Recent Submissions

  • Evaluation of wavelength ranges and tissue depth probed by diffuse reflectance spectroscopy for colorectal cancer detection.

    Nogueira, Marcelo Saito; Maryam, Siddra; Amissah, Michael; Lu, Huihui; Lynch, Noel; Killeen, Shane; O'Riordain, Micheal; Andersson-Engels, Stefan; Mercy University Hospital, Grenville Place, Cork, Ireland (Nature Research, 2021-01-12)
    Colorectal cancer (CRC) is the third most common type of cancer worldwide and the second most deadly. Recent research efforts have focused on developing non-invasive techniques for CRC detection. In this study, we evaluated the diagnostic capabilities of diffuse reflectance spectroscopy (DRS) for CRC detection by building 6 classification models based on support vector machines (SVMs). Our dataset consists of 2889 diffuse reflectance spectra collected from freshly excised ex vivo tissues of 47 patients over wavelengths ranging from 350 and 1919 nm with source-detector distances of 630-µm and 2500-µm to probe different depths. Quadratic SVMs were used and performance was evaluated using twofold cross-validation on 10 iterations of randomized training and test sets. We achieved (93.5 ± 2.4)% sensitivity, (94.0 ± 1.7)% specificity AUC by probing the superficial colorectal tissue and (96.1 ± 1.8)% sensitivity, (95.7 ± 0.6)% specificity AUC by sampling deeper tissue layers. To the best of our knowledge, this is the first DRS study to investigate the potential of probing deeper tissue layers using larger SDD probes for CRC detection in the luminal wall. The data analysis showed that using a broader spectrum and longer near-infrared wavelengths can improve the diagnostic accuracy of CRC as well as probing deeper tissue layers. © 2021, The Author(s).
  • Managing clinical trials during COVID-19: experience from a clinical research facility

    Shiely, Frances; Foley, Jean; Stone, Amy; Cobbe, Emma; Browne, Shaunagh; Murphy, Ellen; Kelsey, Maeve; Walsh-Crowley, Joanne; Eustace, Joseph A.; Mercy University Hospital, Grenville Place, Cork, Ireland (BioMed Central Ltd, 2021-01-18)
    There is a dearth of literature on best practices for managing clinical trials, and little is understood on the role of the clinical trial manager. The COVID-19 pandemic has brought this into focus, and the continuance of clinical trials worldwide has been catapulted into a state of uncertainty as countries enter lockdown to manage the spread of the virus. Participant retention is an ongoing issue in clinical trials, and the concern is that in the current pandemic environment, attrition will be an issue which could potentially jeopardise trial completion. The current situation has necessitated timely problem solving by the trial manager to ensure trials remain open, and most importantly, that participant safety, paramount in clinical trials, is monitored. The purpose of our study is to highlight key issues arising in the management of clinical trials during a pandemic from first-hand experience in a clinical research facility managing both academic and commercial clinical trials. We offer some practical guidance on solution implementation.
  • A telephone assessment and advice service within an ED physiotherapy clinic: a single-site quality improvement cohort study

    Kelly, Marie; Higgins, Anna; Murphy, Adrian; McCreesh, Karen; Mercy University Hospital, Grenville Place, Cork, Ireland (Springer Nature, 2021-02-08)
    Background: In response to issues with timely access and high non-attendance rates for Emergency Department (ED) physiotherapy, a telephone assessment and advice service was evaluated as part of a quality improvement project. This telehealth option requires minimal resources, with the added benefit of allowing the healthcare professional streamline care. A primary aim was to investigate whether this service model can reduce wait times and non-attendance rates, compared to usual care. A secondary aim was to evaluate service user acceptability. Methods: This was a single-site quality improvement cohort study that compares data on wait time to first physiotherapy contact, non-attendance rates and participant satisfaction between patients that opted for a service based on initial telephone assessment and advice, versus routine face-to-face appointments. 116 patients were referred for ED physiotherapy over the 3-month pilot at the ED and out-patient physiotherapy department, XMercy University Hospital, Cork, Ireland. 91 patients (78%) opted for the telephone assessment and advice service, with 40% (n=36) contacting the service. 25 patients (22%) opted for the face-to-face service. Data on wait time and non-attendance rates was gathered using the hospital data reporting system. Satisfaction data was collected on discharge using a satisfaction survey adapted from the General Practice Assessment Questionnaire. Independent-samples t-test or Mann Whitney U Test was utilised depending on the distribution of the data. For categorical data, Chi-Square tests were performed. A level of significance of p ≤ 0.05 was set for this study. Results: Those that contacted the telephone assessment and advice service had a significantly reduced wait time (median 6 days; 3–8 days) compared to those that opted for usual care (median 35 days; 19–39 days) (p ≤ 0.05). There was no significant between-group differences for non-attendance rates or satisfaction. Conclusion: A telephone assessment and advice service may be useful in minimising delays for advice for those referred to ED Physiotherapy for musculoskeleltal problems. This telehealth option appears to be broadly acceptable and since it can be introduced rapidly, it may be helpful in triaging referrals and minimising face-to-face consultations, in line with COVID-19 recommendations. However, a large scale randomised controlled trial is warranted to confirm these findings.
  • Prevalence and predictors of continence containment products and catheter use in an acute hospital: A cross-sectional study

    Condon, Marie; Mannion, Edel; Collins, Gillian; Ghafar, Mohd Zaquan Arif Abd; Ali, Bushra; Small, Majella; Murphy, Robert P; McCarthy, Christine E; Sharkey, Anthony; MacGearailt, Conall; et al. (Elsevier, 2021-03-05)
    Although incontinence is common in hospital, the prevalence and predictors of continence aid use (continence wear and catheters) are poorly described. A one-day cross-sectional study was conducted in a large university hospital assessing consecutive inpatients (≥55) for their pre-admission and current use of continence aids. Barthel Index, Clinical Frailty Scale and Charlson Co-morbidity scores were recorded. Appropriateness was defined by local guidelines. 355 inpatients, median age 75±17 years, were included; 53% were male. Continence aid use was high; prevalence was 46% increasing to 58% for those ≥75. All-in-one pads were the most common, an overall prevalence of 31%. Older age, lower Barthel and higher frailty scores were associated with continence aid use in multivariate analysis. Inappropriate use of aids was high at 45% with older age being the only independent predictor. Continence aids are often used inappropriately during hospitalisation by older patients. Concerted efforts are required to address this issue.
  • The importance of taking a patient-centered, community-based approach to preventing and managing frailty: A public health perspective

    Adja, Kadjo Yves Cedric; Lenzi, Jacopo; Sezgin, Duygu; O'Caoimh, Rónán; Morini, Mara; Damiani, Gianfranco; Buja, Alessandra; Fantini, Maria Pia; Mercy University Hospital, Grenville Place, Cork, Ireland (Frontiers Media S.A., 2020-11-12)
    Across the world, life expectancy is increasing. However, the years of life gained do not always correspond to healthy life years, potentially leading to an increase in frailty. Given the extent of population aging, the association between frailty and age and the impact of frailty on adverse outcomes for older people, frailty is increasingly being recognized to be a significant public health concern. Early identification of the condition is important to help older adults regain function and to prevent the negative outcomes associated with the syndrome. Despite the importance of diagnosing frailty, there is no definitive evidence or consensus of whether screening should be routinely implemented. A broad range of screening and assessment instruments have been developed taking a biopsychosocial approach, characterizing frailty as a dynamic state resulting from deficits in any of the physical, psychological and social domains, which contribute to health. All these aspects of frailty should be identified and addressed using an integrated and holistic approach to care. To achieve this goal, public health and primary health care (PHC) need to become the fulcrum through which care is offered, not only to older people and those that are frail, but to all individuals, favoring a life-course and patient-centered approach centered around integrated, community-based care. Public health personnel should be trained to address frailty not merely from a clinical perspective, but also in a societal context. Interventions should be delivered in the individuals' environment and within their social networks. Furthermore, public health professionals should contribute to education and training on frailty at a community level, fostering community-based interventions to support older adults and their caregivers to prevent and manage frailty. The purpose of this paper is to offer an overview of the concept of frailty for a public health audience in order to raise awareness of the multidimensional aspects of frailty and on how these should be addressed using an integrated and holistic approach to care. © Copyright © 2020 Adja, Lenzi, Sezgin, O'Caoimh, Morini, Damiani, Buja and Fantini.
  • Evaluation of an emergency department falls pathway for older people: A patient chart review

    O'Keeffe, Anne; O'Grady, Sile; Cronin, Finola; Dolan, Clodagh; O'Hea, Ann; O'Shea, Katie Louise; Naughton, Corina; Mercy University Hospital (Elsevier BV, 2020-07)
    The number of older adults presenting to EDs following a fall continues to rise, yet falls management often ignores opportunities for secondary falls risk reduction. Advanced Nurse Practitioners (ANPs) in EDs have an important clinical leadership role in improving outcomes for this group of patients. Aim: This study describes the development of an ANP led falls pathway in an ED to improve safe discharge. It evaluates compliance with the pathway and referrals to community falls prevention services. It also draws comparison with baseline practice as recorded in 2014. Methods: The Falls Pathway involves four steps: 1) screening at triage (3 questions), 2) risk stratification (low, medium, high), 3) risk assessment (lying and standing blood pressure (B/P), timed-up and go (TUG), 4-AT for delirium screening, polypharmacy), and 4) referral to community falls services. We undertook a 12-month chart review of all patients aged 65 years or older presenting following a fall to the ANP service in 2018. We compared data to a baseline audit in 2014; descriptive and Chi squared statistics were used to examine the data. Results: The 2018 audit involved 77 patients representing 27% of ANP caseload. A repeat fall occurred in 42% (32/77) of cases and 35% (22/77) reported a fear of falling. The Falls Pathway was initiated in nearly 80% (62/77) of patients and compliance with falls risk assessment ranged from 42% for lying and standing B/P to 75% for TUG. In 2014, a review of 59 patient charts showed 27% (16/59) experienced a repeat fall, but other risk factors such as fear of falling were not recorded. In 2018, the majority of patients (88%) discharged home were referred to community falls prevention services compared to 22% in 2014. Conclusion: The Falls Pathway improved falls risk assessment in the ED, identified opportunities for risk reduction and optimised referral to community falls services. The pathway continues to be a valuable tool but requires resources for ongoing implementation among the wider ED team.
  • Irritant contact dermatitis in healthcare workers as a result of the COVID-19 pandemic: a cross-sectional study.

    Kiely, L F; Moloney, E; O'Sullivan, G; Eustace, J A; Gallagher, J; Bourke, J F (2020-09-05)
    COVID-19 healthcare workers (HCWs) require frequent handwashing and use of personal protective equipment (PPE) to prevent infection. However, evidence is emerging that these practices are causing adverse effects on their skin integrity. A single-centre, cross-sectional study of HCWs from an Irish hospital was undertaken to evaluate the degree of COVID-19-related irritant contact dermatitis (ICD) between April and May 2020. Of 270 participants surveyed, 223 (82.6%) reported symptoms of ICD. The hands were the most commonly affected site (76.47%) and the most frequently reported symptom was dry skin (75.37%). Nearly all (268; 99.26%) HCWs had increased hand-washing frequency, but 122 (45.35%) did not use emollients. In the ICD group, 24.7% cited a history of dermatitis compared with 4.3% of unaffected staff (P < 0.001). The ICD group recorded PPE usage for an average of 3.15 h compared with the non-ICD group at 1.97 h (P = 0.21). Promoting awareness of COVID-19-related ICD is vital to highlight prevention and treatment for frontline staff.
  • Dual tasking interferes with dynamic balance in young and old healthy adults

    Sulaiman, Amal Al-Shaikh; Kelly, Marie; O'Connor, Mairead; Eva-Bamiou, Doris; Pavlou, Marousa (IOS Press, 2021-01-11)
    BACKGROUND:Functional mobility requires an ability to adapt to environmental factors together with an ability to execute a secondary task simultaneously while walking. A complex dual-tasking gait test may provide an indication of functional ability and falls risk among community-dwelling older adults. PURPOSE:The aim of this cross-sectional study is to investigate age-related differences in dual-tasking ability and to evaluate whether dual-tasking ability is related to executive function. METHODS:Forty-one community-dwelling healthy older and forty-one younger adults completed a dual-tasking assessment in which concurrent tasks were incorporated into the Functional Gait Assessment (FGA). The manual dual-task involved carrying a glass of water (FGA-M) while the cognitive dual-tasks involved numeracy (FGA-N) and literacy (FGA-L) related tasks. FGA scores under single (FGA-S) and dual-task conditions together with associated dual-task costs and response accuracy were determined. Executive function was assessed using The Behavioural Assessment of the Dysexecutive Syndrome (BADS). RESULTS:FGA-N and FGA-L scores were adversely affected in both groups compared to FGA-S (p≤0.001). However, score reductions and dual-task costs were significantly greater for older adults compared to younger adults on FGA-N (p≤0.05) and FGA-L (p≤0.001), with older adult performance on FGA-N associated with falls risk (p≤0.05). Executive function did not appear to be related to dual-tasking ability. CONCLUSION:Findings suggest that cognitively demanding tasks while walking, have a deleterious effect on dynamic balance and could place older adults at a greater risk of falls.
  • Covid-19: safe PPE - hand hygiene first in all cases.

    University of Limerick Hospitals (University pf Limerick Hospitals, 2020-04-03)
    Care of patients with respiratory symptoms/ suspected/confirmed COVID-19.
  • Perinatal factors affect the gut microbiota up to four years after birth.

    Fouhy, Fiona; Watkins, Claire; Hill, Cian J; O'Shea, Carol-Anne; Nagle, Brid; Dempsey, Eugene M; O'Toole, Paul W; Ross, R Paul; Ryan, C Anthony; Stanton, Catherine (2019-04-03)
    Perinatal factors impact gut microbiota development in early life, however, little is known on the effects of these factors on microbes in later life. Here we sequence DNA from faecal samples of children over the first four years and reveal a perpetual evolution of the gut microbiota during this period. The significant impact of gestational age at birth and delivery mode on gut microbiota progression is evident in the first four years of life, while no measurable effects of antibiotics are found in the first year. Microbiota profiles are also characteristic in children dependant on gestational age and maturity. Full term delivery is characterised by Bacteroides (year one), Parabacteroides (year two) and Christensenellaceae (year four). Preterm delivery is characterised by Lactobacillus (year one), Streptococcus (year two) and Carnobacterium (year four). This study reveals that the gut retains distinct microbial profiles of perinatal factors up to four years of age.
  • Standards for the management of cancer-related pain across Europe-A position paper from the EFIC Task Force on Cancer Pain.

    Bennett, Michael I; Eisenberg, Elon; Ahmedzai, Sam H; Bhaskar, Arun; O'Brien, Tony; Mercadante, Sebastiano; Krčevski Škvarč, Nevenka; Vissers, Kris; Wirz, Stefan; Wells, Chris; et al. (2019-01-06)
  • A Technological Review of Wearable Cueing Devices Addressing Freezing of Gait in Parkinson's Disease.

    Sweeney, Dean; Quinlan, Leo R; Browne, Patrick; Richardson, Margaret; Meskell, Pauline; ÓLaighin, Gearóid (2019-03-13)
    Freezing of gait is one of the most debilitating symptoms of Parkinson's disease and is an important contributor to falls, leading to it being a major cause of hospitalization and nursing home admissions. When the management of freezing episodes cannot be achieved through medication or surgery, non-pharmacological methods such as cueing have received attention in recent years. Novel cueing systems were developed over the last decade and have been evaluated predominantly in laboratory settings. However, to provide benefit to people with Parkinson's and improve their quality of life, these systems must have the potential to be used at home as a self-administer intervention. This paper aims to provide a technological review of the literature related to wearable cueing systems and it focuses on current auditory, visual and somatosensory cueing systems, which may provide a suitable intervention for use in home-based environments. The paper describes the technical operation and effectiveness of the different cueing systems in overcoming freezing of gait. The "What Works Clearinghouse (WWC)" tool was used to assess the quality of each study described. The paper findings should prove instructive for further researchers looking to enhance the effectiveness of future cueing systems.
  • Moderate-intensity aerobic and resistance exercise is safe and favorably influences body composition in patients with quiescent Inflammatory Bowel Disease: a randomized controlled cross-over trial.

    Cronin, Owen; Barton, Wiley; Moran, Carthage; Sheehan, Donal; Whiston, Ronan; Nugent, Helena; McCarthy, Yvonne; Molloy, Catherine B; O'Sullivan, Orla; Cotter, Paul D; et al. (2019-02-12)
    Improved physical fitness was demonstrated in the exercise group by increases in median estimated VO2max (Baseline: 43.41mls/kg/min; post-intervention: 46.01mls/kg/min; p = 0.03). Improvement in body composition was achieved by the intervention group (n = 13) with a median decrease of 2.1% body fat compared with a non-exercising group (n = 7) (0.1% increase; p = 0.022). Lean tissue mass increased by a median of 1.59 kg and fat mass decreased by a median of 1.52 kg in the exercising group. No patients experienced a deterioration in disease activity scores during the exercise intervention. No clinically significant alterations in the α- and β-diversity of gut microbiota and associated metabolic pathways were evident.
  • Look-back Review Report

    Safety Incident Management Team (SIMT); South /South West Hospital Group (Health Service Executive (HSE), 2018-12-05)
    In September 2017 a major review of CT Scans, Ultrasounds and Chest X-Rays reported by an individual Consultant Radiologist commenced at University Hospital Kerry (UHK). This was prompted by the notification to hospital management of three Serious Reportable Events (SRE) in the category of Care Management Events where a diagnostic error was considered by the hospital's Safety Incident Management Team (SIMT) to have had a serious impact on patients through a delay in diagnosis, limiting treatment options available to them. The matter was escalated to the South/South West Hospital Group (S/SWHG) who recommended that a look-back review would be carried out. This was approved by the National Director of the Acute Hospital Division, HSE, on the 30th of August, 2017. A Group SIMT was then established, chaired by the Chief Operations Officer S/SWHG, to carry out the look-back review. Following the notification of a further Serious Incident (SI) the review was extended in October 2017 to include all images reported by the individual Consultant concerned. Therefore, the review set about auditing 46,234 images in order to identify if there was any missed pathology within the radiology reporting process; to identify if any further patients had been affected; to communicate with them in a timely and appropriate fashion, and ultimately to ensure that patients received appropriate care. The SIMT endeavoured at all times to treat patients with utmost sensitivity and honesty whilst at the same time minimising unnecessary anxiety or distress. Over the course of the look-back eleven patients were identified as having a delay in diagnosis which had an impact on their care. Four of the eleven patients have passed away over the course of the review period. The hospital and the HSE acknowledge that patients and families’ experiences were devastating for them and have had a profound and lasting effect on both the patients affected and their families. The South/South West Hospital Group, University Hospital Kerry and the Health Service Executive (HSE) would like to apologise sincerely and unreservedly to all patients and families harmed by delayed diagnoses.
  • DVD Versus Physiotherapist-Led Inhaler Education: A Randomised Controlled Trial.

    Khan, R; Yasin, F; O'Neill, S; Cahalane, E; O'Shea, R; Browne, B; Cournane, J; Rand, S; Shannon, H (2018-02-09)
    Correct technique with inhalers is vital for therapeutic effect. Efficacy of DVD inhaler instruction was investigated. Secondary aims were to examine feasibility of an inhaler technique outcome measure, and to compare knowledge and self-efficacy after DVD or individual education. This was a randomised controlled trial conducted in a regional hospital paediatric ward, involving new or existing paediatric inhaler users. Inhaler technique was assessed pre-education in existing inhaler users. Participants were then randomised to message equivalent education by DVD or individually with a physiotherapist. Inhaler technique, self-efficacy and knowledge were assessed immediately post- and three months after education. Twenty one participants received DVD or individual education. There were no significant differences between groups for technique, self-efficacy or knowledge at any time. The outcome measure was feasible for use in a research study. DVD education was equivalent to individual instruction to teach parents how to use inhalers with their child.
  • Distance as a Barrier to Melanoma Care

    McCarthy, S; Feeley, K; Murphy, M; Bourke, J F (2019-08-01)
    Our aim was to review cases of melanoma diagnosed histologically in UHK in 2016 and to compare them to cases of melanoma nationally and in Kerry. Methods For each patient we recorded age, Breslow depth, and shortest distance to travel by car and travelling time (without traffic) to the South Infirmary Victoria University Hospital (SIVUH) from their primary residence (calculated using Google maps™ (2018)). Results 20 cases of invasive melanoma were diagnosed in UHK in 2016. Of the 20 cases, 9 (45%) presented at a very advanced stage with a Breslow depth of greater than 4mm. A further 7 (35%) cases had a depth of 1.5-4mm. These patients with invasive melanoma had a mean age of 72.5 (±15). The mean shortest distance to travel from the patient’s primary residence to the SIVUH was 114.8km (±15.5) taking an average of 102 minutes (±14.6) by car. Conclusion Cases of melanoma diagnosed locally in UHK presented at an advanced stage compared to the national average. We suspect that the long distances to travel to the SIVUH pigmented lesion clinic is a barrier for these patients.
  • Development of an Insulin-Prescribing Chart for Paediatric Diabetes

    Finn, B.P; O’Neill, T.; Bradfield, A.; O’Sullivan, T.; Beattie, S.; O’Connell, S.M. (Irish Medical Journal, 2019-10)
    Our aim was to design a new insulin prescribing tool in compliance with the Irish Medicines Safety Network recommendations.
  • High-flow Nasal Cannulae, Bronchopulmonary Dysplasia and Retinopathy of Prematurity

    Healy, L.I; Corcoran, P.; Murphy, B.P (Irish Medical Journal, 2019-09)
    To determine if HFNC use was associated with changes in incidence of BPD and ROP.
  • Telephone Follow-Up of Mild Traumatic Brain Injury; A Feasibility Study

    Underwood, S.; Campbell, S.; Deasy, C. (Irish Medical Journal, 2019-09)
    This study investigates the prevalence of Post-Concussion Syndrome (PCS) one-year post-injury in patients that were treated for Mild Traumatic Brain Injury (mTBI) in the Clinical Decision Unit (CDU) of Cork University Hospital’s (CUH) Emergency Department.

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