• Early warning scores: a sign of deterioration in patients and systems

      Fox, A; Elliott, Naomi; Adrian FOX, Clinical Facilitator, St. James Hospital Dublin, ICU St. James street, Dublin 8, IRELAND adifox2010@hotmail.com Naomi ELLIOTT, Associate Professor, Trinity College Dublin, School of Nursing and Midwifery, 24 D’Olier Street, Dublin 2, IRELAND naomi.elliott@tcd.ie (2015-02)
      The early warning score is a decision-making tool that has a simple design, yet its implementation in healthcare organisations is proving complex. This article reports the results of a survey that evaluated the nurses’ experiences of using the NEWS (National Early Warning Score) in an acute hospital in Ireland. Staff reported that the NEWS was easy to use, did not increase workload and enhanced their ability to identify deteriorating patients. However, they also identified problems related to doctors’ delayed response times, doctors lack of training in the use of the tool, and a failure by doctors to modify parameters for patients with chronic conditions. NEWS enhances nurses’ role in early detection of patient deterioration but delays in response times by doctors, exposes systematic flaws in healthcare. This suggests that it is not only an indicator of patient deterioration but also of deteriorating healthcare systems.
    • Eastern Health Board Regional Orthodontic Service: an initial audit.

      Dowling, P A; Fitzpatrick, P J; Garvey, M T; McNamara, C M; Department of Public and Child Dental Health, Dublin Dental Hospital. (1997)
      This initial audit of 600 recently assessed Eastern Health Board orthodontic patients suggests that a large number of them (47 per cent) requires referral for routine restorative and preventive dental care. Closer links are needed with general dental practitioners and community dental surgeons to resolve these needs. The trend for a high referral of females and Class 11 Division 1 malocclusion type correlated well with studies in other countries.
    • Eating concerns and media influences in an Irish adolescent context.

      McNicholas, Fiona; Lydon, Alma; Lennon, Ruth; Dooley, Barbara; Department of Child Psychiatry, Our Lady's Children's Hospital, Crumlin,, Dublin12, Ireland. Fiona.mcnicholas@sjog.ie (2012-02-01)
      OBJECTIVE: EPICA is the first large-scale Irish study of a school-going population examining the impact of media influences on eating attitudes. METHOD: Students were screened using the EAT-26, EDI-III and a study-specific questionnaire. A sub-sample of parents' views was included. RESULTS: Three thousand and thirty-one students (mean age 14.74) and 56 parents enrolled. The majority (71.4%) of adolescents felt adversely affected by media portrayal of body weight and shape, with more than a quarter (25.6%) believing it to be 'far too thin'. A significant correlation between media impact and high EAT scores (chi2 = 450.78, df = 2, p < 0.05) and EDI-III scores (chi2 = 387.51, df = 4, p < 0.05) was demonstrated. Parents also view media portrayal as too thin (94.7%), less than half are adversely affected by it (49.2%) but the majority (71.9%) believe their children to be. CONCLUSION: Media portrayal of body weight and shape is correlated with eating psychopathology and may affect adolescents more than adults. School psycho-educational programmes and media policies are urgently needed to minimise any detrimental effect.
    • Ebola virus disease: review and implications for dentistry in Ireland

      Galvin, Sheila; Flint, Stephen R; Healy, Claire M (Journal of the Irish Dental Association, 2015-06)
      The current Ebola outbreak in West Africa has developed into a global healthcare emergency with implications for all healthcare professionals. This article will review the clinical features, transmission and oral manifestations of Ebola virus infection, and discuss the implications of the current outbreak for dental practices in Ireland. The Ebola virus is an RNA virus belonging to the Filoviridae family that was first recognised after two outbreaks of viral haemorrhagic fever in the Democratic Republic of Congo (previously Zaire) and Southern Sudan in 1976.1 The former occurred in a village near the Ebola River, after which the virus was named. Five different species of Ebola virus are now recognised: Bundibugyo, Sudan, Zaire, Reston and Tai Forest. The Zaire strain remains the most lethal, with a mortality rate of 76%, and is the cause of the current, twenty-fifth Ebola epidemic.1,2 The current outbreak in West Africa, which began in Guinea in March 2014, is the largest and most complex since the virus was first recognised, involving more infections and deaths than all previous outbreaks combined, and involving capital cities and major urban centres for the first time. To date, there have been 25,855 cases and 10,717 deaths3,4 (correct on April 17, 2015), with the vast majority of cases in Guinea, Liberia and Sierra Leone. There have also been cases in Nigeria, Senegal, Mali, Spain, the United States and United Kingdom
    • EBV-positive B cell cerebral lymphoma 12 years after sex-mismatched kidney transplantation: post-transplant lymphoproliferative disorder or donor-derived lymphoma?

      Phelan, Paul J; Murphy, Rory K J; Farrell, Michael; O'Toole, Orna; Heffernan, Josie; O'Brien, Donncha; Breathnach, Oscar; Conlon, Peter J; Department of Nephrology, Beaumont Hospital, Dublin, Ireland. paulphel@gmail.com (2010-06)
      We present a follow-up case report of possible transmission of lymphoma 12 years after deceased-donor renal transplantation from a male donor who was found at autopsy to have had an occult lymphoma. The female recipient underwent prompt transplant nephrectomy. However, 12 years later, she presented with cerebral B cell lymphoma. A donor origin for the cerebral lymphoma was supported by in situ hybridization demonstration of a Y chromosome in the lymphoma. There was a dramatic resolution of the cerebral lesions with tapering of immunosuppression and introduction of rituximab treatment. The finding of a Y chromosome in the cerebral lymphoma does not exclude a host contribution to lymphoma development.
    • Eclampsia: trends in incidence and outcomes after 30 years

      O Connor, Hugh D, Hehir, Mark P, Kent, Etaoin M, Foley, Michael E, Fitzpatrick, Chris, Geary, Michael P, Malone, Fergal D.; Rotunda Hospital, National Maternity Hospital, Coombe Women and Infants University Hospital (Thieme Medical, 2012-08-30)
    • Economic analysis of combined endoscopic and endobronchial ultrasound in the evaluation of patients with suspected non-small cell lung cancer.

      Harewood, Gavin C; Pascual, Jorge; Raimondo, Massimo; Woodward, Timothy; Johnson, Margaret; McComb, Barbara; Odell, John; Jamil, Laith H; Gill, Kanwar Rupinder S; Wallace, Michael B; et al. (2010-03)
      Lung cancer remains the most common cause of cancer-related death in the United States. This study evaluated the costs of alternative diagnostic evaluations for patients with suspected non-small cell lung cancer (NSCLC). Researchers used a cost-minimization model to compare various diagnostic approaches in the evaluation of patients with NSCLC. It was less expensive to use an initial endoscopic ultrasound (EUS) with fine needle aspiration (FNA) to detect a mediastinal lymph node metastasis ($18,603 per patient), compared with combined EUS FNA and endobronchial ultrasound (EBUS) with FNA ($18,753). The results were sensitive to the prevalence of malignant mediastinal lymph nodes; EUS FNA remained least costly, if the probability of nodal metastases was <32.9%, as would occur in a patient without abnormal lymph nodes on computed tomography (CT). While EUS FNA combined with EBUS FNA was the most economical approach, if the rate of nodal metastases was higher, as would be the case in patients with abnormal lymph nodes on CT. Both of these strategies were less costly than bronchoscopy or mediastinoscopy. The pre-test probability of nodal metastases can determine the most cost-effective testing strategy for evaluation of a patient with NSCLC. Pre-procedure CT may be helpful in assessing probability of mediastinal nodal metastases.
    • The economic cost of pathways to care in first episode psychosis.

      Heslin, Margaret; McCrone, Paul; Flach, Clare; Fearon, Paul; Morgan, Kevin; Jones, Peter; Murray, Robin M; Dazzan, Paola; Doody, Gill; Morgan, Craig; et al. (2011)
      Few studies have examined the economic cost of psychoses other than schizophrenia and there have been no studies of the economic cost of pathways to care in patients with their first episode of psychosis. The aims of this study were to explore the economic cost of pathways to care in patients with a first episode of psychosis and to examine variation in costs. Data on pathways to care for first episode psychosis patients referred to specialist mental health services in south-east London and Nottingham between 1997-2000. Costs of pathway events were estimated and compared between diagnostic groups. The average costs for patients in south-east London were £54 (CI £33-£75) higher, compared to patients in Nottingham. Across both centres unemployed patients had £25 (CI £7-£43) higher average costs compared to employed patients. Higher costs were associated with being unemployed and living in south-east London and these differences could not be accounted for by any single factor. This should be considered when the National Health Service (NHS) is making decisions about funding.
    • Economic costs associated with an MS relapse

      O'Connell, K.; Kelly, S.B.; Fogarty, E.; Duggan, M.; Buckley, L.; Hutchinson, M.; McGuigan, C.; Tubridy, N.; National Centre for Pharmacoeconomics, Dublin, Ireland. (Multiple Sclerosis and Related Disorders, 2014-09)
      This was an prospective audit composed of medical chart review and patient questionnaire. Relapses were stratified into 3 groups: low, moderate and high intensity. Age, gender, MS subtype, disease duration, expanded disability status scale (EDSS) score, disease modifying therapy (DMT) use and employment status were recorded. Direct costs included GP visits, investigations, clinic visit, consultations with medical staff, medication and admission costs. Indirect costs assessed loss of earnings, partner's loss of earnings, childcare, meals and travel costs.
    • Economics and ethics of paediatric respiratory extra corporeal life

      Callaghan, M; Doyle, Y; O Hare, B; M Healy, M; Nˆ¶lke, L (Irish Medical Journal, 2013-09)
      Extra corporeal membrane oxygenation (ECMO) is a form of life support, which facilitates gas exchange outside the body via an oxygenator and a centrifugal pumping system. A paediatric cardiac ECMO programme was established in 2005 at Our Ladyâ s Childrenâ s Hospital, Crumlin (OLCHC) and to date 75 patients have received ECMO, the majority being post operative cardiac patients. The outcome data compares favourably with international figures. ECMO has been most successful in the treatment of newborn infants with life threatening respiratory failure from conditions such as meconium aspiration, respiratory distress syndrome and respiratory infections. There is no formal paediatric respiratory ECMO programme at OLCHC, or anywhere else in Ireland. Currently, neonates requiring respiratory ECMO are transferred to centres in Sweden or the UK at an average cost of 133,000/infant, funded by the Health Service Executive E112 treatment abroad scheme. There is considerable morbidity associated with the transfer of critically ill infants, as well as significant psycho-social impact on families. OLCHC is not funded to provide respiratory ECMO, although the equipment and expertise required are similar to cardiac ECMO and are currently in place. The average cost of an ECMO run at OLCHC is 65,000. There is now a strong argument for a fully funded single national cardiac and respiratory paediatric ECMO centre, similar to that for adult patients
    • ECSSIT - Elective caesarean section Syntocinon infusion trial a multi-centre randomized controlled trial oxytocin Syntocinon % iu bolus and placebo infusion versus oxtocin 5 iu bolus and 40 iu infusion for the control of blood loss at elective caesarean section

      Sheehan, S; Montgormery, AA; Carey, M; McAuliffe, F; Eogan, M; Gleeson, R; Geary, M; Murphy, DJ; ECSSIT Study Group (Irish Journal of Medical Science, 2011-02)
      Institute of Obstetricians & Gynaecologists, RCPI Four Provinces Meeting, Junior Obstetrics & Gynaecology Society Annual Scientific Meeting, Royal Academy of Medicine in Ireland Dublin Maternity Hospitals Reports Meeting, Nov 2010
    • Ectopic focus in an accessory left atrial appendage: radiofrequency ablation of refractory atrial fibrillation.

      Killeen, Ronan P; O'Connor, Stephen A; Keane, David; Dodd, Jonathan D; Department of Radiology, St Vincent's University Hospital, Dublin, Ireland. (2012-02-01)
    • Ectopic olfactory neuroblastoma: report of four cases and a review of the literature.

      Wormald, R; Lennon, P; O'Dwyer, T P; Department of Otolaryngology-Head and Neck Surgery, The Mater Misericordiae Hospital, 70 Eccles Street, Dublin, Ireland. (2011-04)
      Our objective is to present a short series of four rare cases of ectopic olfactory neuroblastoma. Our methods present four case reports of ectopic olfactory neuroblastoma and a review of the literature for management and treatment of this disease. The results indicate short case series reports of ectopic olfactory neuroblastoma arising from the anterior ethmoidal sinuses, the nasopharynx, the lateral nasal wall and the floor of the nose. The discussion focuses on likely origins of ectopic olfactory neuroblastoma, its clinical features and management. We conclude that ectopic olfactory neuroblastoma is a rare disease. Treatment principles are the same for non-ectopic disease and guided by extension into adjacent structures such as the orbit or anterior cranial fossa and usually involves surgery with or without adjuvant radiotherapy.
    • Educational challenges and requirements for managing leg ulcers in the community.

      Martin, Fiona; Staff Nurse, Health Service Executive, Cherry Orchard Hospital, Dublin, Republic of Ireland. (2014-06)
      The significant impact of leg ulcers upon quality of life and disease burden cannot be overemphasised, with the financial and economic impact from an individual, local and national perspective being widely acknowledged. This article attempts to highlight issues relating to education in leg ulcer management while identifying some current and emerging challenges faced in this area by professionals. With regard to education, formal training and perception of professionals, the provision of more specialised and focused training, increased use of patient-related outcome measures and the concept of knowledge brokering have been identified as important aspects in the planning and further development of education. Issues in the domains of community nursing, technology, pain management, nursing diagnosis, availability of research and recurrence were also highlighted.
    • Effect of 1,24R-dihydroxyvitamin D3 on the growth of human keratinocytes.

      Matsumoto, K; Hashimoto, K; Kiyoki, M; Yamamoto, M; Yoshikawa, K; Department of Dermatology, Osaka University School of Medicine, Japan. (1990-02)
      The effect of 1,24R-dihydroxyvitamin D3 (1,24R(OH)2D3), a synthetic analogue of a biologically active form of vitamin D3 (1,25-dihydroxyvitamin D3, 1,25(OH)2D3), on the growth of human keratinocytes cultured in serum-free medium was investigated. The growth of cultured normal human keratinocytes was inhibited by 65% by 10(-8)M 1,24R(OH)2D3 and by 90% by 10(-7)M 1,24(OH)2D3. It inhibited cell growth almost completely at 10(-6)M. The DNA synthesis of keratinocytes was also inhibited with 1,24R(OH)2D3 by 27% at 10(-8)M, 59% at 10(-7)M, and 92% at 10(-6)M. The inhibition of cell growth and DNA synthesis were more remarkable by 1,24R(OH)2D3 than by 1,25(OH)2D3. 1,24R(OH)2D3 also inhibited the growth of keratinocytes derived from patients with psoriasis vulgaris; the growth inhibitory effect was again more remarkable with 1,24R(OH)2D3 than with 1,25(OH)2D3. The viability and protein synthesis of keratinocytes were not affected by 1,24R(OH)2D3, suggesting that the growth inhibitory effect is due to its biological activity, not to cytotoxicity. The binding of [3H]-labeled 1,25(OH)2D3 to its receptor in the cytosolic fraction of cultured keratinocytes was competitively substituted by unlabeled 1,24R(OH)2D3 as well as 1,25(OH)2D3, suggesting that 1,24R(OH)2D3 binds to the 1,25(OH)2D3 receptor. It was found that the affinity of 1,24R(OH)2D3 for the receptor was slightly higher than that of 1,25(OH)2D3. These results demonstrate that 1,24R(OH)2D3 functions as a potent growth inhibitor in vitro in human keratinocytes from both normal and psoriatic epidermis, and it possesses a higher affinity for the 1,25(OH)2D3 receptor in cultured human keratinocytes. The difference in affinity of 1,24R(OH)2D3 for the 1,25(OH)2D3 receptor correlates with its greater inhibition of keratinocyte growth than 1,25(OH)2D3. 1,24R(OH)2D3 may be useful in the treatment of psoriasis.
    • Effect of a novel air disinfection system on airborne micro-organisms in a hospital outpatient clinic.

      O'Brien, D; Stevens, N; Fitzgerald-Hughes, D; Humphreys, H; Departments of Microbiology, The Royal College of Surgeons in Ireland and, Beaumont Hospital, RCSI Education and Research Centre, Beaumont Hospital, Dublin,, Ireland. (2012-02-01)
    • Effect of alveolar bone support on zygomatic implants in an extra-sinus position – an FEA study

      Freedman, Michael; Ring, Michael; Stassen, Leo F.A. (International Journal of Oral and Maxillofacial Surgery, 2016-02)
      Objective: To investigate the influence of maxillary alveolar bone on the stress distribution of zygomatic implants in an extra-sinus position. Materials & Methods: A threedimensional finite element model was created based on a CT scan of an edentulous female patient. Two zygomatic implants were modelled and placed in the skull in an extrasinus position. These were supported by the zygomatic bone and the maxillary alveolar bone and were connected by a fixed bridge. This model was duplicated, and the area of the maxillary alveolar bone supporting the implants was removed. Occlusal and lateral forces were applied to both models and the maximum von Mises stresses were recorded. Results: Higher maximum stresses were noted in the model with no alveolar support. Occlusal stresses were higher than lateral stresses in the model with no alveolar support, while occlusal stresses were lower than lateral stresses in the model with alveolar support. Low stresses were noted in the zygomatic bone in both models. Conclusion: Maxillary alveolar bone support is beneficial in the distribution of forces for zygomatic implants placed in an extra-sinus position.
    • The effect of an inhaled corticosteroid on glucose control in type 2 diabetes.

      Faul, John L; Wilson, Sandra R; Chu, James W; Canfield, James; Kuschner, Ware G; Department of Respiratory Medicine, Connolly Hospital, Dublin, Ireland. (2009-06)
      OBJECTIVE: To determine the effect of inhaled corticosteroid (ICS) therapy on glucose control in adults with type 2 diabetes mellitus and coexisting asthma or chronic obstructive pulmonary disease (COPD). DESIGN: A prospective randomized, double-blind, double-dummy placebo-controlled, crossover investigation of inhaled steroids and oral leukotriene blockers. SETTING: A United States Department of Veterans Affairs Health Care System outpatient setting. PARTICIPANTS: Adults with type 2 diabetes and asthma or COPD. METHODS: Subjects (n=12) were randomized to receive either inhaled fluticasone propionate (440 microg twice daily) and oral placebo, or inhaled placebo and oral montelukast (10 mg/day). After 6 weeks, subjects were switched to the opposite therapy for 6 weeks. The primary outcome measure was the change in the percentage of glycosylated hemoglobin (%HbA1c) at 6 weeks relative to the baseline value. RESULTS: Ten patients completed the study. The difference between the mean within-subject changes in %HbA1c associated with 6-week periods of fluticasone and the mean changes associated with montelukast therapy was small but statistically significant (mean difference=0.25; P<0.025). Neither fluticasone nor oral montelukast therapy for 6 weeks led to a significantly different mean % HbA1c compared with the relevant baseline (mean differences=0.11 and -0.14, respectively). CONCLUSION: The absence of a clinically significant within-subject difference in the changes in %HbA1c associated with fluticasone versus oral montelukast therapy, or between either therapy or baseline does not warrant recommending changes in therapy for asthma or diabetes in patients with these co-morbid conditions. However, we suggest that clinicians carefully monitor blood glucose control when diabetic patients initiate ICS, especially with higher dosages.
    • The effect of antenatal corticosteroid treatment on the incidence of respiratory distress syndrome in twin pregnancy

      Campbell, Sarah; Geary, Michael; Breathnach, Fionnuala; McAuliffe, Fionnuala; Daly, Sean; Higgins, John; Dornan, James; Morrison, John; Burke, Gerald; Higgins, Shane; et al. (American Journal of Obstetrics and Gynaecology, 2012-01)