• Acute stroke unit booklet: Bridging the information gap between patients, relatives and providers

      Saramago, Inês; Inês Saramago, Acute Stroke Unit, Mercy University Hospital, Cork, Ireland (2019-07-07)
      Background / Problem Identified: Following a stroke, patients are often confronted with many impairments, which can trigger many questions from their relatives. Establishing clear and regular communication with the relatives can be challenging when using a multidisciplinary team approach. Also, the ability to retain all the information and new medical terminology by both patients and their relatives can be limited during this stressful time. The aim of the acute stroke unit booklet is to provide medical and practical information relevant to the acute stroke patients, and their relatives, admitted to the acute stroke unit in St. Finbarr’s Ward, Mercy University Hospital. Measurement Methods / Design / Strategy: The development of the Acute Stroke Unit Booklet was carried out in two phases. Phase I, a review of the published Stroke unit Booklets from UK and Irish Hospitals/Organizations was conducted. MDT opinions and suggestions were also sought. In phase II, the booklet was formally validated by inviting the MDT to assess each relevant section of the booklet for adequacy, coverage and readability of the content. Results / Lessons learned / Limitations: The 44 page booklet was organized into 13 sections. The MDT section incorporates 7 departments and every department provided feedback. The booklet was primarily distributed and explained to acute stroke patients. Where the patient’s cognitive status was significantly impacted, the booklet was then assigned to the patients’ relatives. Conclusions / Reflections: A simple, illustrated information booklet designed for acute stroke patients and their relatives using clear and plain language is an effective mean to maintain communication between patients, relatives and providers. A similar approach focusing on aphasic stroke patients and cognitively impaired stroke patients could be adopted for the development of other accessible information booklets.
    • Adapting stroke rehabilitation during the COVID-19 pandemic: Exploring the experiences of patients and families of an Early Supported Discharge telerehabilitation programme

      Hartigan, Irene; Condon, M.; O'Regan, L.; Pope, L.; Healy, Liam; O'Caoimh, Rónán; Barrett, A; Rónán O'Caoimh, Department of Geriatric and Stroke Medicine, Mercy University Hospital, Grenville Place, Cork (Knowledge Enterprise Journals, 2023-07-17)
      Purpose: To describes stroke survivors (SS) and carer’s experiences of an Early Supported Discharge (ESD) programme delivered via telerehabilitation during the COVID-19 pandemic. Methods: Purposive sampling was conducted to recruit stroke survivors and carers who participated in telerehabilitation with a regional ESD team. Semi-structured interviews were conducted online. Interviews were transcribed and coded. Qualitative data analysis was conducted. Results: Eleven people were recruited including individual stroke survivors (n=4), carers (n=1) and family dyads (n=3). Four major themes were identified: (1) Channels of communication and enabling relationships (2) The importance of the daily rehabilitation routine, (3) Hands-off training and technology, (4) Virtual and non-tactile reality. Open channels of telecommunication were central to ensuring continuity of care and imparting information and education. Conclusion: Despite the implications of the COVID-19 pandemic, most participants described positive experiences of ‘virtual and non-tactile’ video enabled rehabilitation. Telerehabilitation enabled stroke survivors and therapists to build relationships which fostered engagement and supported rehabilitation. Further work is required to examine upscaling telerehabilitation use beyond the pandemic and to better understand key factors regarding patient selection.
    • Advancing surgical research in a sea of complexity.

      O'Sullivan, Gerald C; Department of Surgery, Mercy University Hospital, Cork, Ireland. geraldc@iol.ie (2012-01-31)
    • Ageing well at home: advice to help you age well in your community [updated September 2022]

      Moloney, Elizabeth; Gillman, Ciara; O’Brien, Gillian; Mercy University Hospital, Grenville Place, Cork (Mercy University Hospital, Cork Kerry Community Healthcare, 2022-09)
      The aim of this booklet is to help you age well and avoid becoming frail through general health and wellbeing advice. COVID-19 has made it more difficult to engage in normal social and physical group activities. We have had to adapt our lifestyles and regular social connections. This booklet reflects the hope we all feel as normal routines return. Included is information about a range of activities, services and agencies available in your community to help you age well. As healthcare workers, we want to support you to live well at home. By remaining active and engaged in your local community, you can delay the onset of frailty. This booklet encourages you to look after your health and wellbeing and to feel positive about the future. Now is the time to invest in your physical and mental health so you can reap the benefits in years to come.
    • Ageing well at home: advice to help you age well in your community [Updated version Sept 2022]

      Moloney, Elizabeth; Gillman, Ciara; O’Brien, Gillian; Mercy University Hospital, Grenville Place, Cork (Mercy University Hospital, Cork Kerry Community Healthcare, 2022-09-22)
      The aim of this booklet is to help you age well and avoid becoming frail through general health and wellbeing advice. COVID-19 has made it more difficult to engage in normal social and physical group activities. We have had to adapt our lifestyles and regular social connections. This booklet reflects the hope we all feel as normal routines return. Included is information about a range of activities, services and agencies available in your community to help you age well. As healthcare workers, we want to support you to live well at home. By remaining active and engaged in your local community, you can delay the onset of frailty. This booklet encourages you to look after your health and wellbeing and to feel positive about the future. Now is the time to invest in your physical and mental health so you can reap the benefits in years to come.
    • An analysis of suspected urinary tract infections in older adults: Time to stop the dip!!

      Jones, William; O'Connor, Kieran; William Jones and Kieran O'Connor, Geriatric Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland. (2023-06-29)
      Background: Urinary Tract Infections (UTI) is the most commonly diagnosed infection in older adults. Despite this however studies show it is a diagnosis which is often made excessively and inappropriately. Clinicians often suspect a UTI due to vague non-specific symptoms, such as change in mental status, without sufficient local urinary tract symptoms i.e.dysuria, increased frequency or urgency. This is compounded by high rates of asymptomatic bacteriuria in older adults. This means that in an older adult, if urine testing is unnecessarily ordered, bacteria can be detected as an incidental finding even if no UTI is present. High rates of asymptomatic bacteriuria and inappropriately testing for bacteriuria, without sufficient clinical signs and symptoms can be problematic. It may result in clinicians frequently misdiagnosing UTI or inappropriately attributing a nonspecific finding such as fever or confusion to a UTI. This can promote inappropriate antibiotic prescribing which may promote antibiotic resistant bacteria and unnecessarily expose older adults to side effects of these medications. Incorrectly attributing a patient’s presenting complaint to a UTI can hinder the patient's care as it delays discovering the most appropriate cause of the patient's condition. In September 2021, HSE Antimicrobial Resistance and Infection Control (AMRIC) issued a position statement where they clearly outlined that in the absence of signs of symptoms of UTI, use of dipstick analysis should be avoided. This included those patients presenting with altered mental status and behavioural changes without urinary symptoms. They also state that dipstick analysis should not be used in those over 65 to assess UTI.. Strategy: The aim of the project was: To determine and quantify if dipstick urinalysis is conducted in those over 65 years old to assess UTI in contradiction to HSE guidance; To assess the relationship between clinical presentation and the diagnosis of a UTI; To assess if UTI are diagnosed in individuals in absence of clinical features of UTI; To characterise population of older adults diagnosed with a UTI in the hospital. The population reviewed was adult in-patients aged over 65 years old in the Mercy University Hospital (MUH) between January 2019 to June 2022 who had urine culture (MSU) sent to the microbiology laboratory. We audited a samples using a stratified random sampling strategy to get a spread of cases over the period. All selected cases had a retrospective chart review to determine the signs and symptoms when the MSU was ordered & to examine whether there were other indications of infection or systemic inflammatory response (SIRS). The patients co-morbidities, relevant laboratory results and relevant medication were recorded. The prescription sheet was examined to determine whether antibiotics were prescribed. The medical and nursing records were reviewed to clarify whether a urine dipstick was used in the assessment of possible UTI. For each case it was recorded whether a UTI was diagnosed by the primary team. For each case a determination was made based on recorded signs, symptoms, and laboratory results whether a) there was evidence of infection, & b) whether there was evidence to support a UTI as the diagnosis. The appropriateness of doing dipstick urinalysis was assessed using the AMRIC position statement 2021 as the standard. Results: There was a high use of dipstick urinalysis with 73.8% of cases having a urinary dipstick analysis performed as part of the assessment of possible UTI. In 25% of cases a UTI was “diagnosed” by the primary team. However, only 16.7% had any of the primary symptoms of UTI such as increased frequency, urgency or dysuria. Urine dipstick and MSU were frequently requested for patients with falls (20.2% of cases) and acute altered mental health state (22.6% of cases). The AMRIC statement specifically highlights that altered mental state should not trigger the use of urine dipstick. There was a statistically significant relationship between dipstick urinalysis being conducted and a UTI being “diagnosed”, even when accounting for LUTS as a confounding variable.(p=0.01). Falls, acute AMS and new urinary incontinence were not associated with the diagnosis of a UTI. Haematuria, flank pain, pungent urine and suprapubic pain alone without dysuria was not associated with diagnosis of a UTI. Retrospective accurate diagnosis of UTI is difficult but our project would be in keeping with previous studies showing a high level of incorrect UTI diagnosis and inappropriate antimicrobial therapy (Silver 2009). There is a significant cost to the Mercy University Hospital is inappropriately requested MSU. There was a total of 12,357 MSU over the 42 month period assessed in this project. That equates to nearly 300 samples in the microbiology laboratory each month. Only 16.7% of our cases had potential UTI symptoms. Therefore, potentially up to 250 MSU samples a month maybe inappropriate. Conclusions: Dipstick urinalysis is conducted at high rates in older adults in the Mercy University Hospital despite HSE guidance to the contrary. This is associated with increased likelihood of UTI being diagnosed inappropriately. Urinalysis testing was not associated with any specific clinical presentation suggesting it is conducted broadly in a more routine fashion rather than for specific indications. A very high level of MSU samples are requested with a low level of UTI diagnosis. It is unclear but likely that urinalysis results are driving MSU samples. There is cost saving by improving the use of appropriate dipstick urinalysis and more focused MSU samples. There is a need for more education on diagnosis of UTI in older people and the appropriate use of urine dipstick testing in hospital. References: Silver SA, Baillie L, Simor AE. Positive urine cultures: A major cause of inappropriate antimicrobial use in hospitals? .Can J Infect Dis Med Microbiol. 2009;20(4):107-111. doi:10.1155/2009/702545. Position Statements: Use of Dipstick Urinalysis for assessing evidence of Urinary Tract Infection In Adults, Antimicrobial Resistance and Infection Prevention and Control (AMRIC) clinical programme. v1. August 2021
    • Antimicrobial usage in an intensive care unit: a prospective analysis.

      Conrick-Martin, I; Buckley, A; Cooke, J; O'Riordan, F; Cahill, J; O'Croinin, D; Department of Anaesthesia & Intensive Care Medicine, Mercy University Hospital,, Grenville Place, Cork. iancm25@hotmail.com (2012-01-31)
      Antimicrobial therapies in the Intensive Care Unit (ICU) need to be appropriate in both their antimicrobial cover and duration. We performed a prospective observational study of admissions to our semi-closed ICU over a three-month period and recorded the indications for antimicrobial therapy, agents used, duration of use, changes in therapy and reasons for changes in therapy. A change in therapy was defined as the initiation or discontinuation of an antimicrobial agent. There were 51 patients admitted during the three-month study period and all received antimicrobial therapy. There were 135 changes in antimicrobial therapy. 89 (66%) were made by the ICU team and 32 (24%) were made by the primary team. Changes were made due to a deterioration or lack of clinical response in 41 (30%) cases, due to the completion of prescribed course in 36 (27%) cases, and in response to a sensitivity result in 25 (19%) cases. Prophylactic antibiotic courses (n=24) were of a duration greater than 24 hours in 15 (63%) instances. In conclusion, the majority of changes in antimicrobial therapy were not culture-based and the duration of surgical prophylaxis was in excess of current recommended guidelines.
    • Artificial Intelligence in Radiology-Ethical Considerations.

      Brady, Adrian P; Neri, Emanuele (2020-04-17)
      Artificial intelligence (AI) is poised to change much about the way we practice radiology in the near future. The power of AI tools has the potential to offer substantial benefit to patients. Conversely, there are dangers inherent in the deployment of AI in radiology, if this is done without regard to possible ethical risks. Some ethical issues are obvious; others are less easily discerned, and less easily avoided. This paper explains some of the ethical difficulties of which we are presently aware, and some of the measures we may take to protect against misuse of AI.
    • Audit of "Patient Discharge Plan" checklist for older adults in the acute setting

      Power, Sarah; Sarah Power, Bed Management Unit, Mercy University Hospital, Grenville Place, Cork, Ireland. (2023-06-29)
      Problem identified: The National Inpatient Experience Survey (NIES) conducted in the Mercy University Hospital in 2022 exposed poor quality of information sharing with patients and their families upon discharge. Discharge planning for elderly patients can reduce readmission rates and hospital length of stay (NICE 2018, Goncalves-Bradley et al. 2016). A reduction in days spent in hospital results in reduced cost of care (Goncalves-Bradley et al. 2016). Individualised discharge plans for inpatients improves patient and healthcare provider satisfaction (Goncalves-Bradley et al. 2016). Eighty percent of discharges from an acute hospital setting are considered simple and predictable (NICE 2018). For this reason, failure to communicate effectively is found to be the main cause of simple discharges being delayed (NICE 2018). Discharge planning is not standardised across healthcare settings in the NHS (NICE 2018); however, the Nursing and Midwifery Board of Ireland (NMBI) have set documentation standards in Irish hospitals (NMBI 2015). HIQA (2012) National Standards for Safer Better Healthcare promote sharing of timely and relevant information between the multidisciplinary team and services upon discharge. A Patient Discharge Plan checklist facilitates this in the acute setting. The HSE (2014) sets out nine steps to effective discharge planning in the National Guideline for Quality and Patient Safety. Step eight refers to “Use a discharge checklist 24‐48 hours before discharge” (HSE 2014). Discharge checklists are advised to enhance effective communication between the patient, members of the multi‐disciplinary team, hospital, primary and community service providers (HSE 2014). A discharge checklist can communicate actions taken and those still outstanding (HSE 2014). A re-audit of Patient Discharge Plans within the Careful Nursing Document was conducted. Design: Retrospective review of Healthcare Records (HCR) on 8 medical/surgical wards within 24-72 hours of patient discharge. Tool: NMBI Documentation Discharge Planning Metrix tool. Six indicators included. Collected by 1 person using the data collection tool which was piloted initially. Timeline: Seven consecutive days, 31st January – 7th February 2023. Inclusion/Exclusion Criteria: Include patients 65 years old and older. Quantitative data collected from checklist with some free text in Discharge Care Plan to supplement. Exclude day cases, patients who died and patients taking HCR to another clinical setting. Sample: Consecutive snapshot sampling. 36 HCR audited, approximately half of that week’s total Older Adult (OA) discharges (average of 70-75 OA discharged/week in MUH). Standard: HSE (2014) National Guideline for Quality and Patient Safety. 100% compliance to checklist completion required. Permission: Granted by ADON Bed Management and Quality and Risk Department in MUH. Discussed with Nursing Practice and Development (NPDU) and Discharge Planning Sub-Committee seeking to improve NIES result. GDPR and anonymity were upheld. Medical records number, date of birth and discharge destination recorded. Code sheet used. Results: 100% compliance with all 6 indicators was only achieved in 3 of 36 (8%) of audited HCR. There was 58% compliance with pre-discharge checklist completion (Indicator 1) which increased to 75% completion of Day of Discharge Checklist section (Indicator 2) highlighting discrepancies in timely documentation (see Figure 3). Sixty-three percent compliance with Standard 3 has disimproved since July 2022 audit where 72% compliance was noted. This audit used the same tool but general population over one week. Recommendations: Revise effectiveness/efficiency/conduciveness of discharge planning checklist documentation with the Documentation Committee and Nursing Practice and Development Unit. Make alterations to documentation/checklist and PPPG using feedback (HSE 2016 & Powell et al. 2015). Utilise Documentation Champions on the wards to remind clinicians (Powell et al. 2015). Use findings to focus ward-based education sessions with staff nurses on checklist areas requiring improvements (Powell et al. 2015). Limitations: Convenient snapshot sample method used may not represent the overall compliance. Current reduced nurse staffing levels and seasonal overcrowding of service may have allowed bias. Conclusions; Re-audit should be planned post checklist review and education delivery (approx. 6 months) rather than NMBI (2015) recommendation of annually. Since this audit in February 2023, Discharge Planning sub-committee have progressed with revising the Discharge Planning Checklist with the Documentation Committee and NPDU. Recommendations have been made to alter the information required to be more patient friendly. These alterations are due to go to print in June 2023. The findings of the audit will be utilised going forward to roll out education with new checklists on the wards to staff nurses and CNMs via Documentation Champions, the sub-committee and NPDU. A change in nursing practice is being implemented with the new checklists which includes nursing staff photocopying the checklist for each patient. The patient will take this checklist copy home upon discharge as a source of person-centred information with contact details of community supports and treatment plans outlined. The aim is that each ward will have photocopying facilities and each staff nurse/CNM will have access to this. This project is ongoing.
    • Audit of compliance with HSE standards and recommended practices for healthcare records management for discharge summaries in St. Michael's Unit, Mercy University Hospital, Cork

      Vrabec, Michal; Geary, Eoin; O'Brien, Sinead; North Lee Mental Health Services, HSE Southern Area (Centre for Recovery and Social Inclusion (CRSI), 2019-06-07)
    • An audit of empiric antibiotic choice in the inpatient management of community-acquired pneumonia

      Delaney, F; Jackson, A (Irish Medical Journal, 2017-04)
      Adherence to antimicrobial guidelines for empiric antibiotic prescribing in community-acquired pneumonia (CAP) has been reported to be worryingly low. We conducted a review of empiric antibiotic prescribing for sixty consecutive adult patients admitted to the Mercy University Hospital with a diagnosis of CAP. When analysed against local antimicrobial guidelines, guideline concordant empiric antibiotics were given in only 48% of cases, lower than the average rate in comparable studies. Concordance was 100% in cases where the CURB-65 pneumonia severity assessment score, on which the guidelines are based, was documented in the medical notes. The use of excessively broad spectrum and inappropriate antibiotics is a notable problem. This study supports the theory that lack of knowledge regarding pneumonia severity assessment tools and unfamiliarity with therapeutic guidelines are key barriers to guideline adherence, which remains a significant problem despite increased focus on antimicrobial stewardship programs in Ireland
    • Autophagy induction by Bcr-Abl-expressing cells facilitates their recovery from a targeted or nontargeted treatment.

      Crowley, Lisa C; Elzinga, Baukje M; O'Sullivan, Gerald C; McKenna, Sharon L; Leslie C. Quick Laboratory, Cork Cancer Research Centre, BioSciences Institute,, University College Cork and Mercy University Hospital, Grenville Place, Cork,, Ireland. (2012-01-31)
      Although Imatinib has transformed the treatment of chronic myeloid leukemia (CML), it is not curative due to the persistence of resistant cells that can regenerate the disease. We have examined how Bcr-Abl-expressing cells respond to two mechanistically different therapeutic agents, etoposide and Imatinib. We also examined Bcr-Abl expression at low and high levels as elevated expression has been associated with treatment failure. Cells expressing low levels of Bcr-Abl undergo apoptosis in response to the DNA-targeting agent (etoposide), whereas high-Bcr-Abl-expressing cells primarily induce autophagy. Autophagic populations engage a delayed nonapoptotic death; however, sufficient cells evade this and repopulate following the withdrawal of the drug. Non-Bcr-Abl-expressing 32D or Ba/F3 cells induce both apoptosis and autophagy in response to etoposide and can recover. Imatinib treatment induces both apoptosis and autophagy in all Bcr-Abl-expressing cells and populations rapidly recover. Inhibition of autophagy with ATG7 and Beclin1 siRNA significantly reduced the recovery of Imatinib-treated K562 cells, indicating the importance of autophagy for the recovery of treated cells. Combination regimes incorporating agents that disrupt Imatinib-induced autophagy would remain primarily targeted and may improve response to the treatment in CML.
    • Bacteria as vectors for gene therapy of cancer.

      Baban, Chwanrow K; Cronin, Michelle; O'Hanlon, Deirdre; O'Sullivan, Gerald C; Tangney, Mark; Cork Cancer Research Centre, Mercy University Hospital and Leslie C. Quick Jr., Laboratory, University College Cork, Cork, Ireland. (2012-01-31)
      Anti-cancer therapy faces major challenges, particularly in terms of specificity of treatment. The ideal therapy would eradicate tumor cells selectively with minimum side effects on normal tissue. Gene or cell therapies have emerged as realistic prospects for the treatment of cancer, and involve the delivery of genetic information to a tumor to facilitate the production of therapeutic proteins. However, there is still much to be done before an efficient and safe gene medicine is achieved, primarily developing the means of targeting genes to tumors safely and efficiently. An emerging family of vectors involves bacteria of various genera. It has been shown that bacteria are naturally capable of homing to tumors when systemically administered resulting in high levels of replication locally. Furthermore, invasive species can deliver heterologous genes intra-cellularly for tumor cell expression. Here, we review the use of bacteria as vehicles for gene therapy of cancer, detailing the mechanisms of action and successes at preclinical and clinical levels.
    • A budget impact analysis of a clinical medication review of patients in an Irish university teaching hospital

      Kearney, Alan; Walsh, Elaine. K; Kirby, Ann; Halleran, Ciaran; Byrne, Derina; Haugh, Jennifer; Sahm, Laura. J (Global & Regional Health Technology, 2018-09)
      To measure the net benefit of a pharmacist-led medication review in acute public hospitals. To identify and measure the resources used when completing a pharmacist-led medication review, an observational study was conducted in an acute urban university teaching hospital. Health Information and Quality Authority guidelines were used to value resources used in a pharmacist-led medication review. Model inputs included demographic data, probability of adverse drug events associated with the pharmacist interventions, estimates of future discharges and cost data. The cost of a pharmacist-led medication review and savings generated from avoidance of adverse drug events were estimated and projected over a 5-year period, using hospital discharge rates taken from the hospital inpatient enquiry system and the census of population. Using the per-patient cost of a medication review, the annual cost of delivering a bi-weekly medication review is projected to vary between €6 m and €6.4 m over a 5-year period from 2017 to 2021. The per-patient net benefit of a bi-weekly medication review is €45.88. Therefore, the projected annual net benefit of a bi-weekly medication review is between €29.5 m and €31.2 m over the 5-year period of 2017 to 2021. Introducing a pharmacist-led medication review for each inpatient saves in the short and longer term. The results are consistent with previous findings. Substantial savings were estimated, regardless of variation in model parameters tested in sensitivity analysis.
    • Cautionary considerations regarding N.O.T.E.S. in oncology.

      O'Riordain, M G; Mercy University Hospital, Grenville Place, Cork, Ireland. (2012-01-31)
      Over the last number of years, the emphasis in abdominal surgery has been to reduce invasiveness and to minimise trauma to the patient. This has led to the rapid development of laparoscopic techniques initially for the surgical management of benign disease and later for the successful management of malignant disease. Laparoscopy has now been shown to provide significant benefits to the cancer patient, in particular the reduction of wound infection, herniation and pain. More recently, benefits have been demonstrated in earlier discharge from hospital and return to normal activity. Laparoscopy has therefore been accepted as at least a valid alternative to open surgery for most types of abdominal cancer. With the objective of reducing invasiveness even more, the last few years has seen a rapid expansion in the development of Natural Orifice Translumenal Endoscopic Surgery (NOTES). Currently, NOTES is still in the early stages of evolution but its potential uses in the field of cancer surgery are already being proposed. To develop NOTES to the stage that it will be safe, effective and widely available for the management of cancer patients represents a huge challenge ranging from the development of equipment and techniques to the demonstration of safety and efficacy in clinical trials as well as training and competence issues. It is still not clear whether these challenges will be surmounted so that NOTES becomes mainstream therapy. A period of 'watchful waiting' seems appropriate therefore for the uncommitted general surgeon in order that NOTES may be given time to prove compelling and convincing before its general uptake into routine practice.
    • Characteristics of patients presenting with erythema nodosum and sarcoidosis.

      O'Connor, T M; Cagney, D; Jahangir, A; Brady, A; Fitzgibbon, J; Lee, G; El-Gammal, A; Brennan, N J; Department of Respiratory Medicine, Mercy University Hospital, Cork., terryoconnor@eircom.net (2012-01-31)
      We explored the relationship between erythema nodosum (EN) and sex, age, serum angiotensin converting enzyme (ACE), bronchoalveolar lavage lymphocytosis (BAL-I), interstitial granulomas and radiological stage in patients presenting with pulmonary sarcoidosis in Ireland. Sixty-nine patients diagnosed with sarcoidosis between 2003 and 2006 were studied. Forty one patients (59%) were male. Sixteen patients (23%) presented with EN. Forty one patients of 65 (63%) had transbronchial biopsies demonstrating non-caseating granulomas. Patients with sarcoidosis presenting with EN were more likely to be female (p=0.042), younger (p=0.012) and have earlier stage pulmonary disease (p=0.02). There were no correlations between serum ACE, interstitial granulomas and disease stage. BAL-I did however predict increasing disease radiological stage (p=0.042). In this study, one quarter of patients with sarcoidosis presented with EN among their presenting features. These patients were more likely to be young females with early stage radiological disease.
    • Chronic kidney disease and obesity in Ireland: comparison of self-reported coronary artery disease in population study with clinic attendees.

      Lannin, U; Vaughan, C; Perry, I J; Browne, G (Irish Medical Journal, 2015-02)
      Obesity is a growing issue in Ireland. The link between obesity, CKD and CAD has not previously been described in the Irish population. The prevalence of obesity and CKD was compared across 3 groups: population based estimates with self-reported CAD, population based estimates without self-reported CAD (SLAN-07) and a random selection of cardiology outpatients with CAD. The SLAN-07 is a representative survey of 1207 randomly selected participants ≥ 45 years. Validated methods measured parameters including waist circumference, blood pressure and markers of renal function specifically glomerular filtration rate (eGFR) and albumin: creatinine ratio. The Cardiology clinic surveyed a random selection of 126 participants ≥ 45 years with CAD. Similar parameters were measured using the validated methods utilised in SLAN-07 study. Prevalence of obesity and renal disease was significantly higher in both CAD groups. At population level, risk factors were modelled using logistic regression to compare odds of participants with self-reported CAD with those without. Age, hypertension, obesity, elevated waist circumference, renal disease and diabetes are significantly associated with existing CAD. Obesity and CKD are more frequent in patients with CAD. Routine evaluation is essential to facilitate more intensive management of these risk factors.
    • Comparison of arterial and venous blood gases and the effects of analysis delay and air contamination on arterial samples in patients with chronic obstructive pulmonary disease and healthy controls.

      O'Connor, T M; Barry, P J; Jahangir, A; Finn, C; Buckley, B M; El-Gammal, A; Department of Respiratory Medicine, Mercy University Hospital, Cork, Ireland., terryoconnor@eircom.net (2012-01-31)
      BACKGROUND: Arterial blood gases (ABGs) are often sampled incorrectly, leading to a 'mixed' or venous sample. Delays in analysis and air contamination are common. OBJECTIVES: We measured the effects of these errors in patients with chronic obstructive pulmonary disease (COPD) exacerbations and controls. METHODS: Arterial and venous samples were analyzed from 30 patients with COPD exacerbation and 30 controls. Venous samples were analysed immediately and arterial samples separated into non-air-contaminated and air-contaminated specimens and analysed at 0, 30, 60, 90 and 180 min. RESULTS: Mean venous pH was 7.371 and arterial pH was 7.407 (p < 0.0001). There was a correlation between venous and arterial pH (r = 0.5347, p < 0.0001). The regression equation to predict arterial pH was: arterial pH = 4.2289 + 0.43113 . venous pH. There were no clinically significant differences in arterial PO associated with analysis delay. A statistically significant decline in pH was detected at 30 min in patients with COPD exacerbation (p = 0.0042) and 90 min in controls (p < 0.0001). A clinically significant decline in pH emerged at 73 min in patients with COPD exacerbation and 87 min in controls. Air contamination was associated with a clinically significant increase in PO in all samples, including those that were immediately analyzed. CONCLUSIONS: Arterial and venous pH differ significantly. Venous pH cannot accurately replace arterial pH. Temporal delays in ABG analysis result in a significant decline in measured pH. ABGs should be analysed within 30 min. Air contamination leads to an immediate increase in measured PO, indicating that air-contaminated ABGs should be discarded.
    • Comparison of sodium levels between GEM 5000 Blood Gas Analysers and Abbott c8000 Architect Analyser in patients admitted to ED in MUH

      Yates, Stephanie; Barden, Eithne; Louw, Michael; Lagali, Angeline; Stephanie Yates, Eithne Barden, Michael Louw, Angeline Lagali, Biochemistry, Mercy University Hospital, Grenville Place, Cork, Ireland. (2022-06-23)
      Background / Problem Identified: Sodium is the major cation of extracellular fluid; it plays an essential role in the normal distribution of water and in the maintenance of osmotic pressure in extracellular fluid compartments. Here in MUH, sodium levels are reported using the GEM 5000 Blood Gas Analyser, as a point of care test in the ED. They also form part of a renal panel and are reported in the Biochemistry lab using the c8000 Abbott Architect, using whole blood and serum/li-heparin samples respectively. The c8000 uses Integrated Chip Technology (ICT), Ion Selective Electrode, diluted (Indirect) to measure sodium, whereas the Gem 5000 uses potentiometric sensors to measure sodium (Direct). Hypo and Hypernatremia are the most common electrolyte disorders. Therefore precise and reliable sodium measurements are crucial for correct treatment of the patient. In recent years, several studies have showed a discrepancy in sodium levels between direct and indirect methods. In general, clinicians consider the two methods to be interchangeable and there is a lack of awareness of the associated discrepancy between methods.
    • Compliance with venous thromboembolism protocol in surgical patients in Mercy University Hospital quality improvement project

      Shehata, Danny; Cagney, David; McGreal, Gerald; Danny Shehata, David Cagney, Gerald McGreal, Vascular Surgery, Mercy University Hospital, Grenville Place, Cork, Ireland. (2021-09-30)
      Background / Problem Identified : 63% of all venous thromboembolic (VTE) events occur in the hospital setting, of which 70% may be preventable with appropriate VTE prophylaxis. Local and national quality improvement initiatives have led to development of a generic VTE prophylaxis protocol for hospital inpatients which can be found on page 3 of the hospital drug kardex. This quality improvement project aims to assess and improve the compliance amongst Non-Consultant Hospital Doctors (NCHDs) with completion of the VTE Protocol and as well as the appropriate prescription of VTE prophylaxis amongst surgical patients in Mercy University Hospital.