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Recent Submissions

  • Effectiveness of Group Radical Openness as a treatment of Over control: An Open Trial.

    Dr James McElvaney; Saint Patrick's Hospital, Dublin; Dr Rachel Egan; Dr Richard Booth; Saint Patrick's Hospital, Dublin
  • 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.
  • Patients' perception of privacy and confidentiality in the emergency department of a busy obstetric unit.

    Hartigan, Lucia; Cussen, Leanne; Meaney, Sarah; O'Donoghue, Keelin (BMC Health Services Research, 2018-12-18)
    Privacy and confidentiality are central components of patient care and are of particular importance in obstetrics and gynaecology, where clinical situations of a sensitive nature regularly occur. The layout of the emergency department (ED) in maternity units is often not conducive to maintaining privacy. Our study aimed to discover if changing the environment could improve patients' experiences in the ED. We surveyed patients and asked specific questions about their perception of privacy in the ED. We then repeated the survey following renovations to the ED which involved replacing curtained patient areas with walled cubicles. There were 75 pre-renovation surveys and 82 post-renovation surveys completed. Before the renovations took place, only 21% (n = 16) found their privacy to be adequate during their visit to the ED. However this rose to 89% (n = 73) post-renovation. Our study showed that patients' perception of privacy and confidentiality significantly improved following refurbishment of the ED.
  • Academic Background of Irish Orthopaedic Trainees

    Unknown author (Irish Medical Journal, 2018-11)
    Academic achievement may be used to distinguish between trainees in competition for training or consultant posts. This study aimed to quantify the academic achievement among orthopaedic trainees in Ireland.
  • Human Papilloma Virus- Associated Head and Neck Cancer: A 21st Century Pandemic; Assessing Student Awareness and Knowledge

    Kavanagh, F.G; McNamara, A.T; Fopohunda, O; Keogh, I.J (Irish Medical Journal, 2018-11)
    The Human Papillomavirus (HPV) is a causal agent in a subset of Head and Neck Cancers (HNC) being diagnosed in younger patients without significant tobacco and alcohol use. This survey assessed the awareness level of HNC and HPV vaccinations in university students.
  • Ultrasound as a Diagnostic Tool in Pediatric Distal Forearm Fractures

    Ahmed, A.S; Abdelhady, A.E; McNicholl, B (Irish Medical Journal, 2018-11)
    To evaluate the accuracy of ultrasound in pediatric distal forearm fractures as well as the effect on the ED waiting time for these patients.
  • Annular Rupture During Transcatheter Aortic Valve Implantation: Predictors, Management and Outcomes.

    Coughlan, J J; Kiernan, Thomas; Mylotte, Darren; Arnous, Samer (International Cardiology Review, 2018-09-01)
    Transcatheter aortic valve implantation (TAVI) is the treatment of choice in patients with symptomatic severe aortic stenosis who are either inoperable or at high risk for conventional surgical aortic valve replacement. Recent data have also shown favourable outcomes in patients deemed to be at intermediate operative risk, which expands the application of this novel technology. Despite its success, TAVI has been associated with rare life-threatening complications. Of these, aortic annular rupture is considered to be the most devastating. Advances in pre-procedural screening and patient selection have reduced the incidence of annular rupture. When this complication occurs, early recognition and prompt management are essential. This article is intended to provide a comprehensive review of the predictors, management and clinical outcomes of aortic annular rupture.
  • Canis Caveat (Beware of the Dog) - Septic Shock Due To Capnocytophaga Canimorsus Contracted From A Dog Bite

    O’Shaughnessy, SM; Broderick, L; Walsh, J; Schaffer, K; Westbrook, A; St. Vincent’s University Hospital (Irish Medical Journal, 2018-11)
    We describe the case of a 61-year-old immunocompetent male who developed septic shock and multiorgan failure due to Capnocytophaga canimorsus (C. canimorsus) bloodstream infection, sustained from a dog bite. Unusually, this patient developed acute liver failure and splenic infarction in addition to many of the better-known clinical sequelae of C. canimorsus infection.
  • Attitudes and Knowledge of Healthcare Professionals Regarding Organ Donation. A Survey of the Saolta University Health Care Group.

    Umana, E; Grant, O; Curran, E; May, P; Mohamed, A; O’Donnell, J; University Hospital Galway (Irish Medical Journal, 2018-11)
    Organ donation saves lives and healthcare professionals (HCPs) play a vital role in that process. Therefore, the purpose of this study was to assess the attitudes and level of knowledge of HCPs regarding organ donation. An online anonymous self-administered questionnaire containing 40 questions on organ donation using google forms was created. The survey was distributed to HCPs working in the Saolta University Health Care Group. A hundred and thirty-nine responses were received giving a response rate of 11.8%. HCPs willingness to donate their organs was at 93% compared to 97% willing to receive a transplant. More HCPs understood or had knowledge of the term donation after brain death (64%) than donation after circulatory death (49%). HCPs working in intensive care knew more about the management of brain dead donors than other specialties (p<0.0001). Over 60% of HCPs when asked either disagreed or strongly disagreed with the adequacy of training in organ donation and transplant. Overall, HCPs surveyed had positive attitudes towards organ donation but there was a lack of knowledge particularly among non-intensive care professionals. This study highlights the need to increase awareness along with implementation of educational programmes among HCPs regarding organ donation and transplant.
  • Operative Management of Perinatal Lumbar Disc Herniation and Cauda Equina Syndrome: A Case Series

    Ahern, DP; Gibbons, D; Dodds, M; Timlin, M; Cassidy, N; Morris, S; Synnott, K; Butler, JS (Irish Medical Journal, 2018-11)
    Perinatal lumbar discectomy for lumbar disc herniation or cauda equina syndrome is a rare clinical scenario. This case series outlines the surgical management of this clinical scenario at a national tertiary referral centre over a 10-year period
  • Temporal trends in hyperuricaemia in the Irish health system from 2006-2014: A cohort study.

    Kumar A U, Arun; Browne, Leonard D; Li, Xia; Adeeb, Fahd; Perez-Ruiz, Fernando; Fraser, Alexander D; Stack, Austin G; University Hospital Limerick (PLOS ONE, 2018-01-01)
    Elevated serum uric acid (sUA) concentrations are common in the general population and are associated with chronic metabolic conditions and adverse clinical outcomes. We evaluated secular trends in the burden of hyperuricaemia from 2006-2014 within the Irish health system. Data from the National Kidney Disease Surveillance Programme was used to determine the prevalence of elevated sUA in adults, age > 18 years, within the Irish health system. Hyperuricaemia was defined as sUA > 416.4 μmol/L in men and > 339.06 μmol/L in women, and prevalence was calculated as the proportion of patients per year with mean sUA levels above sex-specific thresholds. Temporal trends in prevalence were compared from 2006 to 2014 while general estimating equations (GEE) explored variation across calendar years expressed as odds ratios (OR) and 95% Confidence intervals (CI). From 2006 to 2014, prevalence of hyperuricaemia increased from 19.7% to 25.0% in men and from 20.5% to 24.1% in women, P<0.001. The corresponding sUA concentrations increased significantly from 314.6 (93.9) in 2006 to 325.6 (96.2) in 2014, P<0.001. Age-specific prevalence increased in all groups from 2006 to 2014, and the magnitude of increase was similar for each age category. Adjusting for baseline demographic characteristics and illness indicators, the likelihood of hyperuricemia was greatest for patients in 2014; OR 1.45 (1.26-1.65) for men and OR 1.47 (1.29-1.67) in women vs 2006 (referent). Factors associated with hyperuricaemia included: worsening kidney function, elevated white cell count, raised serum phosphate and calcium levels, elevated total protein and higher haemoglobin concentrations, all P<0.001. The burden of hyperuricaemia is substantial in the Irish health system and has increased in frequency over the past decade. Advancing age, poorer kidney function, measures of nutrition and inflammation, and regional variation all contribute to increasing prevalence, but these do not fully explain emerging trends.
  • Neonatal Therapeutic Hypothermia in Ireland Annual Report 2016-2017

    Meaney, S; McGinley, J; Horkan, S; Corcoran, P; Greene, RA; Murphy, J; National Perinatal Epidemiology Centre Department of Obstetrics and Gynaecology University College Cork (National Perinatal Epidemiology Centre, 2018)
  • An Audit of Paediatric Organ and Tissue Donation in Ireland

    Marshall, L; Hennessey, I; Lynch, C; Gibbons, C; Crowe, S; 1. Our Lady’s Children’s Hospital Crumlin 2. Temple Street Children’s University Hospital 3. Organ Donation and Transplant Ireland. 4. School of Medicine, University of Dublin, Trinity College, Dublin (Irish Medical Journal, 2018-11)
    Organ donation may be considered in children who die in paediatric intensive care units if certain criteria are met and if their families wish for organ donation. In general organs are donated after death has been confirmed using neurological criteria to diagnose brainstem death (BSD). Donation of organs can also occur in certain circumstances after death has been confirmed using circulatory criteria (DCD). The Intensive Care Society of Ireland has published guidelines on organ donation after brainstem death and more recently on donation after circulatory death1,2. The American College of Critical Care Medicine, The Academy of Royal Medical Colleges and The Australian & New Zealand Intensive Care Society have all also published specific guidelines on the determination of brainstem death in infants and children
  • Infants who required Therapeutic Hypothermia in Ireland, 2016-2017: lay summary

    National Perinatal Epidemiology Centre (Cork University Maternity Hospital, 2018)
    The National Clinical Programme Paediatrics and Neonatology (NCPPN) has identified a gap in the knowledge available nationally to clinicians and managers regarding TH. In 2017, a collaboration was agreed between the NCPPN and the National Perinatal Epidemiology Centre to examine the care of all infants who underwent TH in the years, 2016 and 2017. The primary aim of this report is to present an overview and national statistics on TH in Ireland for the years 2016 and 2017.
  • Maternal and fetal blood lipid concentrations during pregnancy differ by maternal body mass index: findings from the ROLO study.

    Geraghty, Aisling A; Alberdi, Goiuri; O'Sullivan, Elizabeth J; O'Brien, Eileen C; Crosbie, Brenda; Twomey, Patrick J; McAuliffe, Fionnuala M; 1 UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland. 2 Clinical Chemistry, St. Vincent's University Hospital, Dublin 4, Ireland. 3 UCD School of Medicine, University College Dublin, Dublin, Ireland. 4 UCD Perinatal Research Centre, Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin 2, Ireland. (Biomed Central, 2017-10-16)
    Pregnancy is a time of altered metabolic functioning and maternal blood lipid profiles change to accommodate the developing fetus. While these changes are physiologically necessary, blood lipids concentrations have been associated with adverse pregnancy outcomes such as gestational diabetes, pregnancy-induced hypertension and high birth weight. As blood lipids are not routinely measured during pregnancy, there is limited information on what is considered normal during pregnancy and in fetal blood. Data from 327 mother-child pairs from the ROLO longitudinal birth cohort study were analysed. Fasting total cholesterol and triglycerides were measured in early and late pregnancy and fetal cord blood. Intervals were calculated using the 2.5th, 50th and 97.5th centile. Data was stratified based on maternal body mass index (BMI) measured during early pregnancy. Differences in blood lipids between BMI categories were explored using ANOVA and infant outcomes of macrosomia and large-for-gestational-age (LGA) were explored using independent student T-tests and binary logistic regression. All maternal blood lipid concentrations increased significantly from early to late pregnancy. In early pregnancy, women with a BMI < 25 kg/m Blood lipid concentrations increase during pregnancy and differ by maternal BMI. These intervals could help to inform the development of references for blood lipid concentrations during pregnancy.
  • Bio-collections in autism research.

    Reilly, Jamie; Gallagher, Louise; Chen, June L; Leader, Geraldine; Shen, Sanbing; 1 Regenerative Medicine Institute, School of Medicine, BioMedical Sciences Building, National University of Ireland (NUI), Galway, Ireland. 2 Trinity Translational Medicine Institute and Department of Psychiatry, Trinity Centre for Health Sciences, St. James Hospital Street, Dublin 8, Ireland. 3 Department of Special Education, Faculty of Education, East China Normal University, Shanghai, 200062 China. 4 Irish Centre for Autism and Neurodevelopmental Research (ICAN), Department of Psychology, National University of Ireland Galway, University Road, Galway, Ireland. (Biomed Central, 2017-01-01)
    Autism spectrum disorder (ASD) is a group of complex neurodevelopmental disorders with diverse clinical manifestations and symptoms. In the last 10 years, there have been significant advances in understanding the genetic basis for ASD, critically supported through the establishment of ASD bio-collections and application in research. Here, we summarise a selection of major ASD bio-collections and their associated findings. Collectively, these include mapping ASD candidate genes, assessing the nature and frequency of gene mutations and their association with ASD clinical subgroups, insights into related molecular pathways such as the synapses, chromatin remodelling, transcription and ASD-related brain regions. We also briefly review emerging studies on the use of induced pluripotent stem cells (iPSCs) to potentially model ASD in culture. These provide deeper insight into ASD progression during development and could generate human cell models for drug screening. Finally, we provide perspectives concerning the utilities of ASD bio-collections and limitations, and highlight considerations in setting up a new bio-collection for ASD research.
  • Placenta Accreta Spectrum: A Review of Pathology, Molecular Biology, and Biomarkers.

    Bartels, Helena C; Postle, James D; Downey, Paul; Brennan, Donal J; 1 National Maternity Hospital, Holles Street, Dublin 2, Ireland. 2 UCD School of Medicine, National Maternity Hospital, Holles Street, Dublin 2, Ireland (Hindawi, 2018-01-01)
    Placenta accreta spectrum (PAS) is a condition of abnormal placental invasion encompassing placenta accreta, increta, and percreta and is a major cause of severe maternal morbidity and mortality. The diagnosis of a PAS is made on the basis of histopathologic examination and characterised by an absence of decidua and chorionic villi are seen to directly adjacent to myometrial fibres. The underlying molecular biology of PAS is a complex process that requires further research; for ease, we have divided these processes into angiogenesis, proliferation, and inflammation/invasion. A number of diagnostic serum biomarkers have been investigated in PAS, including human chorionic gonadotropin (HCG), pregnancy-associated plasma protein-A (PAPP-A), and alpha-fetoprotein (AFP). They have shown variable reliability and variability of measurement depending on gestational age at sampling. At present, a sensitive serum biomarker for invasive placentation remains elusive. In summary, there are a limited number of studies that have contributed to our understanding of the molecular biology of PAS, and additional biomarkers are needed to aid diagnosis and disease stratification.
  • Fatigue and Activity Management Education for Individuals with Systemic Lupus Erythematosus.

    O'Riordan, Ruth; Doran, Michele; Connolly, Deirdre; 1 Occupational Therapy Department, St. James' Hospital, James' Street, Dublin 8, Ireland. 2 Rheumatology Department, St. James' Hospital, James' Street, Dublin 8, Ireland. 3 Trinity Centre for Health Sciences, Discipline of Occupational Therapy, St. James' Hospital, James' Street, Dublin 8, Ireland. (Wiley, 2017-01-01)
    Fatigue and Activity Management Education (FAME) is a six-week occupational therapy-led programme focusing on fatigue and stress management, exercise, nutrition, and joint protection. Each session consists of education and goal setting. To assess the impact of FAME on occupational participation and fatigue management. Three programmes were facilitated with twenty-one women with SLE. A mixed methods design was used. Quantitative data were collected using self-reported questionnaires administered before, immediately after, and eight weeks after intervention. Data were analysed using descriptive and nonparametric inferential statistics. Qualitative data were collected through focus groups and interviews. Thematic analysis was carried out on the qualitative data. There was a statistically significant improvement in depression as measured by the Hospital Anxiety and Depression Scale and categories of "burden to others" and "fatigue" in the LupusQoL. There were nonsignificant improvements in fatigue, occupational participation, self-efficacy, and anxiety. Participants reported an improved understanding of fatigue and the impact of stress on fatigue. They also identified self-management strategies they were using on a daily basis.
  • Improving the quality of radiation oncology: 10years' experience of QUATRO audits in the IAEA Europe Region.

    Izewska, Joanna; Coffey, Mary; Scalliet, Pierre; Zubizarreta, Eduardo; Santos, Tania; Vouldis, Ioannis; Dunscombe, Peter; 1 International Atomic Energy Agency, Vienna International Centre, Vienna, Austria. Electronic address: j.izewska@iaea.org. 2 Discipline of Radiation Therapy, School of Medicine, Trinity Centre for Health Sciences, St. James' Hospital, Dublin, Ireland. 3 Department of Radiotherapy, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium. 4 International Atomic Energy Agency, Vienna International Centre, Vienna, Austria. 5 University of Calgary, Canada. (Elsevier, 2018-01-01)
    The IAEA has developed a methodology for comprehensive quality audits of radiotherapy practices called Quality Assurance Team for Radiation Oncology (QUATRO). This study explores the factors that impacted quality of care among QUATRO audited centres in the IAEA Europe Region. The 31 QUATRO reports collected over 10years include extensive data describing the quality of radiotherapy at the audited centres. A coding key was developed to aggregate and review these data in terms of recommendations for improvement and positive findings (commendations). Overall 759 recommendations and 600 commendations were given. Eight centres recognized as centres of competence differed from other centres mostly because they operated complete quality management systems and were adequately staffed. Other centres had excessive staff workloads and many gaps in the process of care. Insufficient equipment levels were prevalent. Patient centredness, communication, dosimetry, quality control and radiation protection were frequently commended by QUATRO. This analysis points to barriers to quality care such as insufficient staffing, education/training, equipment and lack of quality management. It highlights the correlation between the human resources availability and quality of care. It has also identified common action items for enhancing quality of radiotherapy programmes in the Region.
  • Individualized dosing with axitinib: rationale and practical guidance.

    Schmidinger, Manuela; Danesi, Romano; Jones, Robert; McDermott, Ray; Pyle, Lynda; Rini, Brian; Négrier, Sylvie; 1 Clinical Division of Oncology, Department of Medicine I & Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria. 2 Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy. 3 Institute of Cancer Sciences, University of Glasgow, The Beatson West of Scotland Cancer Centre, Glasgow, UK. 4 Department of Medical Oncology, St Vincent's University Hospital & The Adelaide & Meath Hospital, Dublin, Ireland. 5 Renal Cancer Unit, Department of Medicine, Royal Marsden Hospital, London, UK. 6 Department of Hematology & Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA. 7 Medical Oncology Department, University of Lyon, Centre Léon Bérard, Lyon, France. (Future Science Group, 2018-04-01)
    Axitinib is a potent, selective, vascular endothelial growth factor receptor inhibitor with demonstrated efficacy as second-line treatment for metastatic renal cell carcinoma. Analyses of axitinib drug exposures have demonstrated high interpatient variability in patients receiving the 5 mg twice-daily (b.i.d.) starting dose. Clinical criteria can be used to assess whether individual patients may benefit further from dose modifications, based on their safety and tolerability data. This review provides practical guidance on the 'flexible dosing' method, to help physicians identify who would benefit from dose escalations, dose reductions or continuation with manageable toxicity at the 5 mg b.i.d. dose. This flexible approach allows patients to achieve the best possible outcomes without compromising safety.

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