• Engaging life in two Irish nursing home units for people with dementia: Quantitative comparisons before and after implementing household environments.

      Morgan-Brown, Mark; Newton, Rita; Ormerod, Marcus; a SURFACE Inclusive Design Research Centre, School of the Built Environment, The University of Salford , Salford , UK. (Aging & mental health, 2012-09-03)
      Objectives: This study compares the Social Engagement and Interactive Occupation of residents with dementia in two Irish nursing homes, before and after conversion to a household model environment. The changes were an open plan design and a functioning unit kitchen, supported by a homemaker role and operational policies which reduced task-based work in favour of person-centred care offering choice. Method: A snapshot observation method was used to obtain quantitative data of resident activity using the Assessment Tool for Occupation and Social Engagement (ATOSE). Residents were assessed for four hours, on seven different weekdays, over a six-week period both pre- and post-renovation. The exception to this was the assessment of the traditional model unit (TMU) for Nursing Home 1 which was reduced to four days due to the early start of the building work. Results: The results were consistent for both nursing homes and data were aggregated. Residents spent more time in the communal living spaces and were more likely to be active and engaged in the household model units (HMUs) compared to the TMUs. Using the independent t-test, these changes were found to be highly significant (p < 0.001). Conclusion: Creating an HMU increased the Interactive Occupation and Social Engagement of residents in the communal areas of the two nursing homes. The physical environment change, in conjunction with supportive staff procedures and organizational initiatives, improved the well-being of residents with dementia. The outcomes must be viewed in context with financial implications.
    • 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.
    • Intra-abdominal pressure and abdominal compartment syndrome in acute general surgery.

      Sugrue, Michael; Buhkari, Yasir; Department of Surgery, Letterkenny General Hospital and Galway University, Hospitals, Letterkenny, Donegal, Ireland. acstrauma@hotmail.com (2012-01-31)
      BACKGROUND: Intra-abdominal pressure (IAP) is a harbinger of intra-abdominal mischief, and its measurement is cheap, simple to perform, and reproducible. Intra-abdominal hypertension (IAH), especially grades 3 and 4 (IAP > 18 mmHg), occurs in over a third of patients and is associated with an increase in intra-abdominal sepsis, bleeding, renal failure, and death. PATIENTS AND METHODS: Increased IAP reading may provide an objective bedside stimulus for surgeons to expedite diagnostic and therapeutic work-up of critically ill patients. One of the greatest challenges surgeons and intensivists face worldwide is lack of recognition of the known association between IAH, ACS, and intra-abdominal sepsis. This lack of awareness of IAH and its progression to ACS may delay timely intervention and contribute to excessive patient resuscitation. CONCLUSIONS: All patients entering the intensive care unit (ICU) after emergency general surgery or massive fluid resuscitation should have an IAP measurement performed every 6 h. Each ICU should have guidelines relating to techniques of IAP measurement and an algorithm for management of IAH.
    • Compression fractures of the vertebrae during a "bumpy" boat ride.

      Chukwunyerenwa, C K; O'Rourke, P; Orthopaedic Unit, Letterkenny General Hospital, Letterkenny, Co. Donegal,, Republic of Ireland. Chukwunyerenwa@yahoo.com (2012-01-31)
      INTRODUCTION: Compression fracture of the vertebrae is common, often the result of falls from height and motor vehicle accidents in the younger age groups. It can occur following minor trauma in the elderly and in those with osteoporosis. MATERIALS AND METHODS: We present an interesting case of compression fracture of the vertebral bodies occurring simultaneously in a couple during a boat ride while on holiday. One individual had fracture of the T8, while the other fractured the L1 vertebrae. Both injuries were treated conservatively with Taylor braces. CONCLUSION: We highlight one of the potential hazards of this recreational activity, and the almost identical fracture pattern in this couple.
    • Adult ileocolic intussusception secondary to ileocaecal valve polyp.

      Chugthai, Saqib Zeeshan; Atif, Abdul Hakeem; Chughtai, Jehan Zeb; Miptah, Najaa Hayatul; Couse, Neville; Letterkenny General Hospital, Surgery, 135 Foxhills, Letterkenny, County Donegal,, Ireland. (2012-01-31)
      Intussusception is relatively common in children, but it is a rare cause of abdominal pain and intestinal obstruction in adults. The aetiology, clinical presentation and management of this condition differs in adults and children. Preoperative clinical diagnosis is usually difficult due to the non-specific and intermittent nature of the symptoms. Ultrasound and computed tomography can be helpful in establishing the diagnosis. We present a case of adult ileocolic intussusception with classical radiological signs and operative findings. In adults the diagnosis of intussusception should be considered in a case of intermittent abdominal pain, especially with clinical signs of intermittent bowel obstruction.
    • 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.
    • 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.
    • Community-based health efforts for the prevention of falls in the elderly.

      Hanley, Alan; Silke, Carmel; Murphy, John; Department of Medicine, Letterkenny General Hospital, Letterkenny, Co Donegal,, Ireland. alan.hanley@gmail.com (2012-01-31)
      Falls are a major public health problem in the elderly population. The associated health care cost is great. It has therefore become an important public health matter to evaluate those interventions that might be effective in reducing the risk of falls. Risk factors that predict an increased risk of falling are described. We discuss interventions that can be employed in the community to reduce the risk of falls and associated injuries by discipline, including physiotherapy, occupational therapy, and physician-led interventions. We also discuss the cost-effectiveness of such interventions.
    • Cigarette use and cardiovascular risk in chronic kidney disease: an unappreciated modifiable lifestyle risk factor.

      Stack, Austin G; Murthy, Bhamidipati V R; Regional Kidney Centre, Department of Medicine, Letterkenny General Hospital,, Health Services Executive, County Donegal, Ireland. austin.stack@hse.ie (2012-01-31)
      Tobacco use is a major modifiable cardiovascular risk factor in the general population and contributes to excess cardiovascular risk. Emerging evidence from large-scale observational studies suggests that continued tobacco use is also an independent cardiovascular risk factor among patients with chronic kidney disease (CKD). The benefits of smoking cessation programs on improving the heath status of patients and reducing mortality are unequivocal in the general population. Despite this, there has been little effort in pursuing tobacco cessation programs in dialysis cohorts or those with lesser degrees of kidney impairment. Most of our attention to date has focused on the development of "kidney-specific" interventions that reduce rates of renal disease progression and improve dialysis outcomes. The purpose of this current review is to describe the epidemiology of tobacco use among patients with CKD, draw attention to its negative impact on cardiovascular morbidity and mortality, and finally highlight potential strategies for successful intervention. We hope that this study heightens the importance of tobacco use in CKD, stimulates renewed interest in the barriers and challenges that exist in achieving smoking cessation, and endorses the efficacy of intervention strategies and the immeasurable benefits of quitting on cardiovascular and noncardiovascular outcomes.
    • 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.
    • 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.
    • Avascular necrosis of femoral heads post-adrenal surgery for Cushing's syndrome: a rare presentation.

      Letterkenny General Hospital, Letterkenny, Co. Donegal, Ireland,, modelian@gmail.com. (2012-01-31)
      Avascular necrosis (AVN) is a well-recognized complication of patients on high-dose steroids for a long time. Exogenous hypercortisolism is a well known cause of AVN and a number of cases have been reported. Cushing's syndrome describes hypercortisolism of any cause endogenous or exogenous. A variety of traumatic and non-traumatic factors contribute to the aetiology of AVN although exogenous glucocorticoids administration and alcoholism are among the most common non-traumatic causes. AVN secondary to endogenous hypercortisolism is rare and very few case reports are available describing this complication. No literature is available on AVN presenting post-adrenal surgery. Here we present a young woman who presented with avascular necrosis of both hips 1 year after adrenalectomy for Cushing's syndrome.
    • Angioembolization for pelvic fractures.

      Letterkenny General Hospital, Letterkenny, Ireland. (2012-01-31)
    • 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)
    • An exploration of occupation in nursing home residents with dementia

      Morgan-Brown, Mark; Ormerod, Marcus; Newton, Rita; Manley, Dympna; Cavan General Hospital,University of Salford,Monaghan General Hospital (The College of Occupational Therapists Ltd., 2011-05)
    • An exploration of occupation in nursing home residents with dementia

      Morgan-Brown, Mark; Ormerod, Marcus; Newton, Rita; Manley, Dympna (2011-05)
      Objectives: This study evaluated the sitting room environment of two nursing homes in Ireland, using interactive occupation and social engagement as outcome measures and defining these rooms as occupational spaces. Method: Snapshot observational recordings were made in the main sitting rooms during the periods of time when the rooms were in most active use. Narrative information was also recorded. Results: Residents were more likely to occupy their time in the main sitting room passively, rather than in interactive occupation and social engagement. The nursing home residents with dementia spent approximately 70% of their daily time in the main sitting room areas in states of occupational disengagement. Discussion: Additional insight is provided through pragmatic narrative descriptions of the functioning of the main sitting room environment in terms of interactive occupation and social engagement. Relevance: The research study demonstrates a methodology for evaluating the sitting room areas of a care environment, using interactive occupation and social engagement as outcome measures, which can be used for descriptive and comparative insights into the performance of care environments.
    • A consultant paediatrician led and public health nurse (PHN) provided Community Enuresis Clinic as a model of care.

      Noone, D; van der Spek, N; Waldron, M; Cavan General Hospital, Cavan Town, Co Cavan. dnoone@O2.ie (2011-02)
      A dedicated Community Enuresis Clinic was established in 2004 in Cavan and Monaghan. The service was audited using ERIC (Education and Resources for Improving Childhood Continence) guidelines. There were 106 males and 47 females, giving an M: F ratio of 2.3:1. Monosymptomatic Nocturnal Enuresis (MNE) accounted for 127 (83%). Adequate follow-up was available for 108 children with MNE and in this group Initial Success was 49% (ERIC target 50%). 71% were dry at 1 year. There was a dropout rate of 20% in the MNE group (ERIC minimum standard < 25%). We believe the structure of this community based clinic and its approach to MNE management has been successful.
    • 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)