99

This Month IMJ Commentary

100

Eradicating Low Value Medical Care

1867 ˜ Established ˜

Original Papers 102

Paediatric Type 1 Diabetes in Ireland – Results of the First National Audit CP Hawkes, NP Murphy

105

Arrest in Hospital: A Study of in Hospital Cardiac Arrest Outcomes NK Fennelly, C Mc Phillips, P Gilligan

107

Distance as a Risk Factor for Amputation in Patients with Diabetes: A Case-Control Study D Gallagher, V Jordan, P Gillespie, J Cullinan, S Dinneen

110

Outpatient Parenteral Antimicrobial Therapy: A Report of Three Years Experience L Glackin, F Flanagan, F Healy, DM Slattery

112

Consultant and Trainee Attitudes Towards Supervision of Operative Procedures in the UK and Ireland BJ O’Neill, KS Rankin, LN Banks, ZJ Daruwalla, AP Sprowson, DP Robinson, MR Reed, PJ Kenny

Short Report 115

Official Journal of the Irish Medical Organisation

An Audit of Smoking Prevalence and Awareness of HSE Smoking Cessation Services among HSE Staff C ÓhAiseadha, M Killeen, F Howell, J Saunders

Case Report 116

Irish Medical

Journal APRIL 2014 Volume 107

■

Number 4

Pulmonary Langerhans Cell Histiocytosis M Kooblall, S Hamad, E Moloney, SJ Lane

117

Spinal Cord Stimulation in Pregnancy with Failed Back Surgery Syndrome B Das, C McCrory

Research Correspondence 118

An Audit of the Management of Thyroid Disease in Children with Down Syndrome K King, CS O’Gorman, S Gallagher

120

Sialoendoscopy in the Management of Salivary Gland Disorders – 4 Years Experience W Hasan, A Curran

121

Does Eliminating Fees at Point of Access Affect Irish General Practice Attendance Rates in the Under 6 Years Old Population? A Cross Sectional Study at Six General Practices W Behan, D Molony, C Beame, W Cullen

Occasional Piece 123

The Romano-Ward Syndrome – 1964–2014: 50 Years of Progress EC Hodkinson, AP Hill, JI Vandenberg

Letters to the Editor 98

BIPAP – Too Little, Too Late? S Oh, G O’Carroll, A Akintola, D Byrne

124

Intrathecal Baclofen Therapy A Khan

125

General Practice, Multimorbidity and Evidence Based Policy Making: A Key Challenge ME Murphy, L Glynn, AW Murphy

127

Continuing Professional Development

98

Letter to the Editor

BIPAP – Too Little, Too Late? Sir, Life-saving treatment for acute respiratory failure (ARF) traditionally mandated endotracheal intubation and positive pressure ventilation. However, this method of mechanical ventilatory assistance has its complications; hence the use of noninvasive ventilation (NIV) has emerged in recent times to become the preferred treatment modality1. The success of NIV depends on careful selection of patients who meet the well-established criteria for NIV and demonstrate no contraindications. Previous studies have shown that application of NIV on patients with an acute exacerbation of COPD may reduce the risk of intubation by almost 70%2.

Irish Medical Journal April 2014 Volume 107 Number 4 www.imj.ie

We conducted a local investigation on the administration of NIV in the form of Bi-level Positive Airway Pressure (BIPAP) in an acute general hospital. We sought to determine if BIPAP was initiated on patients according to standard guidelines and to examine their outcomes. Patients commenced on BIPAP were identified from the Coronary Care Unit (CCU) logbook. Their medical charts were

then sourced from the Hospital Inpatient Enquiry and a predesigned questionnaire based on the British Thoracic Society guidelines3 was completed for each of them. There were 21 patients who received BIPAP treatment from 1st October to