Research by staff affiliated to Our Lady of Lourdes Hospital, Drogheda

Recent Submissions

  • Evaluating the impact of ISO 15189 on an Irish histopathology laboratory

    O’Connor, Linda; Malkin, Alison; Carroll, Breffnie (THE BIOMEDICAL SCIENTIST, 2016-09)
    Accreditation is the acknowledgement that the laboratory has reached and maintains a certain standard of quality. Pre-accreditation, quality standards in hospital laboratories were perceived to exist but were undocumented. The difference post-accreditation is having to prove that this standard of quality actually exists and is maintained. An Irish hospital laboratory is recognised as accredited when an accreditation body such as the Irish National Accreditation Body (INAB) inspects or audits the hospital laboratory and grants it accreditation status.
  • A Quality Improvement Approach to Reducing the Caesarean section Surgical Site Infection Rate in a Regional Hospital

    O’ Hanlon, M; McKenna C; Carton, E; Diviney, D; Costello, MR; O’Sullivan, L; Fitzsimons, J; Toland, L; Dornikova, G; Curran, R; McCann, C; Crinion, L; Doherty, T; Crowley, C; O’Coigligh, S (Irish Medical Journal, 2016-09)
    Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.
  • A quality improvement approach to reducing the caesarean section surgical site infection rate in a regional hospital

    O’ Hanlon, M; McKenna, C; Carton, E; Diviney, D; Costello, MR; O’Sullivan, L; Fitzsimons, J; Toland, L; Dornikova, G; Curran, R; McCann, C; Crinion, L; Doherty, T; Crowley, C; O’Coigligh, S (Iris Medical Journal, 2016-09)
    Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30 day post-discharge SSI programme for caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced, however the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.
  • Simultaneous bilateral Mason type IIb radial head fractures in a young female: Was an increased carrying angle the cause?

    Raval,Pradyumna; Ni Fhoghlu, Cliodhna; Narayan Mahapatra, Anant; Department of Orthopaedics, Our Lady of Lourdes Hospital, County Louth, Ireland (Wolters Kluwer Health, 2015)
    Radial head fracture is the most common type of elbow fracture in adults. It results from a fall on an outstretched hand. However, simultaneous bilateral radial head fractures are extremely rare. We report a case of simultaneous bilateral mason type IIb radial head fractures in a young female, which was treated nonoperatively with excellent results
  • Congenital diaphragmatic hernia surveillance

    Chukwu, J; Cunney, R; Molloy, E (Irish Medical Journal, 2014-09)
    Congenital Diaphragmatic Hernia (CDH) is a rare congenital disorder as a result of deficient development of the diaphragm with resultant herniation of abdominal viscera into the thoracic cavity, mal-development of the alveoli and pulmonary vessels 1,2 . The incidence of CDH â ranges from 1 in 2,000 to 1 in 15,000 births 3 . Due to the legislation in Ireland against termination of pregnancy it was suggested that there may be an increased incidence of CDH. There is no mandatory reporting of CDH cases in the Republic of Ireland (ROI) and Northern Ireland (NI). Voluntary case reporting to the Irish Paediatric Surveillance Unit (IPSU) started in January 2010.
  • Incidence of central line related/associated bloodstream infections in an acute hospital

    O’Hanlon, M; Dornikova, G; Curran, R; Staunton, M; Woolhead, A; Kennedy, M; Tinsley, A; Shepherd, E; Doherty, T (Irish Medical Journal, 2014-09)
    Bloodstream infection related to a central venous catheter in the intensive care unit is a substantial clinical and economic problem. The aim of the study was to examine the incidence of central line related bloodstream infections and central line associated bloodstream infections in Our Lady of Lourdes Hospital, Drogheda, during a six month period, using an active patient based prospective surveillance method. CLRBSI rate in ICU/HDU was 0.93/1000 central line days. There was no CLABSI identified in the studied time period. However, further interventions are needed, particularly with CVC care bundle. Also, the implementation of 2% chlorhexidin in 70% isopropylalcohol use for skin asepsis, which is recommended by the Irish national guidelines, would be beneficial.
  • Atraumatic bilateral inferior pubic rami fractures in a young female: a rare case

    Raval, Pradyumna; Khan, Khalid S.; Department of Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, County Louth, Ireland (Springer-Verlag, 2014-06)
  • Bite injuries to the hand - review of the literature.

    Raval, Pradyumna; Khan, Wasim; Haddad, Behrooz; Narayan Mahapatra, Anant; Department of Orthopaedic Surgery, Our Lady of Lourdes Hospital, Drogheda, County Louth, Ireland. University College London Institute of Orthopaedics & Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, UK (2014-04)
    Patients presenting to the emergency department with bite injuries to the hand sustain them through a number of causes including domesticated as well as stray animal bites, and human bites commonly sustained as a result of violence. The nature of the injuries sustained can be very deceptive. A small tooth mark on the exterior can be a fulminant infection in the tissues deeper down. Tendon injuri es, fractures of the metacarpals and phalanges and management of the wound are critical issues faced by a surgeon in dealing with such patients. Similarly the less common bite injuries to the hand, often with disastrous and sometimes fatal complications, d o also present to the emergency department. A high incidence of suspicion is needed in dealing with these injuries effectively. In our article we discuss the common as well as uncommon causes of bite injuries to the hand and their management. In addition to reviewing the literature to ascertain the management of such injuries, we also discuss interesting and rare case reports.
  • Pharmacological management of co-morbid conditions at the end of life: is less more?

    McLean, S; Sheehy-Skeffington, B; O'Leary, N; O'Gorman, A; Specialist Palliative Care Service, Dochas Centre, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland. smclean81@yahoo.com (2013-03)
    Co-morbid conditions (CMCs) are present in over half of patients with cancer over 50 years of age. As life-limiting illnesses progress, the benefits and burdens of treatments for CMCs become unclear. Relevant issues include physiological changes in advanced illness, time-to-benefit of medications, burden of medications, and psychological impact of discontinuing medications. Optimal prescribing is unclear due to lack of evidence.
  • Dual diagnosis of sarcoidosis and lymphoma.

    Brady, B; Kamel, D; Kiely, J; Hennessy, B; Department of Medical Oncology, Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland. bernadettebrady@gmail.com (2013-06)
    Sarcoidosis is a multisystem granulomatous disease of unknown origin with pulmonary and extrapulmonary manifestations. Worldwide it is most often diagnosed in the third and fourth decades and most often affects Swedish, Danish and black patients. The association between malignancy and sarcoidosis has not been conclusively proven. Cancer can eventually occur in patients who have an established diagnosis of sarcoidosis for example, in sarcoidosis-lymphoma syndrome. Sarcoidosis can also subsequently develop in an oncology patient. There are multiple obstacles to confirming epidemiologically the linkage between sarcoidosis and malignancy. Histological verification and clinical acumen are needed to avoid misdiagnosis. The 18 fluorodeoxyglucose (18-FDG) PET has failed to provide a non invasive diagnostic method to differentiate neoplasia from benign sarcoid lesions and tissue diagnosis is essential before commencing a new therapeutic intervention in patients with lymphoma.
  • Proteomic classification of breast cancer.

    Kamel, Dalia; Brady, Bernadette; Tabchy, Adel; Mills, Gordon B; Hennessy, Bryan; Department of Medical Oncology, Our Lady of Lourdes Hospital, Drogheda, Ireland. dsskamel@hotmail.com (2012-11)
    Being a significant health problem that affects patients in various age groups, breast cancer has been extensively studied to date. Recently, molecular breast cancer classification has advanced significantly with the availability of genomic profiling technologies. Proteomic technologies have also advanced from traditional protein assays including enzyme-linked immunosorbent assay, immunoblotting and immunohistochemistry to more comprehensive approaches including mass spectrometry and reverse phase protein lysate arrays (RPPA). The purpose of this manuscript is to review the current protein markers that influence breast cancer prediction and prognosis and to focus on novel advances in proteomic classification of breast cancer.
  • Fixation of ankle syndesmotic injuries: comparison of tightrope fixation and syndesmotic screw fixation for accuracy of syndesmotic reduction.

    Naqvi, Gohar A; Cunningham, Patricia; Lynch, Bernadette; Galvin, Rose; Awan, Nasir; Department of Trauma and Orthopaedics, Our Lady of Lourdes Hospital, Drogheda, Ireland. drgoharabbas@hotmail.com (2012-12)
    Ankle syndesmotic injuries are complex and require anatomic reduction and fixation to restore the normal biomechanics of the ankle joint and prevent long-term complications.
  • Pulmonary embolism following isolated upper limb injury: a rare complication

    Raval,Pradyumna; Burke, Neil; Harrington, Paul (Springer, 2012-12)
  • Isolated dislocation of pisiform in an 11-year-old, following a horse bite: a rare injury

    Raval, Pradyumna; Saeed, Nauman; Narayan Mahapatra, Anant; Our Lady of Lourdes Hospital (Springer, 2013-01)
  • Interobserver and intraobserver reliability and validity of the Vancouver classification system of periprosthetic femoral fractures after hip arthroplasty.

    Naqvi, Gohar A; Baig, Shakoor A; Awan, Nasir; Department of Trauma and Orthopaedics, Our Lady of Lourdes Hospital, Drogheda, Co., Louth, Republic of Ireland. (2012-06)
    The Vancouver classification system of periprosthetic fractures has been revalidated in this study, using the radiographs of 45 patients. Three consultants and 3 trainees reviewed the radiographs independently, on 2 separate occasions, at least 2 weeks apart. Interobserver and intraobserver agreement and validity were analyzed, using weighted κ statistics. The mean κ value for interobserver agreement was found to be 0.69 (0.63-0.72) for consultants and 0.61 (0.56-0.65) for the trainees, both representing substantial agreement. Intraobserver κ values ranged from 0.74 to 0.90, showing substantial agreement. Validity analysis of 37 type B cases revealed 81% agreement within B1, B2, and B3 subgroups with a κ value of 0.68 (substantial agreement). This study has reconfirmed the reliability and validity of the Vancouver classification while it also emphasizes the intraoperative assessment of implant stability.
  • Tightrope fixation of ankle syndesmosis injuries: clinical outcome, complications and technique modification.

    Naqvi, Gohar A; Shafqat, Aseer; Awan, Nasir; Department of Orthopaedics, Our Lady of Lourdes Hospital, Drogheda, Ireland. drgoharabbas@hotmail.com (2012-06)
    Ankle syndesmotic injuries are complex and require anatomic reduction and fixation. Tightrope fixation is a relatively new technique and we present the largest series of syndesmosis fixation using Arthrex Tightrope™ (Naples, FL, USA).
  • The outcome of laparoscopic cholecystectomy by ultrasonic dissection.

    Sasi, Walid; Department of Surgery, Our Lady of Lourdes Hospital Drogheda, Ireland. (2010-04)
    Electrocautery remains the main energy form used for dissection in laparoscopic cholecystectomy. However, due to its many risks the search continues for safer and more efficient forms of energy. This chapter assesses the outcomes of dissection using ultrasonic energy as compared to monopolar electrocautery during laparoscopic cholecystectomy. Studies included are trials of prospectively randomized adult patients with symptomatic gallstone disease subject either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Seven trials were included in this review, with a total patient number of 695 randomized to two dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. Ultrasonic dissection is shown to be superior to monopolar electrocautery in laparoscopic cholecystectomy. Disadvantages include a difficult maneuvering technique and overall cost. Appropriate training programs may be implemented to overcome the first disadvantage, and it might be argued that given the combined cost of factors associated with standard clip and cautery technique, cost issues may be outweighed by the benefits of ultrasonic dissection. However, this necessitates further cost-benefit analysis.
  • Management of chronic symphysis pubis pain following child birth with spinal cord stimulator.

    Idrees, Ahsan; Department of Anaesthesia & Pain, Our Lady of Lourdes Hospital, Drogheda, Ireland. (2012-01)
    The case of a 39 year old woman who had diastasis of pubic symphysis following childbirth and later developed severe chronic neuropathic pain and disability is presented. She received extensive surgical and medical treatment for 6 years with no improvement of symptoms. The VNRS (Visual Numerical Rating Scale) pain score was 7/10 or more most of the time. This was quite disabling in terms of her quality of life. A spinal cord stimulator was inserted after failure of other modalities of pain management which resulted in dramatic improvement in the quality of life measured with SF-36 questionnaire. Her pain score became 0/10 VNRS and she was free from opioids and psychotropic medications within 3 months post insertion. Spinal cord stimulator can be considered for the management of pain due to diastasis of pubic symphysis, not amenable to other therapies.

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