Research affiliated to staff at the Mater Misericordiae University Hospital

Recent Submissions

  • Transcatheter Mitral Valve-in-Ring Implantation

    Tanner, RE; McCarthy, J; Walsh, K P; Blake, G; Casserly, I P (Irish Medical Journal, 2018-05)
    Failed surgical mitral valve repair using an annuloplasty ring has traditionally been treated with surgical valve replacement or repair1. For patients at high risk for repeat open heart surgery, placement of a trans-catheter aortic valve (i.e., TAVI valve) within the mitral ring (i.e., Mitral-Valve-in-Ring, MViR) has emerged as a novel alternative treatment strategy2-5 . We describe our experience of a failed mitral valve repair that was successfully treated with a TAVI valve delivered via the trans-septal approach, and summarise the data relating to this emerging treatment strategy.
  • Iatrogenic Bowel Injury at Exchange of Supra-Pubic Catheter

    Foran, AT; Nason, GJ; Rohan, P; Keane, GM; Connolly, S; Hegarty, N; Galvin, D; O’Malley, KJ (Irish Medical Journal, 2018-04)
    Suprapubic catheter insertion and exchange is a common urological procedure, but it is not without risks and complications. While bowel perforation is a recognised complication at suprapubic catheter insertion, it is not commonly reported at suprapubic catheter exchange. We report our experience of recognition, diagnosis and subsequent successful management of the most important complication related to suprapubic catheters.
  • Is The Consent Process Appropriate - The Interns’ Perspective?

    Rohan, P; Keane, K; Nason, GJ; Caulfield, RH (Irish Medical Journal (IMJ), 2018-04)
    Consent is an integral component to any medical procedure involving a competent patient, a communicating doctor, and transfer of information about the procedure. The aim of this study was to assess interns’ experience of the consent process.
  • Outcomes of a Clinical Leadership Training Program Amongst Hospital Doctors

    Kelly, D; McErlean, S; Naff, K (Irish Medical Journal, 2018-04)
    To evaluate the effectiveness of formal leadership training amongst medical trainees and to review the current literature in this area
  • Bacteraemia in the ED: Are We Meeting Targets?

    Borhan, N; Borhan, F; Ni Cheallaigh, C; Dinesh, B; O’Reilly, K; Moughty, A (Irish Medical Journal, 2018-03)
    When sepsis is identified early in the Emergency Department (ED) and its severe form is treated aggressively with the protocolised care bundle of early goal directed therapy (EGDT), improvements in mortality are significant1,2. Surviving sepsis guidelines recommend the administration of effective intravenous antimicrobials within the first hour of recognition of septic shock and severe sepsis without septic shock3. The Mater University Hospital has antimicrobial guidelines to guide empiric prescribing in adult sepsis available on the hospital intranet and on a smartphone app.
  • A Borderline Ovarian Tumour in a Patient with Classic Bladder Exstrophy; a Case Report.

    Beauchamp, K; Ryan, G; Gibney, B; Walsh, T; Brennan, D (Irish Medical Journal, 2018-02)
    A 37-year-old Romanian lady presented with a large pelvic mass, urosepsis and deteriorating renal function. She had undergone separation from her conjoined twin. Imaging revealed grossly abnormal anatomy and a suspicious pelvic mass. Examination was consistent with classic bladder exstrophy. Postoperative histology showed borderline ovarian tumour (BTO)
  • New Delhi Metallo-Β-Lactamase-Producing Carbapenem-Resistant Enterobacteriacae Isolated From Bronchial Washings.

    Cullivan, S; Brady, DM; O’Callaghan, DS (Irish Medical Journal, 2017-11)
    The prevalence of Carbapenem resistance among Enterobacteriacae species is increasing and poses a potential major public health risk. In recent years, several new carbapenemases have been identified, including New Delhi metallo-β-lactamase (NDM). A 78-year-old non-smoking female with prior medical history of type 2 diabetes mellitus, gastroesophageal reflux disease (GERD) and prior coronary artery bypass grafting was referred to our respiratory outpatient service for evaluation of a chronic cough and dyspnoea in 2013. Clinical examination revealed bibasal pulmonary crepitations but was otherwise unremarkable. Computed tomography of the chest demonstrated atelectasis of the lingula and right middle lobe. She underwent bronchoscopy, which demonstrated laryngeal mucosa inflammation, consistent with her GERD. There was no growth on bacterial, fungal or mycobacterial bronchial washings cultures.
  • Epithelioid Angiomyolipoma – a case report and review of the literature

    Keane, F; Harrold, E; Barrett, C; McCaffrey, J (Irish Medical Journal, 2017-08)
    Herein we present the case of a 43-year-old female in whom a left renal mass was identified incidentally on imaging performed for staging of a newly diagnosed breast carcinoma. The mass was resected and histologic examination and immunohistochemistry confirmed a diagnosis of epithelioid angiomyolipoma
  • Survey of Bereaved Relatives: VOICES MaJam

    O Coimín, Diarmuid; Korn, Bettina; Prizeman, Geraldine; Donnelly, Sarah; Hynes, Geralyn; Curran, Mairead; Codd, Margaret (Mater Misericordiae University Hospital and St. James’s Hospital, Dublin, 2017-06)
    The report presents findings and recommendations from the largest survey of bereaved relatives undertaken by two adult acute hospitals in Ireland in conjunction with their academic partners TCD and UCD. The findings provide significant insight into the quality of care delivered at end of life from the perspective of bereaved relatives. This report will be of interest to all healthcare staff involved in improving end-of-life care in acute hospitals and other healthcare settings.
  • The Hidden Burden of Outpatient Repeat PSA Testing in a Prospective Cohort

    Browne, E; O'Kelly, F; Lundon, D; Daly, P; Galvin, D; Hegarty, N; Connolly, S; O'Malley, K (Irish Medical Journal, 2017-05)
    PSA testing is widespread throughout Europe for diagnostic purposes and follow up. We performed a prospective outpatient cohort study of 250 men (2013-2015) in two hospital sites. Included were those men being followed up by urology with PSA blood testing. First appointments and those men in whom non-PSA tests were ordered by urology were excluded. The median age was 67.2yrs (46-88). Eighty-one point two percent of samples had a combination of 21 different serology tests at an added cost of >€18,000. Abnormal serology resulted in 53 referrals. Twenty-six-six percentof correspondence referenced abnormal serology other than PSA. Follow up of non-PSA test results poses a challenge in an outpatient setting with failure to appropriately follow-up on abnormal results, increased costs, and medico-legal implications. There is currently no Irish legislature in place to safeguard hospital physicians. This study quantifies the levels of expenditure, resources and risk associated with ambulant PSA testing.
  • A role for susceptibility weighted imaging in progressive multifocal leukoencephalopathy

    Yap, SM; Murray, B; Lynch, T; Kavanagh, E; MacMahon, P (Irish Medical Journal, 2017-04)
    We report a radiologic finding on magnetic resonance imaging (MRI) of the brain of two cases of progressive multifocal leukoencephalopathy (PML) of hypointense signal of subcortical U-fibres on susceptibility weighted (SW) sequence. The first case is a 50-year-old man recently treated with chemotherapy including rituximab for non-Hodgkin's lymphoma. The second case is a 64-year-old woman with human immunodeficiency virus (HIV) infection. Iron deposition is a likely causative factor. We propose that SWI may be especially useful in the assessment of indeterminate cases to reduce the likelihood of a missed diagnosis of PML
  • Post Traumatic Tension Pneumocephalus: The Mount Fuji Sign

    Ryan, J; Shields, G; Finegan, E; Moughty, A (Irish Medical Journal, 2017-04)
    Pneumocephalus is defined as the presence of intracranial air. This is most commonly secondary to a traumatic head injury. Tension pneumocephalus presents radiologically with compression of the frontal lobes and widening of the interhemispheric space between the frontal lobes. It is often termed the Mount Fuji sign due to a perceived similarity with an iconic mountain peak in Japan. We present the case of a 52-year-old gentleman who presented to the emergency department shortly before 8am on a Saturday morning following an assault. He was alert and ambulatory with no clinical evidence of raised intracranial pressure. A plain radiograph of the facial bones showed significant pneumocephalus. A later CT was consistent with a tension pneumocephalus which usually necessitates urgent decompression.The patient showed no clinical signs or symptoms of raised intracranial pressure and was managed conservatively. He was discharged home 16 days later with no neurological deficit
  • Multidisciplinary emergent removal of a metal penoscrotal constriction device

    Nason, GJ; Abdelsadek, AH; Foran, AT; O’Malley, KJ (Irish Medical Journal, 2017-03)
    Strangulation of the genital organs is a rare presentation to the emergency department which requires urgent intervention to avoid long term complications. Penoscrotal constriction devices are either used for autoerotic stimulus or to increase sexual performance by maintaining an erection for a longer period. We report a case of a man who presented with penile strangulation following the application of a titanium penoscrotal constriction ring during sexual intercourse seven hours previously. The Fire Brigade department attended with an electric operated angle grinder to facilitate removal of the ring as standard medical equipment (orthopaedic saws, bolt and bone cutters) were insufficient. Fully functional recovery was achieved.
  • Improving time to surgery for hip fracture patients. Impact of the introduction of an emergency theatre

    French-O’Carroll, F; McDonagh, F; Flood, G (Irish Medical Journal, 2017-01)
    Hip fractures are a major cause of morbidity and mortality1. Surgery performed on the day of or after admission is associated with improved outcome2,3. An audit cycle was performed examining time to surgery for hip fracture patients. Our initial audit identified lack of theatre space as one factor delaying surgery. A dedicated daytime emergency theatre was subsequently opened and a re-audit was performed to assess its impact on time to surgery. Following the opening of the theatre, the proportion of patients with a delay to hip fracture surgery greater than 36 hours was reduced from 49% to 26% with lack of theatre space accounting for 23% (3 of 13) of delayed cases versus 28.6% (9 of 32) previously. 44% of hip fracture surgeries were performed in the emergency theatre during daytime hours, whilst in-hospital mortality rose from 4.6% to 6%. We conclude that access to an emergency theatre during daytime hours reduced inappropriate delays to hip fracture surgery.
  • Diagnosing Lynch Syndrome

    Gleeson, J; Gallagher, D (Irish Medical Journal, 2016-11)
    Lynch Syndrome, also known as Hereditary Non-Polyposis Colorectal Cancer (HNPCC), is a hereditary condition that increases an individual’s risk of developing a constellation of cancers. These most commonly arise in the colon, but also involve other solid organs such as the endometrium and ovaries in women, the stomach, brain and the skin. Ireland’s small population offers an opportunity to identify all those with Lynch Syndrome (LS) in the country, which would represent a powerful preventive opportunity to meaningfully impact on the incidence of cancer in Ireland.
  • Transitioning high sensitivity cardiac troponin I (hs-cTnI) into routine diagnostic use: More than just a sensitivity issue

    Lee, Graham R; Browne, Tara CA; Guest, Berna; Khan, Imran; Murphy, Eamon; McGorrian, Catherine; Mahon, Niall G; Fitzgibbon, Maria C (Practical Laboratory Medicine, 2016-04)
    High sensitivity cardiac troponin T and I (hs-cTnT and hs-cTnI) assays show analytical, diagnostic and prognostic improvement over contemporary sensitive cTn assays. However, given the importance of troponin in the diagnosis of myocardial infarction, implementing this test requires rigorous analytical and clinical verification across the total testing pathway. This was the aim of this study.
  • Culture Negative Infective Endocarditits: a Changing Paradigm

    Daly, A; Redmond, JM; Hannan, MM (Irish Medical Journal, 2016-05)
    Traditionally, the modified Duke's criteria, based primarily on positive blood cultures, is used to diagnose Infective Endocarditis (IE). However, reports demonstrate that 31% of cases are diagnosed as Culture Negative Infective Endocarditis (CNIE)1. Consequently, empiric broad-spectrum antibiotics are prescribed to cover unidentified organisms and, as a result, antibiotic therapy may be compromised. Molecular diagnostic techniques aid with identifying causative organisms in cases of CNIE and we question if the increasing use of such technologies will change the local epidemiology of CNIE. We present the first case of Tropheryma whipplei Infective Endocarditis (TWIE) reported in Ireland.
  • Knowledge, Skills and Experience Managing Tracheostomy Emergencies: A Survey of Critical Care Medicine trainees

    Nizam, AA; Ng, SC; Kelleher, M; Hayes, N; Carton, E (Irish Medical Journal, 2016-10)
    Since the development of percutaneous tracheostomy, the number of tracheostomy patients on hospital wards has increased. Problems associated with adequate tracheostomy care on the wards are well documented, particularly the management of tracheostomy-related emergencies. A survey was conducted among non-consultant hospital doctors (NCHDs) starting their Critical Care Medicine training rotation in a university affiliated teaching hospital to determine their basic knowledge and skills in dealing with tracheostomy emergencies. Trainees who had received specific tracheostomy training or who had previous experience of dealing with tracheostomy emergencies were more confident in dealing with such emergencies compared to trainees without such training or experience. Only a minority of trainees were aware of local hospital guidelines regarding tracheostomy care. Our results highlight the importance of increased awareness of tracheostomy emergencies and the importance of specific training for Anaesthesia and Critical Care Medicine trainees.
  • Accrual to Cancer Clinical Trials

    Kelly, C; Smith, M; Flynn, S; Reyes, A; Higgins, M; McCaffrey, J; Kelly, C (Irish Medical Journal, 2016-07)
    Accrual to cancer clinical trials (CCT) is imperative to safeguard continued improvement in cancer outcomes. A retrospective chart review was performed of patients (n=140) starting a new anti-cancer agent in a north Dublin cancer centre. This review was performed over a four-month period, beginning in November 2015. Only 29% (n=41) had a CCT option. The overall accrual rate to CCT was 5% (n=7), which is comparable to internationally reported figures. The main reasons for failure to recruit to CCT included the lack of a CCT option for cancer type (n=30, 23%), stage (n=25, 19%), and line of treatment (n=23, 17%). Over the last decade, the rate of accrual to CCTs has in fact doubled and the number of trials open to recruitment has tripled. Ongoing governmental and philanthropic support is necessary to continue this trend to further expand CCT patient options with a target accrual rate of 10%.
  • National survey of CT colonography practice in Ireland

    Smyth, A.E.; Healy, C.F.; Aherne, E.A.; MacMathuna, P.; Morrin, M.M.; Fenlon, H.M. (Irish Medical Journal, 2016-06)
    CT Colonography was first introduced to Ireland in 1999. Our aim of this study is to review current CT Colonography practices in the Republic of Ireland. A questionnaire on CT Colonography practice was sent to all non-maternity adult radiology departments in the Republic of Ireland with a CT scanner. The results are interpreted in the context of the recommendations on CT Colonography quality standards as published by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus statement in the journal of European Radiology in 2013. Thirty centres provide CT Colonography; 21 of which responded (70%). Each centre performs median 90 studies per year; the majority follow accepted patient preparation and image acquisition protocols. Seventy-six percent of the centres repsonded that the majority of patients imaged are symptomatic. Of the 51 consultant radiologists reading CT Colonography, 37 (73%) have attended a CT Colonography course. In 17 (81%) of the centres the studies are single read although 81% of the centres have access to a second radiologist’s opinion. Fourteen (67%) of the centres reported limited access to CT scanner time as the major limiting factor to expanding their service. CT Colonography is widely

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