• Vaccination in Renal Transplant Patients (VcRtp study)

      Rathore, F; Berzan, E; Magee, C (Irish Medical Journal, 2016-02)
      Adverse outcomes of influenza & pneumococcal infections in solid organ transplant recipients have been well documented. Vaccinations are therefore recommended by multiple guidelines. Despite emerging evidence of the safety & effectiveness among immunosuppressed patients, most vaccines are still underutilized, we conducted a survey among the renal transplant patients in Beaumont Hospital to determine the awareness and uptake of vaccinations. Questionnaires were handed to patients during a clinic visit over a span of 2 weeks and 250 questionnaires were posted out to randomly selected transplant patients, The Questionnaire addressed various aspects including the awareness of importance of vaccinations, source of information, if they were up to date with the vaccines & where did they receive it?
    • Vaccine-Preventable Admissions to an Irish Paediatric Intensive Care

      Doyle, Y; Healy, M; McMahon, C; Crowe, S (Irish Medical Journal, 2017-05)
      In the Republic of Ireland, the schedule of state-funded immunisation for children is comprehensive and includes diphtheria, pertussis, tetanus, pneumococcus, hepatitis B, meningococcus C, haemophilus B, polio, measles, rubella and mumps. Varicella and meningococcal B vaccines are commercially available but are not currently funded by the government. Each of the illnesses preventable by these vaccines can cause substantial morbidity, and rarely mortality, in infants and children. Our PICU continues to see serious illness due to avoidable infection. There were 39 admissions in a 4 year period, with 34 children surviving to discharge. Nine children were infected with pneumococcus, with 4 deaths. There was one case of pertussis, causing death. Most infections occurred in previously healthy children. These preventable conditions represent a significant burden on children, families, and on social and healthcare resources
    • Vacuolar cerebellopathy, the molecular autopsy and multiple acyl-CoA dehydrogenase deficiency

      Jansen, M; Bourke, W; Howley, R; Crushell, E; Sheahan, K; Farrell, M (2011-01)
    • Vaginal breech delivery at term: the doctors' dilemma.

      Turner, M J; Maguire, P J (Irish Medical Journal, 2015-03)
      "When an operation is once performed, nobody can ever prove that it was unnecessary". The Craze for Operations from The Doctorâ s Dilemma: Preface on Doctors by George Bernard Shaw, 1909*. Breech presentation complicates 3-4% of deliveries at term and it is associated with an increased risk of perinatal mortality and morbidity 1,2 . The increased fetal risks may be due to the hypoxia or trauma associated with a vaginal delivery, but this can be minimised if cases suitable for vaginal delivery are carefully selected and labour is supervised by experienced clinical staff 2,3 . The increased fetal risk may also be due to other causes, such as congenital malformations, which are independent of the mode of delivery. Before 2000, the elective caesarean section (CS) rate for breech presentation had been rising as obstetricians attempted to avoid the fetal risks associated with vaginal delivery.
    • Vaginal haemangioendothelioma: an unusual tumour.

      Mohan, H; Shireen, R; Hayes, B; Canney, A; Mooney, E E; Murphy, J; Department of Gynaecology, St Vincent's University Hospital, Elm Park, Dublin 4, , Ireland. eibhlinmohan@hotmail.com (2012-02-01)
      Vaginal tumours are uncommon and this is a particularly rare case of a vaginal haemangioendothelioma in a 38-year-old woman. Initial presentation consisted of symptoms similar to uterovaginal prolapse with "something coming down". Examination under anaesthesia demonstrated a necrotic anterior vaginal wall tumour. Histology of the lesion revealed a haemangioendothelioma which had some features of haemangiopericytoma. While the natural history of vaginal haemangioendothelioma is uncertain, as a group, they have a propensity for local recurrence. To our knowledge this is the third reported case of a vaginal haemangioendothelioma. Management of this tumour is challenging given the paucity of literature on this tumour. There is a need to add rare tumours to our "knowledge bank" to guide management of these unusual tumours.
    • Vaginal prostaglandin gel to induce labour in women with one previous caesarean section.

      Agnew, G; Turner, M J; UCD School of Medicine and Medical Science, Coombe Women and Infants University, Hospital, Dublin, Ireland. gerryagnew@gmail.com (2012-02-01)
      This retrospective study reviewed the mode of delivery when vaginal prostaglandins were used to induce labour in women with a single previous lower segment caesarean section. Over a 4-year period, PGE 2 gel was used cautiously in low doses in 54 women. Induction with PGE 2 gel was associated with an overall vaginal birth after caesarean section (VBAC) rate of 74%, which compared favourably with the 74% VBAC rate in women who went into spontaneous labour (n = 1969). There were no adverse outcomes recorded after the prostaglandin inductions but the number reported are too small to draw any conclusions about the risks, such as uterine rupture. We report our results because they may be helpful in assessing the chances of a successful VBAC in the uncommon clinical circumstances where prostaglandin induction is being considered.
    • Validating the 5Fs mnemonic for cholelithiasis: time to include family history.

      Bass, Gary; Gilani, S Nadia S; Walsh, Thomas N (2013-11)
      The time-honoured mnemonic of '5Fs' is a reminder to students that patients with upper abdominal pain and who conform to a profile of 'fair, fat, female, fertile and forty' are likely to have cholelithiasis. We feel, however, that a most important 'F'-that for 'family history'-is overlooked and should be introduced to enhance the value of a useful aide memoire.
    • Validation of continuous glucose monitoring in children and adolescents with cystic fibrosis: a prospective cohort study.

      O'Riordan, Stephen M P; Hindmarsh, Peter; Hill, Nathan R; Matthews, David R; George, Sherly; Greally, Peter; Canny, Gerard; Slattery, Dubhfeasa; Murphy, Nuala; Roche, Edna; et al. (Diabetes care, 2009-06)
      To validate continuous glucose monitoring (CGM) in children and adolescents with cystic fibrosis.
    • Validation of examinations

      Carson, K (2011-06)
      European Society of Anaesthesia
    • Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women

      Cox, J; Chapman, Gail; Murray, Declan; Jones, Peter; St. Ita's Hospital (Elsevier, 1996-07)
    • Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard.

      Bruyn, G A W; Pineda, C; Hernandez-Diaz, C; Ventura-Rios, L; Moya, C; Garrido, J; Groen, H; Pena, A; Espinosa, R; Möller, I; et al. (Arthritis care & research, 2010-08)
      To assess the intra- and interobserver reproducibility of musculoskeletal ultrasonography (US) in detecting inflammatory shoulder changes in patients with rheumatoid arthritis, and to determine the agreement between US and the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, using magnetic resonance imaging (MRI) as a gold standard.
    • Value and limitations of existing scores for the assessment of cardiovascular risk: a review for clinicians.

      Cooney, Marie Therese; Dudina, Alexandra L; Graham, Ian M; Cardiology Department, Adelaide Meath Hospital, Tallaght, Dublin, Ireland. (Journal of the American College of Cardiology, 2009-09-29)
      Atherosclerotic cardiovascular diseases (CVDs) are the biggest causes of death worldwide. In most people, CVD is the product of a number of causal risk factors. Several seemingly modest risk factors may, in combination, result in a much higher risk than an impressively raised single factor. For this reason, risk estimation systems have been developed to assist clinicians to assess the effects of risk factor combinations in planning management strategies. In this article, the performances of the major risk estimation systems are reviewed. Most perform usably well in populations that are similar to the one used to derive the system, and in other populations if calibrated to allow for different CVD mortality rates and different risk factor distributions. The effect of adding "new" risk factors to age, sex, smoking, lipid status, and blood pressure is usually small, but may help to appropriately reclassify some of those patients who are close to a treatment threshold to a more correct "treat/do not treat" category. Risk estimation in the young and old needs more research. Quantification of the hoped-for benefits of the multiple risk estimation approach in terms of improved outcomes is still needed. But, it is likely that the widespread use of such an approach will help to address the issues of both undertreatment and overtreatment.
    • The value of appropriate assessment prior to specialist referral in men with prostatic symptoms.

      Quinlan, M R; O'Daly, B J; O'Brien, M F; Gardner, S; Lennon, G; Mulvin, D W; Quinlan, D M; Department of Urology, St Vincent's University Hospital, Dublin 4, Republic of, Ireland. lynagh@hotmail.com (2012-02-01)
      BACKGROUND: Referrals to Urology OPD of men with a likely diagnosis of BPH are common. AIMS: To review referrals to OPD of men with lower urinary tract symptoms (LUTS) to establish how many could have been managed without specialist assessment. METHODS: We reviewed records of 200 male patients referred to OPD with LUTS. We assessed whether the referral source had performed digital rectal examination (DRE), International Prostate Symptom Score (IPSS), Bother Score or PSA level. RESULTS: 74% of patients were referred by GPs. In 31.5% of cases DRE was performed prior to referral. One GP had completed an IPSS, none a Bother Score. 96% had a PSA checked before OPD. Ultimately, 88.5% of our patients were diagnosed with BPH. CONCLUSIONS: With better pre-assessment in the form of DRE, IPSS and Bother Score, allied to a PSA check, many patients with LUTS could be managed in a primary care setting.
    • The value of education in special care dentistry as a means of reducing inequalities in oral health.

      Faulks, D; Freedman, L; Thompson, S; Sagheri, D; Dougall, A; CHU Clermont-Ferrand, Service d'Odontologie and Clermont Université, Université d'Auvergne, EA 3847, Clermont Ferrand, France. (2012-11)
      People with disability are subject to inequality in oral health both in terms of prevalence of disease and unmet healthcare needs. Over 18% of the global population is living with moderate to severe functional problems related to disability, and a large proportion of these persons will require Special Care Dentistry at some point in their lifetime. It is estimated that 90% of people requiring Special Care Dentistry should be able to access treatment in a local, primary care setting. Provision of such primary care is only possible through the education and training of dentists. The literature suggests that it is vital for the dental team to develop the necessary skills and gain experience treating people with special needs in order to ensure access to the provision of oral health care. Education in Special Care Dentistry worldwide might be improved by the development of a recognised academic and clinical discipline and by providing international curricula guidelines based on the International Classification of Functioning, Disability and Health (ICF, WHO). This article aims to discuss the role and value of promoting and harmonising education in Special Care Dentistry as a means of reducing inequalities in oral health.
    • The value of hyperbilirubinaemia in the diagnosis of acute appendicitis.

      Emmanuel, Andrew; Murchan, Peter; Wilson, Ian; Balfe, Paul; Department of Surgery, St. Luke's Hospital, Kilkenny, Ireland. arhemmanuel@gmail.com (2011-04)
      No reliably specific marker for acute appendicitis has been identified. Although recent studies have shown hyperbilirubinaemia to be a useful predictor of appendiceal perforation, they did not focus on the value of bilirubin as a marker for acute appendicitis. The aim of this study was to determine the value of hyperbilirubinaemia as a marker for acute appendicitis.
    • The value of level III clearance in patients with axillary and sentinel node positive breast cancer.

      Dillon, Mary F; Advani, Vriti; Masterson, Catherine; O'Loughlin, Christina; Quinn, Cecily M; O'Higgins, Niall; Evoy, Denis; McDermott, Enda W; Department of Surgery, St Vincent's University Hospital, Elm Park, Dublin,, Ireland. maryfdillon@hotmail.com (2012-02-01)
      BACKGROUND: The value of level III axillary clearance is contentious, with great variance worldwide in the extent and levels of clearance performed. OBJECTIVE: To determine rates of level III positivity in patients undergoing level I-III axillary clearance, and identify which patients are at highest risk of involved level III nodes. METHODS: From a database of 2850 patients derived from symptomatic and population-based screening service, 1179 patients who underwent level I-III clearance between the years 1999-2007 were identified. The pathology, surgical details, and prior sentinel nodes biopsies of patients were recorded. RESULTS: Eleven hundred seventy nine patients had level I-III axillary clearance. Of the patients, 63% (n = 747) were node positive. Of patients with node positive disease, 23% (n = 168) were level II positive and 19% (n = 141) were level III positive. Two hundred fifty patients had positive sentinel node biopsies prior to axillary clearance. Of these, 12% (n = 30) and 9% (n = 22) were level II and level III positive, respectively. On multivariate analysis, factors predictive of level III involvement in patients with node positive disease were tumor size (P < 0.001, OR = 1.36; 95% CI: 1.2-1.5), invasive lobular disease (P < 0.001, OR = 3.6; 95% CI: 1.9-6.95), extranodal extension (P < 0.001, OR = 0.27; 95% CI: 0.18-0.4), and lymphovascular invasion (P = 0.04, OR = 0.58; 95% CI: 0.35-1). Lobular invasive disease (P = 0.049, OR = 4.1; 95% CI: 1-16.8), extranodal spread (P = 0.003, OR = 0.18; 95% CI: 0.06-0.57), and having more than one positive sentinel node (P = 0.009, OR = 4.9; 95% CI: 1.5-16.1) were predictive of level III involvement in patients with sentinel node positive disease. CONCLUSION: Level III clearance has a selective but definite role to play in patients who have node positive breast carcinoma. Pathological characteristics of the primary tumor are of particular use in identifying those who are at various risk of level III nodal involvement.
    • The value of metabolic markers in diagnosis of vitamin 12 deficiency

      Deverrill, D; Fitzsimons PE; Macken, S; Crushell, E; McMahon, C; Mayne, PD; Rotunda Hospital (2009-10)
    • The value of metabolic markers in diagnosis of Vitamin B12

      Deverell, D; Fitzsimons, PE; Macken, S; Crushell, E; McMahon, C; Mayne, PD (2009-10)
      Association of Clinical Biochemists in Ireland 32nd Annual Symposium