• Tackling cholesterol through diet and lifestyle

      Heavey, Dr Patricia (Nursing in General Practice, 2013-01)
    • Tackling transitions in patient care: the process of medication reconciliation.

      Redmond, Patrick; Grimes, Tamasine; McDonnell, Ronan; Boland, Fiona; Hughes, Carmel; Fahey, Tom; HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland. (Family practice, 2013-10)
    • Tailoring a brief intervention for illicit drug use and alcohol use in Irish methadone maintained opiate dependent patients: a qualitative process

      Darker, Catherine; Sweeney, Brion; Keenan, Eamon; Whiston, Lucy; Anderson, Rolande; Barry, Joe (BMC Psychiatry, 2016-11-03)
      Abstract Background The World Health Organization (WHO) recommend the tailoring of a brief intervention (BI) programme of research to ensure that it is both culturally and contextually appropriate for the country and the environment in which it is being tested. The majority of BI research has been conducted with non-opioid dependent participants. The current study developed a tailored BI for illicit drug use and alcohol use to a methadone maintained opioid dependent polydrug using cohort of patients. Methods Focus groups with staff and one-to-one qualitative interviews with patients guided the tailoring of all intervention materials for use in a subsequent cluster randomised controlled trial (RCT). This was done to make them contextually appropriate to an opioid dependent cohort and culturally appropriate to Ireland. Thematic analyses were utilised. Results The BI was modified to ensure its compatibility with the culture of an Irish drug using population, with elements of motivational interviewing (MI) and personalised feedback incorporated. Example scripts of a screening and BI were included, as was an algorithm to facilitate clinicians during a session. Modifications to the ‘Substance Use Risk’ cards included weighting the severity of the problems, writing the language in the first person to personalise the feedback and including tick boxes so as to further highlight the relevant risk factors for individual patients. Photographs of key risk factors were included to display pictorially risks for illiterate or semi-literate patients. Examples of the interaction of particular substances with methadone were of particular importance to this group. Modifications of the ‘Pros and Cons of Substance Use/Reasons to Quit or Cut Down’ included additional categories such as addiction, crime and money that were salient to this cohort. The manual was used to standardise training across trial sites. Conclusion The research team was faithful to WHO recommendations to tailor BI programmes that are culturally and contextually appropriate to the treatment cohort and clinical environment. Outcome data from the cluster RCT have demonstrated that the tailored intervention was effective.
    • Take home naloxone for Ireland.

      Bury, G (Irish Medical Journal, 2015-03)
    • "Take ten minutes": a dedicated ten minute medication review reduces polypharmacy in the elderly.

      Walsh, E K; Cussen, K; General Practice Training Unit, Waterford Regional Hospital, Dunmore Rd, Waterford. elbreathnach@hotmail.com (2010-09)
      Multiple and inappropriate medications are often the cause for poor health status in the elderly. Medication reviews can improve prescribing. This study aimed to determine if a ten minute medication review by a general practitioner could reduce polypharmacy and inappropriate prescribing in elderly patients. A prospective, randomised study was conducted. Patients over the age of 65 (n = 50) underwent a 10-minute medication review. Inappropriate medications, dosage errors, and discrepancies between prescribed versus actual medication being consumed were recorded. A questionnaire to assess satisfaction was completed following review. The mean number of medications taken by patients was reduced (p < 0.001). A medication was stopped in 35 (70%) patients. Inappropriate medications were detected in 27 (54%) patients and reduced (p < 0.001). Dose errors were detected in 16 (32%). A high level of patient satisfaction was reported. A ten minute medication review reduces polypharmacy, improves prescribing and is associated with high levels of patient satisfaction.
    • Talon cusps: a review

      Keane, J; O' Sullivan, R; Field, D (1997)
    • Targeted therapies in colorectal cancer¿an integrative view by PPPM

      Hagan, Suzanne; Orr, Maria C M; Doyle, Brendan (2013-01-28)
      Abstract In developed countries, colorectal cancer (CRC) is the third most common malignancy, but it is the second most frequent cause of cancer-related death. Clinicians are still faced with numerous challenges in the treatment of this disease, and future approaches which target the molecular features of the disorder will be critical for success in this disease setting. Genetic analyses of many solid tumours have shown that up to 100 protein-encoding genes are mutated. Within CRC, numerous genetic alterations have been identified in a number of pathways. Therefore, understanding the molecular pathology of CRC may present information on potential routes for treatment and may also provide valuable prognostic information. This will be particularly pertinent for molecularly targeted treatments, such as anti-vascular endothelial growth factor therapies and anti-epidermal growth factor receptor (EGFR) monoclonal antibody therapy. KRAS and BRAF mutations have been shown to predict response to anti-EGFR therapy. As EGFR can also signal via the phosphatidylinositol 3-kinase (PI3K) kinase pathway, there is considerable interest in the potential roles of members of this pathway (such as PI3K and PTEN) in predicting treatment response. Therefore, a combined approach of new techniques that allow identification of these biomarkers alongside interdisciplinary approaches to the treatment of advanced CRC will aid in the treatment decision-making process and may also serve to guide future therapeutic approaches.
    • Targets and the emergency medical system – intended and unintended consequences

      Conway, Richard; O’Riordan, Deirdre; Silke, Bernard (European Journal of Emergency Medicine, 2014-06-17)
    • Task sharing in Zambia: HIV service scale-up compounds the human resource crisis

      Walsh, Aisling; Ndubani, Phillimon; Simbaya, Joseph; Dicker, Patrick; Brugha, Ruairi (2010-09-17)
      Abstract Background Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. Methods Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. Results Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. Conclusions This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant health worker numbers. The findings are based on an analysis of routine data that are available to district and national managers. Mixed methods research is needed, combining quantitative analyses of routine health information with follow-up qualitative interviews, to explore and explain workload changes, and to identify and measure where problems are most acute, so that decision makers can respond appropriately. This study provides quantitative evidence of a human resource crisis in health facilities in Zambia, which may be more acute in rural areas.
    • Team interventions in acute hospital contexts: a systematic search of the literature using realist synthesis.

      Cunningham, U; Ward, M E; De Brún, A; McAuliffe, E (BMC Health Services Research, 2018-07-11)
      The advantage of using realist synthesis to extrapolate data from the literature is that it considers the context and mechanisms that will impact effectiveness of healthcare team interventions. This methodological approach provides a different perspective to other types of syntheses and offers insight as to why certain contextual elements may yield more success than others. Findings therefore tend to have more practical implications. Specificity of detail in terms of how external drivers impact on healthcare team interventions was limited in the articles extracted for analysis. This broader perspective is therefore an important consideration for future research.
    • Technical report 2: An analysis of the utilisation and expenditure of medicines

      National Centre for Pharmacoeconomics; Health Service Executive (HSE) (2007-02)
    • Technology used at home for children with complex needs

      Nicholl, Honor; School of Nursing and Midwifery, Trinity College Dublin (University of Dublin, Trinity College., 2012-01)
    • Technology, Mental Health and Suicide Prevention in Ireland

      Chambers, D; Murphy, F (ReachOut.com, 2015)
    • Technology-supported dietary and lifestyle interventions in healthy pregnant women: a systematic review

      O'Brien, O A; McCarthy, M; Gibney, E R; McAuliffe, F M (European Journal of Clinical Nutrition, 2014-04)
    • A telephone survey of parental attitudes and behaviours regarding teenage drinking.

      Smyth, Bobby P; Darker, Catherine D; Donnelly-Swift, Erica; Barry, Joe M; Allwright, Shane Pa; Department of Public Health & Primary Care, Trinity College Dublin, Ireland. bobby.smyth@hse.ie (BMC public health, 2010-06)
      We found no evidence of widespread permissive attitudes and behaviours among Irish parents. Given that parental influences have been demonstrated to exert substantial impact on teenage drinking, it may be possible to harness the concerns of Irish parents more effectively to reverse the trends of escalating alcohol related harm in Ireland.
    • Telephone survey of private patients' views on continuity of care and registration with general practice in Ireland.

      Carmody, Patricia; Whitford, David L; Fairview Family Practice, Dublin 3, Ireland. patriciacarmody@ffp.ie <patriciacarmody@ffp.ie> (2007)
      BACKGROUND: The desire of patients for personal continuity of care with a General Practitioner (GP) has been well documented, but not within non-registered private patients in Ireland. This study set out to examine the attitudes and reported behaviours of private fee-paying patients towards continuity of GP care and universal registration for patients. METHODS: Cross-sectional telephone survey of 400 randomly chosen fee-paying patients living within County Dublin. There is no formal system of registration with a GP for these patients. Main outcomes were attendance of respondents at primary health care facilities and their attitudes towards continuity of care and registration with a GP. Data was analysed using descriptive statistics and using parametric and non-parametric tests of association. Pearson correlation was used to quantify the association between the described variables and attitudes towards continuity and registration with a GP. Variables showing significance at the 5% level were entered into multiple linear regression models. RESULTS: 97% of respondents had seen a GP in the previous 5 years. The mean number of visits to the GP for respondents was 2.3 per annum. 89% of respondents had a regular GP and the mean length of time with their GP was 15.6 years. 96% preferred their personal medical care to be provided within one general practice. 16% of respondents had consulted a GP outside of their own practice in the previous year. They were more likely to be female, commute a longer distance to work or have poorer health status. 81% considered it important to be officially registered with a GP practice of their choice. CONCLUSION: Both personal and longitudinal continuity of care with a GP are important to private patients. Respondents who chose to visit GPs other than their regular GP were not easily characterised in this study and individual circumstances may lead to this behaviour. There is strong support for a system of universal patient registration within general practice.
    • Temperature-dependent phenotypic variation of Campylobacter jejuni lipooligosaccharides

      Semchenko, Evgeny A; Day, Christopher J; Wilson, Jennifer C; Grice, Darren; Moran, Anthony P; Korolik, Victoria (2010-11-30)
      Abstract Background Campylobacter jejuni is a major bacterial cause of food-borne enteritis, and its lipooligosaccharide (LOS) plays an initiating role in the development of the autoimmune neuropathy, Guillain-Barré syndrome, by induction of anti-neural cross-reactive antibodies through ganglioside molecular mimicry. Results Herein we describe the existence and heterogeneity of multiple LOS forms in C. jejuni strains of human and chicken origin grown at 37°C and 42°C, respectively, as determined on sodium dodecyl sulphate-polyacrylamide electrophoresis gels with carbohydrate-specific silver staining and blotting with anti-ganglioside ligands, and confirmed by nuclear magnetic resonance (NMR) spectroscopy. The C. jejuni NCTC 11168 original isolate (11168-O) was compared to its genome-sequenced variant (11168-GS), and both were found to have a lower-Mr LOS form, which was different in size and structure to the previously characterized higher-Mr form bearing GM1 mimicry. The lower-Mr form production was found to be dependent on the growth temperature as the production of this form increased from ~5%, observed at 37°C to ~35% at 42°C. The structure of the lower-Mr form contained a β-D-Gal-(1→3)-β-D-GalNAc disaccharide moiety which is consistent with the termini of the GM1, asialo-GM1, GD1, GT1 and GQ1 gangliosides, however, it did not display GM1 mimicry as assessed in blotting studies but was shown in NMR to resemble asialo-GM1. The production of multiple LOS forms and lack of GM1 mimicry was not a result of phase variation in the genes tested of NCTC 11168 and was also observed in most of the human and chicken isolates of C. jejuni tested. Conclusion The presence of differing amounts of LOS forms at 37 and 42°C, and the variety of forms observed in different strains, indicate that LOS form variation may play a role in an adaptive mechanism or a stress response of the bacterium during the colonization of different hosts.
    • Temporal and spatial distribution of human cryptosporidiosis in the west of Ireland 2004-2007.

      Callaghan, Mary; Cormican, Martin; Prendergast, Martina; Pelly, Heidi; Cloughley, Richard; Hanahoe, Belinda; O'Donovan, Diarmuid; Environmental Change Institute, National University of Ireland, Galway, Ireland. mary.callaghan@nuigalway.ie (2009)
      BACKGROUND: Cryptosporidiosis is increasingly recognised as a cause of gastrointestinal infection in Ireland and has been implicated in several outbreaks. This study aimed to investigate the spatial and temporal distribution of human cryptosporidiosis in the west of Ireland in order to identify high risk seasons and areas and to compare Classically Calculated (CC) and Empirical Bayesian (EB) incidence rates. Two spatial scales of analysis were used with a view to identifying the best one in assessing geographical patterns of infection. Global Moran's I and Local Moran's I tests of autocorrelation were used to test for evidence of global and local spatial clustering. RESULTS: There were statistically significant seasonal patterns of cryptosporidiosis with peaks in spring and an increasing temporal trend. Significant (p < 0.05) global spatial clustering was observed in CC rates at the Electoral Division (ED) level but not in EB rates at the same level. Despite variations in disease, ED level was found to provide the most accurate account of distribution of cryptosporidiosis in the West of Ireland but required spatial EB smoothing of cases. There were a number of areas identified with significant local clustering of cryptosporidiosis rates. CONCLUSION: This study identified spatial and temporal patterns in cryptosporidiosis distribution. The study also showed benefit in performing spatial analyses at more than one spatial scale to assess geographical patterns in disease distribution and that smoothing of disease rates for mapping in small areas enhances visualisation of spatial patterns. These findings are relevant in guiding policy decisions on disease control strategies.
    • The temporal dynamics of differential gene expression in Aspergillus fumigatus interacting with human immature dendritic cells in vitro.

      Morton, Charles O; Varga, John J; Hornbach, Anke; Mezger, Markus; Sennefelder, Helga; Kneitz, Susanne; Kurzai, Oliver; Krappmann, Sven; Einsele, Hermann; Nierman, William C; Rogers, Thomas R; Loeffler, Juergen; Department of Clinical Microbiology, Trinity College Dublin, Dublin, Ireland. (2011-01)
      Dendritic cells (DC) are the most important antigen presenting cells and play a pivotal role in host immunity to infectious agents by acting as a bridge between the innate and adaptive immune systems. Monocyte-derived immature DCs (iDC) were infected with viable resting conidia of Aspergillus fumigatus (Af293) for 12 hours at an MOI of 5; cells were sampled every three hours. RNA was extracted from both organisms at each time point and hybridised to microarrays. iDC cell death increased at 6 h in the presence of A. fumigatus which coincided with fungal germ tube emergence; >80% of conidia were associated with iDC. Over the time course A. fumigatus differentially regulated 210 genes, FunCat analysis indicated significant up-regulation of genes involved in fermentation, drug transport, pathogenesis and response to oxidative stress. Genes related to cytotoxicity were differentially regulated but the gliotoxin biosynthesis genes were down regulated over the time course, while Aspf1 was up-regulated at 9 h and 12 h. There was an up-regulation of genes in the subtelomeric regions of the genome as the interaction progressed. The genes up-regulated by iDC in the presence of A. fumigatus indicated that they were producing a pro-inflammatory response which was consistent with previous transcriptome studies of iDC interacting with A. fumigatus germ tubes. This study shows that A. fumigatus adapts to phagocytosis by iDCs by utilising genes that allow it to survive the interaction rather than just up-regulation of specific virulence genes.