• 2016 WSES guidelines on acute calculous cholecystitis.

      Ansaloni, L; Pisano, M; Coccolini, F; Peitzmann, A B; Fingerhut, A; Catena, F; Agresta, F; Allegri, A; Bailey, I; Balogh, Z J; et al. (World journal of emergency surgery : WJES, 2016)
      Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of "high risk" patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.
    • 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias.

      Birindelli, Arianna; Sartelli, Massimo; Di Saverio, Salomone; Coccolini, Federico; Ansaloni, Luca; van Ramshorst, Gabrielle H; Campanelli, Giampiero; Khokha, Vladimir; Moore, Ernest E; Peitzman, Andrew; et al. (BioMed Central, 2017)
      Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.
    • Acceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial.

      Groarke, Jenny M; Richmond, Janice; Mc Sharry, Jenny; Groarke, AnnMarie; Harney, Owen M; Kelly, Mary Grace; Walsh, Jane C; Letterkenny University Hospital (2021-02-16)
      Background A significant proportion of cancer survivors have overweight or obesity. Although this has negative implications for health, weight management is not a standard component of oncology aftercare. Mobile health (mHealth) technology, in combination with behavior change techniques (BCTs), has the potential to support positive lifestyle changes. Few studies have been carried out with cancer survivors; therefore, the acceptability of these tools and techniques requires further investigation. Objective The aim of this study is to examine the acceptability of a behavior change intervention using mHealth for cancer survivors with a BMI of 25 or more and to gather constructive feedback from participants. Methods The intervention consisted of educational sessions and an 8-week physical activity goal setting intervention delivered using mobile technology (ie, Fitbit activity monitor plus SMS contact). In the context of a two-arm randomized controlled trial, semistructured interviews were conducted to assess the retrospective acceptability of the intervention from the perspective of the recipients. The theoretical framework for the acceptability of health care interventions was used to inform a topic guide. The interviews were transcribed and analyzed using thematic analysis. A quantitative survey was also conducted to determine the acceptability of the intervention. A total of 13 participants were interviewed, and 36 participants completed the quantitative survey. Results The results strongly support the acceptability of the intervention. The majority of the survey respondents held a positive attitude toward the intervention (35/36, 97%). In qualitative reports, many of the intervention components were enjoyed and the mHealth components (ie, Fitbit and goal setting through text message contact) were rated especially positively. Responses were mixed as to whether the burden of participating in the intervention was high (6/36, 17%) or low (5/36, 14%). Participants perceived the intervention as having high efficacy in improving health and well-being (34/36, 94%). Most respondents said that they understood how the intervention works (35/36, 97%), and qualitative data show that participants’ understanding of the aim of the intervention was broader than weight management and focused more on moving on psychologically from cancer. Conclusions On the basis of the coherence of responses with theorized aspects of intervention acceptability, we are confident that this intervention using mHealth and BCTs is acceptable to cancer survivors with obesity or overweight. Participants made several recommendations concerning the additional provision of social support. Future studies are needed to assess the feasibility of delivery in clinical practice and the acceptability of the intervention to those delivering the intervention.
    • Adult ileocolic intussusception secondary to ileocaecal valve polyp.

      Chugthai, Saqib Zeeshan; Atif, Abdul Hakeem; Chughtai, Jehan Zeb; Miptah, Najaa Hayatul; Couse, Neville; Letterkenny General Hospital, Surgery, 135 Foxhills, Letterkenny, County Donegal,, Ireland. (2012-01-31)
      Intussusception is relatively common in children, but it is a rare cause of abdominal pain and intestinal obstruction in adults. The aetiology, clinical presentation and management of this condition differs in adults and children. Preoperative clinical diagnosis is usually difficult due to the non-specific and intermittent nature of the symptoms. Ultrasound and computed tomography can be helpful in establishing the diagnosis. We present a case of adult ileocolic intussusception with classical radiological signs and operative findings. In adults the diagnosis of intussusception should be considered in a case of intermittent abdominal pain, especially with clinical signs of intermittent bowel obstruction.
    • Angioembolization for pelvic fractures.

      Letterkenny General Hospital, Letterkenny, Ireland. (2012-01-31)
    • Avascular necrosis of femoral heads post-adrenal surgery for Cushing's syndrome: a rare presentation.

      Letterkenny General Hospital, Letterkenny, Co. Donegal, Ireland,, modelian@gmail.com. (2012-01-31)
      Avascular necrosis (AVN) is a well-recognized complication of patients on high-dose steroids for a long time. Exogenous hypercortisolism is a well known cause of AVN and a number of cases have been reported. Cushing's syndrome describes hypercortisolism of any cause endogenous or exogenous. A variety of traumatic and non-traumatic factors contribute to the aetiology of AVN although exogenous glucocorticoids administration and alcoholism are among the most common non-traumatic causes. AVN secondary to endogenous hypercortisolism is rare and very few case reports are available describing this complication. No literature is available on AVN presenting post-adrenal surgery. Here we present a young woman who presented with avascular necrosis of both hips 1 year after adrenalectomy for Cushing's syndrome.
    • Bird fancier's lung in mushroom workers

      J Hayes,; M Barrett (Irish Medical Journal, 2015-04)
      Hypersensitivity pneumonitis has been described in mushrooms workers caused by exposure to mushroom or fungal spores in the compost used to grow mushrooms. We describe two mushroom workers who developed hypersensitivity pneumonitis due to exposure to avian proteins found in poultry manure which was used in producing mushroom compost. Both workers were employed in the compost production area. Both presented with typical features of HP. Both workers had negative serological and precipitin studies to Apergillus fumigatus, Saccarhopolyspora rectivirgula and thermophilic actinomycetes but had positive responses to poultry antibodies. Neither was exposed to mushroom spores. Both workers required initial therapy with corticosteroids. Relocation with avoidance of further exposure resulted in complete cure in one worker and change in work practice with the use of personal protections equipment resulted in the second worker clinical stabilisation. These are the first reported cases of bird fanciers lung in mushroom workers.
    • Breast cancer risk assessment and screening - Is it a persistent problem in a rural population?

      Johnston, Alison; Neary, Shane; Sugrue, Michael; Department of Breast Surgery, Breast Centre North West, Letterkenny University Hospital, Donegal Clinical Research Academy, Ireland (Remedy Publications LLC, 2017-08-09)
      Trend analysis of breast screening uptake in those meeting screening criteria that were newly diagnosed with breast cancer. Retrospective review of all breast cancer patients diagnosed between 2010 and 2014. Patients’ demographics, screening, risk assessment, pathological stages and surgical treatment utilization were recorded. 150 patients, mean ages 55.4 ± 10.2 years (range 29–90), were studied. Overall 65/150 (43.3%) had optimal screening pre cancer diagnosis and 85/150 (56.7%) suboptimal. The trend in optimal screening improved from 30% to 60% over the study period. The mean overall tumour size (excluding DCIS patients) in 131 patients was 32.8 mm; 26.9 mm in optimally and 38.5 mm in the suboptimally screened groups (p = 0.06 x2 df8). 113/150 (75.3%) diagnosed with early stage breast cancer and 37/150 (24.7%) late stage. Principally late stage at diagnosis was within the group with suboptimal screening; 100%, 100%, 63.6%, 75% and 60% respectively for years 2010–2014. This study identified improving trends in compliance with international screening and risk assessment guidelines. Failure to screen results in more advanced disease; further public health measures to engage appropriate screening may improve stage at presentation and breast cancer outcomes.
    • The Centricity Score: A Novel Measurement to Aid in Conservative Breast Cancer Surgery

      Sugrue, Ryan; McGowan, Katherine; McNamara, Cillian; Sugrue, Michael (Advances in Breast Cancer Research, 2014-10)
      Introduction: This study describes an intra-operative scoring system to advise the surgeon of the centricity of the tumour in the excised specimen. Methods: Spatial estimations were prospectively made in 10 consecutive patients undergoing wide local excision (WLE) using Bioptics intra-operative digital specimen imaging. The centricity score was defined as 100 – (ICD/SD × 100), where ICD is the inter-centre distance between the specimen’s centre and the tumour’s centre. Results: 10 patients with invasive breast cancer (T1b to T4a), mean age 56 years (range 44 - 71) were studied. The mean tumour and specimen diameter was 24 mm ± 10 (range 12 - 48) and 101 mm ± 22 (range 64 - 140). The mean centricity score was 86 ± 9 (range 65 - 95). Conclusion: This study successfully describes an intraoperative radiological spatial scoring system for patients undergoing WLE. Tumours were well centered in specimens with an overall score of 86/100. The centricity score could be used to guide excision and potentially set benchmarks for conservative breast surgery.
    • Cigarette use and cardiovascular risk in chronic kidney disease: an unappreciated modifiable lifestyle risk factor.

      Stack, Austin G; Murthy, Bhamidipati V R; Regional Kidney Centre, Department of Medicine, Letterkenny General Hospital,, Health Services Executive, County Donegal, Ireland. austin.stack@hse.ie (2012-01-31)
      Tobacco use is a major modifiable cardiovascular risk factor in the general population and contributes to excess cardiovascular risk. Emerging evidence from large-scale observational studies suggests that continued tobacco use is also an independent cardiovascular risk factor among patients with chronic kidney disease (CKD). The benefits of smoking cessation programs on improving the heath status of patients and reducing mortality are unequivocal in the general population. Despite this, there has been little effort in pursuing tobacco cessation programs in dialysis cohorts or those with lesser degrees of kidney impairment. Most of our attention to date has focused on the development of "kidney-specific" interventions that reduce rates of renal disease progression and improve dialysis outcomes. The purpose of this current review is to describe the epidemiology of tobacco use among patients with CKD, draw attention to its negative impact on cardiovascular morbidity and mortality, and finally highlight potential strategies for successful intervention. We hope that this study heightens the importance of tobacco use in CKD, stimulates renewed interest in the barriers and challenges that exist in achieving smoking cessation, and endorses the efficacy of intervention strategies and the immeasurable benefits of quitting on cardiovascular and noncardiovascular outcomes.
    • Combined Patients and Medical Related Cosmetic Breast Cancer Outcomes—A Preferred Approach to Outcomes Assessment

      Sugrue, Michael; Johnston, Alison; Degnim, Amy; Rubio, Isabel T.; Van den Tol, M. Petrouska; Djohan, Risal; Valentine, Mark; Mac Gregor, Geraldine; 1. Breast Centre North West, Letterkenny University Hospital, Donegal, Ireland 2. Donegal Clinical Research Academy, Donegal, Ireland. 3. Mayo Clinic, Rochester, NY, USA. 4. Vall d’Hebron Hospital Universitario, Barcelona, Spain. 5&6 University Medical Centre, Amsterdam, Netherlands (Advances in Breast Cancer Research, 2018-12)
      Introduction: Reducing positive margins and need for re-excision yet maintaining cosmesis is key in breast cancer surgery. This study describes the evaluation of early outcomes of a combined cosmetic assessment programme following breast conservation surgery (BCS). Methods: An ethically approved prospective study was conducted at Letterkenny University Hospital and a 15-month timeframe was chosen. All consecutive patients undergoing conservative breast surgery with complete local excision, from July 2015 to October 2016, were entered into the study. Patients undergoing mastectomy and reconstruction with either implant or autologous tissue were not included. 41 patients undergoing BCS were analysed. Objective and subjective cosmetic evaluations were carried out. Assessments used were the Breast Cancer Conservative Treatment—cosmetic results [BCCT.core 2.0] Software, a panel of 4 experts in breast surgery and the Breast Cancer Treatment Outcome Scale (BCTOS). Demographic and pathological data, breast excision weight, % breast volume excised (BVE), margin positivity, complications and re-excision were documented. Data was expressed as mean and standard deviation for normally distributed data and medians and inter quartile range for non-normal data. Scores were also dichotomised to excellent/good and fair/poor and results were analysed. Results: 41 patients’ mean age is 55 ± 13 years. Mean breast volume was 768.3 cm3 ± 440; BVE weighed 78.6g ± 42.6 (18.9 - 214.4) and %BVE 11.3% ± 5.2% (5.1 - 23.3). Re-excision rate was 2/41 (4.9%) all for positive margins. 0/41 infections or haematomas occurred.
    • A community-based advanced nurse practitioner-led integrated oncology care model for adults receiving oral anticancer medication: a pilot study.

      Richmond, Janice P; Kelly, Mary Grace; Johnston, Alison; Murphy, Patrick J; O'Connor, Laura; Gillespie, Paddy; Hobbins, Anna; Alvarez-Iglesias, Alberto; Murphy, Andrew W (2024-02-29)
    • Community-based health efforts for the prevention of falls in the elderly.

      Hanley, Alan; Silke, Carmel; Murphy, John; Department of Medicine, Letterkenny General Hospital, Letterkenny, Co Donegal,, Ireland. alan.hanley@gmail.com (2012-01-31)
      Falls are a major public health problem in the elderly population. The associated health care cost is great. It has therefore become an important public health matter to evaluate those interventions that might be effective in reducing the risk of falls. Risk factors that predict an increased risk of falling are described. We discuss interventions that can be employed in the community to reduce the risk of falls and associated injuries by discipline, including physiotherapy, occupational therapy, and physician-led interventions. We also discuss the cost-effectiveness of such interventions.
    • Comparing Single-Page, Multipage, and Conversational Digital Forms in Health Care: Usability Study.

      Iftikhar, Aleeha; Bond, Raymond R; McGilligan, Victoria; Leslie, Stephen J; Rjoob, Khaled; Knoery, Charles; Quigg, Ciara; Campbell, Ryan; Boyd, Kyle; MC SHANE, ANNE; et al. (2021-05-26)
      Background: Even in the era of digital technology, several hospitals still rely on paper-based forms for data entry for patient admission, triage, drug prescriptions, and procedures. Paper-based forms can be quick and convenient to complete but often at the expense of data quality, completeness, sustainability, and automated data analytics. Digital forms can improve data quality by assisting the user when deciding on the appropriate response to certain data inputs (eg, classifying symptoms). Greater data quality via digital form completion not only helps with auditing, service improvement, and patient record keeping but also helps with novel data science and machine learning research. Although digital forms are becoming more prevalent in health care, there is a lack of empirical best practices and guidelines for their design. The study-based hospital had a definite plan to abolish the paper form; hence, it was not necessary to compare the digital forms with the paper form. Objective: This study aims to assess the usability of three different interactive forms: a single-page digital form (in which all data input is required on one web page), a multipage digital form, and a conversational digital form (a chatbot). Methods: The three digital forms were developed as candidates to replace the current paper-based form used to record patient referrals to an interventional cardiology department (Cath-Lab) at Altnagelvin Hospital. We recorded usability data in a counterbalanced usability test (60 usability tests: 20 subjects×3 form usability tests). The usability data included task completion times, System Usability Scale (SUS) scores, User Experience Questionnaire data, and data from a postexperiment questionnaire. Results: We found that the single-page form outperformed the other two digital forms in almost all usability metrics. The mean SUS score for the single-page form was 76 (SD 15.8; P=.01) when compared with the multipage form, which had a mean score of 67 (SD 17), and the conversational form attained the lowest scores in usability testing and was the least preferred choice of users, with a mean score of 57 (SD 24). An SUS score of >68 was considered above average. The single-page form achieved the least task completion time compared with the other two digital form styles. Conclusions: In conclusion, the digital single-page form outperformed the other two forms in almost all usability metrics; it had the least task completion time compared with those of the other two digital forms. Moreover, on answering the open-ended question from the final customized postexperiment questionnaire, the single-page form was the preferred choice.
    • Compression fractures of the vertebrae during a "bumpy" boat ride.

      Chukwunyerenwa, C K; O'Rourke, P; Orthopaedic Unit, Letterkenny General Hospital, Letterkenny, Co. Donegal,, Republic of Ireland. Chukwunyerenwa@yahoo.com (2012-01-31)
      INTRODUCTION: Compression fracture of the vertebrae is common, often the result of falls from height and motor vehicle accidents in the younger age groups. It can occur following minor trauma in the elderly and in those with osteoporosis. MATERIALS AND METHODS: We present an interesting case of compression fracture of the vertebral bodies occurring simultaneously in a couple during a boat ride while on holiday. One individual had fracture of the T8, while the other fractured the L1 vertebrae. Both injuries were treated conservatively with Taylor braces. CONCLUSION: We highlight one of the potential hazards of this recreational activity, and the almost identical fracture pattern in this couple.
    • A consultant paediatrician led and public health nurse (PHN) provided Community Enuresis Clinic as a model of care.

      Noone, D; van der Spek, N; Waldron, M; Cavan General Hospital, Cavan Town, Co Cavan. dnoone@O2.ie (2011-02)
      A dedicated Community Enuresis Clinic was established in 2004 in Cavan and Monaghan. The service was audited using ERIC (Education and Resources for Improving Childhood Continence) guidelines. There were 106 males and 47 females, giving an M: F ratio of 2.3:1. Monosymptomatic Nocturnal Enuresis (MNE) accounted for 127 (83%). Adequate follow-up was available for 108 children with MNE and in this group Initial Success was 49% (ERIC target 50%). 71% were dry at 1 year. There was a dropout rate of 20% in the MNE group (ERIC minimum standard < 25%). We believe the structure of this community based clinic and its approach to MNE management has been successful.
    • Correction to: Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines.

      De Simone, Belinda; Sartelli, Massimo; Coccolini, Federico; Ball, Chad G; Brambillasca, Pietro; Chiarugi, Massimo; Campanile, Fabio Cesare; Nita, Gabriela; Corbella, Davide; Leppaniemi, Ari; et al. (2021-04-14)
    • Current management of adults receiving oral anti-cancer medications: A scoping review protocol.

      Richmond, Janice P; Kelly, Mary Grace; Johnston, Alison; Hynes, Lisa; Murphy, Patrick J; Murphy, Andrew W (2022-03-09)
      Oncology has been undergoing a profound transition in the last ten years with the increased usage in oral anti-cancer medication. Approximately 25% of all anti-cancer medication is now designed for oral use and this is likely to increase prospectively. These treatments are convenient for patients and are often preferred by them, yet there are similar safety and toxicity concerns as there are to intravenous treatment. Oral anti-cancer medications (OAMs) have the potential to alleviate capacity issues in cancer treating units as patients receive their treatment at home, however there remains a requirement for safe and efficient assessment and care. Consequently, the management of patients on OAMs is of paramount importance. The optimum setting, whether within primary or secondary care, in addition to the appropriate health care professional to carry out patient assessment and monitoring needs to be established. This paper presents a protocol for a scoping review which aims to systematically and comprehensively map the literature on the current management of adults receiving OAMs. The review will follow the published guidance to direct the various steps involved. The protocol will be guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework to ensure methodological and reporting quality. Independent full text review will be performed by two reviewers and any disagreements resolved through discussion with a third reviewer. The process will be iterative in nature. This scoping review will provide a narrative synthesis and map the literature on the management of individuals receiving OAMs. This work is an appropriate initial stage in presenting the literature to inform the subsequent steps in a multi-phased research study which aims to establish and analyse the safety and efficacy of an integrated care model for the management of patients receiving OAM in the community by an advanced practitioner.