Beaumont Hospital
http://hdl.handle.net/10147/125987
2024-03-28T14:08:55ZThe impact of the COVID-19 pandemic on the provision of endovascular thrombectomy for stroke: an Irish perspective.
http://hdl.handle.net/10147/635496
The impact of the COVID-19 pandemic on the provision of endovascular thrombectomy for stroke: an Irish perspective.
Brennan, David; Power, Sarah; O'Hare, Alan; Brennan, Paul; Thornton, John; Brosnan, Conor; Reid, Conor; Crockett, Matthew
Background: The COVID-19 pandemic produced unprecedented challenges to healthcare systems. These challenges were amplified in the setting of endovascular thrombectomy (EVT) for large vessel occlusion strokes given the time-sensitive nature of the procedure.
Aims: To assess the impact of the COVID-19 pandemic on service provision at the primary endovascular stroke centre in Ireland.
Methods: A retrospective review of the National Thrombectomy Service database was performed. All patients undergoing EVT from 1 January to 31 December inclusive of 2019 to 2021 were included. Patient demographics, functional outcomes and endovascular treatment time metrics were recorded.
Results: Data from 2019, 2020 and 2021 were extracted. Three hundred seven thrombectomies were performed in 2019 and 2020; this number increased to 327 in 2021. Median time from arrival to groin puncture for thrombectomy was 64 min in 2019, increasing to 65 min in 2020. In 2021, this decreased to 52 min. Median time taken from groin puncture to first perfusion remained stable from 2019 to 2021 years at 20 min. Total duration of emergency thrombectomies reduced from 32 min in 2019 to 27 min in 2020. This increased to 29 min in 2021.
Conclusions: Despite the myriad of challenges presented by the pandemic, service provision at the primary Irish ESC, and the referring hospitals, has proven to be robust. Procedural time metrics were maintained whilst the expected reduction in number of EVTs performed did not materialise, there actually being a significant increase in number of EVTs performed in the pandemic's second year.
2023-02-16T00:00:00ZAn observational study of dose dense chemotherapy with lipegfilgrastim support in early breast cancer.
http://hdl.handle.net/10147/635155
An observational study of dose dense chemotherapy with lipegfilgrastim support in early breast cancer.
Rashed, Ahmed; Fitzpatrick, Orla M; Easty, David J; Collins, Dearbhaile; Mallet, Victoria; Milewski, Maciej; Egan, Keith; Grogan, Liam; Hennessy, Bryan T; Morris, Patrick G; Fitzpatrick, Orla; coyne, zac; Breathnach, Oscar
This was a single arm, non-interventional, prospective study. The primary endpoint was to determine the rate of neutropenia defined as ANC of < 1.0 × 109/L, during four cycles of dose dense AC with lipegfilgrastim support. The secondary endpoints were the incidence of febrile neutropenia, (temperature > 38 °C and ANC < 1.0 × 109/L), treatment delays, premature treatment cessation and toxicity.
2023-02-20T00:00:00ZAn Oncology Urgent Care Clinic for the Management of Immune-Related Adverse Events: A Descriptive Analysis.
http://hdl.handle.net/10147/635079
An Oncology Urgent Care Clinic for the Management of Immune-Related Adverse Events: A Descriptive Analysis.
Tackett, Sean; Myers, Samantha; Brahmer, Julie R; Browner, Ilene S; Ettinger, David S; Forde, Patrick M; Hales, Russell K; Hann, Christine L; Lam, Vincent K; Marrone, Kristen A; Patel, Tricia; Peterson, Valerie; Sagorsky, Sarah; Turner, Michelle; Voong, Khinh R; Naidoo, Jarushka; Feliciano, Josephine L; Liang, Kai-li
Introduction: With the increasing use of immune checkpoint inhibitors (ICI) for cancer, there is a growing burden on the healthcare system to provide care for the toxicities associated with these agents. Herein, we aim to identify and describe the distribution of encounters seen in an urgent care setting for immune-related adverse events (irAEs) and the clinical outcomes from irAE management.
Methods: Patient demographics, disease characteristics, and treatment data were collected retrospectively from encounters at an oncology Urgent Care Clinic (UCC) from a single tertiary center for upper aerodigestive malignancies from 1 July 2018 to 30 June 2019. Data were summarized using descriptive statistics with odds ratios for associations between patient features and hospitalization after UCC evaluation.
Results: We identified 494 encounters from 289 individual patients over the study period. A history of ICI therapy was noted in 34% (n = 170/494) of encounters and 29 encounters (29/170, 17%) were confirmed and treated as irAEs. For those treated for irAEs, the majority (n = 19/29; 66%) were discharged home. Having an irAE was associated with an increased risk of hospitalization compared to non-irAEs (OR 5.66; 95% CI 2.15-14.89; p < 0.001).
Conclusion: In this single institution experience, the majority of UCC encounters for confirmed irAEs were safely managed within the UCC. In ICI-treated patients, having an irAE was associated with an increased risk of hospitalization versus non-irAEs.
2022-06-17T00:00:00ZIsavuconazole Treatment of Spinal Cord Invasive Aspergillosis Guided by Cerebrospinal Fluid (1,3)-β-d-Glucan Levels in a Patient with Low Interferon-Gamma and Ulcerative Colitis.
http://hdl.handle.net/10147/635076
Isavuconazole Treatment of Spinal Cord Invasive Aspergillosis Guided by Cerebrospinal Fluid (1,3)-β-d-Glucan Levels in a Patient with Low Interferon-Gamma and Ulcerative Colitis.
Reidy, Paul; O'Toole, Aoibhlinn; Caird, John; McNally, Cora; McConkey, Samuel; de Barra, Eoghan; O’Regan, Siobhán; O'Kelly, Brendan
This case highlights the use of (1,3)-beta-d glucan to direct treatment of a cervical spinal cord Aspergillus fumigatus infection in a 22-year-old woman immunocompromised due to steroid and anti-TNF therapy in the context of ulcerative colitis and interferon gamma deficiency. A 4-year treatment course requiring neurosurgical intervention on four occasions and prolonged antifungal therapy, including isavuconazole, resulted in clinical cure with a corresponding decrease in CSF beta-d-glucan to <30 pg/mL. Serum and CSF galactomannan levels were not elevated at any point during the clinical course.
2022-05-25T00:00:00ZSpectrum of Phenotypic, Genetic, and Functional Characteristics in Patients With Epilepsy With Pathogenic Variants.
http://hdl.handle.net/10147/635005
Spectrum of Phenotypic, Genetic, and Functional Characteristics in Patients With Epilepsy With Pathogenic Variants.
Schwarz, Niklas; Seiffert, Simone; Pendziwiat, Manuela; Rademacher, Annika Verena; Brünger, Tobias; Hedrich, Ulrike B S; Augustijn, Paul B; Baier, Hartmut; Bayat, Allan; Bisulli, Francesca; Buono, Russell J; Bruria, Ben Zeev; Doyle, Michael G; Guerrini, Renzo; Heimer, Gali; Iacomino, Michele; Kearney, Hugh; Klein, Karl Martin; Kousiappa, Ioanna; Kunz, Wolfram S; Lerche, Holger; Licchetta, Laura; Lohmann, Ebba; Minardi, Raffaella; McDonald, Marie; Montgomery, Sarah; Mulahasanovic, Lejla; Oegema, Renske; Ortal, Barel; Papacostas, Savvas S; Ragona, Francesca; Granata, Tiziana; Reif, Phillip S; Rosenow, Felix; Rothschild, Annick; Scudieri, Paolo; Striano, Pasquale; Tinuper, Paolo; Tanteles, George A; Vetro, Annalisa; Zahnert, Felix; Goldberg, Ethan M; Zara, Federico; Lal, Dennis; May, Patrick; Muhle, Hiltrud; Helbig, Ingo; Weber, Yvonne
KCNC2 encodes Kv3.2, a member of the Shaw-related (Kv3) voltage-gated potassium channel subfamily, which is important for sustained high-frequency firing and optimized energy efficiency of action potentials in the brain. The objective of this study was to analyze the clinical phenotype, genetic background, and biophysical function of disease-associated Kv3.2 variants.
2022-03-21T00:00:00ZTest-retest reliability of arterial spin labelling for cerebral blood flow in older adults with small vessel disease.
http://hdl.handle.net/10147/634904
Test-retest reliability of arterial spin labelling for cerebral blood flow in older adults with small vessel disease.
Binnie, Lauren R; Pauls, Mathilde M H; Benjamin, Philip; Dhillon, Mohani-Preet K; Betteridge, Shai; Clarke, Brian; Ghatala, Rita; Hainsworth, Fearghal A H; Howe, Franklyn A; Khan, Usman; Kruuse, Christina; Madigan, Jeremy B; Moynihan, Barry; Patel, Bhavini; Pereira, Anthony C; Rostrup, Egill; Shtaya, Anan B Y; Spilling, Catherine A; Trippier, Sarah; Williams, Rebecca; Isaacs, Jeremy D; Barrick, Thomas R; Hainsworth, Atticus
Cerebral small vessel disease (SVD) is common in older people and is associated with lacunar stroke, white matter hyperintensities (WMH) and vascular cognitive impairment. Cerebral blood flow (CBF) is reduced in SVD, particularly within white matter.
Here we quantified test–retest reliability in CBF measurements using pseudo-continuous arterial spin labelling (pCASL) in older adults with clinical and radiological evidence of SVD (N=54, mean (SD): 66.9 (8.7) years, 15 females/39 males). We generated whole-brain CBF maps on two visits at least 7 days apart (mean (SD): 20 (19), range 7-117 days).
Test–retest reliability for CBF was high in all tissue types, with intra-class correlation coefficient [95%CI]: 0.758 [0.616, 0.852] for whole brain, 0.842 [0.743, 0.905] for total grey matter, 0.771 [0.636, 0.861] for deep grey matter (caudate-putamen and thalamus), 0.872 [0.790, 0.923] for normal-appearing white matter (NAWM) and 0.780 [0.650, 0.866] for WMH (all p<0.001). ANCOVA models indicated significant decline in CBF in total grey matter, deep grey matter and NAWM with increasing age and diastolic blood pressure (all p<0.001). CBF was lower in males relative to females (p=0.013 for total grey matter, p=0.004 for NAWM).
We conclude that pCASL has high test–retest reliability as a quantitative measure of CBF in older adults with SVD. These findings support the use of pCASL in routine clinical imaging and as a clinical trial endpoint.
2022-01-26T00:00:00ZThe cost of cancer care: how far would you go for a trial?
http://hdl.handle.net/10147/634425
The cost of cancer care: how far would you go for a trial?
Fitzpatrick, Orla; Murphy, Catherine; Duignan, Erica; Egan, Keith; Hennessy, Bryan T; Grogan, Liam; Murphy, Adrian; Breathnach, Oscar S; Naidoo, Jarushka; Morris, Patrick G
Background: Clinical trials are often considered the gold standard in cancer care. However, patients face barriers in trial participation including distances to cancer centres and personal costs including changing employment status, cost of medications, inpatient admissions, and parking tariffs.
Aim: Our aim was to compare the distances patients travelled for clinical trials compared to those receiving standard systemic anticancer therapy (SACT). We also investigated the additional costs associated with this.
Methods: This was a retrospective review of electronic patient medical records. The distance from the patients' home address to Beaumont was calculated as a one-way journey in kilometres. Patients attending for clinical trials were compared to those receiving standard of care SACT.
Results: A total of 271 patients receiving standard SACT over a 5-day period and 111 patients enrolled on 24 clinical trials were included. The median one-way distance travelled by patients enrolled in clinical trials was 41.4 km, compared to 14 km in those patients' receiving standard of care SACT. The median estimated cost was €13 vs €4.20 for those enrolled on clinical trials compared to those receiving standard of care treatment, respectively.
Conclusion: Patients enrolled on clinical trials often travel more than twice as far to receive their anti-cancer treatment compared to those receiving standard of care SACT and incur an increased cost of travel expenses.
2022-01-17T00:00:00ZBilateral patellar tendon rupture following low-energy trauma in a young patient without predisposing risk factors.
http://hdl.handle.net/10147/634332
Bilateral patellar tendon rupture following low-energy trauma in a young patient without predisposing risk factors.
Murphy, Suzanne M; McAleese, Timothy; Elghobashy, Osama; Walsh, James
We describe the case of a 25 year old male who presented with a bilateral patellar tendon ruptures without any of the identified risk factors for tendon injuries. Our patient is the youngest adult reported to date with confirmed bilateral, unprovoked, patellar tendon ruptures. We accompany our case with an up-to-date literature review on this topic. A degree of clinical suspicion is required for emergency room physicians as well as orthopaedic surgeons assessing such patients to avoid missing bilateral injuries. Point of care ultrasound may be utilised when there is doubt regarding the diagnosis. Prompt surgical management and a specific rehabilitation programme are both required to ensure maximum recovery of these patients.
2022-04-30T00:00:00ZUltraviolet disinfection robots to improve hospital cleaning: Real promise or just a gimmick?
http://hdl.handle.net/10147/634281
Ultraviolet disinfection robots to improve hospital cleaning: Real promise or just a gimmick?
Diab-El Schahawi, Magda; Zingg, Walter; Vos, Margreet; Humphreys, Hilary; Lopez-Cerero, Lorena; Fueszl, Astrid; Zahar, Jean Ralph; Presterl, Elisabeth
The global COVID-19 pandemic due to the novel coronavirus SARS-CoV-2 has challenged the availability of traditional surface disinfectants. It has also stimulated the production of ultraviolet-disinfection robots by companies and institutions. These robots are increasingly advocated as a simple solution for the immediate disinfection of rooms and spaces of all surfaces in one process and as such they seem attractive to hospital management, also because of automation and apparent cost savings by reducing cleaning staff. Yet, there true potential in the hospital setting needs to be carefully evaluated. Presently, disinfection robots do not replace routine (manual) cleaning but may complement it. Further design adjustments of hospitals and devices are needed to overcome the issue of shadowing and free the movement of robots in the hospital environment. They might in the future provide validated, reproducible and documented disinfection processes. Further technical developments and clinical trials in a variety of hospitals are warranted to overcome the current limitations and to find ways to integrate this novel technology in to the hospitals of to-day and the future.
2021-02-12T00:00:00ZDistance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative.
http://hdl.handle.net/10147/633354
Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative.
Haldeman, Scott; Nordin, Margareta; Tavares, Patricia; Mullerpatan, Rajani; Kopansky-Giles, Deborah; Setlhare, Vincent; Chou, Roger; Hurwitz, Eric; Treanor, Caroline; Hartvigsen, Jan; Schneider, Michael; Gay, Ralph; Moss, Jean; Haldeman, Joan; Gryfe, David; Wilkey, Adam; Brown, Richard; Outerbridge, Geoff; Eberspaecher, Stefan; Carroll, Linda; Engelbrecht, Reginald; Graham, Kait; Cashion, Nathan; Ince, Stefanie; Moon, Erin
Abstract:
Background
The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain.
Objective
The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available.
Methods
Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process.
Results
The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient’s spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions.
Conclusions
The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.
2021-02-17T00:00:00Z