• The decline of hysterectomy for benign disease.[commentary]

      Ward, E; Browne, R; Torreggiani, W C (Irish medical journal, 2009)
    • The decline of TURP – An Irish experience

      Quinlan, Mark R; Connolly, Stephen S; McDermott, T.E.D (British Journal of Medical and Surgical Urology, 2009)
    • Defining useful surrogates for user participation in online medical learning.

      Beddy, Peter; Ridgway, Paul F; Beddy, David; Clarke, Eric; Traynor, Oscar; Tierney, Sean; Department of Surgery, Adelaide and Meath Hospital (AMNCH) incorporating the, National Children's Hospital, Tallaght, Dublin 24, Ireland. pbeddy@eircom.net (2012-02-01)
      "School for Surgeons" is a web-based distance learning program which provides online clinical-based tutorials to surgical trainees. Our aim was to determine surrogates of active participation and to assess the efficacy of methods to improve usage. Server logs of the 82 participants in the "School for Surgeons" were assessed for the two terms of the first year of the program. Data collected included total time online, mean session time, page requests, numbers of sessions online and the total number of assignments. An intervention regarding comparative peer usage patterns was delivered to the cohort between terms one and two. Of the 82 trainees enrolled, 83% (85% second term) logged into the program. Of all participants 88% (97% second term) submitted at least one assignment. Median submissions were four (eight second term) per trainee. Assignment submission closely correlated with number of sessions, total time online, downloads and page requests. Peer-based comparative feedback resulted in a significant increase in the number of assignments submitted (p < 0.01). Despite its recent introduction, "School for Surgeons" has a good participation rate. Assignment submission is a valid surrogate for usage. Students can be encouraged to move from passive observation to active participation in a virtual learning environment by providing structured comparative feedback ranking their performance.
    • The detection of heterozygous familial hypercholesterolemia in Ireland.

      O'Kane, Maurice J; Menown, Ian B; Graham, Ian; Maher, Vincent; Tomkin, Gerald; Nicholls, Paul; Graham, Colin; Clinical Chemistry Laboratory, Altnagelvin Hospital, Londonderry, Northern Ireland. Maurice.OKane@westerntrust.hscni.net (Advances in therapy, 2012-05)
      Heterozygous familial hypercholesterolemia (HeFH) is an autosomal dominant condition with a population prevalence of 1 in 500, and is associated with significant cardiovascular morbidity and mortality. It may be caused by mutations in the low-density lipoprotein (LDL) receptor, apolipoprotein B100 (Apo B100), or proprotein convertase subtilisin/kexin type 9 (PCSK9) genes, with over 1,000 causative mutations described. Statin therapy in HeFH is considered effective and safe. Audit data suggest that approximately 80% of the putative HeFH population remains unidentified and, therefore, there is a need to develop a strategy for the identification of affected individuals so that early lipid-lowering treatment may be offered. There is good evidence showing the effectiveness and acceptability of HeFH screening programs in Europe. The authors describe a protocol for an all island approach to HeFH detection in the Republic of Ireland/Northern Ireland. Index cases will be identified by opportunistic screening using the Simon Broome, or Make Early Diagnosis to Prevent Early Death (MedPed) and World Health Organization (WHO) criteria. Patients identified as "definite," "probable," or "possible" HeFH criteria will be offered genetic testing. The authors expect causative mutations to be identified in approximately 80% of patients with "definite" HeFH but in only approximately 20% of patients with "possible" HeFH. Cascade screening will be undertaken in first-degree relatives of the index case using genetic testing (where a causative mutation has been identified), or otherwise using LDL cholesterol concentration. The establishment of a HeFH screening program on an all-island basis will require: expansion of the existing molecular genetics diagnostic services, the establishment of a cohort of nurses/genetic counselors, a HeFH database to support cascade testing, the development of a network of lipid clinics (in a primary or secondary care setting), and an educational initiative to raise awareness of HeFH among healthcare professionals and the general population.
    • Determinants of risk factor control in subjects with coronary heart disease : a report from the EUROASPIRE III investigators.

      Cooney, Marie Therese; Kotseva, Kornelia; Dudina, Alexandra; De Backer, Guy; Wood, David; Graham, Ian; Adelaide Meath Hospital, Dublin, Ireland. (European journal of preventive cardiology, 2012-04-18)
      The EUROASPIRE audits of risk factor control have indicated that, even in those with established coronary heart disease, risk factor control remains poor. We therefore analysed the EUROASPRE III data set to establish the factors associated with success or failure in risk factor control in order to inform future risk factor management strategies. University education, attendance at a specialist cardiology clinic, and participation in a cardiac rehabilitation programme were associated with improved risk factor control. Risk factor control was poorer in women, those with diabetes, and those undergoing coronary artery bypass surgery as opposed to medical therapy or percutaneous coronary intervention. Increasing age, depression, and anxiety were not associated with poorer risk factor control.
    • Determining the economic cost of ICU treatment: a prospective "micro-costing" study.

      McLaughlin, Anne Marie; Hardt, Judy; Canavan, James B; Donnelly, Maria B; Department of Intensive Care, Adelaide and Meath Hospital, The National, Children's Hospital, Tallaght, Dublin 24, Ireland. annemmclaughlin@gmail.com (2012-02-01)
      OBJECTIVE: To prospectively assess the cost of patients in an adult intensive care unit (ICU) using bottom-up costing methodology and evaluate the usefulness of "severity of illness" scores in estimating ICU cost. METHODS AND DESIGN: A prospective study costing 64 consecutive admissions over a 2-month period in a mixed medical/surgical ICU. RESULTS: The median daily ICU cost (interquartile range, IQR) was 2,205 euro (1,932 euro-3,073 euro), and the median total ICU cost (IQR) was 10,916 euro (4,294 euro-24,091 euro). ICU survivors had a lower median daily ICU cost at 2,164 per day, compared with 3,496 euro per day for ICU non-survivors (P = 0.08). The requirements for continuous haemodiafiltration, blood products and anti-fungal agents were associated with higher daily and overall ICU costs (P = 0.002). Each point increase in SAPS3 was associated with a 305 euro (95% CI 31 euro-579 euro) increase in total ICU cost (P = 0.029). However, SAPS3 accounted for a small proportion of the variance in this model (R (2) = 0.08), limiting its usefulness as a stand-alone predictor of cost in clinical practice. A model including haemodiafiltration, blood products and anti-fungal agents explained 54% of the variance in total ICU cost. CONCLUSION: This bottom-up costing study highlighted the considerable individual variation in costs between ICU patients and identified the major factors contributing to cost. As the requirement for expensive interventions was the main driver for ICU cost, "severity of illness" scores may not be useful as stand-alone predictors of cost in the ICU.
    • Determining the economic cost of ICU treatment: a prospective "micro-costing" study.

      McLaughlin, Anne Marie; Hardt, Judy; Canavan, James B; Donnelly, Maria B; Department of Intensive Care, Adelaide and Meath Hospital, The National Children's Hospital, Tallaght, Dublin 24, Ireland. annemmclaughlin@gmail.com (2009-12)
      To prospectively assess the cost of patients in an adult intensive care unit (ICU) using bottom-up costing methodology and evaluate the usefulness of "severity of illness" scores in estimating ICU cost.
    • Development and evaluation of a composite risk score to predict kidney transplant failure.

      Moore, Jason; He, Xiang; Shabir, Shazia; Hanvesakul, Rajesh; Benavente, David; Cockwell, Paul; Little, Mark A; Ball, Simon; Inston, Nicholas; Johnston, Atholl; et al. (American journal of kidney diseases : the official journal of the National Kidney Foundation, 2011-05)
      Although risk factors for kidney transplant failure are well described, prognostic risk scores to estimate risk in prevalent transplant recipients are limited.
    • The development of a preliminary ultrasonographic scoring system for features of hand osteoarthritis.

      Keen, H I; Lavie, F; Wakefield, R J; D'Agostino, M-A; Hammer, H Berner; Hensor, E; Pendleton, A; Kane, D; Guerini, H; Schueller-Weidekamm, C; et al. (Annals of the rheumatic diseases, 2008-05)
      Painful osteoarthritis (OA) of the hand is common and a validated ultrasound (US) scoring system would be valuable for epidemiological and therapeutic outcome studies. US is increasingly used to assess peripheral joints, though most of the US focus in rheumatic diseases has been on rheumatoid arthritis. We aimed to develop a preliminary US hand OA scoring system, initially focusing on relevant pathological features with potentially high reliability.
    • The development of nurse- led extubation service in a children’s operating theatre department

      Harding, Paul (2012-04)
      The European Operating Room Nurses Association Congress, Lisbon, Portugal
    • Diagnostic Laparoscopy

      Conlon KC,; Ridgway P (Fischer JE. Ed. Lippincott, Williams and Wilkins, 2011)
    • Differential effects of raloxifene and estrogen on body composition in growth hormone-replaced hypopituitary women.

      Birzniece, Vita; Meinhardt, Udo J; Gibney, James; Johannsson, Gudmundur; Armstrong, Nicola; Baxter, Robert C; Ho, Ken K Y; Pituitary Research Unit, Garvan Institute of Medical Research and Department of Endocrinology, St. Vincent's Hospital, and The University of New South Wales, Sydney, New South Wales 2010, Australia. (The Journal of clinical endocrinology and metabolism, 2012-03)
      GH deficiency causes reduction in muscle and bone mass and an increase in fat mass (FM), the changes reversed by GH replacement. The beneficial effects of GH on fat oxidation and protein anabolism are attenuated more markedly by raloxifene, a selective estrogen receptor modulator, compared with 17β-estradiol. Whether this translates to a long-term detrimental effect on body composition is unknown.
    • DNA testing in hereditary neuropathies.

      Murphy, Sinéad M; Laurá, Matilde; Reilly, Mary M; MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, Queen Square, London, UK; Department of Neurology, Adelaide & Meath Hospitals Incorporating the National Children's Hospital, Tallaght, Dublin, and Trinity College Dublin, Ireland. Electronic address: Sinead.Murphy@amnch.ie. (2013)
      The inherited neuropathies are a clinically and genetically heterogeneous group of disorders in which there have been rapid advances in the last two decades. Molecular genetic testing is now an integral part of the evaluation of patients with inherited neuropathies. In this chapter we describe the genes responsible for the primary inherited neuropathies. We briefly discuss the clinical phenotype of each of the known inherited neuropathy subgroups, describe algorithms for molecular genetic testing of affected patients and discuss genetic counseling. The basic principles of careful phenotyping, documenting an accurate family history, and testing the available genes in an appropriate manner should identify the vast majority of individuals with CMT1 and many of those with CMT2. In this chapter we also describe the current methods of genetic testing. As advances are made in molecular genetic technologies and improvements are made in bioinformatics, it is likely that the current time-consuming methods of DNA sequencing will give way to quicker and more efficient high-throughput methods, which are briefly discussed here.
    • Do not forget about HELLP!

      Bennett, Michael; Emergency Department, Adelaide and Meath incorporating the National Children's Hospital, Dublin, Ireland. mbennett1977@gmail.com (2011)
      A 32-year-old female para 4 gravi 3, who was 21 weeks pregnant, presented to the emergency department (ED) with a 2-day history of abdominal pain, headache, blurred vision and vomiting. On arrival, she was agitated and confused with a blood pressure 162/106 mm Hg, pulse rate 107, respiratory rate 18, temperature 37 degrees Celsius, point of care blood glucose 6.2 and her Glasgow coma scale was 13/15 M6V4E3. Paramedics witnessed seizure-like activity lasting <1 min during transport. A diagnosis of eclampsia complicated by the HELLP syndrome (haemolysis, elevated liver enzymes, low platelets count) was made. She was commenced on magnesium and labetalol intravenously for blood pressure control. Initial blood test results were consistent with the HELLP syndrome. Recognition of the HELLP syndrome with prompt management of blood pressure and clotting abnormalities is essential in the ED setting. An aggressive multidisciplinary approach is a key to optimise the prognosis for mother and fetus.
    • Do we really understand the role of the oesophagogastric junction in disease?

      McMahon, Barry P; Jobe, Blair A; Pandolfino, John E; Gregersen, Hans; Department of Medical Physics and Clinical Engineering, Adelaide and Meath, Hospital, Tallaght, Dublin 24, Ireland. barry.mcmahon@tcd.ie (2012-02-01)
      The role of the oesophago-gastric junction (OGJ) in gastro-oesophageal reflux disease is still not completely understood, and there is no clinically used method to assess the OGJ function in patients. Only indirect methods such as pH studies are carried out. The OGJ acts a valve controlling the flow of solids, liquids and gases between the oesophagus and the stomach. Manometry can determine if a sphincter is toned or relaxed; but, it cannot confirm that the sphincter region is actually open. Distension is a new technique for measuring function in the OGJ. By measuring the cross-sectional area through the narrow region in the junction during distension of a catheter mounted bag, much more information on the opening and closing patterns of the junction can be determined. This technique has already been demonstrated to show changes in the OGJ after surgical treatments for reflux disease. New measurement ideas around the concept of distending the OGJ offer new hope that a clinically useable test for compliance at the junction can be developed and could potentially help in determining appropriate therapy.