Research by staff affiliated to Waterford Regional Hospital

Recent Submissions

  • Use of “Months of the Year Backwards” (MOTYB) as a Screening Tool for Delirium in Palliative Care Patients in the Acute Hospital Setting

    Ryan, S; Hayes, D; Creedon, B; University Hospital Waterford (Irish Medical Journal, 2018-09)
    Delirium is common in palliative care. It effects up to 88% of patients with advanced cancer at end of life and has a point prevalence of 20% in the acute hospital setting across all diagnoses. It is under diagnosed and not optimally treated. “Months of the Year Backwards” (MOTYB) is an ideal screening tool for delirium with a sensitivity of 83.8%. It is brief to perform and carries low burden for patients. The aim of this study is to investigate the use of MOTYB as a screening tool for delirium in palliative care patients in the acute hospital setting.
  • Safety Incident Management Team Report for NIMLT Case 50796

    Health Service Executive (Health Service Executive (HSE), 2017-01-17)
    This is a report on the management of a patient safety incident involving BowelScreen and symptomatic colonoscopy services at Wexford General Hospital (WGH). The patient safety incident relates to the work of a Consultant Endoscopist (referred to as Clinician Y) employed by WGH who undertook screening colonoscopies on behalf of the BowelScreen Programme since the commencement of the screening programme in WGH in March 2013. Clinician Y also performed non-screening colonoscopies for the diagnosis of symptomatic patients as part of routine surgical service provision at WGH. The management of the patient safety incident was in accordance with the HSE Safety Incident Management Policy with particular reference to the HSE Guidelines for the Implementation a Look-back Review Process in the HSE (1-3).
  • Managing pain in the older person in the community

    Molloy, Niamh (Nursing in General Practice, 2015-03)
    Eff ective pain management remains a challenge in modern day clinical practice. Managing persistent pain in the older adult encounters many challenges and the management of chronic pain in the community demands a comprehensive understanding of the physiology of pain and pain processing as well as an understanding of the various assessment tools available and methods to manage pain. it is essential before treating pain that it is assessed using a recognised pain assessment tool that is valid, reliable and comprehensive. in essence, a holistic approach is required with all aspects of the biopsychosocial model considered.
  • An Irish breast cancer survivorship study: are we meeting our patients' needs?

    Naidoo, J; Hayes, E; Teo, MY; Horgan, A; Calvert, P; O’Connor, M (Irish Medical Journal (IMJ), 2013-10)
    Irish breast cancer survivors' needs have not been studied. Physical, psychological, social and spiritual concerns were investigated. Patient satisfaction with hospital discharge, GP follow-up, and the benefit of a discharge pack was investigated. A cohort of patients from the South East Cancer Centre was identified. Inclusion criteria: localized breast cancer, completion of adjuvant therapy, GP-led follow-up in the last 5 years. An anonymous questionnaire was developed, and ethical approval obtained. Subgroup analyses for age and time since diagnosis and discharge were completed. 80 patients were identified. 44 patients (55%) completed the questionnaire, 5 (6%) were excluded. Commonest concerns included: fatigue (51%), fear of recurrence (69%) and second cancers concerns (69%.) 23 (59%) and 25 patients (64%) were satisfied with discharge and GP follow-up respectively. 27 patients (67%) reported benefit from a discharge pack. Irish breast cancer survivors had concerns, and were satisfied with GP follow-up.
  • Should patients with extrapulmonary small-cell carcinoma receive prophylactic cranial irradiation?

    Naidoo, Jarushka; Teo, Min Yuen; Deady, Sandra; Comber, Harry; Calvert, Paula; * Department of Medical Oncology, Waterford Regional Hospital, Waterford, Ireland; †Department of Medical Oncology, The Adelaide and Meath Hospital Tallaght, Dublin, Ireland; and ‡Department of Research and Data Analysis, National Cancer Registry of Ireland, Cork, Ireland. (2013-09)
    Extrapulmonary small-cell carcinoma (EPSCC) is a rare disease. Management is based on small-cell lung carcinoma. Prophylactic cranial irradiation (PCI) is not routinely administered in EPSCC. This study investigates the role of PCI in EPSCC, by analyzing the incidence, treatment, and survival of patients with brain metastases in a national cohort. Disease biology and epidemiology are also investigated.
  • Cost burden of non-specific chest pain admissions.

    Groarke, J; O'Brien, J; Go, G; Susanto, M; Owens, P; Maree, A O; Department of Cardiology, Waterford Regional Hospital, Waterford, Ireland. (2013-03)
    Non-cardiac aetiologies are common among patients presenting with chest pain.
  • Identification of patients with low-risk pulmonary embolism suitable for outpatient treatment using the pulmonary embolism severity index (PESI).

    McCabe, A; Hassan, T; Doyle, M; McCann, B; Emergency Department, Waterford Regional Hospital, Dunmore East Road, Waterford, Ireland. (2013-06)
    There is increasing evidence that outpatient treatment of patients with low-risk stable pulmonary embolism (PE) is safe, effective and potentially reduces costs. It is not clear how many patients presenting to an Irish Emergency Department (ED) are potentially suitable for outpatient management.
  • Vemurafenib for the treatment of melanoma.

    Jordan, Emmet John; Kelly, Catherine M; Waterford Regional Hospital, Department of Medical Oncology, Dunmore Road, Waterford, Ireland. (2012-12)
    Metastatic melanoma is an aggressive disease resistant to chemotherapy. Recent clinical trials have reported improved survival for two novel agents; ipilimumab, a humanized, IgG1 monoclonal antibody that blocks cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and vemurafenib , a BRAF (v-raf murine sarcoma viral oncogene homolog B1) inhibitor targeting an activating mutation in the serine-threonine-protein kinase BRAF gene. AREAS COVERED: The authors reviewed preclinical and clinical data examining the safety of vemurafenib in melanoma. MEDLINE and EMBASE were searched using the medical subject heading 'vemurafenib' and the following text terms: melanoma, BRAF inhibition, vemurafenib. This review provides the reader with an overview of current data examining the efficacy and safety of vemurafenib in metastatic melanoma. EXPERT OPINION: Vemurafenib is an oral agent licensed for patients with BRAF V600E mutation-positive inoperable and metastatic melanoma. The most common adverse effects observed in Phase III clinical trials were dermatological events, arthralgia and fatigue. Specific dermatological toxicities included development of cutaneous squamous cell cancers and keratoacanthomas. Prolongation of the QT interval was also reported. Regular dermatological assessments and electrocardiograms are recommended. Ongoing trials are examining vemurafenib in both the adjuvant setting and metastatic setting in combination with ipilimumab and MEK inhibitors (mitogen-activated protein kinase/extracellular signal-regulated kinase). Understanding and overcoming mechanisms of resistance to BRAF inhibitors is the focus of ongoing research.
  • A case of pelvic actinomycosis with bilateral hydronephrosis and renal failure associated with prolonged intrauterine contraceptive systems use.

    Ugezu, C H; Kelly, I; Walker, F; Stratton, J F; Department of Obstetrics and Gynaecology, Waterford Regional Hospital, Ireland. (2012-05)
  • The upper hand on compartment syndrome.

    Dolan, Roisin T; Al Khudairy, Ammar; Mc Kenna, Paul; Butler, Joseph S; O'Beirne, Joseph; Quinlan, John F; Department of Trauma & Orthopaedic Surgery, Waterford Regional Hospital, Waterford, Ireland. (2012-11)
    Metacarpal fractures are common injuries, accounting for approximately 30% to 40% of all hand fractures and with a lifetime incidence of 2.5%. Traditionally regarded as an innocuous injury, metacarpal fractures tend to be associated with successful outcomes after closed reduction and immobilization. Hand compartment syndrome (HCS) is a rare clinical entity with potential devastating consequences in terms of loss of function and quality-of-life outcomes. We discuss the case of a 44-year-old woman presenting with multiple closed metacarpal fractures as a result of low-energy trauma, complicated by acute HCS. We review the presentation, clinical assessment, and optimal surgical management of acute HCS with reference to international literature.
  • Arts and health-an intercultural marriage

    Grehan, Mary (Helsinki Metropolia University of Applied Sciences, 2012-10-22)
  • HIV-associated neurocognitive disorder: rate of referral for neurorehabilitation and psychiatric co-morbidity.

    Herlihy, D; Samarawickrama, A; Gibson, S; Taylor, C; O'Flynn, D; Department of Psychiatry, Waterford Regional Hospital, Waterford City, Ireland. (2012-04)
    Despite advances in antiretroviral therapy, HIV-infected patients continue to present with HIV-associated neurocognitive disorder (HAND) which may be associated with significant psychiatric co-morbidity. We audited our patients with HAND referred for psychiatric assessment against the National Service Framework guidelines that they should receive neurorehabilitation. We found that despite these patients posing a risk to themselves and others due to poor insight and medication adherence, high rates of psychiatric co-morbidity and severely challenging behaviour, few were referred for neurorehabilitation. We recommend that clear referral pathways for psychiatric intervention and neurorehabilitation are established in HIV treatment centres.
  • An inconvenient truth: treatment of displaced paediatric supracondylar humeral fractures.

    Donnelly, M; Green, C; Kelly, I P; Department of Orthopaedic Surgery, Waterford Regional Hospital, Dunmore road, Waterford, Ireland. (2012-06)
    The need for emergent management of displaced paediatric supracondylar humeral fractures is being questioned in the literature. Open reduction rates of up to 46% have been reported in the non-emergent management of these injuries. At our institution these fractures are managed as operative emergencies by senior personnel. To examine the ongoing need for this policy we reviewed our results. All patients managed over a five year period with Gartland type IIB or III paeditric supracondylar humeral fractures were identified and a comprehensive chart and radiographic review undertaken. The mean time from injury to fracture reduction and stabilization was 6.6 h. Consultants performed or supervised 90% of cases. Open reduction was necessary in 5% of cases. Complications included a perioperative nerve injury rate of 6% and a superficial pin site infection rate of 3%. This study suggests that, despite the challenge to trauma on-call rostering, the emergency management of these injuries is advantageous to patients in units of our size. Based on the data presented here we continue our practice of emergent management. We suggest that units of a similar size to our own would show a benefit from an analogous policy albeit an inconvenient truth.
  • Acutrak versus Herbert screw fixation for scaphoid non-union and delayed union.

    Oduwole, Kayode O; Cichy, Benedikt; Dillon, John P; Wilson, Joan; O'Beirne, John; Departments of Orthopaedic Surgery, Waterford Regional Hospital, Waterford, Ireland. (2012-04)
    To compare the treatment outcome of Acutrak versus Herbert screw fixation for scaphoid non-union and delayed union.
  • Octreotide for the treatment of chylothorax in neonates.

    Das, Animitra; Shah, Prakeshkumar S; Department of Pediatrics, Waterford Regional Hospital, Dunmore Road, Waterford,, Ireland. (2012-02-01)
    BACKGROUND: Routine care for chylothorax in neonate includes either conservative or surgical approaches. Octreotide, a somatostatin analogue, has been used for the management of patients with refractory chylothorax not responding to conservative management. OBJECTIVES: To assess the efficacy and safety of octreotide in the treatment of chylothorax in neonates. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE and EMBASE (to March 7, 2010). We assessed the reference lists of identified trials and abstracts from the annual meetings of the Pediatric Academic Societies published in Pediatric Research (2002 to 2009) without language restrictions. SELECTION CRITERIA: We planned to include randomised or quasi-randomised controlled trials of octreotide in the treatment of congenital or acquired chylothorax in term or preterm neonates, with any dose, duration or route of administration. DATA COLLECTION AND ANALYSIS: Data on primary (amount of fluid drainage, respiratory support, mortality) and secondary outcomes (side effects) were planned to be collected and analysed using mean difference, relative risk and risk difference with 95% confidence intervals. MAIN RESULTS: No randomised controlled trials were identified. Nineteen case reports of 20 neonates with chylothorax in whom octreotide was used either subcutaneously or intravenously were identified. Fourteen case reports described successful use (resolution of chylothorax), four reported failure (no resolution) and one reported equivocal results following use of octreotide. The timing of initiation, dose, duration and frequency of doses varied markedly. Gastrointestinal intolerance and clinical presentations suggestive of necrotizing enterocolitis and transient hypothyroidism were reported as side effects. AUTHORS' CONCLUSIONS: No practice recommendation can be made based on the evidence identified in this review. A prospective registry of chylothorax patients and a subsequent multicenter randomised controlled trial are needed to assess the safety and efficacy of octreotide in the treatment of chylothorax in neonates.
  • Nosocomial outbreak of hepatitis B virus infection involving two hospitals in the Republic of Ireland.

    Burns, K; Heslin, J; Crowley, B; Thornton, L; Laoi, B Ni; Kelly, E; Ward, E; Doody, B; Hickey, M M; Department of Clinical Microbiology, Waterford Regional Hospital, Waterford,, Ireland. (2012-02-01)
    The routes of nosocomial hepatitis B virus (HBV) transmission have changed over the years. Initiatives to prevent transfusion-associated HBV and healthcare worker-to-patient transmission have had a positive impact on these transmission routes. Recent reports of outbreaks of nosocomial HBV have implicated breaches in standard precautions as important causes of HBV transmission. This report describes a nosocomial outbreak of HBV infection in the Republic of Ireland, which occurred between January 2005 and March 2006. The outbreak was detected following identification of a case of acute HBV infection in a patient whose only risk factor was a recent surgical procedure. The extensive multi-agency investigation that followed revealed that the patient was one of five cases of acute HBV infection and that four separate transmission events between infectious cases had occurred in two different hospitals over a 15-month period. A definitive cause for each transmission event was not identified, although lapses in adherence to standard precautions, safe injection and phlebotomy practices could not be ruled out. Two secondary cases of acute HBV infection in community contacts of two of the nosocomial cases were identified. Phylogenetic analysis proved a useful tool in confirming infection with a pre-core HBV mutant and viral transmission between the seven patients. A patient notification exercise involving 1028 potentially exposed patients found no evidence of additional cases of nosocomial HBV infection. These findings highlight the importance of consistent application of standard precautions.
  • An audit of current practice and management of metastatic spinal cord compression at a regional cancer centre.

    Sui, J; Fleming, J S; Kehoe, M; Waterford Regional Hospital, Dunmore Road, Waterford. (2012-02-01)
    Metastatic spinal cord compression (MSCC) is an oncological emergency requiring prompt recognition and management to preserve neurological function and mobility. We performed an audit to assess current practice of MSCC against current best practice as outlined by NICE. Our retrospective audit identified 10 patients from January to December 2009 with confirmed MSCC. The most common primary tumours were prostate 3 (30%), breast 3 (30%) and lung 2 (20%). Pain was the main presenting symptom 9 (90%), followed by weakness 7 (70%) and sensory changes 1 (10%). 5 (50%) had MRI within 24 hours and only 6 (60%) underwent full MRI scan. 8 (80%) had corticosteroids before MRI scan. 6 (60%) received radiotherapy within 24 hours. Only 4 (40%) were referred to orthopaedics and none of these patients had been recommended surgery. Up 14 days following radiological confirmation of MSCC, the number of patients who were unable to walk increased by 20%. Only 5 (50%) were discharged during this period of study. Our audit reported a number of variances in management compared to NICE guideline. These can be improved by following a'fast track' referral pathway and regular education for junior doctors and primary care doctors.
  • Ectopic pituitary adenoma presenting as midline nasopharyngeal mass.

    Ali, R; Noma, U; Jansen, M; Smyth, D; Department of Otolaryngology, Waterford Regional Hospital, Dunmore Road,, Waterford, Ireland. (2012-02-01)
    INTRODUCTION: Ectopic pituitary adenomas are extremely rare. We report a case of ectopic pituitary adenoma in the midline of the nasopharynx. This adenoma probably arose from the pharyngeal remnant of Rathke's pouch. METHODS: We discuss a case of a lady who presented to our unit with 2 months history of dryness and sensation of lump in her throat and a long standing history of hypothyroidism. Examination of nasopharynx revealed a smooth and fluctuant midline mass. CT scan of nose and paranasal sinuses confirmed the midline mass with small defect communicating with the sphenoid sinus. An initial diagnosis of Thornwaldt's cyst was made and she underwent upper aerodigestive tract endoscopy and marsupialization of the mass. Histopathological examination revealed ectopic pituitary adenoma. CONCLUSION: Ectopic pituitary adenoma is an important differential diagnosis for a midline nasopharyngeal mass. It is recommended that prior to surgical resection of midline nasopharyngeal mass biopsy is taken and MRI is performed.
  • PCL tibial avulsion with an associated medial meniscal tear in a child: a case report on diagnosis and management.

    Department of Orthopaedics, Waterford Regional Hospital, Ardkeen, County, Waterford, Ireland. (2012-02-01)
    Posterior cruciate ligament (PCL) injuries from tibial avulsions are rare in the paediatric setting. One would need a high index of suspicion as clinical examination may be difficult, especially in the early period. Magnetic resonance imaging is an excellent diagnostic modality for this condition and other associated injuries within the knee. We report a rare case in which the patient had a PCL avulsion off the tibial insertion site with an associated posterior horn medial meniscal tear off the posterior capsule. He was treated through open reduction and internal fixation of the avulsed fragment with suture repair of the meniscal tear. We emphasize the importance of diagnosing and managing associated intra-articular injuries when dealing with the rare condition of PCL tibial avulsion in the paediatric setting.

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