• Quality assurance measures in rectal cancer: caveat utilitor.

      Kennelly, R; Winter, D C; Institute for Clinical Outcomes Research and Education (ICORE), St Vincent's, University Hospital, Dublin 4, Ireland. kennellyrory@yahoo.ie (2012-02-01)
    • Quality assurance: The 10-Group Classification System (Robson classification), induction of labor, and cesarean delivery.

      Robson, Michael; Murphy, Martina; Byrne, Fionnuala (Elsevier, 2015-10)
      Quality assurance in labor and delivery is needed. The method must be simple and consistent, and be of universal value. It needs to be clinically relevant, robust, and prospective, and must incorporate epidemiological variables. The 10-Group Classification System (TGCS) is a simple method providing a common starting point for further detailed analysis within which all perinatal events and outcomes can be measured and compared. The system is demonstrated in the present paper using data for 2013 from the National Maternity Hospital in Dublin, Ireland. Interpretation of the classification can be easily taught. The standard table can provide much insight into the philosophy of care in the population of women studied and also provide information on data quality. With standardization of audit of events and outcomes, any differences in either sizes of groups, events or outcomes can be explained only by poor data collection, significant epidemiological variables, or differences in practice. In April 2015, WHO proposed that the TGCS (also known as the Robson classification) is used as a global standard for assessing, monitoring, and comparing cesarean delivery rates within and between healthcare facilities.
    • A quality improvement approach to reducing the caesarean section surgical site infection rate in a regional hospital

      O’ Hanlon, M; McKenna, C; Carton, E; Diviney, D; Costello, MR; O’Sullivan, L; Fitzsimons, J; Toland, L; Dornikova, G; Curran, R; et al. (Iris Medical Journal, 2016-09)
      Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30 day post-discharge SSI programme for caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced, however the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.
    • A Quality Improvement Approach to Reducing the Caesarean section Surgical Site Infection Rate in a Regional Hospital

      O’ Hanlon, M; McKenna C; Carton, E; Diviney, D; Costello, MR; O’Sullivan, L; Fitzsimons, J; Toland, L; Dornikova, G; Curran, R; et al. (Irish Medical Journal, 2016-09)
      Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.
    • Quality Improvement of Clinical Handover in a Liaison Psychiatry Department: A Three-Phase Audit

      Alexander, L; Bechan, N; Brady, S; Douglas, L; Moore, S; Shelley, R (Irish Medical Journal, 2018-06)
      Clinical handover has been identified as a period of high risk in healthcare, with increased incidence of adverse outcomes and near-misses. The purpose of handover is to communicate relevant information between medical professionals, with emphasis on completing management tasks and preventing patients from ‘falling through the cracks’1. Poor handover practices contribute to catastrophic but avoidable adverse events in healthcare. In Ireland, one such high profile incident has been a particular catalyst in the development of comprehensive handover guidelines in maternity settings2. Other specialities have yet to follow suit and there remains a dearth of guidance on handover practices, particularly guidance that can be applied to highly specialised and logistically unique areas, such as psychiatry
    • Quality measures in breast cancer surgery

      Barry, M; Hill, ADK (Irish Medical Journal (IMJ), 2012-07)
      Abstract
    • Quality of 'commercial-off-the-shelf' (COTS) monitors displaying dental radiographs

      McIlgorm, D. J.; Lawinski, C.; Ng, S.; McNulty, J. P. (2013-12-06)
    • Quality of care in the management of major obstetric haemorrhage.

      Johnson, S N; Khalid, S; Varadkar, S; Fleming, J; Fanning, R; Flynn, C M; Byrne, B; Coombe Women and Infant's University Hospital, Dolphin's Barn, Dublin 8. (2012-02-01)
      Substandard care is reported to occur in a large number of cases of major obstetric haemorrhage (MOH). A prospective audit was carried out by a multidisciplinary team at our hospital over a one year period to assess the quality of care (QOC) delivered to women experiencing MOH. MOH was defined according to criteria outlined in the Scottish Audit of Maternal Morbidity (SAMM). 31 cases were identified yielding an incidence of 3.5/1000 deliveries. The predominant causes were uterine atony 11 (35.4%), retained products of conception 6 (19.3%) and placenta praevia/accreta 6 (19.3%). Excellent initial resuscitation and monitoring was noted with a high level of senior staff input. Indicators of QOC compared favourably with the SAMM. Areas for improvement were identified. This pilot study demonstrates the feasibility of detailed prospective data collection in MOH in a busy Dublin obstetric unit with a view to developing a national audit. Standardization of definitions allows for international comparisons.
    • Quality of colonoscopy performance among gastroenterology and surgical trainees: a need for common training standards for all trainees?

      Leyden, J E; Doherty, G A; Hanley, A; McNamara, D A; Shields, C; Leader, M; Murray, F E; Patchett, S E; Harewood, G C; GI Unit, Mater Misericordiae University Hospital, Dublin, Ireland. jleyden@mater.ie (2011-11)
      Cecal intubation and polyp detection rates are objective measures of colonoscopy performance. Minimum cecal intubation rates greater than 90% have been endorsed by the American Society for Gastrointestinal Endoscopy (ASGE) and the Joint Advisory Group (JAG) UK. Performance data for medical and surgical trainee endoscopists are limited, and we used endoscopy quality parameters to compare these two groups.
    • Quality of education at multidisciplinary case conferences in psychiatry.

      Naughton, Marie; MacSuibhne, Seamus; Callanan, Ian; Guerandel, Allys; Malone, Kevin; Department of Psychiatry, St Vincent's University Hospital, Dublin, Ireland., marie.naughton@ucd.ie (2012-02-01)
      PURPOSE: A large Dublin-based teaching hospital facilitates a weekly Psychiatric Case Presentation meeting, which is relatively unique in medicine and even in psychiatry, in that there is a large variety of attendees from various multidisciplinary groups: consultant psychiatrists, psychiatric trainees, nurses, psychologists and psychoanalytic psychotherapists, occupational therapists, social workers and pastoral care staff. The aim of this audit is to assess the quality of education for members of different disciplines at these meetings, and to highlight the differing learning needs of the attendees. DESIGN/METHODOLOGY/APPROACH: Group-structured assessments and Likert scale questionnaires were used to identify what attendees thought were educational and what needed to be improved. FINDINGS: Overall, the case conference is educationally worthwhile but there were several areas of dissatisfaction. Some felt that the case conference was overly medical in its orientation and that there was excessive medical jargon. The seating arrangements were not conducive to group discussion. Consultants and psychiatric trainees felt that the quality of the clinical presentations could be improved. Presentation skills teaching classes and topic-based classes would be useful inclusions. Feedback to the multidisciplinary group on the patients' progress and feedback to the patient is important. Changes were implemented in areas of dissatisfaction, and these changes evaluated. ORIGINALITY/VALUE: The educational qualities of multidisciplinary Case Conferences need to be constantly evaluated to ensure that the learning needs of the different disciplines who attend are being met.
    • Quality of end-of-life care for dementia patients during acute hospital admission: a retrospective study in Ireland.

      Afzal, Neelam; Buhagiar, Kurt; Flood, Joanne; Cosgrave, Mary; Department of Psychiatry, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. (2011-04-05)
      To examine the quality of end-of-life care received by patients with and without dementia on acute medical wards during their final hospitalization.
    • The quality of information on three common ENT procedures on the Internet.

      Department of Otolaryngology, Head and Neck Surgery, Beaumont Hospital, Beaumont , Road, Dublin 9, Ireland, kjeyanthi@gmail.com. (2012-02-01)
      BACKGROUND: The Internet hosts a large number of high-quality medical resources and poses seemingly endless opportunities to inform, teach, and connect professionals and patients alike. However, it is difficult for the lay person to distinguish accurate from inaccurate information. AIM: This study was undertaken in an attempt to assess the quality of information on otolaryngology available on the Internet. METHODS: Sixty appropriate websites, using search engines Yahoo and Google, were evaluated for completeness and accuracy using three commonly performed ENT operations: tonsillectomy (T), septoplasty (S), and myringoplasty (M). RESULTS: A total of 60 websites were evaluated (NT = 20, NM = 20, NS = 20). A total of 86.7% targeted lay population and 13.3% targeted the medical professionals. 35% of the sites included all critical information that patients should know prior to undergoing surgery and over 94% of these were found to contain no inaccuracies. Negative bias towards medical profession was detected in 3% of websites. CONCLUSIONS: In the current climate, with informed consent being of profound importance, the Internet represents a useful tool for both patients and surgeons.
    • Quality of life after iatrogenic bile duct injury: a case control study.

      Hogan, Aisling M; Hoti, Emir; Winter, Desmond C; Ridgway, Paul F; Maguire, Donal; Geoghegan, Justin G; Traynor, Oscar; St. Vincent's University Hospital, Dublin, Ireland. (2012-02-01)
      OBJECTIVE: To compare quality of life (QOL) of patients following iatrogenic bile duct injuries (BDI) to matched controls. SUMMARY BACKGROUND DATA: BDI complicate approximately 0.3% of all cholecystectomy procedures. The literature regarding impact on quality of life is conflicted as assessment using clinical determinants alone is insufficient. METHODS: The medical outcomes study short form 36 (SF-36), a sensitive tool for quantification of life quality outcome, was used. The study group of iatrogenic BDI was compared with an age- and sex-matched group who underwent uncomplicated cholecystectomy. Telephone questionnaire using the SF-36 quality of life tool was administered to both groups at a median postoperative time of 12 years 8 months (range, 2 months -20 years). RESULTS: Seventy-eight patients were referred with BDI but due to mortality (n = 10) and unavailability (n = 6) 62 participated. The age- and sex-matched control cohort had undergone uncomplicated cholecystectomy (n = 62). Comparison between groups revealed that 7 of 8 variables examined were statistically similar to those of the control group (physical functioning, role physical, bodily pain, general health perceptions, vitality and social functioning, and mental health index). Mean role emotional scores were slightly worse in the BDI group (46 vs. 50) but the significance was borderline (P = 0.045). Subgroup analysis by method of intervention for BDI did not demonstrate significant differences. CONCLUSION: Quality of life of surviving patients following BDI compares favorably to that after uncomplicated laparoscopic cholecystectomy.
    • Quality of life in individuals with chronic foot conditions: a cross sectional observational study.

      Groarke, Patrick; Galvin, Rose; Kelly, John; Stephens, Michael M; National Orthopaedic Hospital, Cappagh, Finglas, Dublin 9, Ireland. patrick groarke@yahoo.co.uk (Foot, 2012-06)
      Chronic foot conditions have been reported to be a significant cause of impairment and disability to individuals affected. However, studies to date have particularly focussed on patient satisfaction with outcomes following surgery.
    • Quality of life predicts outcome in a heart failure disease management program.

      O'Loughlin, Christina; Murphy, Niamh F; Conlon, Carmel; O'Donovan, Aoife; Ledwidge, Mark; McDonald, Ken; Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland. (2012-02-01)
      BACKGROUND: Chronic heart failure (HF) is associated with a poor Health Related Quality of Life (HRQoL). HRQoL has been shown to be a predictor of HF outcomes however, variability in the study designs make it difficult to apply these findings to a clinical setting. The aim of this study was to establish if HRQoL is a predictor of long-term mortality and morbidity in HF patients followed-up in a disease management program (DMP) and if a HRQoL instrument could be applied to aid in identifying high-risk patients within a clinical context. METHODS: This is a retrospective analysis of HF patients attending a DMP with 18+/-9 months follow-up. Clinical and biochemical parameters were recorded on discharge from index HF admission and HRQoL measures were recorded at 2 weeks post index admission. RESULTS: 225 patients were enrolled into the study (mean age=69+/-12 years, male=61%, and 78%=systolic HF). In multivariable analysis, all dimensions of HRQoL (measured by the Minnesota Living with HF Questionnaire) were independent predictors of both mortality and readmissions particularly in patients <80 years. A significant interaction between HRQoL and age (Total((HRQoL))age: p<0.001) indicated that the association of HRQoL with outcomes diminished as age increased. CONCLUSIONS: These data demonstrate that HRQoL is a predictor of outcome in HF patients managed in a DMP. Younger patients (<65 years) with a Total HRQoL score of > or =50 are at high risk of an adverse outcome. In older patients > or =80 years HRQoL is not useful in predicting outcome.
    • Quantification and evaluation of the role of antielastin autoantibodies in the emphysematous lung.

      Low, Teck Boon; Greene, Catherine M; O'Neill, Shane J; McElvaney, Noel G; Respiratory Research Division, Department of Medicine, Royal College of Surgeons , in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland. (2012-02-01)
      Chronic obstructive pulmonary disease (COPD) may be an autoimmune disease. Smoking causes an imbalance of proteases and antiproteases in the lung resulting in the generation of elastin peptides that can potentially act as autoantigens. Similar to COPD, Z alpha-1 antitrypsin deficiency (Z-A1ATD) and cystic fibrosis (CF) are associated with impaired pulmonary antiprotease defences leading to unopposed protease activity. Here, we show that there is a trend towards higher bronchoalveolar lavage fluid (BALF) antielastin antibody levels in COPD and Z-A1ATD and significantly lower levels in CF compared to control BALF; the lower levels in CF are due to the degradation of these antibodies by neutrophil elastase. We also provide evidence that these autoantibodies have the potential to induce T cell proliferation in the emphysematous lung. This study highlights that antielastin antibodies are tissue specific, can be detected at elevated levels in COPD and Z-A1ATD BALF despite their being no differences in their levels in plasma compared to controls, and suggests a therapeutic role for agents targeting these autoantibodies in the lungs.
    • Quantification of mitral regurgitation on cardiac computed tomography: comparison with qualitative and quantitative echocardiographic parameters.

      Arnous, Samer; Killeen, Ronan P; Martos, Ramon; Quinn, Martin; McDonald, Kenneth; Dodd, Jonathan Dermot; Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland. (2012-02-01)
      PURPOSE: To assess whether cardiac computed tomographic angiography (CCTA) can quantify the severity of chronic mitral regurgitation (MR) compared to qualitative and quantitative echocardiographic parameters. MATERIALS AND METHODS: Cardiac computed tomographic angiography was performed in 23 patients (mean +/- SD age, 63 +/- 16 years; range, 24-86 years) with MR and 20 patients without MR (controls) as determined by transthoracic echocardiography. Multiphasic reconstructions (20 data sets reconstructed at 5% increments of the electrocardiographic gated R-R interval) were used to analyze the mitral valve. Using CCTA planimetry, 2 readers measured the regurgitant mitral orifice area (CCTA ROA) during systole. A qualitative echocardiographic assessment of severity of MR was made by visual assessment of the length of the regurgitant jet. Quantitative echocardiographic measurements included the vena contracta, proximal isovelocity surface area, regurgitant volume, and estimated regurgitant orifice (ERO). Comparisons were performed using the independent t test, and correlations were assessed using the Spearman rank test. RESULTS: All controls and the patients with MR were correctly identified by CCTA. For patients with mild, moderate, or severe MR, mean +/- SD EROs were 0.16 +/- 0.03, 0.31 +/- 0.08, and 0.52 +/- 0.03 cm(2) (P < 0.0001) compared with mean +/- SD CCTA ROAs 0.09 +/- 0.05, 0.30 +/- 0.04, and 0.97 +/- 0.26 cm(2) (P < 0.0001), respectively. When echocardiographic measurements were graded qualitatively as mild, moderate, or severe, strong correlations were seen with CCTA ROA (R = 0.89; P < 0.001). When echocardiographic measurements were graded quantitatively, the vena contracta and the ERO showed modest correlations with CCTA ROA (0.48 and 0.50; P < 0.05 for both). Neither the proximal isovelocity surface area nor the regurgitant volume demonstrated significant correlations with CCTA ROA. CONCLUSIONS: Single-source 64-slice CCTA provides a strong agreement with qualitative echocardiographic parameters but only a moderate correlation with quantitative echocardiographic parameters of chronic MR. Cardiac computed tomographic angiography slightly overestimates mild MR while slightly underestimating severe MR.
    • Quantification of organ motion during chemoradiotherapy of rectal cancer using cone-beam computed tomography.

      Chong, Irene; Hawkins, Maria; Hansen, Vibeke; Thomas, Karen; McNair, Helen; O'Neill, Brian; Aitken, Alexandra; Tait, Diana; Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, United Kingdom. (Elsevier, 2011-11-15)
      There has been no previously published data related to the quantification of rectal motion using cone-beam computed tomography (CBCT) during standard conformal long-course chemoradiotherapy. The purpose of the present study was to quantify the interfractional changes in rectal movement and dimensions and rectal and bladder volume using CBCT and to quantify the bony anatomy displacements to calculate the margins required to account for systematic (Σ) and random (σ) setup errors.
    • A quantitative assessment of changing trends in internet usage for cancer information.

      McHugh, Seamus M; Corrigan, Mark; Morney, Nora; Sheikh, Athar; Lehane, Elaine; Hill, Arnold D K; Department of Surgery, Royal College of Surgeons in Ireland, and Beaumont Hospital, Dublin 2, Ireland. seamusmchugh@rcsi.ie (2011-02)
      The internet is an important source of healthcare information. To date, assessment of its use as a source of oncologic information has been restricted to retrospective surveys.