Research by staff affiliated to Connolly Hospital, Blanchardstown

Recent Submissions

  • Magnetic Stent Removal in a Nurse-Led Clinic; a Nine-Month Experience.

    O’Connell, L; Broe, MP; Rooney, D; Elhag, S; Cheema, I; McGuire, BB (Irish Medical Journal, 2018-02)
    Ureteric stents are frequently inserted post endourological procedures. However, subsequent endoscopic stent removal requires a second procedure for the patient and the availability of necessary resources. Longer duration of indwelling stents can lead to increased risk of symptoms and complications. The use of magnetic stents removed with a magnetic retrieval device (BlackStar©), offers an alternative which obviates the need for cystoscopy. We assessed the outcomes for this novel method of stent removal in our institution. A retrospective analysis was performed of all patients undergoing magnetic stent insertion and subsequent removal in a nurse-led clinic over a nine-month period. Patients were followed up with a prospective validated Ureteral Stent Symptoms Questionnaire (USSQ)3. A cost analysis was also performed. In total, 59 patients were treated using magnetic stents. The complication rate was low (6.7%). The median duration of indwelling stent was 5.8 days (range 1-11 days). Patients reported haematuria and lower urinary tract symptoms but >90% experienced no functional impairment with minimal days of employment lost (mean 0.75 days). All patients reported satisfaction with nurse-led stent removal and 97% were happy to have stents removed via this method in the future. The total financial savings were estimated at €47,790 over this period. Nurse-led removal of magnetic stents is safe and well tolerated by patients and enables expedient stent removal. It also provides a significant cost benefit and frees up valuable endoscopic resources.
  • Identifying factors that influence the ‘6-hour target’ in the Emergency Department by applying Regression Analysis.

    Borhan, F; Borhan, N; Ahmed, S; Varghese, L; O’Conor, E (Irish Medical Journal, 2018-02)
    To determine factors within the Emergency Department (ED) that have maximum influence on the ‘6-hour target’.
  • A Retrospective Audit of In-Hospital 30-day Mortality from Acute Myocardial Infarction in Connolly Hospital Blanchardstown

    Hensey, M; Cronin, M; Keelan, E; O’Neill, J; Galvin, J (Irish Medical Journal, 2017-09)
    In 2015, The Department of Health published the first annual report of the “National Healthcare Quality Reporting System.” Connolly Hospital was reported to a mortality rate within 30 days post-Acute Myocardial Infarction (AMI) of 9.87 per 100 cases which was statistically significantly higher than the national rate. We carried out a retrospective audit of patients who were HIPE-coded as having died within 30 days of AMI from 2011-2013 and identified 42 patients. On review, only 23 patients (54.8%) were confirmed as having had an AMI. We identified 12 patients who had AMI included on death certificate without any evidence for same. If the 22 patients incorrectly coded were excluded, the mortality rate within 30 days post-AMI in CHB would fall to 4.14 deaths per 100 cases, well below the national average. Inaccuracies of data collection can lead to erroneous conclusions when examining healthcare data.
  • An unusual case of multiple self-inflicted punctures to the precordium

    Borhan, F; Borhan, N; O’Riordan, B (Irish Medical Journal, 2017-06)
    Sewing needles, albeit a rare case of penetrating cardiac injury, are potentially life-threatening. We report a case of successful intra-cardiac needle removal from a 32 year old who inserted multiple needles into the chest and abdomen.
  • Imitation, the greatest form of flattery?

    Murphy, A; Parihar, V; Shahin, A; Farrell, R (Irish Medical Journal, 2016-01)
    A recent interesting case at our institution reminded us to remain cognisant of the oldest known venereal disease; known as the great imitator , syphilis is a sexually transmitted infection caused by the spirochete Treponema pallidum
  • Clinical characteristics, management, and control of permanent vs. nonpermanent atrial fibrillation: insights from the RealiseAF survey.

    Murin, Jan; Naditch-Brûlé, Lisa; Brette, Sandrine; Chiang, Chern-En; O'Neill, James; Steg, P Gabriel; 5Connolly/Mater Hospitals/Royal College of Surgeons in Ireland, Dublin, Ireland. (PLoS ONE, 2014)
    Atrial fibrillation can be categorized into nonpermanent and permanent atrial fibrillation. There is less information on permanent than on nonpermanent atrial fibrillation patients. This analysis aimed to describe the characteristics and current management, including the proportion of patients with successful atrial fibrillation control, of these atrial fibrillation subsets in a large, geographically diverse contemporary sample.
  • Major cost savings associated with biologic dose reduction in patients with inflammatory arthritis.

    Murphy, C L; Awan, S; Sullivan, M O; Chavrimootoo, S; Bannon, C; Martin, L; Duffy, T; Murphy, E; Barry, M (Irish Medical Journal, 2015-01)
    The purpose of this study was to explore whether patients with Inflammatory Arthritis (IA) (Rheumatoid Arthritis (RA), Psoriatic Arthritis (PsA) or Ankylosing Spondylitis (AS)) would remain in remission following a reduction in biologic dosing frequency and to calculate the cost savings associated with dose reduction. This prospective non-blinded non-randomised study commenced in 2010. Patients with Inflammatory Arthritis being treated with a biologic agent were screened for disease activity. A cohort of those in remission according to standardized disease activity indices (DAS28 < 2.6, BASDAI < 4) was offered a reduction in dosing frequency of two commonly used biologic therapies (etanercept 50 mg once per fortnight instead of weekly, adalimumab 40 mg once per month instead of fortnightly). Patients were assessed for disease activity at 3, 6, 12, 18 and 24 months following reduction in dosing frequency. Cost saving was calculated. 79 patients with inflammatory arthritis in remission were recruited. 57% had rheumatoid arthritis (n = 45), 13% psoriatic arthritis (n = 10) and 30% ankylosing spondylitis (n = 24). 57% (n = 45) were taking etanercept and 43% (n = 34) adalimumab. The percentage of patients in remission at 24 months was 56% (n = 44). This resulted in an actual saving to the state of approximately 600,000 euro over two years. This study demonstrates the reduction in biologic dosing frequency is feasible in Inflammatory Arthritis. There was a considerable cost saving at two years. The potential for major cost savings in biologic usage should be pursued further.
  • Re-attenders to the emergency department of a major urban hospital serving a population of 290,000.

    Ramasubbu, B; Lee, B; Collins, N (Irish Medical Journal, 2015-01)
    The national Emergency Medicine Programme (EMP) in Ireland, defines a re-attender as any patient re-presenting to the Emergency Department (ED) within 28 days with the same chief complaint. A retrospective, electronic patient record audit was carried out on all re-attenders to Connolly ED during November 2012. There were 2919 attendances made up from 2530 patients; 230 patients re-attended a total of 389 times. The re-attendance rate was 13% (389/2919). 63 (27%) were frequent presenters. There was a significantly higher admission rate at second attendance than first (89 (39%) vs 39 (17%), p < 0.001). 25% (57/230) of patients 'left before completion of treatment' (LBCT) at first attendance (significantly higher than the number at second attendance (p < 0.01)). 14/57 (25%) of those who LBCT at first attendance required admission at second attendance. 28/89 (31%) of second attendance admissions were failed discharges from first attendance. Reasons for re-attendance are multi-factorial and include both patient and departmental factors.
  • Short-term blood pressure variability over 24 h and target organ damage in middle-aged men and women.

    Madden, J M; O'Flynn, A M; Dolan, E; Fitzgerald, A P; Kearney, P M (2015-03-19)
    Blood pressure variability (BPV) has been associated with cardiovascular events; however, the prognostic significance of short-term BPV remains uncertain. As uncertainty also remains as to which measure of variability most accurately describes short-term BPV, this study explores different indices and investigates their relationship with subclinical target organ damage (TOD). We used data from the Mitchelstown Study, a cross-sectional study of Irish adults aged 47-73 years (n=2047). A subsample (1207) underwent 24-h ambulatory BP monitoring (ABPM). As measures of short-term BPV, we estimated the s.d., weighted s.d. (wSD), coefficient of variation (CV) and average real variability (ARV). TOD was documented by microalbuminuria and electrocardiogram (ECG) left ventricular hypertrophy (LVH). There was no association found between any measure of BPV and LVH in both unadjusted and fully adjusted logistic regression models. Similar analysis found that ARV (24 h, day and night), s.d. (day and night) and wSD were all univariately associated with microalbuminuria and remained associated after adjustment for age, gender, smoking, body mass index (BMI), diabetes and antihypertensive treatment. However, when the models were further adjusted for the mean BP the association did not persist for all indices. Our findings illustrate choosing the appropriate summary measure, which accurately captures that short-term BPV is difficult. Despite discrepancies in values between the different measures, there was no association between any indexes of variability with TOD measures after adjustment for the mean BP.Journal of Human Hypertension advance online publication, 19 March 2015; doi:10.1038/jhh.2015.18.
  • Vitamin D as an adjunctive therapy in asthma. Part 2: A review of human studies.

    Kerley, Conor P; Elnazir, Basil; Faul, John; Cormican, Liam (2015-03-05)
    Vitamin D deficiency (VDD) is highly prevalent worldwide, with adverse effects on bone health but also potentially other unfavorable consequences. VDD and asthma-incidence/severity share many common risk factors, including winter season, industrialization, poor diet, obesity, dark skin pigmentation, and high latitude. Multiple anatomical areas relevant to asthma contain both the enzyme responsible for producing activated vitamin D and the vitamin D receptor suggesting that activated vitamin D (1,25-dihydroxyvitamin D) may have important local effects at these sites. Emerging evidence suggests that VDD is associated with increased airway hyperresponsiveness, decreased pulmonary function, worse asthma control, and possibly decreased response to standard anti-asthma therapy. However the effect is inconsistent with preliminary evidence from different studies suggesting vitamin D is both beneficial and detrimental to asthma genesis and severity. Current evidence suggests that supplementation with moderate doses of vitamin D may be appropriate for maintenance of bone health in asthmatics, particularly steroid users. However emerging data from an increasing number of randomized, controlled, intervention studies of vitamin D supplementation in pediatric and adult asthma are becoming available and should help determine the importance, if any of vitamin D for asthma pathogenesis. The purpose of this second of a two-part review is to review the current human literature on vitamin D and asthma, discussing the possible consequences of VDD for asthma and the potential for vitamin D repletion as adjunct therapy.
  • Validating the 5Fs mnemonic for cholelithiasis: time to include family history.

    Bass, Gary; Gilani, S Nadia S; Walsh, Thomas N (2013-11)
    The time-honoured mnemonic of '5Fs' is a reminder to students that patients with upper abdominal pain and who conform to a profile of 'fair, fat, female, fertile and forty' are likely to have cholelithiasis. We feel, however, that a most important 'F'-that for 'family history'-is overlooked and should be introduced to enhance the value of a useful aide memoire.
  • Methotrexate use and risk of lung disease in psoriasis, psoriatic arthritis, and inflammatory bowel disease: systematic literature review and meta-analysis of randomised controlled trials.

    Conway, Richard; Low, Candice; Coughlan, Robert J; O'Donnell, Martin J; Carey, John J (2015)
    To evaluate the relative risk of pulmonary disease among patients with psoriasis, psoriatic arthritis, and inflammatory bowel disease treated with methotrexate.
  • Implant failure caused by non-union of bisphosphonate-associated subtrochanteric femur fracture.

    O'Neill, Barry James; O'hEireamhoin, Sven; Morrissey, David I; Keogh, Peter; Department of Trauma & Orthopaedics, Connolly Hospital, Dublin, Ireland. (2014-04-03)
    Bisphosphonate use has been identified as a contributory factor in atypical subtrochanteric fracture of the femur. These fractures are commonly treated with an intramedullary device. We present a case of implant failure of an intrameduallary device caused by non-union of an atypical subtrochanteric fracture.
  • Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension (the ROX CONTROL HTN study): a randomised controlled trial.

    Lobo, Melvin D; Sobotka, Paul A; Stanton, Alice; Cockcroft, John R; Sulke, Neil; Dolan, Eamon; van der Giet, Markus; Hoyer, Joachim; Furniss, Stephen S; Foran, John P; Witkowski, Adam; Januszewicz, Andrzej; Schoors, Danny; Tsioufis, Konstantinos; Rensing, Benno J; Scott, Benjamin; Ng, G André; Ott, Christian; Schmieder, Roland E (2015-01-22)
    Hypertension contributes to cardiovascular morbidity and mortality. We assessed the safety and efficacy of a central iliac arteriovenous anastomosis to alter the mechanical arterial properties and reduce blood pressure in patients with uncontrolled hypertension.
  • Vitamin D as an adjunctive therapy in asthma. Part 1: A review of potential mechanisms.

    Kerley, Conor P; Elnazir, Basil; Faul, John; Cormican, Liam (2015-02-27)
    Vitamin D deficiency (VDD) is highly prevlalent worldwide. The classical role for vitamin D is to regulate calcium absorption form the gastrointestinal tract and influence bone health. Recently vitamin D receptors and vitamin D metabolic enzymes have been discovered in numerous sites systemically supporting diverse extra-skeletal roles of vitamin D, for example in asthmatic disease. Further, VDD and asthma share several common risk factors including high latitude, winter season, industrialization, poor diet, obesity, and dark skin pigmentation. Vitamin D has been demonstrated to possess potent immunomodulatory effects, including effects on T cells and B cells as well as increasing production of antimicrobial peptides (e.g. cathelicidin). This immunomodulation may lead to asthma specific clinical benefits in terms of decreased bacterial/viral infections, altered airway smooth muscle-remodeling and -function as well as modulation of response to standard anti-asthma therapy (e.g. glucocorticoids and immunotherapy). Thus, vitamin D and its deficiency have a number of biological effects that are potentially important in altering the course of disease pathogenesis and severity in asthma. The purpose of this first of a two-part review is to review potential mechanisms whereby altering vitamin D status may influence asthmatic disease.
  • Impact of antihypertensive combination and monotreatments on blood pressure variability: assessment by old and new indices. Data from a large ambulatory blood pressure monitoring database.

    Parati, Gianfranco; Dolan, Eamon; Ley, Ludwin; Schumacher, Helmut (2014-06)
    High 24-h ambulatory blood pressure (ABP) variability is associated with poor cardiovascular outcomes. We analysed a large ABP monitoring database containing data from hypertensive patients treated with telmisartan/amlodipine combination or various monotherapies with the aim of quantifying the 24-h distribution of blood pressure (BP) reduction by treatment through the smoothness index and of developing and testing a new treatment-on-variability index (TOVI) to quantify the effects of treatment on both mean BP and BP variability.
  • Dietary nitrate supplementation in COPD: An acute, double-blind, randomized, placebo-controlled, crossover trial.

    Kerley, Conor P; Cahill, Kathleen; Bolger, Kenneth; McGowan, Aisling; Burke, Conor; Faul, John; Cormican, Liam (2014-12-19)
    The acute consumption of dietary nitrate has been shown to improve exercise capacity in athletes, healthy adults and subjects with peripheral vascular disease. Many COPD patients have reduced exercise capacity. We hypothesized that acute nitrate consumption might increase incremental shuttle walk test (ISWT) distance in COPD subjects.
  • Acute hospital, community, and indirect costs of stroke associated with atrial fibrillation: population-based study.

    Hannon, Niamh; Daly, Leslie; Murphy, Sean; Smith, Samantha; Hayden, Derek; Ní Chróinín, Danielle; Callaly, Elizabeth; Horgan, Gillian; Sheehan, Orla; Honari, Bahman; Duggan, Joseph; Kyne, Lorraine; Dolan, Eamon; Williams, David; Wiley, Miriam; Kelly, Peter J; Neurovascular Unit for Translational and Therapeutics Research, University College Dublin/Dublin Academic Medical Centre, Mater Misericordiae University Hospital, Dublin, Ireland (N.H., S.M., D.H., D.N.C., E.C., G.H., O.S., J.D., L.K., P.J.K.); Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Dublin, Ireland (L.D., B.H.); Economic and Social Research Institute, Dublin, Ireland (S.S., M.W.); Stroke and Hypertension Unit, Connolly Hospital, Dublin, Ireland (E.D.); and Department of Geriatric and Stroke Medicine, Beaumont Hospital, Dublin, Ireland (D.W.). (2014-10-30)
    No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents.
  • Heart rate awareness in patients with chronic stable heart failure. A multi-center observational study.

    Moran, D; Buckley, A; Daly, K; Meaney, B; Curtin, R; O'Neill, J O; Colwella, N; Mahon, N; Murphy, N; O'Hanlon, R; Daly, C; Mc Adam, B; Mc Donald, K; Maher, V; Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. Electronic address: darraghmoran@gmail.com. (2014-08-23)
    We assessed adherence to European Society of Cardiology heart rate guidelines (i.e. heart rates less than 70bpm) in patients with chronic stable heart failure. We also investigated the percent of patients on target doses of rate controlling drugs.
  • Imaging of gunshot injuries in a West Dublin teaching hospital: a ten year review

    Murphy, I; Lavelle, L; Ni Mhurchu, E; McCarthy, R; Heffernan, E; Connolly Hospital (Irish Medical Journal, 2014-09)
    There has been an increase in gun-related crime in Ireland over the last decade to gangland violence, especially in west Dublin. This places a burden on hospital services not previously encountered. The aim of this study was to examine the demographics of gunshot injuries presenting to a Dublin teaching hospital, and the impact on radiology over a ten year period. A total of 65 gunshot injuries were seen. Mortality for high velocity wounds was much higher (10/23, 43%) than for low-velocity shotgun injuries (2/34, 6%).

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