• 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.
    • A passion for learning.

      O'Grady, Paul; Cork Dental School. (2011-07-06)
    • The path of least resistance in oral surgery

      Fee, Laura (Irish Dental Assocation (IDA), 2016-04)
    • Patient engagement in the governance and development of national clinical effectiveness processes (i.e. clinical audit & guidelines): A systematic literature review and desk-top analysis

      Lambert, Veronica; Matthews, Anne; El-Moslemany, Riyad; O'Connor, Olivia (School of Nursing and Human Sciences, Dublin City University, Dublin 9, 2016-03)
    • Patient safety instead of adversarial medicolegal claims

      Murphy, J F A (Irish Medical Journal, 2013-09)
    • Patient satisfaction with private physiotherapy for musculoskeletal pain.

      Casserley-Feeney, Sarah N; Phelan, Martin; Duffy, Fionnuala; Roush, Susan; Cairns, Melinda C; Hurley, Deirdre A; School of Physiotherapy & Performance Science, University College Dublin, Ireland. sarah.casserley@ucd.ie (2008)
      BACKGROUND: Despite emphasis on patient centred healthcare, healthcare professionals have been slow to use validated measurements of patient satisfaction in physiotherapy practice. The aim of this cross sectional survey was to measure patient satisfaction with private physiotherapy in Ireland, for patients with musculoskeletal pain, using a previously validated survey instrument. METHODS: A multidimensional patient satisfaction questionnaire 'PTOPS', which assesses patient satisfaction with outpatient physiotherapy treatment, was translated from American English to European English, and relevant demographic and global satisfaction items were included. This was then circulated to patients with musculoskeletal pain (n = 240) for anonymous completion and return to the research team. Data were analysed using the Statistical Package for the Social Sciences (SPSS, v.12). RESULTS: In total 55% (n = 131/240) of questionnaires were returned. Just over half of the respondents were male (53.4%, n = 70), with a mean age (SD) of 37.7 years (12.4), and had previous experience of physiotherapy (65.6%, n = 86). The most common site of musculoskeletal pain was spinal (51.5% n = 66). The mean (SD) number of treatments was 8.3 (8.3), at a mean total cost (SD) of 350.2 euros (322.8 euros). The 'PTOPS' questionnaire categorised and scored satisfaction items under four domains, Enhancer, Detractor, Location and Cost. The mean score (SD), optimum score, and scoring range for each domain were: 'Enhancer' 41.2 (3.8), 50, 10-50; 'Detractor' 19.4 (4.4), 10, 10-50; 'Location' 28.0 (4.1), 35, 7-35; 'Cost' 18.9 (2.8), 7, 7-35. "Overall satisfaction with physiotherapy experience" was scored on a five-point scale "excellent to poor", with a modal response of "Very Good" (42%; n = 55). CONCLUSION: This study measured patient satisfaction with private physiotherapy treatment for musculoskeletal pain in Ireland using a previously validated outcome measure and provides a template for future studies of this increasingly important topic. Results demonstrated high levels of satisfaction with all components of physiotherapy treatment, except cost, and provided valuable patient feedback regarding their physiotherapy treatment for musculoskeletal pain. Results can be used by physiotherapists to improve future patient experiences with a view to improving patient attendance and compliance with physiotherapy treatment protocols for patients with musculoskeletal pain.
    • Patients with colorectal lung oligometastases (L-OMD) treated by dose adapted SABR at diagnosis of oligometastatic disease have better outcomes than patients previously treated for their metastatic disease.

      Mihai, Alina; Mu, Yijia; Armstrong, John; Dunne, Mary; Beriwal, Sushil; Rock, Luke; Thirion, Pierre; Heron, Dwight E; Bird, Brian Healy; Westrup, Jennifer; et al. (Journal of radiosurgery and SBRT, 2017)
      To evaluate the clinical outcomes of patients with OMD from a CRC primary, who underwent SABR either as first treatment at diagnosis of metachronous oligometastatic disease to lung or at progression in lung after prior treatments for metastatic disease.
    • Patterns of psychotropic prescribing and polypharmacy in older hospitalized patients in Ireland: the influence of dementia on prescribing.

      Walsh, Kieran Anthony; O'Regan, Niamh A; Byrne, Stephen; Browne, John; Meagher, David J; Timmons, Suzanne; University College Cork, University of Limerick (Cambridge University Press, 2016-08-16)
      Neuropsychiatric Symptoms (NPS) are ubiquitous in dementia and are often treated pharmacologically. The objectives of this study were to describe the use of psychotropic, anti-cholinergic, and deliriogenic medications and to identify the prevalence of polypharmacy and psychotropic polypharmacy, among older hospitalized patients in Ireland, with and without dementia.
    • Peanut Allergen Threshold Study (PATS): validation of eliciting doses using a novel single-dose challenge protocol

      Zurzolo, Giovanni A; Allen, Katrina J; Taylor, Steve L; Shreffler, Wayne G; Baumert, Joseph L; Tang, Mimi L K; Gurrin, Lyle C; Mathai, Michael L; Nordlee, Julie A; DunnGalvin, Audrey; et al. (2013-09-12)
      Abstract Background The eliciting dose (ED) for a peanut allergic reaction in 5% of the peanut allergic population, the ED05, is 1.5 mg of peanut protein. This ED05 was derived from oral food challenges (OFC) that use graded, incremental doses administered at fixed time intervals. Individual patients’ threshold doses were used to generate population dose-distribution curves using probability distributions from which the ED05 was then determined. It is important to clinically validate that this dose is predictive of the allergenic response in a further unselected group of peanut-allergic individuals. Methods/Aims This is a multi-centre study involving three national level referral and teaching centres. (Cork University Hospital, Ireland, Royal Children’s Hospital Melbourne, Australia and Massachusetts General Hospital, Boston, U.S.A.) The study is now in process and will continue to run until all centres have recruited 125 participates in each respective centre.A total of 375 participants, aged 1–18 years will be recruited during routine Allergy appointments in the centres. The aim is to assess the precision of the predicted ED05 using a single dose (6 mg peanut = 1.5 mg of peanut protein) in the form of a cookie. Validated Food Allergy related Quality of Life Questionnaires-(FAQLQ) will be self-administered prior to OFC and 1 month after challenge to assess the impact of a single dose OFC on FAQL. Serological and cell based in vitro studies will be performed. Conclusion The validation of the ED05 threshold for allergic reactions in peanut allergic subjects has potential value for public health measures. The single dose OFC, based upon the statistical dose-distribution analysis of past challenge trials, promises an efficient approach to identify the most highly sensitive patients within any given food-allergic population.
    • "Pee-in-a-Pot": acceptability and uptake of on-site chlamydia screening in a student population in the Republic of Ireland

      Vaughan, Deirdre; O'Connell, Emer; Cormican, Martin; Brugha, Ruairi; Faherty, Colette; Balfe, Myles; O'Donovan, Diarmuid (2010-11-11)
      Abstract Background The aim of the study was to explore the acceptability and uptake of on-campus screening using a youth friendly approach in two Third Level higher education institutions (HEIs). This study is part of wider research exploring the optimal setting for chlamydia screening in Ireland. Methods Male and female students were given the opportunity to take a free anonymous test for chlamydia during a one week programme of "pee-in-a-pot" days at two HEI campuses in the West of Ireland. The study was set up after extensive consultation with the two HEIs and advertised on the two campuses using a variety of media in the two weeks preceding the screening days. Screening involved the provision and distribution of testing packs at communal areas and in toilet facilities. In Ireland, chlamydia notifications are highest amongst 20-29 year olds and hence the screening criterion was aimed at 18-29 year olds. Urine samples were tested using a nucleic acid amplification test (NAAT). Following the screening days, qualitative in-depth interviews were conducted with participants about their experiences of the event. Results Out of 1,249 test kits distributed in two HEIs, 592 specimens were collected giving a return rate of 47.5%. Tests excluded (54) were due to labelling errors or ineligibility of participants' age. Two thirds of those tested were females and the mean age was 21 years. Overall,3.9% (21/538) of participants tested positive, 5% (17/336) among females and 2% (4/191) among males. Participant interviews identified factors which enhanced student participation such as anonymity, convenience, accessibility of testing, and the informal and non-medical approach to testing. Conclusions Screening for chlamydia using on-campus "pee-in-a-pot" days is an acceptable strategy in this population. This model can detect and treat asymptomatic cases of chlamydia and avoid many of the barriers associated with testing for sexually transmitted infections (STIs) in clinical settings.
    • Penicillin Allergy; Re-moulding Practice

      McCarthy, K; Hourihane, J O B; UCC (Irish Medical Journal, 2018-02)
    • The Penicillin for the Emergency Department Outpatient treatment of CELLulitis (PEDOCELL) trial: update to the study protocol and detailed statistical analysis plan (SAP)

      Boland, Fiona; Quirke, Michael; Gannon, Brenda; Plunkett, Sinead; Hayden, John; McCourt, John; O’Sullivan, Ronan; Eustace, Joseph; Deasy, Conor; Wakai, Abel (2017-08-24)
      Abstract Background Cellulitis is a painful, potentially serious, infectious process of the dermal and subdermal tissues and represents a significant disease burden. The statistical analysis plan (SAP) for the Penicillin for the Emergency Department Outpatient treatment of CELLulitis (PEDOCELL) trial is described here. The PEDOCELL trial is a multicentre, randomised, parallel-arm, double-blinded, non-inferiority clinical trial comparing the efficacy of flucloxacillin (monotherapy) with combination flucloxacillin/phenoxymethylpenicillin (dual therapy) for the outpatient treatment of cellulitis in the emergency department (ED) setting. To prevent outcome reporting bias, selective reporting and data-driven results, the a priori-defined, detailed SAP is presented here. Methods/design Patients will be randomised to either orally administered flucloxacillin 500 mg four times daily and placebo or orally administered 500 mg of flucloxacillin four times daily and phenoxymethylpenicillin 500 mg four times daily. The trial consists of a 7-day intervention period and a 2-week follow-up period. Study measurements will be taken at four specific time points: at patient enrolment, day 2–3 after enrolment and commencing treatment (early clinical response (ECR) visit), day 8–10 after enrolment (end-of-treatment (EOT) visit) and day 14–21 after enrolment (test-of-cure (TOC) visit). The primary outcome measure is investigator-determined clinical response measured at the TOC visit. The secondary outcomes are as follows: lesion size at ECR, clinical treatment failure at each follow-up visit, adherence and persistence of trial patients with orally administered antibiotic therapy at EOT, health-related quality of life (HRQoL) and pharmacoeconomic assessments. The plan for the presentation and comparison of baseline characteristics and outcomes is described in this paper. Discussion This trial aims to establish the non-inferiority of orally administered flucloxacillin monotherapy with orally administered flucloxacillin/phenoxymethylpenicillin dual therapy for the ED-directed outpatient treatment of cellulitis. In doing so, this trial will bridge a knowledge gap in this understudied and common condition and will be relevant to clinicians across several different disciplines. The SAP for the PEDOCELL trial was developed a priori in order to minimise analysis bias. Trial registration EU Clinical Trials Register (EudraCT number: 2016-001528-69). Registered on 5 April 2016. ClinicalTrials.gov, ID: NCT02922686 . Registered on 9 August 2016.
    • People who are transgender: mental health concerns

      McCann, E. (Journal of Psychiatric and Mental Health Nursing, 2014-10)
    • The Perception of Art among Patients and Staff on a Renal Dialysis Unit

      Corrigan, C; Peterson, L; McVeigh, C; Lavin, PJ; Mellotte, GJ; Wall, C; Baker Kerrigan, A; Barnes, L; O’Neill, D; Moss, H (Irish Medical Journal, 2017-10)
    • Performance improvement and health cost reductions

      Murphy, JFA (Irish Medical Journal, 2012-06)