Now showing items 1-20 of 27578

    • The Burden of Severe Lactational Mastitis in Ireland from 2006 to 2015

      Cooney, F; Petty-Saphon, N; Department of Public Health, Dr Steevens' Hospital (irish Medical Journal, 2019-01-15)
    • A Case of Paget-Schroetter Syndrome in a Young Male After Lifting Weights

      Umana, E.; Elsherif, M.; Binchy, J. (Irish Medical Journal, 2019-02)
      Paget-Schroetter Syndrome (PSS) or effort thrombosis of the axillary-subclavian venous axis is a rare disease affecting healthy young adults which requires a high index of suspicion to diagnose. Management often requires not only anticoagulation but also thrombolysis with first rib resection to prevent recurrence and complications. We present a case of a 31-year-old male who presented to our emergency department with pain and swelling of his left upper limb. He was diagnosed with PSS and underwent; anticoagulation, catheter directed thrombolysis and planned for first rib resection.
    • Kicking off a Retropharyngeal Abscess

      Rana, A; Heffernen, L; Binchy, J (Irish Medical Journal, 2019-03)
      Retropharyngeal abscesses (RPA) are deep neck space infections that can pose an immediate life-threatening emergency, such as airway obstruction. [1] The potential space can become infected by bacteria spreading from a contiguous area [2] or direct inoculation from penetrating trauma. [3] Infection is often polymicrobial (most commonly group A beta-hemolytic streptococci). [4
    • Meconium Ileus in Two Irish Newborns: The Presenting Feature of Cystic Fibrosis

      Smith, A.; Ryan, E; O’Keeffe, D; O’Donovan, D. (Irish Medical Journal, 2019-03)
      Cystic Fibrosis (CF) is the most common genetically inherited disease in Ireland1. Approximately 1/ 2,300 infants per year are born with CF in Ireland2. Newborn bloodspot screening (NBS) screening for CF was introduced to Ireland in 20113. NBS screening for CF is associated with improved lung function, nutritional status and increased survival into early adulthood4. Therefore early recognition and management of this chronic condition is vital to ensuring optimal patient management.
    • Ustekinumab-induced subacute cutaneous lupus.

      Tierney, Emma; Kirthi, Shivashini; Ramsay, Bart; Ahmad, Kashif (JAAD Case Reports, 2019-03-01)
      Drug-induced lupus erythematosus (DILE) is a lupus-like syndrome temporally related to continuous drug exposure. DILE can be divided into systemic lupus erythematosus (SLE), subacute cutaneous lupus erythematosus (SCLE) and chronic cutaneous lupus.1 Hydrochlorothiazide was the first drug associated with SCLE in 1985,2 but at least 100 other agents have since been reported to induce/exacerbate SCLE, with terbinafine, tumor necrosis factor (TNF)-α inhibitors, antiepileptics, and proton pump inhibitors, the most frequently associated medications. We present a case of ustekinumab-induced SCLE in a patient being treated for psoriasis.
    • Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy.

      McEachern, Jasmine; Adye-White, Lauren; Priest, Kelsey C; Moss, Eloise; Gorfinkel, Lauren; Wood, Evan; Cullen, Walter; Klimas, Jan (2019-02-01)
      Opioid agonist therapy (OAT) is a first-line treatment for opioid use disorder (OUD); however, the efficacy and role of urine drug screening (UDS) in OAT has received little research attention. Prior evidence suggests that UDS frequency reflects philosophy and practice context rather than differences in patient characteristics or clinical need. Therefore, we reviewed the literature on the effect of and recommendations for the frequency of UDS on health outcomes for persons with OUD who receive OAT. We searched Medline and EMBASE for articles published from 1995-2017. Search results underwent double, independent review with discrepancies resolved through discussion with a third reviewer, when necessary. Additional articles were identified through snowball searching, hand searching (Google Scholar), and expert consultation. The Cochrane tool was used to assess risk of bias. Of the 60 potentially eligible articles reviewed, only one three-arm randomized open-label trial, comparing weekly and monthly UDS testing with take-home OAT doses, met our inclusion criteria. Our review identified an urgent gap in research evidence underpinning an area of clinical importance and that is routinely reported by patients as an area of concern.
    • Perspectives of people with aphasia poststroke towards personal recovery and living successfully: A systematic review and thematic synthesis

      Manning, Molly; MacFarlane, Anne; Hickey, Anne; Franklin, Sue; School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick (Plos One, 2019-03)
    • A comparative analysis of prophylactic antimicrobial use in long-term care facilities in Ireland, 2013 and 2016

      Tandan, Meera; O'Connor, Rory; Burns, Karen; Murphy, Helen; Hennessy, Sarah; Roche, Fiona; Donlon, Sheila; Cormican, Martin; Vellinga, Akke (Eurosurveillance, 2019-03)
    • Evaluation of the Design & Dignity Programme

      Cornally, N; Cagney, O; Burton, A; Coffey, A; Dalton, C; Hartigan, I; Harrison, J; Murphy, M; Nuzum, D; Pennisi, Y; Savage, E; Sweeney, C; Timmons, S; Leahy Warren, P; FitzGerald, S; University College Cork, Cork (Irish Hospice Foundation (IHF), 2019-03)
    • Excellent reliability and validity of the Addiction Medicine Training Need Assessment Scale across four countries.

      Pinxten, W J Lucas; Fitriana, Efi; De Jong, Cor; Klimas, Jan; Tobin, Helen; Barry, Tomas; Cullen, Walter; Jokubonis, Darius; Mazaliauskiene, Ramune; Iskandar, Shelly; Raya, Reynie Purnama; Schellekens, Arnt (2019-04-01)
      Addiction is a context specific but common and devastating condition. Though several evidence-based treatments are available, many of them remain under-utilized, among others due to the lack of adequate training in addiction medicine (AM). AM Training needs may differ across countries because of difference in discipline and level of prior AM training or contextual factors like epidemiology and availability of treatment. For appropriate testing of training needs, reliability and validity are key issues. The aim of this study was to evaluate the psychometric properties of the AM-TNA Scale: an instrument specifically designed to develop the competence-based curriculum of the Indonesian AM course. In a cross-sectional study in Indonesia, Ireland, Lithuania and the Netherlands the AM-TNA was distributed among a convenience sample of health professionals working in addiction care in The Netherlands, Lithuania, Indonesia and General Practitioners in-training in Ireland. 428 respondents completed the AM-TNA scale. To assess the factor structure, we used explorative factor analysis. Reliability was tested using Cronbach's Alpha, ANOVA determined the discriminative validity. Validity: factor analysis revealed a two-factor structure: One on providing direct patient treatment and care (Factor 1: clinical) and one factor on facilitating/supporting direct patient treatment and care (Factor 2: non-clinical) AM competencies and a cumulative 76% explained variance. Reliability: Factor 1 α = 0.983 and Factor 2: α = 0.956, while overall reliability was (α = 0.986). The AM-TNA was able to differentiate training needs across groups of AM professionals on all 30 addiction medicine competencies (P = .001). In our study the AM-TNA scale had a strong two-factor structure and proofed to be a reliable and valid instrument. The next step should be the testing external validity, strengthening discriminant validity and assessing the re-test effect and measuring changes over time.
    • Association between caesarean section delivery and obesity in childhood: a longitudinal cohort study in Ireland.

      Masukume, Gwinyai; McCarthy, Fergus P; Baker, Philip N; Kenny, Louise C; Morton, Susan Mb; Murray, Deirdre M; Hourihane, Jonathan O'B; Khashan, Ali S (BMJ Open, 2019-03-15)
      To investigate the association between caesarean section (CS) birth and body fat percentage (BF%), body mass index (BMI) and being overweight or obese in early childhood. Prospective longitudinal cohort study. Babies After Screening for Pregnancy Endpoints: Evaluating the Longitudinal Impact on Neurological and Nutritional Endpoints cohort. Infants born to mothers recruited from the Screening for Pregnancy Endpoints study, Cork University Maternity Hospital between November 2007 and February 2011.
    • What are the training needs of early career professionals in addiction medicine? A BEME Scoping Review protocol

      Kelly, D; Adam, A; Arya, S; Indave, I; Krupchanka, D; Wood, E; Cullen, W; Klimas, Jan (BEME, 2018)
    • Is birth weight the major confounding factor in the study of gestational weight gain?: an observational cohort study.

      O'Higgins, Amy C; Doolan, Anne; McCartan, Thomas; Mullaney, Laura; O'Connor, Clare; Turner, Michael J (BMC Pregnancy & Childbirth, 2018-06-07)
      Much interest has been focussed on both maternal obesity and gestational weight gain (GWG), particularly on their role in influencing birth weight (BW). Several large reviews have reported that excessive GWG is associated with an increase in BW Women were enrolled at their convenience before 18 weeks gestation. Height and weight were measured accurately at the first antenatal visit and BMI calculated. Maternal weight was measured again after 37 weeks gestation. The weight of the baby was measured at birth. Relationships were tested using linear regression analysis, chi-squared tests and t-tests as appropriate. Of the 522 women studied, the mean BMI was 25.3 kg/m The positive correlation between GWG in pregnancy and BW can be accounted for by the contribution of fetal weight to GWG antenatally without a contribution from increased maternal adiposity. There was a wide range of BW irrespective of the degree of GWG and obese women had a lower GWG than non-obese women. These findings help explain why Randomized Controlled Trials (RCTs) designed to reduce GWG have failed to decrease BW and suggest there is no causative link between excessive GWG and increased BW.
    • Analysis of inflammatory cytokine and TLR expression levels in Type 2 Diabetes with complications.

      Gupta, Saket; Maratha, Ashwini; Siednienko, Jakub; Natarajan, Anandan; Gajanayake, Thusitha; Hoashi, Shu; Miggin, Sinéad (Scientific Reports, 2017-08-09)
      The pathogenesis and complications of type 2 diabetes (T2DM) are closely linked with defective glucose metabolism, obesity, cardiovascular disease and an inability to mount an effective immune response to certain pathogenic organisms. Perturbations in key innate immune receptors known as Toll-like receptors (TLRs) and inflammatory mediators such as IL-6, TNFα and IL-1β have been linked with T2DM. Herein, we sought to establish whether patients with T2DM and underlying complications exhibit perturbations in cytokine and TLR expression. Serum cytokine and mRNA levels of cytokines/TLRs in monocytes (M) and neutrophils (N) were measured in a cohort of 112 diabetic patients: good glycaemic control without complications (GC), good glycaemic control with complications (GCC), poor glycaemic control without complications (PC) and poor glycaemic control with complications (PCC) and compared them with 34 non-diabetic volunteers (NGT). Serum cytokine levels were normal in all study participants. In the GC group, cytokine and TLR gene expression were enhanced compared to NGT. In contrast, suppressed cytokine and TLR gene expression were evident in PC, GCC & PCC groups when compared to the GC. In conclusion, whereas serum pro-inflammatory cytokine levels are unaltered in T2DM patients, differences in inflammatory gene profiles exist among the T2DM patient groups.
    • Intramuscular versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery: randomised controlled trial.

      Adnan, Nita; Conlan-Trant, Rebecca; McCormick, Ciara; Boland, Fiona; Murphy, Deirdre J (BMJ, 2018-09-04)
      To determine whether intravenous oxytocin is more effective than intramuscular oxytocin at preventing postpartum haemorrhage at vaginal delivery. Double blind placebo controlled randomised trial. University affiliated maternity unit in the Republic of Ireland. 1075 women aged 18 years or older, at term with a singleton pregnancy who were aiming for a vaginal delivery with an actively managed third stage of labour.
    • High Rates of Diabetic Ketoacidosis in Patients with New and Known Type 1 Diabetes over a Six-Year Period

      Finn, B.P.; Trayer, J.; Cronin, C.; O’Connell, S.M (Irish Medical Journal, 2019-03)
      Ireland is a high incidence country for type 1 diabetes (T1DM) with 28.8 newly diagnosed cases/100,000/year1. Patients with new onset T1DM frequently (15-70%) present with diabetic ketoacidosis (DKA)2,3,4,5. Lansdown et al found that 25% of children with new onset T1DM under 19 years of age presented in DKA in Wales between 1991 and 20096. The rates of DKA in known T1DM on an international stage remains significant- Austria and Germany (5%), Wales and England (6.4%) and the United States (7.1%)7. The aim of our study was to analyse all admissions with diabetic ketoacidosis to the regional paediatric diabetes centre at Cork University Hospital, over the past six years. Our objectives include assessing the proportion of patients with new and known T1DM, treatment modalities (e.g. pump/multiple daily injections), patient demographics, severity, length of stay and outcomes.
    • Codeine Usage in Ireland- A Timely Discussion on an Imminent Epidemic

      McDonnell, E; Graduate Entry Medical School, University of Limerick (Irish Medical Journal, 2019-03)
    • In-hospital training in addiction medicine: A mixed-methods study of health care provider benefits and differences.

      Gorfinkel, Lauren; Klimas, Jan; Reel, Breanne; Dong, Huiru; Ahamad, Keith; Fairgrieve, Christopher; McLean, Mark; Mead, Annabel; Nolan, Seonaid; Small, Will; Cullen, Walter; Wood, Evan; Fairbairn, Nadia (2019-01-28)
      Hospital-based clinical addiction medicine training can improve knowledge of clinical care for substance-using populations. However, application of structured, self-assessment tools to evaluate differences in knowledge gained by learners who participate in such training has not yet been addressed. Participants (n = 142) of an elective with the hospital-based Addiction Medicine Consult Team (AMCT) in Vancouver, Canada, responded to an online self-evaluation survey before and immediately after the structured elective. Areas covered included substance use screening, history taking, signs and symptoms examination, withdrawal treatment, relapse prevention, nicotine use disorders, opioid use disorders, safe prescribing, and the biology of substance use disorders. A purposefully selected sample of 18 trainees were invited to participate in qualitative interviews that elicited feedback on the rotation. Of 168 invited trainees, 142 (84.5%) completed both pre- and post-rotation self-assessments between May 2015 and May 2017. Follow-up participants included medical students, residents, addiction medicine fellows, and family physicians in practice. Self-assessed knowledge of addiction medicine increased significantly post-rotation (mean difference in scores = 11.87 out of the maximum possible 63 points, standard deviation = 17.00; P < .0001). Medical students were found to have the most significant improvement in addiction knowledge (estimated mean difference = 4.43, 95% confidence interval = 0.76, 8.09; P = .018). Illustrative quotes describe the dynamics involved in the learning process among trainees. Completion of a hospital-based clinical elective was associated with improved knowledge of addiction medicine. Medical students appear to benefit more from the addiction elective with a hospital-based AMCT than other types of learners.
    • Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users.

      Klimas, Jan; Fairgrieve, Christopher; Tobin, Helen; Field, Catherine-Anne; O'Gorman, Clodagh Sm; Glynn, Liam G; Keenan, Eamon; Saunders, Jean; Bury, Gerard; Dunne, Colum; Cullen, Walter (2018-12-05)
      Problem alcohol use is common among people who use illicit drugs (PWID) and is associated with adverse health outcomes. It is also an important factor contributing to a poor prognosis among drug users with hepatitis C virus (HCV) as it impacts on progression to hepatic cirrhosis or opioid overdose in PWID. To assess the effectiveness of psychosocial interventions to reduce alcohol consumption in PWID (users of opioids and stimulants). We searched the Cochrane Drugs and Alcohol Group trials register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and PsycINFO, from inception up to August 2017, and the reference lists of eligible articles. We also searched: 1) conference proceedings (online archives only) of the Society for the Study of Addiction, International Harm Reduction Association, International Conference on Alcohol Harm Reduction and American Association for the Treatment of Opioid Dependence; and 2) online registers of clinical trials: Current Controlled Trials, ClinicalTrials.gov, Center Watch and the World Health Organization International Clinical Trials Registry Platform. We included randomised controlled trials comparing psychosocial interventions with other psychosocial treatment, or treatment as usual, in adult PWIDs (aged at least 18 years) with concurrent problem alcohol use.
    • Infliximab Induced Cardiac Tamponade

      O’Morain, N; Kumar, L; O’Carroll-Lolait, C; Alakkari, A; Ryan, B (Irish Medical Journal, 2019-03)
      Biologic therapies are increasingly used in the treatment of Inflammatory Bowel Disease. Reactions to infusion therapy are not uncommon but are mostly benign and self-limiting. Rarely, life-threatening complications can occur.