University Hospitals Limerickhttp://hdl.handle.net/10147/1320102024-03-29T11:11:26Z2024-03-29T11:11:26ZHealth care needs of Iraqi refugees presenting to the Kurdish Red Crescent clinics in the Al-Hol camp during 12 months of ongoing conflict: a cross-sectional studyGaravan, Karmel CarrieVan Berlaer, GerlantHoughton, FrankBery, Sherwanhttp://hdl.handle.net/10147/6379052023-09-26T02:21:18Z2023-09-17T00:00:00ZHealth care needs of Iraqi refugees presenting to the Kurdish Red Crescent clinics in the Al-Hol camp during 12 months of ongoing conflict: a cross-sectional study
Garavan, Karmel Carrie; Van Berlaer, Gerlant; Houghton, Frank; Bery, Sherwan
Background
The Battle for Mosul began in October 2016 as the world's single largest military operation since the 2003 invasion of Iraq. In anticipation of massive displacement of Iraqi refugees, the Al-Hol camp was erected at the Iraqi-Syrian border meant to respond to the immediate needs of about 100,000 people. The Kurdish Red Crescent (KRC) in partnership with Un Ponte Per (UPP) operated two clinics in the camp, receiving over 200 patients daily.
This study aims to describe health services utilisation, complaints, diagnoses and treatment of Iraqi war refugees in the camp and make recommendations to improve humanitarian response for these vulnerable populations.
Methods
By means of a cross-sectional analysis of all patient data collected in two primary healthcare clinics and an emergency room in the camp between March 2017 and March 2018 are reviewed and analysed, regarding demographics, complaints at presentation, diagnoses and treatment.
Results
Of all 148,743 patient contacts, 93,341 were individual consultations with health services provision to registered Iraqi refugees in both clinics, and 55,402 were Emergency Room encounters.
Most frequent specific complaints (over 20%) were of respiratory origin (including infections and asthma), watery diarrhoea (8%) and urinary tract infections (7.6%). Urinary tract infections, anaemia and vaginal discharge were common among the female population. Non-communicable diseases like diabetes and arterial hypertension were frequent and consistent complaints throughout the year equally in male and female adults. Skin diseases included over 700 cases of leishmaniosis, mainly in the older population and in the first months. Mental health disorders remained under detected and 44% of diagnoses were categorised as unknown or “other”. There were 302 live births, and the highest Crude Mortality Rate (0.21) was in week 33.
Emergency treatment included nebulisations, dressings, injections, suturing, splinting, and stabilization prior to referral to more advanced care outside the camp.
Conclusions
Many Iraqi refugees in Al-Hol sought treatment for illnesses associated with prolonged poor living conditions, combined with seasonal variations in hostile desert climate: respiratory tract infections mainly seen in children, gastrointestinal diseases, urinary tract infections, and gender specific complaints of vaginal discharge and anaemia.
2023-09-17T00:00:00ZWomen's Opinions on Cardiotocograph Monitoring and Staff Communication During Labour.McMahon, GRogers, AWoulfe, ZTuthill, EDoyle, MBurke, GImcha, Mhttp://hdl.handle.net/10147/6358842023-06-16T02:51:15Z2019-12-16T00:00:00ZWomen's Opinions on Cardiotocograph Monitoring and Staff Communication During Labour.
McMahon, G; Rogers, A; Woulfe, Z; Tuthill, E; Doyle, M; Burke, G; Imcha, M
Aims
This study was undertaken to ascertain women’s opinions of having fetal monitoring done in labour, how they felt
the staff taking care of them communicated with them about cardiotocograph (CTG) and how they rated their birthing
experience.
Methods
An anonymous survey was given to women in September 2018, asking them about their experience of CTG monitoring
and staff communication.
Results
All forty-eight women said the staff explained the CTG to them, and 93.8% were satisfied with this communication.
Nearly all women, 97.9%, felt confident that the staff knew what they were doing and 89.6% felt included in any
clinical decision that was made. Of the forty-eight women, 20.8% said they wanted to know something about the CTG
but didn’t ask at the time. When asked about their overall experience of communication from staff, 60.4% said
excellent.
Conclusions
It is important to assess patient’s satisfaction with communication from staff members.
2019-12-16T00:00:00ZHow do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients.Glynn, KevinMcKenna, FrankLally, KevinO'Donnell, MuireannGrover, SandeepChakrabarti, SubhoAvasthi, AjitMattoo, Surendra KSharma, AkhileshGosh, AbhishekShah, RuchitaHickey, DavidFitzgerald, JamesDavis, BridO'Regan, NiamhAdamis, DimitriousWilliams, OlugbenjaAwan, FahadDunne, CCullen, WalterMcInerney, ShaneMcFarland, JohnJabbar, FaizaO'Connell, HenryTrzepacz, Paula TLeonard, MaeveMeagher, Davidhttp://hdl.handle.net/10147/6311632022-01-27T01:45:17Z2021-04-14T00:00:00ZHow do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients.
Glynn, Kevin; McKenna, Frank; Lally, Kevin; O'Donnell, Muireann; Grover, Sandeep; Chakrabarti, Subho; Avasthi, Ajit; Mattoo, Surendra K; Sharma, Akhilesh; Gosh, Abhishek; Shah, Ruchita; Hickey, David; Fitzgerald, James; Davis, Brid; O'Regan, Niamh; Adamis, Dimitrious; Williams, Olugbenja; Awan, Fahad; Dunne, C; Cullen, Walter; McInerney, Shane; McFarland, John; Jabbar, Faiza; O'Connell, Henry; Trzepacz, Paula T; Leonard, Maeve; Meagher, David
Objectives: To investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology.
Design: Cross-sectional study.
Setting: International study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings.
Participants: 1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV).
Primary and secondary outcome measures: Hyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory.
Results: Hypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p<0.001) and had a lower overall burden of delirium symptoms than the other motor subtypes. Hyperactive delirium was associated with younger age, drug withdrawal and the DEC category other systemic aetiologies (p<0.001). Mixed delirium showed the greatest symptom burden and was more often associated with drug intoxication and metabolic disturbance (p<0.001). All three delirium motor subtypes had similar levels of impairment in attention and visuospatial functioning but differed significantly when compared with no subtype (p<0.001).
Conclusions: This study indicates a pattern of aetiology and symptomatology of delirium motor subtypes across a large international sample that had previously been lacking. It serves to improve our understanding of this complex condition and has implications in terms of early detection and management of delirium.
2021-04-14T00:00:00ZQuantifying the impact of COVID-19 on chronic pain services in the Republic of Ireland.Mullins, Cormac FrancisHarmon, DominicO'Connor, Theresehttp://hdl.handle.net/10147/6311182022-01-26T01:56:39Z2021-02-05T00:00:00ZQuantifying the impact of COVID-19 on chronic pain services in the Republic of Ireland.
Mullins, Cormac Francis; Harmon, Dominic; O'Connor, Therese
Introduction: During the COVID-19 pandemic, most medical services were shut down and resources were redistributed. Closures included pain management departments where many staff were redeployed. The aim of this study was to assess the impact of COVID-19 on chronic pain services in the Republic of Ireland.
Methods: An online survey was sent to pain consultants working in public hospitals in the Republic of Ireland between the 22nd and 28th September 2020.
Results: We received responses from 18 consultants from all 15 public hospitals in the Republic of Ireland with chronic pain services. Procedural volume during lockdown fell to 26% of pre-COVID levels. This had recovered somewhat by the time of the survey to 71%. Similarly, in-person outpatient clinic volume fell to 10% of per-COVID numbers and recovered to 50%. On average, 39% of public hospital activity was made up for by the availability of private hospitals. This varied significantly across the country. The use of telemedicine increased significantly during the pandemic. Before COVID, on average, 13% of outpatient clinic volume was composed of telephone or video consultations. This increased to 46% at the time of the survey.
Conclusion: This survey of consultant pain physicians in the Republic of Ireland has revealed how chronic pain services have been affected during the pandemic and how they have evolved.
2021-02-05T00:00:00ZHomelessness amongst psychiatric Inpatients: a cross-sectional study in the mid-west of Ireland.Moloney, NoreenO'Donnell, PatrickElzain, MusaabBashir, AhmadDunne, Colum PKelly, Brendan DGulati, Gautamhttp://hdl.handle.net/10147/6307362021-12-02T01:54:58Z2021-02-15T00:00:00ZHomelessness amongst psychiatric Inpatients: a cross-sectional study in the mid-west of Ireland.
Moloney, Noreen; O'Donnell, Patrick; Elzain, Musaab; Bashir, Ahmad; Dunne, Colum P; Kelly, Brendan D; Gulati, Gautam
Background: This cross-sectional study sought to establish the prevalence of homelessness amongst inpatients in two psychiatric units in Ireland and explore the perceived relationship between psychiatric illness and homelessness.
Methods: The study employed a semi-structured interview format utilising a specifically designed questionnaire which received ethical approval from the Limerick University Hospitals Group ethics committee.
Results: Fifty psychiatric inpatients were interviewed. Fifteen were either "currently" homeless (n = 8) or had experienced "past" homelessness (n = 7). Those who had experienced homelessness were more likely to have a psychotic illness. A majority of those who had experienced homelessness believed that psychiatric illness contributed to their homelessness. Involuntary admission rates were more than double for patients in the homeless group. A number of participants also reported that a lack of accommodation was preventing their discharge.
Conclusion: Homelessness affects a significant number of psychiatric patients and can be both a contributory factor to, and consequence of, mental illness. With homelessness at unprecedented levels, there is a need for the development of tailored programmes aimed at supporting these vulnerable groups.
2021-02-15T00:00:00ZAssessment of the FilmArray® multiplex PCR system and associated meningitis/encephalitis panel in the diagnostic service of a tertiary hospital.Mostyn, AmandaLenihan, MarieO'Sullivan, DonnchadhWoods, SaraO'Hara, MaureenPowell, JamesPower, LorraineO'Connell, Nuala HDunne, Colum Phttp://hdl.handle.net/10147/6307202023-05-09T12:46:19Z2020-02-11T00:00:00ZAssessment of the FilmArray® multiplex PCR system and associated meningitis/encephalitis panel in the diagnostic service of a tertiary hospital.
Mostyn, Amanda; Lenihan, Marie; O'Sullivan, Donnchadh; Woods, Sara; O'Hara, Maureen; Powell, James; Power, Lorraine; O'Connell, Nuala H; Dunne, Colum P
Rapid and accurate diagnosis of meningitis/encephalitis (M/E) is essential for successful patient outcomes. The FilmArray® meningitis/encephalitis Panel (MEP) is a multiplexed PCR test for simultaneous, rapid detection of pathogens directly from cerebrospinal fluid (CSF) samples. 94 prospectively collected CSF specimens from patients with clinical suspicion of infective M/E underwent testing for 14 pathogens simultaneously, including Escherichia coli, Haemophilus influenzae, Neisseria meningitidis, and Varicella zoster. MEP demonstrated 95% agreement with current PCR methods, resulting in 16 diagnosed cases of M/E. Typically, the FilmArray® MEP results were delivered within approximately one hour, contrasting with current practices taking up to 5.6 days. Given the significant morbidity and mortality associated with delayed diagnosis of central nervous system infections, the FilmArray® MEP is a useful addition to the diagnostic capabilities of a clinical microbiology department.
Rapid and accurate diagnosis of meningitis/encephalitis (M/E) is essential for successful patient outcomes. The FilmArray® meningitis/encephalitis Panel (MEP) is a multiplexed PCR test for simultaneous, rapid detection of pathogens directly from cerebrospinal fluid (CSF) samples. 94 prospectively collected CSF specimens from patients with clinical suspicion of infective M/E underwent testing for 14 pathogens simultaneously, including Escherichia coli, Haemophilus influenzae, Neisseria meningitidis, and Varicella zoster. MEP demonstrated 95% agreement with current PCR methods, resulting in 16 diagnosed cases of M/E. Typically, the FilmArray® MEP results were delivered within approximately one hour, contrasting with current practices taking up to 5.6 days. Given the significant morbidity and mortality associated with delayed diagnosis of central nervous system infections, the FilmArray® MEP is a useful addition to the diagnostic capabilities of a clinical microbiology department.
2020-02-11T00:00:00ZOutcomes of point-of-care testing for influenza in the emergency department of a tertiary referral hospital in IrelandT.K. Teoh a, b,d , J. Powell a , J. Kelly c , C. McDonnell b , R. Whelan c , N.H. O’Connell a,b,d , C.P. Dunnehttp://hdl.handle.net/10147/6307192023-05-09T11:57:29Z2021-01-19T00:00:00ZOutcomes of point-of-care testing for influenza in the emergency department of a tertiary referral hospital in Ireland
T.K. Teoh a, b,d , J. Powell a , J. Kelly c , C. McDonnell b , R. Whelan c , N.H. O’Connell a,b,d , C.P. Dunne
Background: Seasonal influenza causes significant morbidity and mortality, and represents
a recurring financial burden for community- and hospital-based treatment. Nosocomial
outbreaks exacerbate the impact of influenza. Rapid diagnosis of influenza has been shown
to reduce transmission. However, point-of-care testing (POCT) in emergency departments
and prudent direction of patients with the virus to reduce hospital-acquired infection
(HAI) have not been evaluated widely.
Aim: To assess performance characteristics of the Abbott ID NOW Influenza A & B 2
system, impact on incidence of hospital-acquired influenza, and admission rate ratio for
patients who have POCT compared with laboratory testing. POCT was introduced in the
2018e2019 influenza season. Data from then were compared with preceding and subsequent seasons.
Methods: Records of POCT and laboratory testing for the 2017e2018, 2018e2019, and
2019e2020 influenza seasons were analysed. Sensitivity and specificity of POCT were
compared pairwise with Xpert Flu A/B/RSV. Patient admission rates and time of waiting for
admission were compared.
Findings: Compared to laboratory assay, POCT demonstrated sensitivity of 90.6% (95%
confidence interval (CI): 78.6e96.5) and specificity of 99.2% (95.2e100) for influenza A,
with 51.4% and 41.9% reductions in numbers of HAIs observed in the two seasons when
POCT was available, respectively. The admission rate ratio for influenza cases diagnosed
by POCT compared with laboratory diagnosis was 0.72 (95% CI: 0.53e0.97; P ¼ 0.031).
Conclusion: POCT for influenza appears a feasible strategy for testing of patients during
peak influenza virus season, with potential to reduce HAI. The relatively rapid turnaround
time may also benefit clinical management of patients presenting at emergency departments with suspected influenza.
2021-01-19T00:00:00ZA retrospective observational study of the impact of 16s and 18s ribosomal RNA PCR on antimicrobial treatment over seven years: A tertiary hospital experience.Teoh, TeeKeatMcNamara, RachelPowell, JamesO'Connell, Nuala HDunne, Colum Phttp://hdl.handle.net/10147/6307142023-05-09T12:41:05Z2021-10-12T00:00:00ZA retrospective observational study of the impact of 16s and 18s ribosomal RNA PCR on antimicrobial treatment over seven years: A tertiary hospital experience.
Teoh, TeeKeat; McNamara, Rachel; Powell, James; O'Connell, Nuala H; Dunne, Colum P
Background: Although culture-based methods remain a staple element of microbiology analysis, advanced molecular methods increasingly supplement the testing repertoire. Since the advent of 16s and 18s ribosomal RNA PCR in the 2000s, there has been interest in its utility for pathogen detection. Nonetheless, studies assessing the impact on antimicrobial prescribing are limited. We report a single-centre experience of the influence of 16s and 18s PCR testing on antimicrobial treatment, including a cost-analysis.
Methods: Data were collected retrospectively for all samples sent for 16s and 18s PCR testing between January 2014 and December 2020. Results were compared to any culture-based result. Assessment focused on any change of antimicrobial treatment based on PCR result, or use of the result as supportive evidence for microbiological diagnosis.
Results: 310 samples relevant to 268 patients were referred for 16s/18s rRNA PCR testing during the period. Culture was performed for 234 samples. Enrichment culture was performed for 83 samples. 82 of 300 samples sent for 16s PCR had positive results (20.8%). When culture was performed, enrichment reduced the outcome of 16s PCR only positive results (4/36 [11.1%] versus 14/35 [40.0%], p = 0.030 where a pathogen found). 18s PCR yielded 9 positive results from 67 samples. The 16s PCR result influenced antimicrobial change for 6 patients (2.2%). We estimated the cost for 16s PCR testing to result in one significant change in antimicrobial therapy to be €3,340. 18s PCR did not alter antimicrobial treatment.
Conclusion: There was limited impact of 16s PCR results on antimicrobial treatments. Relevance to practice was affected by relatively long turn-around-time for results. Utility may be increased in specialised surgical centres, or by reducing turn-around-time. Enrichment culture should be considered on samples where 16s PCR is requested. There remains limited evidence for use of 18s PCR in clinical management, and further studies in this area are likely warranted.
2021-10-12T00:00:00ZSystemic Molecular Mediators of Inflammation Differentiate Between Crohn's Disease and Ulcerative Colitis, Implicating Threshold Levels of IL-10 and Relative Ratios of Pro-inflammatory Cytokines in Therapy.Health Service ExecutiveKiernan, Miranda GCoffey, J CalvinSahebally, Shaheel MTibbitts, PaulLyons, Emma MO'leary, EimearOwolabi, FunkeDunne, Colum Phttp://hdl.handle.net/10147/6306752021-11-27T01:49:58Z2019-06-26T00:00:00ZSystemic Molecular Mediators of Inflammation Differentiate Between Crohn's Disease and Ulcerative Colitis, Implicating Threshold Levels of IL-10 and Relative Ratios of Pro-inflammatory Cytokines in Therapy.
Health Service Executive; Kiernan, Miranda G; Coffey, J Calvin; Sahebally, Shaheel M; Tibbitts, Paul; Lyons, Emma M; O'leary, Eimear; Owolabi, Funke; Dunne, Colum P
Background and Aims
Faecal diversion is associated with improvements in Crohn’s disease but not ulcerative colitis, indicating that differing mechanisms mediate the diseases. This study aimed to investigate levels of systemic mediators of inflammation, including fibrocytes and cytokines, [1] in patients with Crohn’s disease and ulcerative colitis preoperatively compared with healthy controls and [2] in patients with Crohn’s disease and ulcerative colitis prior to and following faecal diversion.
Methods
Blood samples were obtained from healthy individuals and patients with Crohn’s disease or ulcerative colitis. Levels of circulating fibrocytes were quantified using flow cytometric analysis and their potential relationship to risk factors of inflammatory bowel disease were determined. Levels of circulating cytokines involved in inflammation and fibrocyte recruitment and differentiation were investigated.
Results
Circulating fibrocytes were elevated in Crohn’s disease and ulcerative colitis patients when compared with healthy controls. Smoking, or a history of smoking, was associated with increases in circulating fibrocytes in Crohn’s disease, but not ulcerative colitis. Cytokines involved in fibrocyte recruitment were increased in Crohn’s disease patients, whereas patients with ulcerative colitis displayed increased levels of pro-inflammatory cytokines. Faecal diversion in Crohn’s disease patients resulted in decreased circulating fibrocytes, pro-inflammatory cytokines, and TGF-β1, and increased IL-10, whereas the inverse was observed in ulcerative colitis patients.
Conclusions
The clinical effect of faecal diversion in Crohn’s disease and ulcerative colitis may be explained by differing circulating fibrocyte and cytokine responses. Such differences aid in understanding the disease mechanisms and suggest a new therapeutic strategy for inflammatory bowel disease.
2019-06-26T00:00:00ZHealth Care Professionals' Perspectives on Life-Course Immunization: A Qualitative Survey from a European Conference.Philip, Roy KDi Pasquale, Albertahttp://hdl.handle.net/10147/6298242021-06-30T01:37:35Z2020-04-14T00:00:00ZHealth Care Professionals' Perspectives on Life-Course Immunization: A Qualitative Survey from a European Conference.
Philip, Roy K; Di Pasquale, Alberta
Today, fewer children die each year from vaccine-preventable diseases than older adults. Health systems need new immunization strategies to tackle the burden of vaccine-preventable disease in an aging society. A life-course immunization (LCI) approach-which entails vaccination throughout an individual's lifespan-enables adults to age with reduced risk to disease, thereby enabling healthy, active and productive aging. We conducted an audience response system (ARS)-based survey to investigate HCP perspectives on LCI in an opportunistic sample of 222 health care professionals (HCPs) from around the world who attended a European infectious diseases conference. Survey results show that LCI is a priority for HCPs (77.4%-88.6%), with most of them stating the need to frame it as a part of a healthy lifestyle (91.0%-100.0%). Insufficient LCI recommendations by vaccine providers (12.9%-33.3%) and governments (15.2%-41.9%) and insufficient targeted budget allocation (6.1%-21.7%) were indicated as the main barriers to implement LCI, ahead of vaccine hesitancy (9.7%-15.2%). HCPs were willing to make LCI a gateway to healthy aging but need support to work together with other stakeholders involved in the vaccination journey. This could be a step towards equitable health care for all of society.
2020-04-14T00:00:00Z