Recent Submissions

  • A Survey of Colorectal Cancer Surveillance Practices In Ireland, And Implementation of A Survivorship Care Plan Pilot Programme

    Greally, M.; Keane, F; Power, D.G; Leonard, G.D (Irish Medical Journal, 2019-02)
    The number of colorectal cancer (CRC) survivors in Ireland is rising. We aimed to survey current surveillance practices and pilot the use of survivorship care plans (SCPs) in the clinic.
  • Academic Background of Irish Orthopaedic Trainees

    Unknown author (Irish Medical Journal, 2018-11)
    Academic achievement may be used to distinguish between trainees in competition for training or consultant posts. This study aimed to quantify the academic achievement among orthopaedic trainees in Ireland.
  • Human Papilloma Virus- Associated Head and Neck Cancer: A 21st Century Pandemic; Assessing Student Awareness and Knowledge

    Kavanagh, F.G; McNamara, A.T; Fopohunda, O; Keogh, I.J (Irish Medical Journal, 2018-11)
    The Human Papillomavirus (HPV) is a causal agent in a subset of Head and Neck Cancers (HNC) being diagnosed in younger patients without significant tobacco and alcohol use. This survey assessed the awareness level of HNC and HPV vaccinations in university students.
  • Ultrasound as a Diagnostic Tool in Pediatric Distal Forearm Fractures

    Ahmed, A.S; Abdelhady, A.E; McNicholl, B (Irish Medical Journal, 2018-11)
    To evaluate the accuracy of ultrasound in pediatric distal forearm fractures as well as the effect on the ED waiting time for these patients.
  • Attitudes and Knowledge of Healthcare Professionals Regarding Organ Donation. A Survey of the Saolta University Health Care Group.

    Umana, E; Grant, O; Curran, E; May, P; Mohamed, A; O’Donnell, J; University Hospital Galway (Irish Medical Journal, 2018-11)
    Organ donation saves lives and healthcare professionals (HCPs) play a vital role in that process. Therefore, the purpose of this study was to assess the attitudes and level of knowledge of HCPs regarding organ donation. An online anonymous self-administered questionnaire containing 40 questions on organ donation using google forms was created. The survey was distributed to HCPs working in the Saolta University Health Care Group. A hundred and thirty-nine responses were received giving a response rate of 11.8%. HCPs willingness to donate their organs was at 93% compared to 97% willing to receive a transplant. More HCPs understood or had knowledge of the term donation after brain death (64%) than donation after circulatory death (49%). HCPs working in intensive care knew more about the management of brain dead donors than other specialties (p<0.0001). Over 60% of HCPs when asked either disagreed or strongly disagreed with the adequacy of training in organ donation and transplant. Overall, HCPs surveyed had positive attitudes towards organ donation but there was a lack of knowledge particularly among non-intensive care professionals. This study highlights the need to increase awareness along with implementation of educational programmes among HCPs regarding organ donation and transplant.
  • The Experience of the Management of Eating Disorders in a Pop-up Eating Disorder Unit

    McHugh, CM; Harron, M; Kilcullen, A; O’Connor, P; Burns, N; Toolan, A; O’Mahony, E (Irish Medical Journal, 2018-09)
    Anorexia nervosa affects 0.5% of the population (90% female) with the highest mortality of any psychiatric illness, usually suicide, or cardiovascular or neurological sequelae of either malnutrition or refeeding syndrome. The latter two conditions occur in the inpatient setting, carry a high mortality and are thoroughly avoidable with careful informed clinical management.
  • Apixaban-Associated Spontaneous Splenic Rupture - A Case Report

    Abdelhady, A; Ahmed, A; Mohamed, Y; Binchy, J; University Hospital Galway (Irish Medical Journal, 2018-07)
    A 62-year-old lady presented to The Emergency Department (ED) with one-day history of dizziness, vomiting and feeling weak. ECG showed new onset Atrial Fibrillation. Four days ago, she was referred to the Cardiology team where she underwent PCI and was discharged on Apixaban and Plavix. Two days later she represented to the ED pale and hypotensive with BP 70/50. CT-Abdomen showed a large splenic hematoma and thickening of the inferior wall of the stomach.
  • Management of Paediatric Buckle (Torus) Wrist Fractures in Irish Emergency Departments: A National Survey

    Abdelhady, A; Ahmed, A; Umana, E; O’Donnell, J; University Hospital Galway (Irish Medical Journal, 2018-07)
    Buckle fractures are the most common wrist fractures reported in the paediatric age group. National Institute for Clinical Excellence (NICE) recommends using a non-rigid immobilisation with no follow up for these patients and appropriate discharge advice. A telephone survey was conducted to assess the variation in practice in Irish hospitals regarding the mpediatrianagement of buckle fractures. Twenty eight centres that manage paediatric patients with trauma were contacted. This survey demonstrates that over 70% (>20) of centres in Ireland are managing buckle fractures using the traditional approach of backslab cast and follow-up in fracture clinic. Despite relevant research and NICE guideline recommendations, there is a slow adoption of current evidence among Irish hospitals which points to a need for a national consensus on management of buckle fractures.
  • The Perceptions of Patients, their Parents and Healthcare Providers on the Transition of Young Adults with Type 1 Diabetes to Adult Services in the West of Ireland.

    Walsh, Ó; Wynne, M; O Donnell, M; Geoghegan, R; O Hara, Mary Clare; Paediatric Department, University Hospital Galway, School of Medicine, National University of Ireland Galway, Research and Development, HSE Strategic Planning and Transformation (Irish Medical Journal, 2018-07)
    This study aims to describe the perceptions of young adults’, parents of young adults’ and health care professionals’ (HCPs) of the transition process for young adults with Type 1 Diabetes in the West of Ireland.
  • Introduction of an Oral Fluid Challenge Protocol in the Management of Children with Acute Gastroenteritis: A Regional Hospital Experience.

    Umana, E; Rana, A; Maduemem, K; Moylett, E (Irish Medical Journal, 2018-06)
    Oral rehydration therapy (ORT) remains the ideal first line therapy for acute gastroenteritis (AGE). Our aim was to assess the impact of introducing an Oral Fluid Challenge (OFC) protocol on outcomes such as intravenous fluid use and documentation in our institution. A single centre study with data collected retrospectively pre-implementation (April 2015) of the OFC protocol and post implementation (April 2016). Consecutive sampling of the first 55 patients presenting with GE like symptoms and underwent OFC were recruited. One hundred and ten patients were included in this study with 55 patients per cycle. The rates of IVF use decreased from 22% (12) in cycle one to 18% (10) in cycle two. There was an improvement in documentation by 26% (14) for level of dehydration and 52% (31) for OFC volume from cycle one to two. Overall, the addition of the OFC protocol to the management of patients with uncomplicated AGE would help streamline and improve care.
  • Patients’ Attitude towards Travelling For Breast Services versus Waiting Longer For Local Services

    Abd Elwahab, S; McGough, P; Cooley, G; McLaughlin, R (Irish Medical Journal, 2018-05)
    Geographical access is a cornerstone of health care provision. However, prolonged waiting for breast clinic appointments in local services results in delayed diagnosis and excessive anxiety for patients. In this study, we present a patient satisfaction survey results of an initiative to offer out-patient clinic appointments for non-urgent patients referred to the breast unit in Letterkenny General Hospital (LGH), Ireland, and exceeded the recommended waiting period of 12 weeks. These patients were offered appointment in University Hospital Galway (UCHG), which is an average travel time of about 3.5-4.5 hours away from LGH. 163 patients out of 336 (48.5%) patients actively waiting more than 12 weeks for appointments in LGH accepted alternative appointments in UCHG. Despite the long travel distance for these patients, 100% of them reported high satisfaction and 97.3% said they would accept further UCHG appointments if a similar situation of prolonged waiting in LGH arises. None of these patients were diagnosed with cancer, and only one had a benign lumpectomy. This study showed that if offered alternative appointments, just under half of the patients would accept. The initiative provides a feasible solution for long waiters, and the survey shows that patients’ satisfaction remains high despite long travel.
  • Alcohol-related presentations to emergency departments in Ireland: a descriptive prevalence study

    McNicholl, Brian; Goggin, Deirdre; O’Donovan, Diarmuid (BMJ Open, 2018-05-24)
    To determine the prevalence of alcohol-related presentations in all 29 emergency departments (EDs) in Ireland and compare with non-alcohol-related presentations in order to identify opportunities for improvements in the quality of patient care and related data collection.
  • Kernicterus with abnormal high-signal changes bilaterally in the globus pallidus: A case report.

    Culleton, S; Kok, HK; Barras, C; Looby, S; Brennan, P; Asadi,H (Irish Medical Journal, 2018-04)
    Kernicterus is a relatively rare consequence of hyperbilirubinemia. There is an important role for MRI imaging for this entity in the appropriate clinical context as there are distinct signal changes in the globus pallidus. A case report and image findings are presented
  • Fracture Patients’ Attitudes towards Online Health Information & a ‘Prescribed’ Fracture Website

    Clesham, JG; Galbraith, SR; Kearns, ME. O’ Sullivan (Irish Medical Journal, 2018-04)
    Following musculoskeletal injury patient education is essential to help patients understand their treatment. Many attend the orthopaedic fracture clinic with multiple questions related to their diagnosis and treatment.
  • Association between anxiety and depression symptoms with resistant hypertension and central hemodynamics: A pilot study.

    Mermerelis, A; Kyvelou, S-M; Vellinga, A; Papageorgiou, C; Stefanadis, C; Douzenis, A (Elsevier, 2016)
    The hypothesis that symptoms of anxiety and depression contribute to the development of hypertension has been controversial. Rutledge and Hogan found that the risk of developing hypertension is approximately 8% higher among people with psychological distress compared to those with minimal distress. People suffering from either severe depression or anxiety were two to three times more likely to develop hypertension. The aim of the present pilot study was to compare the prevalence of anxiety and depression in patients with resistant HTN (rHTN) who underwent renal denervation (RDN) versus medical management alone. An additional aim was to assess possible associations with central hemodynamics using the cardio-ankle vascular index (CAVI). The study included 34 patients who lacked a comorbid mental health disorder, had rHTN and were a mean age of 58.3 ± 11.2 years. Twenty-four hour ambulatory blood pressure monitoring (24 hABPM) was conducted in all patients, and they were divided into the following groups: group I (n = 20) underwent RDN and group II (n = 14) was treated with medical management alone. The mean office SBP and DBP measurements for group I were 163 mmHg and 92 mmHg, respectively; for group II, they were 159 mmHg and 91 mmHg, respectively. There was no significant difference in the duration of hypertension (10.1 vs 9.4 years, p = NS) or in the familial burden. Finally, there was no difference in the number of antihypertensive medications in the two groups (5.1 vs 5.5, p = NS). The evaluation of anxiety disorder was performed with the Hospital Anxiety Depression Scale (HADS)3,4. The Beck Depression Inventory (BDΙ) was used to evaluate depression5. Both scales consist of a simple, yet reliable, self-assessment screening questionnaire. For the HADS scale, a score of ≥11 is thought to indicate a significant case of psychological morbidity. The BDI is a 21-item self-report depression inventory that measures depressive symptoms. For each item, the score ranges from 1 to 4. The total score is obtained by summing the scores on each of the 21 questions. CAVI was measured with a Vasera VS-1500 (Fukuda Denshi, Tokyo, Japan) vascular screening device. Descriptive and univariate comparisons were made using SPSS (version 20.0). Due to the low number of subjects in each group, only non-parametric tests were used (Spearman for correlations, Mann-Whitney U-test for comparison of groups and Chi square for categorized comparisons). A p-value of 0.05 was set as the cut-off for significance. The HADS and BDI scores were highly correlated in the entire group [correlation coefficient (CC) = 0.787, p = 0.0001] as well as separately in each of the two groups [group I (CC) = 0.825, p = 0.0001 and group II (CC) = 0.779, p = 0.0001, respectively]. When comparing HADS and BDI scores between the two groups, no significant difference was identified. Comparing CAVI results, CAVIR, but not CAVIL, was significantly higher in group I (p = 0.02). In group II, there seems to be a negative correlation between the CAVIR, CAVIL and HADS scores [CAVIR-HADS CC = -0.597, p = 0.024; CAVIL-HADS CC = -0.668, p = 0.009] This small pilot study showed that there is a significant correlation between the two scores in the total population; however, patients treated with RDN are not different from those with medical management alone. A negative association was also noted between the anxiety scoring scale and CAVIR and CAVIL in patients treated with medical management alone. A previous study documented a lack of difference in the prevalence of panic, anxiety and depression between patients with rHTN and non-resistant controls. In agreement with our study, the prevalence of anxiety and depression was high in the two groups of patients with rHTN; however, the RDN made no difference in the total impact of the two modalities, which is in contrast with previous results. To the best of our knowledge, this report describes the first attempt to associate the arterial stiffness using the CAVI with anxiety and depression in this population. In a previous study, there was an association between an increased arterial stiffness, autonomic disbalance and depression in a young hypertensive population. The present study is a small pilot study that highlights the higher prevalence of depression and anxiety in patients with resistant hypertension, as well as a negative association with central hemodynamics. However, because the sample is small, acquisition of a larger sample size with the continuation of this study might reveal stronger correlations in the future.
  • Rapamycin regulates autophagy and cell adhesion in induced pluripotent stem cells.

    Sotthibundhu, Areechun; McDonagh, Katya; von Kriegsheim, Alexander; Garcia-Munoz, Amaya; Klawiter, Agnieszka; Thompson, Kerry; Chauhan, Kapil Dev; Krawczyk, Janusz; McInerney, Veronica; Dockery, Peter; Devine, Michael J; Kunath, Tilo; Barry, Frank; O'Brien, Timothy; Shen, Sanbing (BioMed Central, 2016)
    Cellular reprogramming is a stressful process, which requires cells to engulf somatic features and produce and maintain stemness machineries. Autophagy is a process to degrade unwanted proteins and is required for the derivation of induced pluripotent stem cells (iPSCs). However, the role of autophagy during iPSC maintenance remains undefined.
  • Survivorship care for postmenopausal breast cancer patients in Ireland: What do women want?

    Meade, Elizabeth; McIlfatrick, Sonja; Groarke, Ann Marie; Butler, Eimear; Dowling, Maura (Elsevier, 2017-06)
    The aim of this study was to identify the concerns of postmenopausal breast cancer patients in Ireland and inform the development of a survivorship care plan.
  • Survey of Smartphone Use among Anaesthetists In Saolta University Health Care Group

    Kinirons, Alhomary, B. (Irish Medical Journal, 2018-03)
    Recent centuries have witnessed a revolution in technology which has made significant contributions to improve the quality of many aspects of our lives, including healthcare systems. Among these rapidly advancing technologies, smartphones stand out as an example of valuable devices that have dramatically changed the healthcare domain and the clinical practice. There is substantial evidence of the role of smartphones and medical applications in the daily practice of healthcare professionals. In one market research, it was estimated that 72% of US physicians use smartphones, and this number was expected to rise to 81% by 20121. This increasing popularity of smartphones can be attributed to the numerous benefits associated with their use. For instance, they can provide immediate access to a wealth of medical and health information via internet, emails and instant messages. Furthermore, they can lead to improved communications between healthcare professionals, and hence improved patient care2. An essential feature of smartphones is the integrated software applications (apps). These apps can either be preinstalled on the device or can be web apps that are accessed and downloaded via the internet. It is estimated that over 300,000 apps were developed between 2007 and 20103, and developers categorise a subset of these applications as medical apps. The utilisation of these medical apps by health care personnel, including anaesthetists has evolved recently.
  • Strength in Numbers: an international consensus conference to develop a novel approach to care delivery for young adults with type 1 diabetes, the D1 Now Study

    O’Hara, M. C.; Hynes, L.; O’Donnell, M.; Keighron, C.; Allen, G.; Caulfield, A.; Duffy, C.; Long, M.; Mallon, M.; Mullins, M.; Tonra, G.; Byrne, M.; Dinneen, S. F.; School of Medicine, National University of Ireland, Galway. Health and Wellbeing Division, Health Service Executive, Merlin Park University Hospital, Galway. (BioMed Central, 2017-12-04)
    Abstract: Background A 3-day international consensus meeting was hosted by the D1 Now study team in Galway on June 22–24, 2016 called “Strength In Numbers: Teaming up to improve the health of young adults with type 1 diabetes”. The aim of the meeting was to bring together young adults with type 1 diabetes, healthcare providers, policy makers and researchers to reach a consensus on strategies to improve engagement, selfmanagement and ultimately outcomes for young adults living with type 1 diabetes. Methods This diverse stakeholder group participated in the meeting to reach consensus on (i) a core outcome set (COS) to be used in future intervention studies involving young adults with type 1 diabetes, (ii) new strategies for delivering health services to young adults and (iii) potential digital health solutions that could be incorporated into a future intervention. Results A COS of 8 outcomes and 3 key intervention components that aim to improve engagement between young adults with type 1 diabetes and service providers were identified. A digital health solution that could potentially compliment the intervention components was proposed. Conclusion The outputs from the 3-day consensus conference, that held patient and public involvement at its core, will help the research team further develop and test the D1 Now intervention for young adults with type 1 diabetes in a pilot and feasibility study and ultimately in a definitive trial. The conference represents a good example of knowledge exchange among different stakeholders for health research and service improvement.
  • Formation of a type 1 diabetes young adult patient and public involvement panel to develop a health behaviour change intervention: the D1 Now study

    O’Hara, Mary Clare; Cunningham, Áine; Keighron, Cameron; Allen, Gary; Caulfield, Antony; Duffy, Ciara; Long, Michelle; Mallon, Madeleine; Mullins, Monica; Tonra, Garret; Simkin, Sarah; Hynes, Lisa; O’Donnell, Máire; Byrne, Molly; Dinneen, Sean F (BioMed Central, 2017-10-23)
    Abstract: Background Research indicates that young adults (18–25 year olds) with type 1 diabetes (T1D) often disengage from health services and their general diabetes management. Involving young adults with T1D in co-designing research to develop a behaviour change intervention to improve engagement with health services could potentially improve overall self management and health. A local youth mental health organisation called Jigsaw, Galway developed a very successful model for involving users in service design and development. Based on this model, the aim was to form a Young Adult Panel (YAP) of 18–25 year olds with T1D and involve them in all aspects of a study to develop an intervention to improve health and wellbeing for young adults with T1D called D1 Now. Methods Recruitment of young adults was achieved through a multimedia campaign. A consultation event was organised, followed by interviews with interested young adults. A panel of 8 members was selected. Following initial training for YAP members in committee skills and an introduction to different research methods and terms, YAP members participated in different stages of the research process. They were represented on the research study steering group and attended research meetings. They developed research materials, reviewed and interpreted research findings and helped develop the online platform to enhance engagement between young adults and their diabetes healthcare providers. They contributed to an international consensus conference on health services delivery for young adults with T1D and wrote specific sections of a further grant application to test out the new intervention. Results As a direct result of the YAP, a meaningful dialogue has opened up between healthcare providers and young adults within the D1 Now research team. Their involvement has led to a better understanding of what needs to be achieved in order to improve health service delivery. They have been active members in co-designing a health behaviour change. intervention to improve engagement between young adults with T1D and healthcare providers which will be evaluated in future research. Conclusion Through the formation of the YAP, we have demonstrated that involving young adults with T1D in healthcare research is feasible and productive.

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