• Time of day variation in polyp detection rate for colonoscopies performed on a 3-hour shift schedule.

      Munson, Gregory W; Harewood, Gavin C; Francis, Dawn L; Department of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA. (2011-03)
      Recent research suggests that the colonoscopy polyp detection rate (PDR) varies by time of day, possibly because of endoscopist fatigue. Mayo Clinic Rochester (MCR) schedules colonoscopies on 3-hour shifts, which should minimize fatigue.
    • A "time-and-motion" study of endoscopic practice: strategies to enhance efficiency.

      Harewood, Gavin C; Chrysostomou, Kristia; Himy, Naila; Leong, Wai Ling; Department of Gastroenterology and Hepatology, Beaumont Hospital, Dublin, Ireland. (2008-12)
      With the growing demand on endoscopic resources, achieving optimal efficiency has assumed increasing importance.
    • Toll-like receptors as therapeutic targets in cystic fibrosis.

      Greene, Catherine M; Branagan, Peter; McElvaney, Noel G; Beaumont Hospital, Education and Research Centre, Respiratory Research Division, Royal College of Surgeons in Ireland, 9 Dublin, Ireland. cmgreene@rcsi.ie (2008-12)
      Background: Toll-like receptors (TLRs) are pattern recognition receptors that act as a first-line of defence in the innate immune response by recognising and responding to conserved molecular patterns in microbial factors and endogenous danger signals. Cystic fibrosis (CF)-affected airways represent a milieu potentially rich in TLR agonists and the chronic inflammatory phenotype evident in CF airway epithelial cells is probably due in large part to activation of TLRs. Objective/methods: To examine the prospects of developing novel therapies for CF by targeting TLRs. We outline the expression and function of TLRs and explore the therapeutic potential of naturally-occurring and synthetic TLR inhibitors for CF. Results/conclusion: Modulation of TLRs has therapeutic potential for the inflammatory lung manifestations of CF.
    • Towards continuous improvement of endoscopy standards: Validation of a colonoscopy assessment form.

      National Surgical Training Centre, Royal College of Surgeons in Ireland, RCSI, House, 12 St Stephen's Green, Dublin 2 Department of Gastroenterology Department , of Surgery, Beaumont Hospital, Beaumont, Dublin 9. (2012-02-01)
      Aim: Assessment of procedural colonoscopy skills is an important and topical. The aim of this study was to develop and validate a competency-based colonoscopy assessment form that would be easy to use, suitable for the assessment of junior and senior endoscopists and potentially be a useful instrument to detect differences in performance standards following different training interventions. Method: A standardised assessment form was developed incorporating a checklist with dichotomous yes/no responses and a global assessment section incorporating several different elements. This form was used prospectively to evaluate colonoscopy cases during the period of the study in several university teaching hospitals. Results were analysed using ANOVA with Bonferroni corrections for post-hoc analysis. Results: 81 procedures were assessed, performed by eight consultant and 19 trainee endoscopists. There were no serious errors. When divided into three groups based on previous experience (novice, intermediate and expert) the assessment form demonstrated statistically significant differences between all three groups (p<0.05). When separate elements were taken into account, the global assessment section was a better discriminator of skill level than the checklist. Conclusion: This form is a valid, easy to use assessment method. We intend to use it to assess the value of simulator training in trainee endoscopists. It also has the potential to be a useful training tool when feedback is given to the trainee.
    • Towards safer use of opioids.

      Carson, R W R; Jacob, P; McQuillan, R; Department of Palliative Care Medicine, Beaumont Hospital, Beaumont, Dublin 9. raymondwcarson@hotmail.com (2009-09)
      The main aim of our work was to improve the safety of opioid use in our institution, an acute generalhospital with 620 beds. Initially, all reported opioid errors from 2001 - 2006 were audited. The findings directed a range of multidisciplinary staff educational inputs to improve opioid prescribing and administration practice, and encourage drug error reporting. 448 drug errors were reported, of which 54 (12%) involved opioids; of these, 43 (79%) involved codeine, morphine or oxycodone. 31 of the errors (57%) were associated with administration, followed by 12 (22%) with dispensing and 11 (20%) with prescribing. There were 2 reports of definite patient harm. A subsequent audit examined a 17-month period following the introduction of the above teaching: 17 errors were noted, of which 14 (83%) involved codeine, morphine or oxycodone. Again, drug administration was most error-prone, comprising 11 (65%) of reports. However, just 2 (12%) of the reported errors now involved prescribing, which was a reduction.
    • Towards the development of integrated epilepsy services: an audit of documented epilepsy care.

      Varley, J; O'Connor, R; Delanty, N; O'Riordan, D; Kenny, A; Barry, N; Quigney, M; Normand, C; Fitzsimons, M; Epilepsy Programme, Beaumont Hospital, Beaumont Road, Dublin 9. jarlath.varley@hse.ie (2011-11-17)
      Effective chronic disease management (CDM) requires the ready availability and communication of accurate, clinical disease specific information. Using epilepsy as a probe into CDM, we report on the availability and reliability of clinical information in the primary care records of people with epilepsy (PWE). The medical records of 374 PWE from 53 general practices in the Mid-West region of Ireland were examined. Confirmation of an epilepsy diagnosis by a neurologist was documented for 132 (35%) patients. 282 (75%) patients had no documented evidence of receiving specialist neurology review while 149 (40%) had not been reviewed by their GP in the previous two years for their epilepsy. Significant variation in documentation of epilepsy specific information together with an inadequacy and inconsistency of existing epilepsy services was highlighted.
    • Towards the development of integrated epilepsy services: an audit of documented epilepsy care.

      Varley, J; O'Connor, R; Delanty, N; O'Riordan, D; Kenny, A; Barry, N; Quigney, M; Normand, C; Fitzsimons, M; Epilepsy Programme, Beaumont Hospital, Beaumont Road, Dublin 9., jarlath.varley@hse.ie (2012-02-01)
      Effective chronic disease management (CDM) requires the ready availability and communication of accurate, clinical disease specific information. Using epilepsy as a probe into CDM, we report on the availability and reliability of clinical information in the primary care records of people with epilepsy (PWE). The medical records of 374 PWE from 53 general practices in the Mid-West region of Ireland were examined. Confirmation of an epilepsy diagnosis by a neurologist was documented for 132 (35%) patients. 282 (75%) patients had no documented evidence of receiving specialist neurology review while 149 (40%) had not been reviewed by their GP in the previous two years for their epilepsy. Significant variation in documentation of epilepsy specific information together with an inadequacy and inconsistency of existing epilepsy services was highlighted.
    • Transcatheter embolisation of renal angiomyolipoma.

      Leong, S; Keeling, A N; McGrath, F P; Lee, M J; Department of Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. (2010-06)
      Angiomyolipomas (AML) are rare benign renal tumours which are associated with aneurysms that can cause haemorrhage. Embolisation of AML greater than 4 cm with a variety of embolic agents is now the first-line treatment in these cases.
    • Transforming management of patients undergoing splenectomy in an Irish teaching hospital.

      McHugh, S M; O'Donnell, J; Leahy, A; Broe, P; Beaumont Hospital, Dublin 9, Ireland. seamusmchugh@rcsi.ie (2012-02-01)
      BACKGROUND: Post-splenectomy infection has a mortality rate of up to 70%. Previously we have published data confirming the poor adherence to best practice guidelines with relation to management of the asplenic patient. A defined protocol of care was established, staff education commenced and a 'patient information leaflet' made available. AIM: To ascertain whether management of the asplenic patient has improved since the implementation of a structured programme of care. METHOD: Retrospective chart review of all splenectomies performed in Beaumont Hospital between 2002 and 2008. RESULTS: Overall, 75.9% of patients were documented as having received the recommended vaccinations. Of these, 48.7% were not timed according to recommended guidelines. Prophylactic antibiotics were documented as prescribed in all but five patients discharged. CONCLUSIONS: These results demonstrate an improvement in post-splenectomy care between 2002 and 2008. However, further improvements are necessary.
    • Transforming management of patients undergoing splenectomy in an Irish teaching hospital.

      McHugh, S M; O'Donnell, J; Leahy, A; Broe, P; Beaumont Hospital, Dublin 9, Ireland, seamusmchugh@rcsi.ie. (2011-02-06)
      BACKGROUND: Post-splenectomy infection has a mortality rate of up to 70%. Previously we have published data confirming the poor adherence to best practice guidelines with relation to management of the asplenic patient. A defined protocol of care was established, staff education commenced and a 'patient information leaflet' made available. AIM: To ascertain whether management of the asplenic patient has improved since the implementation of a structured programme of care. METHOD: Retrospective chart review of all splenectomies performed in Beaumont Hospital between 2002 and 2008. RESULTS: Overall, 75.9% of patients were documented as having received the recommended vaccinations. Of these, 48.7% were not timed according to recommended guidelines. Prophylactic antibiotics were documented as prescribed in all but five patients discharged. CONCLUSIONS: These results demonstrate an improvement in post-splenectomy care between 2002 and 2008. However, further improvements are necessary.
    • The Transit/Admission Lounge study.

      Gilligan, P; O'Kelly, P; Hegarty, D; Winder, S; Department of Emergency Medicine, Beaumont Hospital, Dublin. peadargilligan@beaumont.ie (2009-01)
      In response to persistent overcrowding of Emergency Departments in Ireland, the Department of Health and Health Service Executive provided funding for "Transit Lounge" areas to be built. These lounges were to provide a location for patients to wait in beds pending the availability of a ward bed. This research was performed to assess the impact of such a lounge on the overcrowding of the Emergency Department and on patient outcomes. The time period from the opening of the Transit Lounge was compared with the same period a year earlier. The Transit Lounge delivers a comfortable place for patients to wait. It does not reduce Emergency Department overcrowding and has been associated with an increased time waiting for a ward bed. The solution to overcrowding is the creation of real capacity in the system so that ward beds are available in acute hospitals for the "unscheduled unwell".
    • Transversus abdominis plane block for analgesia in renal transplantation: a randomized controlled trial.

      Freir, Noelle M; Murphy, Caitriona; Mugawar, Mohan; Linnane, Anna; Cunningham, Anthony J; Department of Anaesthesia, Beaumont Hospital, Dublin, Ireland. nfreir@yahoo.ie (2012-10)
      The transversus abdominis plane (TAP) block has proven effective in reducing opioid requirements and pain scores for some procedures involving the lower abdominal wall. In this study we assessed its efficacy in patients with end-stage renal failure undergoing cadaveric renal transplantation.
    • Traumatic injuries of the hip.

      Marshall, Nina; Koulouris, George; Royal College of Surgeons in Ireland, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. ninamarshall@rcsi.ie (2009-11)
      Traumatic lesions of the hip in athletes may be clinically challenging because of the overlap in clinical presentation due to differing pathologies and the presence of multiple injuries. Imaging of the hip in the athlete has undergone a recent resurgence of interest and understanding related to the increasing accessibility and use of hip arthroscopy, which expands the treatment options available for intra-articular pathology. MR imaging and MR arthrography have a unique role in diagnosis of these pathologies, guiding the surgeon, arthroscopist, and referring clinician in their management of bony and soft tissue injury.
    • Trimethoprim-sulfamethoxazole induced acute interstitial nephritis in renal allografts; clinical course and outcome.

      Garvey, J P; Brown, C M; Chotirmall, S H; Dorman, A M; Conlon, P J; Walshe, J J; Department of Nephrology, Beaumont Hospital, Dublin, Ireland. (2009-11)
      Acute interstitial nephritis (AIN) secondary to trimethoprim-sulfamethoxazole (TMP-SMX) is well documented as a cause of acute renal failure in native kidneys. TMP-SMX is the standard prophylactic agent against pneumocystis carinii (PCP) used in the early post-transplant period, however, it has to date only been indirectly associated with AIN in renal allografts. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: We describe eleven renal transplant patients with acute allograft dysfunction in whom a transplant biopsy demonstrated primary histopathologic features of allergic AIN, all of whom were receiving TMP-SMX in addition to other medications known to cause AIN.
    • Tumour PAI-1 overexpression correlates with visceral obesity and is an independent prognostic factor in oesophageal adenocarcinoma

      Allott, E H; Lysaght, J; Cathcart, M C; Cummins, R; Howard, J; Reynolds, J V; Pidgeon, G P (2011-01)
    • Turner syndrome: neuroimaging findings: structural and functional.

      Mullaney, Ronan; Murphy, Declan; Department of Psychiatry, Research and Education Centre, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland. ronan.mullancey@kcl.ac.uk (2009)
      Neuroimaging studies of Turner syndrome can advance our understanding of the X chromosome in brain development, and the modulatory influence of endocrine factors. There is increasing evidence from neuroimaging studies that TX individuals have significant differences in the anatomy, function, and metabolism of a number of brain regions; including the parietal lobe; cerebellum, amygdala, hippocampus; and basal ganglia; and perhaps differences in "connectivity" between frontal and parieto-occipital regions. Finally, there is preliminary evidence that genomic imprinting, sex hormones and growth hormone have significant modulatory effects on brain maturation in TS.
    • Twenty-year survivors of kidney transplantation.

      Traynor, C; Jenkinson, A; Williams, Y; O'Kelly, P; Hickey, D; Denton, M; Magee, C; Conlon, P J; Department of Nephrology, Beaumont Hospital, Dublin, Ireland. caroltraynor@physicians.ie (2012-12)
      There have been few studies of patients with renal allografts functioning for more than 20 years. We sought to identify clinical factors associated with ultra long-term (>20 year) renal allograft survival and to describe the clinical features of these patients. We performed a retrospective analysis of the Irish Renal Transplant Database and included 1174 transplants in 1002 patients. There were 255 (21.74%) patients with graft function for 20 years or more. Multivariate analysis identified recipient age (HR 1.01, CI 1.01-1.02), gender (male HR 1.25, CI 1.08-1.45), acute rejection (HR 1.26, CI 1.09-1.45) and transplant type (living related donor vs. deceased donor) (HR 0.52, CI 0.40-0.66) as significantly associated with long-term graft loss. Median serum creatinine was 115 μmol/L. The 5-year graft survival in 20-year survivors was 74.7%. The mean age at death was 62.7 years (±10.6). The most common causes of death were cardiovascular disease and malignancy. The two major causes of graft loss were death (with function) and interstitial fibrosis/tubular atrophy. Comorbidities included skin cancer (36.1%), coronary heart disease (17.3%) and other malignancies (14.5%). This study identifies factors associated with long-term allograft survival and a high rate of morbidity and early mortality in long-term transplant recipients.
    • Twin pregnancy: the impact of the Higgins Nutrition Intervention Program on maternal and neonatal outcomes.

      Dubois, S; Dougherty, C; Duquette, M P; Hanley, J A; Moutquin, J M; Montreal Diet Dispensary. (1991-06)
      Perinatal outcomes were compared between 354 twins treated with the Higgins Nutrition Intervention Program and 686 untreated twins. After differing distributions of key confounding variables were adjusted for, the twins in the intervention group weighed an average of 80 g more (P less than 0.06) than the nonintervention twins; their low-birth-weight rate was 25% lower (P less than 0.05) and their very-low-birth-weight rate was almost 50% lower (P less than 0.05). Although the rate of preterm delivery was 30% lower in the intervention group (P less than 0.05), the rates of intrauterine growth retardation were similar in the two groups. Fetal mortality was slightly higher (14 vs 12 per 1000, NS), but early neonatal mortality was fivefold lower (3 vs 19 per 1000, P less than 0.06) in the intervention group. Maternal morbidity was significantly lower (P less than 0.05) in the intervention group. There was a trend towards lower infant morbidity in the intervention group. These results suggest that nutritional intervention can significantly improve twin-pregnancy outcome.