• E.A.O. guidelines for the use of diagnostic imaging in implant dentistry 2011. A consensus workshop organized by the European Association for Osseointegration at the Medical University of Warsaw.

      Harris, David; Horner, Keith; Gröndahl, Kerstin; Jacobs, Reinhilde; Helmrot, Ebba; Benic, Goran I; Bornstein, Michael M; Dawood, Andrew; Quirynen, Marc; Dublin Dental School and Hospital, Trinity College, Dublin 2, Ireland. david@drdavidharris.com (2012-11)
      Diagnostics imaging is an essential component of patient selection and treatment planning in oral rehabilitation by means of osseointegrated implants. In 2002, the EAO produced and published guidelines on the use of diagnostic imaging in implant dentistry. Since that time, there have been significant developments in both the application of cone beam computed tomography as well as in the range of surgical and prosthetic applications that can potentially benefit from its use. However, medical exposure to ionizing radiation must always be justified and result in a net benefit to the patient. The as low a dose as is reasonably achievable principle must also be applied taking into account any alternative techniques that might achieve the same objectives. This paper reports on current EAO recommendations arising from a consensus meeting held at the Medical University of Warsaw (2011) to update these guidelines. Radiological considerations are detailed, including justification and optimization, with a special emphasis on the obligations that arise for those who prescribe or undertake such investigations. The paper pays special attention to clinical indications and radiographic diagnostic considerations as well as to future developments and trends.
    • Early aggressive intra-venous pulse cyclophosphamide therapy for interstitial lung disease in a patient with systemic sclerosis. A case report.

      Peshin, R; O'Neill, L; Browne, P; O'Connell, P; Kearns, G; Department of Rheumatology, Beaumont Hospital, Dublin, Republic of Ireland. rohit_peshin@yahoo.com (2009-06)
      Interstitial lung disease is an important cause of mortality and morbidity in patients with systemic sclerosis (SSc). There are currently no recommended guidelines for management of these patients. This is probably due to the rarity of this condition, as well as clinical trials with only a small number of cases. There are published case report and case series along with the two main trials, viz. Scleroderma Lung Study and the Fibrosing Alveolitis Study, but again, there is no consensus on treatment protocols. In this report, we present a case of aggressive interstitial lung disease in a patient with SSc, which improved dramatically on treatment with intra-venous cyclophosphamide and high dose prednisolone therapy.
    • Early and late preterm delivery dates. Does tocolysis Matter? [Poster]

      Kent, E; Flood, Karen; Unterschneider, J; Robson, M; Geary, M; Malone, F D (2009)
    • Early and late preterm delivery rates - a comparison of differing tocolytic policies in a single urban population.

      Hehir, Mark P; O'Connor, Hugh D; Kent, Etaoin M; Robson, Michael S; Keane, Declan P; Geary, Michael P; Malone, Fergal D; Rotunda Hospital , Parnell Square, Dublin 1, Ireland. markhehir23@gmail.com (2012-11)
      Preterm delivery results in neonatal morbidity and mortality. We set out to estimate the difference in rates of preterm delivery in two institutions, serving a single population, with differing policies regarding use of tocolytic drugs for the prevention of preterm delivery.
    • Early biomarkers of joint damage in rheumatoid and psoriatic arthritis.

      Mc Ardle, Angela; Flatley, Brian; Pennington, Stephen R; FitzGerald, Oliver (Springer, 2015)
      Joint destruction, as evidenced by radiographic findings, is a significant problem for patients suffering from rheumatoid arthritis and psoriatic arthritis. Inherently irreversible and frequently progressive, the process of joint damage begins at and even before the clinical onset of disease. However, rheumatoid and psoriatic arthropathies are heterogeneous in nature and not all patients progress to joint damage. It is therefore important to identify patients susceptible to joint destruction in order to initiate more aggressive treatment as soon as possible and thereby potentially prevent irreversible joint damage. At the same time, the high cost and potential side effects associated with aggressive treatment mean it is also important not to over treat patients and especially those who, even if left untreated, would not progress to joint destruction. It is therefore clear that a protein biomarker signature that could predict joint damage at an early stage would support more informed clinical decisions on the most appropriate treatment regimens for individual patients. Although many candidate biomarkers for rheumatoid and psoriatic arthritis have been reported in the literature, relatively few have reached clinical use and as a consequence the number of prognostic biomarkers used in rheumatology has remained relatively static for several years. It has become evident that a significant challenge in the transition of biomarker candidates to clinical diagnostic assays lies in the development of suitably robust biomarker assays, especially multiplexed assays, and their clinical validation in appropriate patient sample cohorts. Recent developments in mass spectrometry-based targeted quantitative protein measurements have transformed our ability to rapidly develop multiplexed protein biomarker assays. These advances are likely to have a significant impact on the validation of biomarkers in the future. In this review, we have comprehensively compiled a list of candidate biomarkers in rheumatoid and psoriatic arthritis, evaluated the evidence for their potential as biomarkers of bone (joint) damage, and outlined how mass spectrometry-based targeted and multiplexed measurement of candidate biomarker proteins is likely to accelerate their clinical validation and the development of clinical diagnostic tests.
    • Early diagnosis of bilateral sub-deltoid bursitis using clinic-based ultrasonography in a patient receiving infliximab therapy for ulcerative pouchitis.

      Veerappan, S G; Moinuddin, G; Kennedy, M; O'Morain, C A; Kane, D; Department of Gastroenterology, Adelaide & Meath Hospital, Tallaght, Dublin 24, Republic of Ireland. sveerappan@rcsi.ie (2010-12)
      Infliximab, a monoclonal chimeric antibody to tumour necrosis factor (TNF)α, is a novel therapy used in the management of chronic refractory pouchitis that is unresponsive to conventional medical therapy.
    • Early discharge care with ongoing follow-up support may reduce hospital readmissions in COPD.

      Lawlor, Maria; Kealy, Sinead; Agnew, Michelle; Korn, Bettina; Quinn, Jennifer; Cassidy, Ciara; Silke, Bernard; O'Connell, Finbarr; O'Donnell, Rory; Department of Respiratory Medicine, CResT Directorate, St. James' Hospital,, Dublin 8, Ireland. (2012-02-01)
      BACKGROUND: Early discharge care and self-management education, although effective in the management of chronic obstructive pulmonary disease (COPD), do not typically reduce hospital re-admission rates for exacerbations of the disease. We hypothesized that a respiratory outreach programme that comprises early discharge care followed by continued rapid-access out-patient support would reduce the need for hospital readmission in these patients. METHODS: Two hundred and forty-six patients, acutely admitted with exacerbations of COPD, were recruited to the respiratory outreach programme that included early discharge care, follow-up education, telephone support and rapid future access to respiratory out-patient clinics. Sixty of these patients received self-management education also. Emergency department presentations and admission rates were compared at six and 12 months after, compared to prior to, participation in the programme for the same patient cohort. RESULTS: The frequency of both emergency department presentations and hospital admissions was significantly reduced after participation in the programme. CONCLUSIONS: Provision of a respiratory outreach service that includes early discharge care, followed by education, telephone support and ongoing rapid access to out-patient clinics is associated with reduced readmission rates in COPD patients.
    • Early experience in laparoscopic colectomy for refractory colitis in children

      Stephens, L; Gillick, J (Irish Medical Journal, 2013-01)
      There is limited literature endorsing the laparoscopic approach for the treatment of refractory colitis in children. We report our experiences of paediatric laparoscopic colectomies performed for ulcerative colitis. A retrospective review over a three year period was undertaken. Operative time, length of stay, post-operative analgesia, time to commencement of diet, and complications were recorded. Nine laparoscopic colectomies were performed. Median operative time was 320 minutes (range â 240-475). Mean time to commencement of full diet was 3.9 days (range 2-8). Median length of stay was 6 days (range - 5-16). In our experience, laparoscopic colectomy in children is a feasible and superior method to open colectomy and in our opinion, facilitates further restorative procedures and will become the default method of treatment in the near future.
    • Early experience of a fall and fracture prevention clinic at Mayo General Hospital.

      Hanley, A; Ali, M T; Murphy, J; Beaumont Hospital, Beaumont, Dublin 9, Ireland. alanhanley@gmail.com (2010-06)
      Falls in the elderly are a significant public health problem. Previous studies have shown that most falls are multifactorial and an efficacious way of reducing the risk of falling is provided by a falls clinic.
    • Early fetal anatomical sonography.

      Donnelly, Jennifer C; Malone, Fergal D; Royal College of Surgeons in Ireland, Rotunda Hospital, Parnell Square, Dublin, Ireland. jenniferdonnelly@rcsi.ie (2012-10)
      Over the past decade, prenatal screening and diagnosis has moved from the second into the first trimester, with aneuploidy screening becoming both feasible and effective. With vast improvements in ultrasound technology, sonologists can now image the fetus in greater detail at all gestational ages. In the hands of experienced sonographers, anatomic surveys between 11 and 14 weeks can be carried out with good visualisation rates of many structures. It is important to be familiar with the normal development of the embryo and fetus, and to be aware of the major anatomical landmarks whose absence or presence may be deemed normal or abnormal depending on the gestational age. Some structural abnormalities will nearly always be detected, some will never be and some are potentially detectable depending on a number of factors.
    • Early formula feeding practices and their potential contribution to later obesity risk

      Tarrant, R C; Sheridan-Pereira, M; Younger, K M; Coombe Women and Infants University Hospital, Dublin Institute of Technology (Archives of Disease in Childhood, 2013-01-02)
      Background and Aims: Early feeding practices, including early introduction to solid foods and overfeeding, are known risk factors for childhood obesity. This study aimed to assess maternal formula feeding practices and infant formula feeding patterns, factors that are known to potentially contribute to later obesity risk. Methods: This prospective observational study involved the recruitment and follow-up of 450 eligible mother-infant pairs to 6 weeks postpartum. Data related to formula milk consumption patterns, formula type/brand changing, additions of solid foods to bottle feeds were examined, and available infant weight measurements at 6 weeks recorded. Results: In total, 368 (81.8%) mothers provided any formula milk to their infants at 6 weeks; of these, 14 (3.8%) reported to adding solid foods to their infant’s bottle feeds. Almost 50% of formula feeding mothers (n = 181) reported to changing their infant’s formula type/brand at least once during the first 6 weeks, mainly due to increased hunger and feeding frequency (2-3 hourly) (54.8%). Where 6 week infant weight measurements were available (n = 184), a mean of 205ml (SD 45ml) of formula milk/kilogram body weight/day was consumed by these infants. Conclusion: Several formula feeding practices with potential implications for later obesity risk were identified in this study including premature introduction to solids (≤ 6 weeks) and consumption of excessive formula milk volumes at 6 weeks relative to infant feeding guidelines. Early provision of recommended feeding guidelines including specific advice on age-appropriate milk volumes to parents who formula feed should be considered in obesity prevention programmes.
    • Early intervention and management of adrenal insufficiency in children.

      Moloney, Sinéad; Dowling, Maura; Children's University Hospital, Dublin, Ireland. sinead.moloney@cuh.ie (2012-09)
      The endocrine disorder adrenal insufficiency includes inadequate production of the steroid hormone cortisol. This results in poor physiological responses to illness, trauma or other stressors and risk of adrenal crisis. Management is based on administration of hydrocortisone. It is important to avoid under- or over-treatment and increase the dosage during times of physiological stress. To reduce morbidity, hospital admissions and mortality, the education and empowerment of parents and carers, and prompt intervention when necessary are essential. A steroid therapy card for adrenal insufficiency containing personal information on a patient's condition was developed for use by families and their specialist centres.
    • Early interventions for people with psychotic disorders

      Power, P; McGorry, PD; St. Patrick's University Hospital, Dublin (Oxford University Press, 2011)
    • Early life adversity is associated with brain changes in subjects at family risk for depression.

      Carballedo, Angela; Lisiecka, Danutia; Fagan, Andrew; Saleh, Karim; Ferguson, Yolande; Connolly, Gerard; Meaney, James; Frodl, Thomas; Department of Psychiatry, Institute of Neuroscience, Adelaide and Meath Hospital incorporating the National Children's Hospital (AMNCH), St. James's Hospital and Centre of Advanced Medical Imaging (CAMI), University Dublin, Trinity College, Ireland. (2012-12)
      The interplay of genetic and early environmental factors is recognized as an important factor in the aetiology of major depressive disorder (MDD). The aim of the present study was to examine whether reduced volume of hippocampus and frontal brain regions involved in emotional regulation are already present in unaffected healthy individuals at genetic risk of suffering MDD and to investigate whether early life adversity is a relevant factor interacting with these reduced brain structures.
    • Early mortality in systemic vasculitis: relative contribution of adverse events and active vasculitis

      Little, M. A.; Nightingale, P.; Verburgh, C. A.; Hauser, T.; De Groot, K.; Savage, C.; Jayne, D.; Harper, L. (Annals of the Rheumatic Diseases, 2010-06)
    • Early Onset Neonatal E.Coli Sepsis

      O’Rahelly, M.; Smith, A.; Drew, R.; McCallion, N. (Irish Medical Journal, 2019-02)
      Neonatal sepsis is a major cause of neonatal morbidity and mortality in term and preterm infants. The timely identification of infants at risk of infection is of particular importance in the vulnerable preterm group1 and is a major focus of microbiological research in the Rotunda Hospital. E.coli accounts for approximately 14.1% of early onset sepsis, i.e. sepsis before 72 hours of age in our centre. E.coli is the second most common pathogen, along with coagulase negative Staphylococcus, after group B Streptococcus (GBS)2.
    • Early pregnancy azathioprine use and pregnancy outcomes.

      Cleary, Brian J; Kallen, Bengt; Pharmacy Department, Coombe Women and Infants University Hospital, Dublin 8,, Ireland. bcleary@coombe.ie (2012-02-01)
      BACKGROUND: Azathioprine (AZA) is used during pregnancy by women with inflammatory bowel disease (IBD), other autoimmune disorders, malignancy, and organ transplantation. Previous studies have demonstrated potential risks. METHODS: The Swedish Medical Birth Register was used to identify 476 women who reported the use of AZA in early pregnancy. The effect of AZA exposure on pregnancy outcomes was studied after adjustment for maternal characteristics that could act as confounders. RESULTS: The most common indication for AZA use was IBD. The rate of congenital malformations was 6.2% in the AZA group and 4.7% among all infants born (adjusted OR: 1.41, 95% CI: 0.98-2.04). An association between early pregnancy AZA exposure and ventricular/atrial septal defects was found (adjusted OR: 3.18, 95% CI: 1.45-6.04). Exposed infants were also more likely to be preterm, to weigh <2500 gm, and to be small for gestational age compared to all infants born. This effect remained for preterm birth and low birth weight when infants of women with IBD but without AZA exposure were used as a comparison group. A trend toward an increased risk of congenital malformations was found among infants of women with IBD using AZA compared to women with IBD not using AZA (adjusted OR: 1.42, 95% CI: 0.93-2.18). CONCLUSIONS: Infants exposed to AZA in early pregnancy may be at a moderately increased risk of congenital malformations, specifically ventricular/atrial septal defects. There is also an increased risk of growth restriction and preterm delivery. These associations may be confounded by the severity of maternal illness.
    • Early pregnancy maternal urinary metabolomic profile to predict fetal adiposity and macrosomia

      Walsh, J; Wallace, M; Brennan, L; Mahony, R; Foley, M; McAuliffe, F (American Journal of Obstetrics and Gynaecology, 2012-01)
    • Early pregnancy ultrasound and management – effect of a multifaceted training on physician knowledge

      O’Leary, B; Khalid, A; Higgins, M (2016-02)
      Vaginal bleeding is a common event in early pregnancy, with 20-40% of pregnancies affected. Prompt diagnosis and management of bleeding is important, both to reduce morbidity and to avoid excessive emotional distress. This was a prospective study of an educational programme aimed at Obstetrics and Gynaecology BST trainees in the National Maternity Hospital, Dublin. The educational programme consisted of didactic lectures, and simulation and practical sessions. A questionnaire reviewing early pregnancy complications was used to assess participant knowledge. Six trainees participated in the programme, with five (83%) answering the questionnaire. The pre-education questionnaire showed a generally poor level of knowledge of early pregnancy complications with 8/50 (16%) questions answered correctly. Following the educational intervention there was a statistically significant increase in participant knowledge with 45/50 (90%) questions answered correctly. A significant increase in participant knowledge of early pregnancy complications followed our multifaceted educational programme. Study limitations exist, however we have shown the potential value of our educational programme.
    • Early rise in C-reactive protein is a marker for infective complications in laparoscopic colorectal surgery.

      Nason, Gregory J; Barry, Brian D; Obinwa, Obinna; McMacken, Eamon; Rajaretnam, Nigel S; Neary, Paul C (2014-02)
      Infective complications are the most significant cause of morbidity associated with elective colorectal surgery. It can sometimes be difficult to differentiate complications from the normal postoperative course. C-reactive protein (CRP) is an acute phase reactant which has been reported to be predictive of postoperative infective complications.