• Quality measures in breast cancer surgery

      Barry, M; Hill, ADK (Irish Medical Journal (IMJ), 2012-07)
      Abstract
    • Quality of colonoscopy performance among gastroenterology and surgical trainees: a need for common training standards for all trainees?

      Leyden, J E; Doherty, G A; Hanley, A; McNamara, D A; Shields, C; Leader, M; Murray, F E; Patchett, S E; Harewood, G C; GI Unit, Mater Misericordiae University Hospital, Dublin, Ireland. jleyden@mater.ie (2011-11)
      Cecal intubation and polyp detection rates are objective measures of colonoscopy performance. Minimum cecal intubation rates greater than 90% have been endorsed by the American Society for Gastrointestinal Endoscopy (ASGE) and the Joint Advisory Group (JAG) UK. Performance data for medical and surgical trainee endoscopists are limited, and we used endoscopy quality parameters to compare these two groups.
    • Quality of end-of-life care for dementia patients during acute hospital admission: a retrospective study in Ireland.

      Afzal, Neelam; Buhagiar, Kurt; Flood, Joanne; Cosgrave, Mary; Department of Psychiatry, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. (2011-04-05)
      To examine the quality of end-of-life care received by patients with and without dementia on acute medical wards during their final hospitalization.
    • The quality of information on three common ENT procedures on the Internet.

      Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Beaumont , Road, Dublin 9, Ireland, kjeyanthi@gmail.com. (2012-02-01)
      BACKGROUND: The Internet hosts a large number of high-quality medical resources and poses seemingly endless opportunities to inform, teach, and connect professionals and patients alike. However, it is difficult for the lay person to distinguish accurate from inaccurate information. AIM: This study was undertaken in an attempt to assess the quality of information on otolaryngology available on the Internet. METHODS: Sixty appropriate websites, using search engines Yahoo and Google, were evaluated for completeness and accuracy using three commonly performed ENT operations: tonsillectomy (T), septoplasty (S), and myringoplasty (M). RESULTS: A total of 60 websites were evaluated (NT = 20, NM = 20, NS = 20). A total of 86.7% targeted lay population and 13.3% targeted the medical professionals. 35% of the sites included all critical information that patients should know prior to undergoing surgery and over 94% of these were found to contain no inaccuracies. Negative bias towards medical profession was detected in 3% of websites. CONCLUSIONS: In the current climate, with informed consent being of profound importance, the Internet represents a useful tool for both patients and surgeons.
    • Quantification and evaluation of the role of antielastin autoantibodies in the emphysematous lung.

      Low, Teck Boon; Greene, Catherine M; O'Neill, Shane J; McElvaney, Noel G; Respiratory Research Division, Department of Medicine, Royal College of Surgeons , in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland. (2012-02-01)
      Chronic obstructive pulmonary disease (COPD) may be an autoimmune disease. Smoking causes an imbalance of proteases and antiproteases in the lung resulting in the generation of elastin peptides that can potentially act as autoantigens. Similar to COPD, Z alpha-1 antitrypsin deficiency (Z-A1ATD) and cystic fibrosis (CF) are associated with impaired pulmonary antiprotease defences leading to unopposed protease activity. Here, we show that there is a trend towards higher bronchoalveolar lavage fluid (BALF) antielastin antibody levels in COPD and Z-A1ATD and significantly lower levels in CF compared to control BALF; the lower levels in CF are due to the degradation of these antibodies by neutrophil elastase. We also provide evidence that these autoantibodies have the potential to induce T cell proliferation in the emphysematous lung. This study highlights that antielastin antibodies are tissue specific, can be detected at elevated levels in COPD and Z-A1ATD BALF despite their being no differences in their levels in plasma compared to controls, and suggests a therapeutic role for agents targeting these autoantibodies in the lungs.
    • A quantitative assessment of changing trends in internet usage for cancer information.

      McHugh, Seamus M; Corrigan, Mark; Morney, Nora; Sheikh, Athar; Lehane, Elaine; Hill, Arnold D K; Department of Surgery, Royal College of Surgeons in Ireland, and Beaumont Hospital, Dublin 2, Ireland. seamusmchugh@rcsi.ie (2011-02)
      The internet is an important source of healthcare information. To date, assessment of its use as a source of oncologic information has been restricted to retrospective surveys.
    • A quantitative assessment of changing trends in internet usage for cancer information.

      McHugh, Seamus M; Corrigan, Mark; Morney, Nora; Sheikh, Athar; Lehane, Elaine; Hill, Arnold D K; Department of Surgery, Royal College of Surgeons in Ireland, and Beaumont, Hospital, Dublin 2, Ireland. seamusmchugh@rcsi.ie (2012-02-01)
      BACKGROUND: The internet is an important source of healthcare information. To date, assessment of its use as a source of oncologic information has been restricted to retrospective surveys. METHODS: The cancer-related searches of approximately 361,916,185 people in the United States and the United Kingdom were examined. Data were collected from two separate 100-day periods in 2008 and 2010. RESULTS: In 2008, there were 97,531 searches. The majority of searches related to basic cancer information (18,700, 19%), followed by treatment (8404, 9%) and diagnosis (6460, 7%). This compares with 179,025 searches in 2010 representing an increase of 183%. In 2008 breast cancer accounted for 21,102 (21%) individual searches, increasing to 85,825 searches in 2010. In 2010 a total of 0.2% (321) of searches focused on litigation, with those searching for breast cancer information most likely to research this topic (P=0.000). CONCLUSION: Use of the internet as a source of oncological information is increasing rapidly. These searches represent the most sensitive information relating to cancer, including prognosis and litigation. It is imperative now that efforts are made to ensure the reliability and comprehensiveness of this information.
    • Quantitative cell signalling analysis reveals down-regulation of MAPK pathway activation in colorectal cancer.

      Gulmann, Christian; Sheehan, Katherine M; Conroy, Ronán M; Wulfkuhle, Julia D; Espina, Virginia; Mullarkey, Michelle J; Kay, Elaine W; Liotta, Lance A; Petricoin, Emanuel F; Department of Pathology, Beaumont Hospital, Dublin, Ireland. christiangulmann@beaumont.ie (2009-08)
      Mitogen-activated protein kinases (MAPK) are considered to play significant roles in colonic carcinogenesis and kinase inhibitor therapy has been proposed as a potential tool in the treatment of this disease. Reverse-phase microarray assays using phospho-specific antibodies can directly measure levels of phosphorylated protein isoforms. In the current study, samples from 35 cases of untreated colorectal cancer colectomies were laser capture-microdissected to isolate epithelium and stroma from cancer as well as normal (i.e. uninvolved) mucosa. Lysates generated from these four tissue types were spotted onto reverse-phase protein microarrays and probed with a panel of antibodies to ERK, p-ERK, p38, p-p38, p-JNK, MEK and p-MEK. Whereas total protein levels were unchanged, or slightly elevated (p38, p = 0.0025) in cancers, activated isoforms, including p-ERK, p-p38 and p-JNK, were decreased two- to four-fold in cancers compared with uninvolved mucosa (p < 0.0023 in all cases except for p-JNK in epithelium, where decrement was non-significant). This was backed up by western blotting. Dukes' stage B and C cancers displayed lower p-ERK and p-p38 expression than Dukes' stage A cancers, although this was not statistically significant. It is concluded that MAPK activity may be down-regulated in colorectal cancer and that further exploration of inhibitory therapy in this system should be carefully evaluated if this finding is confirmed in larger series.
    • Qutenza Patch - Our early experience

      Weekes, G; O’Brien, J; Murphy, K; Keavney, J; Pollard, V (Irish Medical Journal, 2013-03)
      Qutenza is a high potency capsaicin topical patch which has been recommended for the treatment of peripheral neuropathic pain. The aim of this study was to assess our selected patients’ response to Qutenza application. All patients had their dynamic pain score recorded prior to application and were asked to fill in a standardised questionnaire for three months post application. Patients were also asked to document any changes to the character of their pain, changes in sleep, activities of daily living and mood as well as any changes to their medication usage. 21 patients had Qutenza applied in a 5 month period. 17 patients completed the questionnaire in a 5 month period. We found that the mean overall reduction in pain score at 3 months was 32.7%. 8 of our patients (47%) reported improved sleep, activities of daily living and mood. 6 patients (35%) reported a reduction in medication use, while 7 (41%) reported an improvement in the character of their pain
    • Radiation protection to the eye and thyroid during diagnostic cerebral angiography: a phantom study.

      Shortt, C P; Malone, L; Thornton, J; Brennan, P; Lee, M J; Department of Radiology, Beaumont Hospital, Dublin, Ireland. (2008-08)
      We measured radiation doses to the eye and thyroid during diagnostic cerebral angiography to assess the effectiveness of bismuth and lead shields at dose reduction. Phantom head angiographic studies were performed with bismuth (study 1) and lead shields (study 2). In study 1 (12 phantoms), thermoluminescent dosimeters (TLD) were placed over the eyes and thyroid in three groups: (i) no shields (four phantoms); (ii) anterior bismuth shields (four phantoms) and (iii) anterior and posterior bismuth shields (four phantoms). In a second study (eight phantoms), lead shields were placed over the thyroid only and TLD dose measurements obtained in two groups: (i) no shielding (four phantoms) and (ii) thyroid lead shielding (four phantoms). A standard 4-vessel cerebral angiogram was performed on each phantom. Study 1 (bismuth shields) showed higher doses to the eyes compared with thyroid (mean 13.03 vs 5.98 mSv, P < 0.001) and a higher eye dose on the X-ray tube side. Overall, the use of bismuth shielding did not significantly reduce dose to either eyes or thyroid in the measured TLD positions. In study 2, a significant thyroid dose reduction was found with the use of lead shields (47%, mean 2.46 vs 4.62 mSv, P < 0.001). Considerable doses to the eyes and thyroid highlight the need for increased awareness of patient protection. Eye shielding is impractical and interferes with diagnostic capability. Thyroid lead shielding yields significant protection to the thyroid, is not in the field of view and should be used routinely.
    • Radical cystectomy in the octogenarian population: a single centre experience

      Raheem, Omer A.; Kamel, Mohamed H.; Leung, Peter; Shields, William P.; Connolly, Stephen S.; Zimmerman, Antonio J.; Mohan, Ponnusammy; Hickey, David P. (2011)
    • Radiological abnormalities associated with Aspergillus colonization in a cystic fibrosis population.

      McMahon, Michelle A; Chotirmall, Sanjay Haresh; McCullagh, Brian; Branagan, Peter; McElvaney, N G; Logan, P M; Department of Radiology, Nottingham University Hospitals, Derby Road, Nottingham NG7 2UH, UK. mmcm75@yahoo.com (2012-03)
      To determine if sputum colonization with Aspergillus species in patients with cystic fibrosis (PWCF) correlates with radiological abnormalities and/or a reduction in pulmonary function (FEV1).
    • Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.

      Harewood, G C; Clancy, K; Engela, J; Abdulrahim, M; Lohan, K; O'Reilly, C; Department of Gastroenterology & Hepatology, Beaumont Hospital Dublin, Dublin, Ireland. Royal College of Surgeons of Ireland Medical School, Dublin, Ireland. (2011-05-17)
      Background  In behavioural economics, a 'nudge' describes configuration of a choice to encourage a certain action without taking away freedom of choice. Aim  To determine the impact of a 'nudge' strategy - prefilling either 3 mL or 5 mL syringes with midazolam - on endoscopic sedation practice. Methods  Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3 mL or 5 mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. Results  Overall, 120 patients received sedation for EGD [59 (5 mL), 61 (3 mL)] and 86 patients were sedated for colonoscopy [38 (5 mL), 48 (3 mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2 mg) vs. 3-mL group (3.3 mg), (P < 0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1 mg) vs. 3-mL group (3.3 mg), (P < 0.0001). There was no significant difference in mean meperidine dose (42.1 mg vs. 42.8 mg, P = 0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. Conclusions  These findings demonstrate that 'nudge' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of 'nudges' in impacting other aspects of endoscopic practice.
    • Randomised clinical trial: a 'nudge' strategy to modify endoscopic sedation practice.

      Harewood, G C; Clancy, K; Engela, J; Abdulrahim, M; Lohan, K; O'Reilly, C; Department of Gastroenterology & Hepatology, Beaumont Hospital Dublin, Dublin,, Ireland. harewood.gavin@gmail.com (2012-02-01)
      BACKGROUND: In behavioural economics, a 'nudge' describes configuration of a choice to encourage a certain action without taking away freedom of choice. AIM: To determine the impact of a 'nudge' strategy - prefilling either 3mL or 5mL syringes with midazolam - on endoscopic sedation practice. METHODS: Consecutive patients undergoing sedation for EGD or colonoscopy were enrolled. On alternate weeks, midazolam was prefilled in either 3mL or 5mL syringes. Preprocedure sedation was administered by the endoscopist to achieve moderate conscious sedation; dosages were at the discretion of the endoscopist. Meperidine was not prefilled. RESULTS: Overall, 120 patients received sedation for EGD [59 (5mL), 61 (3mL)] and 86 patients were sedated for colonoscopy [38 (5mL), 48 (3mL)]. For EGDs, average midazolam dose was significantly higher in the 5-mL group (5.2mg) vs. 3-mL group (3.3mg), (P<0.0001); for colonoscopies, average midazolam dose was also significantly higher in the 5-mL group (5.1mg) vs. 3-mL group (3.3mg), (P<0.0001). There was no significant difference in mean meperidine dose (42.1mg vs. 42.8mg, P=0.9) administered to both colonoscopy groups. No adverse sedation-related events occurred; no patient required reversal of sedation. CONCLUSIONS: These findings demonstrate that 'nudge' strategies may hold promise in modifying endoscopic sedation practice. Further research is required to explore the utility of 'nudges' in impacting other aspects of endoscopic practice.
    • Rapid effects of 17beta-estradiol on epithelial TRPV6 Ca2+ channel in human T84 colonic cells.

      Irnaten, Mustapha; Blanchard-Gutton, Nicolas; Harvey, Brian J; Molecular Medicine Laboratories, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland. mirnaten@rcsi.ie (2008-11)
      The control of calcium homeostasis is essential for cell survival and is of crucial importance for several physiological functions. The discovery of the epithelial calcium channel Transient Receptor Potential Vaniloid (TRPV6) in intestine has uncovered important Ca(2+) absorptive pathways involved in the regulation of whole body Ca(2+) homeostasis. The role of steroid hormone 17beta-estradiol (E(2)), in [Ca(2+)](i) regulation involving TRPV6 has been only limited at the protein expression levels in over-expressing heterologous systems. In the present study, using a combination of calcium-imaging, whole-cell patch-clamp techniques and siRNA technology to specifically knockdown TRPV6 protein expression, we were able to (i) show that TRPV6 is natively, rather than exogenously, expressed at mRNA and protein levels in human T84 colonic cells, (ii) characterize functional TRPV6 channels and (iii) demonstrate, for the first time, the rapid effects of E(2) in [Ca(2+)](i) regulation involving directly TRPV6 channels in T84 cells. Treatment with E(2) rapidly (<5 min) enhanced [Ca(2+)](i) and this increase was partially but significantly prevented when cells were pre-treated with ruthenium red and completely abolished in cells treated with siRNA specifically targeting TRPV6 protein expression. These results indicate that when cells are stimulated by E(2), Ca(2+) enters the cell through TRPV6 channels. TRPV6 channels in T84 cells contribute to the Ca(2+) entry/signalling pathway that is sensitive to 17beta-estradiol.
    • Rapid effects of 17beta-estradiol on TRPV5 epithelial Ca2+ channels in rat renal cells.

      Irnaten, Mustapha; Blanchard-Gutton, Nicolas; Praetorius, Jeppe; Harvey, Brian J; Molecular Medicine Laboratories, Royal College of Surgeons in Ireland, Beaumont Hospital, PO Box 9063, Dublin 9, Ireland. irnatenm@yahoo.fr (2009-08)
      The renal distal tubules and collecting ducts play a key role in the control of electrolyte and fluid homeostasis. The discovery of highly calcium selective channels, Transient Receptor Potential Vanilloid 5 (TRPV5) of the TRP superfamily, has clarified the nature of the calcium entry channels. It has been proposed that this channel mediates the critical Ca(2+) entry step in transcellular Ca(2+) re-absorption in the kidney. The regulation of transmembrane Ca(2+) flux through TRPV5 is of particular importance for whole body calcium homeostasis.In this study, we provide evidence that the TRPV5 channel is present in rat cortical collecting duct (RCCD(2)) cells at mRNA and protein levels. We demonstrate that 17beta-estradiol (E(2)) is involved in the regulation of Ca(2+) influx in these cells via the epithelial Ca(2+) channels TRPV5. By combining whole-cell patch-clamp and Ca(2+)-imaging techniques, we have characterized the electrophysiological properties of the TRPV5 channel and showed that treatment with 20-50nM E(2) rapidly (<5min) induced a transient increase in inward whole-cell currents and intracellular Ca(2+) via TRPV5 channels. This rise was significantly prevented when cells were pre-treated with ruthenium red and completely abolished in cells treated with siRNA specifically targeting TRPV5.These data demonstrate for the first time, a novel rapid modulation of endogenously expressed TRPV5 channels by E(2) in kidney cells. Furthermore, the results suggest calcitropic effects of E(2). The results are discussed in relation to present concepts of non-genomic actions of E(2) in Ca(2+) homeostasis.
    • A rare case of minimal deviation adenocarcinoma of the uterine cervix in a renal transplant recipient.

      Fanning, D M; Gulmann, C; Hickey, D P; Little, D M; Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland. , fanningdee@yahoo.co.uk (2012-02-01)
      INTRODUCTION: We report the first described case of minimal deviation adenocarcinoma of the uterine cervix in the setting of a female renal cadaveric transplant recipient. MATERIALS AND METHODS: A retrospective review of this clinical case was performed. CONCLUSION: This rare cancer represents only about 1% of all cervical adenocarcinoma.
    • A rare case of minimal deviation adenocarcinoma of the uterine cervix in a renal transplant recipient.

      Fanning, D M; Gulmann, C; Hickey, D P; Little, D M; Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland, fanningdee@yahoo.co.uk. (2009-02-03)
      INTRODUCTION: We report the first described case of minimal deviation adenocarcinoma of the uterine cervix in the setting of a female renal cadaveric transplant recipient. MATERIALS AND METHODS: A retrospective review of this clinical case was performed. CONCLUSION: This rare cancer represents only about 1% of all cervical adenocarcinoma.
    • Rare case of primary spinal ependymomatosis occurring in a 26-year-old man: a case report.

      Kaliaperumal, Chandrasekaran; Suttner, Nigel; Herron, Brian; Choudhari, Kishor A; National centre for Neurosurgery, Beaumont Hospital, Dublin-9, Republic of Ireland. (2009)
      The authors report a rare case of primary spinal ependymomatosis in a young adult man. Multiple primary ependymomatous lesions were seen on magnetic resonance imaging and no anaplasia was identified on the surgical-pathological analysis. The aetio-pathological mechanism and surgical significance of this rare occurrence is discussed.