• S. mutans exacerbates base-metal dental casting alloy toxicity

      McGinley E; Moran GP; Dowling AH; Fleming GJP (Journal of Dental Research, 2013)
    • Sacral nerve stimulation increases activation of the primary somatosensory cortex by anal canal stimulation in an experimental model.

      Griffin, K M; Pickering, M; O'Herlihy, C; O'Connell, P R; Jones, J F X; Health Sciences Centre, School of Medicine and Medical Sciences, University College Dublin, Ireland. (The British journal of surgery, 2011-08)
      Sacral and posterior tibial nerve stimulation may be used to treat faecal incontinence; however, the mechanism of action is unknown. The aim of this study was to establish whether sensory activation of the cerebral cortex by anal canal stimulation was increased by peripheral neuromodulation.
    • Safe and judicious paediatric psychotropic prescribing

      McNicholas, F; Orakwue, N (Irish Medical Journal (IMJ), 2014-02)
      Psychotropic medications are now a well-established and evidenced based treatment for increasing number of child mental health disorders prescribed at increasing frequencies and by increasing number of professional groups. Cliniciansâ perceived levels of competence and standardised monitoring lag behind prescribing practice and should be addressed by regular continuous professional development. A study specific questionnaire on psychotropic prescribing practice in children was mailed to all child psychiatrists and paediatricians working in Ireland and GPs from a selected Dublin CAMHS catchment area. Of the 116 who replied, (39% response rate), antidepressants (58.7%), antipsychotics (57.1%) and ADHD medications (36.5%) were most commonly prescribed. Results suggest increasing trends of monitoring amongst Irish clinicians over time, but with some lack of specificity. Commensurate with the wish of clinicians, ongoing training in paediatric psychopharmacology is considered essential in order to benefit from the increasing advances in pharmacology.
    • Safe compounding; it’s in your hands

      Burke, Catriona; Murphy, Dermot; Flynn, Elaine; Garvey, E; Midland Regional Hospital, Tullamore (Midland Regional Hospital, Tullamore, 2012-09-21)
    • Safe surgery: how accurate are we at predicting intra-operative blood loss?

      Surgical Registrar Medical Student Consultant Colorectal Surgeon, Department of, Surgery, Beaumont Hospital, Dublin, Ireland. (2012-02-01)
      Introduction Preoperative estimation of intra-operative blood loss by both anaesthetist and operating surgeon is a criterion of the World Health Organization's surgical safety checklist. The checklist requires specific preoperative planning when anticipated blood loss is greater than 500 mL. The aim of this study was to assess the accuracy of surgeons and anaesthetists at predicting intra-operative blood loss. Methods A 6-week prospective study of intermediate and major operations in an academic medical centre was performed. An independent observer interviewed surgical and anaesthetic consultants and registrars, preoperatively asking each to predict expected blood loss in millilitre. Intra-operative blood loss was measured and compared with these predictions. Parameters including the use of anticoagulation and anti-platelet therapy as well as intra-operative hypothermia and hypotension were recorded. Results One hundred sixty-eight operations were included in the study, including 142 elective and 26 emergency operations. Blood loss was predicted to within 500 mL of measured blood loss in 89% of cases. Consultant surgeons tended to underestimate blood loss, doing so in 43% of all cases, while consultant anaesthetists were more likely to overestimate (60% of all operations). Twelve patients (7%) had underestimation of blood loss of more than 500 mL by both surgeon and anaesthetist. Thirty per cent (n = 6/20) of patients requiring transfusion of a blood product within 24 hours of surgery had blood loss underestimated by more than 500 mL by both surgeon and anaesthetist. There was no significant difference in prediction between patients on anti-platelet or anticoagulation therapy preoperatively and those not on the said therapies. Conclusion Predicted intra-operative blood loss was within 500 mL of measured blood loss in 89% of operations. In 30% of patients who ultimately receive a blood transfusion, both the surgeon and anaesthetist significantly underestimate the risk of blood loss by greater than 500 mL. Theatre staff must be aware that 1 in 14 patients undergoing intermediate or major surgery will have an unexpected blood loss exceeding 500 mL and so robust policies to identify and manage such circumstances should be in place to improve patient safety.
    • Safety comes first: Are doctors attentive enough to their initial clinical assessment notes?

      Daly, C; Callanan, I; Butler, M (Irish Medical Journal (IMJ), 2013-12)
      Accurate hospital admission/initial history and physical examination [H&P] notes are vital to support patient care. We aimed to assess the quality of H&P notes and to compare medical/surgical, and inpatient/outpatient H&P notes. A cross-sectional study examined 154 initial H&P notes for the adherence to a standard protocol in a tertiary referral hospital. 134 doctors (87.1%) adhered to the correct layout in accordance with the standard. Only 77 doctors (50%) recorded the names of the patientâ s medications. 106 (68.8%) documented the allergy status. Six doctors (3.9%) omitted an objective record of their own identity. Surgeons were superior at recording admission type (p=0.0001) and past surgical history (p=0.002) only. The data in this study show that the standard of completeness of the H&P documentation among doctors is suboptimal. We recommend the introduction of a standardised H&P template to reduce errors
    • Safety of Adalimumab Dosed Every Week and Every Other Week: Focus on Patients with Hidradenitis Suppurativa or Psoriasis.

      Ryan, Caitriona; Sobell, Jeffrey M; Leonardi, Craig L; Lynde, Charles W; Karunaratne, Mahinda; Valdecantos, Wendell C; Hendrickson, Barbara A (American Journal of Clinical Dermatology, 2018-06-01)
      Adalimumab is approved for the treatment of hidradenitis suppurativa (HS), plaque psoriasis, and other inflammatory conditions. Our objective was to examine the safety of adalimumab administered every other week (EOW) and every week (EW) in patients with HS and psoriasis and to investigate informative data from non-dermatologic indications. The safety of adalimumab 40-mg EOW versus EW dosing was examined during placebo-controlled and open-label study periods in patients with HS (three studies), psoriasis (two studies), Crohn's disease (six studies), ulcerative colitis (three studies), and rheumatoid arthritis (one study). No new safety risks or increased rates of particular adverse events (AEs) were identified with EW dosing. In patients with HS or psoriasis, the overall safety of adalimumab 40-mg EOW and EW was generally comparable. In studies of adalimumab for non-dermatologic indications, including Crohn's disease, ulcerative colitis, and rheumatoid arthritis, the overall AE rates were similar for EW and EOW dosing.
    • Safety of atrial fibrillation ablation with novel multi-electrode array catheters on uninterrupted anticoagulation-a single-center experience.

      Hayes, Christopher Ruslan; Keane, David; Cardiac Arrhythmia Service, St Vincent's University Hospital, Elm Park, Dublin,, Ireland. chrisrushayes@doctors.org.uk (2012-02-01)
      INTRODUCTION: A recent single-center report indicated that the performance of atrial fibrillation ablation in patients on uninterrupted warfarin using a conventional deflectable tip electrode ablation catheter may be as safe as periprocedural discontinuation of warfarin and bridging with heparin. Novel multi-electrode array catheters for atrial fibrillation ablation are currently undergoing clinical evaluation. While offering the possibility of more rapid atrial fibrillation ablation, they are stiffer and necessitate the deployment of larger deflectable transseptal sheaths, and it remains to be determined if they increase the risk of cardiac perforation and vascular injury. Such potential risks would have implications for a strategy of uninterrupted periprocedural anticoagulation. METHOD AND RESULTS: We audited the safety outcomes of our atrial fibrillation ablation procedures using multi-electrode array ablation catheters in patients on uninterrupted warfarin (CHADS2 score>or=2) and in patients not on warfarin (uninterrupted aspirin). Two bleeding complications occurred in 49 patients on uninterrupted warfarin, both of which were managed successfully without longterm sequelae, and no bleeding complication occurred in 32 patients not on warfarin (uninterrupted aspirin). There were no thromboembolic events or other complication with either anticoagulant regimen. CONCLUSION: Despite the larger diameter and increased stiffness of multi-electrode array catheters and their deflectable transseptal sheaths, their use for catheter ablation in patients with atrial fibrillation on uninterrupted warfarin in this single-center experience does not appear to be unsafe, and thus, an adequately powered multicenter prospective randomized controlled trial should be considered.
    • Safety of grass pollen sublingual immunotherapy for allergic rhinitis in concomitant asthma

      Sahadevan, A; Cusack, R; Lane, SJ (2015-12)
      Seasonal allergic rhinitis (AR) occurs predominantly as a result of grass pollen allergy. Grass pollen sublingual immunotherapy (SLIT) has been proven effective in treating AR 1 . SLIT is currently licensed for use in AR with concomitant stable mild asthma. There is evidence that SLIT improves asthma control when primarily used to treat AR 2 . The aim was to assess the safety of SLIT in patients with severe seasonal allergic rhinitis who have co-existing stable mild asthma. The secondary aim was to determine whether asthma control improved post SLIT. There was no deterioration in asthma control after 6-36 months of SLIT. 27/30 (90%) patientsâ asthma control remained stable or indeed improved (p<0.021). Of this 15 (50%) patientsâ asthma improved. There was no statistically significant change in their asthma pharmacotherapy after SLIT (p=0.059). In conclusion, grass pollen SLIT is safe and can potentially treat dual allergic rhinitis- mild asthmatic patients.
    • Safety of therapeutic Hypothermia in post VF/VT Cardiac Arrest patients

      Riaz, A; Hieb, H; Foley, B; Mulvihill, N; Crean, P; Murphy, RT; Daly, C; Boyle, N (Irish Medical Journal, 2013-02)
    • A Salbutamol responsive myopathy

      Fitzpatrick, A; Walsh, R; Hardiman, O; McConville, J (2011-05)
      Background: Reversibility of weakness is rare in inherited muscle disease and suggests a channelopathy as the underlying pathology. Improvement in muscle strength after treatment with beta-adrenergic agonists has been documented in hyperkalaemic periodic paralysis and only very recently in the congenital myasthenic syndromes. The exact mechanism of action is not understood. Case description: Case A, the second youngest of 10 siblings from a non-consanguineous Irish kindred, presented at the age of 46 years with mild limb-girdle muscle weakness with no other symptoms and no demonstrable fatiguability. Three siblings were similarly affected (2/3 were examined, 1/3 died before examination from unrelated causes). Case B and C reported first symptoms aged 62 and 45 respectively. All 3 remained independently mobile with a waddling gait after follow up of between 11 and 25 years from first symptoms. Case A reported marked improvement in function after a short course of inhaled Salbutamol prescribed by his GP. On oral Salbutamol treatment limb-girdle strength returned to MRC grade 5, but deteriorated to MRC grade 4 when treatment was stopped. The other siblings showed similar response. Results: Initial investigation of cases A and B revealed slightly elevated creatinine kinase (CK: 307; CK:283) and some fibre atrophy and type II predominance on muscle biopsy. Case B showed 16% decrement on repetitive nerve stimulation but the others had no abnormality on neurophysiological examination. Homozygous c.1143dupC mutations in exon of the DOK7 gene were found in all three affected cases confirming a Dok-7 congenital myasthenic syndrome. Discussion: The Dok-7 CMS phenotype is that of a predominantly limb-girdle muscle weakness and a characteristic waddling gait; fatiguability may be very subtle and so these cases may be mistaken for congenital myopathy. The serendipitous prescription of Salbutamol was the clue to a myasthenic pathology in this kindred. Dok-7 CMS has been reported with adult onset but 62 years is the latest reported age at onset to date.
    • Sarcomatoid Carcinoma of the Prostate Presenting in a 44 Year Old

      Conroy, M; Greally, M; MacEneaney, O; O’Keane, C; McCaffrey, J; Mater Misericordiae University Hospital, Dublin (Irish Medical Journal, 2018-10)
      We present the case of a 44-year-old man diagnosed with metastatic sarcomatoid carcinoma of the prostate. The pathogenesis and optimal treatment of this rare and aggressive subtype of prostate cancer are not fully clear. The patient was managed using a multimodality approach of chemotherapy, hormonal blockade and radiation therapy, with palliative intent.
    • Satisfaction with inpatient treatment for first-episode psychosis among different ethnic groups: A report from the UK AeSOP study.

      Boydell, Jane; Morgan, Craig; Dutta, Rina; Jones, Barry; Alemseged, Fana; Dazzan, Paola; Morgan, Kevin; Doody, Gillian; Harrison, Glynn; Leff, Julian; et al. (2010-09-17)
      BACKGROUND: There is concern about the level of satisfaction with mental healthcare among minority ethnic patients in the UK, particularly as black patients have more compulsory admissions to hospital. AIMS: To determine and compare levels of satisfaction with mental healthcare between patients from different ethnic groups in a three-centre study of first-onset psychosis. METHOD: Data were collected from 216 patients with first-episode psychosis and 101 caregivers from South London, Nottingham and Bristol, using the Acute Services Study Questionnaire (Patient and Relative Version) and measures of sociodemographic variables and insight. RESULTS: No differences were found between ethnic groups in most domains of satisfaction tested individually, including items relating to treatment by ward staff and number of domains rated as satisfactory. However, logistic regression modelling (adjusting for age, gender, social class, diagnostic category and compulsion) showed that black Caribbean patients did not believe that they were receiving the right treatment and were less satisfied with medication than white patients. Black African patients were less satisfied with non-pharmacological treatments than white patients. These findings were not explained by lack of insight or compulsory treatment. CONCLUSIONS: The study found that black patients were less satisfied with specific aspects of treatment, particularly medication, but were equally satisfied with nursing and social care. Understanding the reasons behind this may improve the acceptability of psychiatric care to black minority ethnic groups.
    • Satisfaction with services following voluntary and involuntary admission.

      Smith, Damian; Roche, Eric; O'Loughlin, Kieran; Brennan, Daria; Madigan, Kevin; Lyne, John; Feeney, Larkin; O'Donoghue, Brian; Department of Psychiatry, St. Vincent's University Hospital , Elm Park, Dublin , Ireland . (2014-02)
      Service user perspectives are essential for the evaluation and development of mental health services. Service users expressing less satisfaction with services subsequently have poorer treatment outcomes.
    • Saturday night palsy or Sunday morning hangover? A case report of alcohol-induced Crush Syndrome.

      Devitt, Brian M; Baker, Joseph F; Ahmed, Motaz; Menzies, David; Synnott, Keith A; Department of Orthopaedic Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland. (2011-01)
      Saturday night palsy is a colloquial term given to brachial plexus injuries of the arm resulting from stretching or direct pressure against a firm object, often after alcohol or drug consumption. In most circumstances, this condition gives rise to a temporary plexopathy, which generally resolves. However, if the compression is severe and prolonged, a more grave form of this condition known as 'Crush Syndrome' may occur. Skeletal muscle injury, brought about by protracted immobilization, leads to muscle decay, causing rhabdomyolysis, which may in turn precipitate acute renal failure. This condition is potentially fatal and has an extremely high morbidity. The case presented below demonstrates the drastic consequences that can result following an episode of 'binge' drinking in a young man. What is most concerning is that this trend is increasing across society and cases like this may not be as rare in the future.
    • Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom.

      Cantwell, Roch; Clutton-Brock, Thomas; Cooper, Griselda; Dawson, Andrew; Drife, James; Garrod, Debbie; Harper, Ann; Hulbert, Diana; Lucas, Sebastian; McClure, John; et al. (BJOG : an international journal of obstetrics and gynaecology, 2011-03)
      In the triennium 2006-2008, 261 women in the UK died directly or indirectly related to pregnancy. The overall maternal mortality rate was 11.39 per 100,000 maternities. Direct deaths decreased from 6.24 per 100,000 maternities in 2003-2005 to 4.67 per 100,000 maternities in 2006–2008 (p = 0.02). This decline is predominantly due to the reduction in deaths from thromboembolism and, to a lesser extent, haemorrhage. For the first time there has been a reduction in the inequalities gap, with a significant decrease in maternal mortality rates among those living in the most deprived areas and those in the lowest socio-economic group. Despite a decline in the overall UK maternal mortality rate, there has been an increase in deaths related to genital tract sepsis, particularly from community acquired Group A streptococcal disease. The mortality rate related to sepsis increased from 0.85 deaths per 100,000 maternities in 2003-2005 to 1.13 deaths in 2006-2008, and sepsis is now the most common cause of Direct maternal death. Cardiac disease is the most common cause of Indirect death; the Indirect maternal mortality rate has not changed significantly since 2003-2005. This Confidential Enquiry identified substandard care in 70% of Direct deaths and 55% of Indirect deaths. Many of the identified avoidable factors remain the same as those identified in previous Enquiries. Recommendations for improving care have been developed and are highlighted in this report. Implementing the Top ten recommendations should be prioritised in order to ensure the overall UK maternal mortality rate continues to decline.
    • "Say BOO to the FLU!" Introduction of the Seasonal Influenza Peer Vaccination Programme in the Emergency Department and AMAU.

      Donaghy, Lisa; Martin, Patrick; Connolly Hospital Blanchardstown (2018-07-01)
      The Seasonal Influenza Peer Vaccination Programme was developed by the Republic of Ireland Health Service Executive (HSE)1 with the aim of increasing the number of health care workers receiving annual flu vaccinations. Supporting these efforts, various studies illustrated that increasing health care staff vaccination rates decreased patient illness and death,2 while other research reported a 40% reduction of influenza-related deaths in hospitals with higher rates of health care workers' influenza vaccinations.3 Flu vaccination recommendations from The WorldHealthOrganization (WHO) include a target uptake of 75% in health care staff and people age 65 and older.3 In accordance with HSE national guidelines that health care organizations achieve and/or surpass the minimum threshold goal of 40% of employees receiving the flu vaccine,4 and recognizing that Peer-to-Peer Influenza Vaccination Programmes are an essential aspect of the overall infection prevention and control arrangements in our health care setting, Connolly Hospital In Dublin, Ireland, initiated the Peer Vaccination Programme in the Emergency Department and Acute Medical Assessment Unit (AMAU) during the 2016–2017 flu season. The challenges facing successful ED and AMAU programme implementation included the large volume of interdisciplinary staff serving theED area, a vast cohort of undifferentiated complex patients at risk for increased complications if exposed to influenza, and an elevated risk of exposure to the influenza virus for all members of the health care team. Similar to programs in other countries, the Peer-to-Peer Vaccination Programme vaccinates health care workers against the influenza viruses identified as those most likely to circulate in the upcoming season.5 Although recognizing that frontline staff have a duty of care to protect their patients and colleagues, receiving the flu vaccine is not a mandatory requirement for health care worker employment in Ireland.