Research by staff affiliated to Sligo General Hospital

Recent Submissions

  • Natalizumab-associated progressive multifocal leukoencephalopathy (PML) in multiple sclerosis (MS): "a case report from Ireland with review of literature, clinical pitfalls and future direction".

    Mansoor, Salman; Mullane, Gerard; Adenan, Mohammad Hijaz; Kelly, Siobhan; Water, Aine; McPartland, Grainne; Murphy, Kevin (2021-01-07)
    Background: Progressive multifocal leukoencephalopathy (PML) is one of the most serious treatment-related complications that is encountered in patients with multiple sclerosis (MS). PML is a serious complication of MS treatment which is most commonly related to natalizumab. Case presentation: We report clinical course of progressive multifocal leukoencephalopathy (PML) in a 40-year-old man who was on treatment for highly active relapsing-remitting multiple sclerosis with natalizumab (Nz). He was treated with steroids, cidofovir, and mirtazapine and went on to develop long-term disability. The case describes the evolution of PML from diagnosis up till 5 months with changes on sequential brain scans and clinical symptoms in our patient. Conclusion: Patients who are on natalizumab should be aware and consented for the risk of PML. They should be periodically re-assessed for their relative PML risk. There is a growing body of evidence that suggests switching patients from natalizumab who have a higher risk of PML to other safer treatment options.
  • Screening Tools Used by Clinical Pharmacists to Identify Elderly Patients at Risk of Drug-Related Problems on Hospital Admission: A Systematic Review.

    Brady, Amanda; Curtis, Chris E; Jalal, Zahraa (2020-04-10)
    None of the models met the four key stages required to create a quality risk prediction model. Further research is needed to either refine the tools developed to date or develop new ones that have good performance and have been externally validated before considering the potential impact and implementation of such tools.
  • COVID-19 pandemic and the risk of infection in multiple sclerosis patients on disease modifying therapies: "what the bleep do we know?"

    Mansoor, Salman; Kelly, Siobhan; Murphy, Kevin; Waters, Aine; Siddiqui, Nauman Saleem (2020-05-01)
    The novel coronavirus which emerged in Wuhan province of China has taken world by surprise. Since been diagnosed in December 2019, it has been termed a "Pandemic" and there is a growing concern in physicians across the globe. As new evidence is emerging, there are various preventative strategies which are being deployed. Multiple sclerosis patients who are on disease modifying therapies (DMTs) might be at a higher risk of acquiring or a poorer outcome due to their immune status. This review looks at the available evidence in managing this global crisis.
  • Inflammatory marker alteration in response to systemic therapies in psoriasis.

    Grechin, Cristina; Gheucă Solovăstru, Laura; Vâță, Dan; Ionela Pătrașcu, Adriana; Ioana Grăjdeanu, Alina; Porumb-Andrese, Elena (2020-02-18)
    Substantial research has focused on the presence of biomarkers involved in both the pathogenesis of psoriasis and its comorbidities. The identification of these biomarkers has a crucial role in establishing the diagnosis and prognosis, in understanding the physiopathological mechanism and in determining the therapeutic response. The aim of this study was to emphasize the alteration in inflammatory markers in response to systemic therapies in psoriasis. Evolution of inflammatory marker alteration was studied in 194 patients with psoriasis, aged between 7 and 87 years. Two groups were set up: the first comprised of patients treated with methotrexate (n=51), while the second comprised patients treated with biological therapy (n=143). Each group was evaluated for blood values of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and fibrinogen before and after treatment, the fluctuation of these values according to the treatment, the interrelation between inflammatory markers and inflammatory activity of the disease and the evolution of the disease after treatment. In group I, 46 out of 51 patients had elevated levels of acute phase reactants before treatment. After treatment with methotrexate 7.5 mg/week, 12 out of 46 patients had elevated blood levels of ESR and 18 out of 46 patients of CRP and fibrinogen. Before treatment with biological therapy, 138 patients out of 143 presented abnormal high range for acute phase reactants. After treatment with biological therapy, 18 patients out of 138 had elevated blood levels of ESR and 37 patients out of 138 had elevated CRP and fibrinogen. A favorable evolution was noted in 98 patients out of 138. It was concluded that the systemic treatment with both methotrexate and biological therapy showed a marked decline in the patients with abnormal values of CRP, ESR and fibrinogen, indirectly showing a decline in the inflammatory activity of psoriasis.
  • Preference for Alternate-Day Versus Conventional In-Center Dialysis: A Health Utility Elicitation.

    Solimano, Rafael J; Lineen, James; Naimark, David M J (2020-04-26)
    Background: Mortality rates for patients on hemodialysis (HD) continue to be high, in particular, following the long interdialytic period, yet thrice-weekly conventional HD (CHD) is still an almost universal regimen. Alternate-day dialysis (ADD) may have advantages over the current schedule because it would eliminate the long interdialytic break. A preliminary, as yet unpublished, patient simulation and cost-utility analysis compared CHD versus ADD and demonstrated that the economic attractiveness of ADD was sensitive, in particular, to patients' preference for ADD versus CHD. To date, this preference has not been elicited. Objective: To elicit utilities for both CHD and ADD using 3 standard elicitation methods among a prevalent cohort of patients on CHD. Design: This study is a single-center survey of patient preferences (utilities). Setting: This study took place within the dialysis units of Sunnybrook Health Centre, a university-affiliated teaching hospital in Toronto, Ontario, Canada, which encompasses 174 patients on in-center HD. Patients: Those older than 18 years of age, on thrice-weekly HD, were included in this study. Measurements: Descriptive statistics were used to summarize patient characteristics and the utility values generated. A multiple linear regression was performed to determine an association between participant characteristics and the utility ratio. Methods: Via standardized face-to-face interviews by a single investigator, 3 utility elicitation methods, visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG), were administered to generate utilities for each patient for their current health state of CHD (thrice-weekly). After completing this task, we provided each patient with a concise summary regarding the current literature on how ADD may impact their health. Finally, patients were asked to envision their health while on an ADD regimen while repeating the VAS, TTO, and SG. Results: We recruited 65 participants. The mean utilities of CHD versus ADD were similar for all 3 methods. Visual analogue scale, TTO, and SG had utility values of 0.6 ± 0.2, 0.6 ± 0.3, and 0.7 ± 0.3, and 0.6 ± 0.2, 0.7 ± 0.3, and 0.7 ± 0.3 for CHD and ADD, respectively. The ratio for CHD to ADD was 1.1 ± 0.4, 1.1 ± 0.5, and 1.0 ± 0.2 for VAS, TTO, and SG, respectively. Limitations: Small sample size from a single center, where not all participants agreed to participate, wide variability in participant responses and requiring patients to conceptually imagine life on ADD may have affected our results. Conclusions: Compared with CHD, there was no difference in the preference toward ADD which demonstrates promise that adopting an alternate-day schedule may be acceptable to patients. Furthermore, with the generation of a utility for ADD, this will allow for more precise estimates in future simulation studies of the economic attractiveness of ADD.
  • A prospective cohort study of the conservative management of focal cervical intraepithelial neoplasia 2.

    McMahon, Gabriela; Griffin, Sinead; Curley, Jennifer; Hartel, Paul; Kilgallen, Clive; Kondaveeti, Nirmala; Sligo University Hospital (European Society of Gynaecology, 2020)
    Background and Purpose: Traditionally, cervical intraepithelial neoplasia 2 (CIN 2) is managed by the removal of affect-ed tissue in a procedure known as a large loop excision of the transformation zone (LLETZ). In our unit, pathology reports on LLETZ specimens done for a diagnosis of CIN 2 often are reported as CIN 1 or a normal result. So we wondered – are we over-managing CIN 2? Methods: This study was designed to assess the acceptability and outcomes of the conservative management of focal CIN 2. We wanted to establish if monitoring of the disease is sufficient in selected women. In this prospective cohort, women were selected for inclusion in the study by having a histological diagnosis of focal CIN 2 from a cervical biopsy and after discussion at the colposcopy multi-disciplinary team meeting. After explanation of CIN 2 and its future impli-cations, women were informed of the risks and benefits of conservative management versus LLETZ. Women who opted for conservative management were seen in the colposcopy clinic for colposcopy examination, cervical biopsy ± cervical smear and HPV testing at six monthly intervals for two years.Results: Over the two-year follow-up period, 20/31 women (64.5%) had regression of disease, 7/31 women (22.6%) had persistence of CIN 2 and 4/31 women (12.9%) had progression of disease to CIN 3. There were no reported cases of cervical carcinoma in situ or invasive cervical carcinoma. During the follow-up period, patients were offered treatment if there was progression to CIN 3 or worse, persistence of CIN 2 or if they wished to undergo treatment at any stage.Conclusions: Conservative management of CIN 2 may be considered in women who are under the age of 30 with focal CIN 2. However, larger studies should be carried out to define the safety or acceptability of changing this practice.
  • The Experience of the Management of Eating Disorders in a Pop-up Eating Disorder Unit

    McHugh, CM; Harron, M; Kilcullen, A; O’Connor, P; Burns, N; Toolan, A; O’Mahony, E (Irish Medical Journal, 2018-09)
    Anorexia nervosa affects 0.5% of the population (90% female) with the highest mortality of any psychiatric illness, usually suicide, or cardiovascular or neurological sequelae of either malnutrition or refeeding syndrome. The latter two conditions occur in the inpatient setting, carry a high mortality and are thoroughly avoidable with careful informed clinical management.
  • Infants of hypothyroid mothers- are postnatal Thyroid Function Tests necessary? A Retrospective Study in a Regional Hospital

    Hawke, A; Stanzelova, A; Ruth, E; Neylon, OM (Irish Medical Journal, 2017-02)
    Congenital hypothyroidism is a preventable cause of intellectual disability. The aim of this study was to establish whether adding an additional thyroid function check between days of life 10-14 in infants born to mothers with known hypothyroidism identified any additional cases of congenital hypothyroidism requiring treatment that were not detected by the national newborn bloodspot screening programme. Babies who had Thyroid Function Tests (TFTs) measured at 10-14 days of age were identified using the Paediatric Ward attenders log from the years 2012-2014. Data were collected on patients’ TFTs and their mothers’ Anti-Thyroid Peroxidase (Anti-TPO) antibody levels. Of the 121 patients included, none were found to have a significantly raised TSH requiring treatment. 40 infants had repeat TFTs performed. None of the 121 infants had a significantly raised TSH, which required treatment with thyroxine. Congenital hypothyroidism is already being screened for as part of the National Newborn Screening Programme. The findings of our study have led us to recommend stopping current practice of routinely checking TFTs on day 10-14 of life in infants of hypothyroid mothers.
  • Management of Epistaxis – A Single Centre Experience and Economic Considerations

    Keane, E; Subramaniam, T; Khan, AH; Patil, N (Irish Medical Journal, 2016-06)
    Epistaxis represents the most common ENT emergency and its management has been a focus of audit recently, with consideration given to the associated economic burden. The aim of our study is to evaluate the management of epistaxis in terms of treatments used, duration of stay, recurrence and cost. A retrospective review of hospital inpatient enquiry (HIPE) data from a single secondary referral centre was undertaken during a four year period. Four hundrefd and thirty-four patients were identified. The majority (n= 262, 60.3%) were male and the average age was 64.2 years. The vast majority (n=362, 83.4%) were managed non-operatively. Only 15 patients (3.4%) were managed surgically. The average length of stay was 2.5 days and did not vary greatly between the treatment groups. The recurrence rate was 8.2% (n=36). Approximate costs of packing vs EUA and cautery suggest that packing alone is more economical but more data is needed to fully compare the options.
  • The practice nurses guide to new stoma care products

    Moore, Susan (Nursing in General Practice, 2015-11)
    Stoma formation is a common surgical procedure in the management of a number of diseases. A stoma can be temporary or permanent, elective or emergency and formed at any age from birth onwards. There are three main types of stomas; colostomy, ileostomy and urostomy. It is important that nurses involved in the care of stoma patients are knowledgeable on the types of stomas and the care and management of a stoma. It is also necessary to be familiar with the products used to manage a stoma.
  • Primary care management of Acne vulgaris

    Daly,Selene (Nursing in General Practice, 2015-05)
    Acne is a common skin complaint presenting to primary care centres. Pommerville1 deemed acne to be the most common dermatological disease worldwide. Acne is thought to affect 90% of the world’s population at some point in their lives.2 Four major factors are involved in acne pathogenesis as follows:
  • The social networks of young people in Ireland with experience of long-term foster care: some lessons for policy and practice

    Mc Mahon, Conor; Curtin, Chris (Child & Family Social Work, 2013)
    This paper presents findings from the first study of the social networks of a group of young people in Ireland who have experienced longterm foster care. The study group was composed of two groups of young people, a group who were currently in care and a group who had left the care system. The central focus was to examine the impact of foster care on the social network experience of the young people. Findings indicated that foster care impacts on the young people’s social network experience in the following ways: losing contact with extended family; a greater challenge in making and sustaining friendships; an impact on education; and an inability to maintain contact with groups and activities that are of significance. This paper also presents recommendations in relation to policy and practice, including the raising of awareness of the importance of a social network approach in working with young people with care experience.
  • Stress among nurses working in an acute hospital in Ireland.

    Donnelly, Teresa; Sligo Regional Hospital, Ireland. (British Journal of Nursing, 2014)
    Stress among nurses leads to absenteeism, reduced efficiency, long-term health problems and a decrease in the quality of patient care delivered. A quantitative cross-sectional study was conducted. The study's aim was to identify perceived stressors and influencing factors among nurses working in the critical and non-critical care practice areas. A convenience sample of 200 nurses were invited to complete the Bianchi Stress Questionnaire. Information was collected on demographics and daily nursing practice. Findings indicated that perceived stressors were similar in both groups. The most severe stressors included redeployment to work in other areas and staffing levels. Results from this study suggest that age, job title, professional experience and formal post-registration qualifications had no influence on stress perception. These results will increase awareness of nurses' occupational stress in Ireland.
  • Two, four, six, eight... stop and count before it is too late! An audit on swab, needle and instrument counts in theatre.

    Donnelly, T. (2014-07)
    A concurrent audit was conducted over a four week period to determine if the counting of swabs, needles and instruments for surgery adhered to local policy and recommended guidelines. Data were collected on 30 abdominal surgical procedures. This audit highlighted failings in the count process. It identified poor communication within the multidisciplinary team. There needs to be an increased awareness about local policy, national and international guidelines regarding the counting of swabs, needles and instruments for all surgical procedures.
  • Adult-trained perioperative nurses' practice of family-centered care.

    Hamilton, Grainne; Corlett, Jo; Dowling, Maura; Senior Staff Nurse, Trauma and Orthopaedic Theatres, Sligo Regional Hospital, Ireland. (British Journal of Nursing, 2014)
    The aim of this study was to explore adult-trained perioperative nurses' practice of family-centered care (FCC).
  • Laboratory test costs: Attitudes and awareness among staff in a regional hospital

    Clancy, C; Murphy, M (Irish Medical Journal (IMJ), 2013-01)
    There continues to be an unrelenting rise in the volumes of laboratory tests ordered in medicine, which is both expensive and has the potential for over-investigation. We performed a quantitative, observational, cross-sectional study of staff with the authority to initiate a laboratory test, using a voluntary, anonymous questionnaire. Our aim was to assess the awareness of and attitudes towards laboratory test costs. 226 surveys were completed over 2 weeks in June, 2012. Most numerous respondents were Staff nurses 125 (55.3%) followed by senior house officers (SHOs) 26 (11.5%) and clinical nurse managers/ specialists (CNMs and CNSs) 23 (10.2%). The majority of staff, 191(85.6%), felt unaware of the cost of laboratory tests, which they ordered. For non urgent tests, the majority of respondents, 136 (61.8%) felt cost was either quite of very important. For urgent tests, the majority of respondents, 188(84.6%) felt cost was of minor or of no importance. Doctors felt more aware of costs than nurses (26.9% vs. 9.3%) and doctors test cost estimates were correct more often than nurses (33% vs. 21%). The results indicate poor awareness of laboratory test cost amongst doctors and nurses. Given the expenditure incurred by a rise in the volume of tests and the potential for over-investigation for patients, strategies for improving the awareness of and attitudes towards laboratory tests need to be developed.
  • Caries status in 16 year-olds with varying exposure to water fluoridation in Ireland.

    Mullen, J; McGaffin, J; Farvardin, N; Brightman, S; Haire, C; Freeman, R; Health Service Executive, Sligo, Republic of Ireland. (2012-12)
    Most of the Republic of Ireland's public water supplies have been fluoridated since the mid-1960s while Northern Ireland has never been fluoridated, apart from some small short-lived schemes in east Ulster.
  • Development of a residential care policies and procedures framework (ResPaP)

    Fagan, P; Sweeney, J; Sligo General Hospital (The International Society for Quality in Health Care, 2009)
    Development, and evaluation, of a framework of policies and procedures which can be utilised as a basis for the individual process mapping of key care activities in the nursing home sector.
  • Developing a quality management information system (QMIS) in an acute Irish hospital setting

    Reynolds, K; Lynch, S; Ward, D; Fagan, P; Sweeney, J; Sligo General Hospital (The International Society for Quality in Health Care, 2009)
    To develop, and evaluate, a Quality Management Information System to co-ordinate quality and patient safety activities in an acute care setting.
  • Topical lidocaine patch 5% for acute postoperative pain control.

    Gilhooly, D; McGarvey, B; O'Mahony, H; O'Connor, T C; Anaesthesia and Pain Management, Sligo General Hospital, Sligo, Ireland. (2011-02)
    A 39-year-old para 3 woman presented for elective caesarean section (lower segment caesarean section (LSCS)) for breech presentation. The patient had a strong history of atopy and anaphylaxis to paracetamol, codeine, penicillin and latex. The patient was asthmatic, triggered by aspirin. Epidural anaesthesia was unsuccessful and LSCS was carried out under spinal anaesthesia. Postoperatively the patient was unwilling to take analgesic medication due to fear of an allergic reaction. Three 5% lidocaine patches were applied to the wound for postoperative analgesia. This reduced the patient's visual analogue scale pain score from 10/10 to 5/10 at rest and 10/10 to 7/10 with movement. Transcutaneous electrical nerve stimulation was added and this improved associated back pain, reducing the pain further to 2/10. This is the first description of lignocaine patch 5% for postoperative LSCS pain. It is suggested that this method of delivery of local anaesthetic, which is easy to apply and has minimal side effects, should be considered not as a sole agent but as part of a multimodal technique to address postoperative LSCS pain.

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