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7. Oral mite anaphylaxis

Author

Canavan, M, Mitchell, A, Sharkey, A, Whitethorn, C, McNicholl, B, Robinson, S, Ni Riain, U, Tormey, V, and Mulkerrin, E C

Published
2018
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13. National scientific medical meeting 1997 abstracts

Author

Willison, H. J., Lastovica, A. J., Prendergast, M. M., Moran, A. P., Walsh, C., Flitcroft, I., Eustace, P., McMahon, C., Smith, J., Smith, O. P., Lakshmandass, G., Taylor, M. R. H., Holland, C. V., Cox, D., Good, B., Kearns, G. M., Gaffney, P., Shark, K., Frauenshuh, M., Ortmann, W., Messner, R., King, R., Rich, S., Behrens, T., Mahmud, N., Molloy, A., McPartlin, J., Scott, J. M., Weir, D. G., Walsh, K. M., Thorburn, D., Mills, P., Morris, A. J., Good, T., Cameron, S., McCruden, E. A. B., Bennett, M. W., O’Connell, J., Brady, C., Roche, D., Collins, J. K., Shanahan, F., O’Sullivant, G. C., Henry, M., Koston, S., McMahon, K., MacNee, W., FitzGerald, M. X., O’Connor, C. M., McGonagle, D., Gibbon, W., O’Connor, P., Emery, P., Murphy, M., Watson, R., Casey, E., Naidu, E., Murphy, M., Watson, R., Barnes, L., McCann, S., Murphy, M., Watson, R., Barnes, L., Sweeney, E., Barrett, E. J., Graham, H., Cunningham, R. T., Johnston, C. F., Curry, W. J., Buchanan, K. D., Courtney, C. H., McAllister, A. S., McCance, D. R., Hadden, D. R., Bell, P. M., Leslie, H., Sheridan, B., Atkinson, A. B., Kilbane, M. T., Smith, D. F., Murray, M. J., Shering, S. G., McDermott, E. W. M., O’Higgins, N. J., Smyth, P. P. A., McEneny, J., Trimble, E. R., Young, I. S., Sharpe, P., Mercer, C., McMaster, D., Young, I. S., Evans, A. E., Young, I. S., Cundick, J., Hasselwander, O., McMaster, D., McGeough, J., Savage, D., Maxwell, A. P., Evans, A. E., Kee, F., Larkin, C. J., Watson, R. G. P., Johnston, C., Ardill, J. E. S., Buchanan, K. D., McNamara, D. A., Walsh, T. N., Bouchier-Hayes, D. J., Madden, C., Timon, C., Gardiner, N., Lawler, M., O’Riordan, J., Duggan, C., McCann, S. R., Gowing, H., Braakman, E., Lawler, M., Byrne, C., Martens, A. C. M., Hagenbeek, A., McCann, S. R., Kinsella, N., Cusack, S., Lawler, M., Baker, H., White, B., Smith, O. P., Lawler, M., Gardiner, N., Molloy, K., Gowing, H., Wogan, A., McCann, S. R., McElwaine, S., Lawler, M., Hollywood, D., McCann, S. R., Mcmahon, C., Merry, C., Ryan, M., Smith, O., Mulcahy, F. M., Murphy, C., Briones, J., Gardiner, N., McCann, S. R., Lawler, M., White, B., Lawler, M., Cusack, S., Kinsella, N., Smith, O. P., Lavin, P., McCaffrey, M., Gillen, P., White, B., Smith, O. P., Thompson, L., Lalloz, M., Layton, M., Barnes, L., Corish, C., Kennedy, N. P., Flood, P., Mulligan, S., McNamara, E., Kennedy, N. P., Flood, P., Mathias, P. M., Ball, E., Duiculescu, D., Calistru, P., O’Gorman, N., Kennedy, N. P., Abuzakouk, M., Feighery, C., Brannigan, M., Pender, S., Keeling, F., Varghese, J., Lee, M., Colreavy, M., Gaffney, R., Hone, S., Herzig, M., Walsh, M., Dolan, C., Wogan, A., Lawler, M., McCann, S. R., Hollywood, D., Donovan, D., Harmey, J., Bouchier-Hayes, D. J., Haverty, A., Wang, J. H., Harmey, J. H., Redmond, H. P., Bouchier-Hayes, D. J., McGreal, G., Shering, S. G., Moriarty, M. J., Shortt, A., Kilbane, M. T., Smith, D. F., McDermott, E. W. M., O’Higgins, N. J., Smyth, P. P. A., McNamara, D. A., Harmey, J., Wang, J. H., Donovan, D., Walsh, T. N., Bouchier-Hayes, D. J., Kay, E., Pidgeon, G., Harmey, J., McNamara, D. A., Bouchier-Hayes, D. J., Dunne, P., Lambkin, H., Russell, J. M., O’Neill, A. J., Dunne, B. M., O’Donovan, M., Lawler, M., Gaffney, E. F., Gillan, J. E., Cotter, T. G., Horan, J., Jones, D., Biswas, S. K., Mulkerrin, E. C., Brady, H., O’Donnell, J., Neary, J., Healy, E., Watson, A., Keogh, B., Ryan, M., Cassidy, C., Ward, S., Stokes, E., Keoghan, F., Barrett, A., O’Connell, P., Ryall, N., O’Connell, P. A., Jenkinson, A., O’Brien, T., O’Connell, P. G., Harrison, R., Barrett, T., Bailey, D. M. D., Butler, A., Barton, D. E., Byrne, C., McElwaine, S., McCann, S. R., Lawler, M., Cusack, S., Lawler, M., White, B., Smith, O. P., Daly, G., Gill, M., Heron, S., Hawi, Z., Fitzgerald, M., Hawi, Z., Mynett-Johnson, L., Shiels, D., Kendler, K., McKeon, P., Gill, M., Straub, R., Walsh, D., Ryan, F., Barton, D. E., McCabe, D., Murphy, R., Segurado, R., Mulcahy, T., Larson, B., Comerford, C., O’Connell, R., O’Mahony, E., Gill, M., Donnelly, J., Minahan, F., O’Neill, D., Farrell, Z., O’Neill, D., Jones, D., Horan, J., Glynn, C., Biswas, S. K., Mulkerrin, E., Brady, H., Lennox, S. E., Murphy, A., Rea, I. M., McNulty, H., McMeel, C., O’Neill, D., McEvoy, H., Freaney, R., McKenna, M. J., Crowe, M., Keating, D., Colreavy, M., Hone, S., Norman, G., Widda, S., Viani, L., Galvin, Nolan, C. M., Hardiman, O., Hardiman, O., Brett, F., Droogan, O., Gallagher, P., Harmey, M., King, M., Murphy, J., Perryrnan, R., Sukumaran, S., Walsh, J., Farrell, M. A., Hughes, G., Cunningham, C., Walsh, J. B., Coakley, D., O’Neill, D., Hurson, M., Flood, P., McMonagle, P., Hardiman, O., Ryan, F., O’Sullivan, S., Merry, C., Dodd, P., Redmond, J., Mulcahy, F. M., Browne, R., Keating, S., O’Connor, J., Cassidy, B. P., Smyth, R., Sheppard, N. P., Cullivan, R., Crown, J., Walsh, N., Denihan, A., Bruce, I., Radic, A., Coakley, D., Lawlor, B. A., Bridges, P. K., O’Doherty, M., Farrington, A., O’Doherty, M., Farragher, B., Fahy, S., Kelly, R., Carey, T., Owens, J., Gallagher, O., Sloan, D., McDonough, C., Casey, P., Horgan, A., Elneihum, A., O’Neill, C., McMonagle, T., Quinn, J., Meagher, D., Murphy, P., Kinsella, A., Mullaney, J., Waddington, J. L., Rooney, S., Rooney, S., Bamford, L., Sloan, D., O’Connor, J. J., Franklin, R., O’Brien, K., Fitzpatrick, G., Laffey, J. G., Boylan, J. F., Laffey, J., Coleman, M., Boylan, J., Laffey, J. G., McShane, A. J., Boylan, J. F., Loughrey, J. P. R., Gardiner, J., McGinley, J., Leonard, I., Carey, M., Neligan, P., O’Rourke, J., Cunningham, A., Fennessy, F., Kelly, C., Bouchier-Hayes, D., Fennessy, F., Wang, J. H., Kelly, C., Bouchier-Hayes, D., Fennessy, F., Wang, J. H., Kelly, C., Bouchier-Hayes, D. J., Kellett, J., Laffey, J., Murphy, D., Regan, J., O’Keeffe, D., Mahmud, A., Hemeryck, L., Feely, J., Mahmud, A., Hemeryck, L., Hall, M., Feely, J., Menown, I. B. A., Mathew, T. P., Nesbitt, G. S., Syme, M., Young, I. S., Adgey, A. A. J., Menown, I. B. A., Turtle, F., Allen, J., Anderson, J., Adgey, A. A. J., O’Hanlon, R., Codd, M. B., Walkin, S., McCann, H. A., Sugrue, D. D., Rasheed, A. M., Chen, G., Kelly, C., Bouchier-Hayes, D. J., Leahy, A., Rasheed, A. M., Kay, E., Jina, S., Bouchier-Hayes, D. J., Leahy, A., McDowell, I., Rasheed, A. M., Wang, J. H., Wo, Q., Kelly, C., Bouchier-Hayes, D. J., Leahy, A., Shuhaibar, M. N., McGovern, E., Turtle, F., Menown, I. B. A., Manoharan, G., Kirkpatrick, R., Campbell, N. P. S., Walkin, S., Codd, M. B., O’Hanlon, R., McCarthy, C., McCann, H. A., Sugrue, D. D., Wen, Y., Killalea, S., Hall, M., Hemeryck, L., Feely, J., Fahy, C. J., Griffith, A., McGinley, J., McCabe, D., Fraser, A., Casey, E., Ryan, T., Murphy, R., Browne, M., Fenton, J., Hughes, J., Timon, C. I., Fenton, J., Curran, A., Smyth, D., Viani, L., Walsh, M., Hughes, J. P., Fenton, J., Lee, P., Kelly, A., Timon, C. I., Hughes, J. P., Fenton, J., Shine, N., Blayney, A., McShane, D. P., Timon, C. I., Hussey, J., Howlett, M., Langton, A., McEvoy, A., Slevin, J., Fitzpatrick, C., Turner, M. J., Enright, F., Goggin, N., Costigan, C., Duff, D., Osizlok, P., Wood, F., Watson, R., Fitzsimons, R. B., Flanagan, N., Enright, F., Barnes, L., Watson, R., Molloy, E., Griffin, E., Deasy, P. F., Sheridan, M., White, M. J., Moore, R., Gray, A., Hill, J., Glasgow, J. F. T., Middleton, B., Slattery, D., Donoghue, V., McMahon, A., Murphy, J., Slattery, D., McCarthy, A., Oslislok, P., Duff, D., Colreavy, M., Keogh, I., Hone, S., Walsh, M., Henry, M., Koston, S., McMahon, K., MacNee, W., FitzGerald, M. X., O’Connor, C. M., Russell, K. J., Henry, M., Fitzgerald, M. X., O’Connor, C. M., Kavanagh, P. V., McNamara, S. M., Feely, J., Barry, M., O’Brien, J. E., McCormick, P., Molony, C., Doyle, R. M., Walsh, J. B., Coakley, D., Codd, M. B., O’Connell, P. R., Dowey, L. C., McGlynn, H., Thurnham, D. I., Elborn, S. J., Flynn, L., Carton, J., Byrne, B., O’Farrelly, C., Kelehan, P., O’Herlihy, C., O’Hara, A. M., Moran, A. P., Orren, A., Fernie, B. A., Merry, C., Clarke, S., Courtney, G., de Gascun, C., Mulcahy, F. M., Merry, C., Ryan, M., Barry, M., Mulcahy, F. M., Merry, C., Ryan, M., Barry, M., Mulcahy, F. M., Byrne, M., Moylett, E., Murphy, H., Butler, K., Nourse, C., Thaker, H., Barry, C., Russell, J., Sheehan, G., Boyle, B., Hone, R., Conboy, B., Butler, C., Moris, D., Cormican, M., Flynn, J., McCormack, O., Corbally, N., Murray, A., Kirrane, S., O’Keane, C., Hone, R., Lynch, S. M., Cryan, B., Whyte, D., Morris, D., Butler, C., Cormican, M., Flynn, J., Corbett-Feeney, G., Murray, A., Corbally, N., Hone, R., Mackle, T., Colreavy, M., Perkins, J., Saidlear, C., Young, A., Eustace, P., Wrigley, M., Clifford, J., Waddington, J. L., Tighe, O., Croke, D. T., Drago, J., Sibley, D. R., Feely, J., Kelly, A., Carvalho, M., Hennessy, M., Kelly, M., Feely, J., Hughes, C., Hanlon, M., Feely, J., Sabra, K., Keane, T., Egan, D., Ryan, M., Maerry, C., Ryan, M., Barry, M., Mulcahy, F. M., Maerry, C., Ryan, M., Barry, M., Mulcahy, F. M., Sharma, S. C., Williams, D., Kelly, A., Carvalho, M., Feely, J., Williams, D., Kelly, A., Carvalho, M., Feely, J., Codd, M. B., Mahon, N. G., McCann, H. A., Sugrue, D. D., Sayers, G. M., Johnson, Z., McNamara, S. M., Kavanagh, P. V., and Feely, J.

Published
1998
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22. Discordant Thyroid Function Tests at First Presentation of Panhypopituitarism--A "Reversible Cause" of Cognitive Decline?

Author

McDonnell, Tara, Farrell, Amy, O'Shea, P. M., and Mulkerrin, E. C.

Subjects
COGNITION disorders in old age, DISEASES in older women, DROWSINESS, MUSCLE diseases, OSTEOARTHRITIS, HYPOTHYROIDISM
Abstract

The article describes the case of an 82-year-old woman with significant cognitive decline, somnolence and loss of mobility. Topics discussed include evidence of proximal myopathy found on examination with difficulty standing from seated position and evidence of osteoarthritis with deformity of her right knee without joint effusion, relevant biochemical findings and hospital admissions, and a positive diagnosis of central hypothyroidism.

Published
2021
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23. Opportunistic Diagnosis of Extensive Pulmonary Embolus Following "COVID-19 Blood Battery" in Very Frail Older Patients.

Author

O'Brien, Michelle Mary Clare, McLoughlin, J. M., and Mulkerrin, E. C.

Subjects
DIAGNOSTIC errors, HOSPITAL emergency services, PULMONARY embolism, MEDICAL triage, COMORBIDITY, FIBRIN fibrinogen degradation products, COVID-19
Abstract

D-dimer is routinely measured to exclude the diagnosis of venous thromboembolism and is its main biomarker. Appropriate age-adjusted D-dimer testing improves D-dimer specificity, could decrease inappropriate CT pulmonary angiograms in the older person, and prevent unnecessary radiation exposure. A "COVID-19 blood battery", designed to increase the efficiency of evaluation of COVID-19 suspected patients is used in our institution. It includes D-dimers which are elevated in COVID-19 infections and potentially an index of severe infection. These 3 very frail patients presented late to the emergency department, all acutely and non-specifically unwell, with high prevalence of comorbidities and were transferred in by ambulance. They were triaged to the COVID-19 pathway of our hospital, and subsequently had negative COVID-19 swabs. All had an incidental finding of markedly elevated D-dimers, with potential causes of their symptoms other than pulmonary embolus. They were transferred to an acute geriatric ward specifically designated to manage older patients (>75years) who had negative nasopharyngeal swab results. They were all ultimately diagnosed with extensive pulmonary emboli with evidence of raised pulmonary pressures on CTPA and/or echocardiogram. It is possible that these patients had false negative COVID-19 swabs. Allowing for the novel nature of COVID-19, prospective evaluation for new symptoms and complications such as thromboembolic disease in those affected by milder symptoms should be considered. In the absence of clinical improvement following treatment of other conditions in frail older patients, D-dimer testing could be indicated with pursuit of specific diagnostic evaluation for venous thromboembolism when significantly elevated. [ABSTRACT FROM AUTHOR]

Published
2020
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24. Increased rates of hypernatraemia during modest heatwaves in temperate climates.

Author

Brennan, M, Murray, O, O'Shea, P M, and Mulkerrin, E C

Subjects
TEMPERATE climate, METEOROLOGICAL services, OLDER people, ATMOSPHERIC temperature, CROSS-sectional method, HYPERNATREMIA
Abstract

Background Hypernatraemia is associated with morbidity and mortality, particularly in the older person. Last summer, Ireland experienced prolonged periods of excessive heat. The Irish meteorological service defines a heatwave as temperatures exceeding 25°C for five consecutive days. Aim This study sought to compare the frequency of hypernatraemia (sodium (Na+) >145 mmol/l) observed during a modest heatwave with that during average ambient temperature in the temperate Irish climate. Design Retrospective cross-sectional analysis with nested case–control study. Methods The 10-day period from 24 June to 3 July in 2017 and 2018 were chosen as the control and heatwave periods, respectively. Patients aged >65 with at least one Na+ value recorded on the laboratory information system were included. Local meteorological data, age, gender and Na+ levels were evaluated. Results Maximum air temperatures were significantly higher during the heatwave period (mean 27°C vs. 16.8°C, P  < 0.0001). Hypernatraemia was present in 3.6% (66/1840) of samples collected during the heatwave compared to 1.4% (23/1593) in the control period. The mean age of affected patients was similar in both groups, 75 years ±7 (P  = 1.000). Almost half of participants (49.5%) were male. The frequency of hypernatraemia observed was not influenced by gender, P  = 0.33. The median sodium concentrations were similar in both groups, P  = 1.00. Conclusion Hypernatraemia was 2.5 times more frequent in samples drawn during the heatwave compared to the control period. In this study, neither age nor gender impacted the profile of patients diagnosed with hypernatraemia. A modest rise in temperatures increases hypernatraemia rates in temperate climates. [ABSTRACT FROM AUTHOR]

Published
2020
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25. Oral mite anaphylaxis

Author

Canavan, M, primary, Mitchell, A, additional, Sharkey, A, additional, Whitethorn, C, additional, McNicholl, B, additional, Robinson, S, additional, Ni Riain, U, additional, Tormey, V, additional, and Mulkerrin, E C, additional

Published
2017
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27. Attitudes to outcomes measured in clinical trials of cardiovascular prevention.

Author

Canavan, M., Smyth, A., Robinson, S. M., Gibson, I., Costello, C., O'Keeffe, S. T., Walsh, T., Mulkerrin, E. C., and O'Donnell, M. J.

Subjects
CLINICAL trials, CARDIOVASCULAR disease prevention, CROSS-sectional method, MYOCARDIAL infarction, DEMENTIA prevention
Abstract

Background: Selecting outcome measures in cardiovascular prevention trials should be informed by their importance to selected populations. Major vascular event outcomes are usually prioritized in these trials with considerably less attention paid to cognitive and functional outcomes. Aim: To examine views on importance of outcome measures used in clinical trials. Design: Cross-sectional survey. Methods: Of 367 individuals approached, 280 (76%) participated: outpatients attending cardiovascular prevention clinics (n=97), active retirement groups members (n=75), medical students (n=108). Participants were asked to rank, in order of importance, outcome measures, which may be included in cardiovascular prevention trials. Results were compared between two groups: <65s (n=157) and ≥65s (n=104). Results: When asked what outcomes were most important to measure in cardiovascular prevention trials, respondents reported: death (31.6%) stroke (28.5%), dementia (26.9%), myocardial infarction (MI) (7.9%) and requiring nursing home (NH) care (5.1%). When asked the most relevant outcomes regarding successful ageing respondents reported; maintaining independence (32.4%), avoiding major illness (24.3%), good family life (23.6%), living as long as possible (15.8%), avoiding NH care (3.1%) and contributing to society (0.8%) as most important. When asked what outcome concerned them most about the future, respondents reported: dementia (32.6%), dependence (30.4%), death (12.8%), stroke (12.5%), cancer (6.2%) requiring NH care (4.8%) and MI (0.7%). Maintaining independence was considered most important in younger and older cohorts. Conclusion: Cognitive and functional outcomes are important patient-relevant outcomes, sometimes more important than major vascular events. Incorporating these outcomes into trials may encourage patient participation and adherence to preventative regimens. [ABSTRACT FROM AUTHOR]

Published
2016
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33. Reply

Author

MULKERRIN, E. C., primary, ARNOLD, J. D., additional, DEWAR, R., additional, and SYKES, D., additional

Published
1993
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36. A STUDY OF TUBULAR POTASSIUM SECRETORY CAPACITY IN OLDER PATIENTS WITH HYPERKALAEMIA.

Author

Mc Greevy, C., Horan, J., Jones, D., Biswas, K., O'Meara, Y. M., and Mulkerrin, E. C.

Subjects
RENAL tubular transport disorders, POTASSIUM in the body, GLOMERULAR filtration rate, KIDNEY diseases, DISEASES in older people
Abstract

Objectives: Sustained hyperkalaemia usually indicates a defect in renal potassium (K+) excretion and can be due to severe impairment of glomerular filtration rate (GFR). The major determinants of renal K+ secretion were studied in hyperkalaemic and normokalaemic elderly subjects to probe the major determinants of hyperkalaemia in this setting. Design: The transtubular potassium gradient (TTKG) provides an index of tubular K+ secretion and normally rises in patients with significant hyperkalaemia. Both GFR(glomerular filtration rate) and TTKG were assessed at baseline and repeated after 3 hours following ingestion of 0.1 mg of fludrocortisone in three groups. Setting: An acute general hospital in the West of Ireland. Participants: 23 subjects in total; 8 older patients with unexplained hyperkalaemia (OHK), 8 older patients with normokalaemia (ONK) and 9 young normokalaemic controls (YNK). Measurements: The GFR was either measured by 24 hour creatinine clearance estimation or calculated using the Cockroft and Gault formula.TTKG was calculated using a specific formula. Results: Mean baseline TTKG was similar in all three groups and consequently inappropriately low in hyperkalaemic subjects. Three hours post fludrocortisone, the TTKG had risen significantly from baseline levels in the young subjects only (from 7.5+/-0.09 to 11.6+/-1.1, p<0.05). No significant increase was noted in either older group at this timepoint. Conclusions: The inappropriately low baseline TTKG in the OHK group as well as the absence of a response to fludrocortisone indicate tubular insensitivity to aldosterone. GFR values in both OHK (40.06+/-2.31) and ONK (55.58+/-6.1) groups were significantly lower than those in the YNK group (101.66+/-6.9). In aggregate, these findings indicate that older hyperkalaemic patients typically have both impairment of glomerular filtration and renal tubular K+ secretion and highlights the requirement for vigilance in elderly patients when using medications which interfere with tubular function. [ABSTRACT FROM AUTHOR]

Published
2008

38. A decrease of ⩾ points on the Mini-Mental State Examination was the best determinant of delirium in elderly patients admitted to hospital.

Author

O'Keeffe, S. T., Mulkerrin, E. C., Noyeem, K., and Fields, Suzanne D.

Subjects
*DELIRIUM, *HOSPITAL patients, *COGNITION disorders, *DISEASES, *THERAPEUTICS, *MEDICAL research
Abstract

The article discusses whether serial Mini-Mental State Examinations (MMSEs) are accurate for diagnosing delirium in elderly patients admitted to hospital. Delirium frequently accompanies acute medical illness among hospitalized patients. Characteristic features include acute onset and fluctuations in severity over time. Average duration is about 6 days, although for some patients the impairment may persist longer. In elderly patients admitted to hospital, a decrease of ≥ 2 points on the MMSE was the best determinant of delirium.

Published
2005

39. Technology and Specialist Care for Older Patients in the Post Covid-19 Era.

Author

Dervan K, Mulkerrin G, McDonnell T, and Mulkerrin EC

Abstract

The COVID-19 pandemic poses a major challenge to delivering multi-disciplinary complex care for older patients. Modern technology can assist in providing such care. This article highlights efforts to bridge the "digital divide" between generations and addresses the beneficial impact telemedicine has on older people's lifestyles. Novel triage models for accessing emergency care which were successful for patients of all age groups including those over 65 years are described. Moreover, innovative successful approaches to the outpatient assessment of older patients with complex chronic health conditions using telemedicine are highlighted. Furthermore, innovative solutions piloted in remote areas of Australia offer promise for telemedicine-lead remote assessment of older patients, and the results are encouraging compared to in-person consultations. The experience with a General Practitioner (GP)/specialist online real-time interaction model for remote management of HF in mainly older people has also been encouraging. The use of telemedicine in falls prevention has produced impressive results in high-risk older patients albeit with some ambivalence from older participants. Virtual reality rehabilitation programmes have produced better physical outcomes than traditional rehabilitation programmes. Furthermore, telerehabilitation for chronic obstructive pulmonary disease (COPD) and HF have shown to be both feasible and effective. To maximise their benefits in the difficult post-COVID-19 period, technologies must be embraced by both physicians and older patients. Online community care platforms discussed have demonstrated a positive, tangible impact on the lifestyle of the older generation. Furthermore, educational guidelines can assist in implementing the fundamentals of telemedicine, but for the widespread successful and safe integration of these services, adoption of regulatory frameworks with a focus on ethical issues of telehealth is imperative., Competing Interests: No conflict of interest., (© 2020 - JARLIFE.)

Published
2020
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40. Development of acute stroke units--a cost effective reconfiguration which benefits patients.

Author

Canavan M, Ni Mhaille G, and Mulkerrin EC

Subjects
Bed Occupancy economics, Cost-Benefit Analysis, Hospital Units organization & administration, Humans, Ireland, Length of Stay economics, Patient Care Team economics, Patient Care Team organization & administration, Stroke economics, Thrombolytic Therapy economics, Hospital Units economics, Stroke Rehabilitation
Published
2012
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41. Why do older patients die in a heatwave?

Author

Flynn A, McGreevy C, and Mulkerrin EC

Subjects
Aged, Aging physiology, Frail Elderly, France epidemiology, Heat Stress Disorders metabolism, Heat Stress Disorders prevention & control, Humans, Risk Factors, Heat Stress Disorders mortality
Published
2005
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42. Spironolactone therapy in older patients--the impact of renal dysfunction.

Author

Butler JV, McAvoy H, McEnroy D, and Mulkerrin EC

Abstract

Low dose spironolactone reduces the risk of death from heart failure. We examined the effects of spironolactone on potassium homeostasis in a cohort of elderly patients with congestive heart failure (CHF). Eighteen patients >70 years, mean 80.5 (+/- SD 6.3) with New York Heart Association CHF Grade II-IV were enrolled. All patients were commenced on 25 mg spironolactone daily. The dose was reduced to 12.5 mg daily when hyperkalemia (potassium>5.0) occurred. A serum creatinine of >150 micromol/l was defined as indicating renal impairment (RI). Blood pressure, pulse rate, urea, creatinine, Na+ and K+ were measured at baseline, day 2-5, day 28 and more often if clinically indicated. Nine of those recruited had RI. Baseline serum potassium was significantly higher in those with RI, mean 4.56 (+/- 0.30) vs. 4.04 (+/- 0.30) mmol/l (P<0.01). Six patients with RI developed hyperkalemia versus one of those with serum creatinine <150 micromol/l (P<0.05). Serum K+ returned to normal in all patients when the dose of spironolactone was reduced to 12.5 mg daily with one exception in whom the medication was withdrawn. When spironolactone is prescribed to older patients with CHF, hyperkalemia appears more likely in those with RI. Halving the dose to 12.5 mg daily results in normalisation of serum potassium. Older patients commencing spironolactone therapy should have serum potassium monitored frequently, particularly in the presence of RI.

Published
2002
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43. Giant cell arteritis and pericardial effusion.

Author

Butler JV, Callaghan J, O'Keeffe S, and Mulkerrin EC

Subjects
Biopsy, Echocardiography, Female, Giant Cell Arteritis diagnosis, Giant Cell Arteritis therapy, Humans, Middle Aged, Pericardial Effusion diagnostic imaging, Pericardial Effusion therapy, Temporal Arteries pathology, Giant Cell Arteritis complications, Pericardial Effusion etiology
Published
2001

44. Giant cell arteritis.

Author

Butler JV, O'Keeffe S, and Mulkerrin EC

Subjects
Humans, Giant Cell Arteritis diagnosis, Giant Cell Arteritis pathology, Giant Cell Arteritis therapy
Published
2001

45. Reduced renal hemodynamic response to atrial natriuretic peptide in elderly volunteers.

Author

Mulkerrin EC, Brain A, Hampton D, Penney MD, Sykes DA, Williams JD, Coles GA, and Woodhouse KW

Subjects
Adult, Aged, Atrial Natriuretic Factor blood, Hemodynamics drug effects, Humans, Male, Aging physiology, Atrial Natriuretic Factor physiology, Kidney blood supply
Abstract

Aging is associated with decreased ability to excrete salt and water, thus increasing the susceptibility to volume overload in older individuals. Meanwhile, plasma levels of atrial natriuretic peptide (ANP) increase progressively with age for unknown reasons. We compared the natriuretic and renal hemodynamic responses to low-dose ANP infusion in an elderly group of volunteers (mean age, 74 years) with those of a group of younger subjects (mean age, 29 years). A significant reduction below baseline values in effective renal plasma flow occurred in the young group after the 2-hour peptide infusion (657 +/- 125 v 476 +/- 92 mL/min [mean +/- 1 SD]) when compared with the elderly group (two-way analysis of variance; P < 0.02). A concomitant increase in renal vascular resistance was noted in the young group only during the same period (6,631 +/- 1,384 v 9,136 +/- 2,126 dyn s cm2 x 10(6)). This increase was also significantly higher than that in the elderly group (analysis of variance; P < 0.02). Both groups demonstrated similar natriuretic responses. Absolute sodium excretion had increased significantly above baseline values in both young and elderly subjects at the end of the 2-hour peptide infusion (111 +/- 25 mumol/min to 183 +/- 33 mumol/min v 107 +/- 23 mumol/min to 198 +/- 56 mumol/min) and remained elevated until 1 hour postinfusion. We conclude that the elderly subjects in our study demonstrated a diminished renal hemodynamic response to infusion of ANP while preserving a natriuretic response similar to that found in the younger subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Published
1993
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