• Audit of the Health Service Executive orthodontic referral pathway between 2009 and 2011 in the Dublin Mid-Leinster region

      Wolstencroft, Simon; Khosa, Allah Dad (Irish Dental Association (IDA), 2013-10)
      An audit was undertaken in 2009 to determine the success of the new national orthodontic referral protocol introduced to the Health Service Executive (HSE) in 2007 and operated in the Dublin Mid- Leinster HSE region. It was repeated in 2011 to determine if the HSE austerity measures have had a bearing on the orthodontic service performance in the Dublin Mid-Leinster HSE region. The audit also measured the success of referring practitioners in identifying the correct Index of Orthodontic Treatment Need (IOTN) classification of the patient. In the 2011 audit, the figures were broken down to identify the occlusal variables that caused dental practitioners most difficulties in identification. The audit demonstrates a good referral to assessment timeframe in 2009 (85-80% compliance for IOTN 5 and 4 within three to six months, respectively), which deteriorates significantly in 2011 (26- 4% for IOTN 5 and 4 within three to six months, respectively). The ability of dentists to identify the correct IOTN classification was better in 2009 (60% correct) compared to 2011 (51% correct), but both figures fell below the audit standard of 75% of referrals with correct IOTN classifications. The IOTN occlusal dental health components most readily identified by referring practitioners and meeting audit standards were 5a (overjet >9mm), 5i (impacted teeth) and 5h (extensive hypodontia). The remaining occlusal dental health components in the HSE IOTN fell below the audit standard. The audit clearly identifies a requirement for a continued educational effort to maintain the HSE IOTN skill base in primary care, and a need for additional resources to manage the demand for orthodontic assessments
    • Audit of the Health Service Executive orthodontic referral pathway between 2009 and 2011 in the Dublin Mid-Leinster region.

      Wolstencroft, Simon; Khosa, Allah Dad (2014-03-21)
      An audit was undertaken in 2009 to determine the success of the new national orthodontic referral protocol introduced to the Health Service Executive (HSE) in 2007 and operated in the Dublin Mid-Leinster HSE region. It was repeated in 2011 to determine if the HSE austerity measures have had a bearing on the orthodontic service performance in the Dublin Mid-Leinster HSE region. The audit also measured the success of referring practitioners in identifying the correct Index of Orthodontic Treatment Need (IOTN) classification of the patient. In the 2011 audit, the figures were broken down to identify the occlusal variables that caused dental practitioners most difficulties in identification. The audit demonstrates a good referral to assessment timeframe in 2009 (85-80% compliance for IOTN 5 and 4 within three to six months, respectively), which deteriorates significantly in 2011 (26-4% for IOTN 5 and 4 within three to six months, respectively). The ability of dentists to identify the correct IOTN classification was better in 2009 (60% correct) compared to 2011 (51% correct), but both figures fell below the audit standard of 75% of referrals with correct IOTN classifications. The IOTN occlusal dental health components most readily identified by referring practitioners and meeting audit standards were 5a (overjet >9mm), 5i (impacted teeth) and 5h (extensive hypodontia). The remaining occlusal dental health components in the HSE IOTN fell below the audit standard. The audit clearly identifies a requirement for a continued educational effort to maintain the HSE IOTN skill base in primary care, and a need for additional resources to manage the demand for orthodontic assessments.
    • An audit of the quality of referral letters received by the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital.

      Moloney, Justin; Stassen, Leo F A; Dublin Dental Hospital, Lincoln Place, Dublin 2. (Irish Dental Association, 2010-11)
      One hundred consecutive referral letters, sent by dental practitioners to the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital, were audited in terms of quality. The audit was based on the Scottish Intercollegiate Guidelines Network (SIGN) recommendations of 1998. The audit demonstrated that in general referral letters required modification and did not give the clinician the required information. This paper sets out the results of the audit and suggests a template that should be used for future referrals.
    • An audit of the quality of referral letters received by the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital.

      Moloney, Justin; Stassen, Leo F A; Dublin Dental Hospital, Lincoln Place, Dublin 2. (2010-10)
      One hundred consecutive referral letters, sent by dental practitioners to the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital, were audited in terms of quality. The audit was based on the Scottish Intercollegiate Guidelines Network (SIGN) recommendations of 1998. The audit demonstrated that in general referral letters required modification and did not give the clinician the required information. This paper sets out the results of the audit and suggests a template that should be used for future referrals.
    • A audit of the use of PICC lines in preterm infants (<33 weeks) in a tertiary neonatal intensive care unit

      Nosherwan, A; Gill, I; Walsh, H; Knowles, S; Twomey, A (Archives of Disease in Childhood, 2012-10)
    • An audit of the use of Radiologically inserted Gastostomy tubes

      Higgins, K (2009)
      Irish Gerontology Society of Ireland Conference
    • An audit of urinary tract infections in very low birth weight infants--what are we missing?

      Perrem, L M; O'Neill, R; O'Grady, M; White, M (Irish Medical Journal, 2015-01)
      Urinary Tract Infections (UTIs) are a leading cause of bacterial infection in infants and the National Institute of Clinical Excellence recommends that UTIs are actively sought in paediatric patients. 1 Their incidence ranges from between 0.1- 2.0% in full-term newborns, increasing to a reported 25% in preterm and very low birth weight (VLBW) infants. 2-4 The urinary tract is an extremely rare source of infection in the first 72 hours of life and thus routine urine culture in this population is deemed unnecessary. 4 Conversely, UTIs frequently present with late-onset sepsis (LOS) in the VLBW population 1,2 and urine culture is an essential element of a complete sepsis evaluation in this cohort. 1,3 Despite a high incidence of UTI, urine culture is frequently neglected in Neonatal Intensive Care Units (NICUs) 3 as obtaining a clean-catch sample is time consuming and the use of invasive second-line collection methods is limited by fear of complications and medical staff procedural inexperience. Identifying the source of infection will influence subsequent radiological investigations 1 and ensure appropriate treatment.
    • An audit on virological efficacy of anti-retroviral therapy in a specialist infectious disease clinic.

      Reyad, A; Waldron, C; Canning, R; O'Shea, D; Coakley, P; McConkey, S; Department of Infectious Disease, Beaumont Hospital, Beaumont, Dublin 9. A.I.Reyad@hotmail.com (2009-06)
      We have assessed the efficacy of anti retroviral therapy (ART) using undetectable viral load (VL) (<50 RNA copies/ml) as a marker of virological success, in patients who have Human Immunodeficiency Virus (HIV) attending the Department of Infectious Disease. A cross-sectional review of patients' case notes was used to obtain their demographics and treatment details. 79% (253) of the hospital case notes of clinic population was available for analysis, which represents 90% of those receiving ART in the clinic. 166/253 of the cohort were receiving treatment at the time of this study and 95% (157/166) of these were on treatment for greater than 6 months. The total virological success rate is 93%, which is comparable to other centres and are as good as those from published clinical trials. 56% of those on therapy who have virological failure were Intravenous Drug Users (IVDUs). Case by case investigation for those with treatment failure is warranted.
    • Autobuttressing of colorectal anastomoses using a mesenteric flap.

      Mohan, H M; Winter, D C (2013-12)
      Anastomotic leakage is a common and dreaded complication of colorectal surgery. Many different approaches have been tried to attempt to reduce leakage and associated morbidity. The concept of reinforcement of an anastomosis by buttressing is well established. Techniques described include using sutures, native omentum, animal or synthetic material. We report a technique for buttressing using a mesenteric flap to envelope the anastomosis. The primary rationale is to reduce clinical sequelae of anastomotic leakage by promoting local containment, as well as providing a scaffold for healing. Using autologous tissue provides a safe, time-efficient and cost-effective buttress without the risks of infection or reaction associated with foreign material. A mesenteric flap is particularly useful in patients in whom omentum is not available due to previous surgery, or to fill the dead space posterior to a low anastomosis within the pelvis.
    • Autologous bone pate in middle ear and mastoid reconstruction.

      Roche, P; Coolahan, I; Glynn, F; Mc Conn, Walsh R; Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. phoebe.roche@yahoo.co.uk (2011)
      To review outcomes of middle ear and mastoid surgery where autologous bone pate was used.
    • Autophagy in the immune response to tuberculosis: clinical perspectives.

      Ní Cheallaigh, C; Keane, J; Lavelle, E C; Hope, J C; Harris, J; Department of Clinical Medicine, Institute of Molecular Medicine, Trinity College Dublin and St James's Hospital, Dublin 8, Ireland. (2011-06)
      A growing body of evidence points to autophagy as an essential component in the immune response to tuberculosis. Autophagy is a direct mechanism of killing intracellular Mycobacterium tuberculosis and also acts as a modulator of proinflammatory cytokine secretion. In addition, autophagy plays a key role in antigen processing and presentation. Autophagy is modulated by cytokines; it is stimulated by T helper type 1 (Th1) cytokines such as tumour necrosis factor (TNF)-α and interferon (IFN)-γ, and is inhibited by the Th2 cytokines interleukin (IL)-4 and IL-13 and the anti-inflammatory cytokine IL-10. Vitamin D, via cathelicidin, can also induce autophagy, as can Toll-like receptor (TLR)-mediated signals. Autophagy-promoting agents, administered either locally to the lungs or systemically, could have a clinical application as adjunctive treatment of drug-resistant and drug-sensitive tuberculosis. Moreover, vaccines which effectively induce autophagy could be more successful in preventing acquisition or reactivation of latent tuberculosis.
    • Autotransplantation of a single functioning kidney following rupture of renal artery aneurysm

      Sullivan, JF; Forde, JC; Daly, P; Shields, W; O’Kelly, F; Quinlan, DM; Hickey, DP (Irish Medical Journal (IMJ), 2014-02)
      Renal artery aneurysms (RAA) are the second most common visceral artery aneurysm. In cases of rupture they pose a significant and emergent surgical challenge. Extracorporeal arterial reconstruction and autotransplantation is often necessary in certain complex cases that are not amenable to aneurysm repair in vivo. We report a case of a 35 year old female with a RAA in a solitary functioning kidney, requiring ex vivo reconstruction and autotransplantation to the iliac vessels
    • Autumn Weather and Winter Increase in Cerebrovascular Disease Mortality

      McDonagh, R; Harbison, J (Irish Medical Journal, 2016-11)
      Mortality from cerebrovascular disease increases in winter but the cause is unclear. Ireland’s oceanic climate means that it infrequently experiences extremes of weather. We examined how weather patterns relate to stroke mortality in Ireland. Seasonal data for Sunshine (% of average), Rainfall (% of average) and Temperature (degrees Celsius above average) were collected for autumn (September-November) and winter (December-February) using official Irish Meteorological Office data. National cerebrovascular mortality data was obtained from Quarterly Vital Statistics. Excess winter deaths were calculated by subtracting (nadir) 3rd quarter mortality data from subsequent 1st quarter data. Data for 12 years were analysed, 2002-2014. Mean winter mortality excess was 24.7%. Winter mortality correlated with temperature (r=.60, p=0.04). Rise in winter mortality correlated strongly with the weather in the preceding autumn (Rainfall: r=-0.19 p=0.53, Temperature: r=-0.60, p=0.03, Sunshine, r=0.58, p=0.04). Winter cerebrovascular disease mortality appears higher following cool, sunny autum
    • The availability of toxicological analyses for poisoned patients in Ireland.

      Cassidy, Nicola; Herbert, John X; Tracey, Joseph A; National Poisons Information Centre, Beaumont Hospital, Dublin, Ireland. nicolacassidy@beaumont.ie <nicolacassidy@beaumont.ie> (2010-05)
      The National Poisons Information Service and the Association of Clinical Biochemists in the United Kingdom published guidelines on laboratory analyses for poisoned patients in 2002. In 2003, U.S. guidelines were prepared by an expert panel of analytical toxicologists and emergency department (ED) physicians. Some professional associations in different countries quote these guidelines but there are no data to support adherence to these recommendations in the medical literature.
    • Avian influenza A H10N8—a virus on the verge?

      García-Sastre, Adolfo; Schmolke, Mirco (2014-02-05)
    • The Avocado Hand

      Rahmani, G; Martin-Smith, J; Sullivan, P (Irish Medical Journal, 2017-11)
      Accidental self-inflicted knife injuries to digits are a common cause of tendon and nerve injury requiring hand surgery. There has been an apparent increase in avocado related hand injuries. Classically, the patients hold the avocado in their non-dominant hand while using a knife to cut/peel the fruit with their dominant hand. The mechanism of injury is usually a stabbing injury to the non-dominant hand as the knife slips past the stone, through the soft avocado fruit. Despite their apparent increased incidence, we could not find any cases in the literature which describe the “avocado hand”. We present a case of a 32-year-old woman who sustained a significant hand injury while preparing an avocado. She required exploration and repair of a digital nerve under regional anaesthesia and has since made a full recovery.
    • Avoidable iatrogenic complications of urethral catheterization and inadequate intern training in a tertiary-care teaching hospital.

      Thomas, Arun Z; Giri, Subhasis K; Meagher, David; Creagh, Tom; Department of Urology and Renal Transplantation, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland. arunthomas75@gmail.com (2009-10)
      To examine the magnitude of potentially avoidable iatrogenic complications of male urethral catheterization (UC) within a tertiary-care supra-regional teaching hospital, and to evaluate risk factors and subjective feeling of interns in our institution on the adequacy of training on UC.
    • Awareness and Preventative Behaviours Regarding Toxoplasma, Listeria and Cytomegalovirus Among Pregnant Women

      Basit, I; Crowley, D; Geary, M; Kirkham, C; Mc Dermott, R; Cafferkey, M; Sayers, G (Irish Medical Journal, 2019-06)
      Serious fetal infections can be transmitted transplacentally or perinatally. Vaccination is a key prevention method as shown by the dramatic reduction of congenital rubella. Reducing the risk of toxoplasmosis, listeriosis and CMV in pregnancy requires knowledge of their epidemiology and appropriate prevention strategies in the absence of vaccines. Primary infection with Toxoplasma gondii occurs following ingestion of active or inactive cysts. Sources of cysts include undercooked or raw meat (e.g. uncooked or dried meats), contaminated unwashed cooking surfaces and utensils, contaminated cat litter, soil and water supplies, unwashed soil-grown fruits and vegetables, unpasteurised milk, and less frequently, transplanted organs and blood products. Primary toxoplasmosis in pregnancy can lead to chorioretinitis, deafness, microcephaly, developmental delay, late onset of ocular defects, and stillbirth.
    • Awareness of deficits in traumatic brain injury: a multidimensional approach to assessing metacognitive knowledge and online-awareness.

      O'Keeffe, Fiadhnait; Dockree, Paul; Moloney, Pauline; Carton, Simone; Robertson, Ian H; Trinity College Institute of Neuroscience and Department of Psychology, Trinity College, Dublin, Ireland. (Journal of the International Neuropsychological Society, 2007-01)
      Recent models of impaired awareness in brain injury draw a distinction between metacognitive knowledge of difficulties and online awareness of errors (emergent and anticipatory). We examined performance of 31 Traumatic Brain Injury (TBI) participants and 31 healthy controls using a three-strand approach to assessing awareness. Metacognitive knowledge was assessed with an awareness interview and discrepancy scores on three questionnaires--Patient Competency Rating Scale, Frontal Systems Behavioral Scale and the Cognitive Failures Questionnaire. Online Emergent Awareness was assessed using an online error-monitoring task while participants performed tasks of sustained attention. Online anticipatory awareness was examined using prediction performance on two cognitive tasks. Results indicated that the TBI Low Self-Awareness (SA) group and High SA group did not differ in terms of severity, chronicity or standard neuropsychological tasks but those with Low SA were more likely to exhibit disinhibition, interpersonal problems and more difficulties in total competency. Sustained attention abilities were associated with both types of online awareness (emergent and anticipatory). There was a strong relationship between online emergent and online anticipatory awareness. Metacognitive knowledge did not correlate with the other two measures. This study highlights the necessity in adopting a multidimensional approach to assessing the multifaceted phenomenon of awareness of deficits.
    • Axillary fine needle aspiration cytology for pre-operative staging of patients with screen-detected invasive breast carcinoma.

      Hayes, Brian D; Feeley, Linda; Quinn, Cecily M; Kennedy, M M; O'Doherty, Ann; Flanagan, Fidelma; O'Connell, Anna Marie; Department of Histopathology, St Vincent's University Hospital, Dublin 4,, Ireland. brian_hayes@ireland.com (2012-02-01)
      INTRODUCTION: Fine needle aspiration cytology (FNAC) of radiologically abnormal axillary lymph nodes in patients with breast cancer can identify patients suitable for primary axillary clearance (AC) rather than sentinel node biopsy, enabling surgical axillary staging by a single operation. This study assessed the accuracy of FNAC in predicting positive axillary lymph nodes. METHODS: 161 patients with screen-detected invasive carcinoma and who had pre-operative FNAC of a radiologically abnormal axillary lymph node were identified from two screening units, The axillary FNAC reports were correlated with sentinel node biopsy and AC reports, and sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated. RESULTS: FNAC had a moderate sensitivity (66.3%) and NPV (71.8%), and a high specificity (98.7%) and PPV (98.3%). Most patients (86%) had a single axillary operation. The sensitivity was highest in grade 3 (81.8%) and ductal type (77.8%) tumours. The sensitivity was lower in tumours of special type (34.8%), grade 1 tumours (50%) and those without lymphovascular invasion (LVI) (55.9%). The NPV was highest in pT1 (86.7%) and in grade 1 (84.5%) tumours, and lowest (44%) in tumours with LVI. The PPV was 100% in grade 1 and 3 tumours, stage pT2 and pT3 tumours and those without LVI, and was high (>96%) in all other groups. In lymph-node-positive patients, the mean number of lymph nodes involved was higher in the case of a positive (6.4) than negative FNAC (4.4). CONCLUSIONS: FNAC of ultrasonically abnormal axillary lymph nodes achieved surgical staging by a single operation in most patients with screen-detected invasive breast carcinoma, with moderate sensitivity and high specificity.