcription of the interferon β (IFNβ) gene. Here, we demonstrate that the TANK-TBK1 and optineurin (OPTN)-TBK1 complexes control this pathway. The poly(I:C)- or LPS-stimulated phosphorylation of IRF3 at Ser396 and production of IFNβ were greatly reduced in bone marrow-derived macrophages (BMDMs) from TANK knockout (KO) mice crossed to knockin mice expressing the ubiquitin-binding-defective OPTN[D477N] mutant. In contrast, IRF3 phosphorylation and IFNβ production were not reduced significantly in BMDM from OPTN[D477N] knockin mice and only reduced partially in TANK KO BMDM. The TLR3/TLR4-dependent phosphorylation of IRF3 and IFNβ gene transcription were not decreased in macrophages from OPTN[D477N] crossed to mice deficient in IκB kinase ε, a TANK-binding kinase related to TBK1. In contrast with the OPTN-TBK1 complex, TBK1 associated with OPTN[D477N] did not undergo phosphorylation at Ser172 in response to poly(I:C) or LPS, indicating that the interaction of ubiquitin chains with OPTN is required to activate OPTN-TBK1 in BMDM. The phosphorylation of IRF3 and IFNβ production induced by Sendai virus infection were unimpaired in BMDM from TANK KO × OPTN[D477N] mice, suggesting that other/additional TBK1 complexes control the RIG-I-like receptor-dependent production of IFNβ. Finally, we present evidence that, in human HACAT cells, the poly(I:C)-dependent phosphorylation of TBK1 at Ser172 involves a novel TBK1-activating kinase(s)., (© 2017 The Author(s).)

Objective: To evaluate the efficacy and safety of aripiprazole versus placebo in preventing relapse of irritability symptoms associated with autistic disorder in pediatric patients., Method: This multicenter, double-blind, randomized, placebo-controlled, relapse-prevention trial enrolled patients (6-17 years) who met the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DMS-IV-TR) criteria for autistic disorder and who also had serious behavioral problems (ie, tantrums, aggression, self-injurious behavior, or a combination of these behavioral problems) between March 2011 and June 2012. In phase 1, single-blind aripiprazole was flexibly dosed (2-15 mg/d) for 13-26 weeks. Patients with a stable response (≥ 25% decrease in Aberrant Behavior Checklist-irritability subscale score and a rating of "much improved" or "very much improved" on the Clinical Global Impressions-Improvement scale) for 12 consecutive weeks were randomized into phase 2 to continue aripiprazole or switch to placebo. Treatment was continued until relapse or up to 16 weeks. The primary end point was time from randomization to relapse., Results: Eighty-five patients were randomized in phase 2. The difference in time to relapse between aripiprazole and placebo was not statistically significant (P = .097). Kaplan-Meier relapse rates at week 16 were 35% for aripiprazole and 52% for placebo (hazard ratio [HR] = 0.57; number needed to treat [NNT] = 6). The most common adverse events during phase 1 were weight increase (25.2%), somnolence (14.8%), and vomiting (14.2%); and, during phase 2 (aripiprazole vs placebo), they were upper respiratory tract infection (10.3% vs 2.3%), constipation (5.1% vs 0%), and movement disorder (5.1% vs 0%)., Conclusions: In this study, there was no statistically significant difference between aripiprazole and placebo in time to relapse during maintenance therapy. However, the HR and NNT suggest some patients will benefit from maintenance treatment. Patients receiving aripiprazole should be periodically reassessed to determine the continued need for treatment., Trial Registration: ClinicalTrials.gov identifier: NCT01227668., (© Copyright 2014 Physicians Postgraduate Press, Inc.)

This report of an aircraft crash at a major airport in Kingston, Jamaica examines the response of the local Emergency Medical Services (EMS). Factors that impacted the response are discussed, and the need for more disaster simulation exercises is highlighted. The objective of this case report was to document the response of EMS personnel to the crash of American Airlines Flight 331, and to utilize the information to examine and improve the present protocol. While multiple errors can occur during a mass-casualty event, these can be reduced by frequent simulation exercises during which various personnel practice and learn designated roles. Efficient triage, proper communication, and knowledge of the roles are important in ensuring the best possible outcome. While the triage system and response of the EMS personnel were effective for this magnitude of catastrophe, more work is needed in order to meet predetermined standards. Ways in which this can be overcome include: (1) hosting more disaster simulation exercises; (2) encouraging more involvement with first responders; and (3) strengthening the links in the local EMS system. Vigorous public education must be instituted and maintained.

In just over 20 years, laparoscopic cholecystectomy has emerged as the standard therapy for cholelithiasis and is now being performed with increased safety. However an uncommon complication of this technique has been jaundice even in patients without iatrogenic bile duct injury. We report on two cases where this complication occurred and review the literature on this topic.

Background: Injuries in Jamaica are a major public health problem as demonstrated by a hospital based computerized injury surveillance system established in 1999 that provides a risk profile for injuries., Subjects and Method: Injury data from 2004 were selected to provide an annual profile, as comprehensive injury data were available from nine public hospitals. These nine public hospitals provide care for 70% of the Jamaicans admitted to hospitals annually., Results: Data are presented on unintentional injuries where falls caused 44%, lacerations 27% and accidental blunt injuries were 17% of these. For motor vehicle related injuries, 55% were sustained while commuting by motorcars, 17% while riding motorbikes/bicycles and 16% of those injured were pedestrians. Most violence related injuries were due to fights (76%) with acquaintances (47%) who used sharp objects (40%) to inflict the injury., Conclusion: The Jamaica Injury Surveillance System (JISS) data, augmented by data collected on injuries from the health centres and the sentinel surveillance system, give a measure of the magnitude of the impact of injuries on the health services. The JISS provides data on the profile of injuries seen and treated at health facilities in Jamaica. In collaboration with police data and community-based surveys, it can be used to complete the risk profiles for different types of injuries. The data generated at the parish, regional and national levels form the basis for the design and monitoring of prevention programmes, as well as serve to support and evaluate policy, legislative control measures and measures that impact on interventions.

Unlabelled: This report describes the application of a draft version of the World Health Organization (WHO)/ United States Centers for Disease Control and Prevention (CDC) Manual for estimating the economic costs of injuries due to interpersonal and self-directed violence to measure costs of injuries from interpersonal violence., Methods: Fatal incidence data was obtained from the Jamaica Constabulary Force. The incidence of nonfatal violence-related injuries that required hospitalization was estimated using data obtained from patients treated at and/or admitted to three Type A government hospitals in 2006., Results: During 2006, direct medical cost (J$2.1 billion) of injuries due to interpersonal violence accounted for about 12% of Jamaica's total health budget while productivity losses due to violence-related injuries accounted for approximately J$27.5 billion or 160% of Jamaica's total health expenditure and 4% of Jamaica's Gross Domestic Product., Conclusions: The availability of accurate and reliable data of the highest quality from health-related information systems is critical for providing useful data on the burden of violence and injury to decision-makers. As Ministries of Health take a leading role in violence and injury prevention, data collection and information systems must have a central role. This study describes the results of one approach to examining the economic burden of interpersonal violence in developing countries where the burden of violence is heaviest. The WHO-CDC manual also tested in Thailand and Brazil is a first step towards generating a reference point for resource allocation, priority setting and prevention advocacy.

The objective of this prospective study was to evaluate the role of intraoperative cholangiography (IOC) for patients undergoing laparoscopic cholecystectomy (LC) to determine whether it could be safely omitted for all patients who fit standard criteria, namely normal liver function tests, no history of gallstone pancreatitis, common bile duct (CBD) diameter less than 10 mm or previous history of jaundice. Data were collected prospectively from 194 consecutive patients who had LC for symptomatic gall bladder disease. IOC was not performed in any patient. The conversion rate was 6.1% and one CBD injury occurred. Our experience demonstrates that LC performed without routine IOC does not result in an increased incidence of retained stones in selected patients who have no history of pancreatitis, normal liver function tests and CBD less than 10 mm diameter.

An unusual case of bilateral, synchronous breast cancer in a male patient who had a history of long-term estrogen therapy for prostate cancer is presented. The possible role of estrogen in the development of male breast cancer is revisited.

The impact of injuries on the Jamaican health care system is a growing problem. Based on the successful implementation of a Violence-Related Injury Surveillance System (VRISS) in the Accident and Emergency (A&E) department of the Kingston Public Hospital (KPH), Ministry of Health (MOH) officials decided to expand the system to the Jamaica Injury Surveillance System (JISS), allowing for the surveillance of both intentional and unintentional injuries. A working group designed the expanded injury surveillance system based on the International Classification of External Causes of Injury. The expanded system allowed for the collection of data on all injuries seen in the A&E departments by adding four injury projects to the computerized A&E registration process. These were (1) unintentional injury, (2) violence-related injury, (3) suicide attempt (also known as intentional self-harm) and (4) motor vehicle-related injuries. The expanded JISS was implemented at the KPH and four additional hospitals across the island. The geographic distribution of these hospitals provided a reflection of rural and urban, highland and coastal communities and their distinctive injury profiles. Data collected at registration were printed on trauma sheets and reviewed by medical staff before being incorporated into the patient's record. Monthly reports detailing demographics and summary statistics were generated and made available at the local and national level. By monitoring the national injury profile, the JISS provides data to support needed policy changes to minimize the impact of injuries on the health services and on the health of the population.

The care of the infected diabetic foot remains an area for continued research as we try to reduce the morbidity and mortality of this most prevalent disease process. None of the new and advanced products can take the place of proper assessment, timely, and adequate surgical intervention and control of the blood sugar; they are only adjunctive. The use of non-invasive investigative techniques such as magnetic resonance imaging and nuclear bone scan can help to confirm the presence of osteomyelitis which must be eradicated to accelerate the healing process. The gold standard for diagnosing vascular disease is angiography. Defective blood flow to the lower extremity must be corrected to ensure aequate blood supply and nutrients to the wound. In addition, good glucose control, adequate nutrition and strong psychological support will make a difference in healing these difficult wounds.

This review of all laparoscopic cholecystectomies performed between 1993 and 1995 in Jamaica records the experience of local surgeons following an accelerated training programme. Special attention was paid to operating time, conversions, complications, analgesic requirements, time to discharge and cost. Comparisons were made of the local experience with the international experience. Laparoscopic cholecystectomy has been found to be a safe and viable option for Jamaican patients with gall bladder disease.