Research by staff affiliated to Cherry Orchard Hospital

Recent Submissions

  • Treatment of Adolescent Heroin Dependence: The End of an Era.

    Smyth, B P; McCarney, G (2020-01-16)
    In the 1990s, Ireland had the youngest population of heroin dependent patients in Europe.1 At that time problems where largely confined to Dublin, and within Dublin use was concentrated in specific areas of very significant deprivation.2,3 At the peak of the heroin epidemic in 1996, there were over 180 adolescents (under 18) presenting for addiction treatment in Dublin annually with a heroin use disorder.1 Given that addiction services had been developed with adults in mind, the National Drug Treatment Centre established the Young Persons Program (YPP) in 2000, in recognition of the very different needs of these young patients. The authors, both child & adolescent psychiatrists, arrived into the service a few years later. The first National Drug Strategy (NDS), was launched in 2000 and this consolidated the move away from abstinence focused treatment which had begun in the 1990s and endorsed treatment approaches which were based on harm reduction principles. While opioid agonist treatments (OAT), such as methadone and buprenorphine, had become a central component of treatment for heroin dependent adults internationally, their use in adolescents was less established.
  • Molecular epidemiology of an extended multiple-species OXA-48 CPE outbreak in a hospital ward in Ireland, 2018-2019.

    Brehony, Carina; Domegan, Lisa; Foley, Margaret; Fitzpatrick, Margaret; Cafferkey, Jacqueline P; O'Connell, Karina; Dinesh, Binu; McNamara, Eleanor; Duffy, Fionnuala; Fitzpatrick, Fidelma; et al. (2021-12-08)
    Objectives: Molecular epidemiological description of an OXA-48 CPE outbreak affecting a tertiary-care hospital ward in Ireland over an extended period (2018-2019). Methods: Microbiological testing and whole-genome sequencing (WGS) were performed on all 56 positive OXA-48 outbreak case isolates. Results: In total, 7 different species were identified: Enterobacter hormaechei (n = 35, 62.5%), Escherichia coli (n = 12, 21.4%), Klebsiella pneumoniae (n = 5, 8.9%), Klebsiella oxytoca (n = 1, 1.8%), Klebsiella michiganensis (n = 1, 1.8%), Citrobacter freundii (n = 1, 1.8%), and Serratia marcesens (n = 1, 1.8%). E. hormaechei ST78 was the most common genotype (n = 14, 25%). Two major pOXA-48 plasmid types were identified throughout the outbreak, 'types' 1 and 2, and 5 major E. hormaechei clonal groupings were identified: ST78, ST108, ST1126, ST135, and ST66. Within each of the ST108, ST1126, ST135 and ST66 groups, the pOXA-48 harbored within each isolate were the same. Within ST78, 9 isolates contained the pOXA48 'type 2' plasmid and 5 contained the 'type 1' plasmid. Environmental specimens were taken from different outbreak ward locations: handwash basins, sink and shower drains, and taps. Of 394 environmental specimens, OXA-48 CPE was isolated from 26 (6.6%). Conclusions: This prolonged outbreak of OXA-48 CPE was confined to one ward, but it exemplifies the complexity and difficulty in the control of these organisms. With multiple species and genotypes involved, they may be better described as 'plasmid outbreaks.' WGS provided insights into this diversity and potential transmission among cases, though its usefulness would be enhanced by analysis as close as possible to real time so that interventions can be implemented as soon as data are available.
  • Adolescent Substance Use ‘In Search of Solutions’

    Murray, Denis (Murray, Denis, 2018)
    Presentation to The School of Nursing and Midwifery, Trinity College Dublin as part of the Civic Engagement ‘Tell Me About’ Public lecture series.
  • Family therapy within an adolescent addiction treatment service “In search of solutions"

    Murray, Denis (Feedback: Journal of the Family Therapy Association of Ireland, 2016)
    Issues and trends in relation to substance misuse normally develop in the transitional phase of adolescence, as young people begin looking towards their peers for direction and are less subject to parental authority. In relation to substance misuse it is observed that risk and protection factors exist in equal measure within different contexts, including within the individual, family, peer group, school and community settings. In response to problems relating to illicit drug use in Ireland the first adult treatment service was established in Dublin in 1969. As an approach to meeting the complex needs of an adolescent drug using population two designated out-patient treatment adolescent services were established in Dublin during the mid-1990s. Working closely with families, carers and significant others improves communication and mobilises resources in ways that enhances protection for young people especially in circumstances where there are a number of family members engaging in substance misuse.
  • Treatment outcome for adolescents abusing alcohol and cannabis: how many ’reliably improve’?

    Smyth, BP; Kelly, A; Barry, J; Cullen, W; Darker, C (Irish Medical Journal, 2015-05)
    Alcohol and cannabis are the primary substances contributing to referrals of adolescents to substance abuse treatment services. Their outcome has not been examined in Ireland. A three month follow-up was conducted in an outpatient adolescent treatment program. We followed up 35 high risk users of alcohol and 55 high risk users of cannabis. Although the high risk drinkers achieved a significant reduction in median number of days drinking (p=0.004), only four (11%) were abstinent at follow up. A further five (14%) achieved a reliable reduction in days of drinking. The high risk cannabis users demonstrated a significant drop in median days of use (p<0.001), although only six (11%) were abstinent at follow up. A further 20 (36%) achieved a reliable reduction in days of use. Calculation of reliable change allows examination of outcomes which fall short of the elusive goal of abstinence.
  • Educational challenges and requirements for managing leg ulcers in the community.

    Martin, Fiona; Staff Nurse, Health Service Executive, Cherry Orchard Hospital, Dublin, Republic of Ireland. (2014-06)
    The significant impact of leg ulcers upon quality of life and disease burden cannot be overemphasised, with the financial and economic impact from an individual, local and national perspective being widely acknowledged. This article attempts to highlight issues relating to education in leg ulcer management while identifying some current and emerging challenges faced in this area by professionals. With regard to education, formal training and perception of professionals, the provision of more specialised and focused training, increased use of patient-related outcome measures and the concept of knowledge brokering have been identified as important aspects in the planning and further development of education. Issues in the domains of community nursing, technology, pain management, nursing diagnosis, availability of research and recurrence were also highlighted.
  • Exploring the health concerns of people taking methadone

    James, P; Spiro, David; Geoghegan, Noreen; Connor, Anita; Hawthorne, Gail; HSE YoDA Service & Cherry Orchard Hospital (2012)
    This article reports on a study to uncover the health concerns of clients attending a methadone maintenance programme in an addiction service in Ireland. This is an extended version of the article published in Nursing Times; 104: 35, 26–27.
  • Decline in age of drinking onset in Ireland, gender and per capita alcohol consumption.

    Smyth, Bobby P; Kelly, Alan; Cox, Gemma; Department of Public Health & Primary Care, Trinity College Dublin, Addiction Service, Bridge House, Cherry Orchard Hospital, Dublin 10, Ireland. (2011)
    We sought to examine the fall in age of first drinking in Ireland and to determine whether there were gender differences. We also aimed to determine whether there was a relationship between the per capita alcohol consumption evident when people entered later adolescence and their age of drinking onset.