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  • Is It Time To Review The Vaccination Strategy To Protect Adults Against Invasive Pneumococcal Disease?

    Corcoran, M; Mereckiene, J; Murchan, S; McElligott, M; O’Flanagan, D; Cotter, S; Cunney, R; Humphreys, H (Irish Medical Journal, 2019-03)
    Pneumococcal conjugate vaccines (PCVs) have reduced the predominant serotypes causing invasive pneumococcal disease (IPD). We assessed the impact of the paediatric 7- and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13) among older adults. We compared serotype-specific incidence rates from 2007/08 to 2016/17, expressed as incidence rate ratios (IRR). Introducing PCV7 and PCV13 into the childhood immunisation programme resulted in a decline in these serotypes in adults ≥65 years of age, with PCV7 serotypes decreasing by 85% (IRR=0.11, 95%CI: 0.05-0.22, p<0.0001) and PCV13 serotypes not included in PCV7 (PCV13-7), decreasing by 9% (IRR=0.68, 95%CI: 0.40-1.16, p=0.134). However, there was a significant increase in serotypes only found in the 23-valent polysaccharide vaccine, PPV23-PCV13: IRR=2.57, 95%CI: 1.68-4.03, p<0.0001, and non-vaccine types (NVTs), IRR=3.33, 95%CI: 1.75-6.84, p=0.0001. The decline of IPD associated with PCV7/13 serotypes and the increase in PPV23-PCV13 serotypes indicates clear serotype replacement. Increasing PPV23 uptake could still reduce the burden of disease for this population.
  • Scope and Safety of Paediatric Surgery in a Model III Hospital

    Joyce, P.D; Craig, R; Dakin, A.; Elsheik, E.; Ejaz, T.; Mansoor, S.; Toomey, D.P. (Irish Medical Journal, 2019-03)
    In 2016 the Faculty of Paediatrics in the Royal College of Physicians of Ireland, in conjunction with the Royal College of in Surgeons Ireland and the Health Service Executive, published the National Clinical Programme for Paediatrics and Neonatology: improving services for general paediatric surgery1. The purpose of these guidelines was to ensure the provision of safe and efficient paediatric general surgery outside of specialist paediatric hospitals in both local and regional paediatric surgical facilities. These guidelines were necessitated by a variety of factors including the retirement of a generation of consultant surgeons with paediatric surgical skills, a lack of paediatric surgical training for core trainees, increasing sub-specialisation within the field of general surgery with the resultant de-skilling of supporting anaesthetic, radiology and nursing colleagues, and inadequate funding of paediatric surgical services. These challenges are compounded by Ireland having the lowest number of paediatric surgeons per capita when compared to other European countries, despite having the highest birth rate in Western Europe1.
  • Impact of oral rehabilitation on the quality of life of partially dentate elders in a randomised controlled clinical trial: 2 year follow-up.

    McKenna, Gerald; Allen, Patrick Finbarr; Hayes, Martina; DaMata, Cristiane; Moore, Ciaran; Cronin, Michael (Plos One, 2018-01-01)
    This randomised clinical trial aimed to compare the impact of two different tooth replacement strategies for partially dentate older patients namely; removable partial dentures (RPDs) and functionally orientated treatment based on the shortened dental arch (SDA) concept, on Oral Health-related Quality of Life (OHrQOL). 89 patients completed a randomised clinical trial. Patients were recruited in two centres: Cork University Dental Hospital (CUDH) and a Geriatric Day Hospital (SFDH). 44 patients were randomly allocated to the RPD group and 45 to the SDA group where adhesive bridgework was used to provide 10 pairs of occluding contacts. The impact of treatment on OHrQOL was used as the primary outcome measure. Each patient completed the Oral Health Impact Profile (OHIP-14) at baseline, 1, 6, 12 and 24 months after treatment. Both treatment groups reported improvements in OHIP-14 scores at 24 months (p<0.05). For the SDA group OHIP-14 scores improved by 8.0 scale points at 12 months (p<0.001) and 5.9 scale points at 24 months (p<0.05). For the RPD group OHIP-14 scores improved by 5.7 scale points at 12 months (p<0.05) and 4.2 scale points at 24 months (p<0.05). Analysis using ANCOVA showed that there were significant between group differences recorded in both treatment centres. 24 months after intervention the SDA group recorded better OHIP-14 scores by an average of 2.9 points in CUDH (p<0.0001) and by an average of 7.9 points in SFDH (p<0.0001) compared to the RPD group. Patients in the SDA group maintained their improvements in OHrQOL scores throughout the 24 month study period. For the RPD group the initial improvement in OHrQOL score began to diminish after 6 months, particularly for those treated in SFDH. Thus, the benefits of functionally orientated treatment increased over time, particularly for the older, more systemically unwell cohort in SFDH.
  • Are we Over-Imaging the Obese Patient with Suspected Pulmonary Embolus in Ireland

    Gargan, M.L; O'Sullivan, M.; Hunter, K.; Buckley, O.; Torreggiani, W.C (Irish Medical Journal, 2019-02)
    To assess if there was a significant difference in the number of positive studies for pulmonary embolism between obese and non obese patients.
  • Caecal Epiploic Appendagitis Masquerading Clinically as an Acute Appendicitis: A Case Report and Brief Literature Review.

    Ejaz, Tallat; Saad, Eltaib; Nabil, Andik; Slattery, James (Case Reports in Surgery, 2019-01-01)
    A 46-year-old female presented to our emergency department (ED) with a 2-day history of right lower abdominal pain which was associated with nausea and anorexia. Abdominal examination revealed tenderness in the right iliac fossa (RIF) with rebound tenderness and a localized guarding. Urine dipstick was normal, and the pregnancy test was negative. Her laboratory investigations were significant only for a CRP of 16.6. A presumptive clinical diagnosis of acute appendicitis was suggested based on the given history and relevant physical signs. However, an abdominal computed tomography (CT) scan revealed an epiploic appendagitis of the caecum with a normal-looking appendix. She was managed conservatively and responded well and was discharged after 2 days in good health. Though being a relatively rare case of acute localized right-sided lower abdominal pain, caecal epiploic appendagitis should be considered as one of the differential diagnoses with the final diagnosis reached usually by the radiological findings due to the nonspecific nature of clinical and laboratory features.
  • Current advances in the treatment of giant cell arteritis: the role of biologics.

    Low, Candice; Conway, Richard (Therapeutic Advances in Musculoskeletal Disease, 2019-01-01)
    Giant cell arteritis (GCA) is the most common form of systemic vasculitis. It is a potentially severe disease with 25% of patients suffering vision loss or stroke. Our treatment paradigm is based on glucocorticoids. Glucocorticoids are required in high doses for prolonged periods and subsequently are associated with a significant amount of treatment-related morbidity. Alternative treatment options are urgently needed to minimize these glucocorticoid adverse events. Many other agents, such as methotrexate and tumour necrosis factor alpha inhibitors have been used in GCA, with limited or no evidence of benefit. Our emerging understanding of the pathogenic processes involved in GCA has led to an increased interest in the use of biologic agents to treat the disease. Two randomized controlled trials have recently reported dramatic effects of the use of the interleukin-6 targeted biologic tocilizumab in GCA, with significant increases in remission rates and decreases in glucocorticoid burden. While encouraging, longer-term and additional outcomes are awaited to clarify the exact positioning of tocilizumab in the treatment approach. Emerging data for other biologic agents, particularly abatacept and ustekinumab, are also encouraging but less well advanced. We are at the dawn of a new era in GCA treatment, but uncertainties and opportunities abound.
  • A Survey of Colorectal Cancer Surveillance Practices In Ireland, And Implementation of A Survivorship Care Plan Pilot Programme

    Greally, M.; Keane, F; Power, D.G; Leonard, G.D (Irish Medical Journal, 2019-02)
    The number of colorectal cancer (CRC) survivors in Ireland is rising. We aimed to survey current surveillance practices and pilot the use of survivorship care plans (SCPs) in the clinic.
  • The Management of Incidental Prostate Cancer Following TURP

    Matanhelia, D.M; Croghan, S.; Nason, G.J; O’Connell, C.; Galvin, D.J.; 1. St Vincent’s University Hospital 2. Mater Misericordiae University Hospital (Irish Medical Journal, 2019-02)
    Prostate cancer (CaP) is the most common non-cutaneous cancer diagnosed in Ireland with a cumulative lifetime risk of 1 in 7 men1. At autopsy, up to 60% of 80 years olds have latent CaP2 while up to 80% have benign prostatic hyperplasia (BPH) 3. The detection of CaP incidentally has fallen in the post prostate specific antigen (PSA) era from ~ 20% to ~5%4. Incidental CaP detected at transurethral resection of prostate (TURP) can be sub-classified into pT1a (<5% of prostate chips) and pT1b (>5% of prostate chips) and the management subsequently stratified.
  • Counselling in Primary Care – A General Practitioner’s Perspective

    Rafferty, M.; Bradley, C.; 1. Mercy University Hospital 2. Department of General Practice, University College Cork (Irish Medical Journal, 2019-02)
    Counselling in Primary care (CIPC) is a new service introduced by the HSE in 2013, providing short-term counselling for medical-card holders, suffering from mild to moderate mental health problems.
  • Early Onset Neonatal E.Coli Sepsis

    O’Rahelly, M.; Smith, A.; Drew, R.; McCallion, N. (Irish Medical Journal, 2019-02)
    Neonatal sepsis is a major cause of neonatal morbidity and mortality in term and preterm infants. The timely identification of infants at risk of infection is of particular importance in the vulnerable preterm group1 and is a major focus of microbiological research in the Rotunda Hospital. E.coli accounts for approximately 14.1% of early onset sepsis, i.e. sepsis before 72 hours of age in our centre. E.coli is the second most common pathogen, along with coagulase negative Staphylococcus, after group B Streptococcus (GBS)2.
  • "Do as we say, not as we do?" the lifestyle behaviours of hospital doctors working in Ireland: a national cross-sectional study.

    O' Keeffe, Anthony; Hayes, Blánaid; Prihodova, Lucia (BMC Public Health, 2019-02-11)
    This study was conducted to assess the lifestyle behaviours of a national sample of hospital doctors working in Ireland. We also sought to compare the prevalence of these behaviours in doctors to the general Irish population. This was a national cross-sectional study of a randomised sample of hospital doctors working in Irish publicly funded hospitals and residential institutions. The final cohort consisted of 1749 doctors (response rate of 55%). All hospital specialties were represented except radiology. The following data were collected: sociodemographic data (age, sex), work grade (consultant, trainee) average hours worked over a two-week period, specialty and lifestyle behaviours (smoking, alcohol, physical activity). Lifestyle data for the general population was provided by the Healthy Ireland 2015 study. Half of participants were men (50.5%). Just over half of the sample were consultants (54.3%), with 45.7% being trainees. 9.3% of doctors surveyed were smokers, 88.4% consumed alcohol and 24.5% were physically inactive. Trainees were more likely to smoke and be physically inactive when compared to consultants. Smoking rates amongst doctors were lower than the general population (9.3% -v- 23%). Doctors were more likely to consume alcohol than the general population (88.4% -v- 71.7%) but less likely to engage in binge drinking on a typical drinking occasion (12.8% -v- 39.5%). Doctors were more compliant than the general population with minimum exercise targets (75.5% -v- 70.5%), but less likely to engage in health enhancing physical activity (19.1% -v- 33%). While the prevalence of health behaviours amongst hospital doctors in Ireland compares favourably to the general population, their alcohol consumption and engagement in health enhancing physical activity suggest room for improvement. Continued health promotion and education on the importance of personal health behaviours is essential.
  • Combined Patients and Medical Related Cosmetic Breast Cancer Outcomes—A Preferred Approach to Outcomes Assessment

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

    Ibrahim, Abdalla; Ali, Mohamed; Kiernan, Thomas J; Stack, Austin G (European Cardiology Review, 2018-12-01)
    Erectile dysfunction (ED) is a common disorder that affects the quality of life of many patients. It is prevalent in more than half of males aged over 60 years. Increasing evidence suggests that ED is predominantly a vascular disorder. Endothelial dysfunction seems to be the common pathological process causing ED. Many common risk factors for atherosclerosis such as diabetes, hypertension, smoking, obesity and hyperlipidaemia are prevalent in patients with ED and so management of these common cardiovascular risk factors can potentially prevent ED. Phosphodiesterase type 5 inhibitors provide short-term change of haemodynamic factors to help initiate and maintain penile erection. They have been shown to be an effective and safe treatment strategy for ED in patients with heart disease, including those with ischaemic heart disease and hypertension.
  • Diagnostic Yield of Routine EEG in Adults with Active Epilepsy

    McGinty, R.N.; Costello, D.J.; Kinirons, P; McNamara, B (Irish Medical Journal, 2019-01)
    Routine electroencephalogram (rEEG) is an important investigation in suspected seizures but can be normal in people with epilepsy. The diagnostic yield of rEEG varies considerably according to the patient group studied. We aimed to estimate the diagnostic yield of rEEG in a real-world cohort of adults with active epilepsy—a population not previously reported. This single centre study evaluated neurophysiology findings for adults with prolonged inpatient video EEG (vEEG)-confirmed active epilepsy, who had at least one prior rEEG. Sixty-eight patients had a total of 171 rEEGs, of which 93 (54.4%) were normal, 42 (24.6%) found non-specific abnormalities and 36 (21.1%) captured interictal epileptiform abnormalities (IIEAs). Serial rEEGs revealed a 22.1% yield of IIEAs on the first test, with the cumulative yield peaking at 33.8% on the fourth rEEG. This study adds to existing evidence regarding the limited diagnostic usefulness of serial rEEG in patients with active epilepsy.
  • Obstetric Anal Sphincter Injuries: A Survey of Clinical Practice and Education among Obstetricians and Gynaecologists in Ireland

    Abdelrahman, M; Geary, M; Eogan, M (Irish Medical Journal, 2019-01)
    This paper summarises results of a survey of obstetricians in Ireland regarding their technique, management, and education on episiotomy and Obstetric Anal Sphincter Injury (OASIS). An anonymous survey was emailed to all obstetricians and gynaecologists in Ireland, including trainees between January and September 2017. The response rate was 45% (155/343) with 111 out of 144 (77%) reported clinical experience as part of their training and 92 (64%) attended an OASIS workshop or classroom teaching. The majority prescribe antibiotics and laxatives post-op, request physiotherapy review and follow-up patients in outpatient settings. We identified that most specialists and trainees practice within guidelines, but some recognise a need for further teaching and exposure to these types of injuries. These results will direct future curriculum and optimise ongoing training for trainees, unify service provision and contribute to patient safety.
  • Hyperammonaemia in Neonates and Young Children: Potential Metabolic Causes, Diagnostic Approaches and Clinical Consequences

    Giva, S; Finnegan, J; Ihidero, P; Maguire, G; Power, B; Knerr, I; Monavari, A (Irish Medical Journal, 2019-01)
    Hyperammonaemia is a metabolic disturbance characterized by accumulation of ammonia in the blood. Entry of ammonia into the brain via the blood-brain barrier leads to hyperammonaemic encephalopathy. The causes of hyperammonaemia in paediatric patients vary. We present 3 cases of hyperammonaemia in critically ill children in whom an inborn metabolic disorder was identified and provide insights into the phenotypes, diagnostic approaches and management. In children with acute overwhelming illness and progressive neurological deterioration plasma ammonia measurement should be included in the urgent diagnostic work-up. We here raise the awareness that hyperammonaemia is a metabolic emergency requiring prompt recognition and treatment to avoid subsequent complications.
  • “Semenly” Harmless Back Pain: An Unusual Presentation of a Subcutaneous Abscess

    Dunne, L; Murphy, E; Rutledge, R (Irish Medical Journal, 2019-01)
    We report, with review of the literature, the case of a patient who developed a subcutaneous abscess after intravenously injecting his own semen in an attempt to treat longstanding back pain. He had devised this “cure” independent of medical advice.
  • Pulmonary aspiration in preschool children with cystic fibrosis.

    Clarke, D; Gorman, I; Ringholz, F; McDermott, M; Cox, D W; Greally, P; Linnane, B; Mc Nally, P (Respiratory Research, 2018-12-17)
    Pulmonary aspiration of gastric refluxate (PAGR) has been demonstrated in association with pulmonary inflammation in school aged children with Cystic Fibrosis (CF). We sought to determine if similar findings were present in preschool children. Pepsin was measured in Broncho-alveolar lavage (BAL) fluid collected from clinically stable preschool children with CF and controls. Elevated pepsin levels were found in a subgroup of children with CF, but this was not found to be associated with pulmonary infection, pulmonary inflammation or respiratory or gastrointestinal symptoms.
  • Unmarried Mothers Delivered in the National Maternity Hospital - 1987

    Richardson, Valerie; Winston, Nessa; Department of Social Administration and Social Work, University College, Dublin 4. (The National Maternity Hospital Holles St, 1989)
    This report is the second in a series presenting the results of the on-going work of the Social Work Research Unit in the National Maternity Hospital. The Social Work Research Unit was set up in December 1985 as a joint project between the National Maternity Hospital and the Department of Social Work in University College, Dublin.
  • Rotunda Hospital: Clinical Report 2010

    Rotunda Hospital (Rotunda Hospital, 2010)

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