Recent Submissions

  • Report on the death of patients in whom CPE had been detected

    Spencer, Robert C.
    Following the first Irish outbreak of Carbapenemase Producing Enterobacteriaceae [CPE] at UHL in 2011, there has been an ongoing increased detection of CPE in the UL Hospitals Group (ULHG) with multiple associated outbreaks. An extensive screening programme is currently in place; in critical care and for newly admitted patients should they fulfil specific screening criteria [ULHG Guidelines for the Prevention, Control & Management of CRE including KPC. Document: QPRS-IPCH-10 Approved January 2016].
  • Caffeine Treatment for Apnea of Prematurity and the Influence on Dose-Dependent Postnatal Weight Gain Observed Over 15 Years.

    Philip, Roy K; Ismail, Abu; Murphy, Bernadette; Mirza, Adnan; Quinn, Collette; Dunworth, Margo; University Hospital Limerick (Journal of Caffeine and Adenosine Research, 2018-09-01)
    To analyze the influence on weight gain of infants exposed to two dosage regimens of oral caffeine citrate (CC) for apnea of prematurity.
  • Use of “Months of the Year Backwards” (MOTYB) as a Screening Tool for Delirium in Palliative Care Patients in the Acute Hospital Setting

    Ryan, S; Hayes, D; Creedon, B; University Hospital Waterford (Irish Medical Journal, 2018-09)
    Delirium is common in palliative care. It effects up to 88% of patients with advanced cancer at end of life and has a point prevalence of 20% in the acute hospital setting across all diagnoses. It is under diagnosed and not optimally treated. “Months of the Year Backwards” (MOTYB) is an ideal screening tool for delirium with a sensitivity of 83.8%. It is brief to perform and carries low burden for patients. The aim of this study is to investigate the use of MOTYB as a screening tool for delirium in palliative care patients in the acute hospital setting.
  • Temporal trends in acute kidney injury across health care settings in the Irish health system: a cohort study.

    Stack, Austin G; Li, Xia; Kaballo, Mohamed; Elsayed, Mohamed E; Johnson, Howard; Murray, Patrick T; Saran, Rajiv; Browne, Leonard D (Nephrology, dialysis, transplantation, 2018-08-07)
    Complete ascertainment of the true rates of acute kidney injury (AKI) and emerging trends are essential for planning of preventive strategies within health systems. We conducted a retrospective cohort study from 2005 to 2014 using data from regional laboratory information systems to determine incidence rates of AKI and severity Stages 1-3 in the Irish health system. Multivariable models were developed to explore annual trends and the contributions of demographic factors, clinical measures, geographic factors and location of medical supervision expressed as adjusted odds ratios (ORs) and 95% confidence intervals (CIs). From 2005 to 2014, incidence rates of AKI increased from 6.1% (5.8-6.3) to 13.2% (12.7-13.8) per 100 patient-years in men and from 5.0% (4.8-5.2) to 11.5% (11.0-12.0) in women, P < 0.001. Stage 1 AKI accounted for the greatest growth in incidence, from 4.4% (95% CI 4.3-4.6) in 2005 to 10.1% (95% CI 9.8-10.5) in 2014 (P < 0.001 for trend). Compared with 2005, patients in 2014 were more likely to experience AKI [OR 4.53 (95% CI 4.02-5.1) for Stage 1, OR 5.22 (4.16-6.55) for Stage 2 and OR 4.11 (3.05-5.54) for Stage 3], adjusting for changing demographic and clinical profiles. Incidence rates of AKI increased in all locations of medical supervision during the period of observation, but were greatest for inpatient [OR 19.11 (95% CI 17.69-20.64)] and emergency room settings [OR 5.97 (95% CI 5.56-6.42)] compared with a general practice setting (referent). Incidence rates of AKI have increased substantially in the Irish health system, which were not accounted for by changing demographic patterns, clinical profiles or location of medical supervision.
  • Intrapartum fetal deaths and unexpected neonatal deaths in the Republic of Ireland: 2011 - 2014; a descriptive study.

    McNamara, K; O'Donoghue, K; Greene, R A (BMC Pregnancy Childbirth, 2018-01-04)
    Intrapartum fetal death, the death of a fetus during labour, is a tragic outcome of pregnancy. The intrapartum death rate of a country is reflective of the care received by mothers and babies in labour and it is through analysing these cases that good aspects of care, as well as areas for improvement can be identified. Investigating unexpected neonatal deaths that may be associated with an intrapartum event is also helpful to fully appraise intrapartum care. This is a descriptive study of intrapartum fetal deaths and unexpected neonatal deaths in Ireland from 2011 to 2014. Anonymised data pertaining to all intrapartum fetal deaths and unexpected neonatal deaths for the study time period was obtained from the national perinatal epidemiology centre. All statistical analyses were conducted using Statistical package for the Social Sciences (SPSS). There were 81 intrapartum fetal deaths from 2011 to 2014, and 36 unexpected neonatal deaths from 2012 to 2014. The overall intrapartum death rate was 0.29 per 1000 births and the corrected intrapartum fetal death rate was 0.16 per 1000 births. The overall unexpected neonatal death rate was 0.17 per 1000 live births. Major Congenital Malformation accounted for 36/81 intrapartum deaths, chorioamnionitis for 18/81, and placental abruption accounted for eight babies' deaths. Intrapartum asphyxia accounted for eight of the intrapartum deaths. With respect to the neonatal deaths over half (21/36, 58.3%) of the babies died as a result of hypoxic ischaemic encephalopathy. Information is also reported on both maternal and individual baby demographics. This is the first detailed descriptive analysis of intrapartum deaths and unexpected intrapartum event related neonatal deaths in Ireland. The corrected intrapartum fetal death rate was 0.16 per 1000 births. Despite our results being based on the best available national data on intrapartum deaths and unexpected neonatal deaths, we were unable to identify if any of these deaths could have been prevented. A more formal confidential inquiry based system is necessary to fully appraise these cases.
  • Development and psychometric testing of the clinical leadership needs analysis (CLeeNA) instrument for nurses and midwives.

    Mc Carthy, Vera J C; Murphy, Ashling; Savage, Eileen; Hegarty, Josephine; Coffey, Alice; Leahy-Warren, Patricia; Horgan, Aine; O'Connell, Rhona; Marsh, Lynne; Drennan, Jonathan (Journal of Nursing Management, 2018-08-31)
    The aim of this study is to report the development and psychometric testing of the clinical leadership needs analysis instrument (CLeeNA). Limited emphasis is placed on the clinical leadership needs of nurses and midwives that are fundamental to supporting the delivery of high quality, safe patient care. A development and validation study of CLeeNA was undertaken using cross-sectional data. A sample of 324 registered nurses and midwives completed the questionnaire using a 7-point adjectival scale. Principal component analysis was conducted to explore scale grouping of items (n = 103 items). Principal component analysis, item reduction and parallel analysis on the items of the instrument resulted in seven factors consisting of 56 items. These factors were identified as: Staff and Care Delivery; Technology and Care Initiatives; Self and Team Development; Standards of Care; Financial and Service Management; Leadership and Clinical Practice; Patient Safety and Risk Management.
  • Gene-trait matching across the Bifidobacterium longum pan-genome reveals considerable diversity in carbohydrate catabolism among human infant strains.

    Arboleya, S; Bottacini, F; O'Connell-Motherway, M; Ryan, CA; Ross, RP; van Sinderen, D; Stanton, C; University College Cork (Irish Medical Journal, 2018-07)
    Bifidobacterium longum is a common member of the human gut microbiota and is frequently present at high numbers in the gut microbiota of humans throughout life, thus indicative of a close symbiotic host-microbe relationship. Different mechanisms may be responsible for the high competitiveness of this taxon in its human host to allow stable establishment in the complex and dynamic intestinal microbiota environment. The objective of this study was to assess the genetic and metabolic diversity in a set of 20 B. longum strains, most of which had previously been isolated from infants, by performing whole genome sequencing and comparative analysis, and to analyse their carbohydrate utilization abilities using a gene-trait matching approach.
  • Giant Cell Arteritis Presenting as an Ischaemic Upper Limb

    Fitzgerald, Gerald; O’Connor, Mortimer B.; Phelan, Mark J.; Mercy University Hospital, Cork (Irish Medical Journal, 2018-07)
    Aim: To present an interesting case of giant cell arteritis presenting as ischaemic upper limb. Methods Data was collected from the patient’s chart and from radiology and laboratory systems in our institution. Results: The patient had a temporal artery biopsy confirming the diagnosis of temporal arteritis. This was successfully treated with high dose steroids leading to resolution of symptoms in the arm. Conclusion: Arteritis is an important consideration to consider in patients who present with limb ischaemia as it is a reversible cause which can be treated effectively.
  • The Predictive Ability of Pre-Operative Magnetic Resonance Imaging to Detect Pathological Outcomes in Prostate Cancer

    Nason, GJ; Selvarajah, L; O’Connor, EM; O’Kelly, J; Considine, SW; Moss, B; MacMahon, D; Heneghan, J; Meyer, N; Buckley, J; O’Regan, K; O’Brien, MF; Cork university Hospital (Irish Medical Journal, 2018-07)
    Accurate preoperative knowledge of tumour stage is important in preoperative planning at radical prostatectomy (RP). The aim of this study was to assess the predictive ability of multiparametric MRI for detecting pathological outcomes.
  • Sweat Testing in Ireland

    Blake; Tsang, V; Ghori, R; Whelan, S; Boran, G; Linnane, B; University Hospital Limerick (Irish Medical Journal, 2018-07)
    Quick, painless, cheap and reliable, the sweat test remains the gold standard diagnostic test for cystic fibrosis. We aimed to describe the pattern of testing in Ireland over a calendar year.
  • A cross sectional study of the relationship between self-reported levels of loneliness and the experience of Pastoral Care in an Older Adult Day-care Service

    Kiely, Elizabeth; Irish College of Humanities and Applied Sciences (2018-08-04)
    Thesis submitted for the Masters in Counselling and Pastoral Care At the Irish College of Humanities and Applied Sciences. The thesis seeks to establish if a correlation exists between self-reported levels of loneliness and the experience of pastoral care in Older Adult Daycare Services (OADS).
  • Revascularisation of left main stem disease: a prospective analysis of modern practice and outcomes in a non-surgical centre.

    Coughlan, J J; Blake, Nial; Chongprasertpon, Napohn; Ibrahim, Munir; Arnous, Samer; Kiernan, Thomas John; Department of Cardiology, University Hospital Limerick (2018-07)
    In this study, we sought to prospectively analyse the management and long term outcomes associated with revascularisation of left main stem disease via percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in our centre.
  • Enhancing acute stroke services: a quality improvement project.

    McGrath, Keith; Cunningham, Nora; Moloney, Elizabeth; O'Connor, Margaret; McManus, John; Peters, Catherine; Lyons, Declan; University Hospital Limerick (BMJ open quality, 2018-07)
    In a busy stroke centre in Ireland, care for acute stroke was provided by a mixture of general physicians. In acute ischaemic stroke, speed is essential for good outcomes.
  • The Utility of Dopamine Transporter Scans for Diagnosing Parkinsonian Disorders.

    Crotty, GF; O’Corragain, QA; Bogue, C; Crotty, J; O’Sullivan, S S (Irish Medical Journal, 2018-05)
    Dopamine transporter scans are increasingly being used in the diagnosis of clinically undefined Parkinsonism.
  • A core outcome set for studies evaluating the effectiveness of prepregnancy care for women with pregestational diabetes.

    Egan, Aoife M; Galjaard, Sander; Maresh, Michael J A; Loeken, Mary R; Napoli, Angela; Anastasiou, Eleni; Noctor, Eoin; de Valk, Harold W; van Poppel, Mireille; Todd, Marie; Smith, Valerie; Devane, Declan; Dunne, Fidelma P (Diabetologia, 2017-04)
    The aim of this study was to develop a core outcome set (COS) for trials and other studies evaluating the effectiveness of prepregnancy care for women with pregestational (pre-existing) diabetes mellitus.
  • Correction to: Dialectical behaviour therapy for treating adults and adolescents with emotional and behavioural dysregulation: study protocol of a coordinated implementation in a publicly funded health service.

    Flynn, Daniel; Kells, Mary; Joyce, Mary; Suarez, Catalina; Gillespie, Conall (BMC Psychiatry, 2018-05-07)
    Upon publication of the original article (1) it was highlighted by the authors that there was just one error in the manuscript in the 'Sample size' subsection of the Methods/Design.
  • Presentations and Preceding factors of Drug Overdose amongst adolescents admitted to a Large Regional Hospital.

    Maduemem, KE; Adedokun, C; Umana, E (Irish Medical Journal, 2018-04)
    Suicide is the third most common cause of death among adolescents globally, and poisoning is the leading method of attempted suicide. Survival after self-poisoning or drug overdose (OD) is common, providing an opportunity for secondary prevention. The aim of this study was to highlight pattern of presentations and preceding factors of OD in an adolescent population. We retrospectively evaluated the data of 85 adolescents presenting to a large regional hospital with OD over a 3-year period. The female-to-male ratio was 4.3:1. The median age of adolescents was 15.83 (range: 11.32 – 16.98) years. History of deliberate self-harm (DSH) was documented in 44.7%. Twenty-eight (33%) patients had been under the care of the CAMHS prior to index admission. Acetaminophen was the commonest drug used. Depression was the most common cause of mental illness in the study group. Substance abuse and conduct disorder were significantly commoner in males (p<0.05). Self-poisoning including OD in adolescence is a strong predictor of suicide; understanding the probable triggers can be significant in establishing appropriate prevention strategies.
  • Saving Blood and Reducing Costs: Updating Blood Transfusion Practice in Lower Limb Arthroplasty

    Fenelon, C; Galbraith, JG; Kearsley, R; Motherway, C; Condon, F; Lenehan, B (Irish Medical Journal, 2018-04)
    Our aim was to quantify blood transfusion rates in lower limb arthroplasty following the introduction of a multimodal enhanced recovery programme (ERP). We then sought to update the maximum surgical blood ordering schedule (MSBOS) and calculate cost savings achieved.
  • Parental And Clinician Views Of Consent In Neonatal Research

    O’Shea, N; Doran, K; Ryan, C A; Dempsey, E (Irish Medical Journal, 2018-03)
    Informed consent is an obligatory requirement for research participation1. The process of informed consent states that certain measures must be followed to ensure a research participant has made an informed decision about their participation in a research study2,3. Consent for research should be voluntary, informed, and understood by the consenting individual who must also be competent to do so. In the case of neonatal research informed consent is acquired from parent(s)/guardian(s) of a patient.
  • Clozapine Patients at the Interface between Primary and Secondary Care.

    Barrett, Marita; Keating, Anna; Lynch, Deirdre; Scanlon, Geraldine; Kigathi, Mary; Corcoran, Fidelma; Sahm, Laura J (Pharmacy, 2018-02-26)
    Patients receiving clozapine must undergo routine blood monitoring to screen for neutropenia, and to monitor for potential agranulocytosis. In Cork University Hospital, Cork, Ireland, clozapine is dispensed in the hospital pharmacy and the pharmacists are not aware of co-prescribed medicines, potentially impacting upon patient safety. The aim of this study was to examine the continuity of care of patients prescribed clozapine. A retrospective audit was conducted on patients attending the clozapine clinic at Cork University Hospital and assessed patients' (i) independent living, (ii) co-prescribed medicines and (iii) knowledge of their community pharmacists regarding co-prescribed clozapine. A list of prescribed medicines for each patient was obtained, and potential drug-drug interactions between these medicines and clozapine were examined using Lexicomp®and Stockley's Interaction checker. Secondary outcomes included patients' physical health characteristics, and a review of co-morbidities. Data were collected between the 29 May 2017 and 20 June 2017. Local ethics committee approval was granted. Patients were eligible for inclusion if they were receiving clozapine treatment as part of a registered programme, were aged 18 years or more, and had the capacity to provide written informed consent. Microsoft Excel was used for data analysis. Of 112 patients, (33% female; mean age (SD) 43.9 (11.3) years; 87.5% living independently/in the family home) 86.6% patients reported that they were taking other prescribed medicines from community pharmacies. The mean (SD) number of co-prescribed medicines in addition to clozapine was 4.8 (4) per patient. Two thirds of community pharmacists were unaware of co-prescribed clozapine. Interactions with clozapine were present in all but 3 patients on co-prescribed medicines (n= 97). Lexicomp®reported 2.9 drug-drug interactions/patient and Stockley's Interaction Checker reported 2.5 drug-drug interactions/patient. Secondary outcomes for patients included BMI, total cholesterol, and HbA1clevels, which were elevated in 75%, 54% and 17% respectively. Patients prescribed clozapine did not receive a seamless service, between primary and secondary care settings. Community pharmacists were not informed of clozapine, prescribed for their patients, in two thirds of cases. Patients in this study were exposed to clozapine-related drug-drug interactions and hence potential adverse effects. This study supports reports in the literature of substandard management of the physical health of this patient group. This study shows that there is an opportunity for pharmacists to develop active roles in the management of all clozapine-related effects, in addition to their traditional obligatory role in haematological monitoring. This study supports the need for a clinical pharmacist to review inpatients commencing on clozapine, monitor for drug-drug interactions and provide counselling.

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