• Mycoplasma Pneumonia: Late Treatment Leading to Acute Respiratory Distress Syndrome and Renal Failure.

      Cummiskey, A Graham; Reardon, Michael (European Journal of Case Reports in Internal Medicine, 2019-01-01)
      Mycoplasma pneumonia is one of the most common types of pneumonia, although it is often not diagnosed due to mild clinical course.
    • "Say BOO to the FLU!" Introduction of the Seasonal Influenza Peer Vaccination Programme in the Emergency Department and AMAU.

      Donaghy, Lisa; Martin, Patrick; Connolly Hospital Blanchardstown (2018-07-01)
      The Seasonal Influenza Peer Vaccination Programme was developed by the Republic of Ireland Health Service Executive (HSE)1 with the aim of increasing the number of health care workers receiving annual flu vaccinations. Supporting these efforts, various studies illustrated that increasing health care staff vaccination rates decreased patient illness and death,2 while other research reported a 40% reduction of influenza-related deaths in hospitals with higher rates of health care workers' influenza vaccinations.3 Flu vaccination recommendations from The WorldHealthOrganization (WHO) include a target uptake of 75% in health care staff and people age 65 and older.3 In accordance with HSE national guidelines that health care organizations achieve and/or surpass the minimum threshold goal of 40% of employees receiving the flu vaccine,4 and recognizing that Peer-to-Peer Influenza Vaccination Programmes are an essential aspect of the overall infection prevention and control arrangements in our health care setting, Connolly Hospital In Dublin, Ireland, initiated the Peer Vaccination Programme in the Emergency Department and Acute Medical Assessment Unit (AMAU) during the 2016–2017 flu season. The challenges facing successful ED and AMAU programme implementation included the large volume of interdisciplinary staff serving theED area, a vast cohort of undifferentiated complex patients at risk for increased complications if exposed to influenza, and an elevated risk of exposure to the influenza virus for all members of the health care team. Similar to programs in other countries, the Peer-to-Peer Vaccination Programme vaccinates health care workers against the influenza viruses identified as those most likely to circulate in the upcoming season.5 Although recognizing that frontline staff have a duty of care to protect their patients and colleagues, receiving the flu vaccine is not a mandatory requirement for health care worker employment in Ireland.
    • 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’.
    • 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.
    • 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
    • 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.
    • 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.
    • 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; et al. (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.
    • 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.
    • 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.
    • 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; et al. (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.
    • 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%).
    • Extending the reach of stapled anastomosis with a prepared OrVil™ device in laparoscopic oesophageal and gastric cancer surgery.

      Salih, Abdelmonim E A; Bass, Gary A; D'Cruz, Yvonne; Brennan, Robert P; Smolarek, Sebastian; Arumugasamy, Mayilone; Walsh, Thomas N; Department of Surgery, Connolly Hospital, Blanchardstown, Dublin 15, Ireland, monim.salih@yahoo.ie. (2014-08-27)
      The introduction of minimally invasive surgery and the use of laparoscopic techniques have significantly improved patient outcomes and have offered a new range of options for the restoration of intestinal continuity. Various reconstruction techniques have been described and various devices employed but none has been established as superior. This study evaluates our experience with, and modifications of, the orally inserted anvil (OrVil™).
    • 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; et al. (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.
    • Global DNA methylation is altered by neoadjuvant chemoradiotherapy in rectal cancer and may predict response to treatment - A pilot study.

      Tsang, J S; Vencken, S; Sharaf, O; Leen, E; Kay, E W; McNamara, D A; Deasy, J; Mulligan, E D; Department of Surgical Research, Connolly Hospital & RCSI, Blanchardstown, Dublin, Ireland. Electronic address: julianst@yahoo.com. (2014-07-28)
      In rectal cancer, not all tumours display a response to neoadjuvant treatment. An accurate predictor of response does not exist to guide patient-specific treatment. DNA methylation is a distinctive molecular pathway in colorectal carcinogenesis. Whether DNA methylation is altered by neoadjuvant treatment and a potential response predictor is unknown. We aimed to determine whether DNA methylation is altered by neoadjuvant chemoradiotherapy (CRT) and to determine its role in predicting response to treatment.