Publications by staff affiliated to Mayo General Hospital

Recent Submissions

  • Opportunity Costs in Paediatric Training: The Specialist Registrars Experience.

    O’Neill, MB; Nabialek, T; Kandamany, N (Irish Medical Journal, 2017-08)
    In the training process, there is a tension between the work life and home life of trainees. This study explored both the personal impact and the opportunity costs of training from the Specialist Paediatric Registrar (SPR) perspective. The survey explored 1) career progression2) perceived functional effectiveness at work 3) psychological impact of hospital based training and 4) the personal and social cost of training. Fifty-three (71%) SPRs responded of whom 47 (89%)were married or in long term relationships. Seventy-five percent of trainees had a definite career plan with 86% intending to undertake fellowship training. Seventy percent believed they were efficient time managers but 53% had difficulty in making time for academic pursuits and fifty percent experienced negative feelings, which lingered after work and interfered with their relationships at home. Seventy-four percent stated training was undertaken at significant personal cost with only 21% achieving a very satisfactory work/life balance. To address these difficulties trainee wellbeing should be addressed at the Basic Specialist Training (BST) level and the career path clearly explained outlining the challenges that are likely to be encountered.
  • A Survey of Clinical Uncertainty from the Paediatric Basic Specialist Trainee Perspective

    O’Neill, MB; Sarani, ZA; Nicholson, AJ; Elbadry, M; Deasy, AM (Irish Medical Journal, 2017-06)
    This study was undertaken to evaluate uncertainty from the Basic Specialist Trainee perspective. The survey of trainees explored 1) factors in decision making, 2) the personal impact of uncertainty, 3) the responses to both clinical errors and challenges to their decision making and 4) the potential strategies to address uncertainty. Forty-one (93%) of trainees surveyed responded. Important factors in decision making were clinical knowledge and senior colleague’s opinion. Sixty percent experienced significant anxiety post call as a consequence of their uncertainty. When errors are made by colleagues, the trainee’s response is acceptance (52.5%), and sympathy (32%).Trainees are strongly influenced by the opinions of senior colleagues often changing their opinions having made confident decisions. Solutions to address uncertainty include enhanced knowledge translation, and to a lesser extent, enhanced personal awareness and resilience awareness. To enhance the training experience for BST and lessen the uncertainty experienced these strategies need to be enacted within the training milieu.
  • Parental Decisions regarding pre-hospital therapy and costing of the Emergency Department Visit

    McGovern, M; Kernan, R; O’Neill, M B (Irish Medical Journal, 2017-02)
    Paediatric patients represent a large percentage of Emergency Department (ED) visits and there is often a perception that the acuity of these presentations is low. The decision-making process that results in parents attending the ED is poorly understood. We designed a cross-sectional cohort study to explore the reasons for attendance, the treatment initiated at home and to assess parental perception of the economic cost of attendance. Data was collected on 200 patients using a survey administered to parents in ED with a follow-up phone call 4-6 weeks later. Our results suggest that attendances are often prompted by parental anxiety rather than clinical deterioration and that prior ED usage is common among those presenting for assessment. Many parents had attempted community therapy with 128/200 patients (64%) having been referred by a healthcare professional and medical therapy at home having been employed by 114/200 (57%) parents before attendance. Parental knowledge of the safety of over-the-counter medications was variable the economic cost of an ED visit was poorly understood by participants. The results of our study suggest that parental desire for control over worrisome symptoms drives much of their management strategy prior to hospital attendance. Strategies in the ED may need to focus more on managing parental expectations than on managing the illness itself and management strategies employed should focus not only on medical therapy of the child’s illness but on educating and empowering the parent.
  • Patient satisfaction and acceptability: a journey through an ambulatory gynaecology clinic in the West of Ireland

    Uzochukwu, I; Burke, C; Ni Bhuinneain, M (Irish Medical Journal, 2016-06)
    Ambulatory Gynaecology allows a “see-and-treat” approach to managing gynaecological conditions, providing a more streamlined, integrated care pathway than the traditional gynaecology clinic and inpatient care model. This study was designed to assess patient satisfaction and acceptability of Ambulatory Gynaecology services in Mayo University Hospital, Castlebar, Ireland. It also provided for feedback from patients as to how the service might be improved. Eighty questionnaires were appropriately completed. Outcomes revealed positive responses in 84% with respect to their experience before attending the clinic, 93% relating to the Ambulatory Gynaecology clinic environment, 96% for communication within the service, 91% for their experience during the procedure and 88% for aftercare information. This study concludes that an ambulatory approach to managing a range of gynaecology referrals is a highly acceptable approach in an Irish gynaecological population. Valuable feedback was gained from the study, which will allow us to further enhance the service for our patients.
  • Utilisation of clinical networks to facilitate elective surgical workload; a preliminary analysis

    Burke, T; Waters, P; Waldron, RM; Joyce, K; Khan, I; Khan, W; Kerin, M; Barry, K; Mayo General Hospital and Galway University Hospital (Irish Medical Journal, 2015-12)
    Clinical networks have potential to increase elective surgical workload for benign conditions in non-cancer centres. The aims of this study were to determine outcomes for elective laparoscopic cholecystectomy in our unit and to evaluate early experience in managing benign surgical workload referred from the tertiary centre within our clinical network. An analysis of cholecystectomies performed at Mayo General Hospital was conducted (2003-2013). A review of elective procedures more recently referred from Galway University Hospital (GUH) waiting lists was also conducted. 1937 consecutive cholecystectomies were performed with an overall laparoscopic conversion rate of 1.7% (33/1875). The total major complication rate was 0.93% (18/1937). 151 selected procedures originating from GUH have been performed since December 2013 without adverse events. Laparoscopic cholecystectomy can be performed in significant volume in the general hospital environment. This and other appropriate benign surgical procedures may be performed outside of tertiary units according to network agreements.
  • Recurrent adult jejuno-jejunal intussusception due to inflammatory fibroid polyp – Vanek’s tumour: a case report

    Joyce, Kenneth M; Waters, Peadar S; Waldron, Ronan M; Khan, Iqbal; Orosz, Zolt S; Németh, Tamas; Barry, Kevin (2014-06-27)
    Abstract Background Adult intussusception is a rare but challenging condition. Preoperative diagnosis is frequently missed or delayed because of nonspecific or sub-acute symptoms. Case presentation We present the case of a sixty-two year old gentleman who initially presented with pseudo-obstruction. Computerised tomography displayed a jejuno-jejunal intussusception, which was treated by primary laparoscopic reduction. The patient re-presented with acute small bowel obstruction two weeks later. He underwent a laparotomy showing recurrent intussusception and required a small bowel resection with primary anastomosis. Histological examination of the specimen revealed that the intussusception lead point was due to an inflammatory fibroid polyp (Vanek’s tumour) causing double invagination. Conclusions Adult intussusception presents with a variety of acute, intermittent, and chronic symptoms, thus making its preoperative diagnosis difficult. Although computed tomography is useful in confirming an anatomical abnormality, final diagnosis requires histopathological analysis. Vanek’s tumours arising within the small bowel rarely present with obstruction or intussusception. The optimal surgical management of adult small bowel intussusception varies between reduction and resection. Reduction can be attempted in small bowel intussusceptions provided that the segment involved is viable and malignancy is not suspected. Virtual Slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/7292185123639943
  • Staff attitudes to an ultrasound-guided peripheral nerve block room for orthopaedic patients

    Moore, DM; Duggan, M (Irish Medical Journal, 2014-09)
    Ultrasound-guided peripheral nerve blocks have well recognised benefits in orthopaedic patients. Some hospitals, to maximise these benefits, establish dedicated â block roomsâ to deliver this service. Orthopaedic surgery makes up a large proportion of our hospitals work load, and many of these patients would benefit from ultrasound-guided peripheral nerve blocks. We analysed the attitudes of key staff in our hospital towards the establishment of a block room. Sixty questionnaires were distributed and 47 (78%) were completed. Orthopaedic surgeons (n=6) were concerned ultrasound-guided peripheral nerve blocks would delay theatre lists (83%), and cause patients pain (67%) and increased anxiety (67%). Anaesthetists (n=10) and Nurses (n=30) were concerned there was insufficient experience in their departments to deliver this service (80% and 77%, respectively). However, 91% of all staff believed funding should be available for a block room. Our survey has identified areas of concern, and deficiencies that we must address before proceeding with the development of such a service.
  • The impact of changes in work practice and service delivery on surgical infection rates in a general surgical unit

    Piggott, R; Hogan, A; Concannon, E; Sharkey, M; Waldron, R; Khan, W; Barry, K (Irish Medical Journal (IMJ), 2013-10)
    Ring-fencing of elective orthopaedic beds has been shown to significantly reduce surgical site infection (SSI) rates. There are fewer studies in general surgical practice. Comparison of overall surgical workload in 2007 and 2011 was performed. Data pertaining to SSI were collected and analysis of this prospectively maintained database was performed on all SSI diagnosed in 2007 and 2011. There was a significant reduction in the crude SSI rate from 117 cases in 2007 (8%) to 42 cases in 2011 (3.5%). A statistically significant reduction in SSI rate for elective surgery was observed, 7.6% vs. 2.5% (p<0.001 Chi-square test). Apart from the introduction of ring fencing, all other contributory variables remained unchanged. Ring-fencing of inpatient general surgical beds has been associated with a significant reduction in SSI rates. These data provide timely supportive evidence that ring-fencing of inpatient beds is an appropriate patient-orientated strategy.
  • Higher specialist training in paediatrics 2005-2010.The graduates reflections

    O’Neill, MB; Freyne, B; Nicholson, AJ (Irish Medical Journal, 2013-09)
    This study of paediatric trainees, who were awarded their CSCST from 2005 to 2010, evaluated their training experience and assessed whether the curriculum goals were achieved. From an incomplete database 23 (57.7%) graduates based in Ireland and 3(19%) based abroad responded. Twenty one (81%) of respondents were currently working in Ireland as consultants, 20(80%) had a post membership qualification and 23 (92%) had travelled abroad for fellowships. Positive experiences included clinical training (44%), positive role models (44%), quality of the training days (52%).Negative experiences included lack of protected time for research (52%), excessive clinical service (28%), and poor monitoring of trainers (20%). Mean Likert scores for curriculum competencies were clinical care 4.9, clinical knowledge 5, application of evidence 3.7, academic supervisor skills3.3, knowledge of public health 3.2, health economics 2.2, and healthcare systems modification 2.3. The curriculum deficiencies can be addressed through the diploma in Leadership and Quality in Healthcare which has been developed by the Health Service Executive and the College of Physicians but an adequate database of graduates needs to be maintained.
  • Operative surgical yield from general surgical outpatient clinics; Time to change the way we practice?

    Irfan, M; McGovern, M; Robertson, I; Waldron, R; Khan, I; Khan, W; Barry, K (Irish Medical Journal (IMJ), 2013-07)
    The aim of this study was to compare the number of patients attending surgical outpatient clinics in a general hospital to the number of resulting elective procedures scheduled in a single year. Patients initially assessed at private consulting rooms are not included in this study. The number of surgical outpatient appointments issued in 2011 totalled 6503 with non-attendances running at 1489(22.9%).The number of elective surgical theatre cases performed in 2011(i.e. the surgical yield from that period) came to 1078 with an additional 1470 patients referred for endoscopy and 475 patients referred for minor operations. Operative surgical yield from the currently structured outpatient clinic model is low, with the number of theatre cases coming to only 16.58% of the original number of outpatient appointments issued. Recommendations for the improvement of outpatient services are made. These findings are relevant in the context of streamlining access to surgical services.
  • Fertility preservation in young females with non-gynaecologic malignancy: an emerging speciality.

    Smyth, C; Robertson, I; Higgins, L; Memeh, K; O'Leary, M; Keane, M; Khan, W; Barry, K; Department of Surgery, Mayo General Hospital, Castlebar, Co Mayo, Ireland. (Springer, 2013-06-06)
    BACKGROUND: As new treatment and research advances continue to improve the prognosis of cancer patients, oncologists and surgeons are increasingly faced with the issue of fertility protection and preservation. Cancer patients are frequently exposed to gonadotoxic chemotherapy and radiation therapy as a component of their treatment regimens. There are currently various anticipatory techniques available to women who wish to retain future reproductive ability, the most successful of which involves oocyte retrieval followed by in vitro fertilisation and embryo cryopreservation. Innovative methods include oocyte cryopreservation, ovarian follicle cryopreservation and oophoropexy. AIM: The aim of this study was to examine our combined experiences at Mayo General Hospital of treating female patients (<30 years) with non-gynaecologic malignancy and requiring referral to the HARI Unit during a 6-year period (2007-2012). Emphasis was placed on reviewing the fertility-preservation options available. METHODS: The hospital inpatient enquiry system was inspected for all cases of non-gynaecologic malignancy referred for fertility preservation from 2007 to 2012. RESULTS: Three cases of non-gynaecologic malignancy in young females, with an intention to protect and preserve future fertility were identified. The primary treatment plan did not initially incorporate input from a gynaecology or fertility specialist. It was after concerted inquiry and reflection by both physician and patient that oncofertility consultation was sought. CONCLUSION: The responsibility is on both physicians and surgeons to consider a more holistic approach to cancer care in young female patients, which focuses not only on the elimination of malignancy but also on preservation of fertility and quality of life.
  • Paediatric surgery - A general hospital experience

    Fahy, E; Ahmed, K; Lowery, AJ; Khan, W; Waldron, R; Barry, K (Irish Medical Journal, 2012-12)
  • Management of the Acute Appendix Mass: A Survey of Surgical Practice

    Irfan, M; Hogan, AM; Gately, R; Lowery, AJ; Waldron, R; Khan, W; Barry, K (Irish Medical Journal (IMJ), 2012-10)
  • Day of surgery admission for the elective surgical in-patient: successful implementation of the Elective Surgery Programme.

    Concannon, E S; Hogan, A M; Flood, L; Khan, W; Waldron, R; Barry, K; Department of Surgery, Mayo General Hospital, Castlebar, County Mayo, Ireland, lizconcannon@gmail.com. (Springer, 2012-09-11)
    BACKGROUND AND AIMS: The aim of this prospective cross-sectional study was to determine the impact of (1) ring fencing in-patient general surgical beds and (2) introducing a pre-operative assessment clinic (PAC) on the day of surgery admission (DOSA) rate in a single Irish institution. The secondary aim was to analyse the impact of an increased rate of DOSA on cost efficiency and patient satisfaction. METHODS: An 18-month period was examined following ring-fencing of elective and emergency surgical beds. A PAC was established during the study period. Prospectively collected data pertaining to all surgical admissions were retrieved using patient administration system software (Powerterm Pro, Eircom Software) and a database of performance information from Irish Public Health Services (HealthStat). RESULTS: Ring-fencing and PAC establishment was associated with a significant increase in the overall DOSA rate from 56 to 85 %, surpassing the national target rate of DOSA (75 %). Data relating specifically to general surgery admissions mirrored this increase in DOSA rate from a median of 5 patients per month, before the advent of ring-fencing and PAC, to 42 patients per month (p < 0.0387). 100 patient surveys demonstrated high levels of satisfaction with DOSA, with a preference compared to admission one night pre-operatively. Cost analysis demonstrated overall savings of 340,370 Euro from this change in practice. CONCLUSION: The present study supports the practice of DOSA through the introduction of ring-fenced surgical beds and PAC. This has been shown to improve hospital resource utilisation and streamline surgical service provision in these economically challenging times.
  • Successful Introduction of Ring-Fenced Inpatient Surgical Beds in a General Hospital Setting

    Coyle, D; Lowery, AJ; Khan, W; Waldron, R; Barry, K (Irish Medical Journal, 2012-09)
  • The non specialist paediatric training registrar in the healthcare system

    O’Neill, MB; A Kumar, A (Irish Medical Journal (IMJ), 2012-07)
  • Isolated pancreatic metastases from a bronchogenic small cell carcinoma.

    Walshe, T; Martin, S T; Khan, M F; Egan, A; Ryan, R S; Tobbia, I; Waldron, R; Department of Surgery, Mayo General Hospital, Castlebar, Co Mayo., walshetriona@hotmail.com (2012-01-31)
    We describe the case of a 60 year old female smoker who presented with a three month history of weight loss (14 Kg), generalized abdominal discomfort and malaise. Chest radiography demonstrated a mass projected inferior to the hilum of the right lung. Computed Tomography of thorax confirmed a lobulated lesion in the right infrahilar region and subsequent staging abdominal CT demonstrated a low density lesion in the neck of the pancreas. Percutaneous Ultrasound guided pancreatic biopsy was performed, histology of which demonstrated pancreatic tissue containing a highly necrotic small cell undifferentiated carcinoma consistent with metastatic small cell carcinoma of the bronchus.
  • The effectiveness of methicillin-resistant Staphylococcus aureus colonisation screening in asymptomatic healthcare workers in an Irish orthopaedic unit.

    Edmundson, S P; Hirpara, K M; Bennett, D; Department of Trauma and Orthopaedics, Mayo General Hospital, Castlebar, County, Mayo, Ireland. stevenedmundson@yahoo.co.uk (2012-01-31)
    Methicillin-resistant Staphylococcus aureus (MRSA) infections are associated with increased mortality, costs and length of stay compared to non-MRSA infections. This observational 4-year study analyses the impact of screening and treating orthopaedic healthcare workers for MRSA colonisation. A total of 1,011 swabs were taken from 566 healthcare workers. Positive healthcare workers were treated with topical mupirocin to both anterior nares. The prevalence of MRSA colonisation on initial testing was 4.77%. The rate of positive MRSA colonisation of those tested on more than one occasion fell from 5.88% to 2.71% (p = 0.055) on subsequent screening. All healthcare workers receiving treatment were successfully cleared of colonisation; however, some required more than one course of treatment. These results show that there could be a role for screening and treating orthopaedic staff for MRSA colonisation as part of a strategy to reduce the prevalence of MRSA infections in orthopaedic units.
  • Perioperative modifications of respiratory function.

    Duggan, Michelle; Kavanagh, Brian P; Department of Anesthesia, Mayo General Hospital, Castlebar, Co. Mayo, Ireland., Michelle.Duggan@hse.ie (2012-01-31)
    Postoperative pulmonary complications contribute considerably to morbidity and mortality, especially after major thoracic or abdominal surgery. Clinically relevant pulmonary complications include the exacerbation of underlying chronic lung disease, bronchospasm, atelectasis, pneumonia and respiratory failure with prolonged mechanical ventilation. Risk factors for postoperative pulmonary complications include patient-related risk factors (e.g., chronic obstructive pulmonary disease (COPD), tobacco smoking and increasing age) as well as procedure-related risk factors (e.g., site of surgery, duration of surgery and general vs. regional anaesthesia). Careful history taking and a thorough physical examination may be the most sensitive ways to identify at-risk patients. Pulmonary function tests are not suitable as a general screen to assess risk of postoperative pulmonary complications. Strategies to reduce the risk of postoperative pulmonary complications include smoking cessation, inspiratory muscle training, optimising nutritional status and intra-operative strategies. Postoperative care should include lung expansion manoeuvres and adequate pain control.
  • Mortality in perforated duodenal ulcer depends upon pre-operative risk: a retrospective 10-year study.

    Larkin, J O; Bourke, M G; Muhammed, A; Waldron, R; Barry, K; Eustace, P W; Department of Surgery, Mayo General Hospital, Castlebar, Co., Mayo, Ireland., larkin.dundalk@gmail.com (2012-01-31)
    INTRODUCTION: Most patients presenting with acutely perforated duodenal ulcer undergo operation, but conservative treatment may be indicated when an ulcer has spontaneously sealed with minimal/localised peritoneal irritation or when the patient's premorbid performance status is poor. We retrospectively reviewed our experience with operative and conservative management of perforated duodenal ulcers over a 10-year period and analysed outcome according to American Society of Anesthesiologists (ASA) score. METHODS: The records of all patients presenting with perforated duodenal ulcer to the Department of Surgery, Mayo General Hospital, between January 1998 and December 2007 were reviewed. Age, gender, co-morbidity, ASA-score, clinical presentation, mode of management, operative procedures, morbidity and mortality were considered. RESULTS: Of 76 patients included, 48 (44 operative, 4 conservative) were ASA I-III, with no mortality irrespective of treatment. Amongst 28 patients with ASA-score IV/V, mortality was 54.5% (6/11) following operative management and 52.9% (9/17) with conservative management. CONCLUSION: In patients with a perforated duodenal ulcer and ASA-score I-III, postoperative outcome is uniformly favourable. We recommend these patients have repair with peritoneal lavage performed, routinely followed postoperatively by empirical triple therapy. Given that mortality is equivalent between ASA IV/V patients whether managed operatively or conservatively, we suggest that both management options are equally justifiable.

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