• Accuracy of the clinical pulmonary infection score to differentiate ventilator-associated tracheobronchitis from ventilator-associated pneumonia.

      Gaudet, Alexandre; Martin-Loeches, Ignacio; Povoa, Pedro; Rodriguez, Alejandro; Salluh, Jorge; Duhamel, Alain; Nseir, Saad (2020-08-03)
      Background: Differentiating Ventilator-Associated Tracheobronchitis (VAT) from Ventilator-Associated Pneumonia (VAP) may be challenging for clinicians, yet their management currently differs. In this study, we evaluated the accuracy of the Clinical Pulmonary Infection Score (CPIS) to differentiate VAT and VAP. Methods: We performed a retrospective analysis based on the data from 2 independent prospective cohorts. Patients of the TAVeM database with a diagnosis of VAT (n = 320) or VAP (n = 369) were included in the derivation cohort. Patients admitted to the Intensive Care Centre of Lille University Hospital between January 1, 2016 and December 31, 2017 who had a diagnosis of VAT (n = 70) or VAP (n = 139) were included in the validation cohort. The accuracy of the CPIS to differentiate VAT from VAP was assessed within the 2 cohorts by calculating sensitivity and specificity values, establishing the ROC curves and choosing the best threshold according to the Youden index. Results: The areas under ROC curves of CPIS to differentiate VAT from VAP were calculated at 0.76 (95% CI [0.72-0.79]) in the derivation cohort and 0.67 (95% CI [0.6-0.75]) in the validation cohort. A CPIS value ≥ 7 was associated with the highest Youden index in both cohorts. With this cut-off, sensitivity and specificity were respectively found at 0.51 and 0.88 in the derivation cohort, and at 0.45 and 0.89 in the validation cohort. Conclusions: A CPIS value ≥ 7 reproducibly allowed to differentiate VAT from VAP with high specificity and PPV and moderate sensitivity and NPV in our derivation and validation cohorts.
    • Achieving diagnosis by consensus

      Kane, Bridget; Luz, Saturnino (2009-08)
      This paper provides an analysis of the collaborative work conducted at a multidisciplinary medical team meeting, where a patient’s definitive diagnosis is agreed, by consensus. The features that distinguish this process of diagnostic work by consensus are examined in depth. The current use of technology to support this collaborative activity is described, and experienced deficiencies are identified. Emphasis is placed on the visual and perceptual difficulty for individual specialities in making interpretations, and on how, through collaboration in discussion, definitive diagnosis is actually achieved. The challenge for providing adequate support for the multidisciplinary team at their meeting is outlined, given the multifaceted nature of the setting, i.e. patient management, educational, organizational and social functions, that need to be satisfied.
    • Acquired Factor Xiii Deficiency: An Uncommon But Easily Missed Cause Of Severe Bleeding

      Fogarty, H; Byrne, M; O’Connell, NM; Ryan, K; White, B; O’Donnell, JS; Lavin, M (Irish Medical Journal, 2018-05)
      Factor XIII (FXIII) is a plasma clotting protein involved in clot stabilization. Severe FXIII deficiency may present with severe, even fatal bleeding. Critically however, routine coagulation assays may be normal and only specific FXIII assays will detect the abnormality. Herein we discuss a case report of a patient with acquired FXIII deficiency in order to highlight the clinical challenges associated with establishing the diagnosis and discuss the treatment approach. A 70-year-old man presented with a gluteal haematoma despite no preceding personal history of bleeding. Extensive initial haemostatic investigations were normal until a specific FXIII assay showed a marked reduction in FXIII levels. With directed treatment, bleeding episodes ceased and remission was achieved. Clinical awareness of FXIII deficiency is important, so appropriate testing can be implemented in patients with unexplained bleeding diatheses, particularly those in whom bleeding responds poorly to standard replacement therapy.
    • Acute oncological emergencies.

      Gabriel, J; Central South Coast Cancer Network, St James' Hospital, Portsmouth. Janice.gabriel@csccn.nhs.uk (2012)
      The number of people receiving systemic anti-cancer treatment and presenting at emergency departments with treatment-related problems is rising. Nurses will be the first point of contact for most patients and need to be able to recognise oncological emergencies to initiate urgent assessment of patients and referral to the acute oncology team so that the most appropriate care can be delivered promptly. This article discusses the role of acute oncology services, and provides an overview of the most common acute oncological emergencies.
    • Age of transfused blood is not associated with increased postoperative adverse outcome after cardiac surgery.

      McKenny, M; Ryan, T; Tate, H; Graham, B; Young, V K; Dowd, N; Department of Anaesthesia, St James's Hospital, James's Street, Dublin, Ireland. mikemckenny@eircom.net (2011-05)
      This study investigated the hypothesis that storage age of transfused red blood cells (RBCs) is associated with adverse outcome after cardiac surgery, and examined association between volume of RBC transfusions and outcome after cardiac surgery.
    • Ageing brain abnormalities in young obese patients with type 2 diabetes: a cause for concern.

      Nolan, J J; Metabolic Research Unit, St James Hospital, Trinity College, Dublin 8, Ireland., jnolan@stjames.ie (2012-02-01)
    • Allelic expression imbalance of the schizophrenia susceptibility gene CHI3L1: evidence of cis-acting variation and tissue specific regulation.

      Hill, Matthew James; Kenny, Elaine; Roche, Siobhan; Morris, Derek W; Corvin, Aiden; Hawi, Ziarih; Gill, Michael; Anney, Richard J L; Neuropsychiatric Genetics Research Group, Trinity College Dublin, Institute of Molecular Medicine, Ireland. matthew.hill@kcl.ac.uk (2011-12)
      To identify cis-acting regulatory variants influencing the expression of the schizophrenia susceptibility gene chitinase 3-like 1 gene (CHI3L1) in human lymphoblasts and post-mortem brain tissue.
    • An analysis of the dynamics of multi-disciplinary medical team meetings and the use of communication technology [Thesis]

      Kane, Bridget; University of Dublin, Trinity College (2008-05)
      Multidisciplinary medical team meetings (MDTM)s are collaborative fora where healthcare spe- cialists come together to discuss patient cases, establish a definitive diagnosis and determine the best treatment strategy for the patient. The practice of MDTMs is growing in importance as regulatory agencies advocate their adoption into routine practice. This analysis of multi-disciplinary medical team meetings (MDTMs) identifies elements, or mechanics, of collaboration among team members and proposes measures to enhance the proceedings and make the MDTM more effective. The work of MDTMs is analysed both in its overall context of patient care and at the level of person-to-person interaction during a patient case discussion. In this longitudinal study, the development of a multidisciplinary medical team was followed through a series of changes that incorporated the use of teleconferencing technology and a picture archive and communication system (PACS) into the proceedings. Analysis, based on qualitative and quantitative data, identifies the MDTM as a system that adds dependability to overall service delivery processes. Detailed analysis of screen displays and speech interactions, combined with observation data, are used to elucidate structures and analyse the dynamics of the MDTM. System boundaries are defined that extend beyond the actual duration of the meeting. Stable work routines, timing and rhythms, are shown to be critical for MDTM success. Changes in organisation structures associated with MDTMs, both positive and negative, are demonstrated as a result of the adoption of teleconferencing. Although the discussion structure is relatively stable in teleconference, the dynamics of speech interactions are affected and patient case discussions take more time as a result. Cases discussed in teleconference are less satisfactory from the users’ perspective. However, there is a perceptible improvement in the quality of information exchanged at teleconferencing sessions compared to co-located meetings. Case controlled study reveals a doubling effect observed for participants who describe features in artefacts and for those who describe their professional approach (surgeons and radiation oncologist) in teleconference. Discussion around objects (artefacts) is most affected in teleconference. Examination of the use of video reveals an important requirement for the visual display of remote participants, that is not articulated in user surveys. The importance of increasing visual support for participants especially when the discussion involves image assessment and the exchange of professional opinion is highlighted. Visual needs are identified for both sides of the teleconference interface at MDTMs. Providing more control over audio, video and PACS would enhance teleconferences and image review. More control through personal devices is proposed to support interaction and increase participation. Furthermore, results suggest that having separate channels for tasks (pathology and radiology images) and person-to-person communication, by providing multiple displays, would make com- munication easier and save time. The display of radiological images is given special attention. With increasing complexity of imaging modalities, facilitating multiple views simultaneously is needed for satisfactory assessment. The internal temporal structure identified in patient case discussions (PCD)s prompts the in- vestigation of novel technologies for the development of an MDTM record. These results have implications for the design of future systems and the implementation of new channels of commu- nication within the health service.
    • An analysis of vascular surgery in elderly patients to determine whether age affects treatment strategy.

      O'Brien, G; Martin, Z; Haider, N; Colgan, M; O'Neill, S; Moore, D; Madhavan, P; St. James Hospital, Dublin, Ireland. gavinobrien@rcsi.ie (2012-03)
      The incidence of arterial disease increases with age. Increasing life expectancy in the western world will intensify demands on vascular surgeons with regard to increasing caseload, expanding patient selection criteria, and more complex and minimally-invasive treatment options. We analysed our arterial cases over the past 31 years (n = 6,144) and compared our methods of intervention and complication rates in the elderly population (>75) with the younger cohort, in order to determine whether age should influence our management strategies.
    • Annual financial statements for St James Hospital for the year ended 31st December, 2003

      St James's Hospital. (St James's Hospital, 2004)
      The Board is required by the St James's Hospital Board (Establishment) Order. 1971 to prepare tinancial statements for each financial year which give a true and fair view of the state of affairs of Sr. James's Hospital and of its income and expenditure for that period. In preparing those statements the Board is required to • select suitable accounting policies and then-apply them consistently • make judgements and estimates that are reasonable and.prudent • disclose and explain any material departures from applicable accounting standards. and • prepare the financial statements on the.going concern basis unless it is inappropriate or presume that St. James's Hospital will continue in existence.
    • Annual report 1983 - St. James's Hospital

      St. James's Hospital, Dublin (1984)
    • Annual report 1999 - St. James's Hospital

      St. James's Hospital, Dublin (2000)
    • Annual report 2000 - St. James's Hospital

      St. James's Hospital, Dublin (2001)
    • Annual report 2003 - St. James's Hospital

      St. James's Hospital, Dublin (2004)
    • Annual report 2004 - St. James's Hospital

      St. James's Hospital, Dublin (2005)
    • Annual report 2005 - St. James's Hospital

      St. James's Hospital, Dublin (2006)
    • Antimicrobial De-Escalation in the ICU: From Recommendations to Level of Evidence.

      Lakbar, Ines; De Waele, Jan J; Tabah, Alexis; Einav, Sharon; Martin-Loeches, Ignacio; Leone, Marc (2020-05-27)
      Antimicrobial de-escalation (ADE) is a component of antimicrobial stewardship (AMS) aimed to reduce exposure to broad-spectrum antimicrobials. In the intensive care unit, ADE is a strong recommendation that is moderately applied in clinical practice. Following a systematic review of the literature, we assessed the studies identified on the topic which included one randomized controlled trial and 20 observational studies. The literature shows a low level of evidence, although observational studies suggested that this procedure is safe. The effects of ADE on the level of resistance of ecological systems and especially on the microbiota are unclear. The reviewers recommend de-escalating antimicrobial treatment in patients requiring long-term antibiotic therapy and considering de-escalation in short-term treatments.
    • Anxiety and behavioural disturbance as markers of prodromal Alzheimer's disease in patients with mild cognitive impairment.

      Gallagher, Damien; Coen, Robert; Kilroy, Dana; Belinski, Kate; Bruce, Irene; Coakley, Davis; Walsh, Bernard; Cunningham, Conal; Lawlor, Brian A; Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland. gallagherdamien@hotmail.com (2011-02)
      Depression and anxiety have been reported to be independently predictive of conversion to Alzheimer's disease (AD) in patients with mild cognitive impairment (MCI). Anxiety symptoms have been less well studied and findings in this regard have been inconsistent. The objectives of this study are to determine which symptoms among a range of neuropsychiatric symptoms known to commonly occur in patients with MCI are predictive of later conversion to AD. We also wish to determine whether these symptoms track existing measures of declining cognitive and functional status or may be considered distinct and sensitive biomarkers of evolving Alzheimer's pathology.
    • Application of statistical process control to qualitative molecular diagnostic assays

      O'Brien, Cathal P.; Finn, Stephen P.; St. James's Hospital (2014-11)
      Modern pathology laboratories and in particular high throughput laboratories such as clinical chemistry have developed a reliable system for statistical process control (SPC). Such a system is absent from the majority of molecular laboratories and where present is confined to quantitative assays. As the inability to apply SPC to an assay is an obvious disadvantage this study aimed to solve this problem by using a frequency estimate coupled with a confidence interval calculation to detect deviations from an expected mutation frequency. The results of this study demonstrate the strengths and weaknesses of this approach and highlight minimum sample number requirements. Notably, assays with low mutation frequencies and detection of small deviations from an expected value require greater sample numbers to mitigate a protracted time to detection. Modeled laboratory data was also used to highlight how this approach might be applied in a routine molecular laboratory. This article is the first to describe the application of SPC to qualitative laboratory data.