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Recent Submissions

  • Factors Contributing to Non-Exclusive Breastfeeding in Primigravid Mothers

    Panaviene, J.; Zakharchenko, L.; Olteanu, D.; Cullen, M.; EL-Khuffash, E.L (Irish Medical Journal, 2019-10)
    We aimed to examine the factors contributing to non-exclusive breastfeeding in primigravid mothers in a large Irish tertiary maternity hospital.
  • The Prevalence and Management of Metabolic Acidosis of Chronic Kidney Disease

    Ahmed, A.R.; Satti, M.M.; Abdalla, A.E.; Giblin, L.; Lappin, D. (Irish Medical Journal, 2019-10)
    Emerging evidence supports initiating oral sodium bicarbonate (OSB) at a serum bicarbonate (HCO3) level of less than 22mmol/L. We look to identify the prevalence of metabolic acidosis of chronic kidney disease (MA-CKD) and its management with OSB at a regional university hospital.
  • How Much Greater is Obstetric Intervention in Women with Medical Disorders in Pregnancy When Compared to the General Population?

    Keane, R.; Manning, C.; Lynch, C.; Regan, C.; Byrne, B. (Irish Medical Journal, 2019-10)
    The purpose of this study was to compare obstetric and neonatal outcomes between women attending a specialised maternal medicine service and the general obstetric population.
  • Development of an Insulin-Prescribing Chart for Paediatric Diabetes

    Finn, B.P; O’Neill, T.; Bradfield, A.; O’Sullivan, T.; Beattie, S.; O’Connell, S.M. (Irish Medical Journal, 2019-10)
    Our aim was to design a new insulin prescribing tool in compliance with the Irish Medicines Safety Network recommendations.
  • High-flow Nasal Cannulae, Bronchopulmonary Dysplasia and Retinopathy of Prematurity

    Healy, L.I; Corcoran, P.; Murphy, B.P (Irish Medical Journal, 2019-09)
    To determine if HFNC use was associated with changes in incidence of BPD and ROP.
  • Telephone Follow-Up of Mild Traumatic Brain Injury; A Feasibility Study

    Underwood, S.; Campbell, S.; Deasy, C. (Irish Medical Journal, 2019-09)
    This study investigates the prevalence of Post-Concussion Syndrome (PCS) one-year post-injury in patients that were treated for Mild Traumatic Brain Injury (mTBI) in the Clinical Decision Unit (CDU) of Cork University Hospital’s (CUH) Emergency Department.
  • What Stops Doctors Switching from Intravenous to Oral Antibiotics?

    Hogan-Murphy, D.; Waqas, S.; Tuite, H.; Ni Riain, U. (Irish Medical Journal, 2019-09)
    To explore doctors’ perceptions of the motivators and barriers to complying with intravenous to oral switch antibiotic guidelines in a Model 4 Irish hospital.
  • A Temporal Comparative Study of Women’s Rugby Injuries Presenting to an Emergency Department

    Gilmartin, S.; Ryan, J. (Irish Medical Journal, 2019-10)
    We aimed to examine the change in injury patterns, diagnostics and treatments provided to female rugby players in an emergency department between two separate seasons ten years apart.
  • A Geospatial Analysis of Adult Major Trauma Transit Time in Dublin

    Kelly, O.; O'Reilly, M; Collins, N. (Irish Medical Journal, 2019-09)
    To estimate ambulance transit time of Major Trauma patients from scene to Emergency Department (ED) in order to inform future trauma network design.
  • Psychiatry in Ireland: A Lot Done, More to Do

    Kelly, B.D.; Department of Psychiatry, Trinity Centre for Health Sciences (Irish Medical Journal, 2019-10)
    Four decades ago, in April 1979, Time magazine printed a dramatic cover story titled “Psychiatry’s depression”, diagnosing psychiatry with “a bad case of mid-life blues” 1. The magazine pointed to a lack of knowledge about the biology of mental illness, recruitment problems into the profession, uncertainties about treatments, and the inadequacy of community care. Precisely forty years later, in April 2019, the Economist magazine, in a very similar tone, referred to “today’s crisis in the psychiatric profession” 2 and, the following month, the New Yorker cited many of the same problems again in an article about “psychiatry’s fraught history” 3.
  • Being “Mindful” of Dignity in Dying: Developing Awareness, Fostering a Psychological Understanding, and Supporting Dignified Endings-To-Life

    Hession, Natalie; Elmer, Nicola; O'Kane, Aifric; Cotter, Pádraig; Psycho-Oncology Department, St. Luke's Radiation Oncology Network (IJEPP, 2019)
    Experiencing a sense of dignity when nearing end-of-life has been shown to be very important. There are many things that hospice and palliative nurses can do to support dignified endings-to-life. This paper explores the different aspects of this process from both the perspective of the person dying and in particular the individual in the caring role. Consideration is given to the different components of experiencing dignity in dying, especially those aspects that nursing staff can influence most. The importance of a sense of dignity to people who are dying is explored using two psychological models that provide an intrapersonal and transpersonal perspective. These include the Abandonment of Self Model and the Surface-Depth Model respectively. The types of obstacles to nursing staff providing this type of care and support are reflected upon, with particular emphasis placed on the practitioner’s own personal fears and anxieties and how these may manifest within the patient-nurse relationship. The final section explores the use of mindfulness practises as a way of interacting more fully with people diagnosed with terminal illnesses to support their experience of a dignified ending-to-life. This process is termed “mindful engagement”.
  • Varicella Related Hospital Admissions in Ireland

    McCarthy, K.N.; Ó Maoldomhnaigh, C.; Butler, K.M.; Gavin, P.J. (Irish Medical Journal, 2019-07)
    Aim The aim of this study was to evaluate trends in admissions for patients with primary varicella infection in Irish hospitals. Methods The Hospital Inpatient Enquiry System was evaluated from Irish hospitals from 2005-2016 for patients with primary varicella infection. Results There were 2717 admissions with primary varicella infection. The average annual number of admissions was 226 for an incidence of 4.87/100,000. Average length of stay (ALOS) was 5-days. Sixty-two (2.5%) patients required intensive-care with an ALOS of 26-days. The most common secondary diagnoses were cellulitis, volume-depletion and streptococcal infection. The number of admissions due to streptococcal infection and cellulitis significantly increased over the period. Conclusion Chickenpox places a consistent burden on Irish healthcare, accounting for in excess of 1100 acute and 160 intensive-care bed days annually. This study adds weight to the argument that universal varicella vaccine should be considered and provides baseline epidemiology to determine vaccine effectiveness in the future.
  • The Role of Interventional Radiology in the Management of Obstetric and Gynaecological Haemorrhage

    O’Brien, C.; Healy, G.M.; Anglim, B.C.; O’Brien, A.; Duignan, J.; Patel, A.; Cheung, M.; Cantwell, C.P. (Irish Medical Journal, 2019-07)
    Aim We will review our experience of emergent arterial embolization used to treat haemodynamically unstable patients with obstetric and gynaecological haemorrhage. Methods This is a retrospective study of patients with haemodynamically unstable obstetric and gynaecological haemorrhage treated with emergent arterial embolization from 2010 to 2015. Results 22 patients (average age 41 (SD +/-9) years) had emergent arterial embolization. 63% had post-partum haemorrhage(PPH). 82% of cases were performed with conscious sedation and local anaesthesia. Embolization was technically successful in all cases. Embolization was clinically successful in 95% (21/22). In one case of PPH the patient represented six days later with recurrent bleeding and was treated with surgical suturing of the cervix. There were no complications or deaths. Conclusion Arterial embolization is a highly successful treatment of obstetric and gynaecological haemorrhage in unstable patients.
  • Circumcision Rates after the Release of Preputial Adhesions

    Aworanti, O.M; Rasheed, F.; Aldiab, A; Mortell, A. (Irish Medical Journal, 2019-07)
    The non-retractile foreskin in children is one of the most frequent indication for referral to a paediatric surgeon in Ireland. This is probably due to parental concerns when children complain of related symptoms coupled with a misperception among some general practitioners (GP) of the natural separation process of the inner surface of the prepuce from the glans surface1,2,3. Phimosis from the Greek word ‘Ψιμoσισ’ (muzzling) generally describes the non-retractile foreskin. Phimosis is best classified as either pathological or physiological. Pathological phimosis is either due to balanitis xerotica obliterans (BXO) or due to a constricting phimotic ring that hinders retraction, both usually in the older boy. Physiological phimosis is simply the non-retractile or incompletely retractile state of the foreskin in usually asymptomatic young boys. Foreskin retraction has been established to be complete by the age of 3 years in 90% 1 and by the age of 16 years in 99% 2 of boys. During this preputial separation process, complaints such as local discomfort, ballooning of the foreskin during micturition and smegma retention cysts are common and require simple reassurance only 3. No pathologic sequelae have been attributed to these physiologic processes on assessing urine flow rates, post-void residual bladder volumes and bladder wall thickness in young boys with physiologic phimosis 3. Furthermore, as partial separation of the foreskin ensues, young boys can suffer from episodes of balanoposthitis1,3. This inflammation of the glans and prepuce (or prepuce only - termed posthitis) generally resolves with antibiotic treatment and can be prevented with improved local hygiene. Therefore, absolute and strong indications for a medical circumcision are limited to pathological phimosis due to BXO and prevention of recurrent urinary tract infections (UTI) usually in children with vesicoureteric reflux or posterior urethral valves respectively4,5
  • A Prospective Audit of Inappropriately Occupied Hospital Beds in Patients with Newly Acquired Traumatic Spinal Cord Injury

    Smith, E.; Synnott, K. (Irish Medical Journal, 2019-07)
    Aim To quantify the inappropriate bed occupancy amongst patients with traumatic spinal cord injury (TSCI) awaiting transfer of care from the acute to community. Methods A prospective audit was carried out, of all newly acquired cases of TSCI in 2017, who progressed through acute care and specialist rehabilitation. Results Forty-four patients who were audited spent a total of 3915 days occupying a hospital bed, inappropriate for their phase of care, 78 awaiting admission to specialist acute care, 3126 awaiting admission to rehabilitation and 711 awaiting discharge from rehabilitation. Conclusion Valuable health-care resources are being wasted because TSCI patients cannot move seamlessly from one phase of care to the next. This impacts negatively on the quality of care being delivered to this patient cohort.
  • Incidence of Asymptomatic Chiari Malformation

    O’Reilly, E.M; Torreggiani, W (Irish Medical Journal, 2019-07)
    Aim The aim of this study is to define the incidence of asymptomatic Chiari malformation in an Irish population. Methods MRIs performed over 24 months were analysed. Exclusion criteria include: space occupying lesion, hydrocephalus, Chiari symptoms and inadequate views. Data were analysed to give incidence of asymptomatic Chiari and to analyze the relationship between symptom and position of the cerebellar tonsils (Chi square and Fishers exact test). Results Sample Characteristics: 147 patients (Male = 65: Female = 82), age range 15 to 93 years (M age = 53.35, SD= 16.67). 2%had a Chiari malformation (n=2). There was no significant association between symptom and tonsil position (Fishers exact test, ² (8) = 9.98, p = .23.) Conclusion This study shows an asymptomatic Chiari Malformation rate of 2%. This study supports the idea that in asymptomatic patients, a tonsil herniation of up to 5 millimeters may be an incidental and inconsequent finding.
  • Potential Coverage of the 4CMenB Vaccine against Invasive Serogroup B Isolated from 2009 to 2013 in the Republic of Ireland.

    Mulhall, Robert M; Bennett, Desiree; Cunney, Robert; Borrow, Ray; Lucidarme, Jay; Findlow, Jamie; Jolley, Keith A; Bray, James; Maiden, Martin C J; Moschioni, Monica; et al. (2018-08-22)
    Neisseria meningitidis is a common cause of bacterial meningitis in children and young adults worldwide. The 4CMenB vaccine (Bexsero), developed to combat meningococcal serogroup B (MenB) disease, contains subcapsular antigens that may induce immunity against strains of N. meningitidis, regardless of serogroup. Owing to differential levels of expression and peptide diversity in vaccine antigens across meningococcal strains, the meningococcal antigen typing system (MATS) was developed to estimate the potential MenB strain coverage of 4CMenB. Prior to introducing the 4CMenB vaccine into routine use, we sought to estimate the potential 4CMenB coverage against invasive MenB strains isolated in the Republic of Ireland (RoI) over four consecutive epidemiological years. MATS was applied to a panel of 105 invasive MenB strains isolated during July 2009 to June 2013. Sequence data characterizing the multilocus sequence typing (MLST) alleles and the major 4CMenB target peptides were extracted from isolate genome sequence data, hosted in the Bacterial Isolate Sequencing database (BIGSdb). MATS data indicated that 4CMenB may induce protective immunity against 69.5% (95% confidence interval [CI95%], 64.8% to 84.8%) of circulating MenB strains. Estimated coverage was highest against the most prevalent disease-causing lineage, cc41/44, where the most frequently observed sequence types, ST-154 and ST-41 (21% of isolates, collectively), were typically covered by three antigens. No significant temporal trends were observed. Overall, these data provide a baseline of strain coverage prior to the introduction of 4CMenB and indicate that a decrease in invasive meningococcal disease (IMD) is predicted following the introduction of 4CMenB into the routine infant immunization schedule in the RoI.IMPORTANCE The meningococcal antigen typing system (MATS) is an enzyme-linked immunosorbent assay (ELISA) that measures both the levels of expression and the immune reactivity of the three recombinant 4CMenB antigens. Together with PorA variable-region sequence data, this system provides an estimation of how susceptible MenB isolates are to killing by 4CMenB vaccine-induced antibodies. Assays based on subcapsular antigen phenotype analyses, such as MATS, are important in situations where conventional vaccine coverage estimations are not possible. Subcapsular antigens are typically highly diverse across strains, and vaccine coverage estimations would require unfeasibly large efficacy trials and screening of an exhaustive strain panel for antibody functional activity. Here, MATS was applied to all invasive meningococcal serogroup B (MenB) strains isolated over four consecutive epidemiological years (n = 105) and predicted reasonably high 4CMenB vaccine coverage in the Republic of Ireland.
  • Resolution of a Protracted Serogroup B Meningococcal Outbreak with Whole-Genome Sequencing Shows Interspecies Genetic Transfer.

    Mulhall, Robert M; Brehony, Carina; O'Connor, Lois; Meyler, Kenneth; Jolley, Keith A; Bray, James; Bennett, Desiree; Maiden, Martin C J; Cunney, Robert (2016-01-01)
    A carriage study was undertaken (n 112) to ascertain the prevalence of Neisseria spp. following the eighth case of invasive meningococcal disease in young children (5 to 46 months) and members of a large extended indigenous ethnic minority Traveller family (n 123), typically associated with high-occupancy living conditions. Nested multilocus sequence typing (MLST) was employed for case specimen extracts. Isolates were genome sequenced and then were assembled de novo and deposited into the Bacterial Isolate Genome Sequencing Database (BIGSdb). This facilitated an expanded MLST approach utilizing large numbers of loci for isolate characterization and discrimination. A rare sequence type, ST-6697, predominated in disease specimens and isolates that were carried (n 8/14), persisting for at least 44 months, likely driven by the high population density of houses (n 67/112) and trailers (n 45/112). Carriage for Neisseria meningitidis (P < 0.05) and Neisseria lactamica (P < 0.002) (2-sided Fisher’s exact test) was more likely in the smaller, more densely populated trailers. Meningococcal carriage was highest in 24- to 39-year-olds (45%, n 9/20). Evidence of horizontal gene transfer (HGT) was observed in four individuals cocolonized by Neisseria lactamica and Neisseria meningitidis. One HGT event resulted in the acquisition of 26 consecutive N. lactamica alleles. This study demonstrates how housing density can drive meningococcal transmission and carriage, which likely facilitated the persistence of ST-6697 and prolonged the outbreak. Whole-genome MLST effectively distinguished between highly similar outbreak strain isolates, including those isolated from person-toperson transmission, and also highlighted how a few HGT events can distort the true phylogenetic relationship between highly similar clonal isolates.
  • cgMLST characterisation of invasive Neisseria meningitidis serogroup C and W strains associated with increasing disease incidence in the Republic of Ireland.

    Mulhall, Robert M; Bennett, Desiree E; Bratcher, Holly B; Jolley, Keith A; Bray, James E; O'Lorcain, Piaras P; Cotter, Suzanne M; Maiden, Martin C J; Cunney, Robert J (2019-01-01)
    Since 2013 MenC and MenW disease incidence and associated mortality rates have increased in the Republic of Ireland. From 2002/2003 to 2012/2013, the average annual MenC incidence was 0.08/100,000, which increased to 0.34/100,000 during 2013/2014 to 2017/18, peaking in 2016/17 (0.72/100,000) with an associated case fatality rate (CFR) of 14.7%. MenW disease incidence has increased each year from 0.02/100,000 in 2013/2014, to 0.29/100,000 in 2017/18, with an associated CFR of 28.6%. We aimed to characterise and relate recent MenC isolates to the previously prevalent MenC:cc11 ET-15 clones, and also characterise and relate recent MenW isolates to the novel 'Hajj' clones.
  • Does an adapted Dialectical Behaviour Therapy skills training programme result in positive outcomes for participants with a dual diagnosis? A mixed methods study.

    Flynn, Daniel; Joyce, Mary; Spillane, Ailbhe; Wrigley, Conal; Corcoran, Paul; Hayes, Aoife; Flynn, Marian; Wyse, David; Corkery, Barry; Mooney, Brid (2019-08-15)

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