• Validation of a clinical assessment tool for spinal anaesthesia.

      Breen, D; Bogar, L; Heigl, P; Rittberger, J; Shorten, G D; Department of Anaesthesia and Intensive Care, Cork University Hospital, Ireland. dorothy.breen@hse.ie (2011-07)
      There is a need for a procedure-specific means of assessment of clinical performance in anaesthesia. The aim of this study was to devise a tool for assessing the performance of spinal anaesthesia, which has both content and construct validity.
    • Validation of a norovirus multiplex real-time RT-PCR assay for the detection of norovirus GI and GII from faeces samples.

      Jones, S; Douarre, P E; O'Leary, J; Corcoran, D; O'Mahony, J; Lucey, B; Department of Medical Microbiology, Cork University Hospital, Ireland. (2011)
      Norovirus is a leading cause of infectious non-bacterial gastroenteritis. The virus is highly contagious and has multiple modes of transmission, presenting a growing challenge to hospital-based healthcare. In this study, a total of 120 stool samples are tested for the presence of norovirus GI and GII by the Roche two-step Lightcycler 2.0 assay incorporating primers and probes produced by TIB Molbiol, and the results are compared with results from the National Virus Reference Laboratory. The Roche/TIB Molbiol assay produced 51 positive results and 69 negative results. Discrepancy analysis was performed for six conflicting results using a second real-time polymerase chain reaction (PCR) assay (Roche/TIB Molbiol) and this confirmed that four of the five discrepant positive results were true positives. A single discrepant negative result generated by the Roche assay remained negative using the second assay. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to be 98%, 98.6%, 98.0% and 98.6%, respectively. Melting curve analysis was used to differentiate genogroups I and II and this showed that 92% of strains belonged to genogroup II.
    • Variations in battery life of a heart-lung machine using different pump speeds, pressure loads, boot material, centrifugal pump head, multiple pump usage, and battery age.

      Marshall, Cornelius; Hargrove, Martin; O'Donnell, Aonghus; Aherne, Thomas; Cardiothoracic Unit Cork University Hospital, Wilton, Cork, Ireland., hargrovem@shb.ie (2012-02-03)
      Electrical failure during cardiopulmonary bypass (CPB) has previously been reported to occur in 1 of every 1500 cases. Most heart-lung machine pump consoles are equipped with built-in battery back-up units. Battery run times of these devices are variable and have not been reported. Different conditions of use can extend battery life in the event of electrical failure. This study was designed to examine the run time of a fully charged battery under various conditions of pump speed, pressure loads, pump boot material, multiple pump usage, and battery life. Battery life using a centrifugal pump also was examined. The results of this study show that battery life is affected by pump speed, circuit pressure, boot stiffness, and the number of pumps in service. Centrifugal pumps also show a reduced drain on battery when compared with roller pumps. These elements affect the longevity and performance of the battery. This information could be of value to the individual during power failure as these are variables that can affect the battery life during such a challenging scenario.
    • Vasopressin as a target for antidepressant development: an assessment of the available evidence.

      Scott, Lucinda V; Dinan, Timothy G; Department of Psychiatry, Cork University Hospital, Cork, Ireland., lucinda@gofree.indigo.ie (2012-02-03)
      Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis is one of the key biological abnormalities described in major depressive disorder, occurring in 30-50% of depressed subjects. Corticotropin-releasing hormone (CRH) and vasopressin (AVP) are the main regulators of this stress system, with the two neuropeptides acting synergistically in bringing about adrenocorticotropin (ACTH) release from the anterior pituitary and cortisol from the adrenal gland. Based on the demonstration of elevated cerebrospinal fluid levels of CRH in depressives, and other evidence, it has been postulated that excess CRH and the resultant increased HPA forward drive form the basis of neuroendocrine dysregulation in depression. However, there is an accumulating body of evidence to support a significant role for AVP in the regulation of pituitary-adrenal activity in health and also in depressive disorder. This review, based on a Medline search from 1980 to 2001, focuses on the functional neuroanatomy, receptor pharmacology, VP synergism with CRH, and the data from clinical and pre-clinical studies that support an important role for AVP in the pathophysiology of major depression. We suggest that future antidepressants may target the vasopressinergic system.
    • Venous and arterial thrombo-embolic complications of hormonal treatment in a male-to-female transgender patient.

      Mullins, G M; O'Sullivan, S S; Kinsella, J; McEnroy, D; Crimmins, D; Whyte, S; Sturm, J W; Department of Neurology, Cork University Hospital, Wilton, Cork, Ireland., megager@yahoo.com (2012-02-03)
      We present a male-to-female (MTF) transgender patient admitted with a pulmonary embolism. The patient had been treated with high-dose oestrogens since the age of 16. Following a prolonged period of hypotension, our patient sustained cerebral border zone infarcts. There was evidence of bilateral carotid stenosis on Doppler ultrasound. We discuss the treatment and vascular complications of gender dysphoria.
    • Venous thromboembolism risk and prophylaxis in the acute hospital care setting: the Irish results of the ENDORSE study.

      Murphy, O; O'Connell, O; Liston, R; Connaughton, J; Costello, R; Breiden, J; Doran, P; Gaine, S; Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork. (2012-05)
      ENDORSE (Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting), is a multinational, cross-sectional survey of venous thromboembolism (VTE) risk prevalence and effective prophylaxis in the acute hospital care setting. Three Irish hospitals enrolled in the study. The American College of Chest Physicians (ACCP) guidelines were employed to evaluate VTE risk and prophylaxis. Of 552 patients, 297 (53.8%) and 255 (46.2%) were categorised as surgical or medical, respectively, with 175 (59%) surgical and 109 (43%) medical patients deemed to be at risk for VTE. Of these, only 112 (64%) and 51 (47%) received recommended VTE prophylaxis, respectively. The results are consistent with those observed in other countries and demonstrate a high prevalence of risk for VTE and a low rate of prophylaxis use, particularly in medical patients. Awareness of VTE guidelines should be an integral component of health policy.
    • Venous Thromboembolism – Risk Assessment Tool and Thromboprophylaxis Policy: A National Survey

      Khan, MI; O’Leary, C; Silvari, V; O’Brien, A; O’Connor, M; Duggan, C; O’Shea, S (Irish Medical Journal, 2017-01)
      Venous Thromboembolic (VTE) events in hospitalised patients are associated with significant mortality and morbidity and a major economic burden on the health service. It is well established in the literature that active implementation of a mandatory risk assessment tool and thromboprophylaxis policy reduces the incidence of hospital associated thrombosis (HAT). This study examines the utilization of a VTE risk assessment tool and thromboprophylaxis (TP) policy in Irish hospitals that manage acute admissions. A national survey was distributed to forty acute hospitals throughout Ireland. The response rate was 78% (31/40). The results showed that only 26% (n=8/31) of acute hospitals in Ireland have a local implemented TP policy. Six (75%) of these eight had a risk assessment tool in conjunction with the TP policy. All respondents who did not report to have a TP policy and risk assessment tool agreed that they should implement VTE prevention policy at their hospital. Based on the data from this survey and evidence from the effectiveness of the VTE prevention programme introduced in the United Kingdom, there is a need for a national risk assessment and thromboprophylaxis policy in Ireland. This change in practice would have the potential to prevent or reduce the morbidity and mortality associated with hospital acquired thrombosis
    • The vexed relationship between Clostridium difficile and inflammatory bowel disease: an assessment of carriage in an outpatient setting among patients in remission.

      Clayton, Evelyn M; Rea, Mary C; Shanahan, Fergus; Quigley, Eamonn M M; Kiely, Barry; Hill, Colin; Ross, R Paul; Alimentary Pharmabiotic Centre at Moorepark Food Research Centre, Teagasc, Fermoy Co., Cork, Ireland. (2009-05)
      Comorbidity with Clostridium difficile may cause diagnostic delay in newly presenting inflammatory bowel disease (IBD) patients, trigger relapse in established disease, confound therapies, and serve as an indicator of an underlying defect in innate immunity. Retrospective analyses have suggested community acquisition; to address this we conducted a prospective analysis of C. difficile carriage in IBD patients using molecular methods specifically in an outpatient setting.
    • VGKC positive autoimmune encephalopathy mimicking dementia.

      Molloy, Anna; Cassidy, Eugene; Ryan, Aisling; O' Toole, Orna; Neurology Department, Cork University Hospital, Cork, Ireland. annamolusa@gmail.com (2011)
      Voltage gated potassium channel antibodies (VGKC Abs) are known to cause three rare neurological syndromes- neuromyotonia, Morvan's syndrome and limbic encephalitis although an increasing array of other associated neurological symptoms are becoming recognised. The authors describe the case of a 60-year-old female who presented to the neurology clinic with an apparent early onset dementing process. She was noted to have both extrapyramidal and frontal release signs on examination and was admitted for further evaluation. Her dementia investigation including a neoplastic screen was negative except for VGKC antibody positivity. Her symptoms dramatically improved with commencement of immunosuppression. A non-paraneoplastic VGKC antibody associated dementia-like syndrome has rarely been described. The authors add to the few existing reports of what represents an important reversible cause of cognitive impairment.
    • Video-EEG recording: a four-year clinical audit.

      O'Rourke, K; McNamara, B; Sweeney, B J; Department of Neurology, Cork University Hospital, Wilton, Cork, Republic of, Ireland. (2012-02-03)
      In the setting of a regional neurological unit without an epilepsy surgery service as in our case, video-EEG telemetry is undertaken for three main reasons; to investigate whether frequent paroxysmal events represent seizures when there is clinical doubt, to attempt anatomical localization of partial seizures when standard EEG is unhelpful, and to attempt to confirm that seizures are non-epileptic when this is suspected. A clinical audit of all telemetry performed over a four-year period was carried out, in order to determine the clinical utility of this aspect of the service and to determine means of improving effectiveness in the unit. Analysis of the data showed a high rate of negative studies with no attacks recorded. Of the positive studies approximately 50% showed non-epileptic attacks. Strategies for improving the rate of positive investigations are discussed.
    • Videoconferencing of a national program for residents on evidence-based practice: early performance evaluation.

      O'Regan, Kevin; Marsden, Paul; Sayers, Gerardine; Morrissey, Mary; Hegarty, Heather; Allen, Michael; O'Connor, Owen J; Malone, Dermot; Maher, Michael M; Department of Radiology, Cork University Hospital, Cork, Ireland. (2010)
      The aim of this study was to evaluate the effectiveness of the medium of videoconferencing for the delivery of a course for radiology residents in practice-based learning (PBL), including evidence-based practice, at centers geographically separated from the principal teaching site.
    • A virulent vasculopathy

      Molloy, A.; Forde, D.; De Gascun, C.; Fanning, N.; Wyse, G.; O'Toole, O. (2011)
    • Visual and anatomical success with short-term macular tamponade and autologous platelet concentrate.

      Mulhern, M G; Cullinane, A; Cleary, P E; National University of Ireland Cork, Department of Ophthalmology, Cork University, Hospital, Ireland. (2012-02-03)
      BACKGROUND: This study aimed to determine whether, in eyes treated for macular hole by vitrectomy and autologous platelet injection, short-term tamponade with SF6 gas was as effective as longer tamponade with C3F8 gas. METHODS: Patients in group 1 (n=31) had vitrectomy, injection of platelet concentrate, and 16% C3F8 gas/air exchange. Patients in group 2 (n=31) were similarly treated, except that 23% SF6 gas was used. Group 1 patients were required to posture prone for 2-4 weeks, group 2 for 6 days. RESULTS: All patients had 3 months' follow-up. Postoperatively, visual acuity improved faster in group 2. However, the final mean improvement in logMAR acuity was similar in both groups. Intraocular pressure (IOP) spikes occurred in 12 patients in group 2 and in 17 patients in group 1. Posterior subcapsular cataract (PSCC) occurred in 55% of cases in group 1 and in just 37% in group 2. The rate of anatomical success in group 1 was 96.7%, and in group 2, 93.5% (P=1.0). CONCLUSIONS: The combination of SF6 gas, platelet concentrate, and short-term prone posturing gave a degree of anatomical and visual success comparable to that of the group which had longer tamponade. Although no differences were statistically significant, several trends did emerge; in group 2, patients recovered visual acuity faster, had fewer IOP spikes, and there were fewer cases of PSCC formation.
    • Vitamin D deficiency: the time to ignore it has passed.

      Haroon, Muhammad; Regan, Michael J; Department of Rheumatology, Cork University Hospital, National University of Ireland, Cork, Ireland. mharoon301@hotmail.com (2010-10)
      It is true to say that it is just over the past decade and even more so in this new decade that it has become appreciated how vitally important vitamin D is for optimum health. This 'sunshine' vitamin could justifiably be called 'the nutrient of this decade'. Until recently, vitamin D was known primarily for its role in bone health. However, as a result of advances in research this perspective has changed. While it is true to say that the classic function of vitamin D is to control calcium and vitamin D metabolism, we now know that the importance of vitamin D spreads far wider than just bone health. There is much ongoing research with regard to its emerging role in immunopathology, as a potent inhibitor of cellular growth, stimulator of insulin secretion, modulator of immune function and inhibitor of renin production. This review discusses the current evidence with regard to the clinical consequences of vitamin D deficiency and underscores the fact that physicians should be vigilant in searching for and treating this preventable and treatable condition. Furthermore, this review highlights the fact that the time is opportune for rheumatologists to agree upon clinical guidelines to advise practitioners as to when and in which patients to check for, what target vitamin D level to aim for and how best to treat vitamin D deficiency.
    • Volar dislocation of the index carpometacarpal joint in association with a Bennett's fracture of the thumb: a rare injury pattern.

      Dillon, J P; Laing, A J; Thakral, R; Buckley, J M; Mahalingam, K; Department of Orthopaedics, Cork University Hospital, Wilton, Co. Cork, Ireland. , dillonjp@o2.ie (2012-02-03)
      We describe a case of volar dislocation of the index carpometacarpal (CMC) joint in association with a Bennett's fracture of the thumb following a motorcycle accident. Volar dislocation of the index carpometacarpal joint is an exceedingly rare but easily missed injury, with only a few reported cases in the literature. This report highlights the importance of a true lateral radiograph and close scrutiny of the film to detect this injury. Closed reduction supplemented with Kirschner wire fixation restored normal anatomical relations and achieved an excellent clinical result.
    • VR-based training and assessment in ultrasound-guided regional anesthesia: from error analysis to system design.

      Lövquist, Erik; O'Sullivan, Owen; Oh'Ainle, Donnchadh; Baitson, Graham; Shorten, George; Avis, Nick; National Digital Research Centre, Ireland. eriklovquist@gmail.com (2011)
      If VR-based medical training and assessment is to improve patient care and safety (i.e. a genuine health gain), it has to be based on clinically relevant measurement of performance. Metrics on errors are particularly useful for capturing and correcting undesired behaviors before they occur in the operating room. However, translating clinically relevant metrics and errors into meaningful system design is a challenging process. This paper discusses how an existing task and error analysis was translated into the system design of a VR-based training and assessment environment for Ultrasound Guided Regional Anesthesia (UGRA).
    • Waking up to darkness.

      Lowney, Aoife C; Ryan, Stephen A; Ryan, Andrea; Harney, Sinead; Department of Rheumatology, Cork University Hospital, Wilton, Cork, Ireland. aoifelowney@gmail.com (2011-08)
    • Wegener's granulomatosis of the main pulmonary arteries: imaging findings.

      Doyle, D J; Fanning, N F; Silke, C S; Salah, S; Burke, L; Molloy, M; Spence, L; Radiology Department, Cork University Hospital, Wilton, Cork, Ireland., doyledj@hotmail.com (2012-02-03)
    • Weight gain is associated with improved glycaemic control but with adverse changes in plasma lipids and blood pressure isn Type 1 diabetes.

      Ferriss, J B; Webb, D; Chaturvedi, N; Fuller, J H; Idzior-Walus, B; Department of Medicine, Cork University Hospital, Wilton, Cork, Ireland., b.ferriss@ucc.ie (2012-02-03)
      AIMS: To assess the effects of weight gain on metabolic control, plasma lipids and blood pressure in patients with Type 1 diabetes. METHODS: Patients in the EURODIAB Prospective Complications Study (n = 3250) were examined at baseline and 1800 (55%) were re-examined a mean of 7.3 years later. Patients had Type 1 diabetes, defined as a diagnosis made before age 36 years and with a need for continuous insulin therapy within a year of diagnosis. Patients were aged 15-60 years at baseline and were stratified for age, sex and duration of diabetes. RESULTS: The change in HbA(1c) from baseline to follow-up examination was significantly more favourable in those who gained 5 kg or more during follow-up ('marked weight gain') than in patients who gained less or no weight or lost weight ('less or no weight gain'). In those with marked weight gain, there was a significantly greater rise in plasma triglycerides and total cholesterol and significantly less favourable changes in low-density lipoprotein and high-density lipoprotein cholesterol compared with those with less or no weight gain, with or without adjustment for HbA(1c). Systolic and diastolic blood pressure also rose significantly more in the group with marked weight gain. CONCLUSION: Weight gain in patients with Type 1 diabetes has adverse effects on plasma lipids and blood pressure, despite a small improvement in glycaemic control.
    • What a signature adds to the consent process.

      Neary, Peter; Cahill, Ronan A; Kirwan, W O; Kiely, E; Redmond, H P; Department of Surgery, Cork University Hospital, Cork, Ireland. (2012-02-03)
      BACKGROUND: "Consent is a process by which a patient is informed and becomes a participant in decisions regarding their medical management." It is argued, however, that providing a signature to a form adds little to the quality of this process. METHODS: Views regarding the consent ritual of nonselected patients undergoing endoscopy (cystoscopy or sigmoidoscopy) were prospectively studied together with those of the attending staff. Patient volunteers were randomly assigned to one of two groups and given verbal explanation before the procedure, either alone (group A) or with a request to sign a form in addition (group B). A standardized questionnaire regarding preferences then was applied. RESULTS: A total of 37 patients (22 men) were studied along with seven staff members. Most surveyed felt that signing a consent form helped to empower the patient (group A, 84%; group B, 83%; staff, 100%). Although the patients mainly believed that it functioned primarily to protect the hospital and doctor (group A, 89%; group B, 67%), only one patient (3% of total) felt that such a formality undermined the patient-doctor relationship. Most staff members favored signing a form (86%). The majority of patients either favored it (group A, 47%; group B, 78%) or expressed no strong preference (group A, 32%; group B, 11%). Interestingly, more women than men preferred signing (73 vs. 55%; p = 0.25), perhaps because more women believed that it functioned to preserve autonomy (93 vs. 77% of men). Age was no particular determinant of perspective. CONCLUSION: Although it may be viewed as primarily serving to protect the doctor and hospital, the formal process of signing written consent forms appeals to patients and staff.