• Has the ThinPrep method of cervical screening maintained its improvement over conventional smears in terms of specimen adequacy?

      Treacy, A; Reynolds, J; Kay, E W; Leader, M; Grace, A; Department of Pathology, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland. anntreacy@mac.com (2009-04)
      Liquid-based cytology (LBC) has replaced conventional smear assessment in many centers over recent years. In our laboratory this transfer took place in 1999. At that time we performed a split sample study comparing the conventional method of cervical smear evaluation with the ThinPrep system. This split sample study identified a dramatic improvement in specimen adequacy with LBC. While 11% of conventional preparations were reported as unsatisfactory and almost 9% were reported as suboptimal, evaluation of the same cases using LBC saw this combined figure reduced to 2.3%. AIM: To evaluate whether this dramatic fall in unsatisfactory smears has been maintained with the use of LBC. The database for all smears reported for 2005 (100% LBC) was interrogated. The number of unsatisfactory reports was calculated. The reason for an unsatisfactory report was recorded for each case. The overall unsatisfactory rate was compared with that reported in the 1999 split sample study. A total of 41,312 smear tests were reported in 2005. 1,342 (3.25%) were reported as unsatisfactory. Our findings support the ongoing value of LBC in a routine cervical screening laboratory in terms of continuing to maintain a low rate of unsatisfactory smears.
    • The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

      Varley, J; Delanty, N; Normand, C; Fitzsimons, M; Epilepsy Research Department, Beaumont Hospital, Dublin, Ireland., trimvarleys@gmail.com (2012-02-01)
      Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.
    • The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

      Varley, J; Delanty, N; Normand, C; Fitzsimons, M; Epilepsy Research Department, Beaumont Hospital, Dublin, Ireland. trimvarleys@gmail.com (2011-02)
      Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.
    • Healthcare-associated infection in Irish long-term care facilities: results from the First National Prevalence Study.

      Cotter, M; Donlon, S; Roche, F; Byrne, H; Fitzpatrick, F; Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland. mcotter@mater.ie (2012-03)
      Prevalence of healthcare-associated infection (HCAI) and antimicrobial use in Irish long-term care facilities (LTCFs) has never been studied.
    • HER-2 positive and p53 negative breast cancers are associated with poor prognosis.

      Al-azawi, Dhafir; Leong, Sum; Wong, Limy; Kay, Elaine; Hill, Arnold D K; Young, Leonie; Department of Surgery, Beaumont Hospital, Dublin, Ireland. dalazawi@rcsi.ie (2011-06)
      p53 and HER-2 coexpression in breast cancer has been controversial. These markers were tested using immunohistochemistry and HercepTest. HER-2 expression is related to reduced breast cancer survival (p = .02) . p53 expression relates to HER-2 expression (p = .029). Coexpression between p53 and HER-2 has no relation to prognosis. On univariate and multivariate analysis, combination of HER-2 positive and p53 negative expression was associated with a poor prognosis (p = .018 and p = .027, respectively), while the combination of HER-2 negative and p53 positive expression was associated with a favorable prognosis (p = .022 and p = .010, respectively). Therefore the expression of these markers should be considered collectively.
    • HER-2 positive and p53 negative breast cancers are associated with poor prognosis.

      Al-azawi, Dhafir; Leong, Sum; Wong, Limy; Kay, Elaine; Hill, Arnold D K; Young, Leonie; Department of Surgery, Beaumont Hospital, Dublin, Ireland. dalazawi@rcsi.ie (2012-02-01)
      p53 and HER-2 coexpression in breast cancer has been controversial. These markers were tested using immunohistochemistry and HercepTest. HER-2 expression is related to reduced breast cancer survival (p = .02) . p53 expression relates to HER-2 expression (p = .029). Coexpression between p53 and HER-2 has no relation to prognosis. On univariate and multivariate analysis, combination of HER-2 positive and p53 negative expression was associated with a poor prognosis (p = .018 and p = .027, respectively), while the combination of HER-2 negative and p53 positive expression was associated with a favorable prognosis (p = .022 and p = .010, respectively). Therefore the expression of these markers should be considered collectively.
    • HER2 testing in the UK: recommendations for breast and gastric in-situ hybridisation methods

      Bartlett, J. M. S.; Starczynski, J.; Atkey, N.; Kay, E.; O'Grady, A.; Gandy, M.; Ibrahim, M.; Jasani, B.; Ellis, I. O.; Pinder, S. E.; et al. (2011)
      These guidelines supplement existing guidelines on HER2 testing by immunohistochemistry and in-situ hybridisation(ISH) methods in the UK. They provide a specific focus on aspects of guidance relevant to HER2 ISH testing methods, both fluorescent and chromogenic. They are formulated to give advice on methodology, interpretation and quality control for ISH-based testing of HER2 status in common tumour types, including both breast and gastric tumours. The aim is to ensure that all ISH-based testing is accurate, reliable and timely.
    • Hereditary cerebral haemorrhage with amyloidosis

      Chalissery, A J; O'Rourke, D; Cryan, J; Rawluk, D; Brett, F; Farrell, M; Moroney, J T (2010-09)
    • Hidden extras: the projected impact of colorectal cancer screening and the burden of procedures on screening centers.

      Dunne, Cara; Harewood, Gavin C; Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland. (2011-08)
    • High concentrations of pepsin in bronchoalveolar lavage fluid from children with cystic fibrosis are associated with high interleukin-8 concentrations.

      McNally, P; Ervine, E; Shields, M D; Dimitrov, B D; El Nazir, B; Taggart, C C; Greene, C M; McElvaney, N G; Greally, P; Respiratory Research Division, Royal College of Surgeons in Ireland, Beaumont, Hospital, Dublin, Ireland. paul.mcnally@olchc.ie (2012-02-01)
      BACKGROUND: Gastro-oesophageal reflux is common in children with cystic fibrosis (CF) and is thought to be associated with pulmonary aspiration of gastric contents. The measurement of pepsin in bronchoalveolar lavage (BAL) fluid has recently been suggested to be a reliable indicator of aspiration. The prevalence of pulmonary aspiration in a group of children with CF was assessed and its association with lung inflammation investigated. METHODS: This was a cross-sectional case-control study. BAL fluid was collected from individuals with CF (n=31) and healthy controls (n=7). Interleukin-8 (IL-8), pepsin, neutrophil numbers and neutrophil elastase activity levels were measured in all samples. Clinical, microbiological and lung function data were collected from medical notes. RESULTS: The pepsin concentration in BAL fluid was higher in the CF group than in controls (mean (SD) 24.4 (27.4) ng/ml vs 4.3 (4.0) ng/ml, p=0.03). Those with CF who had raised pepsin concentrations had higher levels of IL-8 in the BAL fluid than those with a concentration comparable to controls (3.7 (2.7) ng/ml vs 1.4 (0.9) ng/ml, p=0.004). Within the CF group there was a moderate positive correlation between pepsin concentration and IL-8 in BAL fluid (r=0.48, p=0.04). There was no association between BAL fluid pepsin concentrations and age, sex, body mass index z score, forced expiratory volume in 1 s or Pseudomonas aeruginosa colonisation status. CONCLUSIONS: Many children with CF have increased levels of pepsin in the BAL fluid compared with normal controls. Increased pepsin levels were associated with higher IL-8 concentrations in BAL fluid. These data suggest that aspiration of gastric contents occurs in a subset of patients with CF and is associated with more pronounced lung inflammation.
    • High concentrations of pepsin in bronchoalveolar lavage fluid from children with cystic fibrosis are associated with high interleukin-8 concentrations.

      McNally, P; Ervine, E; Shields, M D; Dimitrov, B D; El Nazir, B; Taggart, C C; Greene, C M; McElvaney, N G; Greally, P; Respiratory Research Division, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland. paul.mcnally@olchc.ie (2011-02)
      Gastro-oesophageal reflux is common in children with cystic fibrosis (CF) and is thought to be associated with pulmonary aspiration of gastric contents. The measurement of pepsin in bronchoalveolar lavage (BAL) fluid has recently been suggested to be a reliable indicator of aspiration. The prevalence of pulmonary aspiration in a group of children with CF was assessed and its association with lung inflammation investigated.
    • High fetal plasma adenosine concentration: a role for the fetus in preeclampsia?

      Espinoza, Jimmy; Espinoza, Andres F; Power, Gordon G; Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan and Oakland University, Rochester, MI, USA. jimmy.espinoza@beaumont (2012-02-01)
      OBJECTIVE: Clinical observations suggest a role for the fetus in the maternal manifestations of preeclampsia, but the possible signaling mechanisms remain unclear. This study compares the fetal plasma concentrations of adenosine from normal pregnancies with those from preeclampsia. STUDY DESIGN: This secondary data analysis included normal pregnancies (n = 27) and patients with preeclampsia (n = 39). Patients with preeclampsia were subclassified into patients with (n = 25) and without (n = 14) abnormal uterine artery Doppler velocimetry (UADV). RESULTS: Fetal plasma concentrations of adenosine were significantly higher in patients with preeclampsia (1.35 +/- 0.09 mumol/L) than in normal pregnancies (0.52 +/- 0.06 mumol/L; P < .0001). Fetal plasma concentrations of adenosine in patients with preeclampsia with abnormal UADV (1.78 +/- 0.15 mumol/L), but not with normal UADV (0.58 +/- 0.14 mumol/L), were significantly higher than in normal pregnancies (P < .0001). CONCLUSION: Patients with preeclampsia with sonographic evidence of chronic uteroplacental ischemia have high fetal plasma concentrations of adenosine.
    • High incidence of osteoporosis and fractures in an aging post-polio population.

      Mohammad, Ausaf F; Khan, Khalid Ali; Galvin, Leo; Hardiman, Orla; O'Connell, Paul G; Department of Rheumatology, Beaumont Hospital, Dublin, Ireland. ausafmohammad@gmail.com (2009)
      Since the polio epidemic in Ireland in the 1950s, most polio survivors are approaching into the 6th and 7th decade of their lives. There is little data about bone density and risk of fractures in these patients. In 2006, we undertook an audit of post-polio patients attending rheumatology and neurology outpatient clinics in a university teaching hospital. Our aim was to determine the prevalence of osteoporosis (OP), falls and fractures and to evaluate the association of bone density with other potential contributing factors to OP.
    • Higher tacrolimus trough levels on days 2-5 post-renal transplant are associated with reduced rates of acute rejection.

      O'Seaghdha, C M; McQuillan, R; Moran, A M; Lavin, P; Dorman, A; O'Kelly, P; Mohan, D M; Little, P; Hickey, D P; Conlon, P J; et al. (2011-04-06)
      We analyzed the association between whole-blood trough tacrolimus (TAC) levels in the first days post-kidney transplant and acute cellular rejection (ACR) rates. Four hundred and sixty-four consecutive, deceased-donor kidney transplant recipients were included. All were treated with a combination of TAC, mycophenolate mofetil and prednisolone. Patients were analyzed in four groups based on quartiles of the mean TAC on days 2 and 5 post-transplant: Group 1: median TAC 11 ng/mL (n = 122, range 2-13.5 ng/mL), Group 2: median 17 ng/mL (n = 123, range 14-20 ng/mL), Group 3: median 24 ng/mL (n = 108, range 20.5-27 ng/mL) and Group 4: median 33.5 ng/mL (n = 116, range 27.5-77.5 ng/mL). A graded reduction in the rates of ACR was observed for each incremental days 2-5 TAC. The one-yr ACR rate was 24.03% (95% CI 17.26-32.88), 22.20% (95% CI 15.78-30.70), 13.41% (95% CI 8.15-21.63) and 8.69% (95% CI 4.77-15.55) for Groups 1-4, respectively (p = 0.003). This study suggests that higher early TACs are associated with reduced rates of ACR at one yr.
    • HLA testing for coeliac disease in Ireland?

      Kutty, J; Hussey, S; Broderick, AM; Quinn, S; Bourke, B (Irish Medical Journal, 2015-05)
      Recent studies have shown a worldwide prevalence of coeliac disease (CD) of around 1% and one of the highest prevalence rates (1 in 300) has been found in the West of Ireland. 1,2 The incidence of coeliac disease appears to be increasing. For example, a greater than 6-fold increase over a 20 year period was evident in a recent retrospective Scottish study. 3 Children with selective IgA deficiency, Down syndrome, Type I diabetes mellitus and autoimmune diseases are at increased risk of CD. Those with a family history are particularly vulnerable with as many as 1 in 10 first-degree, and 1 in 40 second-degree relatives affected. 1 The presenting features of coeliac disease are heterogeneous. The most commonly described symptoms include diarrhoea, excessive flatulence, weight loss, failure to thrive, abdominal distension, pain, bloating, vomiting and anorexia. Irritability is a particularly consistent finding in symptomatic coeliac disease in childhood and CD can also present with many other systemic symptoms such as iron deficiency, anaemia, fatigue, short stature, abnormal liver enzyme tests, osteopenia and dermatitis herpetiformis. However, it must also be remembered that the vast majority of affected individuals manifest few or no symptoms at all
    • HLA-A*3101 and carbamazepine-induced hypersensitivity reactions in Europeans.

      McCormack, Mark; Alfirevic, Ana; Bourgeois, Stephane; Farrell, John J; Kasperavičiūtė, Dalia; Carrington, Mary; Sills, Graeme J; Marson, Tony; Jia, Xiaoming; de Bakker, Paul I W; et al. (2011-03-24)
      Carbamazepine causes various forms of hypersensitivity reactions, ranging from maculopapular exanthema to severe blistering reactions. The HLA-B*1502 allele has been shown to be strongly correlated with carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS-TEN) in the Han Chinese and other Asian populations but not in European populations.
    • Hodgkin lymphoma in a patient with chronic lymphocytic leukaemia a rare presentation of Richter's transformation

      De La Harpe, P; Egan, C; Leader, M; Murphy, PT; Quinn, J (Irish Medical Journal, 2015-04)
      Richter's transformation of chronic lymphocytic leukaemia (CLL) to high-grade B-cell Non-Hodgkin lymphoma occurs in < 5% of CLL cases. Transformation of CLL to Hodgkin Lymphoma is a much rarer event and here we describe a patient who developed Richterâ s transformation into a Hodgkin Lymphoma presenting as rapidly progressive hepatosplenomegaly
    • Home enteral feeding

      Corrigan, Grainne (Nursing in General Practice, 2015-09)
      Enteral nutrition is a well-established therapy for patients with a functioning gastrointestinal tract who require nutrition support due to inadequate or unsafe oral intake to treat or prevent malnutrition.1 Common indications for patients going home on enteral feeding include dysphagia due to neurological conditions, cancer, gastrointestinal obstruction or surgery and those with higher nutritional requirements (eg Cystic Fibrosis). Home Enteral Nutrition (HEN) provides patients with adequate and safe nutrition while allowing them to return to a familiar environment and for some, a degree of independence.2 HEN may be the sole source of nutrition for some patients, or be supplemental to diet for others. It may be given continuously via a pump or by boluses via a syringe, or a combination of both, during the day or overnight. Various enteral feeding tubes are available and are typically classified by site of insertion and location of the distal tip of the feeding tube. (See Table 1) The organisation of HEN usually occurs in the hospital setting and involves the dietitian, medical team, social worker, nursing staff and liaison with community personnel such as the Director of Public Health Nursing (DPHN), the public health nurse (PHN), the general practice and the community dietitian.
    • Home enteral nutrition recipients: patient perspectives on training, complications and satisfaction

      Boland, Karen; Maher, Niamh; O'Hanlon, Carmel; O'Sullivan, Maria; Rice, Niamh; Smyth, Martina; Reynolds, John V (BMJ, 2016-10)
      The equitable provision of home enteral nutrition (HEN) in the community can have a transformative effect on patient experience and family life for adults and children alike. While optimising quality of life in HEN patients can be challenging, the initiation of HEN positively impacts this measure of healthcare provision.1 Quality of life scores have been shown to improve in the weeks after hospital discharge, and HEN is physically well tolerated. However, it may be associated with psychological distress, and sometimes reluctance among HEN patients to leave their homes.2 Globally, HEN can attenuate cumulative projected patient care costs through a reduction in hospital admission and complications including hospital acquired infections.3 In an era where the cost of disease related malnutrition and associated prolonged hospital stay is being tackled in our healthcare systems, the role of HEN is set to expand. This is a treatment which has clear clinical and social benefits, and may restore some independence to patients and their families. Rather than the indications for HEN being focused on specific diagnoses, the provision of months of quality life at home for patients is adequate justification for its prescription.4 Previously, a review of HEN service provision in 39 cases demonstrated that patients want structured follow-up after hospital discharge, and in particular, would like one point of contact for HEN education and discharge.5 Management structures, funding challenges and the need for further education, particularly within the primary care setting may limit optimal use of HEN. The Irish Society for Clinical Nutrition and Metabolism (IrSPEN) aims to develop a national guideline document, drawing on international best practice, forming a template and standards for local policy development in the area of HEN service provision, training and follow-up. The first step in guideline development was to investigate patient experience for adults and children alike. Care needs and supports may differ in these distinct populations. The unmet needs of carers of older adults on HEN have been documented,6 although multidisciplinary interventions and evolution of standards for successful discharge will benefit all affected patients and their families. The aim of this study, therefore, was to survey domiciliary HEN clients, to document and analyse user experience, attitudes and complications associated with HEN.
    • Home haemodialysis in Ireland.

      Connaughton, D M; Jamal, A; McWilliams, J; O'Kelly, P; Ormond, J; Butler, A; McEntee, N; Tierney, E; Lambe, G; Denton, M; et al. (2013-03)
      A home haemodialysis programme (HHD) was established in Ireland in 2009 following studies suggesting better outcomes and a survival advantage when compared to conventional in-centre dialysis.