• Paediatric early warning scores on a children's ward: a quality improvement initiative.

      Ennis, Linda; University Hospital Waterford, Ireland. (Nursing children and young people, 2014-09-09)
      The aim of this quality improvement initiative was to incorporate a paediatric early warning score (PEWS) and track and trigger system in the routine care of children in an acute general children's ward at a regional hospital in the Republic of Ireland. In the absence of a nationally recommended specific PEWS strategy, a local plan was developed. The experience of structuring and implementing the PEWS and track and trigger system is presented in this article. Data from the first year of use were collected to evaluate the clinical utility and effectiveness of this system. In the busy acute children's service, the PEWS initiative was found to benefit processes of early detection, prompt referral and timely, appropriate management of children at potential risk of clinical deterioration. Nursing staff were empowered and supported to communicate concerns immediately and to seek rapid medical review, according to an agreed PEWS escalation plan. Outcomes were significantly improved.
    • Paediatric flexible bronchoscopy and its indications

      Carroll, C; Slattery, PM; Department of Respiratory Medicine, Children's University hospital, Temple St, Dublin 1 (Irish Medical Journal, 2010)
    • Paediatric palliative care: development and pilot study of a 'directory' of life-limiting conditions

      Hain, Richard; Devins, Mary; Hastings, Richard; Noyes, Jayne (2013-12-11)
      Abstract Background Children’s palliative care services are developing. Rational service development requires sound epidemiological data that are difficult to obtain owing to ambiguity in the definitions both of the population who needs palliative care and of palliative care itself. Existing definitions are of trajectory archetypes. The aim of this study was to develop and pilot a directory of the commonest specific diagnoses that map on to those archetypes. Methods The diagnoses of patients under the care of five children hospices and a tertiary specialist palliative medicine service in the UK were recorded. Duplicates and diagnoses that were not life-limiting conditions according to the ACT/RCPCH criteria or were not primary were removed. The resulting Directory of life-limiting conditions was piloted by analysing Death Certificate data of children in Wales between 2002 and 2007. Results 1590 diagnoses from children’s hospices and 105 from specialist palliative medicine were combined. After removals there were 376 diagnostic label. All ICD10 chapter headings were represented by at least one condition. The pilot study showed that 569 (54%) deaths in Wales were caused by LLC. Only four LLC resulted in ten or more deaths. Among deaths from LLC, the ten commonest diagnoses accounted for 32%, while the 136 diagnoses that caused one or two deaths accounted for 25%. The majority occurred from a small number of life-limiting conditions. Conclusion The Directory is a practical tool for identifying most life-limiting conditions using ICD10 codes that facilitates extraction and analysis of data from existing sources in respect of life-limiting conditions in children such as death certificate data, offering the potential for rapid and precise studies in paediatric palliative care.
    • Paediatrics and child health in general practice: the trainees’ perspective

      O’Conor, J; Shanahan, E; Cullen, W; O’Gorman, C (Irish Medical Journal, 2016-02)
    • Palivizumab use in preterm neonates.

      Kingston, S; Murphy, B P; Department of Neonatology, Cork University Maternity Hospital, Wilton, Cork. (2010-05)
      Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis in infants. Palivizumab is an immunoprophylactic agent for RSV prevention in preterm infants and those with neonatal chronic lung disease. This study examines its use across neonatal units in Ireland. A questionnaire was administered to one Consultant Neonatologist or Paediatrician in each of the 20 maternity centres in Ireland about their guidelines for Palivizumab administration. There is variation in administration of Palivizumab with little consistency found between protocols reported in terms of age and presence of chronic lung disease. Ten centres have in house protocols, 3 centres use the American Academy of Paediatrics (AAP) guidelines, 2 centres prefer the UK Joint Committee on Vaccination and Immunisation (JCVI) guidelines and 3 centres do not have a set protocol. Four participants felt its use has impacted on hospital admissions and 61% believe its use is cost effective. The budgetary implication for immunoprophylaxis with Palivizumab in Ireland is estimated at 1.5 to 2 million euros annually. Given current pharmacoeconomic constraints there is a need to implement a national protocol on RSV immunoprophylaxis.
    • Palliative care in People with Parkinson’s disease

      The Irish Palliative Care in Parkinson’s Disease Group. (The Irish Palliative Care in Parkinson’s Disease Group., 2016)
    • Pan-genome analysis of the emerging foodborne pathogen Cronobacter spp. suggests a species-level bidirectional divergence driven by niche adaptation

      Grim, Christopher J; Kotewicz, Michael L; Power, Karen A; Gopinath, Gopal; Franco, Augusto A; Jarvis, Karen G; Yan, Qiong Q; Jackson, Scott A; Sathyamoorthy, Venugopal; Hu, Lan; Pagotto, Franco; Iversen, Carol; Lehner, Angelika; Stephan, Roger; Fanning, Séamus; Tall, Ben D (2013-05-31)
      Abstract Background Members of the genus Cronobacter are causes of rare but severe illness in neonates and preterm infants following the ingestion of contaminated infant formula. Seven species have been described and two of the species genomes were subsequently published. In this study, we performed comparative genomics on eight strains of Cronobacter, including six that we sequenced (representing six of the seven species) and two previously published, closed genomes. Results We identified and characterized the features associated with the core and pan genome of the genus Cronobacter in an attempt to understand the evolution of these bacteria and the genetic content of each species. We identified 84 genomic regions that are present in two or more Cronobacter genomes, along with 45 unique genomic regions. Many potentially horizontally transferred genes, such as lysogenic prophages, were also identified. Most notable among these were several type six secretion system gene clusters, transposons that carried tellurium, copper and/or silver resistance genes, and a novel integrative conjugative element. Conclusions Cronobacter have diverged into two clusters, one consisting of C. dublinensis and C. muytjensii (Cdub-Cmuy) and the other comprised of C. sakazakii, C. malonaticus, C. universalis, and C. turicensis, (Csak-Cmal-Cuni-Ctur) from the most recent common ancestral species. While several genetic determinants for plant-association and human virulence could be found in the core genome of Cronobacter, the four Cdub-Cmuy clade genomes contained several accessory genomic regions important for survival in a plant-associated environmental niche, while the Csak-Cmal-Cuni-Ctur clade genomes harbored numerous virulence-related genetic traits.
    • Pancreaticoduodenectomy in children optimising outcome of uncommon paediatric procedures

      Yeap, B; Corbally, M; El Gohary, Y (Irish Medical Journal, 2011-01)
    • Paper 6: EUROCAT member registries: organization and activities

      Greenlees, Ruth; Neville, Amanda; Addor, Marie-Claude; Amar, Emmanuelle; Arriola, Larraitz; Bakker, Marian; Barisic, Ingeborg; Boyd, Patricia A.; Calzolari, Elisa; Doray, Berenice; Draper, Elizabeth; Emil Vollset, Stein; Garne, Ester; Gatt, Miriam; Haeusler, Martin; Kallen, Karin; Khoshnood, Babak; Latos-Bielenska, Anna; Martinez-Frias, Maria-Luisa; Materna-Kiryluk, Anna; Matias Dias, Carlos; McDonnell, Bob; Mullaney, Carmel; Nelen, Vera; O'Mahony, Mary; Pierini, Anna; Queisser-Luft, Annette; Randrianaivo-Ranjatoélina, Hanitra; Rankin, Judith; Rissmann, Anke; Ritvanen, Annukka; Salvador, Joaquin; Sipek, Antonin; Tucker, David; Verellen-Dumoulin, Christine; Wellesley, Diana; Wertelecki, Wladimir (2011)
    • Par6 is an essential mediator of apoptotic response to transforming growth factor beta in NMuMG immortalized mammary cells

      Avery-Cooper, Geordon; Doerr, Meghan; Gilbert, Richard WD; Youssef, Mahmoud; Richard, Amy; Huether, Patricia; Viloria-Petit, Alicia M (2014-03-01)
      Abstract Background We previously observed that the TGFbeta-Par6 pathway mediates loss of polarity and apoptosis in NMuMG cells. Here we investigate the contribution of Par6 versus TGFbeta receptor I activation to TGFbeta-induced apoptosis in association with changes in apico-basal polarity. We focus on the effect of Par6 activation on alpha6beta4 integrin expression and localization, and Nuclear Factor-kappaB (p65/RelA) activation, previously shown to mediate polarity-dependent cell survival. Methods Using immunoblotting and/or immunofluorescence we investigated the effect of TGFbeta1 on apoptosis, alpha6, beta4 and beta1 integrin expression/localization, and p65/RelA phosphorylation/localization in monolayer and three-dimensional (3D) cultures of NMuMG cells with an overactive or inactive Par6 pathway. Results were quantified by band densitometry or as percent of 3D structures displaying a phenotype. Differences among means were compared by two-way ANOVA. Results Blocking Par6 activation inhibits TGFbeta-induced apoptosis. Par6 overactivation enhances TGFbeta-induced apoptosis, notably after 6-day exposure to TGFbeta (p < 0.001), a time when parental NMuMG cells no longer respond to TGFbeta apoptotic stimuli. 48-hour TGFbeta treatment reduced beta4 integrin levels in NMuMG monolayers and significantly reduced the basal localization of alpha6 (p < 0.001) and beta4 (p < 0.001) integrin in NMuMG 3D structures, which was dependent on both Par6 and TGFbeta receptor I activation and paralleled apoptotic response. After 6-day exposure to TGFbeta, Par6-dependent changes to beta4 integrin were no longer apparent, but there was reduced phosphorylation of p65/RelA (p < 0.001) only in Par6 overexpressing cells. Differences in p65/RelA localization were not observed among the different cell lines after 48-hour TGFbeta exposure. Conclusions Par6 and TGFbeta receptor I activation are both necessary for TGFbeta-induced apoptosis in NMuMG cells. Importantly, Par6 overexpression enhances the sensitivity of NMuMG to TGFbeta-induced apoptosis, notably upon prolonged exposure to this growth factor, when NMuMG parental cells are usually apoptosis-resistant. Thus, endogenous Par6 level might be important in determining whether TGFbeta will function as either a pro-apoptotic or pro-survival factor in breast cancer, and potentially aid in predicting patient’s prognosis and therapy response.
    • A parental experience of eczema

      Brazel, Jeannette; Irish Skin Foundation (Nursing in General Practice, 2015-09)
    • Parental knowledge, attitudes and beliefs on fever: a cross-sectional study in Ireland.

      Kelly, Maria; Sahm, Laura J; Shiely, Frances; O'Sullivan, Ronan; de Bont, Eefje G; Mc Gillicuddy, Aoife; Herlihy, Roisin; Dahly, Darren; McCarthy, Suzanne (BMJ Open, 2017-07-09)
      Parental knowledge of fever and fever management was found to be deficient which concurs with existing literature. Parental experience and other sociodemographic factors were generally not helpful in identifying parents with high or low levels of knowledge. Resources to help parents when managing a febrile illness need to be introduced to help all parents provide effective care.
    • Parenting groups, how long is enough? The efficacy of a community-run Parents Plus Early Years Program as a preschool parenting intervention of modifiable duration

      Lonergan, Aoife; Gerbe, Sarah-Jane; Streek, Adrienne; Sharry, John (Global Journal of Community Psychology Practice, 2015-06)
    • Parents' perspectives of the transition to home when a child has complex technological health care needs.

      Brenner, Maria; Larkin, Philip J; Hilliard, Carol; Cawley, Des; Howlin, Frances; Connolly, Michael (International journal of integrated care, 2015-09)
      There is a need for clear and equitable assessments and shared policies and protocols for the discharge of children with complex care needs. Direction and support are required at the level of health service policy and planning to redress these problems. This study provides evidence that the transition of children with complex care needs from hospital to home is a challenging dynamic in need of further improvement and greater negotiation between the parent and health service provider. There are tangible issues that could be addressed including the introduction of a standardised approach to assessment of the needs of the child and family in preparation for discharge and for clear timelines and criteria for reassessment of needs once at home.
    • Parents' preference as to whether they would like to accompany their child when receiving dental treatment - results from a national survey.

      Crowley, E.; Whelton, H.; O'Mullane, D.; Cronin, M.; Kelleher, V.; Flannery, E.; Oral Health Services Research Centre, University Dental School and Hospital, Wilton, Cork (Irish Dental Association, 2005)
    • Parkinson’s disease – a brief practical approach

      Browne, Patrick; Daly, Lorna; Counihan, Timothy (Nursing in General Practice, 2014-09)
      Parkinson’s disease (PD) is the second most common neurodegenerative disease after Alzheimer’s disease, and affects about 1% of the population over 65 year of age. Although the incidence of PD rises with advancing age, juvenile onset PD (onset under 40 years of age) is well recognised and is associated with identifiable genetic mutations in a significant proportion of cases. The cause of PD remains unknown. One possibility is that affected individuals may have inherited a predisposition to developing PD and that some environmental exposure may trigger the start of neuronal degeneration. The recent identification of a number of genetic mutations in families with several affected members, has enhanced our understanding of the pathogenesis of neuronal degeneration in PD. These gene mutations result in a number of possible abnormalities including abnormal protein folding/aggregation, defective protein clearance, defective cell resistance to oxidative stress, mitochondrial dysfunction – such abnormalities may contribute to pathogenesis.
    • Participation in everyday activities and quality of life in pre-teenage children living with cerebral palsy in South West Ireland.

      Mc Manus, Vicki; Corcoran, Paul; Perry, Ivan J; School of Nursing and Midwifery, UCC, Cork, Republic of Ireland. v.mcmanus@ucc.ie (2008)
      BACKGROUND: Cerebral palsy (CP) is the most common cause of physical disability in children but its impact on quality of life is not well understood. This study examined participation in everyday activities among children without CP and children with mild, moderate and severe impairment due to CP. We then examined ten domains of quality of life in children with CP and investigated whether participation in everyday activities was associated with improved quality of life independent of gender, age and level of impairment. METHODS: This was a cross-sectional study of children aged 8-12 years based on two questionnaires, frequency of participation (FPQ) and KIDSCREEN, completed by parents of 98 children on the South of Ireland Cerebral Palsy Register (response rate = 82%) and parents of 448 children attending two Cork city schools (response rate = 69%) who completed one questionnaire (FPQ). Multiple linear regression was used: firstly to estimate the effect of severity of CP on participation in everyday activities independent of age and gender and secondly we estimated the effect of participation on quality of life independent of age gender and level of impairment. RESULTS: Participation in 11 of the 14 everyday activities examined varied across the children without CP and the children with varying severity of CP. In general, increased impairment decreased participation. Independent of age and gender, there was a highly significant decrease in overall participation with a fall of -6.0 (95% CI = -6.9 to -5.2) with each increasing level of impairment. The children with CP generally had high quality of life. Increased impairment was associated with diminished quality of life in just two domains - Physical well-being and Social support and peers. Overall participation in everyday activities was significantly associated with quality of life in 3 of the 10 domains (Physical well-being, Social support and peers & Moods and emotions) in analysis adjusted for gender age and level of impairment. CONCLUSION: While increased impairment due to CP restricts participation in the majority of everyday activities, the level of participation has a limited effect on the quality of life of the children with CP in age 8-12 years.
    • Particulate matter exposure during pregnancy is associated with birth weight, but not gestational age, 1962-1992: a cohort study

      Pearce, Mark S; Glinianaia, Svetlana V; Ghosh, Rakesh; Rankin, Judith; Rushton, Steven; Charlton, Martin; Parker, Louise; Pless-Mulloli, Tanja (2012-03-09)
      Abstract Background Exposure to air pollutants is suggested to adversely affect fetal growth, but the evidence remains inconsistent in relation to specific outcomes and exposure windows. Methods Using birth records from the two major maternity hospitals in Newcastle upon Tyne in northern England between 1961 and 1992, we constructed a database of all births to mothers resident within the city. Weekly black smoke exposure levels from routine data recorded at 20 air pollution monitoring stations were obtained and individual exposures were estimated via a two-stage modeling strategy, incorporating temporally and spatially varying covariates. Regression analyses, including 88,679 births, assessed potential associations between exposure to black smoke and birth weight, gestational age and birth weight standardized for gestational age and sex. Results Significant associations were seen between black smoke and both standardized and unstandardized birth weight, but not for gestational age when adjusted for potential confounders. Not all associations were linear. For an increase in whole pregnancy black smoke exposure, from the 1st (7.4 μg/m3) to the 25th (17.2 μg/m3), 50th (33.8 μg/m3), 75th (108.3 μg/m3), and 90th (180.8 μg/m3) percentiles, the adjusted estimated decreases in birth weight were 33 g (SE 1.05), 62 g (1.63), 98 g (2.26) and 109 g (2.44) respectively. A significant interaction was observed between socio-economic deprivation and black smoke on both standardized and unstandardized birth weight with increasing effects of black smoke in reducing birth weight seen with increasing socio-economic disadvantage. Conclusions The findings of this study progress the hypothesis that the association between black smoke and birth weight may be mediated through intrauterine growth restriction. The associations between black smoke and birth weight were of the same order of magnitude as those reported for passive smoking. These findings add to the growing evidence of the harmful effects of air pollution on birth outcomes.