The Journal of the Irish Practice Nurses Association
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
The Journal of the Irish Practice Nurses Association
Issue 2 Volume 3 March / April 2010
Lung cancer:
risk factors,
presentation
and diagnosis
Eileen Byrne
A practical guide
to the CervicalCheck
call/re-call process
Carrie Powles
Niomh McCollam
Health
significance of meningitis and
fat quality of meningococcal Osteoporotic
our diet disease fractures
Dr Patricia Heavey Lisa M Slattery Melanie Fox
editorial
What a pity that some
GPs insist on retaining
their old ‘territory’
D
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
group.
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
1
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; www.novonordisk.ie.
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 www.imb.ie.
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 www.novonordisk.ie
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
Abstracts
44 Allergy
46 Gastroenterology
Poster series
Editor
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
Publishers
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.
graham@greencrosspublishing.ie Tel: 4789770 Fax: 4789764
Maura at Email: maura@greencrosspublishing.ie
maura@greencrosspublishing.ie
© Copyright GreenCross Publishing 2010
Disclaimer
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
3
news
nec news
IPNA AWARDS 2010
Mater Private
joins Healthlink.ie
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.
Healthlink.ie 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
irishpracticenurses.ie 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: admin@irishpracticenurses.ie • 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.
4
news
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 stu@cervicalcheck.ie 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.”
5
news
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: admin.cllc@olchc.ie
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
INTERNATIONAL
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.
6
Give them more
than just a great tasting
pudding style supplement
r e m o re m o re m o
Forticreme Complete is the mo re
e
pudding style supplement or
m
that’s easy to swallow and
re
provides more*:
mo
• more energy and protein
o re
• more vitamins and minerals
o r e m o re m
• more satisfaction!
and it tastes just great!
r e m
mo
re
o
m
e r
o
4 great tasting flavours to choose from: m
• Vanilla • Forest Fruit • Banana • Chocolate
e r ore
m o re m o r e m o
Give them back their taste for life!
For samples, advice, recipes and
patient literature, call Freephone:
1800 923 404 (ROI) 0800 783 4379 (NI)
* Compared with Ensure Plus Crème. ON-Aug09-02 Complete
news
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.
8NE
Onbrez - fast action ®
W
1
with superior efficacy
2,3,4*
A new first line once daily
5
LABA for COPD
Onbrez ® versus
tiotropium provides
•5 minute rapid onset of action 1,6
•Less Breathlessness 7
•Superior FEV 1 4*
ABBREVIATED PRESCRIBING INFORMATION
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 www.medicines.ie 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 Tiotropiumnews
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 www.rockyroad.ie
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.
unitedagainstprostatecancer.com which
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
Hospital.
Entitled “Silent Voices”, the survey
took place in France, Italy, Spain, Poland,
Germany and Ireland and researched 50
At the launch of www.unitedagainstprostatecancer.com 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).
10news
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.
happythreads.ie, 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 glen@thevillagesurgery.ie 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 receptionthree@slievemore-clinic.com
11regional news
N ews f o r I P N A b r anches c o unt r ywide
CLARE
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.
Cavan/Monaghan
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.
patriciajenkins@eircom.net
Cork
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-
Cilag.
Kerry
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-
care.
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
12regional 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.
Kilkenny
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.
Midlands
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.
Wicklow
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.
13COPD patients with severe COPD (FEV1
clinical review
Meningitis and
meningococcal
disease –
adults get it too
Lisa M Slattery RGN BSc MA MSc,
Community Services Nurse,
The Meningitis Trust
M
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.
treatment.
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,
2009).
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).
15clinical 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.
16You can also read
