• Perforated and bleeding peptic ulcer: WSES guidelines.

      Tarasconi, Antonio; Coccolini, Federico; Biffl, Walter L; Tomasoni, Matteo; Ansaloni, Luca; Picetti, Edoardo; Molfino, Sarah; Shelat, Vishal; Cimbanassi, Stefania; Weber, Dieter G; et al. (2020-01-07)
      Background: Peptic ulcer disease is common with a lifetime prevalence in the general population of 5-10% and an incidence of 0.1-0.3% per year. Despite a sharp reduction in incidence and rates of hospital admission and mortality over the past 30 years, complications are still encountered in 10-20% of these patients. Peptic ulcer disease remains a significant healthcare problem, which can consume considerable financial resources. Management may involve various subspecialties including surgeons, gastroenterologists, and radiologists. Successful management of patients with complicated peptic ulcer (CPU) involves prompt recognition, resuscitation when required, appropriate antibiotic therapy, and timely surgical/radiological treatment. Methods: The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the board of the WSES to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the 5th WSES Congress, and for each statement, a consensus among the WSES panel of experts was reached. Conclusions: The population considered in these guidelines is adult patients with suspected complicated peptic ulcer disease. These guidelines present evidence-based international consensus statements on the management of complicated peptic ulcer from a collaboration of a panel of experts and are intended to improve the knowledge and the awareness of physicians around the world on this specific topic. We divided our work into the two main topics, bleeding and perforated peptic ulcer, and structured it into six main topics that cover the entire management process of patients with complicated peptic ulcer, from diagnosis at ED arrival to post-discharge antimicrobial therapy, to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process.
    • Proceedings of resources for optimal care of acute care and emergency surgery consensus summit Donegal Ireland.

      Sugrue, M; Maier, R; Moore, E E; Boermeester, M; Catena, F; Coccolini, F; Leppaniemi, A; Peitzman, A; Velmahos, G; Ansaloni, L; et al. (World Journal of Emergency Surgery, 2017-01-01)
      Opportunities to improve emergency surgery outcomes exist through guided better practice and reduced variability. Few attempts have been made to define optimal care in emergency surgery, and few clinically derived key performance indicators (KPIs) have been published. A summit was therefore convened to look at resources for optimal care of emergency surgery. The aim of the Donegal Summit was to set a platform in place to develop guidelines and KPIs in emergency surgery. The project had multidisciplinary global involvement in producing consensus statements regarding emergency surgery care in key areas, and to assess feasibility of producing KPIs that could be used to monitor process and outcome of care in the future. Forty-four key opinion leaders in emergency surgery, across 7 disciplines from 17 countries, composed evidence-based position papers on 14 key areas of emergency surgery and 112 KPIs in 20 acute conditions or emergency systems. The summit was successful in achieving position papers and KPIs in emergency surgery. While position papers were limited by non-graded evidence and non-validated KPIs, the process set a foundation for the future advancement of emergency surgery.
    • Revesz syndrome masquerading as bilateral cicatricial retinopathy of prematurity

      van der Spek, Nick; McElnea, E; Smith, O; Fitzsimons, S; Patel, C; O’Marcaigh, A (European Society of Ophthalmology, 2013-06-11)
    • Rigid or flexible sigmoidoscopy in colorectal clinics? Appraisal through a systematic review and meta-analysis.

      Ahmad, Nasir Zaheer; Ahmed, Aftab; Letterkenny General Hospital, Letterkenny, County Donegal, Ireland. nasirzahmad@gmail.com (2012-06)
      Rigid sigmoidoscopy is sometimes performed at first presentation in colorectal clinics. We assessed the feasibility of flexible sigmoidoscopy in similar situations by comparing it with rigid sigmoidoscopy as a first investigative tool.
    • Rocuronium and sugammadex: An alternative to succinylcholine for electro convulsive therapy in patients with suspected neuroleptic malignant syndrome.

      Ramamoorthy, Karthik G; Downey, H; Hawthorne, P; Department of Anaesthesia, Consultant, Letterkenny General Hospital, Letterkenny,, Ireland. (2012-01-31)
      We report a case of presumptive neuroleptic malignant syndrome requiring muscle relaxation for electro-convulsive therapy. short acting muscle relaxation without the use of succinylcholine was achieved using rocvronivm reversed with the novel reversal agent sugammadex. We suggest that this combination is a safe and effective alternative to succinylcholine in such cases.
    • Social and occupational engagement of staff in two Irish nursing homes for people

      Morgan-Brown, M; Ormerod, M; Newton, R; Manley, D; Fitzpatrick, M (Irish Journal of Occupational Therapy, 2011)
    • Social and occupational engagement of staff in two Irish nursing homes for people with dementia

      Morgan-Brown, M; Omerod, M; Newton, R; Manley, D; Fitzpatrick, M; Cavan General Hospital (2011)
      This observational study evaluated the amounts of social and occupational engagement of staff (nurses, care workers, activity coordinators) in two traditional style Irish residential nursing homes for people with dementia. A snapshot observational technique was used to obtain daily quantitative data. Approximately 65% of the time that staff were in communal sitting rooms during the observational periods was spent in work and care tasks, with approximately 25% of the time spent in social engagement and 10% spent in interactive occupational activities with the residents. Staff were absent from the room for over one-third of the observed time. Environmental and operational observations are discussed using narrative descriptions to give a context to the quantitative outcome measures.
    • Sport injuries in Donegal Gaelic footballers.

      El-Gohary, Y; Roarty, A; O'Rourke, P; Orthopaedic Department, Letterkenny General Hospital, Letterkenny, Co Donegal., gohary77@yahoo.com (2012-01-31)
      We aimed to identify any pattern of injuries that impacted on the long-term physical wellbeing o f players, sustained by Senior County Gaelic-football players during their playing career and the impact of those injuries on their quality of life. A questionnaire was sent to different Donegal-Panels looking for injuries and surgical procedures undergone in playing and post-playing career including chronic joint and musculoskeletal problems.
    • Survival trends of US dialysis patients with heart failure: 1995 to 2005.

      Stack, Austin G; Mohammed, Amir; Hanley, Alan; Mutwali, Arif; Nguyen, Hoang; Regional Kidney Centre, Department of Medicine, Letterkenny General Hospital,, Letterkenny, Donegal, Ireland. Austin.Stack@hse.ie (2012-01-31)
      BACKGROUND AND OBJECTIVES: Congestive heart failure (CHF) is a major risk factor for death in end-stage kidney disease; however, data on prevalence and survival trends are limited. The objective of this study was to determine the prevalence and mortality effect of CHF in successive incident dialysis cohorts. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a population-based cohort of incident US dialysis patients (n = 926,298) from 1995 to 2005. Age- and gender-specific prevalence of CHF was determined by incident year, whereas temporal trends in mortality were compared using multivariable Cox regression. RESULTS: The prevalence of CHF was significantly higher in women than men and in older than younger patients, but it did not change over time in men (range 28% to 33%) or women (range 33% to 36%). From 1995 to 2005, incident death rates decreased for younger men (70 years). For women, the pattern was similar but less impressive. During this period, the adjusted mortality risks (relative risk [RR]) from CHF decreased in men (from RR = 1.06 95% Confidence intervals (CI) 1.02-1.11 in 1995 to 0.91 95% CI 0.87-0.96 in 2005) and women (from RR = 1.06 95% CI 1.01-1.10 in 1995 to 0.90 95% CI 0.85-0.95 in 2005 compared with referent year 2000; RR = 1.00). The reduction in mortality over time was greater for younger than older patients (20% to 30% versus 5% to 10% decrease per decade). CONCLUSIONS: Although CHF remains a common condition at dialysis initiation, mortality risks in US patients have declined from 1995 to 2005.
    • A systematic review and meta-analysis of randomized and non-randomized studies comparing laparoscopic and open abdominoperineal resection for rectal cancer.

      Ahmad, N Z; Racheva, G; Elmusharaf, H; Department of Surgery, Letterkenny General Hospital, Letterkenny, County Donegal, Ireland. nasirzahmad@gmail.com (2013-03)
      Evidence supporting the role of laparoscopy in abdominoperineal resection (APR) is limited. This study compared the short-term and long-term outcomes and complications associated with open and laparoscopic APR.
    • Take care caring for ourselves as we care for patients at the end of life a reflective guide for health care staff at Cavan General Hospital

      Marron, Martina; Cavan General Hospital (Health Service Executive (HSE), Cavan General Hospital, 2011)
    • Targeting breast cancer outcomes-what about the primary relatives?

      Johnston, Alison; Sugrue, Michael (Wiley-Blackwell, 2017-07)
      Up to 65% of newly diagnosed breast cancer patients had not been screened correctly before diagnosis resulting in increased stage of cancer at presentation. This study assessed whether their primary relatives are, in turn, assessed appropriately.
    • Telepsychiatry and carer education for schizophrenia.

      Haley, C; O'Callaghan, E; Hill, S; Mannion, N; Donnelly, B; Kinsella, A; Murtagh, A; Turner, N; Donegal Mental Health Services, Letterkenny, Co. Donegal, Ireland. (2011)
      Despite the scientific evidence, most families of people with schizophrenia in Europe never receive a carer education programme. We evaluated whether a carer education course delivered by telepsychiatry was as effective as a carer education course delivered in situ.
    • A toddler with a yellow nose and excessive intake of sweet potato.

      Eltayeb, Mohamed; Paediatric Department, Letterkenny General Hospital, Letterkenny, Ireland. meltayeb12@yahoo.com (2011-12)
    • Understanding phenomenology.

      Flood, Anne; Letterkenny General Hospital, Letterkenny, County Donegal, Ireland. (2012-01-31)
      Phenomenology is a philosophic attitude and research approach. Its primary position is that the most basic human truths are accessible only through inner subjectivity, and that the person is integral to the environment. This paper discusses the theoretical perspectives related to phenomenology, and includes a discussion of the methods adopted in phenomenological research.
    • Update from the Abdominal Compartment Society (WSACS) on intra-abdominal hypertension and abdominal compartment syndrome: past, present, and future beyond Banff 2017.

      Kirkpatrick, Andrew W; Sugrue, Michael; McKee, Jessica L; Pereira, Bruno M; Roberts, Derek J; De Waele, Jan J; Leppaniemi, Ari; Ejike, Janeth C; Reintam Blaser, Annika; D'Amours, Scott; et al. (Via Medica Journals, 2017)
    • A user's guide to intra-abdominal pressure measurement.

      Sugrue, Michael; De Waele, Jan J; De Keulenaer, Bart L; Roberts, Derek J; Malbrain, Manu L N G (Anaesthesiology intensive therapy, 2015)
      The intra-abdominal pressure (IAP) measurement is a key to diagnosing and managing critically ill medical and surgical patients. There are an increasing number of techniques that allow us to measure the IAP at the bedside. This paper reviews these techniques. IAP should be measured at end-expiration, with the patient in the supine position and ensuring that there is no abdominal muscle activity. The intravesicular IAP measurement is convenient and considered the gold standard. The level where the mid-axillary line crosses the iliac crest is the recommended zero reference for the transvesicular IAP measurement; moreover, marking this level on the patient increases reproducibility. Protocols for IAP measurement should be developed for each ICU based on the locally available tools and equipment. IAP measurement techniques are safe, reproducible and accurate and do not increase the risk of urinary tract infection. Continuous IAP measurement may offer benefits in specific situations in the future. In conclusion, the IAP measurement is a reliable and essential adjunct to the management of patients at risk of intra-abdominal hypertension.
    • Variations in Abnormal Nipple Discharge Management in Women- a Systematic Review and Meta-analysis

      Leong, Alison; Johnston, Alison; Sugrue, Michael (Journal of surgery, 2018-07)
      Nipple discharge accounts for 5% of referrals to breast units; breast cancer in image negative nipple discharge patients varies from 0 to 21%. This systematic review and meta-analysis determined variability in breast cancer rates in nipple discharge patients, diagnostic accuracy of modalities and surgery rates. An ethically approved meta-analysis was conducted using databases PubMed, EMBASE, and Cochrane Library from January 2000 to July 2015. For the breast cancer rates’ review, studies were excluded if no clinical follow-up data was available. For the diagnostic accuracy meta-analysis, studies were excluded if there was no reference standard, or the number of true and false positives and negatives were not known. Pooled sensitivities were determined using Mantel-Haenszel method. For the surgery rates’ review, only studies with consecutive nipple discharge patients were included. Average risk of having a breast cancer is 10.2% in nipple discharge patients. Most studies reported an age threshold of 50 above which breast cancer risk greatly increases. Pooled sensitivities of ultrasound, mammogram, mammogram and ultrasound, breast MRI, conventional galactography, smear cytology, ductal lavage cytology and ductoscopy were 0.64, 0.34, 0.65, 0.81, 0.75, 0.37, 0.49 and 0.82 respectively. Average surgery rate was 43.4%. Malignancy rate of 10.2% indicates the need to continue surgery, especially for patients aged over 50. Patients below 50, in the absence of risk factors such as family history, can be managed conservatively with close follow up.