Objectives: Service users with severe psychiatric illnesses, such as schizophrenia, major depressive disorder and bipolar disorder, are more likely to suffer from ill health. There is evidence that lifestyle interventions, for example, exercise, dietary advice and smoking cessation programmes for service users with severe mental illness can be of health benefit. This review was carried out to identify the literature pertaining to physical health interventions for service users who have experienced a first-episode psychosis (FEP), to examine the nature of the interventions which were carried out and to assess these interventions in terms of feasibility and efficacy. Methods: A narrative review was conducted in August 2019 by searching ‘Pubmed’ and ‘Embase’ electronic databases. Studies investigating the effect a physical health intervention had on service users who had experienced a FEP were included in the review. Results: Fifteen studies met inclusion criteria: 12 quantitative studies and 3 qualitative. Exercise, dietary advice, smoking cessation and motivational coaching were some of the physical health interventions utilised in the identified studies. Positive effects were seen in terms of physical health markers wherever they were investigated, particularly when the intervention was delivered early. The impact on psychiatric symptoms and longer-term impacts on health were less frequently assessed. Conclusions: Physical health interventions have a positive impact on service users who have experienced a FEP. More research is warranted in this area in Ireland. These studies should include controls, have longer follow-up periods and should assess the impact on psychiatric health.

We describe antiglomerular basement membrane (anti-GBM) disease with rapidly progressive glomerulonephritis and concurrent parainfluenza pneumonia. Circulating anti-GBM antibodies were barely detectable and disappeared rapidly following corticosteroids, cyclophosphamide and plasma exchange. Kidney biopsy demonstrated strong linear GBM staining for IgG and IgG4 and unusually prominent endocapillary hypercellularity, suggesting ‘atypical anti-GBM disease’, although glomerular necrosis and crescents were also seen. When kidney function deteriorated further, despite persistently absent circulating anti-GBM antibodies, a repeat kidney biopsy was performed, showing crescents in 100% of glomeruli with ongoing endocapillary hypercellularity and strong IgG and IgG4 GBM staining. This case highlights complexities in the diagnosis of anti-GBM disease, with clinical and histological features bridging the atypical to typical anti-GBM disease spectrum. We hypothesise that these findings might be explained by the presence of IgG4 (rather than traditional IgG1 or IgG3) autoantibodies. To our knowledge, this is also the first report of parainfluenza associated with anti-GBM disease.

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Background The discharge summary is the main method of communication integrating the care of older adults from the acute hospital admission to their discharge destination. HIQA published standards to ensure high quality and safe information transfer between settings. We designed an audit to evaluate the quality of the discharge summaries from the orthogeriatric service before and after the introduction of a discharge summary template for use by Non-Consultant Hospital Doctors (NCHDs) on the service Methods Data were collected anonymously using an excel data collection tool with 51 data points covering the seven key areas outlined in the standards. Initial data collection included patients admitted in November 2021. We introduced a discharge template and education sessions for orthopaedic NCHDs regarding discharge summary completion. We then retrospectively collected data from discharge summaries completed after the intervention in March 2021 Results We examined discharge summaries of 10 patients in each group. Admission and discharge details, and details of the patient, GP and author met the HIQA standards in all summaries and there was no significant change documented. There was an appropriate clinical narrative included for 8 patients preintervention and all patients after. There was a 70% improvement in documentation of patients’ living circumstances and 90% for details of functional state. Medications on discharge were included for three patients initially and eight after. Specific details regarding medication changes were included for one patient initially and seven after. Details of future management improved in 5, 7 and 3 summaries regarding hospital actions, GP actions and community actions respectively. Conclusion High-quality discharge summaries are essential for continuity of care and patient safety. The introduction of a discharge summary template and education of NCHDs significantly improved the quality of the discharge summaries in our unit.

Objectives: The aim of this study is to examine alanine aminotransferase (ALT) levels in a cohort of women diagnosed with gestational diabetes mellitus (GDM) and to investigate the association between elevated ALT and pregnancy outcomes. Design: A retrospective cross-sectional study. Setting: Cork University Maternity Hospital Population: Women attending the gestational diabetes outpatients’ department in CUMH. Methods: This is a retrospective cross-sectional study. The participants were divided into 2 groups: those with ALTs within the ALT N range and those with elevated but with no other documented diagnosis of liver disease that may be a cause for their elevated ALT level. Primary and secondary measure outcomes: a) To quantify the number of participants with an elevated ALT and to compare them to a group of participants with normal ALT, b) To investigate if there is an association between elevated ALT and BMI and c) To compare the two groups in terms premature birth, macrosomia, induction of labour, operative delivery and neonatal ICU admission. Results: 24.7% of women with GDM had elevated ALT. 23.9% of the entire group had elevated ALT and no diagnosis of liver disease. When this group was compared to the group with ALT N, there was a statistically significant association between elevated ALT and both elevated BMI and premature delivery. Conclusions: In this cohort there is an association between GDM and increased ALT. There is also an association between elevated ALT and increased BMI and premature. These groups should be treated as high risk pregnancies.