• Failure to attend out-patient clinics: is it in our DNA?

      Roberts, Kinley; Callanan, Ian; Tubridy, Niall; Department of Neurology, St. Vincent's University Hospital, Dublin, Ireland. (2012-02-01)
      PURPOSE: This paper aims to determine the reasons why patients miss clinic appointments and to ascertain patients' views on the implementation of reminder systems and penalty fees to reduce the rates of did not attend (DNAs). Overall, the paper seeks to establish novel ways to run a more efficient out-patient department (OPD) service to improve waiting times and access for patients to limited neurology resources. DESIGN/METHODOLOGY/APPROACH: A questionnaire-based study was approved by the audit committee and was offered to 204 out-patients attending the neurology clinics over a three-month period (July to September 2009). The patients' demographic details and non-attendance records were reviewed. The paper aimed to ascertain, from the patients' perspective, why people failed to attend clinic appointments. Each participant was asked their views on how they felt their public hospital service might reduce the number of DNAs at their neurology OPD. FINDINGS: A total of 204 patients took part. Participants had a mean age of 31 years (range 25-75 years) with a modal peak in the 26 to 35 age bracket. Almost 10 per cent of those surveyed admitted to missing a hospital out-patient appointment in the past. The most common reason was that they simply "forgot" (28 per cent). DNA rates by age range were proportionally similar to the overall age profile of attenders. Over 55 per cent said they would like a pre-appointment reminder via a mobile telephone text message, 19 per cent preferred a pre-appointment telephone call, and 19 per cent an e-mail. Of those surveyed, 47 per cent said they would be willing to pay a fee on booking that could be refunded on attending for their appointment. The majority of these felt Euro 20 was the most appropriate amount (39 per cent). The rate of acceptance for various fee amounts was uniform across age ranges. Over half (52 per cent) said that they would agree to a "buddy" system whereby the appointment reminder was sent to the patient but also a nominated friend or relative. ORIGINALITY/VALUE: Non-attendance rates at the neurology clinics in our institution are high with almost 10 per cent of attendees admitting to missing an appointment. One of the main reasons why people did not attend was because they simply "forgot" that they had an appointment and the patients favoured a text messaging reminder system to help reduce non-attendance. Almost half of the respondents said that they would be willing to pay a refundable booking fee.
    • Family-related non-abuse adverse life experiences occurring for adults diagnosed with eating disorders: a systematic review.

      Grogan, Katie; MacGarry, Diarmuid; Bramham, Jessica; Scriven, Mary; Maher, Caroline; Fitzgerald, Amanda (2020-07-22)
      Background: Although previous reviews suggest a strong association between abuse and eating disorders, less is known about non-abuse adverse life experiences, such as parental mental illness or family discord, which occur frequently for this population. The aim of the current study was to identify family-related non-abuse adverse life experiences occurring for adults with eating disorders, and to establish whether they occur for people with anorexia nervosa, bulimia nervosa or binge-eating disorder more than the general population and other psychiatric populations. Method: A systematic review of studies focusing on family-related non-abuse adverse life experiences and eating disorders was conducted in accordance with PRISMA guidelines. The search string was applied to four electronic databases including Psycinfo, PubMed/Medline, CINAHL Plus and EMBASE. Results: Of the 26 studies selected for inclusion, six types of family-related non-abuse adverse life experiences were identified: adverse parenting style; family disharmony; loss of a family member, relative or close person; familial mental health issues; family comments about eating, or shape, weight and appearance; and family disruptions. Findings provided tentative evidence for eating disorder specific (i.e. parental demands and criticism) and non-specific (i.e. familial loss and family disruptions) non-abuse adversities, with findings also suggesting that those with bulimia nervosa and binge-eating disorder were more impacted by loss, family separations and negative parent-child interactions compared to those with anorexia nervosa. Conclusions: This review provides a clear synthesis of previous findings relating to family-related non-abuse adverse life experiences and eating disorders in adults. Implications for trauma-informed care in clinical practice were discussed (e.g. considering the impact of past life events, understanding the function of ED behaviours, reducing the risk of potential re-traumatisation).
    • Fingolimod-induced atrioventricular conduction defects in a young lady with multiple sclerosis--insights into possible drug mechanism.

      Voon, Victor; Saiva, Lavanya; O'Kelly, Sara; Keane, David; St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland, victor.voon@gmail.com. (2014-03)
    • First isolation and outbreak of OXA-48-producing Klebsiella pneumoniae in an Irish hospital, March to June 2011.

      O'Brien, D J; Wrenn, C; Roche, C; Rose, L; Fenelon, C; Flynn, A; Murphy, V; FitzGerald, S F; Fenelon, L E; Crowley, B; et al. (2012-02-01)
      Five OXA-48-producing Klebsiella pneumoniae were detected in a tertiary referral hospital in Ireland between March and June 2011. They were found in the clinical isolates of five cases that were inpatients on general surgical wards. None of the cases had received healthcare at a facility outside of Ireland in the previous 12 months. This is the first report of OXA-48-producing K. pneumoniae in Ireland.
    • First reported finding of a malignant pleural mesothelioma in a patient post liver transplant

      Gleeson, J; Doyle, A; M Iqbal, SF Oon, (Iris Medical Journal, 2016-03)
      The case history of a liver transplant recipient is presented, who presented with acute dyspnoea after an innocuous fall. His early management was complicated and he was eventually diagnosed with malignant mesothelioma. This is the first such case report in the literature.
    • Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair.

      Joyce, C W; Whately, K E; Chan, J C; Murphy, M; O'Brien, F J; Carroll, S M; 1Department of Plastic and Reconstructive Surgery, St. Vincent's University Hospital, Elm Park, Dublin, Ireland. (2014-01)
      We compared the tensile strength of a novel knotless barbed suture method with a traditional four-strand Adelaide technique for flexor tendon repairs. Forty fresh porcine flexor tendons were transected and randomly assigned to one of the repair groups before repair. Biomechanical testing demonstrated that the tensile strengths between both tendon groups were very similar. However, less force was required to create a 2 mm gap in the four-strand repair method compared with the knotless barbed technique. There was a significant reduction in the cross-sectional area in the barbed suture group after repair compared with the Adelaide group. This would create better gliding within the pulley system in vivo and could decrease gapping and tendon rupture.
    • Focal Thyroid Incidentalomas identified with Whole-Body FDG-PET warrant further investigation

      Prichard, RS; Cotter, M; Evoy, D (Irish Medical Journal, 2011-06)
    • Focal thyroid incidentalomas identified with whole-body FDG-PET warrant further investigation.

      Prichard, R S; Cotter, M; Evoy, D; Gibbons, D; Collins, C; McDermott, E; Skehan, S; St Vincent's University Hospital, Elm Park, Dublin 4 ruthprichard@rcsi.ie (2012-02-01)
      Fluorodeoxyglucose (FDG) whole body positron emission computed tomography (PET-CT) detects clinically occult malignancy. The aim of this study was to assess the prevalence and significance of focal thyroid 18F - fluorodeoxyglucose uptake. A retrospective review of all patients who had FDG PET-CT examinations, in a single tertiary referral centre was performed. PET scan findings and the final pathological diagnosis were collated. 2105 scans were reviewed. Focal uptake was identified in 35 (1.66%) patients. Final surgical histology was available on eight patients, which confirmed papillary carcinoma in four (20%) patients and lymphoma and metastatic disease in two patients respectively. This gave an overall malignancy rate in focal thyroid uptake of at least 33%. Thyroid incidentalomas occurred with a frequency of 2.13%, with an associated malignancy rate of at least 33% in focal thyroid uptake. The high malignancy rate associated with focal thyroid uptake mandates further investigation in medically fit patients.
    • Friedreich's Ataxia: a review from a cardiology perspective.

      Bourke, T; Keane, D; Cardiac Arrhythmia Service, St Vincent's University Hospital, Elm Park, Dublin, Ireland. tarabourke@hotmail.com (2011-12)
      Neuromuscular disorders are not among the common causes of cardiomyopathy in the general population; however, cardiomyopathy is known to occur in several neuromuscular disorders including Friedreich's Ataxia (FA). In patients with neuromuscular disorders, concomitant cardiac involvement contributes significantly to morbidity and mortality and often leads to premature death.
    • Gastric applications of electrical field stimulation.

      Hogan, Aisling M; Gallagher, Tom K; Kennelly, Rory; Baird, Alan W; Winter, Desmond C; Department of General Surgery, Institute of Clinical Outcomes Research and, Education (iCORE), St Vincent's University Hospital, Dublin, Ireland., Aislinghogan@yahoo.com (2012-02-01)
      Advances in clinical applications of electricity have been vast since the launch of Hayman's first cardiac pacemaker more than 70 years ago. Gastric electrical stimulation devices have been recently licensed for treatment of gastroparesis and preliminary studies examining their potential for use in refractory obesity yield promising results.
    • Gastrointestinal Erdheim-Chester disease

      Tevlin, R; Cahalane, AM; Larkin, JO; Treacy, A; Connaghan, D; Winter, DC (Irish Medical Journal, 2014-05)
      We report a rare case of Erdheim-Chester Disease, a non-Langerhans cell histiocytosis. A 60-year old female presented with a seven-month history of vague abdominal symptoms. A large retroperitoneal mass was detected on computed tomography (CT), but multiple CT-guided biopsy samples were inconclusive. Laparoscopy revealed a mass in the distal ileum, which was resected. Histology and immuno-histochemistry supported a diagnosis of Erdheim-Chester Disease.
    • Gastrointestinal perforation in metastatic carcinoma: a complication of bevacizumab therapy.

      Collins, D; Ridgway, P F; Winter, D C; Fennelly, D; Evoy, D; Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin 4,, Dublin, Ireland. daniellecollins@rcsi.ie (2012-02-01)
    • Genetic variation in DNMT3B and increased global DNA methylation is associated with suicide attempts in psychiatric patients

      Murphy, T. M.; Mullins, N.; Ryan, M.; Foster, T.; Kelly, C.; McClelland, R.; O'Grady, J.; Corcoran, E.; Brady, J.; Reilly, M.; et al. (Genes, Brain and Behavior, 2012-09)
      Recently, a significant epigenetic component in the pathology of suicide has been realized. Here we investigate candidate functional SNPs in epigenetic-regulatory genes, DNMT1 and DNMT3B, for association with suicide attempt (SA) among patients with co-existing psychiatric illness. In addition, global DNA methylation levels [5-methyl cytosine (5-mC%)] between SA and psychiatric controls were quantified using the Methylflash Methylated DNA Quantification Kit. DNA was obtained from blood of 79 suicide attempters and 80 non-attempters, assessed for DSM-IV Axis I disorders. Functional SNPs were selected for each gene (DNMT1; n =7, DNMT3B; n =10), and genotyped. A SNP (rs2424932) residing in the 3 UTR of the DNMT3B gene was associated with SA compared with a non-attempter control group (P =0.001; Chi-squared test, Bonferroni adjusted P value=0.02). Moreover, haplotype analysis identified a DNMT3B haplotype which differed between cases and controls, however this association did not hold after Bonferroni correction (P =0.01, Bonferroni adjusted P value=0.56). Global methylation analysis showed that psychiatric patientswith a history of SA had significantly higher levels of global DNA methylation compared with controls (P =0.018, Student’s t -test). In conclusion, this is the first report investigating polymorphisms in DNMT genes and global DNA methylation quantification in SA risk. Preliminary findings suggest that allelic variability in DNMT3B may be relevant to the underlying diathesis for suicidal acts and our findings support the hypothesis that aberrant DNA methylation profiles may contribute to the biology of suicidal acts. Thus, analysis of global DNA hypermethylation in blood may represent a biomarker for increased SA risk in psychiatric patients.
    • The genetics of obstructive sleep apnoea.

      Kent, Brian D; Ryan, Silke; McNicholas, Walter T; Pulmonary and Sleep Disorders Unit, St Vincent's University Hospital, Dublin,, Ireland. (2012-02-01)
      PURPOSE OF REVIEW: Obstructive sleep apnoea syndrome (OSAS) is a highly prevalent disorder associated with reduced quality of life and adverse cardiovascular and metabolic sequelae. Recent years have seen an intensification of the research effort to establish the genetic contribution to the development of OSAS and its sequelae. This review explores emerging evidence in this field. RECENT FINDINGS: A genetic basis for sleep-disordered breathing has been demonstrated for discrete disorders such as Treacher-Collins and Down syndromes, but the picture is less clear in so-called idiopathic OSAS. A degree of heritability appears likely in some of the intermediate phenotypes that lead to OSAS, particularly craniofacial morphology. However, only sparse and often contradictory evidence exists regarding the role of specific polymorphisms in causing OSAS in the general population. Similarly, investigations of the cardiovascular sequelae of OSAS have in general failed to consistently find single causative genetic mutations. Nonetheless, evidence suggests a role for tumour necrosis factor-alpha polymorphisms in particular, and large-scale family studies have suggested shared pathogenetic pathways for the development of obesity and OSAS. SUMMARY: As with other common disorders, OSAS is likely to result from multiple gene-gene interactions occurring in a suitable environment. The application of modern genetic investigative techniques, such as genome-wide association studies, may facilitate new discoveries in this field.
    • Geriatric Medicine in the Emergency Department

      Tan, KM; Lannon, R; O’Keeffe, L; Barton, D; Ryan, J; O’Shea, D; Hughes, G (Irish Medical Journal, 2012-09)
    • Giant desmoid tumour of the thorax following latissimus dorsi and implant breast reconstruction: case report and review of the literature

      Collins, AM; Granahan, AM; Healy, DG; Lawlor, CA; O’Neill, SP (Irish Medical Journal, 2017-03)
      The case of a giant thoracic desmoid tumour in a 44-year-old woman, who presented two years following a breast reconstruction with a latissimus dorsi (LD) flap and implant, is reported. Clinical findings included a rapidly growing, painless mass. Computed tomography (CT) suggested skin and intercostal soft tissue invasion. The tumour was resected en bloc with the LD muscle, implant capsule and underlying rib segments. The resultant thoracic and abdominal wall defects were reconstructed with Dualmesh® and polypropylene meshes respectively. There was no evidence of recurrence at thirty-six months follow-up.
    • Giant right atrial myxoma: characterization with cardiac magnetic resonance imaging.

      Ridge, Carole A; Killeen, Ronan P; Sheehan, Katherine M; Ryan, Ronan; Mulligan, Niall; Luke, David; Quinn, Martin; Dodd, Jonathan D; Department of Radiology, St. Vincent's University Hospital, Elm Park, Dublin 4,, Ireland. c.ridge@st-vincents.ie <c.ridge@st-vincents.ie> (2012-02-01)
      A 53-year-old woman presented to the emergency department with a 2-week history of dyspnoea and chest pain. Computed tomography pulmonary angiography was performed to exclude acute pulmonary embolism (PE). This demonstrated a large right atrial mass and no evidence of PE. Transthoracic echocardiography followed by cardiac magnetic resonance imaging confirmed a mobile right atrial mass. Surgical resection was then performed confirming a giant right atrial myxoma. We describe the typical clinical, radiologic, and pathologic features of right atrial myxoma.
    • Gitelman's syndrome: a rare presentation mimicking cauda equina syndrome.

      Quinlan, C S; Walsh, J C; Moran, A-M; Moran, C; O'Rourke, S K; Department of Orthopaedic Surgery, St. Vincent's University Hospital, Elm Park,, Dublin 4, Ireland. christinequinlan@rcsi.ie (2012-02-01)
      We describe a case of bilateral weakness of the lower limbs, sensory disturbance and intermittent urinary incontinence, secondary to untreated Gitelman's syndrome, in a 42-year-old female who was referred with presumed cauda equina syndrome. On examination, the power of both legs was uniformly reduced, and the perianal and lower-limb sensation was altered. However, MRI of the lumbar spine was normal. Measurements of serum and urinary potassium were low and blood gas analysis revealed metabolic alkalosis. Her symptoms resolved following potassium replacement. We emphasise the importance of measurement of the plasma and urinary levels of electrolytes in the investigation of patients with paralysis of the lower limbs and suggest that they, together with blood gas analysis, allow the exclusion of unusual causes of muscle weakness resulting from metabolic disorders such as metabolic alkalosis.
    • Glucagon-like peptide-1 (GLP-1) - a key regulator of innate immune function with clinical efficacy in a range of inflammatory diseases

      Hogan, Andrew (2012-06)
      American Diabetes Association Annual Meeting in Philadelphia in June 2012
    • Glucagon-like peptide-1 analogue therapy for psoriasis patients with obesity and type 2 diabetes: a prospective cohort study.

      Ahern, T; Tobin, A-M; Corrigan, M; Hogan, A; Sweeney, C; Kirby, B; O'Shea, D; Obesity Research Group, and Dermatology Research Group, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. (Journal of the European Academy of Dermatology and Venereology : JEADV, 2012-06-13)
      Background  Diabetes and obesity are more prevalent amongst psoriasis patients as is disturbance of the innate immune system. GLP-1 analogue therapy considerably improves weight and glycaemic control in people with type 2 diabetes and its receptor is present on innate immune cells. Objective  We aimed to determine the effect of liraglutide, a GLP-1 analogue, on psoriasis severity. Methods  Before and after 10 weeks of liraglutide therapy (1.2 mg subcutaneously daily) we determined the psoriasis area and severity index (PASI) and the dermatology life quality index (DLQI) in seven people with both psoriasis and diabetes (median age 48 years, median body mass index 48.2 kg/m(2) ). We also evaluated the immunomodulatory properties of liraglutide by measuring circulating lymphocyte subset numbers and monocyte cytokine production. Results  Liraglutide therapy decreased the median PASI from 4.8 to 3.0 (P = 0.03) and the median DLQI from 6.0 to 2.0 (P = 0.03). Weight and glycaemic control improved significantly. Circulating invariant natural killer T (iNKT) cells increased from 0.13% of T lymphocytes to 0.40% (P = 0.03). Liraglutide therapy also effected a non-significant 54% decrease in the proportion of circulating monocytes that produced tumour necrosis factor alpha (P = 0.07). Conclusion  GLP-1 analogue therapy improves psoriasis severity, increases circulating iNKT cell number and modulates monocyte cytokine secretion. These effects may result from improvements in weight and glycaemic control as well as from direct immune effects of GLP-1 receptor activation. Prospective controlled trials of GLP-1 therapies are warranted, across all weight groups, in psoriasis patients with and without type 2 diabetes.