• 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.
    • 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.
    • Genomic and oncoproteomic advances in detection and treatment of colorectal cancer.

      McHugh, Seamus M; O'Donnell, Jill; Gillen, Peter; Dept. of Surgery, Our Lady of Lourdes Hospital, Drogheda, County Louth, Ireland. , seamusmchugh@rcsi.ie (2012-02-01)
      AIMS: We will examine the latest advances in genomic and proteomic laboratory technology. Through an extensive literature review we aim to critically appraise those studies which have utilized these latest technologies and ascertain their potential to identify clinically useful biomarkers. METHODS: An extensive review of the literature was carried out in both online medical journals and through the Royal College of Surgeons in Ireland library. RESULTS: Laboratory technology has advanced in the fields of genomics and oncoproteomics. Gene expression profiling with DNA microarray technology has allowed us to begin genetic profiling of colorectal cancer tissue. The response to chemotherapy can differ amongst individual tumors. For the first time researchers have begun to isolate and identify the genes responsible. New laboratory techniques allow us to isolate proteins preferentially expressed in colorectal cancer tissue. This could potentially lead to identification of a clinically useful protein biomarker in colorectal cancer screening and treatment. CONCLUSION: If a set of discriminating genes could be used for characterization and prediction of chemotherapeutic response, an individualized tailored therapeutic regime could become the standard of care for those undergoing systemic treatment for colorectal cancer. New laboratory techniques of protein identification may eventually allow identification of a clinically useful biomarker that could be used for screening and treatment. At present however, both expression of different gene signatures and isolation of various protein peaks has been limited by study size. Independent multi-centre correlation of results with larger sample sizes is needed to allow translation into clinical practice.
    • Glomus tumour of the thumb in a child with neurofibromatosis: a case report.

      Leonard, Michael; Harrington, Paul; Department of Orthopaedic Surgery, Our Lady of Lourdes, Drogheda, Ireland., mikeleonard77@gmail.com (2012-02-01)
      This case report is unique in reporting the occurrence of a glomus tumour in a child with neurofibromatosis-1 (NF-1) and serves to support the link between neurofibromatosis-1 and glomus tumours.
    • 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.
    • 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.
    • Irish neonatal mortality statistics for 2004 and over the past 17 years: how do we compare internationally?

      Fleming, P; Clarke, T; Gormally, S M; Department of Neonatology and Paediatrics, Our Lady of Lourdes Hospital,, Drogheda, Co Louth. (2012-02-01)
      In the past 17 years neonatal mortality survey has provided important data on the trends in deaths of all live born infants born in Southern Ireland who are greater than 500 g birth weight and who die within the first 28 days of life. The aims of this study were to report neonatal mortality data for Southern Ireland for 2004, to examine trends in neonatal mortality over the past 17 years and compare Irish Neonatal Mortality rates to other countries around the world. The neonatal mortality rate for 2004 was 2.9/1000 with a corrected NMR of 1.9/1000. The response rate to the survey was 100%. Prematurity is now the leading cause of neonatal mortality representing a change from previous years. Deaths related to asphyxia have remained largely unchanged. When compared to international figures Ireland compares favourably to other countries around the world.
    • 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)
    • Localized plaques on the sacral area of a child.

      Fallon, J; Jones, B; Egan, C A; Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland., eur@health.ie (2012-02-01)
    • 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.
    • Maternal post natal hospital readmission-trends and association with mode of delivery.

      Ade-Conde, J A; Alabi, O; Higgins, S; Visvalingam, G; Our Lady of Lourdes Hospital, Drogheda, Co Louth. tunjitola@yahoo.com (2012-02-01)
      The aim of this study is to examine the trend in maternal postnatal readmission within six weeks of discharge from childbirth hospitalisation. It is a retrospective review of the maternity computer records system, patient's clinical notes and HIPE data base. All women who delivered babies weighing > 500 g and/ > or = 24 weeks gestational age at Our Lady of Lourdes Hospital, Drogheda, Ireland from 1st January 2005 to 31st December 2008 who were re-hospitalised within six weeks of discharge from hospital following child birth were included in the study. A total of 15782 women were delivered over the four year study period. Of these, 236 were readmitted. A series of chi-square analysis were conducted to assess the difference in readmission rates between the year 2008 86 (2.03%) and the years 2005-51(1.46%), 2006-39 (1.01%) and 2007-60 (1.42%). The readmission rate was found to be significantly higher in 2008 compared with the three preceding years. Complications of Caesarean section and secondary postpartum haemorrhage following spontaneous vaginal delivery constitute the major indications for readmission.
    • Minimally-invasive treatment of high velocity intra-articular fractures of the distal tibia.

      Leonard, M; Magill, P; Khayyat, G; Our Lady Of Lourdes Hospital, Drogheda, Co. Louth, Ireland., mikeleonard77@gmail.com (2012-02-01)
      The pilon fracture is a complex injury. The purpose of this study was to evaluate the outcome of minimally invasive techniques in management of these injuries. This was a prospective study of closed AO type C2 and C3 fractures managed by early (<36 hours) minimally invasive surgical intervention and physiotherapist led rehabilitation. Thirty patients with 32 intra-articular distal tibial fractures were treated by the senior surgeon (GK). Our aim was to record the outcome and all complications with a minimum two year follow-up. There were two superficial wound infections. One patient developed a non-union which required a formal open procedure. Another patient was symptomatic from a palpable plate inferiorly. An excellent AOFAS result was obtained in 83% (20/24) of the patients. Early minimally invasive reduction and fixation of complex high velocity pilon fractures gave very satisfactory results at a minimum of two years follow-up.
    • Modes of death in neonatal intensive care units.

      Finan, E; Bolger, T; Gormally, S M; Dept of Neonatology, Our Lady of Lourdes Hospital, Drogheda, Co. Louth. (2006-04)
      With the ever-increasing availability of aggressive medical treatment and technical support, neonatologists are offered an increasing ability to prolong life. While "end-of-life" decisions within NICUs have been studied internationally, there is limited data available for Ireland. Through the auspices of the Irish Faculty of Paediatrics 2002 Neonatal Mortality Ouestionnaire, decisions made around the time of death in Irish Neonatal Intensive Care Units were examined. The overall response rate to the questionnaire was 96% (n=25). One hundred and eighty seven deaths were reported for 2002. Information pertaining to the mode of death was available in 53% of cases. Seventy seven percent of those paediatricians who answered this question, reported either withdrawing or withholding treatment in babies thought to have a hopeless outcome, with the greatest proportion of these deaths occurring in premature infants (n=30) and babies with congenital defects (n=40).
    • Necrotizing fasciitis of the lower extremity: a case report and current concept of diagnosis and management.

      Naqvi, G A; Malik, S A; Jan, W; Department of Orthopaedics, Our Lady of Lourdes Hospital, Drogheda, Republic of, Ireland. drgoharabbas@hotmail.com (2012-02-01)
      Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries high mortality rate and require prompt diagnosis and urgent treatment with radical debridement and antibiotics. We describe a case of 21-year old man who presented with the history of trivial injury to the knee. Initially he was admitted and treated for septic arthritis but later was diagnosed as necrotizing fasciitis which was successfully treated with no ill effects what so ever from this devastating condition. This rare condition has been reported in literature but still early diagnosis, which is a key for successful treatment, remains a challenge.
    • 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.
    • Peripheral nerve field stimulation for pruritus relief in a patient with notalgia paraesthetica.

      Ricciardo, Bernadette; Kumar, Sandeep; O'Callaghan, James; Boyce, Zachary; Department of Dermatology, Our Lady Of Lourdes Hospital, Drogheda, Louth,, Ireland. berniricciardo@yahoo.com.au (2012-02-01)
      This case study is presented to exemplify the application of peripheral nerve field stimulation in the treatment of recalcitrant notalgia paraesthetica. The patient was a 60-year-old woman with severe and disabling notalgia paraesthetica. The itch persisted despite the use of several medications - topical and oral. Following a successful trial of peripheral nerve field stimulation with a temporary electrode, two subcutaneous electrodes were inserted into the affected area with a battery implanted subcutaneously in her right buttock. The patient was reviewed at 5 months post implantation. She reported a greater than 85% improvement in her itch. She also reported a major improvement in her quality of life, with particular improvement in her ability to sleep through the night. This case illustrates the possible utilization of peripheral nerve field stimulation in the treatment of notalgia paraesthetica, which is a common yet poorly understood and treated condition. Replication and controlled studies are required to determine the general applicability of this approach.
    • 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.
    • Pneumomediastinum following high pressure air injection to the hand.

      Kennedy, J; Harrington, P; Department of Orthopaedics, Our Lady of Lourdes Hospital, Drogheda, Co Louth., getjimkennedy@gmail.com (2012-02-01)
      We present the case of a patient who developed pneumomediastinum after high pressure air injection to the hand. To our knowledge this is the first reported case of pneumomediastinum where the gas injection site was the thenar eminence. Fortunately the patient recovered with conservative management.
    • Point of Care Echocardiography in an Irish Critical Care Unit

      Kuriakose, D; O’Mahony, R; Rooplalsingh, R; McCanny, P; Colreavy, F; Our Lady of Lourdes Hospital, Drogheda, Connolly Hospital, Blanchardstown, Co. Dublin, The Prince Charles Hospital, Rode Road, Chermside, QLD AUS, Liverpool Hospital, Liverpool, New South Wales 2170, Australia, Consultant Intensivist, Mater Misercordiae University Hospital, Eccles Street, Dublin 7 (Irish Medical Journal, 2018-09)
      Transthoracic echocardiography (TTE) has become an established component of critical care monitoring1-5 .Traditionally performed by Cardiology Services, either cardiac physiologists or cardiology doctors, a major limitation has been availability of these personnel on a 24 hour /7 day per week basis to the critical care area. As a result performance of TTE examinations has moved beyond the traditional users and now involves critical care doctors. Definition of the competencies required for basic level critical care echocardiography has provided a practical roadmap to Intensivists involved in echocardiography training. We introduced a basic level echocardiography training course into our critical care unit and it was the aim of this study to evaluate the impact of echocardiography training on clinical practice.