• Has the ThinPrep method of cervical screening maintained its improvement over conventional smears in terms of specimen adequacy?

      Treacy, A; Reynolds, J; Kay, E W; Leader, M; Grace, A; Department of Pathology, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin 9, Ireland. anntreacy@mac.com (2009-04)
      Liquid-based cytology (LBC) has replaced conventional smear assessment in many centers over recent years. In our laboratory this transfer took place in 1999. At that time we performed a split sample study comparing the conventional method of cervical smear evaluation with the ThinPrep system. This split sample study identified a dramatic improvement in specimen adequacy with LBC. While 11% of conventional preparations were reported as unsatisfactory and almost 9% were reported as suboptimal, evaluation of the same cases using LBC saw this combined figure reduced to 2.3%. AIM: To evaluate whether this dramatic fall in unsatisfactory smears has been maintained with the use of LBC. The database for all smears reported for 2005 (100% LBC) was interrogated. The number of unsatisfactory reports was calculated. The reason for an unsatisfactory report was recorded for each case. The overall unsatisfactory rate was compared with that reported in the 1999 split sample study. A total of 41,312 smear tests were reported in 2005. 1,342 (3.25%) were reported as unsatisfactory. Our findings support the ongoing value of LBC in a routine cervical screening laboratory in terms of continuing to maintain a low rate of unsatisfactory smears.
    • HDACi: cellular effects, opportunities for restorative dentistry.

      Duncan, H F; Smith, A J; Fleming, G J P; Cooper, P R; Division of Restorative Dentistry & Periodontology, Dublin Dental University Hospital, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland. (2011-12)
      Acetylation of histone and non-histone proteins alters gene expression and induces a host of cellular effects. The acetylation process is homeostatically balanced by two groups of cellular enzymes, histone acetyltransferases (HATs) and histone deacetylases (HDACs). HAT activity relaxes the structure of the human chromatin, rendering it transcriptionally active, thereby increasing gene expression. In contrast, HDAC activity leads to gene silencing. The enzymatic balance can be 'tipped' by histone deacetylase inhibitors (HDACi), leading to an accumulation of acetylated proteins, which subsequently modify cellular processes including stem cell differentiation, cell cycle, apoptosis, gene expression, and angiogenesis. There is a variety of natural and synthetic HDACi available, and their pleiotropic effects have contributed to diverse clinical applications, not only in cancer but also in non-cancer areas, such as chronic inflammatory disease, bone engineering, and neurodegenerative disease. Indeed, it appears that HDACi-modulated effects may differ between 'normal' and transformed cells, particularly with regard to reactive oxygen species accumulation, apoptosis, proliferation, and cell cycle arrest. The potential beneficial effects of HDACi for health, resulting from their ability to regulate global gene expression by epigenetic modification of DNA-associated proteins, also offer potential for application within restorative dentistry, where they may promote dental tissue regeneration following pulpal damage.
    • HDL cholesterol protects against cardiovascular disease in both genders, at all ages and at all levels of risk.

      Cooney, M T; Dudina, A; De Bacquer, D; Wilhelmsen, L; Sans, S; Menotti, A; De Backer, G; Jousilahti, P; Keil, U; Thomsen, T; et al. (Atherosclerosis, 2009-10)
      We aimed to clarify some previous inconsistencies regarding the role of high density lipoprotein cholesterol (HDL-C) as a CVD protective factor.
    • Head and neck cancer of unknown primary site

      McArdle, Orla; McDermott, Ronan (2013-11-21)
    • Heading for a fall? Management of head injury in infants

      Williamson, M; Keenan, P; McKay, M; Kuan, S (Irish Medical Journal, 2010-09)
    • Headshop heartache: acute mephedrone 'meow' myocarditis.

      Nicholson, Patrick J; Quinn, Martin J; Dodd, Jonathan D; Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland. (2012-02-01)
    • The healing of bony defects by cell-free collagen-based scaffolds compared to stem cell-seeded tissue engineered constructs.

      Lyons, Frank G; Al-Munajjed, Amir A; Kieran, Stephen M; Toner, Mary E; Murphy, Ciara M; Duffy, Garry P; O'Brien, Fergal J; Department of Anatomy, Royal College of Surgeons in Ireland, Dublin 2, Ireland. (2010-12)
      One of the key challenges in tissue engineering is to understand the host response to scaffolds and engineered constructs. We present a study in which two collagen-based scaffolds developed for bone repair: a collagen-glycosaminoglycan (CG) and biomimetic collagen-calcium phosphate (CCP) scaffold, are evaluated in rat cranial defects, both cell-free and when cultured with MSCs prior to implantation. The results demonstrate that both cell-free scaffolds showed excellent healing relative to the empty defect controls and somewhat surprisingly, to the tissue engineered (MSC-seeded) constructs. Immunological analysis of the healing response showed higher M1 macrophage activity in the cell-seeded scaffolds. However, when the M2 macrophage response was analysed, both groups (MSC-seeded and non-seeded scaffolds) showed significant activity of these cells which are associated with an immunomodulatory and tissue remodelling response. Interestingly, the location of this response was confined to the construct periphery, where a capsule had formed, in the MSC-seeded groups as opposed to areas of new bone formation in the non-seeded groups. This suggests that matrix deposited by MSCs during in vitro culture may adversely affect healing by acting as a barrier to macrophage-led remodelling when implanted in vivo. This study thus improves our understanding of host response in bone tissue engineering.
    • A health and safety survey of Irish funeral industry workers.

      Kelly, N; Reid, A; Occupational Health Unit, The Adelaide and Meath Hospital, incorporating the, National Children's Hospital, Dublin 24, Ireland. nualakelly@physicians.ie (2012-02-01)
      BACKGROUND: Those handling deceased individuals, including the funeral industry, face a variety of health and safety hazards including occupationally acquired infectious disease. AIMS: To identify the knowledge, attitudes and beliefs of Irish funeral industry workers towards occupational hazards and infectious disease in 2009. METHODS: The sample analysed consisted of all listed member premises of the Irish Association of Funeral Directors as at 1 July 2009. A postal survey was sent to each premises in July 2009, with two rounds of follow-up reviews sent to non-responders. Four main areas were covered--occupational hazards, embalming, industry expertise and demographics. The quantitative and qualitative results were analysed to assess knowledge, attitudes and beliefs. Data collection was completed on 31 December 2009. RESULTS: Two hundred and thirty listed member premises were contacted. Twenty-two were unsuitable for the survey. One hundred and thirty-eight valid replies were received from 130 premises, representing a premises response rate of 63% (130/208). Seventy-three premises (56%) identified themselves as embalmers. Embalmers had variable vaccine uptake and variable knowledge, attitude and beliefs towards embalming those with blood-borne viruses. Fifteen per cent of respondents reported a work-related injury, back injury being the most common. Splash and sharps injuries were reported as a work-related injury, and infections believed to be work related were also reported. CONCLUSIONS: This study demonstrates widespread occupational health concerns among this professional group. It confirms the need for occupational health advice and services. There is also a strong desire for regulation of this profession in Ireland.
    • The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

      Varley, J; Delanty, N; Normand, C; Fitzsimons, M; Epilepsy Research Department, Beaumont Hospital, Dublin, Ireland. trimvarleys@gmail.com (2011-02)
      Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.
    • The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

      Varley, J; Delanty, N; Normand, C; Fitzsimons, M; Epilepsy Research Department, Beaumont Hospital, Dublin, Ireland., trimvarleys@gmail.com (2012-02-01)
      Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.
    • The Health Professions Admission Test (HPAT) score and leaving certificate results can independently predict academic performance in medical school: do we need both tests?

      Halpenny, D; Cadoo, K; Halpenny, M; Burke, J; Torreggiani, W C; Department of Radiology, AMNCH, Tallaght, Dublin 24. (2010-11)
      A recent study raised concerns regarding the ability of the health professions admission test (HPAT) Ireland to improve the selection process in Irish medical schools. We aimed to establish whether performance in a mock HPAT correlated with academic success in medicine. A modified HPAT examination and a questionnaire were administered to a group of doctors and medical students. There was a significant correlation between HPAT score and college results (r2: 0.314, P = 0.018, Spearman Rank) and between leaving cert score and college results (r2: 0.306, P = 0.049, Spearman Rank). There was no correlation between leaving cert points score and HPAT score. There was no difference in HPAT score across a number of other variables including gender, age and medical speciality. Our results suggest that both the HPAT Ireland and the leaving certificate examination could act as independent predictors of academic achievement in medicine.
    • Health-related quality of life after prolonged pediatric intensive care unit stay.

      Conlon, Niamh P; Breatnach, Cormac; O'Hare, Brendan P; Mannion, David W; Lyons, Barry J; Department of Anaesthesia and Intensive Care Medicine, Our Lady's Hospital for, Sick Children, Crumlin Road, Crumlin, Dublin, Ireland. (2012-02-01)
      OBJECTIVE: To investigate the long-term health-related quality of life (HRQOL) outcomes for patients requiring at least 28 days of pediatric intensive care. DESIGN: Retrospective cohort and prospective follow-up study. SETTING: A 21-bed pediatric intensive care unit (PICU) in a university-affiliated, tertiary referral pediatric hospital. PATIENTS: One hundred ninety-three patients who spent 28 days or longer in the PICU between January 1, 1997 and December 31, 2004. INTERVENTIONS: Quality of life was measured using the Pediatric Quality of Life Inventory (Peds QL 4.0) parent-proxy version at 2 to 10 yrs after discharge. The PedsQL 4.0 is a modular measure of HRQOL, which is reliable in children aged 2 to 18 yrs. It generates a total score and physical, emotional, social, school, and psychosocial subscores. MEASUREMENTS AND MAIN RESULTS: Of the 193 patients, 41 died during their PICU admission and 27 died between PICU discharge and follow-up. Quality of life questionnaires were posted to parents of 108 of the 125 survivors and 70 were returned completed. Forty children (57.1%) had scores indicating a normal quality of life, whereas 30 (42.9%) had scores indicating impaired HRQOL. Of these, 14 (20%) had scores indicating poor quality of life with ongoing disabling health problems requiring hospitalization or the equivalent. CONCLUSIONS: Our results indicate that, while long PICU stay is associated with significant mortality, the long-term HRQOL is normal for the majority of surviving children.
    • Healthcare-associated infection in Irish long-term care facilities: results from the First National Prevalence Study.

      Cotter, M; Donlon, S; Roche, F; Byrne, H; Fitzpatrick, F; Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland. mcotter@mater.ie (2012-03)
      Prevalence of healthcare-associated infection (HCAI) and antimicrobial use in Irish long-term care facilities (LTCFs) has never been studied.
    • Heart rate awareness in patients with chronic stable heart failure. A multi-center observational study.

      Moran, D; Buckley, A; Daly, K; Meaney, B; Curtin, R; O'Neill, J O; Colwella, N; Mahon, N; Murphy, N; O'Hanlon, R; et al. (2014-08-23)
      We assessed adherence to European Society of Cardiology heart rate guidelines (i.e. heart rates less than 70bpm) in patients with chronic stable heart failure. We also investigated the percent of patients on target doses of rate controlling drugs.
    • HeartScore predicts surrogate markers of cardiovascular disease in individuals aged below 40 years.

      Cooney, Marie Therese; Dudina, Alexandra; Graham, Ian (European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology, 2009-08)
    • Hedgehog signaling and therapeutics in pancreatic cancer.

      Kelleher, Fergal C; Department of Medical Oncology, St Vincent's University Hospital, Dublin, Ireland. fergalkelleher@hotmail.com (2011-04)
      To conduct a systematic review of the role that the hedgehog signaling pathway has in pancreatic cancer tumorigenesis.
    • Hedgehog signaling and therapeutics in pancreatic cancer.

      Kelleher, Fergal C; Department of Medical Oncology, St Vincent's University Hospital, Dublin,, Ireland. fergalkelleher@hotmail.com (2012-02-01)
      OBJECTIVE: To conduct a systematic review of the role that the hedgehog signaling pathway has in pancreatic cancer tumorigenesis. METHOD: PubMed search (2000-2010) and literature based references. RESULTS: Firstly, in 2009 a genetic analysis of pancreatic cancers found that a core set of 12 cellular signaling pathways including hedgehog were genetically altered in 67-100% of cases. Secondly, in vitro and in vivo studies of treatment with cyclopamine (a naturally occurring antagonist of the hedgehog signaling pathway component; Smoothened) has shown that inhibition of hedgehog can abrogate pancreatic cancer metastasis. Thirdly, experimental evidence has demonstrated that sonic hedgehog (Shh) is correlated with desmoplasia in pancreatic cancer. This is important because targeting the Shh pathway potentially may facilitate chemotherapeutic drug delivery as pancreatic cancers tend to have a dense fibrotic stroma that extrinsically compresses the tumor vasculature leading to a hypoperfusing intratumoral circulation. It is probable that patients with locally advanced pancreatic cancer will derive the greatest benefit from treatment with Smoothened antagonists. Fourthly, it has been found that ligand dependent activation by hedgehog occurs in the tumor stromal microenvironment in pancreatic cancer, a paracrine effect on tumorigenesis. Finally, in pancreatic cancer, cells with the CD44+CD24+ESA+ immunophenotype select a population enriched for cancer initiating stem cells. Shh is increased 46-fold in CD44+CD24+ESA+ cells compared with normal pancreatic epithelial cells. Medications that destruct pancreatic cancer initiating stem cells are a potentially novel strategy in cancer treatment. CONCLUSIONS: Aberrant hedgehog signaling occurs in pancreatic cancer tumorigenesis and therapeutics that target the transmembrane receptor Smoothened abrogate hedgehog signaling and may improve the outcomes of patients with pancreatic cancer.
    • Height in Turner syndrome: Does growth hormone therapy have impact?

      Nadeem, M; Roche, EF (Irish Medical Journal (IMJ), 2014-02)
    • Helicobacter pylori and nonmalignant diseases.

      Alakkari, Alaa; Zullo, Angelo; O'Connor, Humphrey J; Department of Gastroenterology, Adelaide and Meath Hospital, Faculty of Health, Sciences of Trinity College, Dublin, Ireland. (2012-02-01)
      Research published over the past year has documented the continued decline of Helicobacter pylori-related peptic ulcer disease and increased recognition of non-H. pylori, non-steroidal anti-inflammatory drugs ulcer disease--idiopathic ulcers. Despite reduced prevalence of uncomplicated PUD, rates of ulcer complications and associated mortality remain stubbornly high. The role of H. pylori in functional dyspepsia is unclear, with some authors considering H. pylori-associated nonulcer dyspepsia a distinct organic entity. There is increasing acceptance of an inverse relationship between H. pylori and gastroesophageal reflux disease (GERD), but little understanding of how GERD might be more common/severe in H. pylori-negative subjects. Research has focused on factors such as different H. pylori phenotypes, weight gain after H. pylori eradication, and effects on hormones such as ghrelin that control appetite.