https://www.um.edu.mt/library/oar/handle/123456789/148 Fri, 10 Apr 2026 01:31:24 GMT 2026-04-10T01:31:24Z https://www.um.edu.mt:443/library/oar/retrieve/54a7f5d4-4ec9-4fee-850f-4ccf79cb899d/ https://www.um.edu.mt/library/oar/handle/123456789/148 https://www.um.edu.mt/library/oar/handle/123456789/144692 Title: Malta : demographic transition deferred Abstract: A recent paper reviewed the influence of migration on Malta’s demographic transition, commenting on a debate that has moved beyond academic demography and into the public policy, economic sustainability and healthcare planning. It is timely to revisit this study after international bodies have commented on the current local economic model. The paper traces fertility, population and employment trends over more than two decades, revealing a delayed of the demographic transition phenomenon at the cost of reliance on inward migration. [excerpt] Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/144692 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/144690 Title: Potentially inappropriate prescription of hypnotic drugs in the elderly : a quality improvement project Authors: Zehlicke, Clarissa-Marie; Massa, Lisa; Laybats, Francesco; Aldhuhli, Saud; Grech, Gareth; Cordina, John Abstract: INTRODUCTION AND BACKGROUND: Both the American Beers Criteria and the STOPP/START criteria for potentially inappropriate prescribing in older people, have recommended that benzodiazepines and Z-drugs should be avoided in older adults with a history of falls or fractures. Unfortunately, their misuse and overuse remains a worldwide epidemic. An initial audit at our rehabilitation hospital showed a significant increase in the number of patients discharged on hypnotics when compared to admission. To improve our practices we carried out a quality improvement project and a re-audit.; METHODS: Multiple educational interventions were carried out. In a 2nd cycle audit we retrospectively analysed the proportion of geriatric patients admitted versus discharged on hypnotics from our rehabilitation hospital throughout 2022. We assessed for a concurrent history of falls or fractures. Results were compared to the 1st cycle.; RESULTS: 1033 patient records were initially examined. Of those included, 132 (17.6%) were discharged on a hypnotic in the 2nd cycle compared to 183 (19.3%) in the 1st cycle. This change did not reach statistical significance. 55% had adequate documentation of prescription rationale in the 2nd cycle compared to 43% in the 1st cycle (p = 0.046). The majority of patients discharged on treatment had a history of fractures or falls in both cycles.; CONCLUSION: Prescribing practices did not improve significantly following our educational interventions. Whilst educational interventions may help with raising awareness, individually they are often not enough to instil change in practices. Multi-faceted and targeted interventions should be the focus of future attempts at improving outcomes. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/144690 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/144687 Title: A study about the immune-related side effects at SAMOC : incidence, grades of toxicity & relation to past treatment and radiotherapy Authors: Grech, Joanna; Abela, Estelle; Mifsud Taliana, Kelly; Camilleri, Liberato Abstract: BACKGROUND: Immunotherapy targeting cytotoxic T-lymphocyte associated antigen 4 (CTLA4) and the programmed death receptor (PD-1) and its ligand (PDL1) is becoming the standard of care for many malignancies. Hence, the number of patients on immunotherapy is increasing as is the probability of developing toxicities secondary to these treatments. This project mainly aims to look at the frequency of ir-AEs at Sir Anthony Mamo Oncology Centre Malta between June 2016 and June 2020.; METHOD: A cohort of 177 patients were treated with immunotherapy between June 2016 and June 2020 at Sir Anthony Mamo Oncology Centre. These were assessed for immunotherapy related toxicities. These individuals were assessed for the following: age, gender, malignancy diagnosed, immunotherapeutic agents (single or combination therapy) used, systemic anticancer therapy exposure prior to ICI therapy (namely chemotherapy and TKIs), concomitant/ concurrent radiotherapy (radical and palliative RT), line of treatment at which ICI therapy was administered, the CTCAE grade and frequency of Ir-AEs studied.; RESULTS: Adverse events occurred in 43.6% of the cohort and none were recorded for 56.4%. The most common ir-AEs in our cohort were dermatological AEs (8%), thyroid-related AEs (19.4%), hepatic AEs (8%) and GI AEs (9.2%). Other data was collected and discussed further below.; CONCLUSION: The increasing use of immunotherapy for various cancer sites with immune checkpoint inhibitors has resulted in positive primary treatment outcomes. Secondarily, immune-related adverse events have been widely observed, as seen in the cohort assessed for all types of Ir-AEs in this study. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/144687 2026-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/144682 Title: Stone free rates following ureteroscopy at Mater Dei Hospital Authors: Curmi, Arthur; Cauchi, Daphne; Mamo, Kimberly; Eze, Belinda; Busuttil, Gerald Abstract: INTRODUCTION: Renal calculi pose a huge burden on health care systems and their rising prevalance has led to an increased reliance on surgery, particulary for upper urinary tract stones. Techincal advancements has made ureterscopy (URS) a mainstay treatment for both renal and ureteric stones. Despite its increase use, reported stone free rates following URS vary considerably owing to the different imaging modalites used and the different defintions of stone free. The aim of this audit is to assess the stone free rates of patients who underwent a URS at Mater Dei Hospital, Malta.; METHODS: All patients who underwent a URS for stones between January 2019 and December 2020 were included. Data was collected retrospectively by reviewing records on two main online hospital systems: Isoft Clincal Manager (ICM) and Picture Archiving and Communication System (PACS).; RESULTS: A total of 588 patients were selected for data analysis after applying inclusion/exclusion criteria. CT KUB was most common imaging modality for both diagnosis (83%, n=496) and follow-up (64%). At first follow-up, 418 patients (71%) were stone free when using the 5mm cut off, while 298 patients (50%) were stone free when using the 2mm criteria. At first follow-up, 209 (66%) of pre-stented patients were stone free when using the 5mm cut off, while 148 (47%) patients were stone free when using the stricter 2mm criterion. Patients with ureteric stones had better stone free rates at first follow-up at both 2mm (0.01) and 5mm cuts offs (p=0.013). Stone free rates were worse for patients who had stones higher up in the calyces of the kidney (p=0.01). The distribution of HU was the same across all categories of stone free at first follow-up when considering 2mm cut off (p=0.544). A total of 22 patients sufferred post-operative complications. 13 of these were re-admitted within 30 days of surgery and one patient died.; CONCLUSION: Different stone parameters as well as different imaging techniques influence stone free rates. Ureteroscopy is now the most commonly performed stone removing procedure. Efforts should be made to render patients stone free, as this will reduce the requirements for future secondary interventions. Thu, 01 Jan 2026 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/144682 2026-01-01T00:00:00Z