Research by staff affiliated to Mercy University Hospital

Recent Submissions

  • Audit of compliance with HSE standards and recommended practices for healthcare records management for discharge summaries in St. Michael's Unit, Mercy University Hospital, Cork

    Vrabec, Michal; Geary, Eoin; O'Brien, Sinead; North Lee Mental Health Services, HSE Southern Area (Centre for Recovery and Social Inclusion (CRSI), 2019-06-07)
  • Counselling in Primary Care – A General Practitioner’s Perspective

    Rafferty, M.; Bradley, C.; 1. Mercy University Hospital 2. Department of General Practice, University College Cork (Irish Medical Journal, 2019-02)
    Counselling in Primary care (CIPC) is a new service introduced by the HSE in 2013, providing short-term counselling for medical-card holders, suffering from mild to moderate mental health problems.
  • A budget impact analysis of a clinical medication review of patients in an Irish university teaching hospital

    Kearney, Alan; Walsh, Elaine. K; Kirby, Ann; Halleran, Ciaran; Byrne, Derina; Haugh, Jennifer; Sahm, Laura. J (Global & Regional Health Technology, 2018-09)
    To measure the net benefit of a pharmacist-led medication review in acute public hospitals. To identify and measure the resources used when completing a pharmacist-led medication review, an observational study was conducted in an acute urban university teaching hospital. Health Information and Quality Authority guidelines were used to value resources used in a pharmacist-led medication review. Model inputs included demographic data, probability of adverse drug events associated with the pharmacist interventions, estimates of future discharges and cost data. The cost of a pharmacist-led medication review and savings generated from avoidance of adverse drug events were estimated and projected over a 5-year period, using hospital discharge rates taken from the hospital inpatient enquiry system and the census of population. Using the per-patient cost of a medication review, the annual cost of delivering a bi-weekly medication review is projected to vary between €6 m and €6.4 m over a 5-year period from 2017 to 2021. The per-patient net benefit of a bi-weekly medication review is €45.88. Therefore, the projected annual net benefit of a bi-weekly medication review is between €29.5 m and €31.2 m over the 5-year period of 2017 to 2021. Introducing a pharmacist-led medication review for each inpatient saves in the short and longer term. The results are consistent with previous findings. Substantial savings were estimated, regardless of variation in model parameters tested in sensitivity analysis.
  • Giant Cell Arteritis Presenting as an Ischaemic Upper Limb

    Fitzgerald, Gerald; O’Connor, Mortimer B.; Phelan, Mark J.; Mercy University Hospital, Cork (Irish Medical Journal, 2018-07)
    Aim: To present an interesting case of giant cell arteritis presenting as ischaemic upper limb. Methods Data was collected from the patient’s chart and from radiology and laboratory systems in our institution. Results: The patient had a temporal artery biopsy confirming the diagnosis of temporal arteritis. This was successfully treated with high dose steroids leading to resolution of symptoms in the arm. Conclusion: Arteritis is an important consideration to consider in patients who present with limb ischaemia as it is a reversible cause which can be treated effectively.
  • An audit of empiric antibiotic choice in the inpatient management of community-acquired pneumonia

    Delaney, F; Jackson, A (Irish Medical Journal, 2017-04)
    Adherence to antimicrobial guidelines for empiric antibiotic prescribing in community-acquired pneumonia (CAP) has been reported to be worryingly low. We conducted a review of empiric antibiotic prescribing for sixty consecutive adult patients admitted to the Mercy University Hospital with a diagnosis of CAP. When analysed against local antimicrobial guidelines, guideline concordant empiric antibiotics were given in only 48% of cases, lower than the average rate in comparable studies. Concordance was 100% in cases where the CURB-65 pneumonia severity assessment score, on which the guidelines are based, was documented in the medical notes. The use of excessively broad spectrum and inappropriate antibiotics is a notable problem. This study supports the theory that lack of knowledge regarding pneumonia severity assessment tools and unfamiliarity with therapeutic guidelines are key barriers to guideline adherence, which remains a significant problem despite increased focus on antimicrobial stewardship programs in Ireland
  • Management of patients with subclinical hypothyroidism in primary

    McCarthy, E; Russell, A; Kearney, PM (Irish Medical Journal, 2016-01)
    Subclinical hypothyroidism (SCH) is defined as a raised serum thyroid stimulating hormone level with normal thyroxine. Despite a prevalence of up to 9% of the adult population there is widespread uncertainty on how to manage it. The aim of this study was to assess how older adults with SCH are managed in primary care. A retrospective case-note review was carried out on patients attending Mallow Primary Healthcare Centre. This study identified patients 65 years and over meeting the criteria for SCH in one year. The prevalence of SCH in this study was calculated as 2.9%. 22.2% of patients were treated with thyroxine. 6.1% of untreated patients progressed to clinical hypothyroidism within the study period while 18.2% spontaneously reverted to normal TSH levels.
  • Chronic kidney disease and obesity in Ireland: comparison of self-reported coronary artery disease in population study with clinic attendees.

    Lannin, U; Vaughan, C; Perry, I J; Browne, G (Irish Medical Journal, 2015-02)
    Obesity is a growing issue in Ireland. The link between obesity, CKD and CAD has not previously been described in the Irish population. The prevalence of obesity and CKD was compared across 3 groups: population based estimates with self-reported CAD, population based estimates without self-reported CAD (SLAN-07) and a random selection of cardiology outpatients with CAD. The SLAN-07 is a representative survey of 1207 randomly selected participants ≥ 45 years. Validated methods measured parameters including waist circumference, blood pressure and markers of renal function specifically glomerular filtration rate (eGFR) and albumin: creatinine ratio. The Cardiology clinic surveyed a random selection of 126 participants ≥ 45 years with CAD. Similar parameters were measured using the validated methods utilised in SLAN-07 study. Prevalence of obesity and renal disease was significantly higher in both CAD groups. At population level, risk factors were modelled using logistic regression to compare odds of participants with self-reported CAD with those without. Age, hypertension, obesity, elevated waist circumference, renal disease and diabetes are significantly associated with existing CAD. Obesity and CKD are more frequent in patients with CAD. Routine evaluation is essential to facilitate more intensive management of these risk factors.
  • The Intensity of QuantiFERON TB-Gold Response does not Differentiate Active from Latent Tuberculosis

    F Khan, F; Cotter, O; Kennedy, B; Clair, J; O’Connor, B; Collins, J; Curran, D; O’Connor, T (Irish Medical Journal (IMJ), 2013-12)
    We analyzed positive QuantiFERON (QFT) assays, performed between July 2009 and April 2011 in the Mercy University Hospital, Cork, Ireland, which included, 94 patients with latent tuberculosis (LTBI) and 35 patients with active tuberculosis. There was no difference in the intensity of response between patients with LTBI and active tuberculosis (p=0.1589). In patients with LTBI, there were no correlations between age (p=0.353), sex (p=0.476), smoking (p=0.323), contact (p=0.612), Mantoux response (p=0.055), Irish nationality (p=0.768), previous BCG vaccination (p=0.504), WCC (p=0.187), lymphocyte count (p=0.786), neutrophil count (p=0.157) and the intensity of QFT response. Similarly in patients with active TB, there were no correlations between these variables and QFT response. The intensity of QFT response does not help to differentiate active from LTBI. The intensity of QFT response is not influenced by age, sex, smoking, remoteness of contact history, Mantoux response, nationality, CXR abnormalities, BCG vaccination and peripheral lymphocyte count.
  • COPD exacerbations: a comparison of Irish data with European data from the ERS COPD audit

    Crinion, S; Cotter, O; Kennedy, B; O’Connor, B; Curran, DR; McCormack, S; McDonnell, T J; O’Connor, TM (Irish Medical Journal (IMJ), 2013-10)
    The European Respiratory Society COPD audit was a cross-sectional, multicentre study that analysed outcomes for COPD patients admitted to hospital with an exacerbation across Europe. We present the data on patients admitted to 11 Irish hospitals that participated in the audit. Among 237 patients (123 Male), the median age was 71 years and 79 (33%) patients were current smokers. 82 (35%) patients received high-flow oxygen before admission and 43 (18%) were cared for in a dedicated respiratory ward. 54 (23%) patients required ventilatory support. Median length of stay was 7 days, 98 (41%) patients were readmitted and 211 (89%) patients were alive at the 90 day follow up point. Irish patients were more likely to receive high-flow oxygen before admission, less likely to be managed in a dedicated respiratory ward and had a higher likelihood of readmission or death within 90 days than the European average.
  • Pancreatico pleural fistula an unusual complication of chronic pancreatitis

    Ferris, H; Buckley, M (Irish Medical Journal (IMJ), 2012-07)
  • Effective immunotherapy of weakly immunogenic solid tumours using a combined immunogene therapy and regulatory T-cell inactivation.

    Whelan, M C; Casey, G; MacConmara, M; Lederer, J A; Soden, D; Collins, J K; Tangney, M; O'Sullivan, G C; Cork Cancer Research Centre, Mercy University Hospital and Leslie C Quick Jnr, Laboratory, University College Cork, Cork, Ireland. (2012-01-31)
    Obstacles to effective immunotherapeutic anti-cancer approaches include poor immunogenicity of the tumour cells and the presence of tolerogenic mechanisms in the tumour microenvironment. We report an effective immune-based treatment of weakly immunogenic, growing solid tumours using a locally delivered immunogene therapy to promote development of immune effector responses in the tumour microenvironment and a systemic based T regulatory cell (Treg) inactivation strategy to potentiate these responses by elimination of tolerogenic or immune suppressor influences. As the JBS fibrosarcoma is weakly immunogenic and accumulates Treg in its microenvironment with progressive growth, we used this tumour model to test our combined immunotherapies. Plasmids encoding GM-CSF and B7-1 were electrically delivered into 100 mm(3) tumours; Treg inactivation was accomplished by systemic administration of anti-CD25 antibody (Ab). Using this approach, we found that complete elimination of tumours was achieved at a level of 60% by immunogene therapy, 25% for Treg inactivation and 90% for combined therapies. Moreover, we found that these responses were immune transferable, systemic, tumour specific and durable. Combined gene-based immune effector therapy and Treg inactivation represents an effective treatment for weakly antigenic solid growing tumours and that could be considered for clinical development.
  • A rare cause of fatal intracranial haemorrhage.

    Neligan, A; Mullins, G M; O'Sullivan, S S; Fitzgerald, P; Harrington, H; Department of Neurology, Mercy University Hospital, Grenville Place, Cork,, Ireland. a.neligan@ion.ucl.ac.uk (2012-01-31)
    INTRODUCTION: We report the case of a 53-year-old farmer with a 5-day history of severe headache, photophobia and neck stiffness. Full blood count (platelets 173), coagulation screen were normal throughout. Liver function tests remained normal apart from an elevated gamma-GT (156). CT Brain was normal. CSF analysis showed a WCC of 454/mm(3) (60% lymphocytes), elevated CSF protein (1.42 g/l) and a normal CSF glucose. He was commenced on IV antibiotics and IV acyclivor and improved. On day 3 of admission, he complained of a sudden severe headache, became unresponsive (GCS 3/15). INVESTIGATIONS: CT Brain showed a massive left intraventricular haemorrhage. He died 4 days later. Subsequent serum serology for leptospirosis was positive. A repeat sample taken 4 days post-admission, showed a rising IgM indicating active leptospirosis. Detailed pathological examination confirmed intracerebral haemorrhage with normal cerebral vasculature. CONCLUSION: Leptospirosis is a rare cause of intracerebral haemorrhage even in the absence of coagulopathy.
  • Urine cytology in the evaluation of urological malignancy revisited: is it still necessary?

    Falebita, Opeyemi Adegboyega; Lee, Garry; Sweeney, Paul; Department of Urology, Mercy University Hospital, Glenville Place, Cork, Ireland., opefaleb@yahoo.com (2012-01-31)
    OBJECTIVE: We aim to determine if urine cytology was still necessary as a routine part of the evaluation for the presence of urological malignancy and to evaluate its cost effectiveness. METHODS: Urine cytology reports over a 6-year period (2000-2005) were retrieved from our institution's pathology department database. Patients with urine cytology positive for malignant cells were identified. We retrospectively reviewed the charts of these patients for age, sex, flexible cystoscopy and radiological imaging results. The cost of urine cytology was retrieved from the pathology department. RESULTS: There were a total of 2,568 urine cytological examinations. Of these, 25 were positive for malignant cells. There were 19 male (76%) and 6 female (24%) patients with a mean age of 72 years (range: 49-97). In 21 patients with positive cytology, a bladder tumor was identified at flexible cystoscopy and/or imaging studies. For a positive cytology yield of 1%, EUR 210,000 was spent. CONCLUSIONS: Routine urine cytology was not cost effective and did not add to the diagnostic yield beyond cystoscopy and diagnostic imaging. It may be omitted in the initial evaluation of urological malignancy.
  • Tumour targeting with systemically administered bacteria.

    Morrissey, David; O'Sullivan, Gerald C; Tangney, Mark; Cork Cancer Research Centre, Mercy University Hospital, University College Cork, , Ireland. (2012-01-31)
    Challenges for oncology practitioners and researchers include specific treatment and detection of tumours. The ideal anti-cancer therapy would selectively eradicate tumour cells, whilst minimising side effects to normal tissue. Bacteria have emerged as biological gene vectors with natural tumour specificity, capable of homing to tumours and replicating locally to high levels when systemically administered. This property enables targeting of both the primary tumour and secondary metastases. In the case of invasive pathogenic species, this targeting strategy can be used to deliver genes intracellularly for tumour cell expression, while non-invasive species transformed with plasmids suitable for bacterial expression of heterologous genes can secrete therapeutic proteins locally within the tumour environment (cell therapy approach). Many bacterial genera have been demonstrated to localise to and replicate to high levels within tumour tissue when intravenously (IV) administered in rodent models and reporter gene tagging of bacteria has permitted real-time visualisation of this phenomenon. Live imaging of tumour colonising bacteria also presents diagnostic potential for this approach. The nature of tumour selective bacterial colonisation appears to be tumour origin- and bacterial species- independent. While originally a correlation was drawn between anaerobic bacterial colonisation and the hypoxic nature of solid tumours, it is recently becoming apparent that other elements of the unique microenvironment within solid tumours, including aberrant neovasculature and local immune suppression, may be responsible. Here, we consider the pre-clinical data supporting the use of bacteria as a tumour-targeting tool, recent advances in the area, and future work required to develop it into a beneficial clinical tool.
  • An unusual pelvic mass: bladder lymphoma.

    Alsinnawi, M; Quinlan, M; Brady, A; Khan, N; Department of Urology, Mercy University Hospital, Cork, Ireland. (2012-01-31)
  • Predictors of early arrival at the emergency department in acute ischaemic stroke.

    Curran, C; Henry, C; O'Connor, K A; Cotter, P E; Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland. (2012-01-31)
    BACKGROUND: A requirement of an effective acute stroke service is the early arrival of patients to the hospital emergency department (ED). This will allow the possible use of thrombolytic therapy or other acute interventions within a limited time window. AIMS: We investigated the predictors of early arrival in a single hospital serving a mixed urban and rural catchment area. METHODS: A retrospective review of all case notes for 1 year was performed. RESULTS: Of 105 acute strokes, 91 were cerebral infarcts and a total of 71 cases presenting initially to the ED had timing available for analysis. 39.4% presented within 3 h, and 12.7% were potentially suitable for thrombolysis. Those living closer to the hospital were not more likely to arrive within 3 h (Z = -0.411, p = 0.68). Presenting directly to the hospital by emergency services (or private transport) was significantly associated with early arrival in a univariate comparison (p < 0.001), and in a multivariate model. CONCLUSION: The only independent predictor of early arrival to the ED is direct presentation. Improved public education of the importance of recognition of stroke symptoms and rapid contact with the emergency services will improve the early attendance following acute stroke, allowing increased use of acute stroke treatments.
  • Fulminant limb and retroperitoneal necrotizing fasciitis in a 15-year-old girl with Fanconi anaemia.

    O'Regan, Kevin; O'Mahony, Edward; MacEneaney, Peter; Fitzgerald, Edward; Maher, Michael M; Department of Radiology, Mercy University Hospital, Cork, Republic of Ireland., kevin.oregan@ucc.ie (2012-01-31)
    Necrotizing fasciitis (NF) is an uncommon soft-tissue infection in children that carries a high mortality rate. We present a 15-year-old girl with chronic pancytopenia secondary to Fanconi anaemia who developed extensive NF of the lower limb, which unfortunately resulted in a fatal outcome. Immunodeficiency is a known risk factor for the development of this condition. The findings in this case demonstrate that patients with Fanconi anaemia may be susceptible to NF and that the clinical course may be more aggressive due to underlying immunosuppression. Prompt diagnosis of NF is vital in order to initiate appropriate treatment and to optimize patient outcome. Radiological investigation demonstrated extensive soft-tissue gas and destruction affecting the entire lower limb, abdominal wall and retroperitoneum, which led to timely definitive diagnosis and management.
  • Increased thyroidal T4 to T3 conversion in autonomously functioning thyroid adenoma: from euthyroidism to thyrotoxicosis.

    Solter, M; Posavec, L; Solter, D; Vargek-Solter, V; Department of Endocrinology, Sisters of Mercy University Hospital Center,, University of Zagreb, School of Medicine, Vinogradska , Croatia., miljenkosolter@yahoo.com (2012-01-31)
    AIM: The aim was to investigate whether the intrathyroid conversion of T4 to T3 in autonomously functioning thyroid adenoma (AFTA) tissue could influence serum T3 levels and suppression of TSH, especially in patients with borderline thyroid function. PATIENTS AND METHODS: In ten patients with AFTA, thyroidal conversion of T4 to T3 was investigated in nodular and paranodular, TSH-suppressed tissue. All patients had normal serum T4 and suppressed TSH. Serum T3 was normal in six, and borderline or slightly increased in four. AFTA and paranodular tissues were surgically removed and frozen at -70 degrees C, then homogenized in a glass homogenizer, centrifuged at 100,000xg, and particulate fraction collected as a pellet. Analysis mixture consisted of thyroid enzyme suspension in 50 mumol/L TRIS buffer with 5 mumol DTT and 200 muL 1.3 mumol T4. Incubation was performed at 37 degrees C and the generation of T3 measured after 5, 10, 20 and 40 minutes respectively. RESULTS: T3 production (pmol/mg protein) was significantly higher in AFTA than in paranodular tissues (8.8 1.2/Mean +/- SE/vs. 1.8 +/- 0.2; p<0.01), and excessively high (9.8, 14.1, 14.2 and 15.0) in four patients with borderline or slightly supranormal serum T3. A significant correlation was found between serum T3 concentrations and T3 generation (T4 conversion) in AFTA tissues. CONCLUSION: Results suggest that increased thyroidal T4 to T3 conversion in AFTA tissue could be involved in an increased delivery of T3, increased serum T3 and suppressed serum TSH, particularly in patients with the disease evolving from euthyroid to an early hyperthyroid phase.
  • Incidence and predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular block and dual chamber pacemaker implantation.

    Radeljic, Vjekoslav; Pavlovic, Nikola; Manola, Sime; Delic-Brkljacic, Diana; Pintaric, Hrvoje; Petrac, Dubravko; Department of Cardiology, Sisters of Mercy University Hospital Center,, Vinogradska cesta 29, 10000 Zagreb, Croatia. (2012-01-31)
    AIM: To evaluate predictors of asymptomatic atrial fibrillation in patients older than 70 years with complete atrioventricular (AV) block, normal left ventricular systolic function, and implanted dual chamber (DDD) pacemaker. METHODS: Hundred and eighty six patients with complete AV block were admitted over one year to the Sisters of Mercy University Hospital. The study recruited patients older than 70 years, with no history of atrial fibrillation, heart failure, or reduced left ventricular systolic function. All the patients were implanted with the same pacemaker. Out of 103 patients who were eligible for the study, 81 (78%) were evaluated. Among those 81 (78%) were evaluated. Eighty one (78%) patients were evaluated. Follow-up time ranged from 12 to 33 months (average +/-standard deviation 23 +/- 5 months). Primary end-point was asymptomatic atrial fibrillation occurrence recorded by the pacemaker. Atrial fibrillation occurrence was defined as atrial high rate episodes (AHRE) lasting >5 minutes. Binary logistic regression was used to identify the predictors of development of asymptomatic atrial fibrillation. Results. The 81 patients were stratified into two groups depending on the presence of AHRE lasting >5 minutes (group 1 had AHRE>5 minutes and group 2 AHRE<5 minutes). AHRE lasting >5 minutes were detected in 49 (60%) patients after 3 months and in 53 (65%) patients after 18 moths. After 3 months, only hypertension (odds ratio [OR], 17.63; P = 0.020) was identified as a predictor of asymptomatic atrial fibrillation. After 18 months, hypertension (OR, 14.0; P = 0.036), P wave duration >100 ms in 12 lead ECG (OR, 16.5; P = 0.001), and intracardial atrial electrogram signal amplitude >4 mV (OR, 4.27; P = 0.045) were identified as predictors of atrial fibrillation. CONCLUSION: In our study population, hypertension was the most robust and constant predictor of asymptomatic atrial fibrillation after 3 months, while P wave duration >100 ms in 12-lead ECG and intracardial atrial signal amplitude were predictors after 18 months.
  • Novel agents in the management of lung cancer.

    Kennedy, B; Gargoum, F; Bystricky, B; Curran, D R; O'Connor, T M; Department of Respiratory Medicine, Mercy University Hospital, Cork, Ireland. (2012-01-31)
    Lung cancer is the leading cause of cancer death worldwide. Survival remains poor as approximately 80% of cases present with advanced stage disease. However, new treatments are emerging which offer hope to patients with advanced disease. Insights into cell biology have identified numerous intracellular and extracellular peptides that are pivotal in cancer cell signalling. Disrupting the function of these peptides inhibits intracellular signal transduction and diminishes uncontrolled proliferation, resistance to apoptosis and tumour angiogenesis. The most widely studied signalling pathway is the Epidermal Growth Factor (EGF) pathway. EGF signalling can be disrupted at numerous points. Blockade of the cell surface receptor is achieved by the monoclonal antibody cetuximab; intracellular tyrosine kinase activity is inhibited by erlotinib. Vascular Endothelial Growth Factor (VEGF) regulates another pathway important for tumour growth. Inhibition of VEGF impairs angiogenesis and disrupts metastatic spread. Bevacizumab is a monoclonal antibody that binds to VEGF and blocks interaction with its cell surface receptor. Clinical trials have demonstrated that disruption of these signalling pathways can improve survival in advanced lung cancer. New compounds including folate antimetabolites such as pemetrexed, proteasome inhibitors such as bortezomib, modified glutathione analogues such as TLK286, and other agents such as epothilones and other small molecules are currently being evaluated in patients with lung cancer. As more and more signalling peptides are targeted for manipulation, it is hoped that a new era is dawning in the treatment of advanced stage lung cancer. This review will focus on emerging new therapies in the management of lung cancer.

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