• Factors affecting return to driving post-stroke.

      Tan, K M; O'Driscoll, A; O'Neill, D; Stroke Service, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. (2012-02-01)
      BACKGROUND: Stroke can affect a person's ability to drive, an important means of transportation in the developed world. AIMS: To determine percentage of patients and factors associated with return to driving post-stroke in a service with emphasis on driver assessment. METHODS: Retrospective study of patients discharged from the Stroke Service of our 470-bed teaching hospital from 1998 to 2002. RESULTS: Of 72 drivers pre-stroke, 54% recalled a driving assessment and 68% returned to driving. Younger patients (58.6 +/- 12.0 vs. 66.5 +/- 10.5, p = 0.008) with lower Modified Rankin Score (median 1 vs. 2, p = 0.0001) and normal cognition (55 vs. 43%, p = 0.45) were more likely to resume driving. More patients who were assessed returned to driving than those who were not (74 vs. 61%, p = 0.31). CONCLUSIONS: A relatively high level of return to driving can be achieved post-stroke with a pro-active approach to driver assessment and rehabilitation. A structured assessment and referral programme should be offered where appropriate.
    • Familial evaluation in arrhythmogenic right ventricular cardiomyopathy: impact of genetics and revised task force criteria.

      Quarta, Giovanni; Muir, Alison; Pantazis, Antonios; Syrris, Petros; Gehmlich, Katja; Garcia-Pavia, Pablo; Ward, Deirdre; Sen-Chowdhry, Srijita; Elliott, Perry M; McKenna, William J; et al. (Circulation, 2011-06-14)
      With recognition of disease-causing genes in arrhythmogenic right ventricular cardiomyopathy, mutation analysis is being applied.
    • Family Meeting or Care Planning Meeting-is there a difference?

      Donnelly, S (2011-04)
      Grand Round Presentation, Adelaide and Meath Hospital Tallaght, April 2011.
    • Family Meetings with vulnerable patients-an exploration of Multidisciplinary Team practices and communication using an action research approach

      Donnelly, S (2010)
      the 6th International Conference on Social Work in Health and Mental Health,1st July, University College Dublin
    • A fatal case of Pasteurella multocida epiglottitis.

      O'Connell, K; Fennell, J; Callaghan, J; Rowaiye, B; Cormican, M; Department of Medical Microbiology, Galway University Hospital, Ireland. karina.oconnell@hse.ie (Irish journal of medical science, 2009-12)
      Pasteurella multocida, a Gram-negative bacillus, is rarely associated with acute respiratory infections.
    • Fatigue fracture of tibial arthroplasty implant masked by contralateral knee arthritis.

      O'Neill, Barry J; Cleary, May; McElwain, John P; Department of Orthopaedic Surgery, The Adelaide & Meath Hospital Incorporating the National Children's Hospital, Tallaght, Dublin 24, Ireland. Electronic address: barryoneill1922@gmail.com. (2013)
      The wear of polyethylene components is a well-recognised long-term complication of total knee arthroplasty.
    • Fine needle aspiration cytology in symptomatic breast lesions: still an important diagnostic modality?

      Smith, Myles J; Heffron, Cynthia C; Rothwell, Jane R; Loftus, Barbara M; Jeffers, Michael; Geraghty, James G; Department of Surgery, Adelaide and Meath Incorporating the National Children's Hospital (AMNCH), Tallaght, Dublin, Ireland. mylessmith@hotmail.com (The breast journal, 2012)
      The objective of this study was to make an assessment of the utility of fine needle aspiration cytology (FNAC), in a "one-stop" symptomatic breast triple assessment clinic. Controversy surrounds the optimal tissue biopsy methodology in the diagnosis of symptomatic breast cancer and the identification of benign disease. FNAC in the context of a Rapid Assessment Breast Clinic (RABC) allows the same day diagnosis and early treatment of breast cancer, with the immediate reassurance and discharge of those with benign disease. We analyzed prospective data accrued at a RABC, over a 4-year period from 2004 to 2007. All patients were triple assessed, with FNACs performed on site by two consultant cytopathologists. Investigations were reported immediately, and clinical data were captured via a database using compulsory data field entry. There were 4487 attendances at our RABC, with 1572 FNACs were performed. The positive predictive value of FNAC with a C5 cancer diagnosis was 100%, 95.6% for a C4 report, with a complete sensitivity of 94%. The full specificity of correctly identified benign lesions was 77.4%, with a false negative rate of 3.85%. This enabled 66% of patients attending the RABC to receive a same day diagnosis of benign disease and discharge. FNAC is highly accurate in the diagnosis of symptomatic breast cancer in an RABC. FNAC allows accurate diagnosis of benign disease and immediate discharge of the majority of patients. In this era, when a large majority of patients have benign disease, we believe that FNAC provides an equivalent, if not better, method of evaluation of patients in a triple assessment RABC.
    • First patient: HSE and Tallaght Hospital: patient centred care project: first patient project: phase 1: an evaluation.

      Gavin, Katherine; Brady, Marie; Health Service Executive (HSE); Adeleide and Meath Hospital Dublin; Eastern Regional Health Authority (ERHA) (Health Service Executive (HSE), 2013-01-09)
      The Eastem Regional Health Authority (ERHA) and the Adelaide, Meath incorporating the National Children's Hospital embarked on a joint initiative aimed at developing person-centred care and establishing a partnership of care between service providers and patients. The neurology service at the hospital was chosen as the pilot site for the project. The project aimed to establish a consistent and consensus view of patient centred care with management, clinicians and patients and to explore the concept of new models of care with the patient at the centre of service delivery. The priorities and preferences for care from the perspectives of neurology service providers were determined by a multidisciplinary focus group with neurology staff (n= 7) and interviews with medical staff (n=2). Staff was asked to assess the best and worst aspects of the current neurology service, to describe the key features of patient focused neurology care and to suggest priorities for establishing a "model" of patient centred care.
    • Five-year experience of critical incidents associated with patient-controlled analgesia in an Irish University Hospital.

      Ahmad, I; Thompson, A; Frawley, M; Hu, P; Heffernan, A; Power, C; Department of Anaesthesia, Adelaide and Meath Hospital, Belgard Road, Tallaght,, Dublin 24, Ireland. ishtiaqahmad99@hotmail.com (2012-02-01)
      BACKGROUND: Patient-controlled analgesia (PCA) is a common and effective means of managing post-operative pain. We sought to identify factors that may lead to critical incidents (CIs) in patient safety when using PCA in our institution. METHODS: An observational study of prospectively collected data of patients who received PCA from 2002 to 2006 was performed. All CIs were documented and analysed by staff members of the acute pain service (APS). Cause analysis of CIs was undertaken to determine if measures can be instituted to prevent recurrence of similar events. RESULTS: Over eight thousand patients (8,240) received PCA. Twenty-seven CIs were identified. Eighteen were due to programming errors. Other CIs included co-administration of opioids and oversedation. CONCLUSION: In our institution, the largest contributory factor to CIs with PCAs was programming error. Strategies to minimize this problem include better education and surveillance.
    • Focal femoral condyle resurfacing.

      Brennan, S A; Devitt, B M; O'Neill, C J; Nicholson, P; Adelaide and Meath Hospital Dublin, Tallaght, Dublin 24, Ireland. (2013-03)
      Focal femoral inlay resurfacing has been developed for the treatment of full-thickness chondral defects of the knee. This technique involves implanting a defect-sized metallic or ceramic cap that is anchored to the subchondral bone through a screw or pin. The use of these experimental caps has been advocated in middle-aged patients who have failed non-operative methods or biological repair techniques and are deemed unsuitable for conventional arthroplasty because of their age. This paper outlines the implant design, surgical technique and biomechanical principles underlying their use. Outcomes following implantation in both animal and human studies are also reviewed. Cite this article: Bone Joint J 2013;95-B:301-4.
    • Fortuitous Vasculitis

      Sharma, Hema; Keshavan, Ashvini; Little, Mark Alan; Cross, Jennifer; Lipman, Marc C.; Talukdar, Sabrina; Hopkins, Susan (Renal Failure, 2012)
    • Frequency and consequences of violence in community pharmacies in Ireland.

      Fitzgerald, D; Reid, A; Occupational Health Department, Tallaght Hospital, Tallaght, Dublin, Ireland. (2012-09-11)
      BackgroundViolence in community pharmacies in Ireland is thought to be common but underreported. The frequency and consequences of violence has not been studied previously.AimsTo establish the frequency and nature of violence in community pharmacies over 12 months, and to investigate the impact of violence on employees and possible consequence for the industry.MethodsA two-part survey was distributed to community pharmacies in Ireland in 2011 (n = 200). The first part related to pharmacy demographics, the frequency of various violent events (verbal abuse, threats etc.), the respondents' worry regarding violence and its impact on their co-workers. The second part concerned individual employees' subjective response to a violent event, using the Impact of Event Scale-Revised (IES-R).ResultsFifty-seven per cent of the pharmacies responded, with 77% reporting some violent event (verbal or physical), over the past year. Eighteen per cent reported physical assault, and 63% were worried about workplace violence. There was no association between late night opening hours or pharmacy size and violence frequency. Positive statistically significant correlations were present between all types of violence and absenteeism and employee fear levels. An IES-R score could be calculated for 75 respondents; the median IES-R score was 8 with 19% reporting clinically significant scores.ConclusionsViolence is common in Irish community pharmacies and impacts on employees and the industry.
    • Frequency of mutations in the genes associated with hereditary sensory and autonomic neuropathy in a UK cohort.

      Davidson, G L; Murphy, S M; Polke, J M; Laura, M; Salih, M A M; Muntoni, F; Blake, J; Brandner, S; Davies, N; Horvath, R; et al. (Journal of neurology, 2012-08)
      The hereditary sensory and autonomic neuropathies (HSAN, also known as the hereditary sensory neuropathies) are a clinically and genetically heterogeneous group of disorders, characterised by a progressive sensory neuropathy often complicated by ulcers and amputations, with variable motor and autonomic involvement. To date, mutations in twelve genes have been identified as causing HSAN. To study the frequency of mutations in these genes and the associated phenotypes, we screened 140 index patients in our inherited neuropathy cohort with a clinical diagnosis of HSAN for mutations in the coding regions of SPTLC1, RAB7, WNK1/HSN2, FAM134B, NTRK1 (TRKA) and NGFB. We identified 25 index patients with mutations in six genes associated with HSAN (SPTLC1, RAB7, WNK1/HSN2, FAM134B, NTRK1 and NGFB); 20 of which appear to be pathogenic giving an overall mutation frequency of 14.3%. Mutations in the known genes for HSAN are rare suggesting that further HSAN genes are yet to be identified. The p.Cys133Trp mutation in SPTLC1 is the most common cause of HSAN in the UK population and should be screened first in all patients with sporadic or autosomal dominant HSAN.
    • Frequent inaccuracies in ABCD(2) scoring in non-stroke specialists' referrals to a daily Rapid Access Stroke Prevention service.

      Bradley, David; Cronin, Simon; Kinsella, Justin A; Tobin, W Oliver; Mahon, Ciara; O'Brien, Margaret; Lonergan, Róisín; Cooney, Marie Therese; Kennelly, Sean; Collins, D Rónán; et al. (Elsevier, 2013-09-15)
      The 'accuracy' of age, blood pressure, clinical features, duration and diabetes (ABCD(2)) scoring by non-stroke specialists referring patients to a daily Rapid Access Stroke Prevention (RASP) service is unclear, as is the accuracy of ABCD(2) scoring by trainee residents. In this prospective study, referrals were classified as 'confirmed TIAs' if the stroke specialist confirmed a clinical diagnosis of possible, probable or definite TIA, and 'non-TIAs' if patients had a TIA mimic or completed stroke. ABCD(2) scores from referring physicians were compared with scores by experienced stroke specialists and neurology/geriatric medicine residents at a daily RASP clinic; inter-observer agreement was examined. Data from 101 referrals were analysed (mean age=60.0years, 58% male). The median interval between referral and clinic assessment was 1day. Of 101 referrals, 52 (52%) were 'non-TIAs': 45 (86%) of 52 were 'TIA mimics' and 7 (14%) of 52 were completed strokes. There was only 'fair' agreement in total ABCD(2) scoring between referring physicians and stroke specialists (κ=0.37). Agreement was 'excellent' between residents and stroke specialists (κ=0.91). Twenty of 29 patients scored as 'moderate to high risk' (score 4-6) by stroke specialists were scored 'low risk' (score 0-3) by referring physicians. ABCD(2) scoring by referring doctors is frequently inaccurate, with a tendency to underestimate stroke risk. These findings emphasise the importance of urgent specialist assessment of suspected TIA patients, and that ABCD(2) scores by non-stroke specialists cannot be relied upon in isolation to risk-stratify patients. Inter-observer agreement in ABCD(2) scoring was 'excellent' between residents and stroke specialists, indicating short-term training may improve accuracy.
    • Functional connectivity of emotional processing in depression.

      Carballedo, Angela; Scheuerecker, Johanna; Meisenzahl, Eva; Schoepf, Veronika; Bokde, Arun; Moller, Hans-Jurgen; Doyle, Myles; Wiesmann, Martin; Frodl, Thomas; Discipline of Psychiatry, School of Medicine & Trinity College Institute of, Neuroscience, Integrated Neuroimaging, Trinity Academic Medical Centre, The, Adelaide and Meath Hospital incorporating the National Children's Hospital, & St , James's Hospital, Trinity College, Dublin, Ireland. carbala@tcd.ie (2012-02-01)
      OBJECTIVES: The aim of the study is to map a neural network of emotion processing and to identify differences in major depression compared to healthy controls. It is hypothesized that intentional perception of emotional faces activates connections between amygdala (Demir et al.), orbitofrontal cortex (OFC), anterior cingulate cortex (ACC) and prefrontal cortex (PFC) and that frontal-amygdala connections are altered in major depressive disorder (MDD). METHODS: Fifteen medication-free patients with MDD and fifteen healthy controls were enrolled. All subjects were assessed using the same face-matching functional Magnetic Resonance Imaging (fMRI) task, known to involve those areas. Brain activations were obtained using Statistical Parametric Mapping version 5 (SPM5) for data analysis and MARSBAR for extracting of fMRI time series. Then data was analyzed using structural equation modeling (SEM). RESULTS: A valid model was established for the left and the right hemispheres showing a circuit involving ACC, OFC, PFC and AMY. The left hemisphere shows significant lower connectivity strengths in patients than controls, for the pathway that goes from AMY to the OF11, and a trend of higher connectivity in patients for the path that goes from the PF9 to the OF11. In the right hemisphere, patients show lower connectivity coefficients in the paths from the AMY to OF11, from the AMY to ACC, and from the ACC to PF9. By the contrary, controls show lower connectivity strengths for the path that goes from ACC to AMY. CONCLUSIONS: Functional disconnection between limbic and frontal brain regions could be demonstrated using structural equation modeling. The interpretation of these findings could be that there is an emotional processing bias with disconnection bilaterally between amygdala to orbitofrontal cortices and in addition a right disconnection between amygdala and ACC as well as between ACC and prefrontal cortex possibly in line with a more prominent role for the right hemisphere in emotion processing.
    • Gallbladder Carcinoma

      A Gillis, A; Cleary, S; Ridgway, PF (UOT Press, 2012)
    • General practitioner ENT referral audit.

      Oosthuizen, J C; McShane, D; Kinsella, J; Conlon, B; The Adelaide and Meath, Incorporating the National Children's Hospital, Dublin, Ireland, c.oosth@gmail.com. (2014-02-14)
      During 2009, there were 3.3 million outpatient attendances at outpatient clinics across Ireland. Up to 20 % of these are directed towards ENT services.
    • Genetic dysfunction of MT-ATP6 causes axonal Charcot-Marie-Tooth disease.

      Pitceathly, Robert D S; Murphy, Sinéad M; Cottenie, Ellen; Chalasani, Annapurna; Sweeney, Mary G; Woodward, Cathy; Mudanohwo, Ese E; Hargreaves, Iain; Heales, Simon; Land, John; et al. (Neurology, 2012-09-11)
      Charcot-Marie-Tooth (CMT) disease is the most common inherited neuromuscular disorder, affecting 1 in 2,500 individuals. Mitochondrial DNA (mtDNA) mutations are not generally considered within the differential diagnosis of patients with uncomplicated inherited neuropathy, despite the essential requirement of ATP for axonal function. We identified the mtDNA mutation m.9185T>C in MT-ATP6, encoding the ATP6 subunit of the mitochondrial ATP synthase (OXPHOS complex V), at homoplasmic levels in a family with mitochondrial disease in whom a severe motor axonal neuropathy was a striking feature. This led us to hypothesize that mutations in the 2 mtDNA complex V subunit encoding genes, MT-ATP6 and MT-ATP8, might be an unrecognized cause of isolated axonal CMT and distal hereditary motor neuropathy (dHMN).
    • Genetically distinct subsets within ANCA-associated vasculitis.

      Lyons, Paul A; Rayner, Tim F; Trivedi, Sapna; Holle, Julia U; Watts, Richard A; Jayne, David R W; Baslund, Bo; Brenchley, Paul; Bruchfeld, Annette; Chaudhry, Afzal N; et al. (The New England journal of medicine, 2012-07-19)
      Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a severe condition encompassing two major syndromes: granulomatosis with polyangiitis (formerly known as Wegener's granulomatosis) and microscopic polyangiitis. Its cause is unknown, and there is debate about whether it is a single disease entity and what role ANCA plays in its pathogenesis. We investigated its genetic basis.