• Achieving diagnosis by consensus

      Kane, Bridget; Luz, Saturnino (2009-08)
      This paper provides an analysis of the collaborative work conducted at a multidisciplinary medical team meeting, where a patient’s definitive diagnosis is agreed, by consensus. The features that distinguish this process of diagnostic work by consensus are examined in depth. The current use of technology to support this collaborative activity is described, and experienced deficiencies are identified. Emphasis is placed on the visual and perceptual difficulty for individual specialities in making interpretations, and on how, through collaboration in discussion, definitive diagnosis is actually achieved. The challenge for providing adequate support for the multidisciplinary team at their meeting is outlined, given the multifaceted nature of the setting, i.e. patient management, educational, organizational and social functions, that need to be satisfied.
    • Acquired Factor Xiii Deficiency: An Uncommon But Easily Missed Cause Of Severe Bleeding

      Fogarty, H; Byrne, M; O’Connell, NM; Ryan, K; White, B; O’Donnell, JS; Lavin, M (Irish Medical Journal, 2018-05)
      Factor XIII (FXIII) is a plasma clotting protein involved in clot stabilization. Severe FXIII deficiency may present with severe, even fatal bleeding. Critically however, routine coagulation assays may be normal and only specific FXIII assays will detect the abnormality. Herein we discuss a case report of a patient with acquired FXIII deficiency in order to highlight the clinical challenges associated with establishing the diagnosis and discuss the treatment approach. A 70-year-old man presented with a gluteal haematoma despite no preceding personal history of bleeding. Extensive initial haemostatic investigations were normal until a specific FXIII assay showed a marked reduction in FXIII levels. With directed treatment, bleeding episodes ceased and remission was achieved. Clinical awareness of FXIII deficiency is important, so appropriate testing can be implemented in patients with unexplained bleeding diatheses, particularly those in whom bleeding responds poorly to standard replacement therapy.
    • Acute oncological emergencies.

      Gabriel, J; Central South Coast Cancer Network, St James' Hospital, Portsmouth. Janice.gabriel@csccn.nhs.uk (2012)
      The number of people receiving systemic anti-cancer treatment and presenting at emergency departments with treatment-related problems is rising. Nurses will be the first point of contact for most patients and need to be able to recognise oncological emergencies to initiate urgent assessment of patients and referral to the acute oncology team so that the most appropriate care can be delivered promptly. This article discusses the role of acute oncology services, and provides an overview of the most common acute oncological emergencies.
    • Age of transfused blood is not associated with increased postoperative adverse outcome after cardiac surgery.

      McKenny, M; Ryan, T; Tate, H; Graham, B; Young, V K; Dowd, N; Department of Anaesthesia, St James's Hospital, James's Street, Dublin, Ireland. mikemckenny@eircom.net (2011-05)
      Storage age of RBC transfusion up to 35 days was not associated with increased postoperative adverse outcome after cardiac surgery. The number of RBC units transfused is consistently associated with adverse outcome.
    • Ageing brain abnormalities in young obese patients with type 2 diabetes: a cause for concern.

      Nolan, J J; Metabolic Research Unit, St James Hospital, Trinity College, Dublin 8, Ireland., jnolan@stjames.ie (2012-02-01)
    • Allelic expression imbalance of the schizophrenia susceptibility gene CHI3L1: evidence of cis-acting variation and tissue specific regulation.

      Hill, Matthew James; Kenny, Elaine; Roche, Siobhan; Morris, Derek W; Corvin, Aiden; Hawi, Ziarih; Gill, Michael; Anney, Richard J L; Neuropsychiatric Genetics Research Group, Trinity College Dublin, Institute of Molecular Medicine, Ireland. matthew.hill@kcl.ac.uk (2011-12)
      To identify cis-acting regulatory variants influencing the expression of the schizophrenia susceptibility gene chitinase 3-like 1 gene (CHI3L1) in human lymphoblasts and post-mortem brain tissue.
    • An analysis of the dynamics of multi-disciplinary medical team meetings and the use of communication technology [Thesis]

      Kane, Bridget; University of Dublin, Trinity College (2008-05)
      Multidisciplinary medical team meetings (MDTM)s are collaborative fora where healthcare spe- cialists come together to discuss patient cases, establish a definitive diagnosis and determine the best treatment strategy for the patient. The practice of MDTMs is growing in importance as regulatory agencies advocate their adoption into routine practice. This analysis of multi-disciplinary medical team meetings (MDTMs) identifies elements, or mechanics, of collaboration among team members and proposes measures to enhance the proceedings and make the MDTM more effective. The work of MDTMs is analysed both in its overall context of patient care and at the level of person-to-person interaction during a patient case discussion. In this longitudinal study, the development of a multidisciplinary medical team was followed through a series of changes that incorporated the use of teleconferencing technology and a picture archive and communication system (PACS) into the proceedings. Analysis, based on qualitative and quantitative data, identifies the MDTM as a system that adds dependability to overall service delivery processes. Detailed analysis of screen displays and speech interactions, combined with observation data, are used to elucidate structures and analyse the dynamics of the MDTM. System boundaries are defined that extend beyond the actual duration of the meeting. Stable work routines, timing and rhythms, are shown to be critical for MDTM success. Changes in organisation structures associated with MDTMs, both positive and negative, are demonstrated as a result of the adoption of teleconferencing. Although the discussion structure is relatively stable in teleconference, the dynamics of speech interactions are affected and patient case discussions take more time as a result. Cases discussed in teleconference are less satisfactory from the users’ perspective. However, there is a perceptible improvement in the quality of information exchanged at teleconferencing sessions compared to co-located meetings. Case controlled study reveals a doubling effect observed for participants who describe features in artefacts and for those who describe their professional approach (surgeons and radiation oncologist) in teleconference. Discussion around objects (artefacts) is most affected in teleconference. Examination of the use of video reveals an important requirement for the visual display of remote participants, that is not articulated in user surveys. The importance of increasing visual support for participants especially when the discussion involves image assessment and the exchange of professional opinion is highlighted. Visual needs are identified for both sides of the teleconference interface at MDTMs. Providing more control over audio, video and PACS would enhance teleconferences and image review. More control through personal devices is proposed to support interaction and increase participation. Furthermore, results suggest that having separate channels for tasks (pathology and radiology images) and person-to-person communication, by providing multiple displays, would make com- munication easier and save time. The display of radiological images is given special attention. With increasing complexity of imaging modalities, facilitating multiple views simultaneously is needed for satisfactory assessment. The internal temporal structure identified in patient case discussions (PCD)s prompts the in- vestigation of novel technologies for the development of an MDTM record. These results have implications for the design of future systems and the implementation of new channels of commu- nication within the health service.
    • An analysis of vascular surgery in elderly patients to determine whether age affects treatment strategy.

      O'Brien, G; Martin, Z; Haider, N; Colgan, M; O'Neill, S; Moore, D; Madhavan, P; St. James Hospital, Dublin, Ireland. gavinobrien@rcsi.ie (2012-03)
      The incidence of arterial disease increases with age. Increasing life expectancy in the western world will intensify demands on vascular surgeons with regard to increasing caseload, expanding patient selection criteria, and more complex and minimally-invasive treatment options. We analysed our arterial cases over the past 31 years (n = 6,144) and compared our methods of intervention and complication rates in the elderly population (>75) with the younger cohort, in order to determine whether age should influence our management strategies.
    • Annual financial statements for St James Hospital for the year ended 31st December, 2003

      St James's Hospital. (St James's Hospital, 2004)
      The Board is required by the St James's Hospital Board (Establishment) Order. 1971 to prepare tinancial statements for each financial year which give a true and fair view of the state of affairs of Sr. James's Hospital and of its income and expenditure for that period. In preparing those statements the Board is required to • select suitable accounting policies and then-apply them consistently • make judgements and estimates that are reasonable and.prudent • disclose and explain any material departures from applicable accounting standards. and • prepare the financial statements on the.going concern basis unless it is inappropriate or presume that St. James's Hospital will continue in existence.
    • Annual report 1983 - St. James's Hospital

      St. James's Hospital, Dublin (1984)
    • Annual report 1999 - St. James's Hospital

      St. James's Hospital, Dublin (2000)
    • Annual report 2000 - St. James's Hospital

      St. James's Hospital, Dublin (2001)
    • Annual report 2003 - St. James's Hospital

      St. James's Hospital, Dublin (2004)
    • Annual report 2004 - St. James's Hospital

      St. James's Hospital, Dublin (2005)
    • Annual report 2005 - St. James's Hospital

      St. James's Hospital, Dublin (2006)
    • Anxiety and behavioural disturbance as markers of prodromal Alzheimer's disease in patients with mild cognitive impairment.

      Gallagher, Damien; Coen, Robert; Kilroy, Dana; Belinski, Kate; Bruce, Irene; Coakley, Davis; Walsh, Bernard; Cunningham, Conal; Lawlor, Brian A; Mercer's Institute for Research on Ageing, St. James's Hospital, Dublin, Ireland. gallagherdamien@hotmail.com (2011-02)
      Neuropsychiatric symptoms and anxiety symptoms in particular are common in patients with MCI. In this sample anxiety for upcoming events and purposeless activity frequently co-occurred and were significant clinical predictors of earlier conversion to AD. However, these findings were not independent of cognitive status at baseline and therefore may be markers of severity rather than independent predictors of disease progression.
    • Application of statistical process control to qualitative molecular diagnostic assays

      O'Brien, Cathal P.; Finn, Stephen P.; St. James's Hospital (2014-11)
      Modern pathology laboratories and in particular high throughput laboratories such as clinical chemistry have developed a reliable system for statistical process control (SPC). Such a system is absent from the majority of molecular laboratories and where present is confined to quantitative assays. As the inability to apply SPC to an assay is an obvious disadvantage this study aimed to solve this problem by using a frequency estimate coupled with a confidence interval calculation to detect deviations from an expected mutation frequency. The results of this study demonstrate the strengths and weaknesses of this approach and highlight minimum sample number requirements. Notably, assays with low mutation frequencies and detection of small deviations from an expected value require greater sample numbers to mitigate a protracted time to detection. Modeled laboratory data was also used to highlight how this approach might be applied in a routine molecular laboratory. This article is the first to describe the application of SPC to qualitative laboratory data.
    • Are there meaningful longitudinal changes in health related quality of life--SF36, in cardiac rehabilitation patients?

      McKee, Gabrielle; Trinity College Dublin School of Nursing and Midwifery Studies in collaboration, with Cardiac Rehabilitation Unit, St. James Hospital Dublin, Ireland., gmckee@tcd.ie (2012-02-01)
      BACKGROUND: This study aimed to observe changes in quality of life and minimal clinical important differences of quality of life over time in cardiac rehabilitation patients and to compare these with published normal data. METHODS: In this non-randomised study, SF36 questionnaires were completed by 187 patients recruited to a Phase III cardiac rehabilitation multidisciplinary outpatient programme. Data was collected at beginning, end and six months after Phase III cardiac rehabilitation programme. RESULTS: There were significant improvements in physical functioning, role limitation due to physical function, pain and general health perception scales, over the above time frame, from both a statistically and a mean clinical important difference point of view. These improvements occurred mainly during the cardiac rehabilitation programme phase. CONCLUSIONS: These improvements meant that patients six months post-cardiac rehabilitation were only 5% below the quality of life for an aged matched normal group. However patients still had significant deficits in physical role and emotional role limitations. Suitable measurement of quality of life on an individual basis, supported by normal values is needed. This would facilitate the identification of shortfalls in patient quality of life and the subsequent tailoring of care to address these individualised patient needs.
    • Association of visceral adiposity with oesophageal and junctional adenocarcinomas.

      Beddy, P; Howard, J; McMahon, C; Knox, M; de Blacam, C; Ravi, N; Reynolds, J V; Keogan, M T; Department of Radiology, St James' Hospital and Trinity College Dublin, Dublin,, Ireland. (2012-02-01)
      BACKGROUND: Obesity is associated with an increased incidence of oesophageal and oesophagogastric junction adenocarcinoma, in particular Siewert types I and II. This study compared abdominal fat composition in patients with oesophageal/junctional adenocarcinoma with that in patients with oesophageal squamous cell carcinoma and gastric adenocarcinoma, and in controls. METHOD: In total, 194 patients (110 with oesophageal/junctional adenocarcinoma, 38 with gastric adenocarcinoma and 46 with oesophageal squamous cell carcinoma) and 90 matched control subjects were recruited. The abdominal fat area was assessed using computed tomography (CT), and the total fat area (TFA), visceral fat area (VFA) and subcutaneous fat area (SFA) were calculated. RESULTS: Patients with oesophageal/junctional adenocarcinoma had significantly higher TFA and VFA values compared with controls (both P < 0.001), patients with gastric adenocarcinoma (P = 0.013 and P = 0.006 respectively) and patients with oesophageal squamous cell carcinoma (both P < 0.001). For junctional tumours, the highest TFA and VFA values were seen in patients with Siewert type I tumours (respectively P = 0.041 and P = 0.033 versus type III; P = 0.332 and P = 0.152 versus type II). CONCLUSION: Patients with oesophageal/junctional adenocarcinoma, in particular oesophageal and Siewert type I junctional tumours, have greater CT-defined visceral adiposity than patients with gastric adenocarcinoma or oesophageal squamous cell carcinoma, or controls.