Recent Submissions

  • Safety of Adalimumab Dosed Every Week and Every Other Week: Focus on Patients with Hidradenitis Suppurativa or Psoriasis.

    Ryan, Caitriona; Sobell, Jeffrey M; Leonardi, Craig L; Lynde, Charles W; Karunaratne, Mahinda; Valdecantos, Wendell C; Hendrickson, Barbara A (American Journal of Clinical Dermatology, 2018-06-01)
    Adalimumab is approved for the treatment of hidradenitis suppurativa (HS), plaque psoriasis, and other inflammatory conditions. Our objective was to examine the safety of adalimumab administered every other week (EOW) and every week (EW) in patients with HS and psoriasis and to investigate informative data from non-dermatologic indications. The safety of adalimumab 40-mg EOW versus EW dosing was examined during placebo-controlled and open-label study periods in patients with HS (three studies), psoriasis (two studies), Crohn's disease (six studies), ulcerative colitis (three studies), and rheumatoid arthritis (one study). No new safety risks or increased rates of particular adverse events (AEs) were identified with EW dosing. In patients with HS or psoriasis, the overall safety of adalimumab 40-mg EOW and EW was generally comparable. In studies of adalimumab for non-dermatologic indications, including Crohn's disease, ulcerative colitis, and rheumatoid arthritis, the overall AE rates were similar for EW and EOW dosing.
  • Point of Care Echocardiography in an Irish Critical Care Unit

    Kuriakose, D; O’Mahony, R; Rooplalsingh, R; McCanny, P; Colreavy, F; Our Lady of Lourdes Hospital, Drogheda, Connolly Hospital, Blanchardstown, Co. Dublin, The Prince Charles Hospital, Rode Road, Chermside, QLD AUS, Liverpool Hospital, Liverpool, New South Wales 2170, Australia, Consultant Intensivist, Mater Misercordiae University Hospital, Eccles Street, Dublin 7 (Irish Medical Journal, 2018-09)
    Transthoracic echocardiography (TTE) has become an established component of critical care monitoring1-5 .Traditionally performed by Cardiology Services, either cardiac physiologists or cardiology doctors, a major limitation has been availability of these personnel on a 24 hour /7 day per week basis to the critical care area. As a result performance of TTE examinations has moved beyond the traditional users and now involves critical care doctors. Definition of the competencies required for basic level critical care echocardiography has provided a practical roadmap to Intensivists involved in echocardiography training. We introduced a basic level echocardiography training course into our critical care unit and it was the aim of this study to evaluate the impact of echocardiography training on clinical practice.
  • A Life-Saving Palsy: Hereditary Neuropathy with Liability to Pressure Palsies (HNPP) Presenting As Hand Weakness during Cardiopulmonary Resuscitation (CPR) Training

    Hughes, H; Tubridy, N; Connolly, S; St. Vincent’s University Hospital, Dublin (Irish Medical Journal, 2018-09)
    Hereditary neuropathy with liability to pressure palsies (HNPP), is an uncommon condition characterised by recurrent episodes of painless, focal motor and sensory peripheral neuropathies, often preceded by nerve compression 1, 2. Despite the rarity of the condition, HNPP should form part of the differential diagnosis in patients presenting with this picture.
  • National Medicines Information Centre VOLUME 24 NUMBER 3 2018

    National Medicines Information Centre (National Medicines Information Centre St James Hospital, 2018-08)
    Newsletter of the National Medicines Information Centre
  • Cannabis Oil in an Irish Children’s Critical Care Unit

    Fennessy, P; Murphy, L; Crowe, S (Irish Medical Journal, 2018-09)
    We present a case of a five-year-old female admitted postoperatively to the Paediatric Critical Care Unit (PCCU). She had a history of refractory seizures. Her parents had obtained cannabis oil from the United States and were administering it to her at night, in addition to her regular anticonvulsant medication. Her parents reported decreased seizure frequency since its commencement. The child had elective tonsillectomy for management of significant obstructive sleep apnoea (OSA), possibly exacerbated by the sedative properties of cannabis. The admitting surgical and critical care teams were unaware that the child was regularly receiving cannabis until 14 hours after admission to hospital. The PCCU and the hospital do not currently have any guidelines to assist medical and nursing staff with the safe use of this potentially psychogenic preparation. The Irish Health Products Regulatory Authority (HPRA) published a scientific review on the subject in January 20171. After discussion with the child’s parents, we agreed an administration regimen, the timing of which was separate to regular sedative medication in view of the child’s history of OSA. The child’s postoperative course and stay in PCCU was uncomplicated.
  • A Low Glycaemic Index Diet in Pregnancy Induces DNA Methylation Variation in Blood of Newborns: Results from the ROLO Randomised Controlled Trial.

    Geraghty, Aisling A; Sexton-Oates, Alexandra; O'Brien, Eileen C; Alberdi, Goiuri; Fransquet, Peter; Saffery, Richard; McAuliffe, Fionnuala M; National Maternity Hospital Holles Street Dublin, University College Dublin, Cancer and Disease Epigenetics, Murdoch Children's Research Institute, Melbourne, Victoria, Aus, Department of Paediatrics, University of Melbourne, Victoria, Aus (MDPI, 2018-04-06)
    The epigenetic profile of the developing fetus is sensitive to environmental influence. Maternal diet has been shown to influence DNA methylation patterns in offspring, but research in humans is limited. We investigated the impact of a low glycaemic index dietary intervention during pregnancy on offspring DNA methylation patterns using a genome-wide methylation approach. Sixty neonates were selected from the ROLO (Randomised cOntrol trial of LOw glycaemic index diet to prevent macrosomia) study: 30 neonates from the low glycaemic index intervention arm and 30 from the control, whose mothers received no specific dietary advice. DNA methylation was investigated in 771,484 CpG sites in free DNA from cord blood serum. Principal component analysis and linear regression were carried out comparing the intervention and control groups. Gene clustering and pathway analysis were also explored. Widespread variation was identified in the newborns exposed to the dietary intervention, accounting for 11% of the total level of DNA methylation variation within the dataset. No association was found with maternal early-pregnancy body mass index (BMI), infant sex, or birthweight. Pathway analysis identified common influences of the intervention on gene clusters plausibly linked to pathways targeted by the intervention, including cardiac and immune functioning. Analysis in 60 additional samples from the ROLO study failed to replicate the original findings. Using a modest-sized discovery sample, we identified preliminary evidence of differential methylation in progeny of mothers exposed to a dietary intervention during pregnancy.
  • National Medicines Information Centre VOLUME 24 NUMBER 4 2018

    National Medicines Information Centre (National Medicines Information Centre St James Hospital, 2018-08)
    Newsletter of the National Medicines Information Centre
  • National Survey Of The Aetiological Assessment Service Of Permanent Childhood Hearing Loss In Ireland

    Balfe, J; Van Der Spek, N; Waldron, D (Irish Medical Journal, 2018-09)
    Best practice indicates that all children who are identified with permanent childhood hearing loss (PCHL) should have access to prompt paediatric assessment to determine the need for aetiological investigations[i]. Early paediatric assessment allows the identification and management of potentially treatable causes e.g. congenital CMV (cCMV) infection and provides an opportunity to prevent or reduce disability. It also allows the identification of associated co-morbidities including potentially fatal cardiac arrhythmias. The role of the paediatrician also includes liaison with agencies including tertiary specialist services, education, disability services and other community based organisations
  • Predictors of quality of life among inpatients in forensic mental health: implications for occupational therapists.

    O' Flynn, Padraic; O' Regan, Roisin; O' Reilly, Ken; G Kennedy, Harry; Central Mental Hospital, Dundrum (BMC Psychiatry, 2018-01-19)
    Optimising quality of life (QOL) for service users in a forensic hospital is an important treatment objective. The factors which contribute to QOL in this setting are currently unclear. The aim of this study was to analyse the predictors of QOL amongst service users within an inpatient forensic mental health hospital.
  • Biosimilar infliximab introduction into the gastroenterology care pathway in a large acute Irish teaching hospital: a story behind the evidence

    Carroll, Donal; O'Brien, Gary; Mulcahy, Mark; Courtney, Garry; Byrne, Stephen; Walshe, Valerie; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Ireland/St Luke’s General Hospital, Freshford Road, Kilkenny, Ireland/Department of Accounting, Finance and Information Systems, Cork University Business Schools, University College Cork, College Road, Ireland/Cost Accounting & Funding Team, National Finance Division, Health Service Executive, First Floor East, Model Business Park, Model Farm Road, Cork, Ireland (Pro Pharma Communications International, 2018-02-27)
    Background and aim: Biosimilar medicines are not considered exact replicas of originator biological medicines. As a result, prescribers can be hesitant to introduce such medicines into the clinical setting until evidence surfaces confirming their safety and effectiveness. In Ireland, a national biosimilar medicines policy is currently in development but the decision to prescribe biosimilar medicines remains at the discretion of the physician. The aim of this descriptive review is to tell the story of the evidence used by a large acute Irish teaching hospital to introduce biosimilar infliximab CT-P13 for the treatment of inflammatory bowel disease (IBD) in a safe and timely manner into routine care. Methods: To explore the evidence supporting the effective introduction of biosimilar infliximab in a large acute Irish teaching hospital, a literature review was conducted. Evidence consisted of published studies, reviews, reports, position statements, articles, clinical guidelines, and recommendations from national bodies, regulatory authorities and professional organizations. All evidence was published in English. Results and discussion: In September 2014, the accumulated evidence base provided physicians with reassurance to prescribe biosimilar infliximab CT-P13 for new patients suffering from IBD in this large acute Irish teaching hospital. In September 2016, as the evidence base grew, physicians began to safely and confidently switch patients from the originator infliximab product to the biosimilar product. Conclusion: There was a significant time lag between regulatory approval and clinical acceptance given that the European Medicines Agency had granted market authorization for biosimilar infliximab CT-P13 three years prior to the initiation of this hospital’s switching process. Although conservative in their execution, the authors conclude that with the existential concern and uncertainty still surrounding biosimilar medicines, a distinct and individualized approach for biosimilar medicine implementation is required. It is with hope that the Irish biosimilar medicines policy will improve upon biosimilar medicine clinical acceptance once published.
  • Bringing the Board of Directors on Board with Quality and Safety of Clinical Care

    Temple Street Children’s University Hospital; HSE Quality Improvement Division (Health Service Executive, 2018-08)
    The genesis of this project was about bringing the Temple Street Children’s University Hospital Board of Directors on a journey, which would result in the Board holding the hospital Executive accountable for the quality of clinical care delivered. It was a collaboration between the Board, the Project Team and the HSE Quality Improvement Division. Governing Boards of healthcare organisations are responsible for their organisations’ performance (HSE 2017). Prior to this project Temple Street Children’s University Hospital (TSCUH) Board of Directors received operational information on access, efficiency, human resources and finance indicators through a monthly balanced score card report, while the quality indicators were reported quarterly. Data on the score card were presented using a red, amber and green speedometer with an associated line chart, which demonstrated if the desired target was achieved.
  • Misdiagnosis of myasthenia gravis presenting with tongue and palatal weakness.

    Marshal, Megan; Mustafa, Moneeb; Crowley, Paul; McGovern, Rory; Ahern, Emer; Ragab, Inas (Oxford Medical Case Reports, 2018-08-01)
    We discuss the case of an elderly male who presented with a history of dysphagia, dysphonia, palatal weakness and a sensation of tongue swelling, each symptom of varying time duration. Myasthenia gravis may have a variety of presentations that include ocular fatigability, respiratory muscle weakness and bulbar symptoms. The variety of these myasthenic syndromes can serve as a barrier to diagnosis and can often result in delayed or incorrect diagnosis. In this report, we present an atypical presentation of a relatively rare condition.
  • Imapct of Eating Disorders on Biological Ageing

    Prof. Declan McLoughlin; Dr Eimear Doody; Trinity College Dublin - Institute of Neuroscience
  • Staff Attitudes towards Patient Safety Culture and Working Conditions in an Irish Tertiary Neonatal Unit

    Dwyer, L; Smith, A; McDermott, R; Breatnach, C; El-Khuffash, A; Corcoran, JD; Rotunda Hospital, Dublin (Irish Medical Journal, 2018-07)
    There is little published research evaluating attitudes towards patient safety culture and working conditions in neonatal units. This study aimed to explore this within a Level III Irish neonatal unit setting.
  • Maternal Early Warning Scores (MEWS)

    Nair, Shrijit; Dockrell, Lucy; Mac Colgain, Siaghal; St. Vincent’s University Hospital (World Federation of Societies of Anesthesiologists, 2018-07)
    According to Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries in the UK (MBRRACE-UK) report 2016, maternal mortality rate is 8.5 per 100,000 maternities. More than 50% of maternal deaths are potentially preventable.Nine pregnant women develop severe maternal morbidity for every maternal death. Evolving morbidity can be difficult to recognise in the obstetric population because of the normal changes in peripartum physiology. Delays in recognition of patient deterioration and initiation of treatment lead to worse outcomes.2 Early Warning Systems (EWS) have been used since 1999 in the general patient population to identify clinical deterioration. The Maternal Early Warning System (MEWS) has been advocated with the aim to reduce maternal morbidity and mortality, and improve clinical outcomes. The MEWS tracks physiological parameters and evolving morbidity and once a predetermined threshold has been reached, it triggers evaluation by a healthcare professional.
  • St Vincent’s University Hospital Make Bold Move by Banning Soap

    Murphy, Lisa (St Vincent's University Hospital, 2017)
  • The Triangular Sign, a Useful Diagnostic Marker for Biliary Atresia: A Case Series of Three Irish Infants

    Smith, A; Shankar, A; Collins, A; Tarrant, A; Boyle, MA (Irish Medical Journal, 2018-06)
    The triangular cord (TC) sign is the appearance of a triangular shaped echogenic density visualised immediately cranial to the portal vein bifurcation on ultrasonographic examination. Several studies have reported that this ultrasonographic sign is a reliable and helpful marker in identifying Biliary Atresia (BA).
  • Extramammary Paget ’s disease Of Glans Penis: A Rare Case Report

    Inder, M S; O’Kelly, F; Sheikh, M; O’Hare, K; Barbara, M L; Thornhill, J A (Irish Medical Journal, 2018-06)
    We present the case of an 83-year-old man with Extramammary Paget’s disease (EMPD) of the penis. He underwent a total penectomy and histopathology confirms the association of underlying invasive high grade urothelial carcinoma. Penile EMPD is rare and can be misinterpreted for benign skin conditions. A high index of suspicion is required for correct diagnosis and appropriate treatment.
  • A Combination of Surgery And Methotrexate for Successful Treatment of a Caesarean Scar Ectopic Pregnancy.

    Tadesse, WG; Von Bunau, G (Irish Medical Journal, 2018-06)
    Caesarean scar ectopic pregnancy (CSEP) is one of the rarest forms of ectopic pregnancies. With rising caesarean delivery (CD) rates worldwide, there is an increase in the incidence of CSEP. Patients usually present with painless vaginal bleeding and often misdiagnosed as spontaneous miscarriage. The use of ultrasonography with colour flow Doppler helps in the differential diagnosis. Different treatment options are described in the literature, although there is insufficient evidence regarding the best approach. We report the diagnosis and management of a case of CSEP in a woman with four previous CD who presented with vaginal bleeding and lower abdominal cramps at six weeks of gestation. She was treated with laparoscopic and ultrasound guided aspiration of the gestational sac and local injection of methotrexate supplemented by intramuscular methotrexate injection.
  • Subtrochanteric Femur Fractures in an Irish Trauma Centre over 9 years: How the Impact of Hospital Coding on Diagnosis of Subtrochanteric Femur Fractures Leads to Inaccurate Occurrence Rates

    Coveney, EI; Harriz, E; Gibney, B; Quinlan, JF (Irish Medical Journal, 2018-06)
    Our aim was to assess the occurrence rates of subtrochanteric femur fractures in an orthopaedic tertiary referral centre and to assess the correlation of patient’s actual diagnosis with national hospital inpatient enquiry data.

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