• Added Value of Stroke Protocol MRI Following Negative Initial CT in the Acute Stroke Setting

      Gargan, ML; Kok, HK; Kearney, J; Collins, R; Coughlan, T; O’Neill, D; Ryan, D; Torreggiani, W; Doody, O (Irish Medical Journal, 2015-12)
      The aim of the study was to determine the added value of stroke protocol MRI following negative initial CT brain in the acute stroke setting. A retrospective study was performed over a 6 month period in a tertiary referral stroke centre. Patients were selected from the stroke and radiology databases. Inclusion criteria: clinical stroke syndrome, negative initial CT with subsequent MRI study with diffusion weighted sequences. Ninety two patients were reviewed and 73 (M:F of 39:34, mean age 62.1 – 14.0 years) met the inclusion criteria. Twenty MRI studies (27.4%) were positive for acute/ subacute ischaemia in the setting of a normal initial CT. The average time interval between initial CT and MRI brain imaging was 4.7 – 2.6 days. Whilst CT continues to be the first line imaging investigation for acute stroke, MRI has substantial added value following negative initial CT in the diagnosis of stroke.
    • Ageism And Clinical Research

      Briggs, R; Robinson, S; O’Neill, D (Irish Medical Journal (IMJ), 2012-10)
    • Barriers to dental attendance in older patients

      Shanahan, D; O’Neill, D (Irish Medical Journal, 2017-04)
      Health professionals in Ireland are increasingly concerned about the quality of oral health in older patients. The aim of this study is to identify the obstacles that face this age-group when accessing dental care, so that we are in a better position to address them. A questionnaire was completed by 105 patients attending a geriatric outpatient clinic. Over 50 percent of respondents had not attended a dentist in over 36 months, for the reasons that 'I have no problem or need for treatment’ (62%) and ‘I have no teeth, and therefore I have no need to go’ (54%). While it is common to assume that no teeth means no need to see a dentist, research shows that regular dental visits are vital for ensuring the early screening of oral cancer and other mucosal pathologies, and the optimisation of existing rosthesis/restorations. The chief recommendation of this paper is thus to provide better education and access to older people on the importance of visiting the dentist.
    • Efficiency of computerized discharge letters

      Keane, B; O’Neill, D; Coughlan, T; Collins, R (Irish Medical Journal, 2014-07)
    • Investigation and diagnostic formulation in patients admitted with transient loss of consciousness

      Briggs, R; Coughlan, T; Doherty, J; Collins, DR; O’Neill, D; Kennelly, SP (Irish Medical Journal, 2017-05)
      Several commonly completed tests have low diagnostic yield in the setting of transient loss of consciousness (T-LOC). We estimated the use and cost of inappropriate investigations in patients admitted with T-LOC and assessed if these patients were given a definitive diagnosis for their presentation. We identified 80 consecutive patients admitted with T-LOC to a university teaching hospital. Eighty-eight percent (70/80) had a computerized topography (CT) brain scan and 49% (34/70) of these scans were inappropriate based on standard guidelines. Almost half (17/80) of electroencephalograms (EEG) and 82% (9/11) of carotid doppler ultrasound performed were not based on clinical evidence of seizure or stroke respectively. Forty-four percent (35/80) of patients had no formal diagnosis documented for their presentation. Inappropriate investigation in T-LOC is very prevalent in the acute hospital, increasing cost of patient care. In addition, there is poor diagnostic formulation for T-LOC making recurrent events more likely in the absence of definitive diagnoses
    • Longitudinal assessment of coagulation system potential in response to alteration of antiplatelet therapy after TIA or ischemic stroke

      Tobin, WO; Kinsella, JA; Kavanagh, GF; O’Donnell, JS; McGrath, RA; Collins, DR; Coughlan, T; O’Neill, D; Egan, B; Tierney, S; et al. (Cerebrovascular Diseases, 2012)
    • Older Motorcyclists in Ireland

      Fitzpatrick, D; O’Neill, D (Irish Medical Journal, 2017-06)
      Older motorcyclists are under-recognised as vulnerable road users. Using Irish data from the Central Statistics Office, the Road Safety Authority and the Healthcare Pricing Office, we explored the trend of ageing riders and factors in older motorcyclist collisions and injuries. In 2005, 17 motorcyclists ≥55 were injured compared to 31 in 2012. Motorcyclists aged between 30 and 49 years and ≥50 have longer lengths of stay compared to riders <30. The percentage of motorcycles with an engine capacity of ≥750cc increased from 39.6% in 2007 to 46.7% in 2015. Older motorcyclists are less likely to be fatally injured in single vehicle collisions. Older motorcyclists are generally safer than younger riders but the proportion of older motorcyclist injury is rising. Irish road safety strategies and trauma services need to incorporate these findings into planning and development of preventive and treatment approaches
    • Patterns of Mortality in Modern Stroke Care

      Dalton, M; Coughlan, T; Cogan, N; Greene, S; McCabe, DJH; McCarthy, A; Murphy, S; Walsh, R; O’Neill, D; Kennelly, S; et al. (Irish Medical Journal, 2018-05)
      Stroke is a leading cause of death. We looked at the causes (direct and indirect) of in-hospital mortality in a modern stroke unit over a two-year period.
    • Structuring Diabetes Mellitus Care in Long-Term Nursing Home Residents

      Fitzpatrick, D; Ibrahim, ES; Kennelly, S; Sherlock, M; O’Neill, D (Irish Medical Journal, 2018-03)
      Nursing home residents with diabetes have more complex care needs with higher levels of comorbidity, disability and cognitive impairment. We compared current practice in the 44 long-term residents in Peamount hospital with the standards recommended in the Diabetes UK “Good Clinical Practice Guidelines for Care Home Residents with Diabetes”. Of 44 residents, 11 were diabetic. Residents did not have specific diabetes care plans. There were some elements of good practice with a low incidence of hypoglycaemia and in-house access to dietetics and chiropody. However, diabetes care was delivered on an ad-hoc basis without individualised care plans, documented glycaemic targets, or scheduled monitoring for complications and no formal screening for diabetes on admission. National and local policy to guide management of diabetes mellitus should be developed. There should be individualised diabetes care plans, clear policies for hypoglycaemia, hyperglycaemia and long-term diabetes complications, screening on admission and increased uptake of the national retinal screening and foot care programmes.