Research by staff affiliated to Mercy University Hospital

Recent Submissions

  • An investigation of psychological responses to COVID-19 in Irish healthcare workers: longitudinal quantitative and nested qualitative study.

    Fortune, Donal G; Richards, Helen L; Wormald, Andrew; O Connor, Kieran; McKiernan, Margaret; Najt, Pablo; O Dwyer, Amanda; O Dea, Edmond; Burke, Paul; Eustace, Joseph (2021-02-03)
    COVID-19 is an unprecedent occurrence in modern times and individuals who work within healthcare settings, face a broad array of challenges in responding to this worldwide event. Key information on the psychosocial responses of such healthcare workers (HCWs) in the context of COVID-19 is limited and in particular there is a need for studies that utilise longitudinal methods, an overarching theoretical model, and use of a cohort of participants within a defined geographical area across acute and community settings. The work packages making up the current research project use quantitative and qualitative methods to examine the psychological sequelae for HCWs in the context of COVID-19 in geographically adjacent healthcare areas (South and Mid-West of Ireland) across four time points (induction, 3 months, 6 months, and 1 year follow-up). The quantitative arm of the project (WP 1) utilises the Common-Sense Model of Self-Regulation (CSM-SR) and examines a number of key psychological factors pertinent to this model including perceptions about COVID-19 and infection more generally, coping, formal and informal support and a number of impact variables including mood, sleep quality, and perceptions of stigma. The qualitative study (WP 2) will address HCWs experiences of working during the pandemic, ascertain any additional areas of psychological functioning, environmental and workplace factors and resources that may be utilised by HCWs and that are not assessed by the quantitative study protocol, focusing particularly on those staff groups typically underrepresented in previous studies.
  • A qualitative study of the views of healthcare professionals on providing vaccines information to patients.

    Loftus, Ruth; Sahm, Laura J; Fleming, Aoife (2021-06-21)
    Background Healthcare professionals (HCPs) such as pharmacists, general practitioners and practice nurses are a trusted source of vaccines information for patients in primary care. Global regulators have highlighted the key role of HCPs in fostering confidence in COVID-19 vaccines. Objective This study aims to gain insight into the views and experiences of HCPs on providing vaccines information to patients. Setting Primary care general practice surgeries and community pharmacies in Ireland. Methods Qualitative, semi-structured interviews were conducted with 14 HCPs (five General practitioners [GPs], four practice nurses and five community pharmacists) identified through purposive and convenience sampling. The interviews were analysed by inductive thematic analysis. Main outcome measure Participants' views and experiences of providing vaccines information to patients. Results Five key themes were identified: roles and responsibilities, perception of risk, perception of the public, building a relationship, and emotion. HCPs were motivated by duty and care for their patients. They respected patient autonomy and were driven by their concern for public health. HCPs were influenced by their perception of risk and their perceptions of the public. HCPs practiced patient-centred care by providing tailored vaccines information. They favoured an approach of providing patients with information and support to make their own decision. The topic was emotive; HCPs empathised with patients but were also frustrated by their perceived inability to change some patients' views. Conclusion The provision of vaccines information by HCPs to patients is multifactorial with participants mindful of patient autonomy and the HCP role to support vaccinations as a public health priority. Participants suggested that education and support on vaccines communication would enable them to support the vaccines uptake in their practice.
  • Successful maintenance of process and outcomes for oesophageal cancer surgery in Ireland during the first wave of the COVID-19 pandemic.

    Bolger, Jarlath C; Donlon, Noel E; Butt, Waqas; Neary, Colm; Al Azzawi, Mohammed; Brett, Orla; King, Sinead; Downey, Eithne; Arumugasamy, Mayilone; Murphy, Thomas; et al. (2021-03-16)
    Introduction: The emergence of the novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the coronavirus disease COVID-19 has impacted enormously on non-COVID-19-related hospital care. Curtailment of intensive care unit (ICU) access threatens complex surgery, particularly impacting on outcomes for time-sensitive cancer surgery. Oesophageal cancer surgery is a good example. This study explored the impact of the pandemic on process and short-term surgical outcomes, comparing the first wave of the pandemic from April to June in 2020 with the same period in 2019. Methods: Data from all four Irish oesophageal cancer centres were reviewed. All patients undergoing resection for oesophageal malignancy from 1 April to 30 June inclusive in 2020 and 2019 were included. Patient, disease, and peri-operative outcomes (including COVID-19 infection) were compared. Results: In 2020, 45 patients underwent oesophagectomy, and 53 in the equivalent period in 2019. There were no differences in patient demographics, co-morbidities, or use of neoadjuvant therapy. The median time to surgery from neoadjuvant therapy was 8 weeks in both 2020 and 2019. There were no significant differences in operative interventions between the two time periods. There was no difference in operative morbidity in 2020 and 2019 (28% vs 40%, p = 0.28). There was no in-hospital mortality in either period. No patient contracted COVID-19 in the perioperative period. Conclusions: Continuing surgical resection for oesophageal cancer was feasible and safe during the COVID-19 pandemic in Ireland. The national response to this threat was therefore successful by these criteria in the curative management of oesophageal cancer.
  • Utilisation of a suite of screening tools to determine adverse healthcare outcomes in an older frail population admitted to a community virtual ward

    Lewis, Clare; O'Caoimh, Rónán; Patton, Declan; O'Connor, Tom; Moore, Zena; Nugent, Linda E; Rónán O'Caoimh, Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, Cork, T12 WE28, Ireland. (MDPI, 2021-05-24)
    Risk stratification to assess healthcare outcomes among older people is challenging due to the interplay of multiple syndromes and conditions. Different short risk-screening tools can assist but the most useful instruments to predict responses and outcomes following interventions are unknown. We examined the relationship between a suite of screening tools and risk of adverse outcomes (pre-determined clinical 'decline' i.e., becoming 'unstable' or 'deteriorating' at 60-90 days, and institutionalisation, hospitalisation and death at 120 days), among community dwellers (n = 88) after admission to a single-centre, Irish, Community Virtual Ward (CVW). The mean age of patients was 82.8 (±6.4) years. Most were severely frail, with mean Clinical Frailty Scale (CFS) scores of 6.8 ± 1.33. Several instruments were useful in predicting 'decline' and other healthcare outcomes. After adjustment for age and gender, higher frailty levels, odds ratio (OR) 3.29, (p = 0.002), impaired cognition (Mini Mental State Examination; OR 4.23, p < 0.001), lower mobility (modified FIM) (OR 3.08, p < 0.001) and reduced functional level (Barthel Index; OR 6.39, p < 0.001) were significantly associated with clinical 'decline' at 90 days. Prolonged (>30 s) TUG times (OR 1.27, p = 0.023) and higher CFS scores (OR 2.29, p = 0.045) were associated with institutionalisation. Only TUG scores were associated with hospitalisation and only CFS, MMSE and Barthel scores at baseline were associated with mortality. Utilisation of a multidimensional suite of risk-screening tools across a range of domains measuring frailty, mobility and cognition can help predict clinical 'decline' for an already frail older population. Their association with other outcomes was less useful. A better understanding of the utility of these instruments in vulnerable populations will provide a framework to inform the impact of interventions and assist in decision-making and anticipatory care planning for older patients in CVW models.
  • Mapping the colorectal tumor microbiota

    Murphy, C L; Barrett, M; Pellanda, P; Killeen, S; McCourt, M; Andrews, E; O' Riordain, M; Shanahan, F; O'Toole, Pw; Shane Killeen, Department of Colorectal Surgery, Mercy University Hospital, Grenville Place, Cork T12 WE28, Ireland (Taylor & Francis, 2021-05-25)
    The gut microbiome in patients with colorectal cancer (CRC) is different than that of healthy controls. Previous studies have profiled the CRC tumor microbiome using a single biopsy. However, since the morphology and cellular subtype vary significantly within an individual tumor, the possibility of sampling error arises for the microbiome within an individual tumor. To test this hypothesis, seven biopsies were taken from representative areas on and off the tumor in five patients with CRC. The microbiome composition was strikingly similar across all samples from an individual. The variation in microbiome alpha-diversity was significantly greater between individuals' samples then within individuals. This is the first study, to our knowledge, that shows that the microbiome of an individual tumor is spatially homogeneous. Our finding strengthens the assumption that a single biopsy is representative of the entire tumor, and that microbiota changes are not limited to a specific area of the neoplasm. © 2021 The Author(s).
  • A systematic review of dedicated models of care for emergency urological patients.

    Kinnear, Ned; Herath, Matheesha; Barnett, Dylan; Hennessey, Derek; Dobbins, Christopher; Sammour, Tarik; Moore, James; Derek Hennessey, Department of Urology, Mercy University Hospital, Grenville Place, Cork T12 WE28, Ireland (Elsevier, 2020-06-26)
    Objective: To systematically evaluate the spectrum of models providing dedicated resources for emergency urological patients (EUPs). Methods: A search of Cochrane, Embase, Medline and grey literature from January 1, 2000 to March 26, 2019 was performed using methods pre-published on PROSPERO. Reporting followed Preferred Reporting Items for Systematic Review and meta-analysis guidelines. Eligible studies were articles or abstracts published in English describing dedicated models of care for EUPs, which reported at least one secondary outcome. Studies were excluded if they examined pathways dedicated only to single presentations, such as torsion, or outpatient solutions, such as rapid access clinics. The primary outcome was the spectrum of models. Secondary outcomes were time-to-theatre, length of stay, complications and cost. Results: Seven studies were identified, totalling 487 patients. Six studies were conference abstracts, while one study was of full-text length but published in grey literature. Four distinct models were described. These included consultant urologists allocated solely to the care of EUPs ("Acute Urological Unit") or dedicated registrars or operating theatres ("Hybrid structures"). In some services, EUPs bypassed emergency department assessment and were referred directly to urology ("Urological Assessment Unit") or were managed by other dedicated means. Allocating services to EUPs was associated with reduced time-to-theatre, length of stay and hospital cost, and improved supervision of junior medical staff. Conclusion: Multiple dedicated models of care exist for EUPs. Low-level evidence suggests these may improve outcomes for patients, staff and hospitals. Higher quality studies are required to explore patient outcomes and minimum requirements to establish these models.
  • Presence and germination of the probiotic DE111 in the human small intestinal tract: A randomized, crossover, double-blind, and placebo-controlled study

    Colom, Joan; Freitas, Daniela; Simon, Annie; Brodkorb, Andre; Buckley, Martin; Deaton, John; Winger, Alison M; Martin Buckley, Gastroenterology Department, Mercy University Hospital, Grenville Place, Cork, Ireland. (Frontiers, 2021-08-02)
    Spore-based probiotics offer important advantages over other probiotics as they can survive the harsh gastric conditions of the stomach and bile salts in the small intestine, ultimately germinating in the digestive tract. A novel clinical trial in 11 ileostomy participants was conducted to directly investigate the presence and germination of the probiotic strain Bacillus subtilis DE111® in the small intestine. Three hours following ingestion of DE111®, B. subtilis spores (6.4 × 104 ± 1.3 × 105 CFU/g effluent dry weight) and vegetative cells (4.7 × 104 ± 1.1 × 105 CFU/g effluent dry weight) began to appear in the ileum effluent. Six hours after ingestion, spore concentration increased to 9.7 × 107 ± 8.1 × 107 CFU/g and remained constant to the final time point of 8 h. Vegetative cells reached a concentration of 7.3 × 107 ± 1.4 × 108 CFU/g at 7 h following ingestion. These results reveal orally ingested B. subtilis DE111® spores are able to remain viable during transit through the stomach and germinate in the small intestine of humans within 3 h of ingestion.
  • The Persian version of the Quick Mild Cognitive Impairment Screen (Qmci-Pr): Psychometric properties among middle-aged and older Iranian adults

    Rezaei, Mohammad; Shariati, Behnam; Molloy, David William; O'Caoimh, Rónán; Rashedi, Vahid; Rónán O'Caoimh, Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, Cork, T12 WE28, Ireland. (MDPI, 2021-08-14)
    Brief cognitive screening instruments are used to identify patients presenting with cognitive symptoms that warrant further assessment. This study aimed to evaluate the reliability and validity of the Persian version of the Quick Mild Cognitive Impairment (Qmci-Pr) among middle-aged and older Iranian adults. Consecutive patients aged ≥55 years and caregivers attending with them as normal controls (NCs) were recruited from geriatric outpatient clinics and a hospital in Tehran, Iran. All patients completed the Qmci-Pr before completing an independent detailed neuropsychological assessment and staging using the Clinical Dementia Rating (CDR) Scale. NCs underwent the same assessment. In all, 92 participants with a median age of 70 years (±13) were available. Of these, 20 participants were NCs, 24 had subjective memory complaints (SMC), 24 had mild cognitive impairment (MCI), and 24 had Alzheimer's disease (AD). The Qmci-Pr had good accuracy in differentiating SMC and NC from MCI (area under the curve (AUC): 0.80 (0.69-0.91)) and in identifying cognitive impairment (MCI and mild AD) (AUC: 0.87 (0.80-0.95)) with a sensitivity of 88% and specificity of 80%, at an optimal cut-off of <53/100. The Qmci-Pr is an accurate short cognitive screening impairment for separating NC and patients with SMC from MCI and identifying cognitive impairment. Further research with larger samples and comparison with other widely used instruments such as the Montreal Cognitive Assessment is needed. Given its established brevity, the Qmci-Pr is a useful screen for Iranian adults across the spectrum of cognitive decline.
  • Reply to the letter to the editor in response to the position statement and best practice recommendations on the imaging use of ultrasound from the European Society of Radiology ultrasound subcommittee.

    Brady, Adrian P; Clevert, Dirk-André; Sidhu, Paul S; Adrian P. Brady, Radiology Department, Mercy University Hospital, Grenville Place, Cork T12 WE28, Ireland (Springer, 2021-05-21)
    [No abstract available]
  • Factors affecting physician implementation of hospital pharmacists' medication appropriateness recommendations in older adults.

    Dalton, Kieran; Fleming, Aoife; O'Mahony, Denis; Byrne, Stephen; Aoife Fleming, Pharmacy Department, Mercy University Hospital, Grenville Place, Cork T12 WE28, Ireland. (Wiley, 2021-07-16)
    Aims: Non-implementation of pharmacist recommendations by physician prescribers may prolong potentially inappropriate prescribing in hospitalised older adults, increasing the risk of adverse clinical outcomes. The aim of this study was to ascertain the key factors affecting physician prescriber implementation of pharmacists' medication appropriateness recommendations in hospitalised older adults. Methods: Semi-structured interviews were conducted with hospital pharmacists and physicians who provided care to older adults (≥65 years) in 2 acute university teaching hospitals in Ireland. Content analysis was employed to identify the key themes that influence physician prescriber implementation of pharmacist recommendations. Results: Fourteen interviews were conducted with 6 hospital pharmacists and 8 hospital physicians between August 2018 and August 2019. Five key factors were found to affect physician implementation of pharmacist recommendations: (i) the clinical relevance and complexity of the recommendation-recommendations of higher priority and those that do not require complex decision-making are implemented more readily; (ii) interprofessional communication —recommendations provided verbally, particularly those communicated face to face with confidence and assertion, are more likely to be implemented than written recommendations; (iii) physician role and identity —the grade, specialty, and personality of the physician significantly affect implementation; (iv) knowing each other and developing trusting relationships —personal acquaintance and the development of interprofessional trust and rapport greatly facilitate recommendation implementation; and (v) the hospital environment —organisational issues such as documentation in the patient notes, having the opportunity to intervene, and the clinical pharmacy model all affect implementation. Conclusion: This study provides a deeper understanding of the underlying behavioural determinants affecting physician prescriber implementation of pharmacist recommendations and will aid in the development of theoretically-informed interventions to improve medication appropriateness in hospitalised older adults. © 2021 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.
  • Screening for cognitive impairment after stroke: Validation of the Chinese version of the Quick Mild Cognitive Impairment screen

    Xu, Yangfan; Yi, Lingrong; Lin, Yangyang; Peng, Suiying; Wang, Weiming; Lin, Wujian; Chen, Peize; Zhang, Weichao; Deng, Yujie; Guo, Suimin; et al. (Frontiers, 2021-03-05)
    Background: Screening for post-stroke cognitive impairment (PSCI) is necessary because stroke increases the incidence of and accelerates premorbid cognitive decline. The Quick Mild Cognitive Impairment (Qmci) screen is a short, reliable and accurate cognitive screening instrument but is not yet validated in PSCI. We compared the diagnostic accuracy of a Chinese version of the Qmci screen (Qmci-CN) compared with the widely-used Chinese versions of the Montreal Cognitive Assessment (MoCA-CN) and Mini-Mental State Examination (MMSE-CN). Methods: We recruited 34 patients who had recovered from a stroke in rehabilitation unit clinics in 2 university hospitals in China: 11 with post-stroke dementia (PSD), 15 with post-stroke cognitive impairment no dementia (PSCIND), and 8 with normal cognition (NC). Classification was made based on clinician assessment supported by a neuropsychological battery, independent of the screening test scores. The Qmci-CN, MoCA-CN, and MMSE-CN screens were administered randomly by a trained rater, blind to the diagnosis. Results: The mean age of the sample was 63 ± 13 years and 61.8% were male. The Qmci-CN had statistically similar diagnostic accuracy in differentiating PSD from NC, an area under the curve (AUC) of 0.94 compared to 0.99 for the MoCA-CN (p = 0.237) and 0.99 for the MMSE-CN (p = 0.293). The Qmci-CN (AUC 0.91), MoCA-CN (AUC 0.94), and MMSE-CN (AUC 0.79) also had statistically similar accuracy in separating PSD from PSCIND. The MoCA-CN more accurately distinguished between PSCIND and normal cognition than the Qmci-CN (p = 0.015). Compared to the MoCA-CN, the administration times of the Qmci-CN (329s vs. 611s, respectively, p < 0.0001) and MMSE-CN (280 vs. 611s, respectively, p < 0.0001) were significantly shorter. Conclusion: The Qmci-CN is accurate in identifying PSD and separating PSD from PSCIND in patients post-stroke following rehabilitation and is comparable to the widely-used MoCA-CN, albeit with a significantly shorter administration time. The Qmci-CN had relatively poor accuracy in identifying PSCIND from NC and hence may lack accuracy for certain subgroups. However, given the small sample size, the study is under-powered to show superiority of one instrument over another. Further study is needed to confirm these findings in a larger sample size and in other settings (countries and languages).
  • A qualitative study of parental views of HPV vaccination in Ireland

    Creed, Stephanie; Walsh, Elaine; Foley, Tony; Stephanie Creed, Mercy University Hospital, Grenville Place, Cork T12 WE28, Ireland.
    An in-depth qualitative study, using semi-structured interviews was conducted among parents of 11-13-year-old girls (n = 18) who had not yet been offered the HPV vaccine. Convenience sampling was used. Interviews, conducted in the Republic of Ireland over six-months in 2018, were audio-recorded, transcribed, and analysed by thematic analysis.
  • A national survey of oncology survivors examining nutrition attitudes, problems and behaviours, and access to dietetic care throughout the cancer journey.

    Sullivan, Erin S; Rice, Niamh; Kingston, Elaine; Kelly, Aoife; Reynolds, John V; Feighan, Jennifer; Power, Derek G; Ryan, Aoife M; Derek J. Power, Department of Medical Oncology, Mercy University Hospital, Grenville Place, Cork, Ireland. (Elsevier, 2021)
    Background: Attitudes of cancer survivors to nutrition and nutrition care have rarely been captured. A better understanding of their needs based on a review of their experiences would give voice to this patient group (which has rarely been captured) and allow for better planning of nutritional care. Aims: To conduct a national survey to determine: (1) survivors' experience in relation to nutrition and diet-related problems, (2) perceived importance of the role of nutrition to cancer survivors, (3) the experience of accessing dietetic support, (4) the sources where survivors get nutrition information, and (5) their use of alternative dietary strategies. Methods: Survivors (any adult ever diagnosed with cancer) who had been diagnosed with or treated for cancer in Ireland within the past 5 years, were asked to complete a 25-item paper-based survey at one of 20 different hospital sites in Ireland. The survey was also hosted online on the websites of major cancer charities. Descriptive statistics were used to examine quantitative data. Results: In total, 1073 valid responses were received (63% female, mean age 57 years (range 18–88)). Breast cancer was the most common (n = 362), followed by colorectal (n = 121). One third of respondents had metastatic disease. Diet-related problems were reported by 45%. Weight loss was experienced by 44% and amongst those, 42% reported they were ‘unhappy or worried’ by this, while 27% reportedbeing ‘delighted/happy’ with their weight loss. Muscle loss was noted by 52%, with 20% reporting they had noticed ‘a lot’ of muscle loss. Nutrition was rated as ‘very/extremely’ important to cancer care by 89% of respondents, yet 58% reported being asked about dietary issues by their medical team only ‘sometimes’, ‘rarely’ or ‘never’. Only 39% had been assessed/treated by a registered dietitian (RD) and 74% rated their advice/care as ‘very/extremely’ helpful. Worryingly, 39% of survivors with involuntary weight loss, and 29% of survivors on a texture modified diet had not received nutritional care from an RD. Overall, 57% of those who did not see an RD said they wanted more dietetic support (access to a helpline/dietitian/additional reliable information). Of concern, 37% of survivors were following or had tried alternative, unproven dietary strategies (e.g. restrictive diets, herbal remedies, juicing or detoxes), and 32% reported avoiding specific foods, e.g. processed meat or dairy. A majority (56%) felt confused by the often conflicting nutrition information available in the media and offered by people around them. Conclusions: While nutrition is considered highly important by cancer survivors and a high proportion experience potentially serious diet-related problems including weight and muscle loss, fewer than half surveyed had access to a dietitian. Over a third had used at least one alternative dietary strategy, and over half felt confused about nutrition. Comprehensive nutritional screening and referral programmes to oncology dietitians need to be implemented in the ambulatory setting in order to identify and facilitate early management of the nutritional concerns of cancer survivors.
  • A metapopulation network model for the spreading of SARS-CoV-2: Case study for Ireland

    Humphries, Rory; Spillane, Mary; Mulchrone, Kieran; Wieczorek, Sebastian; O'Riordain, Micheal; Hövel, Philipp; Micheal Ó Riordáin, Department of Surgery, Mercy University Hospital, Grenville Place, Cork T12 WE28, Ireland (Elsevier, 2021-02-04)
    We present preliminary results on an all-Ireland network modelling approach to simulate the spreading the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2), commonly known as the coronavirus. In the model, nodes correspond to locations or communities that are connected by links indicating travel and commuting between different locations. While this proposed modelling framework can be applied on all levels of spatial granularity and different countries, we consider Ireland as a case study. The network comprises 3440 electoral divisions (EDs) of the Republic of Ireland and 890 superoutput areas (SOAs) for Northern Ireland, which corresponds to local administrative units below the NUTS 3 regions. The local dynamics within each node follows a phenomenological SIRX compartmental model including classes of Susceptibles, Infected, Recovered and Quarantined (X) inspired from Science 368, 742 (2020). For better comparison to empirical data, we extended that model by a class of Deaths. We consider various scenarios including the 5-phase roadmap for Ireland. In addition, as proof of concept, we investigate the effect of dynamic interventions that aim to keep the number of infected below a given threshold. This is achieved by dynamically adjusting containment measures on a national scale, which could also be implemented at a regional (county) or local (ED/SOA) level. We find that - in principle - dynamic interventions are capable to limit the impact of future waves of outbreaks, but on the downside, in the absence of a vaccine, such a strategy can last several years until herd immunity is reached.
  • Radiology in the era of value-based healthcare: A multi society expert statement from the ACR, CAR, ESR, IS3R, RANZCR, and RSNA

    Brady, Adrian P; Bello, Jaqueline A; Derchi, Lorenzo E; Fuchsjäger, Michael; Goergen, Stacy; Krestin, Gabriel P; Lee, Emil J Y; Levin, David C; Pressacco, Josephine; Rao, Vijay M; et al. (Elsevier, 2020-12-21)
    Background: The Value-Based Healthcare (VBH) concept is designed to improve individual healthcare outcomes without increasing expenditure, and is increasingly being used to determine resourcing of and reimbursement for medical services. Radiology is a major contributor to patient and societal healthcare at many levels. Despite this, some VBH models do not acknowledge radiology's central role; this may have future negative consequences for resource allocation. Methods, findings and interpretation: This multi-society paper, representing the views of Radiology Societies in Europe, the USA, Canada, Australia, and New Zealand, describes the place of radiology in VBH models and the health-care value contributions of radiology. Potential steps to objectify and quantify the value contributed by radiology to healthcare are outlined.
  • Penile cancer in Ireland - A national review

    Anderson, S; Breen, K J; Davis, N F; Deady, S; Sweeney, P; Paul Sweeney, Department of Urology, Mercy University Hospital, Grenville Place, Cork T12 WE28, Ireland (Elsevier, 2021-05-22)
    Objective: Penile cancer is a rare malignancy, with a reported incidence of 1.5/100,000 males in the Republic of Ireland in 2015. The aim of this study was to perform the first national review and to evaluate clinicopathological factors affecting survival. Subjects and methods: All cases of penile cancer in Ireland between 1995 and 2010 were identified through the National Cancer Registry Ireland (NCRI) and analysed to identify factors affecting survival. Results: 360 cases of penile cancer were identified, with a mean age at diagnosis of 65.5 years and 88% (n = 315) of cases occurred in those over 50. 91% (n = 328) of cases were squamous cell carcinomas (SCC). The majority of patients were treated surgically (n = 289), with 57% (n = 206) and 24% (n = 87) undergoing partial penectomy and total penectomy respectively. Only 18% (n = 65) received radiotherapy, and 8% (n = 27) received chemotherapy. Mean overall survival (OS) was 113 months, and five year disease specific survival (DSS) was 70% (95%CI: 59.1–77.8%). Age at diagnosis, nodal status and presence of metastatic disease were independent prognostic markers on multivariate analysis. Conclusion: This study represents the first national review of penile cancer in Ireland. The annual incidence and survival rates are comparable to European figures, though superior DSS has previously been reported from our institution, highlighting the role for centralisation of care in Ireland. Level of evidence: 2b. © 2021 The Authors
  • Effects of non-invasive respiratory support on gas exchange and outcomes in COVID-19 outside the ICU

    Gough, Ciara; Casey, Michelle; McCartan, Thomas A; Franciosi, Alessandro N; Nash, Derek; Doyle, Dominic; Hyland, Neil; Kavanagh, Grace; Toland, Sile; Powell, Caleb; et al. (Elsevier, 2021-05-25)
    Non-invasive respiratory support (NRS) outside of the ICU has played an important role in the management of COVID-19 pneumonia. There is little data to guide selection of NRS modality. We present outcomes of NRS outside the ICU and discuss the effects of NRS on gas exchange with implications for management.
  • The relationship between the BMI-adjusted weight loss grading system and quality of life in patients with incurable cancer.

    Daly, Louise; Dolan, Ross; Power, Derek; Ní Bhuachalla, Éadaoin; Sim, Wei; Fallon, Marie; Cushen, Samantha; Simmons, Claribel; McMillan, Donald C; Laird, Barry J; et al. (2019-11-06)
    Background: Weight loss (WL) has long been recognized as an important factor associated with reduced quality of life (QoL) and reduced survival in patients with cancer. The body mass index (BMI)-adjusted weight loss grading system (WLGS) has been shown to be associated with reduced survival. However, its impact on QoL has not been established. The aim of this study was to assess the relationship between this WLGS and QoL in patients with advanced cancer. Methods: A biobank analysis was undertaken of adult patients with advanced cancer. Data collected included patient demographics, Eastern Cooperative Oncology Group performance status, and anthropometric parameters (BMI and %WL). Patients were categorized according to the BMI-adjusted WLGS into one of five distinct WL grades (grades 0-4). QoL was collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. The Kruskal-Wallis test and multivariate logistic regression analyses were used to assess the relationship between the WLGS and QoL scores. Overall survival was assessed using Kaplan-Meier curve and Cox proportional hazard models. Results: A total of 1027 patients were assessed (51% male, median age: 66 years). Gastrointestinal cancer was most prevalent (40%), and 87% of patients had metastatic disease. Half (58%) of patients had a WL grade of 0-1, while 12%, 20%, and 10% had WL grades of 2, 3, and 4, respectively. Increasing WL grades were significantly associated with poorer QoL functioning and symptoms scales (all P < 0.05). Physical, role, and emotional functioning decreased by a median of >20 points between WL grade 0 and WL grade 4, while appetite loss, pain, dyspnoea, and fatigue increased by a median score >20 points, indicative of a large clinical significant difference. Increasing WL grades were associated with deteriorating QoL summary score. WL grades 2, 3, and 4 were independently associated with a QoL summary score below the median (<77.7) [odds ratio (OR) 1.69, P = 0.034; OR 2.06, P = 0.001; OR 4.29, P < 0.001, respectively]. WL grades 3 and 4 were independently associated with reduced overall survival [hazard ratio 1.54 (95% confidence interval: 1.22-1.93), P < 0.001 and hazard ratio 1.87 (95% confidence interval: 1.42-2.45), P < 0.001, respectively]. Conclusions: Our findings support that the WLGS is useful in identifying patients at risk of poor QoL that deteriorates with increasing WL grades. WL grade 4 is independently associated with a particularly worse prognosis and increased symptom burden. Identification and early referral to palliative care services may benefit these patients.
  • Artificial Intelligence in Radiology-Ethical Considerations.

    Brady, Adrian P; Neri, Emanuele (2020-04-17)
    Artificial intelligence (AI) is poised to change much about the way we practice radiology in the near future. The power of AI tools has the potential to offer substantial benefit to patients. Conversely, there are dangers inherent in the deployment of AI in radiology, if this is done without regard to possible ethical risks. Some ethical issues are obvious; others are less easily discerned, and less easily avoided. This paper explains some of the ethical difficulties of which we are presently aware, and some of the measures we may take to protect against misuse of AI.
  • Ageing well at home: advice to help you age well in your community

    Moloney, Elizabeth; Gillman, Ciara; O’Brien, Gillian; Mercy University Hospital, Grenville Place, Cork (Mercy University Hospital, Cork Kerry Community Healthcare, 2021-06)
    The aim of this booklet is to help you age well and avoid becoming frail through general health and wellbeing advice. COVID-19 has made it more difficult to engage in normal social and physical group activities. We have had to adapt our lifestyles and regular social connections. This booklet reflects the hope we all feel as normal routines return. Included is information about a range of activities, services and agencies available in your community to help you age well. As healthcare workers, we want to support you to live well at home. By remaining active and engaged in your local community, you can delay the onset of frailty. This booklet encourages you to look after your health and wellbeing and to feel positive about the future. Now is the time to invest in your physical and mental health so you can reap the benefits in years to come.

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