• Challenges of Cancer Screening

      Kelly, D; OConnor, M (Irish Medical Journal, 2019-06)
      The goal of cancer screening is to detect presymptomatic disease and commence treatment sooner, thereby reducing the incidence of advanced disease and the associated morbidity and mortality1. Challenges exist around designing, managing and evaluating national screening strategies. Programs require clear governance, reporting structures, accountability and regular appraisal of staff. The Scally report highlighted the vital role Public health expertise should play in delivering and integrating these services along with managing the flow of patient information between the National Cancer Control Programme and the National Cancer Registry2. All screening programmes must have a robust Quality Assurance (QA) process and be able to conduct audit effectively1.
    • Surgical Parathyroidectomy Services

      Burke, E; Waris, A; O’Donoghue, G (Irish Medical Journal, 2019-04)
      Retrospectively audit our experience with surgical parathyroidectomy over a 5 year period from the beginning of 2013 to June 2018.
    • 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.
    • 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. aileenmccabe@rcsi.ie (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.
    • 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. johngroarke1@eircom.net (2013-03)
      Non-cardiac aetiologies are common among patients presenting with chest pain.
    • 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.
    • 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. roshdolan@hotmail.com (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)
    • 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.
    • 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. chugez031070@yahoo.co.uk (2012-05)
    • 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. odukayolajide@yahoo.com (2012-04)
      To compare the treatment outcome of Acutrak versus Herbert screw fixation for scaphoid non-union and delayed union.
    • 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. daniel.herlihy@slam.nhs.uk (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.
    • Ocular injury requiring hospitalisation in the south east of Ireland: 2001-2007.

      Saeed, Ayman; Khan, Irfan; Dunne, Orla; Stack, Jim; Beatty, Stephen; Waterford Regional Hospital, Waterford, Ireland. aymantalat@gmail.com (2012-02-01)
      AIM: To investigate whether recent socio-demographic changes and recent health and safety measures have impacted on the trends of ocular trauma in the South East of Ireland. METHODS: We retrospectively reviewed all cases of ocular trauma admitted to our department between October 2001 and September 2007, and the following data were retrieved: demographic details; mechanism of injury and nature of injury. RESULTS: During the study period, 517 patients were admitted with ocular trauma. Work-related and home-related activities were the commonest causes of admission, and accounted for 160 (31.8%) and 145 (28.4%) cases, respectively. In 2006/2007, and following the influx of migrant workers from the 10 new EU accession states (EUAS), the incidence of hospitalised ocular injuries per 100,000 was 89 in persons from the EUAS versus 18 in those of Irish origin, P < or = 0.0001. After adding the offence of not wearing a seat belt to the traffic penalty point system in Ireland, the proportion of road traffic accident (RTA)-related ocular injuries dropped significantly from 6.7% to 2.4%, P=0.03. CONCLUSION: The inclusion of the offence of not wearing a seat belt in the traffic penalty point system may have contributed to the significantly lower proportion of hospitalised ocular injuries attributable to RTAs. Also, the demographic profile of patients admitted because of ocular trauma has changed over the last 6 years, reflected in an increasing proportion of these injuries in persons from the EUAS. These data will inform healthcare providers, and those involved in developing health and safety guidelines for the workplace.
    • Rituximab as a first-line agent for the treatment of dermatomyositis.

      Department of Rheumatology, Waterford Regional Hospital, Waterford, Republic of, Ireland, mharoon301@hotmail.com. (2012-02-01)
      B cells may play a pivotal role in the pathophysiology of DM, and reports have claimed that targeting B cells is a viable treatment option in patients with dermatomyositis. A 20-year-old girl presented in October 2007, with few weeks' history of proximal muscle weakness. Gottron's papules were noted on her knuckles. She had normal inflammatory markers and negative autoantibody screen. Her CPK was 7,000 U/L (normal range 0-170) with an LDH of 1,300 U/L (normal range 266-500). EMG and muscle biopsy was consistent with active myositis. She had normal pulmonary function tests. HRCT showed no interstitial lung disease. She was started with 60 mg glucocorticoids (1 mg/kg), with a good clinical response. However, any attempt to taper down the steroid dose led to recurrence of her symptoms. The options of available immunosuppressive therapies, including the experimental usage of rituximab, were discussed with her; averse to long-term systemic treatments, she opted to try a course of rituximab. She had rituximab 1,000 mg on days 0 and 14, and her glucocorticoids were tapered in next few weeks. Now, 24 months since her rituximab infusions, she remains in complete clinical and biochemical remission and is naive to other immunosuppressive agents apart from glucocorticoids and rituximab. Depleting peripheral B cells with rituximab (one course) in our patient has led not only to complete resolution of muscle and skin disease (induction) but also remains off all immunosuppressives including glucocorticoids.
    • Practical experience of ustekinumab in the treatment of psoriasis: experience from a multicentre, retrospective case cohort study across the U.K. and Ireland.

      Dermatological Sciences, Salford Royal Hospital, The University of Manchester,, Manchester Academic Health Science Centre, Manchester M6 8HD, U.K. Department of , Dermatology, Royal Devon & Exeter Hospital, Exeter, U.K. Department of, Dermatology, Royal Liverpool and Broadgreen NHS Trust, Liverpool, U.K. St John's , Institute of Dermatology, King's College London and Guy's and St Thomas' NHS, Foundation Trust, London, U.K. Department of Dermatology, Queen's Medical Centre,, Nottingham, U.K. St Vincent's University Hospital, Dublin, Ireland Department of , Dermatology, Waterford Regional Hospital Ardkeen, Waterford, Ireland Department, of Dermatology, Western Infirmary, Glasgow, U.K. Department of Dermatology, The, Royal Free Hospital, London, U.K. Department of Dermatology, Royal Gwent, Hospital, Newport, U.K. (2012-02-01)
      Background There are limited data on the use of ustekinumab outside of clinical trials. Objectives To assess the efficacy and safety of ustekinumab in patients with severe psoriasis attending 10 dermatology centres in the U.K. and Ireland. Methods A retrospective case-note review of 129 patients with psoriasis treated with ustekinumab. Results Baseline Psoriasis Area and Severity Index (PASI) was 22.9 +/- 10.1 (mean +/- SD). After 16 weeks of treatment with ustekinumab PASI 75 (75% reduction in PASI) was observed in 63.0% (n = 80/127) of patients, although four patients required concomitant therapy at the 16-week time point. Previous biologic use did show a small, non-significant trend towards treatment failure. A PASI 75 response was seen in 29.4% (n = 5/17) of individuals weighing 90-100 kg and treated with the standard 45 mg ustekinumab dose compared with PASI 75 of 70.3%, 71.4%, 75.0% and 55.6% for weight groups < 80, 80-90, 100-110 and > 110 kg, respectively (P = 0.024). Ustekinumab therapy was well tolerated; serious adverse events were observed in 2.3% (n = 3/129) of patients. Conclusions Ustekinumab is a novel biologic agent for psoriasis. When used in everyday clinical practice it demonstrates high levels of short-term therapeutic efficacy with an acceptable short-term safety profile.