• P084 The impact of the SARS-CoV-2 pandemic on people living with cystic fibrosis in Ireland: real-world data from the Irish cystic fibrosis registry

      Rees, H.; Babu, S.; Fletcher, G.; Kirwan, L. (Journal of Cystic Fibrosis, 2021-06-11)
      The impact of the SARS-CoV-2 pandemic on people living with cystic fibrosis (PWCF) in Ireland was investigated by comparing the utilisation of regular hospital facilities in 2020, with data collected in 2019.
    • Pancreatectomy for metastatic disease: a systematic review.

      Adler, H; Redmond, C E; Heneghan, H M; Swan, N; Maguire, D; Traynor, O; Hoti, E; Geoghegan, J G; Conlon, K C; National Surgical Centre for Pancreatic Cancer, St Vincent's University Hospital, Elm Park, Dublin, Ireland. Electronic address: hugh.adler@gmail.com. (2014-04)
      Tumours rarely metastasise to the pancreas. While surgical resection of such metastases is believed to confer a survival benefit, there is limited data to support such management. We present a systematic review of case series of pancreatic metastasectomy and analysis of survival outcomes.
    • Pap smears for men: a vision of the future?

      Oon, S F; Hanly, A; Winter, D C; Department of Colorectal Surgery, St. Vincent's University Hospital, Elm Park,, Dublin 4, Ireland. sheng-fei.oon@ucd.ie (2012-02-01)
      BACKGROUND: Anal intraepithelial neoplasia (AIN) rarely receives as much publicity as its neighbouring orifice, the cervix. As in the cervix, intraepithelial neoplasias are precursors to cancer in the anal canal. AIN and cervical interstitial neoplasia (CIN) undergo dysplasia as a consequence of human papillomavirus (HPV) infection. Since the advent of screening with the Pap smear in CIN, cervical cancer has plummeted to a fifth of its initial incidence. Anal cancer, however, has been rising, with a predilection for human immunodeficiency virus-infected men. HPV causes a squamous epithelial dysplasia and converts healthy tissue into AINs of increasing severity until anal cancer manifests. CLINICAL CASE: This article describes a clinical case of anogenital HPV infection refractory to medical and surgical therapy. It also describes an effective surgical excision technique associated with a good cosmetic outcome. CONCLUSIONS: The paper concludes by briefly discussing the implications of a national screening programme against AIN in the future.
    • Paracetamol overdose: the liver unit perspective.

      Iqbal, M; Cash, W J; Sarwar, S; McCormick, P A; Liver Unit, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. miqbal70@hotmail.com (2012-09)
      Liver failure resulting from deliberate or accidental paracetamol overdose continues to be an important reason for referral to liver transplant centres. Severe hepatic dysfunction often appears 72-96 h after overdose. Liver injury can be prevented by timely administration of the specific antidote, N-acetylcysteine. Unfortunately, administration of N-acetylcysteine is frequently delayed due to late presentation or late administration. While N-acetylcysteine works best if given within 8 h of overdose, it is beneficial at any time period and should always be given if there is concern about significant overdose, irrespective of interval from time of ingestion. Early discussion with liver transplant unit is suggested if there is any doubt or evidence of liver failure.
    • Pathogenesis of and unifying hypothesis for idiopathic pouchitis.

      Coffey, J Calvin; Rowan, Fiachra; Burke, John; Dochery, Neil G; Kirwan, William O; O'Connell, P Ronan; School of Medicine and Medical Sciences University College Dublin, St Vincent's, University Hospital, Dublin, Ireland. calvincoffey@hotmail.com (2012-02-01)
      Ileal pouch-anal anastomosis is the procedure of choice in the surgical management of refractory ulcerative colitis. Pouchitis affects up to 60% of patients following ileal pouch-anal anastomosis for ulcerative colitis. It overlaps significantly with ulcerative colitis such that improvements in our understanding of one will impact considerably on the other. The symptoms are distressing and impinge significantly on patients' quality of life. Despite 30 years of scientific and clinical investigation, the pathogenesis of pouchitis is unknown; however, recent advances in molecular and cell biology make a synergistic hypothesis possible. This hypothesis links interaction between epithelial metaplasia, changes in luminal bacteria (in particular sulfate-reducing bacteria), and altered mucosal immunity. Specifically, colonic metaplasia supports colonization by sulfate-reducing bacteria that produce hydrogen sulfide. This causes mucosal depletion and subsequent inflammation. Although in most cases antibiotics lead to bacterial clearance and symptom resolution, immunogenetic subpopulations can develop a chronic refractory variant of pouchitis. The aims of this paper are to discuss proposed pathogenic mechanisms and to describe a novel mechanism that combines many hypotheses and explains several aspects of pouchitis. The implications for the management of both pouchitis and ulcerative colitis are discussed.
    • Patient knowledge of peripheral vascular disease in an outpatient setting: An achilles heel?

      Owens, M; Mohan, H; Moloney, MA; Roche-Nagle, G; Baker, J; Sheehan, S; Mehigan, D; Barry, M (Irish Medical Journal, 2013-04)
    • Patients Hospitalised with an Acute Exacerbation of COPD: Is There a Need for a Discharge Bundle of Care?

      Migone, C; O’Connor, M; Kelly, E; McDonnell, TJ (Irish Medical Journal (IMJ), 2015-10)
      Acute Exacerbations of COPD (AECOPD) are the commonest cause of hospitalisation for patients with COPD. A number of interventions are known to improve care for such patients. Internationally and in Ireland, there is significant variation in care delivered to such patients. We reviewed admissions with AECOPD (n=174) to an Irish teaching hospital during one year, to determine if recommended interventions had been delivered to patients prior to discharge. The most frequently delivered of such interventions were: assessment of oxygen requirements 151 (87%) and arrangements for follow-up 135 (78%). The least frequently delivered were: referral for pulmonary rehabilitation 19 (11%) and advice given regarding influenza vaccination 27 (17%). Patients who received care from a respiratory physician or respiratory clinical nurse specialist (RCNS) received more interventions than those cared for by other specialties. This study demonstrates poor compliance with internationally agreed interventions. The introduction of a discharge bundle of care for use in Irish hospitals should be considered.
    • Perceived coercion in voluntary hospital admission.

      O'Donoghue, Brian; Roche, Eric; Shannon, Stephen; Lyne, John; Madigan, Kevin; Feeney, Larkin; Department of General Adult Psychiatry, Cluain Mhuire Mental Health Service, Newtownpark Avenue, Blackrock, Dublin, Ireland. Electronic address: briannoelodonoghue@gmail.com. (2014-01-30)
      The legal status of service users admitted to psychiatric wards is not synonymous with the level of coercion that they can perceive during the admission. This study aimed to identify and describe the proportion of individuals who were admitted voluntarily but experienced levels of perceived coercion comparable to those admitted involuntarily. Individuals admitted voluntarily and involuntarily to three psychiatric hospitals were interviewed using the MacArthur Admission Experience Interview and the Structured Clinical Interview for DSM-IV diagnoses. One hundered sixty-one individuals were interviewed and 22% of the voluntarily admitted service users had levels of perceived coercion similar to that of the majority of involuntarily admitted service users. Voluntarily admitted service users who experienced high levels of perceived coercion were more likely to have more severe psychotic symptoms, have experienced more negative pressures and less procedural justices on admission. Individuals brought to hospital under mental health legislation but who subsequently agreed to be admitted voluntarily and those treated on a secure ward also reported higher levels of perceived coercion. It needs to be ensured that if any service user, whether voluntary or involuntary, experiences treatment pressures or coercion that there is sufficient oversight of the practice, to ensure that individual's rights are respected.
    • Percutaneous radiofrequency ablation of lung tumors: evaluation of the literature using evidence-based techniques.

      Chan, Victoria O; McDermott, Shaunagh; Malone, Dermot E; Dodd, Jonathan D; Department of Radiology, St Vincent's University Hospital, Dublin, Ireland. (2012-02-01)
      PURPOSE: The aim of this study was to evaluate the literature for articles assessing radiofrequency ablation (RFA) for pulmonary malignancy. MATERIALS AND METHODS: The "bottom-up" approach to evidence-based practice was applied by 2 reviewers to the retrieval and appraisal of original research articles published on pulmonary RFA between 2002 and 2009. Primary lung cancer and pulmonary metastases data were analyzed separately. The relationship between the percentage of local recurrence rate and lesion size, patient age, follow-up duration, and time to local recurrence was assessed using Spearman's rank correlation. Discrete time series were used to evaluate time trends. RESULTS: Secondary evidence yielded 1 review of 26 observational studies. Primary evidence yielded 46 studies that seemed suitable for detailed appraisal. A total of 2905 ablations were performed in 1584 patients. Eight studies evaluated primary lung cancers alone, 11 evaluated pulmonary metastases alone, 25 evaluated both, and 2 did not specify the histology. Results revealed trends toward increasing use of conscious sedation over general anesthesia, increasing use of multitined probes, decreasing size of nodule selection, and use of positron emission tomography/computed tomography as the optimal follow-up tool. Mean morbidity was 24.6%. The most prevalent side effects included pneumothorax (28.3%), pleural effusions (14.8%), and pain (14.1%). Procedure-related mortality ranged from 0 to 5.6, with an overall procedure-related mortality rate of 0.21%. There were 282 (12.2%) local recurrences occurring at a mean of 13 months. The mean overall survival rate was 59.4%, and the cancer-specific survival rate was 82.6%. CONCLUSIONS: This evidence-based practice review of pulmonary RFA shows it to be a promising treatment for pulmonary malignancy in carefully selected patient populations. Studies with higher levels of evidence, including case-control, prospective nonrandomized and randomized trials, that compare RFA with alternative contemporary local treatments are urgently needed.
    • Percutaneous Transhepatic Cholecystoscopic Gallstone Fragmentation: A novel approach for the medically unfit patient

      Joyce, DP; Thomas, AZ; O’Kelly, F; Malone, D; Quinlan, D (Irish Medical Journal, 2013-03)
    • A pernicious leucoencephalopathy.

      Molloy, A; Cawley, N; Ali, E; Connolly, S; Tubridy, N; Hutchinson, M; Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4. (2012-02-01)
      Pernicious anaemia may manifest various neurological symptoms and signs ranging from the subtle to the dramatic. We describe a young man with cobalamin deficiency presenting with sensorimotor deficits, ataxia, dysarthria, mild cognitive deterioration and altered mood of insidious onset. The MRI brain findings were in keeping with a leucoencephalopathy without evidence of MRI changes in the spinal cord. This constellation of features has been reported rarely. His response to treatment as well as the marked improvement of the leucoencephalopathy on imaging suggests at least partial reversibility of the neurological deficits.
    • Personalised treatment for cancer: role of biomarkers

      Duffy, Michael J; St. Vincent's University Hosptial, Dublin (2014-02-11)
    • PET/CT and breast cancer.

      Hegarty, C; Collins, C D; St. Vincent's University Hospital, Dublin 4, Ireland. (2012-02-01)
      This paper summarises the current status of PET/CT in relation to breast cancer.
    • Phenotypic diversity associated with the mitochondrial m.8313G>A point mutation.

      O'Rourke, Killian; Buddles, Mark R; Farrell, Michael; Howley, Rachel; Sukuraman, Sunita; Connolly, Sean; Turnbull, Douglass M; Hutchinson, Michael; Taylor, Robert W; Department of Neurology, St. Vincent's University Hospital, Dublin 4, Ireland., killian.orourke@gmail.com (2012-02-01)
      We report the clinical, histochemical, and molecular genetic findings in a patient with progressive mitochondrial cytopathy due to the m.8313G>A point mutation in the mitochondrial tRNA(Lys) (MTTK) gene. The clinical features in this case are severe, including short stature, myopathy, peripheral neuropathy, and osteoporosis, while extensive analysis of maternal relatives indicate that the mutation has arisen de novo and was not maternally inherited. This report of a second case, together with single muscle fiber mutation analysis that shows clear segregation of mutation load with cytochrome c oxidase deficiency, confirms that the mutation is pathologic.
    • Physician's initial impression of elderly breast cancer patients allows appropriate treatment stratification despite lack of quantitative assessment.

      Prichard, R S; Haren, A; Evoy, D; McDermott, E; St Vincent's University Hospital, Elm Park, Dublin 4. ruthprichard@rcsi.ie (2012-02-01)
      The management of older women with breast cancer is often suboptimal based on perceived patient comorbidities. The aim of this study was to evaluate the choice of treatment modality based on clinicians 'gut-feeling' compared to comorbidity scoring indices. A retrospective review of women over 70 presenting with breast cancer was performed. Presenting comorbidities (Charlson Comorbidity Index and Cumulative Illness Rating Scale) and the treatment received was documented. Sixty-six patients were identified. Forty-six had surgery while twenty patients had primary endocrine manipulation. The mean age of patients having surgery was 76.4 in comparison to 84.4 for the endocrine group (p = 0.001). The CCI scores for the surgical group and endocrine group were 6.62 and 9.26 respectively (p = 0.001). The scores for the CIRS were 8.93 and 22.68 (p = 0.001). This study has demonstrated that physician's "gut feelings' are often correct in identifying patients who may benefit from primary hormone therapy.
    • Physiotherapist-Led Triage at a Rheumatology-Based Musculoskeletal Assessment Clinic: an 18-Month Service Evaluation of Activity and Outcomes

      Caffrey, Aoife; Smart, Keith M.; Fitzgerald, Oliver (American College of Rheumatology, 2019)
      Physiotherapist-led musculoskeletal triage clinics are an effective and efficient means of managing patients presenting with musculoskeletal disorders in primary and secondary care. Data regarding the activity and outcomes of physiotherapist-led triage in hospital-based outpatient rheumatology clinics are scarce. Thus, the aim of this study was to undertake a service evaluation of activity and outcomes of a physiotherapist-led rheumatologybased Musculoskeletal Assessment Clinic (MAC). The primary objective was to quantify the proportion of patients independently managed by the clinical specialist physiotherapists (CSPs).
    • A pilot training programme for health and social care professionals providing oncological and palliative care to lesbian, gay and bisexual patients in Ireland.

      Reygan, Finn C G; D'Alton, Paul; Department of Psycho-oncology, St. Vincent's University Hospital, Dublin 4, Ireland. finncgreygan@yahoo.com. (2012-05-09)
      OBJECTIVE: The international literature points to the specific cancer risks and palliative care needs of lesbian, gay and bisexual (LGB) populations. However, with the exception of a programme in the USA, there is a lack of training internationally for health and social care professionals providing oncological and palliative care to LGB patients. In Ireland, a training project funded by the Irish Cancer Society, the Irish Hospice Foundation and the Health Service Executive developed a training pilot programme for health and social care professionals providing oncological and palliative care to LGB patients. METHODS: Over 200 (N = 201) oncology and palliative care staff participated in 17 brief, 50-min trainings in pilot sites. Evaluation of the training included self-report questionnaires at the end of each training and an evaluation interview with one participant from each of the four sites. RESULTS: The majority of participants reported that they would recommend the training to their colleagues, were interested in further training in the area and found the training useful for their practice. They also reported becoming more familiar with LGB-related language and terminology, became more knowledgeable of LGB health issues and reported becoming more confident in providing care to LGB patients. CONCLUSIONS: Recommendations are that the training be made available across the health services in Ireland and included in postgraduate courses for trainee health and social care professionals. Copyright © 2012 John Wiley & Sons, Ltd.
    • PML and rheumatology: the contribution of disease and drugs.

      Molloy, Eamonn S; Department of Rheumatology, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. E.Molloy@st-vincents.ie (2011-11)
      Progressive multifocal leukoencephalopathy (PML), a rare, typically fatal, opportunistic infection caused by the JC virus, is becoming relevant to physicians in multiple specialties, including those who prescribe biologic agents for the treatment of autoimmune disorders. Reports of PML have led to US Food and Drug Administration alerts and warning letters regarding four immunosuppressive agents in recent years (natalizumab, rituximab, efalizumab, and mycophenolate mofetil). Consequently, informed clinical decision-making requires understanding the risk of PML associated with these therapies. An estimate of the relative frequency of PML associated with specific rheumatic conditions has been generated. Systemic lupus erythematosus appears to be associated with susceptibility to PML that cannot be fully explained by the intensity of immunosuppressive therapy. Further, the use of rituximab in patients with rheumatic disease has raised concerns. However, definitive attribution of cause is precluded by the limitations of the currently available data. All patients with rheumatic disease, regardless of the intensity of their current immunosuppressive therapy, should be considered potentially at risk of PML. With an evolving understanding of a greater clinical heterogeneity of PML, advances in diagnostic methods, and significant implications for therapy, PML should be considered in the differential diagnosis of neurologic manifestations of rheumatic diseases.
    • Poor prognostic factors in predicting abatacept response in a phase III randomized controlled trial in psoriatic arthritis.

      Mease, Philip J; McInnes, Iain B; Strand, Vibeke; FitzGerald, Oliver; Ahmad, Harris A; Elbez, Yedid; Banerjee, Subhashis (2020-04-30)
      In ASTRAEA (NCT01860976), abatacept significantly increased American College of Rheumatology criteria 20% (ACR20) responses at Week 24 versus placebo in patients with psoriatic arthritis (PsA). This post hoc analysis explored relationships between prospectively identified baseline characteristics [poor prognostic factors (PPFs) ] and response to abatacept. Patients were randomized (1:1) to receive subcutaneous abatacept 125 mg weekly or placebo for 24 weeks; those without ≥ 20% improvement in joint counts at Week 16 switched to open-label abatacept. Potential predictors of ACR20 response were identified by treatment arm using multivariate analyses. Likelihood of ACR20 response to abatacept versus placebo was compared in univariate and multivariate analyses in subgroups stratified by the PPF, as defined by EULAR and/or GRAPPA treatment guidelines. Odds ratios (ORs) were generated using logistic regression to identify meaningful differences (OR cut-off: 1.2). 424 patients were randomized and treated (abatacept n = 213; placebo n = 211). In abatacept-treated patients, elevated C-reactive protein (CRP), high Disease Activity Score based on 28 joints (CRP), presence of dactylitis, and ≥ 3 joint erosions were identified as predictors of response (OR > 1.2). In placebo-treated patients, only dactylitis was a potential predictor of response. In the univariate analysis stratified by PPF, ACR20 response was more likely (OR > 1.2) with abatacept versus placebo in patients with baseline PPFs than in those without; multivariate analysis confirmed this finding. Response to abatacept versus placebo is more likely in patients with features indicative of high disease activity and progressive disease; these characteristics are recognized as PPFs in treatment guidelines for PsA.
    • "Porcelain heart" cardiomyopathy secondary to hyperparathyroidism: radiographic, echocardiographic, and cardiac CT appearances.

      Freeman, James; Dodd, Jonathan D; Ridge, Carol A; O'Neill, Ailbhe; McCreery, Charles; Quinn, Martin; Department of Cardiology, St Vincent's University Hospital, Dublin 4, Ireland. (2012-02-01)
      We report the radiographic, echocardiographic and cardiac CT appearances of 'porcelain heart' in an 85-year-old woman who presented with progressive heart failure. The extensive myocardial calcification was secondary to hyperparathyroidism with renal failure.