Research by staff affiliated to Tallaght University Hospital (formerly Adelaide Meath Hospital, Tallaght)

Recent Submissions

  • National Survey Of The Aetiological Assessment Service Of Permanent Childhood Hearing Loss In Ireland

    Balfe, J; Van Der Spek, N; Waldron, D (Irish Medical Journal, 2018-09)
    Best practice indicates that all children who are identified with permanent childhood hearing loss (PCHL) should have access to prompt paediatric assessment to determine the need for aetiological investigations[i]. Early paediatric assessment allows the identification and management of potentially treatable causes e.g. congenital CMV (cCMV) infection and provides an opportunity to prevent or reduce disability. It also allows the identification of associated co-morbidities including potentially fatal cardiac arrhythmias. The role of the paediatrician also includes liaison with agencies including tertiary specialist services, education, disability services and other community based organisations
  • Extramammary Paget ’s disease Of Glans Penis: A Rare Case Report

    Inder, M S; O’Kelly, F; Sheikh, M; O’Hare, K; Barbara, M L; Thornhill, J A (Irish Medical Journal, 2018-06)
    We present the case of an 83-year-old man with Extramammary Paget’s disease (EMPD) of the penis. He underwent a total penectomy and histopathology confirms the association of underlying invasive high grade urothelial carcinoma. Penile EMPD is rare and can be misinterpreted for benign skin conditions. A high index of suspicion is required for correct diagnosis and appropriate treatment.
  • A Combination of Surgery And Methotrexate for Successful Treatment of a Caesarean Scar Ectopic Pregnancy.

    Tadesse, WG; Von Bunau, G (Irish Medical Journal, 2018-06)
    Caesarean scar ectopic pregnancy (CSEP) is one of the rarest forms of ectopic pregnancies. With rising caesarean delivery (CD) rates worldwide, there is an increase in the incidence of CSEP. Patients usually present with painless vaginal bleeding and often misdiagnosed as spontaneous miscarriage. The use of ultrasonography with colour flow Doppler helps in the differential diagnosis. Different treatment options are described in the literature, although there is insufficient evidence regarding the best approach. We report the diagnosis and management of a case of CSEP in a woman with four previous CD who presented with vaginal bleeding and lower abdominal cramps at six weeks of gestation. She was treated with laparoscopic and ultrasound guided aspiration of the gestational sac and local injection of methotrexate supplemented by intramuscular methotrexate injection.
  • Subtrochanteric Femur Fractures in an Irish Trauma Centre over 9 years: How the Impact of Hospital Coding on Diagnosis of Subtrochanteric Femur Fractures Leads to Inaccurate Occurrence Rates

    Coveney, EI; Harriz, E; Gibney, B; Quinlan, JF (Irish Medical Journal, 2018-06)
    Our aim was to assess the occurrence rates of subtrochanteric femur fractures in an orthopaedic tertiary referral centre and to assess the correlation of patient’s actual diagnosis with national hospital inpatient enquiry data.
  • Patterns of Mortality in Modern Stroke Care

    Dalton, M; Coughlan, T; Cogan, N; Greene, S; McCabe, DJH; McCarthy, A; Murphy, S; Walsh, R; O’Neill, D; Kennelly, S; Ryan, D; Collins, R (Irish Medical Journal, 2018-05)
    Stroke is a leading cause of death. We looked at the causes (direct and indirect) of in-hospital mortality in a modern stroke unit over a two-year period.
  • Involuntary psychiatric admission based on risk rather than need for treatment: report from the Dublin Involuntary Admission Study (DIAS).

    Kelly, BD; Curley, A; Duffy, RM (Irish Medical Journal, 2018-04)
    Involuntary psychiatric admission in Ireland is based on the presence of mental disorder plus serious risk to self/others and/or need for treatment. This study aimed to examine differences between use of risk and treatment criteria, about which very little is known.
  • An analytic observational study on complaints management in the general practice out of hours care setting: who complains, why, and what can we do about it?

    Barragry, Ruth A; Varadkar, Leo E; Hanlon, David K; Bailey, Ken F; O'Dowd, Tom C; O'Shea, Brendan J (BioMed Central, 2016)
    General Practice Co-Operatives provide most out of hours care in communities in Ireland. Limited data exists on patient complaints. This study reports on complaints at Kildare and West Wicklow Doctors on Call ('K Doc'), a GP Co-Operative in Ireland, examining the impact of a formal risk reduction strategy implemented (2010-2013). The aim of the study was to determine if it was possible to reduce the rate of written complaints per 1000 consultations through a formal approach encompassing evaluation of complaints, improved communication in relation to complaints, and more direct use of insights gained from complaints analysis in continuing professional development at the Co-Operative.
  • Single Centre Experience – Clinical Presentation and Frequency of Paediatric Diabetic Ketoacidosis (DKA) At Diagnosis over a 5-Year Period

    McKenna, A; Sandys, N; Ryder, K; Metwally, N; Brennan, A; O’Regan, M; Hoey, MCV; Roche, EF (Irish Medical Journal, 2018-03)
    Type 1 diabetes (T1D) symptoms are subtle and easily overlooked. Delayed diagnosis can result in Diabetic ketoacidosis (DKA), a life threatening complication with lasting consequences. We sought to define the presenting features of T1D and DKA frequency, in children <15 years diagnosed in a single national tertiary centre, and identify predictive factors for DKA. A review of T1D incident cases was undertaken from 2008-2012 using the National Diabetes Register (ICDNR) and clinical case notes. Data were compared with a 1997/8 national study. We found DKA at presentation in 28.7 % of children and 15.5% had moderate/severe DKA. Commonest symptoms were polydipsia, polyuria, weight loss, and lethargy. Median symptom duration was 17 days. Clinical presentation was similar and frequency of DKA at T1D diagnosis remains high. The proportion with moderate/severe DKA is lower than the 25% previously reported (p=0.038). National monitoring and targeted action to reduce DKA at diagnosis is required.
  • Primary Renal Carcinoid - A Case Report

    O’Sullivan, M; Gargan, ML; Flynn, R; Crowther, S; Torreggiani, W (Irish Medical Journal, 2018-01)
    Carcinoid tumours in the abdomen are uncommon, but typically occur in the gastrointestinal tract. Primary renal carcinoid is an extremely rare tumour, poorly described in the literature. We describe an unusual case where an atypical renal mass on imaging led to a preoperative diagnosis of renal carcinoid on imaging guiding biopsy.
  • Peripherally Inserted Central Catheters (PICCs) and Potential Cost Savings and Shortened Bed Stays In an Acute Hospital Setting.

    O’Brien, C; Mc Marrow, J; O’Dwyer, E; Govender, P; Torreggiani, WC (Irish Medical Journal, 2018-01)
    Peripheral inserted central catheters (PICCs) have increasingly become the mainstay of patients requiring prolonged treatment with antibiotics, transfusions, oncologic IV therapy and total parental nutrition. They may also be used in delivering a number of other medications to patients. In recent years, bed occupancy rates have become hugely pressurized in many hospitals and any potential solutions to free up beds is welcome. Recent introductions of doctor or nurse led intravenous (IV) outpatient based treatment teams has been having a direct effect on early discharge of patients and in some cases avoiding admission completely. The ability to deliver outpatient intravenous treatment is facilitated by the placement of PICCs allowing safe and targeted treatment of patients over a prolonged period of time. We carried out a retrospective study of 2,404 patients referred for PICCs from 2009 to 2015 in a university teaching hospital. There was an exponential increase in the number of PICCs requested from 2011 to 2015 with a 64% increase from 2012 to 2013. The clear increase in demand for PICCs in our institution is directly linked to the advent of outpatient intravenous antibiotic services. In this paper, we assess the impact that the use of PICCs combined with intravenous outpatient treatment may have on cost and hospital bed demand. We advocate that a more widespread implementation of this service throughout Ireland may result in significant cost savings as well as decreasing the number of patients on hospital trollies.
  • Oral Cancer Awareness of Non-Consultant Hospital Doctors in Irish Hospitals

    Shanahan, D; Healy, CM (Irish Medical Journal, 2018-01)
    The incidence of oral cancer is rising in Ireland. The aim of this study is to assess the level of awareness of oral cancer amongst non-consultant hospital doctors (NCHDs) in Ireland, so any knowledge deficits can be identified and addressed. Data was collected by means of an anonymous online questionnaire, which was distributed via a private social media page for NCHDs in Ireland. It was completed by 221 participants, of which over 80% recorded that they do not regularly examine patients’ oral mucosa. Sixty percent were ‘unsure’, and 21%, ‘very unsure’, about diagnosing oral cancer based on clinical appearance. Nor were respondents able to identify confidently the various potential risk factors for oral cancer. Eighty-four percent of NCHDs requested further education on the topic. The response rate of the study was low, and further investigation is required to determine if the findings of this study are representative of the wider NCHD community. The chief recommendation of this paper is to provide more education about oral cancer, at both medical undergraduate and postgraduate levels, and to increase awareness of the condition amongst hospital doctors.
  • Hidradenitis Suppurativa and Crohn’s Disease: A Case Series

    Kirthi, S; Hellen, R; O’Connor, R; Connolly, M; Tobin, AM; McNamara, D (Irish Medical Journal, 2017-09)
    Hidradenitis Suppurativa (HS) is characterized by chronic recurrent abscesses, nodules and draining sinus tracts with scar formation. Cutaneous Crohn’s Disease (CD) may also present similarly. We wished to identify and describe an Irish cohort with combined HS and CD, with a view to a better recognition of clinical manifestations and understanding of the pathophysiology underlying these two overlapping conditions. Cases were identified using the HIPE Code at Tallaght Hospital from 1990-2014 and retrospective review was performed. Seven patients with both HS and CD were identified, 5(71%) female. The median age of diagnosis with both conditions was 37 years. In all cases, CD had preceded the diagnosis of HS. All patients smoked. Six had an increased BMI and 43% had additional autoimmune conditions. All patients required treatment with a TNF-alpha inhibitor for HS with 5 of 6 subjects having reduced frequency of flare ups and clinically less active HS on follow up
  • Pelvic and acetabular trauma care in Ireland: the past, present and future

    Queally, JM; O’Daly, B; Leonard, M; McElwain, JP (Irish Medical Journal, 2017-08)
    Pelvic injuries involve injury to the osseo-ligamentous ring structure of the pelvis or the acetabulum of either hip joint. They are typically caused by high-energy trauma and may be associated with significant morbidity or mortality at the time of injury due to excessive haemorrhage and associated abdominal, chest or head injuries with mortality rates of 8.6% to 19.1% reported for closed injuries and rates of up to 50% reported for open injuries1. Despite the severity of these injuries and the potential for poor long term outcomes, these injuries were managed with non-surgical treatment until the middle of the 20th century. Treatment typically involved prolonged bed rest, traction or compression devices, pelvic slings and spica casts with poor outcomes due to persistent pelvic deformity in pelvic injures and early osteoarthritis in acetabular fractures2,3. In the 1930’s, with the advent of radiography, significant progress was made in terms of understanding injury patterns, subsequent displacement and the significance of pelvic instability and deformity post injury. Along with the improved definitive management of pelvic injuries, similar progress was made with the immediate management of life-threatening haemodynamic instability and resuscitation with a significant improvement in mortality rate achieved over the past 50 years3,4. In contemporary trauma care, to ensure optimal outcomes, pelvic trauma is now considered a subspecialty practised in tertiary centres by fellowship trained specialists. Herein we describe the evolution of pelvic trauma care in Ireland over the past 30 years in an overall context of improved international paradigms of care and discuss potential future developments
  • Older Motorcyclists in Ireland

    Fitzpatrick, D; O’Neill, D (Irish Medical Journal, 2017-06)
    Older motorcyclists are under-recognised as vulnerable road users. Using Irish data from the Central Statistics Office, the Road Safety Authority and the Healthcare Pricing Office, we explored the trend of ageing riders and factors in older motorcyclist collisions and injuries. In 2005, 17 motorcyclists ≥55 were injured compared to 31 in 2012. Motorcyclists aged between 30 and 49 years and ≥50 have longer lengths of stay compared to riders <30. The percentage of motorcycles with an engine capacity of ≥750cc increased from 39.6% in 2007 to 46.7% in 2015. Older motorcyclists are less likely to be fatally injured in single vehicle collisions. Older motorcyclists are generally safer than younger riders but the proportion of older motorcyclist injury is rising. Irish road safety strategies and trauma services need to incorporate these findings into planning and development of preventive and treatment approaches
  • Life After the Event: A Review of Basic Life Support Training for Parents Following Apparent Life-Threatening Events and Their Experience and Practices Following Discharge

    Macken WL; Clarke N; Nadeem M; Coghlan D (Irish Medical Journal, 2017-05)
    Apparent Life-Threatening Events (ALTEs) are a common presentation to paediatric hospitals and represent a significant cause of parental anxiety. Basic Life Support (BLS) training is recommended for all caregivers following ALTEs. This study aimed to assess the rate of caregiver BLS training and reviewed parents experience following discharge. Parents were interviewed by phone following discharge. Over the study period 25 children attended the Emergency Department with ALTE, 17/25 (68%) were trained and 13/17 (76%) were contactable for interview. All parents found training decreased their anxiety level and were interested in attending for re-training. BLS resuscitation was subsequently required by 2/13 (15%) of children. Non-medical grade monitors were in use by 10/13 (77%) of caregivers following discharge. Caregivers are eager to engage in BLS training and it effectively reduces their caregiver anxiety. We recommend an increase in instructor staff and use of group re-training post discharge
  • Investigation and diagnostic formulation in patients admitted with transient loss of consciousness

    Briggs, R; Coughlan, T; Doherty, J; Collins, DR; O’Neill, D; Kennelly, SP (Irish Medical Journal, 2017-05)
    Several commonly completed tests have low diagnostic yield in the setting of transient loss of consciousness (T-LOC). We estimated the use and cost of inappropriate investigations in patients admitted with T-LOC and assessed if these patients were given a definitive diagnosis for their presentation. We identified 80 consecutive patients admitted with T-LOC to a university teaching hospital. Eighty-eight percent (70/80) had a computerized topography (CT) brain scan and 49% (34/70) of these scans were inappropriate based on standard guidelines. Almost half (17/80) of electroencephalograms (EEG) and 82% (9/11) of carotid doppler ultrasound performed were not based on clinical evidence of seizure or stroke respectively. Forty-four percent (35/80) of patients had no formal diagnosis documented for their presentation. Inappropriate investigation in T-LOC is very prevalent in the acute hospital, increasing cost of patient care. In addition, there is poor diagnostic formulation for T-LOC making recurrent events more likely in the absence of definitive diagnoses
  • Barriers to dental attendance in older patients

    Shanahan, D; O’Neill, D (Irish Medical Journal, 2017-04)
    Health professionals in Ireland are increasingly concerned about the quality of oral health in older patients. The aim of this study is to identify the obstacles that face this age-group when accessing dental care, so that we are in a better position to address them. A questionnaire was completed by 105 patients attending a geriatric outpatient clinic. Over 50 percent of respondents had not attended a dentist in over 36 months, for the reasons that 'I have no problem or need for treatment’ (62%) and ‘I have no teeth, and therefore I have no need to go’ (54%). While it is common to assume that no teeth means no need to see a dentist, research shows that regular dental visits are vital for ensuring the early screening of oral cancer and other mucosal pathologies, and the optimisation of existing rosthesis/restorations. The chief recommendation of this paper is thus to provide better education and access to older people on the importance of visiting the dentist.
  • Emergency Aeromedical Services in Ireland – A Single-Centre Study in 2014

    Sheridan, G.A.; Cooper, D.; Gibbons, J.P.; Breathnach, O.; Quinlan, J.F. (Irish Medical Journal, 2017-03)
    This retrospective analysis includes patients requiring Emergency Aeromedical Services (EAS) in 2014. The aim of this paper is to evaluate the HEMS service in a single centre and to accurately assess whether certain internationally validated criteria can predict admission rates better than the currently used criteria. Using the American College of Surgeons (ACS) trauma-related dispatch criteria, each case was retrospectively evaluated. Results showed the mean total criteria met were 2.73 (σ=0.88) and 1.45 (σ=0.82) in admitted and discharged patients respectively. The total criteria met had a significant predictive value on admission rates (p<0.05). Increased admission rates were shown in patients with a high Mechanism of Injury (MOI) (p<0.05). False positive rates of HEMS transfer were higher when applying the current criteria compared to the ACS criteria. ACS total criteria can predict admission in HEMS patients with a higher specificity than currently used guidelines.
  • Seasonal Influenza Vaccine Uptake in a Respiratory Outpatients Clinic

    Rossiter, A; O’Morain, NR; Varghese, C; Lane, S (Irish Medical Journal, 2017-02)
    Influenza is an acute viral respiratory illness that continues to cause significant morbidity and mortality in Ireland. Despite well-established national and international guidelines1 and increased public awareness campaigns, vaccine uptake rates are well below target worldwide2. We performed an audit of influenza vaccine uptake at a Respiratory outpatient clinic in a tertiary referral centre. 54% (n=41) of patients received the annual vaccine, well below the target of 75% set by the European Centre for Disease Prevention and Control (ECDC).
  • An Approach to Optimise Therapeutic Vancomycin Dosage in a Haemodialysis Population

    Gunning, H; Taylor, G; Smyth, H; Mellotte, G; Fennell, J; Murphy, P; Lavin, P; Wall, C (Irish Medical Journal, 2016-10)
    Haemodialysis patients are at risk of gram-positive bacteraemia and commonly require intravenous vancomycin. Intravenously administered vancomycin is primarily excreted by the kidney and exhibits complex pharmacokinetics in haemodialysis patients; achieving therapeutic levels can be challenging. An audit in our unit showed current practises of vancomycin administration resulted in a high proportion of sub-therapeutic levels. A new protocol was developed with fixed weight-based loading and subsequent dosing guided by pre-dialysis levels, target levels were 10-20mg/L. Its effectiveness was prospectively evaluated between 24th September 2012, and 8th February 2013. During this period 25 patients commenced vancomycin, 15 were included. In total, 112 vancomycin levels were taken, 94 (84%) were therapeutic, this was a significant improvement compared to previous practise (odds ratio 5.4, CI 3.1-9.4, p < 0.0001). In conclusion, our study shows this protocol can consistently and reliably achieve therapeutic vancomycin levels

View more