Research by staff affiliated to St. Luke's Hospital Carlow/Kilkenny

Recent Submissions

  • Biosimilar infliximab introduction into the gastroenterology care pathway in a large acute Irish teaching hospital: a story behind the evidence

    Carroll, Donal; O'Brien, Gary; Mulcahy, Mark; Courtney, Garry; Byrne, Stephen; Walshe, Valerie; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, College Road, Ireland/St Luke’s General Hospital, Freshford Road, Kilkenny, Ireland/Department of Accounting, Finance and Information Systems, Cork University Business Schools, University College Cork, College Road, Ireland/Cost Accounting & Funding Team, National Finance Division, Health Service Executive, First Floor East, Model Business Park, Model Farm Road, Cork, Ireland (Pro Pharma Communications International, 2018-02-27)
    Background and aim: Biosimilar medicines are not considered exact replicas of originator biological medicines. As a result, prescribers can be hesitant to introduce such medicines into the clinical setting until evidence surfaces confirming their safety and effectiveness. In Ireland, a national biosimilar medicines policy is currently in development but the decision to prescribe biosimilar medicines remains at the discretion of the physician. The aim of this descriptive review is to tell the story of the evidence used by a large acute Irish teaching hospital to introduce biosimilar infliximab CT-P13 for the treatment of inflammatory bowel disease (IBD) in a safe and timely manner into routine care. Methods: To explore the evidence supporting the effective introduction of biosimilar infliximab in a large acute Irish teaching hospital, a literature review was conducted. Evidence consisted of published studies, reviews, reports, position statements, articles, clinical guidelines, and recommendations from national bodies, regulatory authorities and professional organizations. All evidence was published in English. Results and discussion: In September 2014, the accumulated evidence base provided physicians with reassurance to prescribe biosimilar infliximab CT-P13 for new patients suffering from IBD in this large acute Irish teaching hospital. In September 2016, as the evidence base grew, physicians began to safely and confidently switch patients from the originator infliximab product to the biosimilar product. Conclusion: There was a significant time lag between regulatory approval and clinical acceptance given that the European Medicines Agency had granted market authorization for biosimilar infliximab CT-P13 three years prior to the initiation of this hospital’s switching process. Although conservative in their execution, the authors conclude that with the existential concern and uncertainty still surrounding biosimilar medicines, a distinct and individualized approach for biosimilar medicine implementation is required. It is with hope that the Irish biosimilar medicines policy will improve upon biosimilar medicine clinical acceptance once published.
  • Misdiagnosis of myasthenia gravis presenting with tongue and palatal weakness.

    Marshal, Megan; Mustafa, Moneeb; Crowley, Paul; McGovern, Rory; Ahern, Emer; Ragab, Inas (Oxford Medical Case Reports, 2018-08-01)
    We discuss the case of an elderly male who presented with a history of dysphagia, dysphonia, palatal weakness and a sensation of tongue swelling, each symptom of varying time duration. Myasthenia gravis may have a variety of presentations that include ocular fatigability, respiratory muscle weakness and bulbar symptoms. The variety of these myasthenic syndromes can serve as a barrier to diagnosis and can often result in delayed or incorrect diagnosis. In this report, we present an atypical presentation of a relatively rare condition.
  • Rare Case of Non Tuberculous Mycobacterial: A Diagnostic dilemma

    Marathe, N; Canavan, B (Irish Medical Journal, 2017-02)
    Non-Tuberculous Mycobacterial (NTM) infections occur in HIV-negative patients with or without underlying lung disease. It is generally felt that these organisms are acquired from the environment. Unlike tuberculosis, there are no convincing data demonstrating human-to-human OR animal-to-human transmission of NTM. We report a case of NTM infection in a 38 year old patient with underlying emphysematous lung disease. The case highlights the diagnostic dilemma which occurs when persistent sputum Acid- Fast Bacilli (AFB) smears are positive, but Nucleic acid amplification test is negative. To aid the diagnosis and rule out Pulmonary Tuberculosis as the other differential diagnosis, we applied American Thoracic Society/Infectious Disease Society of America (ATS/IDSA) guidelines & recommendations1. The decision to treat was taken on basis of CT findings, clinical, microbiologic criteria and expert consultation with Microbiology department at Waterford.
  • The Prevalence of Grass Pollen-Related Allergic Rhinoconjunctivitis in Elite Amateur Irish Athletes

    Grace, M; Hunt, D; Hourihane, J O'B (Irish Medical Journal, 2016-09)
    Allergic rhinoconjunctivitis (AR/C), has been shown to impact upon athletic performance. The championships of the unique, amateur Irish sports of hurling and Gaelic football (collectively known as GAA) take place during the prime pollen months of summer. Elite GAA players must perform optimally when most exposed to pollen. Elite GAA subjects (n=254) underwent skin prick testing to 6 aeroallergens and completed a validated questionnaire (AQUA), producing a score indicating likelihood of having allergy. The prevalence of allergy (positive to at least one aeroallergen on SPT and positive AQUA score) was 27.1% (n=69). Sixteen and a half percent (n=42) of the subjects tested had grass pollen AR/C while 22% (n=54) had house dust mite AR/C, though none were on standard medical therapies or had used allergen-specific immunotherapy. Grass pollen AR/C prevalence appears as common in elite Irish athletes as it is in other countries. It appears to be mild rather than well controlled in these subjects.
  • Clinical medical students’ experiences of unprofessional behaviour and how these should inform approaches to teaching of professionalism

    Abu, Ozotu Rosemary; O Abu, Sanni; Flaherty, Gerard; 1. Department of Psychiatry, Saint Luke's Hospital, 2. Special Operations Unit, Kilkenny, 3. National University of Ireland, Galway, (Mededpublish, 2016-08)
    This mixed method research explores unprofessional behaviour experienced by clinical Medical students, during clinical training in Ireland; with a view to obtaining learning points that inform future design of modules on Professionalism. It also looks at the impact of these on students and the relationship between gender/ethnicity and students’ experiences of these behaviours.
  • Flexible fiberoptic bronchoscopy service; an aid to patient management

    Marathe, N; Canavan, B (Irish Medical Journal, 2016-02)
    The study illustrates advantages of Fiberoptic Bronchoscopy, a new service started at St. Luke’s General Hospital in patient care since April 2014. Retrospective review of Bronchoscopies and referrals to Tertiary care unit for Bronchoscopy, prior and after initiation of service at St. Luke’s Hospital were studied. In total, 106 procedures were performed out of which 103(98%) were for diagnostic purpose. Common indications for bronchoscopy were functional airway assessment in 38 cases (35%) of chronic cough, 26 cases (24.8%) of suspected malignancy. The average time taken for procedure was 15 + 1 minute with overall rate of complication recorded in 1 case (0.95%). 32(30%) inpatients were referred before bronchoscopy services were started locally. Fifteen (14%) patients were referred for Endobronchial Ultrasound (EBUS) after diagnostic procedure performed at St. Luke’s Hospital. To conclude, Bronchoscopy is a safe procedure used for diagnosis of various Lung conditions. The services offered locally reduced the time and cost involved in referrals. The diagnostic bronchoscopies performed for malignancy at St. Luke’s Hospital have rightly increased references for EBUS at Tertiary care Unit
  • Endoscopic disease severity is independently associated with higher levels of depression in IBD patients [poster]

    Calpin, Padraig; Kelly, Orlaith; Khan, Mohman; Moloney, Jenny; McDermott, Edel; Courtney, Garry (Royal College of Physicians in Ireland, 2013)
  • Agomelatine: Clinical experience and adherence to EMA

    Sinnott, C; Morris, M (Irish Medical Journal, 2013-02)
    In 2009, the European Medicines Agency (EMA) granted marketing authorisation for the novel antidepressant agomelatine, with the recommendation that liver function tests (LFTs) are checked before, and 6, 12 and 24 weeks after, commencing the drug. This paper describes early clinical experience with agomelatine and audits physician adherence to EMA recommendations. A retrospective review of patients attending general adult psychiatry services in Carlow /Kilkenny (catchment population 120,000) over one year was performed. 62 patients were prescribed agomelatine. 32 patients (52%) had unipolar depression, and 43 (73%) were already established on antidepressant medication. 60 patients (97%) had LFTs measured before starting treatment with agomelatine, but half of patients (47%) did not have further LFTs as recommended. To increase adherence to EMA recommendations and ensure optimal patient safety, existing barriers to effective monitoring must be addressed.
  • Is laparoscopic appendicectomy a safe procedure for trainees in the peripheral hospital setting?

    Emmanuel, A; Byrne, J; Wilson, I; Balfe, P; Department of Surgery, St Luke's Hospital, Freshford Road, Kilkenny. arhemmanuel@gmail.com (2011-10)
    Laparoscopic appendicectomy has become standard in the treatment of acute appendicitis in most hospitals in Ireland. Studies have shown that it is a safe procedure for trainees to perform. However, these studies were conducted in university teaching hospitals whereas a significant proportion of training in Ireland takes place in peripheral hospitals which provide a different training environment. The aim of this study was to determine whether laparoscopic appendicectomy is a safe procedure for surgical trainees to perform in a peripheral hospital setting. A retrospective analysis was performed of appendicectomies carried out at a peripheral hospital over a 12 month period. Comparisons were made between consultant surgeons and trainees for a variety of outcomes. Of 155 appendicectomies, 129 (83.2%) were performed laparoscopically, of which 10 (7.75%) were converted to open. Consultants performed 99 (77%) laparoscopic appendicectomies. There were no statistically significant differences between consultants and trainees in complication rates (19 (19.2%) vs. 4 (13.3%), p = 0.46), mean length of hospital stay (4.7 +/- 4.0 vs. 3.4 +/- 3.3 days, p = 0.13), or rate of conversion to open operation (9 (9.1%) vs. 1 (3.3%), p = 0.45). For cases of complicated appendicitis there were no significant differences between consultants and trainees in complication rates (12 vs. 2, p = 0.40) or length of hospital stay (6.4 +/- 3.9 vs. 4.7 +/- 5.6 days, p = 0.27). We conclude that laparoscopic appendicectomy is a safe procedure for trainees to perform in the peripheral hospital setting and should be incorporated into surgical training programs at an early stage of training.
  • The value of hyperbilirubinaemia in the diagnosis of acute appendicitis.

    Emmanuel, Andrew; Murchan, Peter; Wilson, Ian; Balfe, Paul; Department of Surgery, St. Luke's Hospital, Kilkenny, Ireland. arhemmanuel@gmail.com (2011-04)
    Hyperbilirubinaemia is a valuable marker for acute appendicitis. Patients with hyperbilirubinaemia are also more likely to have appendiceal perforation or gangrene. Bilirubin should be included in the assessment of patients with suspected appendicitis.
  • Biliary sphincter of Oddi dysfunction: response rates after ERCP and sphincterotomy in a 5-year ERCP series and proposal for new practical guidelines.

    Heetun, Zaid S; Zeb, Faisal; Cullen, Garrett; Courtney, Garry; Aftab, Abdur Rahman; Department of Gastroenterology, St Luke's Hospital, Kilkenny, Ireland. heetunz@gmail.com (2011-04)
    Our findings are similar to other studies documenting response rates to ES in manometry proven SOD. Our simpler guidelines are more applicable to clinical practice. Group 3 remains the most challenging group. Risk and benefits of ERCP and ES should be discussed with patients in centres where sphincter of Oddi manometry is unavailable, noting that 50% of patients respond favourably to ES.