The Journal of the Irish Practice Nurses Association

The Journal of the Irish Practice Nurses Association
The Journal of the Irish Practice Nurses Association
                                          Issue 2 Volume 3 March / April 2010

                                                  Lung cancer:
                                                  risk factors,
                                                 and diagnosis
                                                               Eileen Byrne

                A practical guide
              to the CervicalCheck
              call/re-call process
                      Carrie Powles
                     Niomh McCollam

significance of         meningitis and
fat quality of          meningococcal              Osteoporotic
our diet                disease                    fractures
Dr Patricia Heavey      Lisa M Slattery            Melanie Fox
The Journal of the Irish Practice Nurses Association
The Journal of the Irish Practice Nurses Association

What a pity that some
GPs insist on retaining
their old ‘territory’

              espite the demise of the Celtic Tiger there are some very positive
              developments of late.
                The National Cancer Screening Service's colorectal screening process
              has started its selection process. Mary Harney has decided to reverse
              her previous decision not to go ahead with the cervical cancer vaccine
programme. The HPV vaccine will soon be available to around 30,000 first year
secondary schoolgirls, free of charge. The minister has also launched guidelines for
quality assurance in cervical screening.
   Also on a positive note, the National Screening Service is considering the
introduction of a triage system of HPV testing for women with abnormal smear
test results. All of this is very positive, however, in the midst of all these positive
developments I was disappointed to spot the following headline: 'Death by a
thousand cuts' by Dr Muiris Houston in the new fortnightly newspaper – the
Medical Independent. Dr Houston’s article went on at length about all the hard work
general practitioners carry out with little thanks from the Government and little
negotiation over fees.
   His article also bemoans the future shortage of GPs :“a shortage of over 300
GPs by 2021”...(Medical Independent Issue 3 Vol. 1 p 29) “..the more astute GPs
have realised what the collective agenda is: turn doctors into employers, expand
nurse prescribers and encourage them to take over much of what doctors do”...he
finished his attack by encouraging GPs to “stand up and shout stop”.
   His article returned us to the old professional territorialism about who does what
and who ultimately maintains power. Until we all settle down and become more
patient/people focused, disharmony will prevail.
   During the worst period in the history of Irish healthcare for doctors, patients and
nurses alike, practice nurses have become an eminently reliable and responsible
   We were there for the swine flu, for the National Cervical Screening Programme,
for the childhood vaccination programme 6 and 1, for the PCV catch-up
programme, for the heart watch programme...
   I didn't hear many of our GP colleagues mouthing Muiris’s “Stop!” in relation to
the above.

Darina Lane

The Journal of the Irish Practice Nurses Association
Once-daily Victoza® (liraglutide), in combination with metformin,
                                                                                                         impacts on multiple factors associated with type 2 diabetes
                                                                                                         providing, from baseline:1,2

                                                                                                               Reductions in HbA1c: up to 1.30%1,2
                                                                                                               Reductions in weight: up to 2.8kg1,2
                                                                                                               Reductions in systolic blood pressure1,2
                                                                                                               Improvements in beta-cell function1,2

Abbreviated Prescribing Information                                                     Hypersensitivity to the active substance or any of the excipients. Warnings and       distension, dyspepsia, gastritis, flatulence, gastroesophageal reflux disease,
Victoza® 6 mg/ml solution for injection in pre-filled pen (liraglutide). Please refer   Precautions for use: Victoza® should not be used in patients with type 1              gastroenteritis viral, toothache, headache, dizziness, nasopharyngitis, bronchitis,
to the Summary of Product Characteristics for full information. Victoza® 2 x 3 ml       diabetes mellitus or for the treatment of diabetic ketoacidosis. Limited experience   anorexia, appetite decreased, fatigue and pyrexia. Gastrointestinal adverse
pre-filled pens. Victoza® 3 x 3 ml pre-filled pens. 1 ml of solution contains 6 mg      in patients with congestive heart failure New York Heart Association (NYHA)           reactions are more frequent at start of therapy but are usually transient. Very
of liraglutide. Indication: Treatment of adults with type 2 diabetes mellitus in        class I-II and no experience in patients with NYHA class III-IV. Due to limited       few hypoglycaemic episodes observed other than with sulphonylureas. Patients
combination with metformin or a sulphonylurea, in patients with insufficient            experience Victoza® is not recommended for patients with inflammatory bowel           >70 years or with mild renal impairment (creatinine clearance ≤ 60-90 ml/min)
glycaemic control despite maximal tolerated dose of metformin or sulphonylurea          disease and diabetic gastroparesis. Victoza® is associated with transient             may experience more gastrointestinal effects. Consistent with medicinal products
monotherapy; or in combination with metformin and a sulphonylurea, or                   gastrointestinal adverse reactions, including nausea, vomiting and diarrhoea.         containing proteins/peptides, patients may develop anti-liraglutide antibodies
metformin and a thiazolidinedione in patients with insufficient glycaemic control       Other GLP-1 analogues have been associated with pancreatitis; patients should         following treatment but this has not been associated with reduced efficacy of
despite dual therapy. Dosage: Victoza® is administered once daily by                    be informed of symptoms of acute pancreatitis: persistent, severe abdominal           Victoza®. Few cases reported of angioedema (0.05%), acute pancreatitis
subcutaneous injection and can be administered at any time independent of               pain. If pancreatitis suspected, Victoza® and other suspect medicinal products        (65 years old) without dose         pregnancy occurs, treatment with Victoza® should be discontinued; use of insulin      Limited, 3-4 Upper Pembroke Street, Dublin 2, Ireland;
adjustment but therapeutic experience in patients ≥75 years of age is limited.          is recommended instead. Undesirable effects: During clinical trials with              Date created: July 2009
No dose adjustment is required for patients with mild renal impairment                  Victoza® the most frequently observed adverse reactions which varied according
(creatinine clearance ≤60-90 ml/min). Due to lack of therapeutic experience             to the combination used (sulphonylurea, metformin or a thiazolidinedione) were:
Victoza® is not to be recommended for use in patients with moderate (creatinine         Very common: nausea, diarrhoea, hypoglycaemia when used in combination with                 Information about adverse event reporting is available at
clearance of 30-59 ml/min) and severe renal impairment (creatinine clearance            metformin and a sulphonylurea and headache when used in combination with                 Adverse events should be reported to the Novo Nordisk Medical department:
below 30 ml/min), patients with end stage renal disease, patients with hepatic          metformin; Common: hypoglycaemia when used in combination with a                                                     Tel: 1850 665 665.
impairment and children below 18 years of age. Contraindications:                       thiazolidinedione, vomiting, constipation, abdominal pain, discomfort and

                                                                                                                                                                                          Further Information is available from:
References: 1. Victoza® Summary of Product Characteristics, July 2009.                                                                                                                                    Novo Nordisk Limited
2. Nauck M et al; for the LEAD-2 Study Group. Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin,                                            3/4 Upper Pembroke Street
in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care 2009;32(1):84-90.                                                                                              Dublin 2, Ireland
                                                                                                                                                                                                               Tel: 01 678 5989
Victoza® is a trademark owned by Novo Nordisk A/S.                                                                                                                                                            Fax: 01 676 3259
                                                                                                                                                                                                          Lo Call: 1850 665 665
Date of preparation: July 2009. IR/LR/0709/0268                                                                                                                                                  
The Journal of the Irish Practice Nurses Association
The Journal of the Irish
     Practice Nurses
     Association                                                        Contents                     Issue 5 Volume  2 September
                                                                                                             Issue 2 Volume       / October2009
                                                                                                                            3 March  / April 2010

 1	Editorial                                                            	Review
 4        News                                                          15      Meningitis and meningococcal
 12       Branch news                                                           disease – adults get it too
                                                                        	Lisa M Slattery
                                                                        22	Lung cancer: risk factors,
                                                                            presentation and diagnosis
                                                                        	Eileen Byrne
                                                                        28      A practical guide to the
                                                                                CervicalCheck call/re-call process
                                                                        	Carrie Powles
                                                                          Niomh McCollam
                                                                        33	Osteoporotic fractures
                                                                                Melanie Fox
                                                                        40	Health significance of fat quality of
                                                                           our diet
                                                                        	Dr Patricia Heavey
                                                                        44      Allergy
                                                                        46	Gastroenterology
                                                                                Poster series
     Maura Henderson                                                    48      Maximising women’s health in
     Consulting Editors                                                         general practice
     Darina Lane and Ruth Morrow                                        	Claire Bourke, Margaret Geoghegan,
     Sub Editor                                                           Ruth Morrow and Margaret O'Reilly.
     Tim Ilsley                                                         50	Walking in to primary care
     Designer                                                           	Linda Latham
     Barbara Vasic
                                                                        51      Products
     Graham Cooke                                                       53      Crossword
     Maura Henderson

                        *GreenCross Publishing is a recently
                        established publishing house which is
                        jointly owned by Graham Cooke and
                        Maura Henderson. Between them Graham
                        and Maura have over 30 years experience
working in healthcare publishing. Their stated aim is to publish        Nursing in General Practice is published by
titles which are incisive, vibrant and pertinent to their readership.   GreenCross Publishing, Lower Ground Floor,
Graham can be contacted at                                              5 Harrington Street, Dublin 8.                                          Tel: 4789770 Fax: 4789764
Maura at                                                                Email:
                                                                        © Copyright GreenCross Publishing 2010
The views expressed in Nursing in General Practice are not              The contents of Nursing in General Practice are protected by copyright.
necessarily those of the publishers, editor or editorial advisory       No part of this publication may be reproduced, stored in a retrieval
board. While the publishers, editor and editorial advisory board        system, or transmitted in any form by any means – electronic,
have taken every care with regard to accuracy of editorial and          mechanical or photocopy recording or otherwise – whole or in part, in
advertisement contributions, they cannot be held responsible for        any form whatsoever for advertising or promotional purposes without
any errors or omissions contained.
                                                                        the prior written permission of the editor or publishers

The Journal of the Irish Practice Nurses Association
     nec news

      IPNA AWARDS 2010
                                                                          Mater Private
      The following Awards will be offered to members this year:
        IPNA Educational Bursary 2010 – closing date for entries is
      31st July 2010.
        Practice Nurse of the Year Award 2010 – closing date for
      branch nominations is 31st July 2010.                               The Mater Private Hospital, one of Europe’s leading hospitals,
        Valerie Mangan IPNA Loyalty Award 2010 – closing date             has become the first private hospital in the country to join the
      for branches to send names of members eligible to enter this        highly acclaimed online National Healthlink Project; a web-
      award is 31st July 2010.                                            based messaging service which allows the secure transmission
        Please see IPNA website and attend your upcoming branch           of patient information such as results and referrals over the
      meetings for further details on all awards.                         internet.
                                                                    already has over 1800 General Practitioners
      IPNA CONFERENCE/AGM 2010                                            around Ireland and brings significant benefits and efficiencies
      15th/16th October 2010, Ballybofey, Co Donegal – hosted by          to general practice including reducing both the length of
      the IPNA Donegal Branch.                                            time it takes to receive patients’ test results and the length of
                                                                          time spent contacting hospital departments, a reduction in
      POSTER DISPLAY                                                      administration and direct integration of results with practice
      If any current member created a poster that is relevant to          management systems.
      Practice Nursing within the last three years and would like to         GPs can now use Healthlink to send referrals electronically
      display it at the conference, please contact Lisa at admin@         to the Mater Private Specialist Breast Centre. The Mater Private to book a poster display board, before       Hospital’s Specialist Breast Centre offers a full range of services
      Monday 6th September 2010. Posters that have not been               including rapid access to triple assessment, diagnosis and
      pre-booked by this date cannot be accommodated at the               treatment for patients with breast cancer. Appointments are
      conference.                                                         confirmed by phone with the patient on day of referral receipt.
                                                                             Currently, for the Mater Private the range of services available
      2010 NEC MEETINGS                                                   to GPs using Healthlink include:
      Wednesday 12th May 2010 – Ashling Hotel, Parkgate Street,              •    Radiology Results
      Dublin 7 - please note this has changed from original date of 5th      •    Cardiology Results (first hospital to send this message
      May.                                                                        type)
        Wednesday 8th September 2010 - Ashling Hotel, Parkgate               •    Referral to the Mater Private Specialist Breast Centre
      Street, Dublin 7.                                                      •    Death and Discharge Notifications
        Friday 15th October 2010 at IPNA Conference in Jackson's
      Hotel, Ballybofey, Co Donegal.                                        It is planned to add additional services in the coming months
                                                                            •      Laboratory Results
      Lisa Nolan, IPNA Administrator                                        •      Outpatient Appointment Messages
      Lisa Nolan, IPNA Administrator.                                       •      Prostate Referrals
      Tel: 042-9692403                                                      •      Cardiology Referrals
      e-mail:                                  •      Diagnostic Imaging Referrals

    NUI Galway opens new nursing and midwifery library
    NUI Galway’s President, Dr James J. Browne, opened NUIG’s new
    Nursing and Midwifery Library on the 3rd February.
       The new library, which adjoins the James Hardiman Library
    on the main campus, provides a modern learning environment
    for over 700 nursing and midwifery students with group study
    rooms, computer suites, laptop-enabled study spaces, and wire-
    less access to the University’s networked services.
       The need for a new, purpose-built library was driven by
    changes in nursing education and the increase in student
    numbers, which resulted in greater pressure on space as well
    as a need for new types of learning resources. The new library
    has over 100 study places, and has been heavily used and much
    appreciated by students and staff since it opened.
       Over 700 nursing and midwifery students now have access
    to the full resources of the University Library, including a wide
    range of information sources and extensive opening hours, in
    a central location on campus. Previously, NUI Galway’s Nursing
    Library was located on the site of the former Nurses’ Home at          At the opening of the Nursing and Midwifery Library at NUI
    University College Hospital and it relocated temporarily to the        Galway were John Cox, Librarian, James Hardiman Library;
    IDA Business Park in Dangan in 2004.                                   Professor Kathy Murphy, Head of Nursing and Midwifery,
       The library was developed at a total cost of €2 million. Of this    NUI Galway; Dr James J. Browne, NUI Galway President;
    total, a sum of €1 million was provided by the Department of           Mary McHugh, Director of Nursing, GUH; and Keith
    Health and Children. The balance has been provided from the            Warnock, Vice-President for Capital Projects, NUI Galway.
    University’s own resources.

The Journal of the Irish Practice Nurses Association
CervicalCheck Smeartaker
training unit clinical updates
The Smeartaker Training            standards. The aim of the           Clinical update meeting           • 20 April Rochestown Park
Unit of CervicalCheck – The        Clinical Update Meetings is to    dates:                                Hotel, Rochestown, Cork
National Cervical Screening        provide advice and assistance     • 23 March Carlton Hotel,           • 21 April Desmond Suite,
Programme is holding a series      to GPs and practice nurses in       Dublin Road, Galway City            Thomond Park, Limerick
of CME accredited Clinical         applying the Guidelines to        • 25 March Bracken Court Ho-        • 28 April Tullamore Court
Update Meetings for Cervical-      practice and the management         tel, Balbriggan, Co Dublin          Hotel, O’Moore Street, Tul-
Check registered smeartakers       of quality smeartaking.           • 3 April Ramada Encore Ho-           lamore Co Offaly
(practice nurses and GPs) in          CervicalCheck Clinical           tel, Letterkenny, Co Donegal      • 28 April Ramada Viking Ho-
primary care.                      Updates also promote current      • 14 April Best Western Ais-          tel, Cork Road, Waterford
   The National Cancer             best practice in the taking and     ling Hotel, Parkgate Street,
Screening Service recently         management of quality smear         Dublin 8
launched ‘Guidelines for           tests and provide smeartak-       • 14 April Brehon Hotel, Kil-       Each meeting runs from
Quality Assurance in Cervical      ers with an opportunity to          larney, Co Kerry                  7.00-9.30pm and booking is
Screening’. The Guidelines         increase their knowledge and      • 14 April Cavan General Hos-       required. To book a place or for
will help ensure that women        understanding of Cervical-          pital, Cavan, Co Cavan            further information, contact
in Ireland receive a quality as-   Check. Each meeting will be       • 15 April Stillorgan Park          the Smeartaker Training Unit
sured screening service in line    followed by an in-depth ques-       Hotel, Stillorgan Road,           at or call
with the highest international     tion and answer session.            Dublin 18                         061-461146 / 461234.

Labour publishes Bill to control spread of
head shops and sex shops
The Labour Party has published        Under the terms of Labour’s    month, specific planning            expressed about the opening of
a draft Private Members Bill to    Planning and Development          permission would be required        both head shops and sex shops
restrict the spread of so-called   (Amendment) Bill, 2010, details   for a change of use of a premises   in locations that are particularly
‘headshops’.                       of which were published last      to open either a head shop or a     inappropriate, such as close to
                                                                     sex shop.                           schools.
                                                                         According to Ms Jan                “These shops are selling
                                                                     O’Sullivan TD, Labour Spokes-       products which are not covered
                                                                     person for Health: “The proprie-    by the Misuse of Drugs Act, but
                                                                     tor of a grocery store, takeaway    which clearly mimic illegal drugs
                                                                     or internet café must apply and     and have damaging physical
                                                                     obtain planning permission to       and psychological effects on
                                                                     open for business. However, that    those who consume or inject
                                                                     same owner or a new owner           those products. Because these
                                                                     can then decide to convert the      shops are not illegal but are
                                                                     premises into a head shop or        unlicensed and unregulated and
                                                                     a sex shop overnight without        can sell their products to minors
                                                                     even having to apply to the local   as well as adults there is serious
                                                                     authority for planning permis-      concern in local communities at
                                                                     sion for change of use. In effect   the failure of the authorities to
                                                                     there is nothing to stop a person   take action.”
                                                                     from seeking and securing plan-        Ms O’Sullivan added that the
                                                                     ning permission to open a sweet     Bill was not a total solution to
                                                                     shop and then, overnight, turn-     the problem of head shops, as
                                                                     ing it into a head shop. Because    this would require the banning
                                                                     no specific planning permission     of the dangerous substances on
                                                                     is required for change of use       sale in these outlets, which she
                                                                     from one existing retail function   said was “a complex and difficult
                                                                     to another, members of local        procedure which may take
                                                                     communities have no opportu-        some time”. However, she said
                                                                     nity whatsoever to express any      it offered “an interim solution
                                                                     concerns they might have.”          that would, if enacted, at a very
 Jan O’Sullivan, Labour Spokesperson for Health is                       Ms O’Sullivan added that        minimum restrict the further
 seeking to restrict the spread of headshops                         particular concern had been         spread of these outlets.”

The Journal of the Irish Practice Nurses Association
    Continuing education in caring for
    children with life-limiting conditions
    A Palliative Care Needs Assessment for Children (Department             symptom assessment and management, and ethical perspectives.
    of Health and Children and Irish Hospice Foundation, 2005),             There is no fee for this programme. The programme dates for
    identified the “substantial need for further education and training     2010 are:
    for all professionals involved in caring for children with life-          24th March	Red Cow Moran Hotel, Dublin
    limiting conditions”. There are over 1,300 Irish children who live        3rd June           Claregalway Hotel, Galway
    with a life-limiting illness and between 350 and 400 children die         7th September Hotel Kilmore, Cavan
    each year prior to their 18th birthday.                                   2nd November 	Red Cow Moran Hotel, Dublin
       The report states that all providers of care for children with
    life-limiting conditions should have an opportunity to acquire          Seven Day Programme
    additional knowledge, experiences and skills to assist them, as         The seven day Level B programme is a more in-depth
    they support these children and their families.                         programme for registered nurses and midwives directly involved
       In response to this, two programmes are managed and co-              in caring for children with a life-limiting condition. The aim is
    ordinated by the Centre of Children’s Nurse Education in Our            to further develop the knowledge, skills and attitudes required
    Lady’s Children’s Hospital, Crumlin (OLCHC) and are funded by           to enhance each child’s quality of life through meeting his /her
    the Irish Hospice Foundation. A one day awareness programme             identified needs and to provide supportive and palliative care for
    – Caring for the Child with a Life-Limiting Condition Level A and       these children and their families. The programme is facilitated in
    a seven day continuing education programme – Caring for the             the Centre of Children’s Nurse Education at Our Lady’s Children’s
    Child with a Life-Limiting Condition Level B. Both programmes           Hospital, Crumlin. Again there is no fee for this programme and
    have An Bord Altranais Post Registration Category 1 approval            a bursary of up to €500 is available to support the participant’s
    (Feb. 2010).                                                            attendance. The programme dates are:
                                                                               Summer           April 19, 20, 27 and May 4, 11, 18, 25.
    One Day Awareness Programme                                                Autumn           September 13, 14, 21, 28 and October 5, 12, 19.
    The one day Level A awareness programme is for nursing                     Winter           November 10, 11, 17, 24 and December 1, 8, 15.
    and medical personnel, palliative care specialists (nursing and            Nurses, midwives and other healthcare professionals are invited
    medical), psychologists, social workers and other personnel             to attend either or both of these programmes. Early booking is
    from various voluntary and statutory organisations who are              advisable as places are limited.
    occasionally required to provide care for children with life-limiting
    conditions and their families                                           For further details and bookings please contact Fiona Woods,
       Topics addressed include healthcare provision for these              Programme Co-ordinator.
    children, supporting social and psychological needs, pain and           Phone: 01 4096605 and 087 7455952 or Email:

    Workshop on female genital mutilation
    “A practise that hurts is           and girls have undergone FGM
    unacceptable” was the               worldwide. It is estimated
    message delivered at a recent       that 500,000 women victims
    workshop on female genital          of FGM live in Europe while
    mutilation held in the Menlo        the estimate for Ireland is
    Park Hotel Galway.. The aim of      approximately 2,600.
    the workshop was to explore            The Irish National Action
    the effects of FGM and              Plan (NAP) to address FGM
    how men and women from              was launched in November
    communities in which FMG            2008. To date AkiDwA, the
    is practised can contribute         African and migrant women’s
    to the European and global          network has developed
    campaign to end FGM.                support for healthcare
       Speaking in advance of           professionals by providing
    the meeting, the Consortium         materials, information,
    of International Women              research, lectures and training     the new legislation that          greater support and solidarity
    Leaders – a group that has          to enhance knowledge.               prohibits children being          among all parties and those
    been established by active          The organisation has, and           taken outside Ireland for the     who are committed to human
    African women leaders,              continues to, deliver training      procedure.                        rights.
    extended their support: “We         to students, midwives and              With financial support            AkiDwA is also a partner
    believe both men and women,         social workers and has been         from the HSE, AkiDwA is           with Amnesty International
    especially those from our           calling for legislation in          also progressing with the         Ireland in Amnesty's European

    own communities should be           Ireland to prohibit FGM. The        implementation of the health      Campaign to end FGM.
    heavily involved in efforts to      organisation is also calling        aspects of NAP. Speaking at       For further information contact:
    end FGM .”                          for the introduction of an          the meeting Salome Mbugua,        Salome Mbugua, AkiDwA, 9B
       Over 140 million women           extraterritorial element into       Director of AkiDw, called for     Lower Abbey Street, Dublin 1.

The Journal of the Irish Practice Nurses Association
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The Journal of the Irish Practice Nurses Association
    Colorectal Cancer Screening Hot topics in renal medicine
    Programme approved          Abbott Educational Day for nurses
    The National Cancer Screening      screening for this age group
    Service (NCSS) today wel-          on a two yearly cycle using
    comed receipt of approval to       the faecal immunochemical
    proceed with the introduction      test (FIT) which operates on an
    of a national population-based     automated testing platform,
    colorectal cancer screening        as the primary screening tool.
    programme for men and              This will be one of the first in-
    women in Ireland.                  ternational population-based
       At a joint press conference     screening programmes for
    with the NCSS, the Minister for    colorectal cancer that utilises
    Health and Children, Ms Mary       this technology as the primary
    Harney TD, today announced         screening tool.
    approval of the NCSS to               In order to develop capac-
    commence preparation and           ity to implement a screening
    implementation of Ireland’s        programme for the full 55-74
    first colorectal cancer screen-    population, the programme           Abbott recently sponsored the fourth annual Renal Nurse Study
    ing programme.                     will be implemented on a            Day, educating nurses in Ireland on the latest trends in renal
       The incidence of colorectal     phased basis starting with men      care. Dr Joe Eustace, Consultant Nephrologist, Cork University
    cancer increases with age and      and women aged 60-69. Fifty         Hospital, spoke to about 60 senior renal nurses about recent
    the highest rate of incidence is   per cent of all cases of colorec-   developments in cardio-renal syndrome.
    among men and women aged           tal cancer in the 55-74 year age      The event was Abbott’s fourth annual Renal Care Study Day,
    55-74. The NCSS has recom-         group are diagnosed in men          providing a strong platform for the discussion of hot topics in
    mended the introduction of         and women aged 60-69.               renal nursing to an audience of approximately 60 senior renal
                                                                           nurses. The objective of the study day was to educate renal
                                                                           nurses on improvements in renal care and advances in this area
    First 2010 meeting of the Roche                                        of medicine. Abbott's dedicated renal care business provides

    Rheumatoid Arthritis Academy
                                                                           products aimed at improving the lives of patients living with
                                                                           renal disease.

                                                                            Mind your head
                                                                           Kerry Councillor Michael Healy Rae swapped his trademark
                                                                           cap for a cycling helmet to raise awareness of the importance
                                                                           of wearing protective headgear in preventing head and
                                                                           brain injuries. The safety message was issued during Brain
                                                                           Awareness Week which ran from 8th – 14th March 2010.

    Mary Breen (Clinical Nurse Specialist, Beaumont Hospital),
    Clara Bannon (Acting Clinical Nurse Specialist, Connolly
    Memorial Hospital), Sandra Griffin (Staff Nurse, Connolly
    Memorial Hospital) and Miriam Molloy (Clinical Nurse
    Specialist, St. Vincent’s University Hospital).

     Ann Maria Curran
        (Clinical Nurse
     Specialist, Merlin
         Park Hospital
     Galway) and Trish
       Bewley (Clinical
      Nurse Specialist,                                                     Kerry Councillor Michael Healy Rae with Lucia Power,
        Galway Clinic).                                                     Regional Manager with Acquired Brain Injury Ireland.

Onbrez - fast action                        ®

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                                                                                                                       tiotropium provides
                                                                                                                       •5 minute rapid onset of action 1,6
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Please refer to Summary of Product Characteristics (SmPC) before prescribing.
Presentation: Onbrez Breezhaler 150mcg and 300mcg inhalation powder hard capsules containing indacaterol maleate, and separate Onbrez Breezhaler inhaler. Indications: For
maintenance bronchodilator treatment of airflow obstruction in adult patients with chronic obstructive pulmonary disease (COPD). Dosage and administration: Recommended dose is the
inhalation of the content of one 150mcg capsule once a day, administered at the same time of the day each day, using the Onbrez Breezhaler inhaler. Capsules must not be swallowed.
Dose should only be increased on medical advice. The inhalation of the content of one 300mcg capsule once a day has been shown to provide additional clinical benefit with regard to
breathlessness, particularly for patients with severe COPD. Maximum dose is 300mcg once daily. No dose adjustment required in elderly patients, for patients with mild and moderate
hepatic impairment or for patients with renal impairment. No data available for use in patients with severe hepatic impairment. No relevant use in the paediatric population.
Contraindications: Hypersensitivity to the active substance, to lactose or to any of the other excipients. Warnings/Precautions: Asthma: ◆ONBREZ BREEZHALER SHOULD NOT BE USED
IN ASTHMA. Paradoxical bronchospasm: ◆If paradoxical bronchospasm occurs Onbrez Breezhaler should be discontinued immediately and alternative therapy substituted. Deterioration
of disease: ◆Not indicated for treatment of acute episodes of bronchospasm, i.e. as rescue therapy. Systemic effects: ◆Indacaterol should be used with caution in patients with
cardiovascular disorders (coronary artery disease, acute myocardial infarction, cardiac arrhythmias, hypertension), in patients with convulsive disorders or thyrotoxicosis, and in patients
who are unusually responsive to beta 2 -adrenergic agonists. Cardiovascular effects: ◆Indacaterol may produce a clinically significant cardiovascular effect in some patients as measured
by increases in pulse rate, blood pressure, and/or symptoms, ECG changes. In case such effects occur, treatment may need to be discontinued. Hypokalaemia: ◆ Beta 2 -adrenergic
agonists may produce significant hypokalaemia in some patients, which has the potential to produce cardiovascular effects. In patients with severe COPD, hypokalaemia may be potentiated
by hypoxia and concomitant treatment which may increase the susceptibility to cardiac arrhythmias. Hyperglycaemia: ◆Inhalation of high doses of beta 2 -adrenergic agonists may produce
increases in plasma glucose. Upon initiation of treatment with Onbrez Breezhaler plasma glucose should be monitored more closely in diabetic patients. ◆During clinical studies, clinically
notable changes in blood glucose were generally more frequent by 1-2% on Onbrez Breezhaler at the recommended doses than on placebo. Onbrez Breezhaler has not been investigated in
patients with not well controlled diabetes mellitus. Pregnancy and Lactation: ◆No data available from the use of indacaterol in pregnant women. Onbrez Breezhaler should only be used
during pregnancy if the expected benefits outweigh the potential risks. ◆Not known whether indacaterol / metabolites are excreted in human milk. A decision must be made whether to
discontinue breast-feeding or discontinue Onbrez Breezhaler therapy, taking into account the benefit of breast-feeding for the child and the benefit of therapy for the woman. Interactions:
◆Concomitant administration of other sympathomimetic agents may potentiate the undesirable effects of Onbrez Breezhaler. Onbrez Breezhaler should not be used in conjunction with
other long-acting beta 2 -adrenergic agonists or medicinal products containing long-acting beta 2 -adrenergic agonists. ◆Concomitant hypokalaemic treatment with methylxanthine
derivatives, steroids, or non-potassium-sparing diuretics may potentiate the possible hypokalaemic effect of beta 2 -adrenergic agonists, therefore use with caution. ◆Indacaterol should not
be given together with beta-adrenergic blockers (including eye drops) as these may weaken or antagonise the effect of beta 2 -adrenergic agonists. Where required, cardioselective
beta-adrenergic blockers should be preferred, although they should be administered with caution. ◆Inhibition of the key contributors of indacaterol clearance, CYP3A4 and P-gp, does not
raise any safety concerns given the safety experience of treatment with Onbrez Breezhaler. ◆Indacaterol has not been shown to cause interactions with co-medications. Adverse reactions:
◆The most common adverse reactions with Onbrez Breezhaler are: nasopharyngitis, upper respiratory tract infection, sinusitis, diabetes mellitus and hyperglycaemia, headache, ischaemic
heart disease, cough, pharyngolaryngeal pain, rhinnorrhoea, respiratory tract congestion, muscle spasm, peripheral oedema. ◆Uncommon: paraesthenia, atrial fibrillation and non-cardiac
chest pain. ◆Please refer to SmPC for a full list of adverse events for Onbrez Breezhaler. Legal Category: POM Pack sizes: Carton containing 30 capsules (3x10 capsule blister strips) and
one Onbrez Breezhaler inhaler. Marketing Authorisation Holder: Novartis Europharm Limited, Wimblehurst Road, Horsham, West Sussex, RH12 5AB, United Kingdom. Marketing
Authorisation Numbers: EU/1/09/593/002 & 007. Full prescribing information is available on request from Novartis Ireland Ltd, Beech Hill Office Campus, Clonskeagh, Dublin 4. Tel: 01
2601255 or at Date of Creation of API Text: Jan 2010 Date of Preparation: Feb 2010 NO1109471 References: 1. Balint et al. (ERS Poster) 2009. 2. Dahl et al. (ERS
poster) 3. Kornmann et al. (Chest Poster) 2009 4. Fogarty et al. (ERS Poster) 2009 5. Onbrez Breezhaler SmPC 6. Spiriva® HandiHaler® SmPC 7. Mahler et al. (ERS Poster) 2009
* INHANCE Study comparitor Open Label Tiotropium
     Irish pump €86m                                                                               Ronnie Whelan walks
                                                                                                   for Myasthenia Gravis
     into illicit medicines                                                                        Former Ireland International footballer,
                                                                                                   Ronnie Whelan, has announced his plans
                                                                                                   to take part in a 130km walk around
     More than 600,000 Irish people have             offer (6.5 per cent); or in a nightclub/pub   Ireland in an effort to raise awareness of
     admitted to buying prescription only            (2 per cent.).                                Myasthenia Gravis.
     medicines from illegal sources according           The report also revealed that the             Ronnie Whelan is patron of the
     to new research.                                counterfeit medicines market in Ireland       Myasthenia Gravis Association, and
        The Cracking Counterfeit Europe report       may be worth more than €86 million a          he became aware of the disease
     commissioned by Pfizer and published            year contributing to the €10.5 billion        when Elizabeth was diagnosed in
     last month, revealed that one in five or        European wide black market.                   2005. Myasthenia Gravis (MG) is an
     21 per cent of 1,000 people in Ireland             Until now putting a value on the size      auto-immune disease, which causes a
     surveyed admitted to buying prescrip-           of the counterfeit medicines market in        breakdown between nerves and muscles,
     tion only medicines from illicit sources.       Ireland has been difficult. However, the      and results in loss of effectiveness in the
        Worryingly, the results suggest that         ‘Cracking Counterfeit Europe’ research        muscles of the arms, legs and eyes
     thousands of Irish people are turning           revealed that a massive black market             ‘Ronnie Whelan’s Rocky Road to Dublin
     to the internet to buy medicines that           economy is generated by counterfeit           Walking Challenge’ takes place from 29th
     should be prescribed by a healthcare            medicines. This comes just weeks after        April – 4th May and will cover four stages:
     professional – despite the fact that it has     Gunter Verheugen, Vice-President of           The Western Way, Slieve Bloom Moun-
     been estimated that between 50 and              the European Commission, announced            tains, Kevin’s Way in Glendalough and the
     90 per cent of medicines bought online          that 34 million fake tablets had been         coastal route from Greystones to Dublin.
     are fake. According to the report, other        seized on European borders in just two           Walkers can choose to join Ronnie in
     sources where people are purchasing             months. The number of counterfeit             all stages of the challenge, or join him
     prescription medicines without prescrip-        medicines uncovered at EU borders             on one of the stages as he walks across
     tion include overseas or on holidays            has increased from 560,598 in 2005 to         Ireland.
     (16.6 per cent); through a friend (12 per       4,081,056 in 2007 – a seven-fold increase     Eager walkers can visit
     cent); in response to an email or spam          over two years.                               for more details and registration forms.

     Need for patient information tools
     after prostate cancer diagnosis
     Some 72% of prostate cancer patients            on behalf of Astellas Pharma Co.Ltd           other resources useful, mainly because
     felt the effect on their lifestyle was the        87% of patients rely solely on their        of the language used can be difficult to
     most important factor when diagnosed            specialist to provide information with        comprehend.
     but 56% of those did not speak to their         remaining numbers seeking further                In response to the survey results
     specialist about it at the time of diagnosis,   knowledge through websites or books           Astellas Pharma Co.Ltd have
     according to a recent survey, carried out       but only 10% found website and 3% find        developed the website www.
                                                                                                   provides a post diagnosis information
                                                                                                   tool for patients.
                                                                                                      “The website is an excellent aid for
                                                                                                   patients who can be overwhelmed when
                                                                                                   they are first diagnosed. It will help
                                                                                                   patients and their family members review
                                                                                                   the condition, treatments and expected
                                                                                                   lifestyle changes they may incur. It will be
                                                                                                   useful for patients to be able to digest the
                                                                                                   information given and help them prepare
                                                                                                   further questions for their subsequent
                                                                                                   consultations” said Mr Paul Sweeney,
                                                                                                   consultant oncologist Mercy University
                                                                                                      Entitled “Silent Voices”, the survey
                                                                                                   took place in France, Italy, Spain, Poland,
                                                                                                   Germany and Ireland and researched 50
      At the launch of were Jim Scott,                         prostate cancer patients in each country.
      chairman of MAC (Men Against Cancer); Olwyn Ryan, Irish Cancer Society;                      It was undertaken in Ireland with the
      Ms Aine Brady TD, Minister for Older People and Health Promotion; Dublin                     support of St. James’s Hospital Oncology
      football star of the ‘90’s Charlie Redmond and John Dowling, MAC.                            Dept, Mercy University Hospital Oncology
                                                                                                   Dept and MAC (Men Against Cancer).

Readers offer
In a world of drab and generic medical uniforms, what’s a
fashionista nurse to wear?
   Happythreads is supplying the koi range of boutique
scrubs, the Hejco range of tunics and Alegria ergonomic
footwear. They have recently launched their website www., which offers a easy to use and fun method
of purchasing and personalising uniforms online.
   Designed in California, the koi range of uniforms is made
from a hardwearing, yet easy care, soft poly-cotton twill.
With a great choice of colours and styles for both women
and men and trousers that come in different styles and leg
lengths every size and shape can get the correct fit. When
people feel the soft fabric of the koi scrubs they fall in love
with them, they don’t require ironing and hold onto their
shape and colour very well. Happythreads is the exclusive
distributer for koi in Ireland and the UK and are currently
negotiating with Medical suppliers and retail outlets to
supply the uniforms.
   New to Ireland are the Alegria range of ergonomic
footwear designed for people who spend long hours on
their feet. They feature a heavenly footbed padded with latex
and memory foam and a rocker outsole reducing heal and
metatarsal pressure.                                                the koi Katelyn top in Navy and Karlie trousers. We just loved
   Happythreads also provide an embroidery service with a           the soft fabric and feminine tailoring of the Katelyn top. The
range of specially designed logos and will also embroider           surgeons and doctors went for the koi steel grey Maxx top.
specific practice names and logos. The embroidery service is        Our logo is shocking pink and came out really well on the
undertaken in Ireland, adding real value to the products.           steel and navy uniforms”
   “Happythreads organised all the sizes we needed to allow           Happythreads are offering readers of Nursing in General
the staff to get the correct fit,” said Lorraine Power, Clinical    Practice a special discount of 10% for the month of April,
Nurse Manager of the Eccles Street Clinic. “The girls ordered       please use promocode nurse10 when ordering online.

Anna May Driscoll                                                   Practice Nurse required
Foundation                                                         Practice nurse required for our
Presentation                                                       Dublin 7 general practice
                                                                   Approx 30+ hours in fully computerized surgery,
                                                                   previous practice nurse experience desirable.

                                                               Please email CV to or
                                                               call practice manager on 0871251815 for further information.

                                                                    Practice Nurse required
                                                           2-3 mornings per week
                                                           (extending to more sessions depending on demand )
                                                           Skills required: phlebotomy, ECG, spirometry, ability to do
                                                           dressings, smeartaking, travel vaccinations.
Sharon Cassidy, Staff Nurse, Theatres at                   I am also interested in extending the role of a suitable candidate to
Galway University Hospitals, recipient                     perform the following: microdermabrasion, laser hair removal, after
of the inaugural Learning Bursary from                     appropriate mentoring and training.
the Anna May Driscoll Foundation with
Damien Dyar, Emerge Education, the                         Experience essential.
company which established the Anna May
Driscoll Foundation.                                       Please send CV to

regional news
                                          N ews f o r I P N A b r anches c o unt r ywide

     Aine Lally
     As always our monthly meetings are held in the lovely Old Ground Hotel in Ennis on the third Tuesday of every month. We are really
     hoping this year the attendance will improve as the meetings prove an invaluable way to share and discuss any relevant issues. Practice
     nursing can be quite isolating so we do feel it is imperative for as many as possible to attend. It is also such a lovely get together.
        At the January meeting Carol McNamara and Elaine Buckley gave us great updates and answered many questions on the latest Cer-
     vicalCheck programme. All in all it all seems to be going well.
        For the February meeting, Hilda Clarke, diabetic nurse specialist at Portiuncula Hospital gave an excellent talk on diabetes. She works
     with Dr Maeve Durkin in Ballinasloe and her enthusiasm, practical and down-to-earth attitude encouraged us all to think about how
     we could improve the management and care of our diabetic clients in general practice. It was very kindly sponsored by Tommy O
     Donoghue from Merck Sharpe Dome.
        The annual conference in October is in Jacksons Hotel in Donegal and we encourage as many members as possible to attend.

     Patricia Jenkins
     ‘Reducing Cardiovascular Risk in Type 2 Diabetes’ was the topic of our December meeting. This was kindly sponsored by Takeda and
     was well attended by our members. A scrumptious meal was served in the Old Post Restaurant at Clover Hill.
       Our January meeting held in Errigal Hotel, Cootehill, was sponsored by Allen and Hanbury. Jacqueline and Catriona, A&H Medical
     Representatives, introduced the COPD Assessment Tool (CAT questionnaire). Martina Carolan, Nurse Specialist, Navan Hosptial, gave a
     very informed talk on rheumatology and the importance monitoring patient’s treatments.
       Our March meeting was sponsored by Nutricia. Joanna Hovey, Paediatric Dietitian, gave a talk on Cow Protein Milk Allergy in Infants.
       For those nurses who completed the Bradford Diploma in Diabetes we were given a one day update provided by the HSE Cardiovas-
     cular Facilitator, Celine Croarkan.
       Recent national nurse’s conferences included Abracadabra’s Diabetes conference weekend in the Osprey Hotel, Naas and the Sexual
     Health Conference in the Strand Hotel in Limerick. If you attended any of these, I am sure you will agree the speakers at both confer-
     ences were only excellent.
       In April the Primary Care Diabetes Society has its annual conference in the Radisson Hotel in Athlone. This is well worth attending
     with health professionals from north and south and UK attending.
       It was with sadness we learned of the deaths of Maura Burke’s mother and Jennifer Wilson’s brother. May they rest in peace, Amen.
       If you wish to join the Cavan/Monaghan practice nurse branch please e-mail me and I will give you further details on how to apply.

     Trish O’Connor
     We in the Cork Branch had no scheduled IPNA January meeting but instead we had a very enjoyable and educational visit to ARC
     House where Dr Seamus O’Reilly (Consultant Medical Oncologist) gave a very informative talk on the oncology services. ARC
     House founded in 1994, is a registered charity offering professional support to men and women affected by cancer and those who care
     for them. The support is holistic and complements primary medical treatment with education and psychological care.  
        The topic of February’s meeting was Nutrition and was very kindly sponsored by Carol Ann Notley, Abbott. GuestsSpeaker on the
     night Julie O’Sullivan, Nutritionist. Julie gave a very informative and interactive presentation on the Malnutrition Universal Screening
     Tool (M.U.S.T) & also provided us with very useful patient information packs. Pauline Lynch of the Diabetes Federation of Ireland also
     gave an informative presentation on CODE, the structured patient education programme.
        We hope to see you all at the next Cork Branch meeting which will take place in the Rochestown Park Hotel on Wednesday the 10th
     March at 7.30pm. The topic of the meeting is Urinary Incontinence and has been very kindly sponsored by Gretchen Kelleher, Janssen-

     Mary Brick
     We braved the elements on Wednesday 20th January at our new venue, Carlton Hotel, Tralee. We were treated to an excellant educa-
     tional evening given by Dr Beatrice Neufeldt, gynaecologist/obstetrician and specialist in psychosomatic medicine. Her topic on the
     night was The female menopause and is there a male menopause? The evening was sponsored by Eilish McGroarty of Bayer Health-
        Our February meeting was hosted by Ciara Leahy of Pfizer Nutrician. We were updated on the topic MUST by Sheila King, Commu-
     nity dietitian. Ciara Leahy shared her expertise regarding infant nutrition. Corina Corridan community dietitian and leader with X-Pert

regional news
shared with us the success of our primary care diabetic referrals to X-Pert. Dr Anna Clark travelled from Cork to emphasize the impor-
tance of health promotion in a primary care setting. She devotes her expertise to the Diabetic Federation of Ireland.
   A special thanks to the practice nurses who subscribed so generously to the Haiti appeal at our January meeting.
   A reminder to all practice nurses to complete the posted questionnaire before the forthcoming INMO Annual Delegate Conference
in the Knightsbrook Hotel, Trim, Co Meath.
   Our March meeting is scheduled a week early Wednesday 10th so we can celebrate St Patrick’s day with our families.

Patricia McQuillan
Our first meeting of the year was on January 27th. It was sponsored by MSD and our local reps, Ray Farrell and Frank Tynan. Roseann
Coughlan,the CNS/Cardiac in St. Luke’s General Hospital, Kilkenny came and gave an excellent presentation on the service that is
offered in her hospital and the latest methods of treatment for cardiovascular patients. She reminded us about the Framingham
Study,the Canadian Guidelines and the Reynolds Risk Score.
  The next meeting of the Kilkenny Branch was on Wednesday February 24th. Our sponsor on the night was Hannah Connolly from
Schering Plough. Dr Chantelle MacNamara from the Keogh Practice in Waterford came with a trainee colleague. Dr MacNamara
was as always forthright and entertaining in her talk. he covered many topics including the importance of health education,
documentation and insurance. We had a light-hearted look at heart sink patients, however, we were reminded that we are the
advocates for our patients coming into us.

Kerrie Martin
I’d first like to introduce myself as the new chairperson for the Midlands Branch and my colleague Gillian Redmond as vice chairperson.
I would like to thank Una Ghee for all her hard work as chairperson over the last three years, hopefully myself and Gillian can keep up
the high standard Una has set.
   Our first meeting of 2010 took place in the Tullamore Court Hotel. There was a great turn out for this meeting. The meeting was
sponsored by Margaret Byrne, nutritionist for Milupa Aptamil. Margaret did an excellent presentation on infant feeding and weaning.
   Our next meeting is due to take place on 23rd March, again in the Tullamore Court Hotel. Topic dyslipidemia: update on new thera-
pies by cardiology nurse specialist Rose Coughlan. Sponsor Caroline Johnston, MSD. We hope to see everyone there.

Mary Finnegan
We held our AGM on 16th November in Grand Hotel Wicklow, and I am delighted to say, all the outgoing committee agreed to stay
on for another year! All were duly proposed and elected, and thanks to everyone for coming forward again for election. I would like
to say a personal ‘thank you’ to all the committee and branch members who have once again supported me in past year as Chair. Our
guest speaker at the AGM was Aoife O Shea, Clinical Nurse Manager with Smith & Nephew, who gave us an excellent update on wound
management, including use of Profore bandages.
  Our 1st meeting for 2010 was held on 25th Jan in the Ramada Hotel in Bray. Our speaker on that date was Ken O’Dwyer, an Advanced
EMT, who gave us an excellent talk on medical emergencies and an overview of what his job entails.
  This talk was very well received and was very kindly sponsored by Maria Sheerin, from Cow & Gate, who opened the meeting with an
update on infant feeding. She also held a raffle for some bottles of wine, which very nicely closed her presentation! That meeting was
very well attended, as we had several members from Dublin branch joining us.
  Our tiny branch of just 20, has now increased to 38! We are delighted to welcome all our new members. We held the next meeting
on 1st March, again. Our excellent speaker was Aideen Walsh, Clinical Nurse Specialist in Sexual Assault and Forensic examination,
based in the Rotunda Hospital. The information regarding details of referral and exactly what the forensic exam involves. Again we
welcomed several new members to our branch at that meeting.
  Our last meeting before the summer is scheduled for Monday 10th May, in the Ramada Hotel. The topic planned for that meeting is
an overview on travel medicine, and will be sponsored by Niamh Bird from Sanofi Pasteur.
  Our meeting venue had been in Wicklow town for past seven years to try to facilitate those members living as far south as Arklow,
but as their attendance has been falling off over past three years, and 80 per cent of our members are living in Bray or Dublin areas, we
decided to move our meetings north of the county to try to encourage better attendance at meetings.
  The good news is there has been a huge increase in attendance, and very positive feedback regarding the convenience of the venue.
At the meeting on 1st March, Rita Brown gave us a report from the recent NEC meeting, and details of the annual AGM.
  Deirdre Small will attend the next INMO meeting at end of March, and members were encouraged to return their questionnaire from
the INMO re our pay, asap, as this is a contentious issue at present, with cuts imposed by some GPs on nurses salaries.
  It is hoped to arrange a BLS/Heartsaver/AED course for the branch in near future as certification has expired for several members.
  Pfizer are also very kindly sponsoring a course on Spirometry in Glenview Hotel in Wicklow on Monday 29th March. Course is limited
to just 12 participant – on first come first served basis.
  As I close, can I once again extend a very warm welcome to all our new members, and a special thank you to all our ‘old’ ones.

COPD patients with severe COPD (FEV1
clinical review

Meningitis and
disease –
adults get it too
Lisa M Slattery RGN BSc MA MSc,
Community Services Nurse,
The Meningitis Trust

                 eningitis is a serious and life-threatening disease.
                 While under five year olds are most at risk of
                 meningitis in Ireland and throughout Europe, it
                 is important to remember that adults contract
                                                                        Bacterial meningitis
                 meningitis as well.
                                                                        Bacterial meningitis is a medical emergency which requires
   The aim of this article is to discuss meningitis in relation to
                                                                        early diagnosis, rapid transport to hospital and urgent medical
diagnosis, transmission, treatment and after-effects for adults.
It will also include two case studies, one bacterial and one viral.
                                                                           It is usually caused by infection with one of the following
While most individuals recover with no after-effects, recovery
                                                                        organisms: Neisseria meningitidis (meningococcal) (see Figure
from meningitis can take many months. Understanding
                                                                        1), Streptococcus pneumoniae (pneumococcal) or Haemophilus
the range of after-effects can help healthcare professionals
                                                                        influenzae B (Hib). The adult population, in particular those
appreciate the true impact of the disease.
                                                                        aged over 64 years, are the second most at-risk group from
                                                                        meningitis, more commonly pneumococcal meningitis.
What is meningitis?
                                                                           Many of the bacteria that cause meningitis occur commonly
Meningitis is an inflammation of the meninges, which are the
                                                                        and are often harmless commensals of the nose and throat
membranous tissues surrounding the brain and part of the
                                                                        (Donovan & Blewitt, 2009). Transmission occurs between
spinal cord. Bacteria, viruses and, more rarely, fungi are the
                                                                        individuals who have close, prolonged contact through
main causes of meningitis.
                                                                        coughing, sneezing and intimate kissing. Approximately 10
  Some bacteria that cause meningitis can also cause
                                                                        per cent of the general population will carry meningococcus
septicaemia and the two (meningitis and septicaemia) can
                                                                        harmlessly in the nasopharynx, developing natural immunity
occur separately or together. Meningococcal disease is the
                                                                        within 14 days. This increases to 25-30 per cent in teenagers
term used when both meningitis and septicaemia are caused
                                                                        due to altered social behaviour, such as smoking (results in
by Neisseria meningitidis.
                                                                        carriage of bacteria for longer periods of time) and intimate
                                                                        kissing (MacLennan et al, 2006). Carriage normally helps
                                                                        to improve natural immunity; however, in a small number
                                                                        of individuals, the bacteria crosses the nasopharyngeal
                                                                        membrane into the bloodstream where it multiplies rapidly
                                                                        and crosses the blood-brain barrier leading to inflammation of
                                                                        the meninges.
                                                                            In 2008, there were 253 reported cases of bacterial
                                                                        meningitis in Ireland, 168 cases of invasive meningococcal
                                                                        disease (IMD) (149 [89 per cent] of those were Neisseria
                                                                        meningitidis serogroup B), 22 cases of pneumococcal disease,
                                                                        4 cases of Hib, 6 cases of Group B Strep and 38 others (HPSC,
                                                                           In 2008, four cases of meningococcal C meningitis were
                                                                        recorded, all four occurred in adults aged 17-46 years. Four (50
                                                                        per cent) of the deaths due to IMD occurred in adults aged >20
                                                                        years. The mortality rate for bacterial meningitis is 10 per cent
                                                                        with an estimated 15-25 per cent of survivors being left with
Figure 1. Neisseria meningitidis. (Source: The Meningitis Trust.)       varying degrees of after-effects (The Meningitis Trust, 2007).

clinical review
      Viral meningitis                                                       refill (more than two seconds). Research has highlighted the
      Viral meningitis is more common than bacterial meningitis              need to identify the early signs of sepsis (cold hands and feet,
      and is rarely life-threatening (Logan & MacMahon, 2008).               leg pains, pale or blotchy skin). Thompson et al (2006) showed
      Many cases are mild and can be mistaken for influenza, but it          that these signs and symptoms occur much earlier than the
      is important to remember that, in some cases, individuals can          classic features of meningitis as described above.
      become very ill, resulting in a slow recovery. It is commonly             The septicaemic rash occurs primarily with meningococcal
      caused by infection with enteroviruses, herpes simplex and             septicaemia, so it is vital to remember not all types of
      mumps. Viral meningitis can occur in infants and children but is       meningitis will produce a rash. The rash is a result of the high
      more commonly reported in adults.                                      levels of endotoxins produced by the invading bacteria. This
         In 2008, 97 cases of viral meningitis were notified in Ireland      leads to damage of the endothelial lining of the capillaries,
      (HPSC, 2009). Viral meningitis activity tends to be highest in         resulting in capillary leakage and the classic haemorrhagic rash.
      the second half of the year.                                           Figure 2 shows an image of the septicaemic rash with non-
                                                                             blanching petechiae.
      Recognition                                                               Where a rash is present with other signs of a febrile illness in
      Due to a high mortality rate and rapid deterioration prior             a child or adult, it is important to make a thorough examination
      to admission to hospital, early recognition, diagnosis and             as it is easy to miss one petechia amongst a widespread
      treatment are vital. Early treatment can also affect outcome           maculopapular rash (Brogan and Raffles, 2000). The rash can
      in relation to the after-effects experienced by an adult who           be difficult to see on darker skin and it may help to check the
      survives meningitis.                                                   conjunctivae, under the lower eyelid, palms of hands, soles of
         In the early stages, the symptoms of meningitis may be              feet and palate.
      similar to other common illnesses, such as influenza and,
      more recently, swine flu. Differentiating between meningitis
      and swine flu in the early stages can be difficult. Meningitis
      can develop quickly and, in some cases, will become life
      threatening within hours of the first symptoms occurring.
      A high index of suspicion is vital to avoid missing anyone
      presenting with early flu-like, non-specific symptoms. Patients
      should be monitored every four to six hours for any changes or
      disease progression.
         There are, however, characteristic features of meningitis
      that may be easier to recognise. Adults may complain of neck
      stiffness, photophobia, muscle or joint pains and a severe
      headache. They may also be confused, be in respiratory distress
      or have impaired consciousness. Anyone developing these
      symptoms should seek medical advice.
         The signs and symptoms of viral meningitis are similar              Figure 2. Septicaemic rash. (Source: The Meningitis Trust.)
      to those of bacterial meningitis thus making it difficult to
      distinguish between them without further investigation (Logan             Adults may not appear severely ill in the early stages of
      and MacMahon, 2008).                                                   illness, but may rapidly deteriorate even following admission to
                                                                             hospital. Not all the symptoms appear at one time, and the rash
      Septicaemic rash                                                       may appear very late, if at all. It is therefore important to have
      Where septicaemia is present, adults will have signs of                a high index of suspicion with patients who present with non-
      circulatory failure such as cool peripheries and delayed capillary     specific signs and symptoms.

       Surviving meningitis – Case 1
       Nick’s Story
       My name is Nick. I’m 34 years old and I’m from Wales. I’ve lived      make it through the night. Thankfully, I made it through. I’m
       in Ireland for almost seven years. Back in May 2006, I thought        okay, but some people are not so fortunate. I’m a big, strong
       I was coming down with the flu. I was running the electrical          boy, 5 foot 10 inches and 16 stone. The meningitis nearly killed
       side of a new development in Bray, Co Wicklow. I spent nine           me. I’m an ex-boxer, and I’ve never lost a fight!
       days lying on my sofa, thinking I only had the flu, although I           Since I got sick, I’ve developed epilepsy. The depression is
       have never felt so ill in my life. I went into work after the ninth   something I’ve never known before. I’m a fun-loving guy, but
       day. I was sweating so badly, even my shins were soaking wet.         this has changed my life in a very big way. I’ve had about eight
       I was shaking from head to foot. To make matters worse, I was         fits to date and, as a result, I can’t work. I’ve only ever been
       working on top of a 13-foot stepladder all morning.                   an electrician, I don’t know anything else. I can’t do my job,
          At around 12.30pm, I took a delivery of cable tray and             because I have to wait at least one year before I can go onto a
       trunking. I started to feel very ill. As I was waiting for the        building site.
       second delivery van to reverse, I collapsed in the middle of the         My last seizure was about four weeks ago, cooking dinner
       road.                                                                 would you believe? One minute, I was making shepherd’s pie,
          I woke up talking to two paramedics. I didn’t know my              the next, I was on the floor with my girlfriend Liz asking me to
       name, age, or where I was from. They took me to St Vincent’s          talk to her. I’m getting there though.
       Hospital in Dublin with the blue lights going – that scared me!          The Meningitis Trust has been there for me from day
       I knew something was very wrong.                                      one. Lisa has been a fantastic help. I’ve been able to call her
          The doctor spoke to my sister and told her it was 50/50 if I’d     whenever I’ve felt down.

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