Connolly Hospital

This is the second of two articles presenting the European Crohn's and Colitis Organisation [ECCO] evidence‑based consensus guidelines on the management of adult patients with ulcerative colitis [UC]. The first article covers the medical management of UC, including acute severe colitis. The present article addresses the surgical management of medically refractory UC, including the general surgical approach and perioperative optimisation, surgical strategies and techniques, and recommended levels of centre expertise and surgical specialisation. Together, these two articles aim to inform shared decision‑making and to guide clinicians and healthcare professionals involved in the care of patients with UC, drawing on the best available evidence.

The Objective Structured Clinical Examination (OSCE) first appeared as a title and as an acronym in 1979. It has now become a worldwide phenomenon with almost 3,200 related publications reported in PubMed to date. Prior to its introduction, there were very real concerns regarding Objectivity, Validity and Reliability of prior clinical assessment methods and the overall fairness to students on their assessment of clinical competence. Variations and applications in other allied clinical sub-specialties and non-allied, have now emerged on the method. In addition, numerous psychometric papers have resulted. However, very little in reference to its precise origin has been accurately reported. What has been reported thus far, in some otherwise excellent publications, has been significantly incorrect. A combination of the Steeplechase Examination method, a joint paper from the University of Dundee and the University of Glasgow, and a dissertation for a Diploma in Educational Technology by the author, has resulted in what has now become the globally recognised term: OSCE. The detailed evidence-based narrative of its true origins and its Irish connections to The Royal College of Surgeons in Ireland (RCSI) in this paper summarises the preceding two years of academic endeavour in Dundee prior to its publication debut in January 1979.

BACKGROUND:Cardiopulmonary exercise testing (CPET) assesses physiological responses to incremental exercise and identifies potential causes of exercise limitation. There have been several population-specific reference equations published, but none that span the human age range. It would be advantageous to have all-age global reference ranges. This task force aimed to derive Global Lung Function Initiative reference equations for peak oxygen uptake (V̇ O2 peak) and peak work rate (Wpeak) in healthy individuals. METHODS:CPET data were collected retrospectively. Generalised additive models of location, shape and scale were used to develop reference ranges, including age, sex, height and weight as explanatory variables. The influence of geographic region, equipment, testing protocols and averaging methods for peak exercise data were also examined. RESULTS:Data from 5956 healthy individuals aged between 6 and 83 years across 17 sites in Europe, North and South America and Asia were analysed. There was substantial between-subject variability in both V̇ O2 peak and Wpeak, with wide confidence intervals across age groups. Heterogeneity in V̇ O2 peak was related to geographic region, metabolic cart type, and averaging methods for peak exercise values. Controlling for these variables improved model fit, but not sufficiently to be reliable predictors for reference ranges. CONCLUSION:Significant heterogeneity in CPET testing methodology and outcomes between sites precluded the development of reference ranges for V̇ O2 peak and Wpeak. This task force has developed a framework for prospective data collection with strictly standardised protocols and centralised data analysis to reduce variability and establish robust, clinically meaningful reference ranges for CPET outcomes.

In this study, we surveyed Irish dermatologists and highlight that the majority lack formal training in psychodermatology but are cognisant in recognizing mental health issues in patients with chronic dermatological diseases. Access to psychology remains significantly limited and there is an urgent need for interdisciplinary collaboration and standardization of referral pathways to bridge the gap between dermatology, psychology and psychiatry in Ireland.