• Paediatric diagnostic reference levels in nuclear medicine imaging in Ireland.

      Gray, L; Torreggiani, W; O'Reilly, G (The British journal of radiology, 2008-11)
    • Paediatric early warning trigger, a cry for help

      Bolger, T; Clarke, N; Crowe, S; Martin, C; Koe, S (Irish Medical Journal, 2015-12)
      In paediatrics, it is crucial to ensure that the child who is clinically deteriorating is rapidly recognised and treated. We implemented a Paediatric Early Warning Trigger (PEWT) in our unit to improve recognition of these patients. Our trigger was a series of physiological measurements with a PEWT call if any result was outside the accepted range. We retrospectively compared 12 months prior to the introduction of the trigger (January to December 2009) to the three years post the introduction of the trigger (January 2010 to December 2012). We compared the time from deterioration to involvement of senior staff during the two time periods. We also examined the rates of crash calls and PICU transfers in the two periods. We found that the time from deterioration to senior clinician involvement reduced from 312 minutes to 166 minutes and the rate of transfers to PICU among the triage category 1&2 patients reduced from 1:50 in 2009 to 1:129, 1:118 and 1:131 during the three years of the trial. The rate of cardiac arrest among this group reduced from 1:100 in 2009 to 1:129, 1:216 and 1:542 during the three years of the trial. This study demonstrates the effectiveness of a Paediatric Early Warning Trigger in an Irish setting. We have been able to maximise senior clinician input into our sickest children in a more timely fashion.
    • A painful right leg.

      Smith, Laura-Jane E; Murphy, Sinéad M; Holmes, Paul; Reilly, Mary M; Reiniger, Lilla; Thom, Maria; Lunn, Michael P (BMJ (Clinical research ed.), 2011)
    • Pancreatic Adenocarcinoma in A Companion to Specialist Surgical Practice

      Conlon KC,; Kelly M.E. (Elsevier, Edinburgh, UK,, 2012)
    • A patient reported outcome measure (PROM) assessing quality of care in the urology hospital outpatient setting

      Alsinnawi, M; Dowling, CM; McKeown, S; Flynn, R; McDermott, TED; Grainger, R; Thornhill, JA (Irish Medical Journal, 2014-09)
      A prospective blind PROM (patient reported outcome measure) study performed in our urology department examined the outpatient-clinic experience. 104 questionnaires were completed. 23 patients (22%) felt the waiting times for appointments was excessive. 13 patients (13%) experienced difficulty in contacting administrative staff. 98 patients (94%) considered the waiting areas good but 31 patients (31%) considered lack of privacy an issue. Consultants saw 65 patients (63%). 62 patients (60%) expected to be seen by a consultant. 32 patients (31%) felt consultation with a different doctor on return visits was unsatisfactory. 76 patients (73%) â fully trustedâ their doctors. 78 patients (75%) rated their visit excellent, 10 patients (10%) added comments. Despite frustration with waiting times, the experience of patients reflects a positive rapport and trust between patient and doctor.
    • Patients with chronic pancreatitis are at increased risk for osteoporosis.

      Duggan, SN; O'Sullivan, Maria; Hamilton, Samuel; Feehan, Sinead M; Ridgway, Paul F; Conlon, Kevin C; Centre for Pancreatico-Biliary Diseases, Department of Surgery, Trinity College Dublin, Tallaght, Dublin, Republic of Ireland. siduggan@tcd.ie (Pancreas, 2012-10)
      Patients with chronic pancreatitis may be at an increased risk of low bone density because of malabsorption of vitamin D and calcium, poor diet, pain, alcoholism, and smoking. We investigated the rates of osteoporosis in patients with chronic pancreatitis compared to matched controls.
    • 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; et al. (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.
    • Pedestrian fatalities and injuries involving Irish older people.

      Martin, A J; Hand, E B; Trace, F; O'Neill, D; Centre for Ageing, Neuroscience and the Humanities, Adelaide and Meath Hospital, , Dublin, Ireland. alanmartin@physicians.ie (2012-02-01)
      BACKGROUND: It has been established internationally that road traffic accidents (RTAs) involving older drivers follow clearly different patterns of timing, location and outcomes from those of younger age groups. Older pedestrians are also a vulnerable group and fewer analyses have been undertaken of the phenomenology of their injuries and fatalities. We studied the pattern of pedestrian RTAs in Ireland over a five-year period with the aim of identifying differences between older pedestrians (aged 65 or older) and younger adults. METHODS: We examined the datasets of the Irish National Road Authority (now the Road Safety Authority) from 1998-2002. We analysed patterns of crashes involving older pedestrians (aged 65) and compared them with younger adults (aged 18-64). RESULTS: Older people represented 36% (n = 134) of pedestrian fatalities and 23% of serious injuries while they only account for 19% of total RTAs. Mortality in RTA is more than doubled for older pedestrians compared to younger adults (RR 2.30). Most accidents involving older pedestrians happen in daylight with good visibility (56%) and in good weather conditions (77%). CONCLUSIONS: Older pedestrians are particularly vulnerable in RTAs. These occur more frequently during daylight hours and in good weather conditions. This may point to a need for prevention strategies that are targeted at the traffic environment and other road users rather than at older people.
    • Pelvic and Acetabular Fractures

      O’Neill, F; Leonard, M; Lui, D; McElwain, J; Morris, S (Irish Medical Journal (IMJ), 2012-10)
    • 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
    • People living in Tallaght and their health: a community based cross-sectional survey

      Adelaide Hospital Society; Trinity College Dublin. Department of Community Health and Practice (Adelaide Hospital Society by the Department of Community Health and Practice, Trinity College Dublin., 2002-03)
      We conducted a cross sectional study in the 13 district electoral divisions of Tallaght and we interviewed primary or principal carers (defined as the person in the household who manages the welfare and health of the family/household) in 344 of the selected 420 households. We selected the households employing a cluster sampling methodology. We chose 30 clusters from both the six less deprived district electoral divisions and the seven more deprived district electoral divisions of Tallaght. Each of the 60 clusters consisted of seven adjacent households. We interviewed the primary carers in their homes using an interviewer administered questionnaire
    • Percutaneous computed tomography-guided oesophageal needle biopsy

      Kok, HK; Govender, P; Leong, S; Browne, RFJ; Torreggiani, WC (Irish Medical Journal (IMJ), 2014-02)
    • 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.
    • Periprosthetic fractures in the resurfaced hip--A case report and review of the literature.

      Brennan, Stephen A; Devitt, Brian M; O'Neill, Cathleen J; Nicholson, Paul; Adelaide and Meath Hospital, Dublin, Ireland. stevobrennan@hotmail.com (2013-02)
      Traumatic periprosthetic fractures adjacent a hip resurfacing prosthesis are rare. When proximal fractures are encountered the obvious surgical solution is to revise to a large head stemmed femoral component. A previously well functioning implant may however be retained as various non-operative and operative treatment options exist. This paper reports the case history of a traumatic periprosthetic fracture successfully treated with cannulated screw fixation and reviews the current literature.
    • Peritoneal dialysis in an ageing population: a 10-year experience.

      Smyth, Andrew; McCann, Evonne; Redahan, Lynn; Lambert, Barbara; Mellotte, George J; Wall, Catherine A; Department of Nephrology, Adelaide & Meath Hospital, Dublin 24, Tallaght, Ireland. andrewsmyth@physicians.ie (2012-02)
      Chronic kidney disease (CKD) is becoming increasingly prevalent and there are increasing numbers of older patients with advanced CKD. Peritoneal dialysis (PD) is a potential treatment. This study aims to compare PD outcomes in age-defined populations in the largest PD centre in the Republic of Ireland over 10 years.
    • Persistent next-day effects of excessive alcohol consumption on laparoscopic surgical performance.

      Gallagher, Anthony G; Boyle, Emily; Toner, Paul; Neary, Paul C; Andersen, Dana K; Satava, Richard M; Seymour, Neal E; National Surgical Training Centre, Royal College of Surgeons in Ireland, RCSI House, 121 St Stephen's Green, Dublin 2, Ireland. (Archives of surgery, 2011-04)
      To examine the effect of previous-day excessive alcohol consumption on laparoscopic surgical performance.
    • Pharmacy services at admission and discharge in adult, acute, public hospitals in Ireland.

      Grimes, Tamasine; Duggan, Catherine; Delaney, Tim; Pharmacy Department, Adelaide and Meath Hospital, incorporating the National, Children's Hospital (AMNCH), Tallaght, Dublin, Ireland. tamasine.grimes@amnch.ie (2012-02-01)
      OBJECTIVES: to describe hospital pharmacy involvement in medication management in Ireland, both generally and at points of transfer of care, and to gain a broad perspective of the hospital pharmacy workforce. METHODS: a survey of all adult, acute, public hospitals with an accident and emergency (A&E) department (n = 36), using a semi-structured telephone interview. KEY FINDINGS: there was a 97% (n = 35) response rate. The majority (n = 25, 71.4%) of hospitals reported delivery of a clinical pharmacy service. On admission, pharmacists were involved in taking or verifying medication histories in a minority (n = 15, 42.9%) of hospitals, while few (n = 6,17.1%) deployed staff to the A&E/acute medical admissions unit. On discharge, the majority (n = 30,85.7%) did not supply any take-out medication, a minority (n =5,14.3%) checked the discharge prescription, 51.4% (n = 18) counselled patients, 42.9% (n = 15) provided medication compliance charts and one hospital (2.9%) communicated with the patient's community pharmacy. The number of staff employed in the pharmacy department in each hospital was not proportionate to the number of inpatient beds, nor the volume of admissions from A&E. There were differences identified in service delivery between hospitals of different type: urban hospitals with a high volume of admissions from A&E were more likely to deliver clinical pharmacy. CONCLUSIONS: the frequency and consistency of delivering pharmacy services to facilitate medication reconciliation at admission and discharge could be improved. Workforce constraints may inhibit service expansion. Development of national standards of practice may help to eliminate variation between hospitals and support service development.
    • Phenotype expression in women with CMT1X.

      Siskind, Carly E; Murphy, Sinéad M; Ovens, Richard; Polke, James; Reilly, Mary M; Shy, Michael E; Department of Neurology, Wayne State University, Detroit, MI 48201, USA. csiskind@med.wayne.edu (Journal of the peripheral nervous system : JPNS, 2011-06)
      Charcot-Marie-Tooth disease type 1X (CMT1X) is the second most common inherited peripheral neuropathy. Women with CMT1X typically have a less severe phenotype than men, perhaps because of X-inactivation patterns. Our objective was to determine the phenotype of women with CMT1X and whether X-inactivation patterns in white blood cells (WBCs) differ between females with CMT1X and controls. Thirty-one women with CMT1X were evaluated using the CMT neuropathy score (CMTNS) and the CMT symptom score in cross-sectional and longitudinal analyses. Lower scores correspond to less disability. WBCs were analyzed for X-inactivation pattern by androgen receptor X-inactivation assay in 14 patients and 23 controls. The 31 women's mean CMTNS was 8.35. Two-thirds of the cohort had a mild CMTNS (mean 4.85) and one-third had a moderate CMTNS (mean 14.73). Three patients had a CMTNS of 0. The pattern of X-inactivation did not differ between the affected and control groups. Women with CMT1X presented with variable impairment independent of age, type of mutation, or location of mutation. No evidence supported the presence of a gap junction beta-1 (GJB1) mutation affecting the pattern of X-inactivation in blood. Further studies are planned to determine whether X-inactivation is the mechanism for CMT1X females' variable phenotypes.
    • Physical Activity and Cardiovascular Disease risk factors in urban school children

      Kilbride, E; Hussey, J; Boran, G; Greally, P (Irish Medical Journal, 2013-01)