• 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)
    • 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.
    • 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.
    • Bilateral calf chronic compartment syndrome in an elderly male: a case report.

      Siau, Keith; O'Rourke, Killian P; Khanna, Arun; Laversuch, Cathy J; Department of Rheumatology, Musgrove Park Hospital Taunton, TA1 5DA UK. keith@siau.org (2009)
      Leg pain is a common presentation to the outpatient department. Bilateral calf chronic compartment syndrome is a rare cause of bilateral calf pain. Although this condition has been well documented in young athletes, it has rarely been reported in the elderly. We present the case of a 68-year-old male bodybuilder with bilateral calf chronic compartment syndrome, describe the presentation and evaluation of the condition, and provide a review of the literature herewith.
    • 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)
    • 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.
    • 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
    • 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.
    • 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.
    • 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.
    • Malignancy in scleroderma patients from south west England: a population-based cohort study.

      Siau, Keith; Laversuch, C J; Creamer, P; O'Rourke, K P; Department of Medicine, Great Western Hospital, Swindon, SN3 6BB, UK, keith@siau.org. (2010-01-08)
      The pathophysiological relationship between scleroderma and malignancy remains poorly understood. Although some previous studies have demonstrated an increased malignancy risk in patients with scleroderma, others have been inconclusive. We aimed to determine if patients with scleroderma had an increased risk of malignancy compared to an age- and sex-matched local South West England population, and if there were any important differences between scleroderma patients with and without malignancy. Methods of this study are as follows. Notes were obtained on all local scleroderma patients (n = 68) locally, and those diagnosed with malignancy verified by contacting each patient's general practitioner. Expected malignancy figures were obtained from age- and sex-stratified regional prevalence data provided by the South West Cancer Intelligence Service registry. Among the patients, 22.1% with scleroderma were identified with concurrent malignancy. Affected sites were of the breast (n = 5), haematological system (n = 5), skin (n = 4), and unknown primary (n = 1). Overall, malignancy risk was found to be increased in scleroderma (RR = 3.15, 95% CI 1.77-5.20, p = 0.01). In particular, this risk was the highest for haematological malignancies (RR = 18.5, 95% CI 6-43, p = 0.03), especially for non-Hodgkin's lymphoma (RR = 25.8, 95% CI 5-75, p = 0.10). The majority of patients (86.7%) developed malignancy after the onset of scleroderma (mean = 6.9 years). Age of >70 and patients with limited scleroderma were significant risk factors for a patient with scleroderma to have a concurrent malignancy; however, no increased risk was found in patients with any particular pattern of organ involvement, cytotoxic usage or serology. To conclude, in this small patient cohort, we have found that scleroderma is associated with an increased risk of malignancy. This risk is statistically significant in patients with limited scleroderma. Patients who are elderly and those with limited disease should be closely scrutinized at follow-up appointments.
    • Medication reconciliation in oncology & haematology inpatients

      Lydon, S; Garvey, E; Midland Regional Hospital, Arden Road, Tullamore, Co. Offaly (Midland Regional Hospital, Tullamore, 2008)
      The aim was to assess whether the established advantages of pharmacist conducted medication reconciliation, applies to oncology and haematology inpatients
    • Midland Regional Hospital, Tullamore, annual report, 2003.

      Midland Regional Hospital Tullamore.; Midland Health Board (MHB) (Midland Regional Hospital, Tullamore, 2004)
      The year 2003 saw the Midland Health Boord continue to provide services of the highest quality and standard to the people of Laois, Longford, Offaly ond Westmeath. The Board continued to benefit from the Notional Development Plan by: the completion of the Paediatric Unit, and Acute In·Patient Psychiatric Unit at the Midland Regional Hospital at Portlaoise; The tremendous progress in the building of the new Midland Regional Hospital of Tullamore, which is due for completion in 2005, and t the completion of the Development Control Plan Phase 2B for the Midland Regional Hospital at Mullingar, which proposes a €57 million capital development, and will see the bed complement at the hospital increase from 203 to 311. Twenty-four nurses from the Midland Regional School of Nursing were conferred with their diplomas at a graduation ceremony held in Tullamore on Thursday 13 February. This is the second group to graduate from the Midland Regional School of Nursing since it wos established in 1998. Nurse training, which is now a Degree programme, is conducted as a partnership between the Midland Health Board and the Institute of Technology, Athlone.
    • 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 .
    • 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.
    • Myocardial infarction ( ST- elevation)

      Wakai, Abel P (BMJ Publishing Group Ltd, 2011)
    • Patients' lived experience of myeloma.

      Kelly, Mary; Dowling, Maura; Regional Oncology Haematology Day Unit, Tullamore General Hospital, Ireland. Maura.dowling@nuigalway.ie (2011-03)
      The study findings illustrate the importance of addressing patients' emotional and psychological needs, and the significance of providing support for those with myeloma.
    • Pre-printed prescriptions as a means of reducing medication incidents in Haematology Patients at Midland Regional Hospital, Tullamore

      Garvey, E; Carr, J; Midland Regional Hospital, Tullamore (Midland Regional Hospital, Tullamore, 2012)
      A number of incidents have occurred in the midlands area due to patients receiving inappropriately prolonged courses of cytotoxic chemotherapy. For example; Incident 1: On discharge, one patient was prescribed Melphalan and Prednisolone as a 6- day course, to be repeated every 28 days. The G.P. wrote a G.M.S. prescription for a 6-day course every week. The patient had received 16 days of treatment before the error was detected. Incident 2: Patient prescribed Chlorambucil in hospital. The hospital pharmacy dispensed the full course. The patient was discharged after 5 days. Patient was due to receive 7 days of chlorambucil. Patient brought home 2 days supply from hospital. Chlorambucil was also prescribed on the discharge prescription. Patient received another 7 days supply in the community. Patient received 14 days instead of 7 days of treatment.
    • 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)