• 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)
    • Ergonomic intervention: its effect on working posture and musculoskeletal symptoms in female biomedical scientists.

      Kilroy, N; Dockrell, S; Physiotherapy Department, Tullamore General Hospital, Co. Offaly, Ireland. (2000)
      This study investigates the effect of ergonomic intervention on working posture and musculoskeletal symptoms in female biomedical scientists. The Nordic musculoskeletal questionnaire (NMQ), body discomfort chart (BDC) and rapid upper-limb assessment (RULA) are the tools for assessment. The study was conducted in three phases: pre-intervention, intervention and post-intervention. Pre-intervention, 79% of subjects reported a three-month prevalence of symptoms, and these were reported more frequently by those working in haematology/transfusion. Analysis by RULA showed that the majority (59%) of postures had a grand score of four. A further 24% had scores of five or six. The highest frequency of poor postures was seen in haematology/transfusion. Intervention comprised physical workplace changes, a seminar, and advice on risk factors. In the post-intervention phase, baseline measurements were repeated. Reporting of three-month prevalence of symptoms had decreased to 54%, and reports of body discomfort also had decreased. The majority (64%) had a RULA grand score of three. No observed postures had scores of five or six. In conclusion, ergonomic intervention resulted in an improvement in working postures, and a decrease in the prevalence of musculoskeletal symptoms and body discomfort. Analysis of findings indicate that RULA scores generally corresponded with reporting of symptoms (NMQ) and discomfort (BDC).
    • 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.
    • 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.
    • 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.
    • 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.
    • Patients' lived experience of myeloma.

      Kelly, Mary; Dowling, Maura; Regional Oncology Haematology Day Unit, Tullamore General Hospital, Ireland. Maura.dowling@nuigalway.ie (2011-03)
      To explore patients' lived experience of being diagnosed with myeloma.
    • 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)
    • Review of a single contemporary femoral neck fracture fixation method in young patients.

      Henari, Shwan; Leonard, Michael; Hamadto, Mohammed; Cogley, David; Department of Orthopedics, Midlands Regional Hospital, Tullamore, Ireland. shwanhenari@hotmail.com (2011-03)
      An intracapsular femoral neck fracture in a young patient is a rare and difficult injury to manage. The occurrence of complications following fixation is multifactorial. Initial displacement and timing and accuracy of reduction are the key factors affecting outcome. The severities of the trauma to the hip and the impact of the intracapsular hematoma also play a role, the importance of which remains poorly understood. The purpose of this study was to evaluate the high incidence of femoral neck fractures treated in our institution over a 7-month period, to record the long-term outcome of these patients, all of whom were treated with contemporary methods of internal fixation, and to highlight the reasons for this injury being termed an "orthopedic emergency" and its differences from the same injury in the elderly population. We performed a retrospective analysis of 12 cases of intracapsular femur neck fracture in patients younger than 50 years treated over 7 months in a regional trauma center. All patients underwent satisfactory reduction and fixation. Nine of the 12 patients had a good outcome at a mean follow-up of 29 months. One patient developed a nonunion of the femoral head requiring total hip arthroplasty, one developed avascular necrosis of the femoral head, and one developed partial avascular necrosis. This compares favorably with other studies.
    • 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.
    • 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.
    • 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.
    • Young patients with chronic lymphocytic leukaemia.

      Kelly, Mary; Dowling, Maura; Meenaghan, Teresa; Tullamore General Hospital, Offaly, Ireland. (2012-01-31)