Recent Submissions

  • 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.
  • 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
  • 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
  • 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.
  • Factors Associated with Maternal Wellbeing at Four Months Post-Partum in Ireland.

    Bennett, Annemarie E; Kearney, John M; 1 Department of Clinical Medicine, Trinity Centre for Health Sciences, St. James' Hospital Campus, Dublin 8, Ireland. 2 School of Biological Sciences, Dublin Institute of Technology, Kevin Street, Dublin 8, Ireland. (MDPI, 2018-05-14)
    This study aimed to examine factors associated with maternal wellbeing at four months post-partum in the Irish context. Socio-demographic, health behaviour and infant feeding data were collected in pregnancy, at birth and at 17 weeks post-partum. Maternal distress, body image and resilience were measured at 17 weeks post-partum. Binary logistic regression predicted maternal distress and statistical significance was taken at
  • 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.
  • Preclinical validation of the small molecule drug quininib as a novel therapeutic for colorectal cancer.

    Murphy, Adrian G; Casey, Rory; Maguire, Aoife; Tosetto, Miriam; Butler, Clare T; Conroy, Emer; Reynolds, Alison L; Sheahan, Kieran; O'Donoghue, Diarmuid; Gallagher, William M; Fennelly, David; Kennedy, Breandán N; O'Sullivan, Jacintha; 1 Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. 2 UCD School of Biomolecular and Biomedical Science Conway Institute, University College Dublin, Dublin 4, Ireland. 3 Trinity Translational Medicine Institute, Department of Surgery, Trinity College Dublin, St James's Hospital, Dublin 8, Ireland. 4 Department of Histopathology, St. James's Hospital, Dublin 8, Ireland. (Nature Publishing Group, 2016-10-14)
    Colorectal cancer (CRC) is a leading cause of cancer deaths. Molecularly targeted therapies (e.g. bevacizumab) have improved survival rates but drug resistance ultimately develops and newer therapies are required. We identified quininib as a small molecule drug with anti-angiogenic activity using in vitro, ex vivo and in vivo screening models. Quininib (2-[(E)-2-(Quinolin-2-yl) vinyl] phenol), is a small molecule drug (molecular weight 283.75 g/mol), which significantly inhibited blood vessel development in zebrafish embryos (p < 0.001). In vitro, quininib reduced endothelial tubule formation (p < 0.001), cell migration was unaffected by quininib and cell survival was reduced by quininib (p < 0.001). Using ex vivo human CRC explants, quininib significantly reduced the secretions of IL-6, IL-8, VEGF, ENA-78, GRO-α, TNF, IL-1β and MCP-1 ex vivo (all values p < 0.01). Quininib is well tolerated in mice when administered at 50 mg/kg intraperitoneally every 3 days and significantly reduced tumour growth of HT-29-luc2 CRC tumour xenografts compared to vehicle control. In addition, quininib reduced the signal from a α
  • CD10/ALDH cells are the sole cisplatin-resistant component of a novel ovarian cancer stem cell hierarchy.

    Ffrench, Brendan; Gasch, Claudia; Hokamp, Karsten; Spillane, Cathy; Blackshields, Gordon; Mahgoub, Thamir Mahmoud; Bates, Mark; Kehoe, Louise; Mooney, Aoibhinn; Doyle, Ronan; Doyle, Brendan; O'Donnell, Dearbhaile; Gleeson, Noreen; Hennessy, Bryan T; Stordal, Britta; O'Riain, Ciaran; Lambkin, Helen; O'Toole, Sharon; O'Leary, John J; Gallagher, Michael F; 1 Department of Histopathology, Trinity College Dublin, Central Pathology Laboratory, St. James's Hospital, Dublin 8, Ireland. 2 Pathology Research Laboratory, Coombe Women and Infant's University Hospital, Dublin 8, Ireland. 3 Smurfit Institute of Genetics, Trinity College Dublin, Dublin 2, Ireland. 4 Department of Obstetrics and Gynaecology, Trinity College Dublin, Trinity Centre for Health Sciences, St. James's Hospital, Dublin 8, Ireland. 5 School of Biological Sciences, Dublin Institute of Technology, Kevin Street, Dublin, Ireland. 6 Department of Clinical Medicine, Trinity College Dublin, St. James's Hospital, Dublin 8, Ireland. 7 Department of Molecular Medicine, Royal College of Surgeons in Ireland, Dublin 2, Ireland. 8 Department of Natural Sciences, Middlesex University, Hendon, London, UK. (Springer Nature, 2017-10-19)
    It is long established that tumour-initiating cancer stem cells (CSCs) possess chemoresistant properties. However, little is known of the mechanisms involved, particularly with respect to the organisation of CSCs as stem-progenitor-differentiated cell hierarchies. Here we aimed to elucidate the relationship between CSC hierarchies and chemoresistance in an ovarian cancer model. Using a single cell-based approach to CSC discovery and validation, we report a novel, four-component CSC hierarchy based around the markers cluster of differentiation 10 (CD10) and aldehyde dehydrogenase (ALDH). In a change to our understanding of CSC biology, resistance to chemotherapy drug cisplatin was found to be the sole property of CD10
  • The characterization of an intestine-like genomic signature maintained during Barrett's-associated adenocarcinogenesis reveals an NR5A2-mediated promotion of cancer cell survival.

    Duggan, Shane P; Behan, Fiona M; Kirca, Murat; Zaheer, Abdul; McGarrigle, Sarah A; Reynolds, John V; Vaz, Gisela M F; Senge, Mathias O; Kelleher, Dermot; 1 Department of Medicine, Division of Gastroenterology, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia, Canada. 2 Life Science Institute, 2350 Health Sciences Mall, Vancouver, British Columbia, Canada. 3 Department of Clinical Medicine, Institute of Molecular Medicine, Trinity College Dublin, St James' Hospital, Dublin, Ireland. 4 Department of Gastroenterology, St James' Hospital, Dublin, Ireland. 5 Department of Surgery, Institute of Molecular Medicine, Trinity College Dublin, St James' Hospital, Dublin 8, Ireland. 6 Medicinal Chemistry, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin, St James' Hospital, Dublin 8, Ireland. (Nature Publishing Group, 2016-09-02)
    Barrett's oesophagus (BO), an intestinal-type metaplasia (IM), typically arising in conjunction with gastro-oesophageal reflux disease, is a prominent risk factor for the development of oesophageal adenocarcinoma (OAC). The molecular similarities between IM and normal intestinal tissues are ill-defined. Consequently, the contribution of intestine-enriched factors expressed within BO to oncogenesis is unclear. Herein, using transcriptomics we define the intestine-enriched genes expressed in meta-profiles of BO and OAC. Interestingly, 77% of the genes differentially expressed in a meta-profile of BO were similarly expressed in intestinal tissues. Furthermore, 85% of this intestine-like signature was maintained upon transition to OAC. Gene networking analysis of transcription factors within this signature revealed a network centred upon NR5A2, GATA6 and FOXA2, whose over-expression was determined in a cohort of BO and OAC patients. Simulated acid reflux was observed to induce the expression of both NR5A2 and GATA6. Using siRNA-mediated silencing and an NR5A2 antagonist we demonstrate that NR5A2-mediated cancer cell survival is facilitated through augmentation of GATA6 and anti-apoptotic factor BCL-XL levels. Abrogation of NR5A2-GATA6 expression in conjunction with BCL-XL co-silencing resulted in synergistically increased sensitivity to chemotherapeutics and photo-dynamic therapeutics. These findings characterize the intestine-like signature associated with IM which may have important consequences to adenocarcinogenesis.
  • Adolescent Substance Use ‘In Search of Solutions’

    Murray, Denis (Murray, Denis, 2018)
    Presentation to The School of Nursing and Midwifery, Trinity College Dublin as part of the Civic Engagement ‘Tell Me About’ Public lecture series.
  • Maximising Refractive Outcomes with an Extended Depth of Focus IOL.

    Power, Barry; Murphy, Rory; Leccisotti, Antonio; Moore, Tara; Power, William; O'Brien, Paul (The Open Ophthalmology Journal, 2018-01-01)
    To assess the impact of the magnitude of preoperative and postoperative corneal astigmatism on refractive outcomes in patients undergoing cataract surgery or lens exchange with an extended depth of focus intraocular lens. To compare visual outcomes of steep and temporal on-axis corneal incisions. Department of Ophthalmology, Blackrock Clinic, Dublin, Ireland. Prospective cohort analysis. Fifty-three consecutive adult patients (94 eyes) undergoing routine phacoemulsification with Symfony IOL implantation were analysed. Exclusion criteria: targets for mini-monovision, incomplete data, other ocular pathology. Data were prospectively collected on pre- and postoperative refraction, keratometry, distance vision, near vision, surgical wound site and Surgically Induced Astigmatism (SIA).
  • Maternal body mass index and the prevalence of spontaneous and elective preterm deliveries in an Irish obstetric population: a retrospective cohort study.

    Vinturache, Angela; McKeating, Aoife; Daly, Niamh; Sheehan, Sharon; Turner, Michael; Centre for Human Reproduction, University College Dublin, Coombe Women and Infants University Hospital, Dublin, Ireland (BMJ, 2017-10-15)
    To estimate the association between maternal body mass index (BMI) and risk of spontaneous preterm delivery (sPTD) and elective preterm delivery (ePTD) in singleton and multiple pregnancies. Retrospective cohort study. Electronic records of all deliveries from 2009 through 2013 in a tertiary university hospital were abstracted for demographic and obstetrical information. A total of 38 528 deliveries were included. Participants with missing data were excluded from the study. BMI was calculated from the measurement of height and weight at the first prenatal visit and categorised. Sonographic confirmation of gestational age was standard.
  • Intramuscular oxytocin versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery (LabOR trial): study protocol for a randomised controlled trial.

    Adnan, Nita; Boland, Fiona; Murphy, Deirdre J; Academic Department of Obstetrics and Gynaecology, Trinity College, University of Dublin & Coombe Women & Infants University Hospital, Dublin 8, Ireland/ Department of General Practice, Royal College of Surgeons in Ireland, Dublin 2, Ireland (Biomed Central, 2017-11-15)
    Primary postpartum haemorrhage (PPH) is one of the leading causes of maternal morbidity and mortality worldwide. The most common cause of primary PPH is uterine atony. Atonic PPH rates are increasing in developed countries despite routine active management of the third stage of labour. In less-developed countries, primary PPH remains the leading cause of maternal death. Although the value of routine oxytocics in the third stage of labour has been well established, there is inconsistent practice in the choice of agent and route of administration. Oxytocin is the preferred agent because it has fewer side effects than other uterotonics with similar efficacy. It can be given intravenously or intramuscularly; however, to date, the most effective route of administering oxytocin has not been established. A double-blind randomised controlled trial is planned. The aim of the study is to compare the effects of an intramuscular bolus of oxytocin (10 IU in 1 mL) and placebo intravenous injection (1 mL 0.9% saline given slowly) with an intravenous bolus of oxytocin (10 IU in 1 mL given slowly over 1 min) and placebo intramuscular injection (1 mL 0.9% saline) at vaginal delivery. The study will recruit 1000 women at term (>36 weeks) with singleton pregnancies who are aiming for a vaginal delivery. The primary outcome will be PPH (measured blood loss ≥ 500 mL). A study involving 1000 women will have 80% power at the 5% two-sided alpha level, to detect differences in the proportion of patients with measured blood loss > 500 ml of 10% vs 5%. Given the increasing trends of atonic PPH it is both important and timely that we evaluate the most effective route of oxytocin administration for the management of the third stage of labour. To date, there has been limited research comparing the efficacy of intramuscular oxytocin vs intravenous oxytocin for the third stage of labour. ISRCTN Registry, ISRCTN14718882 . Registered on 4 January 2016. Pilot commenced 12.12.2015; trial commenced 04.01.2016. The protocol (Ref 012012) was approved by the National Maternity Hospital Research Ethics Committee on 10.06.2015 and the Research Ethics Committee of the Coombe Women & Infants University Hospital (Ref 26-2015) on 09.12.2015.
  • Children's complex care needs: a systematic concept analysis of multidisciplinary language.

    Brenner, Maria; Kidston, Claire; Hilliard, Carol; Coyne, Imelda; Eustace-Cook, Jessica; Doyle, Carmel; Begley, Thelma; Barrett, Michael J; School of Nursing & Midwifery, Trinity College Dublin (Springer, 2018-11-01)
    Complex care in the arena of child health is a growing phenomenon. Although considerable research is taking place, there remains limited understanding and agreement on the concept of complex care needs (CCNs), with potential for ambiguity. We conducted a systematic concept analysis of the attributes, antecedents, and consequences of children's CCNs from a multidisciplinary perspective. Our data sources included PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Inclusion criteria included publications in peer-reviewed journals between January 1990 and December 2017, written in the English language. One hundred and forty articles were included. We found that children's CCNs refer to multidimensional health and social care needs, in the presence of a recognized medical condition or where there is no unifying diagnosis.Conclusion: Children's CCNs are individual and contextualized, are continuing and dynamic, and are present across a range of settings, impacted by family and healthcare structures. There remain extensive challenges to caring for these children and their families, precluding the possibility that any one profession can possess the requisite knowledge or scope to singularly provide high-quality competent care. What is Known: • Complex care is a growing phenomenon and population prevalence figures show that there is an increasing number of children with complex care needs (CCNs). However, the concept has not been systematically analyzed before, leaving it generally ill-defined and at times confusing. What is New: • This is the first time this concept has been systematically analyzed and this analysis provides a much-needed theoretical framework for understanding the multidimensional nature of CCNs in children. • Children's CCNs refer to multidimensional health and social care needs in the presence of a recognized medical condition or where there is no unifying diagnosis. They are individual and contextualized, are continuing and dynamic, and are present across a range of settings, impacted by family and healthcare structures. It is clear that the very nature of CCNs precludes the possibility that any one profession or discipline can possess the requisite knowledge or scope for high-quality competent care for this population.
  • Growth Patterns in the Irish Pyridoxine Nonresponsive Homocystinuria Population and the Influence of Metabolic Control and Protein Intake.

    Purcell, Orla; Coughlan, Aoife; Grant, Tim; McNulty, Jenny; Clark, Anne; Deverell, Deirdre; Mayne, Philip; Hughes, Joanne; Monavari, Ahmad; Knerr, Ina; Crushell, Ellen; Temple St (2017-01-01)
    A low methionine diet is the mainstay of treatment for pyridoxine nonresponsive homocystinuria (HCU). There are various guidelines for recommended protein intakes for HCU and clinical practice varies. Poor growth has been associated with low cystine levels. This retrospective review of 48 Irish pyridoxine nonresponsive HCU patients assessed weight, height, body mass index (BMI), protein intake, and metabolic control up to 18 years at nine set time points. Patients diagnosed through newborn screening (NBS) were compared to late diagnosed (LD) patients. At 18 years the LD group
  • "Say BOO to the FLU!" Introduction of the Seasonal Influenza Peer Vaccination Programme in the Emergency Department and AMAU.

    Donaghy, Lisa; Martin, Patrick; Connolly Hospital Blanchardstown (2018-07-01)
    The Seasonal Influenza Peer Vaccination Programme was developed by the Republic of Ireland Health Service Executive (HSE)1 with the aim of increasing the number of health care workers receiving annual flu vaccinations. Supporting these efforts, various studies illustrated that increasing health care staff vaccination rates decreased patient illness and death,2 while other research reported a 40% reduction of influenza-related deaths in hospitals with higher rates of health care workers' influenza vaccinations.3 Flu vaccination recommendations from The WorldHealthOrganization (WHO) include a target uptake of 75% in health care staff and people age 65 and older.3 In accordance with HSE national guidelines that health care organizations achieve and/or surpass the minimum threshold goal of 40% of employees receiving the flu vaccine,4 and recognizing that Peer-to-Peer Influenza Vaccination Programmes are an essential aspect of the overall infection prevention and control arrangements in our health care setting, Connolly Hospital In Dublin, Ireland, initiated the Peer Vaccination Programme in the Emergency Department and Acute Medical Assessment Unit (AMAU) during the 2016–2017 flu season. The challenges facing successful ED and AMAU programme implementation included the large volume of interdisciplinary staff serving theED area, a vast cohort of undifferentiated complex patients at risk for increased complications if exposed to influenza, and an elevated risk of exposure to the influenza virus for all members of the health care team. Similar to programs in other countries, the Peer-to-Peer Vaccination Programme vaccinates health care workers against the influenza viruses identified as those most likely to circulate in the upcoming season.5 Although recognizing that frontline staff have a duty of care to protect their patients and colleagues, receiving the flu vaccine is not a mandatory requirement for health care worker employment in Ireland.

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