• Thromboembolism prophylaxis practices in orthopaedic arthroplasty patients.

      Cawley, D; Lenehan, B; Devitt, A; Department of Orthopaedic Surgery, Merlin Park Hospital, Galway. derekcawley@hotmail.com (2010-10)
      Thromboembolic events are a post-operative complication of arthroplasty surgery for up to 3 months. The incidence however, is not fully known. Some form of prophylaxis should be provided to all arthroplasty patients. Clinicians are wary of side effects, compliance profile and the associated cost. The objective of this study is to investigate practice patterns and their relevance to 3 risk groups. Ninety questionnaires were sent to orthopaedic surgeons with 3 hypothetical clinical scenarios and 10 prophylaxis regimes for thromboembolism across different risk groups. The response rate was 81/90 (90%). The most popular options in all 3 cases were early mobilisation, thrombo-embolism deterrant (TED) stockings and low molecular weight heparin (LMWH) (51/81, 62% of all cases). An inconsistent relationship exists between preferred practice and relevant guidelines. Preferred practice does not correlate with each level of risk.
    • Thrombolysis versus thrombectomy in acute deep vein thrombosis

      O’Sullivan, Gerard J (Interventional Cardiology, 2011)
    • To establish trimester-specific reference ranges for glycated haemoglobin (HbA1c) in pregnancy

      O'Connor, CM; O'Shea, P; Owens, LA; Carmody, L; Avalos, G; Nestor, L; Lydon, K; Dunne, F; Department of Endocrinology, National University of Ireland, Galway, Ireland, 2Department of Clinical Biochemistry, University College Hospital, Galway, Ireland. (European Association for the Study of Diabetes, 2011-09)
      Background and aims: Diabetes in Pregnancy imposes additional risks to both mother and infant. These poor outcomes are considered to be primarily related to glycaemic control which is monitored longitudinally through pregnancy by means of HbA1c. The correlation between HbA1c levels with clinical outcomes emphasises the need to measure HbA1c accurately, precisely and for data interpretation comparison to appropriately defined reference intervals. From July 1st 2010, the HbA1c assay in Irish laboratories became fully metrologically traceable to the IFCC standard, permitting HbA1c to be reported in IFCC units (mmol/mol) and derived DCCT/NGSP units (%) using the IFCC-DCCT/NGSP master equation (DCCT = Diabetes Control and Complications Trial, NGSP = National Glycohemoglobin standardisation program). The aim of this project is to establish trimester-specific reference ranges in pregnancy for IFCC standardised HbA1c in non-diabetic Caucasian women. This will allow us to define the goal for HbA1c during pregnancy complicated by diabetes. Materials and methods: Following informed consent blood was collected from 234 pregnant and 36 age -matched controls into EDTA and Fluoride oxalate tubes for HbA1c, haemoglobin and glucose measurement. Pregnancy trimester was defined as follows: T1 (up to 12 weeks), T2 (13 to 27 weeks), T3 (>28 weeks to term). The Menarini HA8160 automated haemoglobin (Hb) analyser was used to assay HbA1c. Results: Non-parametric analysis of the data was performed. The 95% IFCC HbA1c (DCCT) reference interval for Controls (n=59) 29-37mmol/mol (4.8-5.5%), Trimester 1 (n=27) 36mmol/mol (4.6-5.4%), Trimester 2 (n=107) 25-35mmol.mol (4.4-5.4%) and Trimester 3 (n=110) 28- 39 mmol/mol (4.7-5.7%). A statistically significant difference between the median HbA1c concentration of the control and Trimester 2 subjects, p <0.0001 was determined (Mann-Whitney test). Conclusion: As HbA1c changes throughout pregnancy, trimester-specific HbA1c reference intervals are required to manage diabetes in pregnancy appropriately.
    • Tracheal intubation by inexperienced medical residents using the Airtraq and Macintosh laryngoscopes--a manikin study.

      Maharaj, Chrisen H; Ni Chonghaile, Martina; Higgins, Brendan D; Harte, Brian H; Laffey, John G; Department of Anaesthesia, University College Hospital Galway, Ireland. (2006-11)
      The Airtraq laryngoscope is a novel intubation device that may possess advantages over conventional direct laryngoscopes for use by personnel that are infrequently required to perform tracheal intubation. We conducted a prospective study in 20 medical residents with little prior airway management experience. After brief didactic instruction, each participant took turns performing laryngoscopy and intubation using the Macintosh (Welch Allyn, Welch Allyn, NY) and Airtraq (Prodol Ltd. Vizcaya, Spain) devices, in 3 laryngoscopy scenarios in a Laerdal Intubation Trainer (Laerdal, Stavanger, Norway) and 1 scenario in a Laerdal SimMan manikin (Laerdal, Kent, UK). They then performed tracheal intubation of the normal airway a second time to characterize the learning curve. In all scenarios tested, the Airtraq decreased the duration of intubation attempts, reduced the number of optimization maneuvers required, and reduced the potential for dental trauma. The residents found the Airtraq easier to use in all scenarios compared with the Macintosh laryngoscope. The Airtraq may constitute a superior device for use by personnel infrequently required to perform tracheal intubation.
    • Tracheal intubation in patients with cervical spine immobilization: a comparison of the Airwayscope, LMA CTrach, and the Macintosh laryngoscopes.

      Malik, M A; Subramaniam, R; Churasia, S; Maharaj, C H; Harte, B H; Laffey, J G; Department of Anaesthesia, Galway University Hospitals, Galway, Ireland. (2009-05)
      The purpose of this study was to evaluate the effectiveness of the Pentax AWS, and the LMA CTrach, in comparison with the Macintosh laryngoscope, when performing tracheal intubation in patients with neck immobilization using manual in-line axial cervical spine stabilization.
    • Transcutaneous bilirubin--comparing the accuracy of BiliChek(R) and JM 103(R) in a regional postnatal unit.

      Qualter, Yvonne M; Allen, Nicholas M; Corcoran, John D; O'Donovan, Donough J; Department of Midwifery, Galway University Hospital, Newcastle Road, Galway,, Ireland. y139q@hotmail.com (2012-01-31)
      OBJECTIVE: Transcutaneous bilirubin (TcB) has the potential to reduce serum bilirubin sampling. During a recent survey on the use of TcB in postnatal units in the Republic of Ireland, we identified that only 58% of the 19 units were using TcB and that only two devices were in use, the BiliChek(R) and JM 103(R). We aimed to evaluate and compare these two devices in a regional postnatal unit. METHODS: To evaluate and compare the accuracy of the BiliChek(R) and JM 103(R), we studied simultaneous TcB and total serum bilirubin (TSB) measurements from a population of jaundiced term and near term infants. We evaluated each device with regard to correlation with TSB and potential to safely reduce serum bilirubin testing. RESULTS: Both TcB devices strongly correlated with TSB (r = 0.88 for BiliChek(R) and r = 0.70 for JM 103(R). The BiliChek(R) and JM 103(R) were accurate up to cut-off values of 200 mumol/L and 180 mumol/L, respectively. Using Bhutani's nomogram, 100% sensitivity was achieved using the 75th percentile for BiliChek(R) and the 40th percentile for JM 103(R). CONCLUSION: Both TcB devices correlated closely with moderately increased TSB levels and are suitable screening tools to identify jaundiced infants that require a serum bilirubin, with upper limit cut-off values. Both devices reduced the need for TSB levels. We found the BiliChek(R) slightly more accurate than the JM 103(R) for our study population. TcB however, is not in widespread use.
    • The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.

      Carney, John; McDonnell, John G; Ochana, Alan; Bhinder, Raj; Laffey, John G; Department of Anaesthesia, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. (2008-12)
      Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial.
    • Transversus abdominis plane block: a cadaveric and radiological evaluation.

      McDonnell, John G; O'Donnell, Brian D; Farrell, Thomas; Gough, Niall; Tuite, David; Power, Camillus; Laffey, John G; Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Tallaght, Dublin, Ireland. (2011-04-11)
      The abdominal wall is a significant source of pain after abdominal surgery. Anterior abdominal wall analgesia may assist in improving postoperative analgesia. We have recently described a novel approach to block the abdominal wall neural afferents via the bilateral lumbar triangles of Petit, which we have termed a transversus abdominis plane block. The clinical efficacy of the transversus abdominis plane block has recently been demonstrated in a randomized controlled clinical trial of adults undergoing abdominal surgery.
    • Trends in the Fractures and Fatalities of Farmyard Injuries in Ireland: A 10 year analysis

      Lee, MJ; Cawley, DT; Ng, JP; Kaar, K (Irish Medical Journal, 2017-01)
      The farming and agricultural sector remains one of Ireland’s primary industries. Fatality rates remain higher than the European average. The aim of this study was to analyze the national trend in hospital in-patient admissions for farmyard related fractures and related fatalities in Ireland from 2005 to 2014. Relevant socioeconomic trends were used for comparison. There were 2,064 farm-related fractures and 187 fatalities recorded over the same period. Despite a decrease in incidence of farmyard fractures over 2005-2014, fatality rates have increased indicating the alarming continued occupational hazards and severity of sustained injuries.
    • Trimester specific reference ranges for glycated haemoglobin (HbA1C) in pregnancy

      O Connor, C; O Shea, P; Owens, L (Irish Journal of Medical Science, 2010)
    • Trimester-specific reference intervals for haemoglobin A(1c) (HbA(1c)) in pregnancy.

      O'Connor, Catherine; O'Shea, Paula Mary; Owens, Lisa Ann; Carmody, Louise; Avalos, Gloria; Nestor, Laura; Lydon, Katherine; Dunne, Fidelma; Department of Medicine, College of Medicine Nursing and Health Sciences, National University of Ireland, Galway, Ireland. (2011-11-26)
      Abstract Background: Diabetes in pregnancy imposes additional risks to both mother and infant. These increased risks are considered to be primarily related to glycaemic control which is monitored by means of glycated haemoglobin (HbA(1c)). The correlation of HbA(1c) with clinical outcomes emphasises the need to measure HbA(1c) accurately, precisely and for correct interpretation, comparison to appropriately defined reference intervals. Since July 2010, the HbA(1c) assay in Irish laboratories is fully metrologically traceable to the IFCC standard. The objective was to establish trimester-specific reference intervals in pregnancy for IFCC standardised HbA(1c) in non-diabetic Caucasian women. Methods: The authors recruited 311 non-diabetic Caucasian pregnant (n=246) and non-pregnant women (n=65). A selective screening based on risk factors for gestational diabetes was employed. All subjects had a random plasma glucose <7.7 mmol/L and normal haemoglobin level. Pregnancy trimester was defined as trimester 1 (T1, n=40) up to 12 weeks +6 days, trimester 2 (T2, n=106) 13-27 weeks +6 days, trimester 3 (T3, n=100) >28 weeks to term. Results: The normal HbA(1c) reference interval for Caucasian non-pregnant women was 29-37 mmol/mol (Diabetes Control and Complications Trial; DCCT: 4.8%-5.5%), T1: 24-36 mmol/mol (DCCT: 4.3%-5.4%), T2: 25-35 mmol/mol (DCCT: 4.4%-5.4%) and T3: 28-39 mmol/mol (DCCT: 4.7%-5.7%). HbA(1c) was significantly decreased in trimesters 1 and 2 compared to non-pregnant women. Conclusions: HbA(1c) trimester-specific reference intervals are required to better inform the management of pregnancies complicated by diabetes.
    • Trimester-specific reference ranges for glycated haemoglobin in pregnancy

      O'Connor, C; O'Shea, P; Owens, L; Carmody, L; Avalos, G; Lydon, K; Nestor, L; Dunne, F; Department of Endocrinology, Galway University Hospitals, Galway 2Department of Clinical Biochemistry, Galway University Hospitals, Galway (Diabetic Pregnancy Study Group, 2011)
      Background and Aims: Diabetes in Pregnancy imposes additional risks to both mother and infant. These poor outcomes are considered to be primarily related to glycaemic control which is monitored longitudinally through pregnancy by means of HbA1c. The correlation between HbA1c levels with clinical outcomes emphasises the need to measure HbA1c accurately, precisely and for data interpretation comparison to appropriately defined reference intervals. From July 1st 2010, the HbA1c assay in Irish laboratories became fully metrologically traceable to the IFCC standard, permitting HbA1c to be reported in IFCC units (mmol/mol) and derived DCCT/NGSP units (%) using the IFCC-DCCT/NGSP master equation (DCCT = Diabetes Control and Complications Trial, NGSP = National Glycohemoglobin standardisation program). The aim of this project is to establish trimester-specific reference ranges in pregnancy for IFCC standardised HbA1c in non-diabetic Caucasian women. This will allow us to define the goal for HbA1c during pregnancy complicated by diabetes. Materials and methods: Following informed consent blood was collected from 234 pregnant and 36 age -matched controls into EDTA and Fluoride oxalate tubes for HbA1c, haemoglobin and glucose measurement. Pregnancy trimester was defined as follows: T1 (up to 12 weeks), T2 (13 to 27 weeks), T3 (>28 weeks to term). The Menarini HA8160 automated haemoglobin (Hb) analyser was used to assay HbA1c. Results: Non-parametric analysis of the data was performed. The 95% IFCC HbA1c (DCCT) reference interval for Controls (n=59) 29-37mmol/mol (4.8-5.5%), Trimester 1 (n=26) 36mmol/mol (4.6-5.4%), Trimester 2 (n=107) 25-35mmol.mol (4.4-5.4%) and Trimester 3 (n=107) 28- 39 mmol/mol (4.7-5.7%). A statistically significant difference between the median HbA1c concentration of the control and Trimester 2 subjects, p <0.0001 was determined (Mann-Whitney test). Conclusion: Trimester-specific HbA1c reference intervals are required to manage diabetes in pregnancy as HbA1c changes throughout pregnancy.
    • 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.
    • An unusual interpretation of "blind drunk".

      McAnena, Lisa; O'Regan, Anthony; Fahy, G E; Department of Medicine, Galway University Hospital, Galway, Ireland. (2012-01-31)
    • Use of palivizumab and infection control measures to control an outbreak of respiratory syncytial virus in a neonatal intensive care unit confirmed by real-time polymerase chain reaction.

      O'Connell, K; Boo, T W; Keady, D; Niriain, U; O'Donovan, D; Commane, M; Faherty, C; Cormican, M; Department of Clinical Microbiology, University College Hospital, Galway, Ireland. karinaoconnell@gmail.com (2011-04)
      Respiratory syncytial virus (RSV) is a potentially life-threatening infection in premature infants. We report an outbreak involving four infants in the neonatal intensive care unit (NICU) of our hospital that occurred in February 2010. RSV A infection was confirmed by real-time polymerase chain reaction. Palivizumab was administered to all infants in the NICU. There were no additional symptomatic cases and repeat RSV surveillance confirmed that there was no further cross-transmission within the unit. The outbreak highlighted the infection control challenge of very high bed occupancy in the unit and the usefulness of molecular methods in facilitating detection and management.
    • Validation of a diabetes risk score in identifying patients at risk of progression to abnormal glucose tolerance post partum

      Noctor, E; Crowe, C.; Carmody, LA; Wickham, B; Avalos, G; Gaffney, G; O'Shea, P; Dunne, F; Galway University Hospitals (Royal Academy of Medicine in Ireland, 2011)
    • Validity evidence for USMLE examination cut scores: results of a large-scale survey.

      Margolis, Melissa J; Clauser, Brian E; Winward, Marcia; Dillon, Gerard F; mmargolis@nbme.org (2010-10)
      This research examined the credibility of the cut scores used to make pass/fail decisions on United States Medical Licensing Examination (USMLE) Step 1, Step 2 Clinical Knowledge, and Step 3.
    • What Stops Doctors Switching from Intravenous to Oral Antibiotics?

      Hogan-Murphy, D.; Waqas, S.; Tuite, H.; Ni Riain, U. (Irish Medical Journal, 2019-09)
      To explore doctors’ perceptions of the motivators and barriers to complying with intravenous to oral switch antibiotic guidelines in a Model 4 Irish hospital.