Recent Submissions

  • 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).
  • 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.
  • Screening For Gestational Diabetes Mellitus Selectively in a University Maternity Hospital

    O’Malley, EG; O’Duill, M; McArdle, C; Kennedy, RAK; Reynolds, CM; Turner, MJ (Irish Medical Journal, 2018-06)
    Gestational diabetes mellitus (GDM) is one of the commonest complications of pregnancy. The prevalence varies depending, for example, on the diagnostic criteria, the screening test used, laboratory standards and the population studied. However, the prevalence is increasing globally due to the increasing levels of maternal obesity. The detection of GDM is important because there are clinical consequences. The woman has an increased risk of pre-eclampsia and of developing Type 2 diabetes mellitus (T2DM) in later life. Up to 70% of those women with GDM develop T2DM by 28 years after the affected pregnancy2. In a pregnancy complicated by GDM there is an increased risk of fetal macrosomia and polyhydramnios due to fetal hyperglycaemia3. This is associated with an increased risk of shoulder dystocia and caesarean delivery4. Neonatal hypoglycaemia may develop due to increased insulin production secondary to intrauterine hyperglycaemia. The offspring also have an increased risk in their childhood and adult life for the development of diabetes, obesity and metabolic syndrome5.
  • 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.
  • The Doctor Can See You Now: A Key Stakeholder Study Into The Acceptability Of Ambulance Based Telemedicine.

    Gilligan, P; Bennett, A; Houlihan, A; Padki, A; Owens, N; Morris, D; Chochliouros, I; Mohammed, A; Mutawa, A; Eswararaj, M A; Gannon, S; Alrmawi, A; Gasem, J Z; Sheung, N; Tynan, C; Little, R; Merriman, W; Amadi-Obi, A; Kenna, L; Alim, D A; O’Donnel, C (Irish Medical Journal, 2018-06)
    Using telecommunications technology it would be possible to link a patient and paramedic to a Doctor in the Emergency Department (ED) at the point of first patient contact. A questionnaire-based study on telemedicine in the pre-hospital environment involving patients, paramedics, doctors and nurses in the ED, was performed to assess if they would want and accept telemedicine in pre-hospital emergency care. When asked 98.5% (55) of patients, 89% (11) of doctors, 76% (14) of nurses and 91% (42) of ambulance personnel saw the potential of an audio-visual link from the pre-hospital environment to the ED. The potential benefits were felt to be in diagnosis of time-dependent illnesses, time management, increased hospital preparedness for incoming patients and increased triage efficiency. Stakeholder enthusiasm for pre-hospital telemedicine must be met with the technological requirements to provide such a service. As noted by one patient a pre-hospital audio-visual link to the ED could be “potentially a life saving service”.
  • A Review of the Parenteral Nutrition Supply Service in an Irish Neonatal Unit

    Smith, A; Glynn, AC; Shankar, A; McDermott, C; McCallion, N (Irish Medical Journal, 2018-06)
    Neonatal Intensive Care (NICU) patients have individual nutritional requirements often requiring Patient Specific Parenteral Nutrition (PSPN). From October 2015, the national PSPN compounding service availability changed from 7 days per week service to 5 days per week (i.e. no weekend and limited bank holiday ordering available). The aim of this study was to examine the introduction of a 5 day only PSPN supply on neonatal patient parenteral nutrition availability in a tertiary NICU.
  • Quality Improvement of Clinical Handover in a Liaison Psychiatry Department: A Three-Phase Audit

    Alexander, L; Bechan, N; Brady, S; Douglas, L; Moore, S; Shelley, R (Irish Medical Journal, 2018-06)
    Clinical handover has been identified as a period of high risk in healthcare, with increased incidence of adverse outcomes and near-misses. The purpose of handover is to communicate relevant information between medical professionals, with emphasis on completing management tasks and preventing patients from ‘falling through the cracks’1. Poor handover practices contribute to catastrophic but avoidable adverse events in healthcare. In Ireland, one such high profile incident has been a particular catalyst in the development of comprehensive handover guidelines in maternity settings2. Other specialities have yet to follow suit and there remains a dearth of guidance on handover practices, particularly guidance that can be applied to highly specialised and logistically unique areas, such as psychiatry
  • Patient satisfaction with joint colorectal-urogynaecology pelvic floor surgery

    O’Leary, BD; Hanly, AM; Agnew, GJ (Irish Medical Journal, 2018-05)
  • Seasonal Variation in the Emergency Department Prevalence Of Sepsis

    McNevin, C; McDowell, R; Ni Shearcaigh, A; Wakai, A (Irish Medical Journal, 2018-05)
    The incidence and mortality of sepsis and severe sepsis in hospitalised patients is seasonal and consistently highest during the winter. The primary aim of this study was to measure the seasonal variation in the prevalence of emergency department (ED) patients with sepsis. This cross-sectional study was performed over two four-week periods in the summer and in the winter, respectively. The clinical records of all patients presenting to the ED during the study periods were retrospectively screened to determine if they met the criteria for “uncomplicated” sepsis and severe sepsis or septic shock. The prevalence of “uncomplicated” sepsis was higher in the winter (43.9 per 1000) compared to the summer (30.7 per 1000). The prevalence of severe sepsis or septic shock was also higher in the winter (17.7 per 1000) compared to the summer (11.7 per 1000). This quantitatively demonstrates the increased ED burden of sepsis in the winter that can be used to inform healthcare planning and resource allocation.
  • The Utility of Routine Echocardiography in Newborn Infants with a Persistent Oxygen Requirement

    Walsh, N; Breathnach, C; El-Khuffash, A; Franklin, O; Corcoran, JD (Irish Medical Journal, 2018-05)
    In the era of antenatal screening for congenital heart disease (CHD), infants presenting with an undiagnosed significant CHD are rare. However, term infants admitted with an initial diagnosis of TTN and a prolonged oxygen requirement often undergo an echocardiogram. We aimed to assess whether this practice yields any additional cases of undiagnosed CHD. We performed a retrospective chart review over a three year period [2013 – 2015] of term (> 36 weeks) infants admitted to the NICU for ≥ 5 days with a diagnosis of TTN and received an echocardiogram. The presence of CHD on the echocardiogram was assessed. Forty-seven infants were enrolled. The median age of echocardiogram was day four [2 – 8]. No infant had a diagnosis of significant CHD on the postnatal echocardiogram. A small muscular VSD was identified in two infants. Routine echocardiography for this cohort of infants to rule out major CHD appears to be unwarranted.
  • Patterns of Mortality in Modern Stroke Care

    Dalton, M; Coughlan, T; Cogan, N; Greene, S; McCabe, DJH; McCarthy, A; Murphy, S; Walsh, R; O’Neill, D; Kennelly, S; Ryan, D; Collins, R (Irish Medical Journal, 2018-05)
    Stroke is a leading cause of death. We looked at the causes (direct and indirect) of in-hospital mortality in a modern stroke unit over a two-year period.
  • Final Report Investigation Of Incident Mary Conroy

    Health Service Executive (HSE) (Health Service Executive (HSE), 2018)
  • Transcatheter Mitral Valve-in-Ring Implantation

    Tanner, RE; McCarthy, J; Walsh, K P; Blake, G; Casserly, I P (Irish Medical Journal, 2018-05)
    Failed surgical mitral valve repair using an annuloplasty ring has traditionally been treated with surgical valve replacement or repair1. For patients at high risk for repeat open heart surgery, placement of a trans-catheter aortic valve (i.e., TAVI valve) within the mitral ring (i.e., Mitral-Valve-in-Ring, MViR) has emerged as a novel alternative treatment strategy2-5 . We describe our experience of a failed mitral valve repair that was successfully treated with a TAVI valve delivered via the trans-septal approach, and summarise the data relating to this emerging treatment strategy.
  • Acquired Factor Xiii Deficiency: An Uncommon But Easily Missed Cause Of Severe Bleeding

    Fogarty, H; Byrne, M; O’Connell, NM; Ryan, K; White, B; O’Donnell, JS; Lavin, M (Irish Medical Journal, 2018-05)
    Factor XIII (FXIII) is a plasma clotting protein involved in clot stabilization. Severe FXIII deficiency may present with severe, even fatal bleeding. Critically however, routine coagulation assays may be normal and only specific FXIII assays will detect the abnormality. Herein we discuss a case report of a patient with acquired FXIII deficiency in order to highlight the clinical challenges associated with establishing the diagnosis and discuss the treatment approach. A 70-year-old man presented with a gluteal haematoma despite no preceding personal history of bleeding. Extensive initial haemostatic investigations were normal until a specific FXIII assay showed a marked reduction in FXIII levels. With directed treatment, bleeding episodes ceased and remission was achieved. Clinical awareness of FXIII deficiency is important, so appropriate testing can be implemented in patients with unexplained bleeding diatheses, particularly those in whom bleeding responds poorly to standard replacement therapy.
  • Therapeutics Today May 2018 Number 5

    National Medicines Information Centre, St. James’s Hospital (SJH) Dublin 8 (National Medicines Information Centre, St. James’s Hospital (SJH) Dublin 8, 2018-05)
  • Impact of somatic PI3K pathway and ERBB family mutations on pathological complete response (pCR) in HER2-positive breast cancer patients who received neoadjuvant HER2-targeted therapies.

    Toomey, Sinead; Eustace, Alexander J; Fay, Joanna; Sheehan, Katherine M; Carr, Aoife; Milewska, Malgorzata; Madden, Stephen F; Teiserskiene, Ausra; Kay, Elaine W; O'Donovan, Norma; Gallagher, William; Grogan, Liam; Breathnach, Oscar; Walshe, Janice; Kelly, Catherine; Moulton, Brian; Kennedy, M John; Gullo, Guiseppe; Hill, Arnold D; Power, Colm; Duke, Deirdre; Hambly, Niamh; Crown, John; Hennessy, Bryan T (BioMed Central, 2017-07-27)
    The Cancer Genome Atlas analysis revealed that somatic EGFR, receptor tyrosine-protein kinase erbB-2 (ERBB2), Erb-B2 receptor tyrosine kinase 3 (ERBB3) and Erb-B2 receptor tyrosine kinase 4 (ERBB4) gene mutations (ERBB family mutations) occur alone or co-occur with somatic mutations in the gene encoding the phosphatidylinositol 3-kinase (PI3K) catalytic subunit (PIK3CA) in 19% of human epidermal growth factor receptor 2 (HER2)-positive breast cancers. Because ERBB family mutations can activate the PI3K/AKT pathway and likely have similar canonical signalling effects to PI3K pathway mutations, we investigated their combined impact on response to neoadjuvant HER2-targeted therapies.

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