Annual General Meeting of the Irish Thoracic Society - IJMS | Irish ...

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SESSION THREE ONE
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
ANNUAL MEETING OF THE IRISH THORACIC SOCIETY • 11 - 12 November 2005 • WESTWOOD HOUSE HOTEL, GALWAY
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SESSION
SESSION THREE ONE
sarcoidosis (non-caseating granulomata with
negative stains and cultures for tuberculosis and
fungi) underwent diagnostic fibreoptic brochoscopy.
Six of the patients had Stage I sarcoidosis, 11 were
Stage II, and the remaining five were Stage III. All
patients had bronchoalvoelar lavage (BAL), 21 of 22
had transbronchial lung biopsy (TBLB), 20 of 22 had
transbrochial needle aspiration (TBNA) of subcarinal
lymph nodes, and 20 of 22 had endobronchial
biopsy (EBBB). Nineteen of the 21 patients had a
positive TBLB (90.4%), four of 20 had positive EBBB
(20%) of which only one had a negative TBLB, and
two of 20 (10%) patients had positive histology
on TBNA though both of whom also had positive
3.31
Audit on the use of serum ACE in an Irish regional
hospital
Introduction
An audit on the clinical use of serum ACE levels
(SACE) in an Irish Regional Hospital.
Methods
Retrospective chart review of patients who presented
to the Midland Regional Hospital Mullingar between
May 2003 and May 2004 and had a SACE level
measured.
Research
283 patients had SACE levels measured. 100 of these
patients were randomly selected for chart review. 80
had levels measured as part of the diagnostic work-up
for suspected sarcoidosis; the remaining 20 patients
had levels drawn for assessment of disease activity in
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Asthma
TBLB. Six patients had significant lymphocytosis
on BAL (27.2%); all had positive TBLB apart from
one. The combined sensitivity of all four diagnostic
procedures was 94.1%; the sensitivity of TBLB alone
was 88.2%. Our data suggests that of the four
bronchoscopic methods, TBLB had the maximum
yield in the diagnosis of pulmonary sarcoidosis. There
was no significant additional benefit from TBNA or
BAL, and minimal additional benefit from EBB.
Conclusion
TBLB is the preferred diagnostic technique in
sarcoidosis; BAL and TBNA are of no additive benefit.
already diagnosed sarcoid patients. Of the 80 patients
with SACE drawn for suspicion of sarcoidosis, only 13
(16.3%) were finally diagnosed with sarcoidosis. Of
these 13 patients, only 15.4% (2/13) had increased SACE.
SACE levels were increased in 5 of the 80 diagnostic
group (6.25%); only 2 (40%) of these patients were
subsequently diagnosed with sarcoidosis. In patients
with SACE levels measured as part of the diagnosis
evaluation for sarcoidosis, the sensitivity, specificity,
positive and negative predictive value of SACE was
15.4%, 95.5%, 40.0% and 85.3% respectively.
Conclusion
SACE is not a sensitive test for the diagnosis of
sarcoidosis and should not be included in the
diagnostic work-up.
Auditing paediatric asthma – does it work?
Introduction
Clinical audits are widely encouraged in the
NHS although there is limited evidence of their
effectiveness in improving key aspects of care. We
wished to determine whether participation in a
national audit programme for asthma resulted in
defined improvements in patient care.
Method
Craigavon Area Hospital Paediatric department
participated in the BPRS/ BTS Asthma audit in
November 2002, 2003 and 2004. Changes were
implemented after year 1. Results of this three-year
audit were analysed and compared to that of the
national standard (Natl).
C Murtagh,
A Shamboul. Y Vapra,
A Brennan, A O’Brien
Midland Regional
Hospital Mullingar,
Co Westmeath
S Thavagnanam,
M Smith
Dept of Paediatrics and
AIR Centre, Craigavon
Area Hospital
Results
There were 11-16 patients with acute asthma admitted
each November during the study periods (M: 74%,
F: 26%). Ninety-seven per cent of patients received
bronchodilators either via spacer /nebuliser as first
line (Natl =98%). Oral/IV steroids were given on an
average of 88% (Natl=88%). There was an increase
in the use of aminophylline (19% vs 4% Natl),
antibiotics (30% vs 20% Natl) and Chest X-rays (59%
vs 34% Natl). An increasing proportion of patients
were given management plans (32% to 64%) and had
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3.34
Asthma admissions in children in Galway, trends over
15 years
Objective
To study trends in admissions with acute asthma in
children aged one to 14 years over the past 15 years.
Setting
Paediatric department in Regional hospital serving a
child population of c.45,000.
Methods
Analysis of hospital in-patient enquiry system for
children with a diagnosis of acute asthma 1990 -2004.
Results
Admissions increased steadily from 1990 to 1995, and
thereafter halved over the next 10 years. This decline
was most evident in the school age population (5-14
years). Age specific admission rates were higher in
the pre-school group throughout, and the though
all rates have declined, that in one- to four-year-olds
is still five times greater than in 5-14 year olds. The
increase, and subsequent decrease in admissions
was more evident in males.
Conclusions
Admission of children to hospital with acute asthma
has declined in this area. This decline is most evident
in school age children.
An evaluation of nurse-led respiratory service in the 21st
century: can clinical nurse specialists make a difference?
Introduction
The work of a respiratory clinical nurse specialist
(CNS) has a significant impact on changing outcomes
and improving quality of patient care. Continuity
of care has been a problem with COPD and asthma
patients with care frequently delegated to junior non
consultant hospital doctors (NCHD). In St Michael’s
Hospital we have provided a respiratory nurse led
service since October 2004. We assessed the patient’s
perception of the benefits of this nurse led service.
Methods
The CNS has seen 60 patients since commencement of
this service. Subjects (n= 25) were recruited to answer
a postal questionnaire consisting of 12 questions.
The questions were divided into five different areas:
history, diagnosis, existing knowledge of condition,
evaluation of service and additional comments.
device technique assessed (50% to 64%). There was
no change in frequency of information leaflets given
(50% to 45%).
Conclusions
Participation and implementation of change based on
the national asthma audit programme has resulted
in an increase in evidence-based care however it has
also highlighted deficiencies in certain areas. Effective
implementation of change needs to involve all
stakeholders and involve multi-layer interventions.
Results
The response rate to the questionnaire showed that
94% were satisfied with the nurse led service however,
6% expressed a concern there was inadequate
explanation provided regarding their condition.
Continuity of care is demonstrated by the fact that
33% of the patients returned twice and 8% returned
three times.
Conclusion
The results support the use of a respiratory nurse led
service. This has demonstrated continuity of care and
no patient has expressed a desire to relocate to the
conventional doctor led clinic. This clinic is an example
of how a nurse led respiratory service is progressing
towards advanced nurse practitioner status.
A Shabu, E Crushell,
BG Loftus
Dept of Paediatrics,
NUI, Galway
MF O’Driscoll, 1
MM Nagle, 1
TJ Mc Donnell 2
1. Dept of Nursing, and
2. Respiratory
Medicine
St Michael’s
Hospital,
Dun Laoghaire,
Co. Dublin
38 IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3
IRISH JOURNAL OF MEDICAL SCIENCE • VOLUME 174 • NUMBER 4 • SUPPLEMENT 3 39