• An Unusual Case of a Facial Guard Causing Penetrating Soft Tissue Injury in the Game of Hurling

      Farrell, T; McDonald, C.; Sheehan, E. (Irish Medical Journal, 2019-02)
      Hurling is a fast-paced impact sport that is known to be associated with trauma to the head, face and hands1. Helmets with facial guards have been introduced by the Gaelic athletic association (GAA) in 2010 as a means of preventing head and maxillofacial injuries. Although the national safety authority of Ireland (NSAI) identify certain standards for hurling helmets, modifications are known to be quite common2. A recent study by O’Connor (2018) showed that 31% of players surveyed from a total of 304 had modified their helmet in some fashion either by changing the faceguard completely or removal of single bars. The main reasons given for modification were; restricted vision, comfort and perceived poor quality of the helmet/faceguard. Anecdotally, players may modify one’s helmet to help improve peripheral vision and thus situational awareness. In the literature, there exists only one case of penetrating injury from a facial guard of a hurling helmet3. The trend of modifying helmets seems to be increasing the incidence of these serious injuries. We believe that there is a general lack of awareness among players and officials as to the dangers of modifying protective equipment. We present the case of a penetrating hand injury as a direct result of a modified facial guard where a single bar was removed.
    • Survivorship care for postmenopausal breast cancer patients in Ireland: What do women want?

      Meade, Elizabeth; McIlfatrick, Sonja; Groarke, Ann Marie; Butler, Eimear (European Journal of Oncology Nursing, 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.
    • Multidisciplinary approach to consent in arthroplasty surgery

      Mohamed, KMS; Foy, D; Cogley, D; DM Niall, DM; E Sheehan, E; Midland Regional Hospital, Tullamore, Co Offaly (Irish Medical Journal, 2014-06)
      The process of consenting has been in the heart of the surgical practice as the binding contract between the informed patient and the entrusted treating surgeon. This is to protect the patient' s autonomy and respect their right to determine their treatment. Consent validity relies on the provision of procedure information and the capacity of competent patient to understand it 1 . The Irish law states no medical or surgical treatment to be carried out without informed consent of the patient, however the law is not exactly clear in how much information to be provided prior to obtaining consent for administration of medical treatment or procedure 2 . The Irish medical council guidelines published in 2008 defines the significant information as any risk over 1-2% or any risk of grave consequences. It also implies the patient understanding is crucial part of the process 3 .
    • Through the looking glass; bioactive glass S53P4 (BonAlive®) in the treatment of chronic osteomyelitis.

      McAndrew, J; Efrimescu, C; Sheehan, E; Niall, D; Department of Orthopaedic Surgery, Midland Regional Hospital, Tullamore, County Offaly, Ireland. josephmcandrew@gmail.com (2013-09)
      In terms of eradication, osteomyelitis represents one of the most challenging infective conditions in medicine and surgery. In recent years, the use of bioactive glass in conjunction with antimicrobial therapy has emerged as a viable new treatment.
    • Safe compounding; it’s in your hands

      Burke, Catriona; Murphy, Dermot; Flynn, Elaine; Garvey, E; Midland Regional Hospital, Tullamore (Midland Regional Hospital, Tullamore, 2012-09-21)
    • A little less conversation, more action please!

      Scully, Patricia; Midland Regional Hospital, Tullamore (Midland Regional Hospital, Tullamore, 2012-09-20)
      Interruptions and distractions are significant factors in medication errors in the pharmacy environment. “Although only a small percentage of these errors cause harm, medication errors need to be minimised in an effort to improve patient safety1.” Due to the volume of telephone calls within the Regional Oncology Haematology Pharmacy (ROHP), we decided to analyse all phone calls over a secound three week period , the phonecalls were analysed in the same way using the same time frame and parameters. The recommendations from the previous study were applied . The staff in ROHDU were told which extensions were to be used when directing queries into ROHP. All go ahead confirmations were to be emailed to ROHP as apposed to ring through on the phone.
    • Acute shoulder injury with a normal x-ray: a simple algorithm of patient assessment to guide the need for further imaging

      O’Rourke, S; Kelly, P; Midland Regional Hospital, Tullamore (Royal College of Surgeons in Ireland (RCSI), 2012-09-20)
      Purpose: Patients presenting to their General Practitioner or to the Emergency Department following an acute shoulder injury but a normal x-ray may have a significant underlying injury to the Rotator Cuff. Imaging (whether by ultrasound or MRI) is often indicated but available clinical evidence has yet to establish what group of patients benefit most from early imaging. Method: In March 2012 a multidisciplinary approach has been introduced to assess adult patients attending the Emergency Department with acute shoulder injuries, severe pain and/or restricted shoulder movement, but a normal x-ray. This involved a senior medical assessment within 7 days following presentation. All patients with pseudo-paralysis (defined as the inability to abduct the shoulder beyond 45°) and patients with abduction in the range of 45-90° with positive clinical tests suggesting significant rotator cuff involvement are referral for urgent ultrasound. Image confirmed acute, full thickness rotator cuff tears were seen within ten days by an orthopaedic surgeon with a special interest in shoulder surgery. Results: To date 25 patients have been assessed. 11 patients (aged between 42 and 80 years) have met the criteria for early imaging for acute rotator cuff tears. Five confirmed acute tears of the rotator cuff have been referred for early surgical intervention. One patient had a fracture of the greater tuberosity not seen on x-ray. Conclusion: Early post-trauma assessment of patients with acute shoulder injuries with normal x-rays using simple assessment criteria will identify patients at significant risk of acute rotator cuff tears requiring early surgical intervention.
    • Use of Gamma locking nail(®) in tri-planar osteotomy in bilateral severe slipped upper femoral epiphysis: a case study and literature review.

      Sharafeldin, K N; Butt, A J; Burke, T; Orthopaedic Department, Midland Regional Hospital at Tullamore, Tullamore, Offaly, Republic of Ireland. knsharaf@gmail.com (Springer, 2012-09)
      Slipped upper femoral epiphysis (SUFE) is a common condition affecting adolescent boys and girls. It is classified as acute, chronic or acute on chronic. The slip can be mild, moderate or severe.
    • Aseptic compounding practice in Ireland – how are we doing it?

      Scully, Patricia; Garvey, E; Regional Oncology Haematology Pharmacy, Midland Regional Hospital, Arden Road, Tullamore, Co. Offaly (2012-06)
      To assess whether compounding practice in the ROHP is the same as other hospitals in Ireland. To assess whether other hospitals are using closed system or needle free compounding devices.
    • A rare case of calcaneal tumour in a young adult.

      Efrimescu, Catalin Iulian; Bandorf, Nadine; Maxwell, Norman; Niall, Dorothy; Department of Ortho and Trauma Surgery, MRH Tullamore, Tullamore, Ireland. catalin_efrimescu@yahoo.com (BMJ, 2012-05)
    • Acute lumbar Morel-Lavallee haematoma in a 14-year-old boy.

      Efrimescu, Catalin-Iulian; McAndrew, Joseph; Bitzidis, Apostolos; Midland Regional Hospital at Tullamore, Orthopaedic and Trauma Surgery Department, Tullamore, Co. Offaly, Ireland. catalin_efrimescu@yahoo.com (2012-05)
    • Strangulated obturator hernia - an unusual presentation of intestinal obstruction.

      Zeeshan, Saqib; Muhammad, Khalid; Chughtai, Jehanzeb; Ademola, Moses; Masood, Aqsa; Johnston, Sean; Department of Surgery, Midland Regional Hospital, Tullamore, Ireland., saqibzeeshan23@hotmail.com (2012-01-31)
      An 81-year-old Caucasian emaciated female presented with 3 days history of colicky abdominal pain nausea, projectile vomiting and abdominal distension. A pre-operative diagnosis of mechanical bowel obstruction was made. The absence of characteristic clinical signs in this thin elderly woman with a small bowel obstruction failed to provide a pre-operative diagnosis. She underwent a midline laparotomy and resection and anastomosis of small bowel and repair of the strangulated right obturator hernia. The high mortality rate associated with this type of abdominal hernias requires a high index of suspicion to facilitate rapid diagnosis and prompt surgical intervention if the survival rate is to be improved.
    • Living with a diagnosis of non-small cell lung cancer: patients' lived experiences.

      McCarthy, Ita; Dowling, Maura; Tullamore General Hospital, Co.Offaly, Ireland. (2012-01-31)
      The aim of this study was to explore patients' experience of living with non-small cell lung cancer (NSCLC). Patients diagnosed with NSCLC know that their treatment is not with curative intent and can expect distressing symptoms. In this phenomenological study, six adults with a diagnosis of NSCLC were interviewed. Data was analysed guided by van Manen's six-step process. Four main themes were interpreted: 'Maintaining my life'; 'The enemy within'; 'Staying on the train', and 'I'm still me'. The study findings contribute to nurses' understanding of patients living with this distressing diagnosis, where treatment is palliative. Understanding these patients' experiences can help nurses to interact in a different way, and to maximize opportunities to care holistically for this group of patients and best meet their needs.
    • Evaluation of bone marrow examinations performed by an advanced nurse practitioner: an extended role within a haematology service.

      Kelly, Mary; Crotty, Gerard; Perera, Kanthi; Dowling, Maura; Department of Haematology, Tullamore General Hospital, Co.Offaly, Ireland., maryb.kelly@hse.ie (2012-01-31)
      PURPOSE: Traditionally, medical personnel have undertaken bone marrow (BM) examination. However, specially trained nurses in advanced practice roles are increasingly undertaking this role. This paper presents the findings from an audit of BM examinations undertaken by an advanced nurse practitioner (ANP) at a regional haematology specialist centre. METHODS: The audit evaluated the quality of BM examinations performed by the ANP over the past two years (September 2007-September 2009). Over the two year period, 324 BM examinations were performed at the centre of which 156 (48.1%) were performed by the ANP. A random sample of 30 BM examinations undertaken by the ANP were analysed by the consultant haematologist. RESULTS: All 30 BM examinations undertaken by the ANP were sufficient for diagnosis. CONCLUSIONS: The ANP is capable and competent to obtain BM samples which are of a sufficient quality to permit diagnosis.
    • Myeloma: making sense of a complex blood cancer.

      Kelly, Mary B; Meenaghan, Teresa; Dowling, Maura; Tullamore General Hospital, Ireland. (2012-01-31)
      Myeloma is a challenging blood cancer characterized by bone destruction, hypercalcaemia, renal insufficiency and anaemia. Although myeloma remains incurable, recent advancements in treatments have resulted in significant improvements in morbidity. The use of immunomodulatory drugs-thalidomide, lenalidomide, pomalidomide (in clinical trials)-and the proteasome inhibitor, bortezomib, in conjunction with conventional chemotherapy and supportive therapies, have resulted in a significant shift in approaches to treatment and an improvement in patients' quality of life. Nurses must remain up-to-date with current treatments for myeloma and their related side-effects. In addition, nurses play a key role in the coordination of a multidisciplinary approach to care for myeloma patients.
    • Young patients with chronic lymphocytic leukaemia.

      Kelly, Mary; Dowling, Maura; Meenaghan, Teresa; Tullamore General Hospital, Offaly, Ireland. (2012-01-31)
    • Intra-articular lignocaine versus intravenous analgesia with or without sedation for manual reduction of acute anterior shoulder dislocation in adults.

      Wakai, Abel; O'Sullivan, Ronan; McCabe, Aileen; Emergency Care Research Unit [ECRU], Midland Regional Hospital, Arden Road,, Tullamore, Co. Offaly, Ireland. (2012-01-31)
      BACKGROUND: There is conflicting evidence regarding the use of intra-articular lignocaine injection for the closed manual reduction of acute anterior shoulder dislocations. A systematic review may help cohere the conflicting evidence. OBJECTIVES: To compare the clinical efficacy and safety of intra-articular lignocaine and intravenous analgesia (with or without sedation) for reduction of acute anterior shoulder dislocation. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 1), MEDLINE (1950 to March 2010), and EMBASE (1980 to March 2010). We searched Current Controlled Trials metaRegister of Clinical Trials (compiled by Current Science) (March 2010). We imposed no language restriction. SELECTION CRITERIA: Randomized controlled trials comparing intra-articular lignocaine (IAL) with intravenous analgesia with or without sedation (IVAS) in adults aged 18 years and over for reduction of acute anterior shoulder dislocation. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. Where possible, data were pooled and relative risks (RR) and mean differences (MD), each with 95% confidence intervals (CI), were computed using the Cochrane Review Manager statistical package (RevMan). MAIN RESULTS: Of 1041 publications obtained from the search strategy, we examined nine studies. Four studies were excluded, and five studies with 211 participants were eligible for inclusion. There was no difference in the immediate success rate of IAL when compared with IVAS in the closed manual reduction of acute anterior shoulder dislocation (RR 0.95; 95% CI 0.83 to 1.10). There were significantly fewer adverse effects associated with IAL compared with IVAS (RR 0.16; 95% CI 0.06 to 0.43). The mean time spent in the emergency department was significantly less with IAL compared with IVAS (MD 109.46 minutes; 95% CI 84.60 to 134.32). One trial reported significantly less time for reduction with IVAS (105 seconds; 95% CI 84.0 to 126.1) compared with IAL (284.6 seconds; 95% CI 185.3 to 383.9). One trial reported no joint infection associated with intra-articular lignocaine injection and no mortality associated with either IAL or IVAS. AUTHORS' CONCLUSIONS: We observed no significant difference between IAL and IVAS with regard to the immediate success rate of reduction, pain during reduction, post-reduction pain relief and reduction failure. Compared to IVAS, IAL may be less expensive and may be associated with fewer adverse effects and a shorter recovery time.
    • Cost savings from batch production of IV anti-neoplastic treatments

      Nykänen, Jenni; Rautio, Eveliina; Garvey, E; Midland Regional Hospital, Tullamore (Midland Regional Hospital, Tullamore, 2012)
    • Falls prevention advice for patients, relatives and carers

      Medical Illustration Unit, Midland Regional Hospital, Tullamore; Midland Regional Hospital, Tullamore (2012)
      Falls within the hospital environment are an uncomfortable Fact for both patients and staff. Inpatient falls are generally the highest single reported incident to risk management. The aim of the fall prevention strategy is to to prevent factors within MRHM and the wider community associated with patient falls
    • So you thought they were clean enough?...

      Kaur, Harpreet; Midland Regional Hospital, Tullamore (Midland Regional Hospital, Tullamore, 2012)
      The extensive use of cytotoxic drugs in the treatment of cancer patients represents a health risk for all staff involved in the preparation and handling of such drugs. This qualifies as an occupational health hazard and the two groups with the highest levels of exposure are pharmacists who dispense these drugs and nursing staff who administer them [1]. Equally other staff involved in their compounding, as well as logistical and training personnel are likely to be exposed.