Research by staff affiliated to the University Hopsitals in Limerick, comprising Univeristy Hospital Limerick,Dooradoyle, Croom Orthopaedic Hospital, University Maternity Hospital, Ennis Road, Limerick

Recent Submissions

  • Temporal trends in acute kidney injury across health care settings in the Irish health system: a cohort study.

    Stack, Austin G; Li, Xia; Kaballo, Mohamed; Elsayed, Mohamed E; Johnson, Howard; Murray, Patrick T; Saran, Rajiv; Browne, Leonard D (Nephrology, dialysis, transplantation, 2018-08-07)
    Complete ascertainment of the true rates of acute kidney injury (AKI) and emerging trends are essential for planning of preventive strategies within health systems. We conducted a retrospective cohort study from 2005 to 2014 using data from regional laboratory information systems to determine incidence rates of AKI and severity Stages 1-3 in the Irish health system. Multivariable models were developed to explore annual trends and the contributions of demographic factors, clinical measures, geographic factors and location of medical supervision expressed as adjusted odds ratios (ORs) and 95% confidence intervals (CIs). From 2005 to 2014, incidence rates of AKI increased from 6.1% (5.8-6.3) to 13.2% (12.7-13.8) per 100 patient-years in men and from 5.0% (4.8-5.2) to 11.5% (11.0-12.0) in women, P < 0.001. Stage 1 AKI accounted for the greatest growth in incidence, from 4.4% (95% CI 4.3-4.6) in 2005 to 10.1% (95% CI 9.8-10.5) in 2014 (P < 0.001 for trend). Compared with 2005, patients in 2014 were more likely to experience AKI [OR 4.53 (95% CI 4.02-5.1) for Stage 1, OR 5.22 (4.16-6.55) for Stage 2 and OR 4.11 (3.05-5.54) for Stage 3], adjusting for changing demographic and clinical profiles. Incidence rates of AKI increased in all locations of medical supervision during the period of observation, but were greatest for inpatient [OR 19.11 (95% CI 17.69-20.64)] and emergency room settings [OR 5.97 (95% CI 5.56-6.42)] compared with a general practice setting (referent). Incidence rates of AKI have increased substantially in the Irish health system, which were not accounted for by changing demographic patterns, clinical profiles or location of medical supervision.
  • Sweat Testing in Ireland

    Blake; Tsang, V; Ghori, R; Whelan, S; Boran, G; Linnane, B; University Hospital Limerick (Irish Medical Journal, 2018-07)
    Quick, painless, cheap and reliable, the sweat test remains the gold standard diagnostic test for cystic fibrosis. We aimed to describe the pattern of testing in Ireland over a calendar year.
  • A cross sectional study of the relationship between self-reported levels of loneliness and the experience of Pastoral Care in an Older Adult Day-care Service

    Kiely, Elizabeth; Irish College of Humanities and Applied Sciences (2018-08-04)
    Thesis submitted for the Masters in Counselling and Pastoral Care At the Irish College of Humanities and Applied Sciences. The thesis seeks to establish if a correlation exists between self-reported levels of loneliness and the experience of pastoral care in Older Adult Daycare Services (OADS).
  • Revascularisation of left main stem disease: a prospective analysis of modern practice and outcomes in a non-surgical centre.

    Coughlan, J J; Blake, Nial; Chongprasertpon, Napohn; Ibrahim, Munir; Arnous, Samer; Kiernan, Thomas John; Department of Cardiology, University Hospital Limerick (2018-07)
    In this study, we sought to prospectively analyse the management and long term outcomes associated with revascularisation of left main stem disease via percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in our centre.
  • Enhancing acute stroke services: a quality improvement project.

    McGrath, Keith; Cunningham, Nora; Moloney, Elizabeth; O'Connor, Margaret; McManus, John; Peters, Catherine; Lyons, Declan; University Hospital Limerick (BMJ open quality, 2018-07)
    In a busy stroke centre in Ireland, care for acute stroke was provided by a mixture of general physicians. In acute ischaemic stroke, speed is essential for good outcomes.
  • A core outcome set for studies evaluating the effectiveness of prepregnancy care for women with pregestational diabetes.

    Egan, Aoife M; Galjaard, Sander; Maresh, Michael J A; Loeken, Mary R; Napoli, Angela; Anastasiou, Eleni; Noctor, Eoin; de Valk, Harold W; van Poppel, Mireille; Todd, Marie; Smith, Valerie; Devane, Declan; Dunne, Fidelma P (Diabetologia, 2017-04)
    The aim of this study was to develop a core outcome set (COS) for trials and other studies evaluating the effectiveness of prepregnancy care for women with pregestational (pre-existing) diabetes mellitus.
  • Saving Blood and Reducing Costs: Updating Blood Transfusion Practice in Lower Limb Arthroplasty

    Fenelon, C; Galbraith, JG; Kearsley, R; Motherway, C; Condon, F; Lenehan, B (Irish Medical Journal, 2018-04)
    Our aim was to quantify blood transfusion rates in lower limb arthroplasty following the introduction of a multimodal enhanced recovery programme (ERP). We then sought to update the maximum surgical blood ordering schedule (MSBOS) and calculate cost savings achieved.
  • A Comparison of Perceived and Measured Paternal Weight and BMI, and Relationship to Weight and BMI of his Children

    Power, RF; Power, B; O’Gorman, CS (Irish Medical Journal, 2018-02)
    Nineteen percent of 9 years old Irish children are overweight; seven percent are obese. Our aims were: to examine whether differences exist between paternal self-reported and measured height, weight and BMI in a population representative sample; and to explore paternal perceptions of their own weight status. Measures of height and weight for fathers and for their children from the National Longitudinal Study of Children Growing Up in Ireland were obtained using validated methods. Three quarters of fathers (6,263 of 8,568 study children) with a mean age of 42 years (SD 5.04) responded. The mean difference between self-reported and measured weight was -1.03kg (SD=4.52), indicating that weight was underestimated. Obese fathers were more likely to have an obese son (9.4% compared to 5.3% for the full cohort) and an obese daughter (12.4% compared to 7.7%). These data suggest that there is a strong relationship between fathers' weights and his childrens’ weights. A leading factor in the development of childhood obesity is parental obesity. Targeting overweight and obesity in the child should occur simultaneously with tackling overweight and obesity in the parents; in this study, the fathers
  • Hemorrhagic lesion on the chest wall after trauma.

    Roche, Lisa; Wall, Dmitri; Hackett, Catriona (JAAD case reports, 2018-01)
    A 59-year-old woman presented with a burning, rapidly progressive mass on the midchest, occurring after a fall, 4 months prior. Examination found a large well-circumscribed mass over the lower xiphisternum (Figs 1 and 2). Results of baseline investigations were normal apart from mildly elevated liver function values. A computerized tomography scan confirmed a 6.4- x 4.9-cm lobulated soft tissue heterogeneous-density mass located in the subcutaneous fat with ill-defined borders and no obvious infiltration of the chest wall. A single focal abnormality was noted in the liver. Several incision/drainage procedures were complicated by difficulty achieving hemostasis. Ellipse incisional biopsy was performed (Figs 3 and 4).
  • Determination of the Lung Clearance Index (LCI) in a Paediatric Cystic Fibrosis Cohort

    Mulligan, M; Collins, L; Dunne, CP; Keane, L; Linnane, B (Irish Medical Journal, 2017-10)
    The pathogenesis of CF lung disease may start in infancy. Therefore, it is important to monitor the early stages of its progress. The Exhalyzer D is the first commercially available device designed to measure lung ventilation inhomogeneity at any age. This study was conducted to assess the performance and feasibility of using the Exhalyzer D in a paediatric CF clinic. A total of 91 subjects were recruited (23 controls, and 68 patients with CF). The majority of CF patients (79%) and controls (78%) completed at least two successful washouts. A strong linear correlation was noted between LCI and FEV1. Children with CF under six years of age struggled to perform the washout in a technically correct manner. A clear learning effect was observed, with improved technique and shorter testing times on repeated visits.
  • Knitting the Threads of Silk through Time: Behçet's Disease-Past, Present, and Future.

    Adeeb, Fahd; Stack, Austin G; Fraser, Alexander D (International Journal of Rheumatology, 2017)
    Behçet's disease (BD) is a chronic relapsing vasculitis that affects vessels of all types and sizes with a broad spectrum of phenotypic heterogeneity and complex immunopathogenesis. Efforts by the scientific community to resolve the unmet needs of BD and gaps in our knowledge have been hampered by considerable challenges that primarily relate to the rare nature of the disease in many parts of the world and its heterogeneity. Controversies remain in many aspects of the disease including the diagnostic criteria, immunopathogenesis and biomarker discovery, geographical variation, and therapeutic considerations. In this review, we highlight recent advances in our scientific understanding of BD, shed new insights into diagnostic and treatment strategies, and discuss residual gaps in our knowledge that will serve as the basis for current and future research.
  • An unusual case of recurrent chest infections.

    Dahab, Taqua; Saleem, Shahzaib; Gumani, Dikshaini; Casserly, Brian; Sharkey, Claire; Laghi, Frank; Newmarch, William (2017-08)
    This case presentation relates to a 53 year old male, cachectic in appearance, who presented with progressively worsening dyspnoea, cough, intermittent haemoptysis and a history of nasal dryness ongoing over five months. The patient had received multiple courses of oral antibiotics for suspected community acquired pneumonia with no significant improvement. He was referred to our Respiratory Department for further evaluation of his symptoms. His HRCT showed right middle lobe consolidation with central cavitations. Furthermore, the transbronchial biopsy had been performed and the cytological examination revealed lipid laden macrophage with interstitial inflammatory changes. With return to the patient over the counter drug history, he described the frequent use of petroleum jelly to alleviate the symptoms of nasal dryness. This is the first report case of exogenous lipoid pneumonia presented with haemoptysis and cavitations in the HRCT.
  • High Vitamin D Levels May Downregulate Inflammation in Patients with Behçet's Disease.

    Adeeb, Fahd; Khan, Maria Usman; Li, Xia; Stack, Austin G; Devlin, Joseph; Fraser, Alexander D (International Journal of Inflammation, 2017)
    Vitamin D plays a significant role in the immune system modulation and may confer a protective role in autoimmune diseases. We conducted a case-control study to compare 25(OH)D levels in patients with BD who were managed at a regional rheumatology programme in the midwest region of Ireland compared to matched controls. Healthy controls were selected from the Irish health system and matched in 1 : 5 ratio for age, sex, and the month of the year. 25(OH)D levels <20 nmol/L were classified as deficient while levels between 20 and 40 nmol/L were classified as insufficient. Differences between groups were assessed using Mann-Whitney test and associations between cases and controls were expressed as odds ratios and 95% confidence intervals. Nineteen patients with BD were compared with 95 controls matched by age, sex, and month of blood draw. 25(OH)D levels were significantly higher in patients in BD than in matched controls (median values: 45 nmol/L versus 22 nmol/L, p < 0.005) and tended to be lower in patients with active disease than in those without (median values: 35 nmol/L (IQR: 22.75-47.25 nm/L) versus 50 nmol/L (IQR: 35-67 nmol/L), p = 0.11). Compared to controls, patients with BD were significantly less likely to have 25(OH)D deficiency or insufficiency (OR: 0.09, 95% CI: 0.03-0.28, p < 0.001). Our findings suggest a possible role for 25(OH)D in modifying the inflammatory response in BD and uncover a potential opportunity to assess whether correction of Vit D deficiency confers protective benefits.
  • Comparing cardiovascular risk factors, disease and treatment in participants with rheumatoid arthritis and without arthritis in a population based study

    O’Driscoll, N; Kennedy, N; Anjum, S; Fraser, A; Hannigan, A (Irish Medical Journal, 2017-05)
    Rheumatoid Arthritis (RA) is associated with a significant increase in mortality compared to the general population, with cardiovascular disease (CVD) the leading cause of death. The aim of this study is to compare the prevalence and treatment of modifiable CV risk factors and history of CVD in those with RA and those without arthritis in Ireland. Data from the Irish Longitudinal Study on Ageing (TILDA), a population-representative cohort study of people in Ireland aged 50 or over, was used. Participants with RA (n=457) were twice as likely to be obese (OR 2.02, 95% CI 1.99 to 2.06) compared to those without arthritis (n=4,063). Participants with RA were also more likely to be physically inactive (OR 1.73, 95% CI 1.69 to 1.76) and taking antihypertensive medication than those without arthritis. Exercise can have a beneficial impact on CVD and specific interventions to increase physical activity in those with RA may be warranted
  • Peritoneal tuberculosis in the setting of ustekinumab treatment for psoriasis.

    Lynch, Maeve; Roche, Lisa; Horgan, Mary; Ahmad, Kashif; Hackett, Caitriona; Ramsay, Bart (JAAD case reports, 2017-05)
    Biologics have revolutionized the treatment of moderate-to-severe psoriasis, but serious infection is a risk with these immunosuppressive agents.1 An increased risk of tuberculosis (TB) reactivation in patients with latent TB infection is well recognized with antietumor necrosis factor (TNF)-a agents, as TNF has a central role in TB immunity, and antieTNF-a agents interfere with innate and cellmediated immune responses.2 Testing for and treating latent TB before starting therapy reduces the risk of reactivation of TB on biologic agents
  • Does exercise impact on sleep for people who have rheumatoid arthritis?

    McKenna, Sean (Rheumatology International, 2017-03-01)
    Objectives: To systematically search for the availability of evidence for exercise impacting on sleep for people who have rheumatoid arthritis. Methods: Two reviewers independently searched seven electronic databases, identified and extracted relevant studies by applying eligibility criteria. Sources of bias were assessed independently by two reviewers using the Cochrane bias assessment tool for randomized controlled trials (RCTs) and Newcastle-Ottawa Quality Assessment Scale for non-RCT’s. Data were synthesized using a level of evidence approach. Meta-analyses were deemed to be inappropriate due to the heterogeneity of study designs, measurement tools and interventions. Results: Five studies were included: 1 RCT; 2 pilot RCT’s and 2 sample of convenience. A total of 262 people with RA were included. Interventions used were difficult to assess due to the heterogeneity of study designs and the inclusion of two using different types of Yoga as an intervention. Different sleep outcome measures were used thus, it was not feasible to pool results. Studies had a high risk of bias.
  • Ghana Health Services and the Irish health system – bridging the gap.

    Akaateba, D; Andan, M; Hadfield, K; Elmusharaf K; Leddin D; Murphy F; Ofosu W; Sheehan C; Finucane P (Irish Medical Journal, 2017-02)
    The University of Limerick Hospitals Group (ULHG), and the University of Limerick (UL), are committed to fostering links with the developing world and contributing to solutions of the challenges these countries face. In 2016 a group from UL and ULHG visited the Upper West Region of Ghana1 to explore the possibility of establishing a partnership with Ghana Health Services (GHS). In this article, we describe aspects of GHS and outline some of the challenges for Irish institutions trying to engage with the realties of the developing world.
  • Bed Utilisation in an Irish Regional Paediatric Unit A Cross-Sectional Study Using the Paediatric Appropriateness Evaluation Protocol (PAEP)

    Ó hAiseadha, Coilín; Mannix, Mai; Saunders, Jean; Philip, Roy K. (Int J Health Policy Manag, 2016-05)
    Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources.
  • Car safety seat usage and selection among families attending University Hospital Limerick

    Scully, P; Finner, N; Letshwiti, JB; O’Gorman, C (Irish Medical Journal, 2016-05)
    The safest way for children to travel within a car is by provision of a weight-appropriate safety-seat. To investigate this, we conducted a cross-sectional study of adult parents who had children under 12 years, and collected information related to: car use, safety-seat legislation, and type of safety-seat employed. Data were reviewed on 120 children from 60 respondents. Ninety-eight (81.7%) children were transported daily by car. Forty-eight (81.4%) respondents were aware that current safety-seat legislation is based on the weight of the child. One hundred and seven (89.9%) children were restrained during travel using a car safety-seat. One hundred and two (96.2%) safety seats were newly purchased, installed in 82.3% (88) cases by family members with installation instructions fully read in 58 (55.2%) cases. Ninety-nine (83.2%) children were restrained using an appropriate safety-seat for their weight. The results show that four out of five families are employing the most appropriate safety-seat for their child, so providing an effective mechanism to reduce car-related injury. However, the majority of safety-seats are installed by family members, which may have child safety consequences.
  • Irish medical students’ understanding of the intern year

    Gouda, P,; Kitt, K; Evans, D.S; Goggin, D; McGrath, D; Last, J; Hennessy, M; Arnett, R; Dunne, F; O’Donovan, D; S O’Flynn, S (Irish Medical Journal, 2016-03)
    Upon completion of medical school in Ireland, graduates must make the transition to becoming interns. The transition into the intern year may be described as challenging as graduates assume clinical responsibilities. Historically, a survey of interns in 1996 found that 91% felt unprepared for their role. However, recent surveys in 2012 have demonstrated that this is changing with preparedness rates reaching 52%. This can be partially explained by multiple initiatives at the local and national level. Our study aimed evaluate medical student understanding of the intern year and associated factors. An online, cross-sectional survey was sent out to all Irish medical students in 2013 and included questions regarding their understanding of the intern year. Two thousand, two hundred and forty-eight students responded, with 1224 (55.4%) of students agreeing or strongly agreeing that they had a good understanding of what the intern year entails. This rose to 485 (73.7%) among senior medical students. Of junior medical students, 260 (42.8%) indicated they understood what the intern year, compared to 479 (48.7%) of intermediate medical students. Initiatives to continue improving preparedness for the intern year are essential in ensuring a smooth and less stressful transition into the medical workforce

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