Recent Submissions

  • 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.
  • 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.
  • 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.
  • 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.
  • Antimicrobial-resistant faecal organisms in algae products marketed as health supplements

    Ryan; Molloy, M; Evans, L; Quinn, A; Burke, E; McGrath, E; Cormican, M (2017-09)
    Dietary supplements are increasingly popular in Irish society. One of these is blue-green algae which is used with a variety health benefits in mind. A batch of Chlorella powder was found to be contaminated with Salmonella species in Ireland in 2015. This prompted additional testing of a total of 8 samples of three different products (Chlorella, Spirulina and Super Greens), for other faecal flora and antimicrobial resistance in any bacteria isolated. All 8 samples cultured enteric flora such as Enterococci, Enterobacteriaceae and Clostridium species. Antimicrobial susceptibility testing revealed one isolate with extended-spectrum β-lactamase (ESBL) activity and one with carbapenemase activity. Clinicians caring for vulnerable patients should be aware of the potential risk of exposure to antimicrobial resistant bacteria associated with these products
  • Opportunity Costs in Paediatric Training: The Specialist Registrars Experience.

    O’Neill, MB; Nabialek, T; Kandamany, N (Irish Medical Journal, 2017-08)
    In the training process, there is a tension between the work life and home life of trainees. This study explored both the personal impact and the opportunity costs of training from the Specialist Paediatric Registrar (SPR) perspective. The survey explored 1) career progression2) perceived functional effectiveness at work 3) psychological impact of hospital based training and 4) the personal and social cost of training. Fifty-three (71%) SPRs responded of whom 47 (89%)were married or in long term relationships. Seventy-five percent of trainees had a definite career plan with 86% intending to undertake fellowship training. Seventy percent believed they were efficient time managers but 53% had difficulty in making time for academic pursuits and fifty percent experienced negative feelings, which lingered after work and interfered with their relationships at home. Seventy-four percent stated training was undertaken at significant personal cost with only 21% achieving a very satisfactory work/life balance. To address these difficulties trainee wellbeing should be addressed at the Basic Specialist Training (BST) level and the career path clearly explained outlining the challenges that are likely to be encountered.
  • Food Allergy Emergencies in Children – To what extent are Early Years Services Prepared? A cross-sectional survey

    MacGiobuin, S; Stitt, V; Philbin, D; Higgins, B; McGuire, G; Marie O’Regan, A; Kelly, M (Irish Medical Journal, 2017-08)
    Food allergies are common in preschool children. This study’s aims are to establish prevalence, to clarify management practices, levels of preparedness and the perceived role of General Practitioners amongst Early Years Services providers. This study is an anonymous, quantitative, cross sectional study. An online questionnaire was distributed to 282 Early Years Service providers. Data were analysed using SPSS. Response rate was 35% (n=98). Prevalence of food allergy was 3% (n=119). Allergic reactions to food had occurred on site in 16% (n=15). Written emergency action plans were available in 47% of facilities (n=46). Medications were not kept on site in 63% (n=62) of facilities. General practitioners were felt to have an important role in the management of food allergies by 76% of respondents (n=61). This study identifies significant areas for improvement in the management of food allergic child in Early Years Services
  • The Selfie Wrist – Selfie induced trauma

    Lyons, RF; Kelly, JC; Murphy, CG (Irish Medical Journal, 2017-06)
    The selfie phenomenon has exploded worldwide over the past two years. Selfies have been linked to a large number of mortalities and significant morbidity worldwide. However, trauma associated with selfies including fractures, is rarely publicised. Here we present a case series of upper extremity trauma secondary to selfies across all age groups during the summer period. Four cases of distal radius and ulna trauma in all age groups were reported. This case series highlights the dangers associated with taking selfies and the trauma that can result.
  • A Survey of Clinical Uncertainty from the Paediatric Basic Specialist Trainee Perspective

    O’Neill, MB; Sarani, ZA; Nicholson, AJ; Elbadry, M; Deasy, AM (Irish Medical Journal, 2017-06)
    This study was undertaken to evaluate uncertainty from the Basic Specialist Trainee perspective. The survey of trainees explored 1) factors in decision making, 2) the personal impact of uncertainty, 3) the responses to both clinical errors and challenges to their decision making and 4) the potential strategies to address uncertainty. Forty-one (93%) of trainees surveyed responded. Important factors in decision making were clinical knowledge and senior colleague’s opinion. Sixty percent experienced significant anxiety post call as a consequence of their uncertainty. When errors are made by colleagues, the trainee’s response is acceptance (52.5%), and sympathy (32%).Trainees are strongly influenced by the opinions of senior colleagues often changing their opinions having made confident decisions. Solutions to address uncertainty include enhanced knowledge translation, and to a lesser extent, enhanced personal awareness and resilience awareness. To enhance the training experience for BST and lessen the uncertainty experienced these strategies need to be enacted within the training milieu.
  • I Still Haven’t Found What I’m Looking For….. Bono, Google and Glaucoma Awareness

    Lyons, C; Ellard, R; McElnea, E; Townley, D (Irish Medical Journal, 2017-05)
    The effect of celebrity diagnosis on public awareness of health conditions has already been well documented. In October 2014, Bono, the lead singer with U2, revealed publicly for the first time that he has glaucoma. This study aimed to analyze the impact of Bono’s announcement on public awareness of glaucoma using Google Search trends as an indicator of public interest in the disease. Google Trends was used to examine Google Search activity for the term ‘Glaucoma’ between 2009 and 2015 in both Ireland and the United Kingdom. Trend analyses were performed using Microsoft Excel Version 14.3.5. Increased Google Search activity for ‘Glaucoma’ in October 2014 was found in both Ireland and the United Kingdom. A five-fold increase from the mean Google Search activity for this term was found in Ireland and a two-fold increase from the mean Google Search activity for this term was found in the United Kingdom. No such increase in Google Search activity occurred during each country’s 2014 Glaucoma Awareness week. Google Trends is useful in medical research as a means of assessing public awareness of, and/or interest in, health related topics. Current approaches to glaucoma related health promotion in both Ireland and the United Kingdom have failed to yield an increase in on-line Google Search activity. While there was an increase in interest in glaucoma it is unclear whether this led to an increase in health seeking behaviour.
  • See and Treat Model of Care Department of Plastic and Reconstructive Surgery In Roscommon Hospital

    Department of Plastic and Reconstructive Surgery In Roscommon Hospital (2015-10)
  • Evaluation of the self care to wellness programme (SCWP)

    Evans, David S; McSharry, Kathy; Lynott, Jackie; Department of Public Health Health Service Executive West, Health Service Executive CHO2, Centre for Independent Living Mayo (2017-03)
    The HSE is committed to supporting people to self-manage long term health conditions. The Self Care to Wellness Programme (SCWP) is a community based self-management training programme for those with long term health conditions which commenced in county Mayo in January 2015. It is a joint partnership between the HSE, Mayo Centre of Independent Living (CIL), Disability Federation of Ireland (DFI) and the Multiple Sclerosis Society (MS). The six week Programme follows the Stanford Model for Chronic Disease Self Management (Lorig et al. 1999). The aim of the study was to obtain feedback from Programme participants in terms of its impact on managing their condition. All those that attended the programme between January and December 2015 were invited to complete a questionnaire at the beginning and six months after completing the Programme. The study utilised a number of validated measures, in addition to open ended questions to allow respondents to elaborate on their responses.

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