Now showing items 1-20 of 1698

    • Increasing melanoma awareness among health and social care professionals in secondary care in an era of reduced skin cancer referrals due to COVID-19.

      Gill, R; Murphy, M; Quinlan, Catherine (2020-07-22)
      The role of secondary care providers in detecting melanoma has been poorly explored. Our recent study identified that patients with thick melanomas were seen in secondary care in the year prior to their melanoma diagnosis. In this era of reduced skin cancer referrals and heightened public anxiety, it is more important than ever that health professionals are equipped with the knowledge to identify atypical skin lesions to facilitate earlier detection and treatment. The aim of this study was to evaluate the level of awareness of skin cancer among health and social care professionals in secondary care and to facilitate education sessions on skin cancer awareness.
    • Intramural Hematoma During a Complex Chronic Total Occlusion Intervention.

      Gupta, Vijay; O'Sullivan, Cróchán J (2022-06-15)
      We describe a patient who presented for elective percutaneous coronary intervention to treat a chronic total occlusion of the right coronary artery. An intramural hematoma resulted from the intervention and was discovered with intravenous ultrasound. The complication was successfully managed conservatively, and follow-up showed patent coronary arteries. (Level of Difficulty: Intermediate.).
    • Study protocol: assessing SleeP IN infants with early-onset atopic Dermatitis by Longitudinal Evaluation (The SPINDLE study).

      O'Connor, Cathal; Irvine, Alan; Murray, Deirdre; Murphy , Michelle; Hourihane, Jonathan; Boylan, Geraldine (2022-06-18)
      Background: Atopic dermatitis (AD) is the most common chronic inflammatory skin condition in childhood. Most (50-60%) children with AD report sleep disturbance, which is secondary to itch, dry skin, inflammation, and abnormal circadian rhythm. Sleep is essential for brain development, learning, and growth. Sleep disruption in early life is associated with cognitive and psychological dysfunction in later life. The aim of this study is to describe in detail the sleep architecture of infants with early-onset atopic dermatitis (AD), compared to controls, by using EEG polysomnography, sleep actigraphy, and parental reporting. Methods: This observational study will recruit six- to eight-month old infants with moderate to severe AD and age-matched control infants who do not have AD. At six-eight months diurnal sleep electroencephalography and polysomnography will be performed in our research center. Nocturnal sleep actigraphy will be performed at home for five consecutive nights at six-eight months and 12 months. Between six and 12 months, monthly questionnaires will capture data on quantitative sleep and parental sleep. Skin barrier and immune profiles will be captured at six-eight and 12 months. AD will be assessed using standardized severity assessment tools and treated according to protocol. A neurodevelopmental assessment will be performed at 18 months to assess cognition and behaviour. An estimated sample size of 50 participants in each group is required to power the primary outcome of disturbed macrostructure of sleep and secondary outcomes of disturbed microstructure of sleep, and disturbed parental sleep, assuming an attrition rate of 60%. Potential confounding factors which will be controlled for in the data analysis will include parental educational level, parental depression, feeding practice, and number of siblings. Discussion: This study will provide a rich analysis of sleep in infants with AD in the first year of life using detailed electroencephalography, novel actigraphy techniques, and longitudinal parent-reported data. It may provide guidance on the optimal treatment of AD to prevent or reduce sleep disruption. Trial registration: clinicaltrials.gov NCT05031754 , retrospectively registered on September 2nd, 2021.
    • Ileo-ileal intussusception due to inflammatory fibroid polyp: a rare cause of small bowel obstruction in adults.

      Hassan, Mekki; Tul-Zahra, Fatima; Neary, Peter; Saeed, Rafeh (2022-06-28)
      Intussusception in adults is a relatively uncommon occurrence for a cause of bowel obstruction, which can present acutely, chronically or in an acute on chronic fashion. It is clinically concerning because of the possibility of cancer acting as a lead point. Small bowel tumours are rare, mostly detected incidentally with small bowel obstruction. Inflammatory fibroid polyp (IFP) is a rare benign tumour of the small bowel, either detected incidentally on imaging or endoscopy carried out for other reasons, or presents with acute features. We present a case of small bowel intussusception caused by IFP within the distal third of the ileum as a leading point. The patient presented acutely with small bowel obstruction, on a background of recurrent non-specific abdominal pain over the preceding month, and the computed tomography scan revealed an intussusception that was timely managed with a laparoscopy-assisted small bowel segmental resection.
    • Porokeratotic adnexal ostial nevus: A paradigm of cutaneous mosaicism.

      Kiely, Lisa; Ni Mhaolcatha, Sarah; Fitzgibbon, Jim; Murphy, Lesley-Ann; O'Connor, Cathal (2022-04-12)
      Porokeratotic adnexal ostial nevus (PAON) is a term encompassing porokeratotic eccrine ostial and dermal duct naevus (PEODDN) and porokeratotic eccrine and hair follicle naevus (PEHFN). We present the case of a 7‐year‐old girl who presented with hyperkeratotic verrucous papules in a blaschkolinear distribution on the sole of her left foot.
    • Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: a mixed methods approach.

      Flynn, Daniel; Joyce, Mary; Gillespie, Conall; Kells, Mary; Swales, Michaela; Spillane, Ailbhe; Hurley, Justina; Hayes, Aoife; Gallagher, Edel; Arensman, Ella; et al. (2020-05-14)
    • Case Report: Thrombotic-Thrombocytopenic Purpura Following Ipilimumab and Nivolumab Combination Immunotherapy for Metastatic Melanoma.

      Mullally, W J; Cooke, F J; Crosbie, I M; Kumar, S; Abernethy, V E; Jordan, E J; O'Connor, M; Horgan, A M; Landers, R; Naidoo, J; et al. (2022-04-20)
      Case report: A man in his early 50s presented with small bowel obstruction, requiring emergency laparoscopic small bowel resection for the metastatic melanoma of the jejunum with no identifiable primary lesion. One week after his first treatment with ipilimumab and nivolumab, he presented with diffuse abdominal pain, constipation, and fatigue. A computerized tomography scan did not identify a cause for his symptoms. This was rapidly followed by thrombocytopenia on day 11 and then anemia. He commenced intravenous corticosteroids for a suspected diagnosis of immune-related thrombocytopenia. On day 15, a generalized onset motor seizure occurred, and despite plasmapheresis later that day, the patient died from fatal immune-related thrombotic thrombocytopenic purpura (TTP). This was confirmed with suppressed ADAMTS13 (<5%) testing on day 14. Immune-related TTP is a rare and, in this case, fatal immune- related adverse event. Further studies are required to identify additional immunosuppressive management for immune-related TTP.
    • Troponin testing in the emergency department in MUH

      Yates, Stephanie; Barden, Eithne; Healy, Anne; Dairiam, Samuel; Sharma, Abhishek; White, Cáit; Stephanie Yates, Eithne Barden, Cáit White, Biochemistry Laboratory/Pathology IT, Mercy University Hospital, Grenville Place, Cork, Ireland; Anne Healy, Samuel Dariam, Abhishek Sharma, Emergency Department, Mercy University Hospital, Grenville Place, Cork, Ireland (2021-09-30)
      Background / Problem Identified: Chest pain is one of the most common reasons for people attending the emergency department (ED). As there are many causes of chest pain, the physician has the responsibility of ruling out serious and potentially life threatening conditions such as acute myocardial infarction (MI), aortic dissection or pulmonary embolism (PE). Acute Coronary Syndrome (ACS) is one of the most common presentations in acute hospital settings. Cardiac troponin (TnI) is the preferred biomarker for the detection of myocardial injury. High sensitivity assays can detect elevated levels of TnI (above the 99th percentile of an apparently healthy reference population) within 3 hours after the onset of chest pain. It is particularly of value for the cohort of patients who have ACS, without typical features. For example diabetic patients, the very elderly or those with asymptomatic ACS. However if troponin is used incorrectly and without true clinical context then it can be elevated in a number of non cardiac conditions which can lead to a false clinical diagnosis, inappropriate workup and an increased patient stay in hospital. It was felt that an excessive amount of troponin tests were being requested especially in the ED so an audit was carried out to examine patterns of troponin requesting and to determine if troponin tests are requested appropriately from the ED in MUH and if the timings of the repeat requests were appropriate.
    • Exploring the impact of over requesting of laboratory tests in biochemistry, MUH and devising a demand management strategy to reduce costs without compromising patient care and safety

      Yates, Stephanie; Barden, Eithne; White, Cáit; Stephanie Yates, Eithne Barden, Cáit White, Biochemistry Laboratory/Pathology IT, Mercy University Hospital, Grenville Place, Cork, Ireland (2020-07-07)
      Like many other areas of the health care sector, there is increasing pressure being put on medical laboratories to cut costs and eliminate wastefulness, while still maintaining and improving standards and expanding test repertoire. As a result many laboratories are turning to demand management as a way of cutting excess costs. It is estimated that up to 25% of pathology investigations are unnecessary indicating a significant potential waste. The aim of demand management is to control the appropriateness of tests that are requested. There are 3 main categories used when trying to achieve demand management; (1) Pre laboratory. This involves educating and engaging with requestors with regards to testing, examining the test repertoire available and also the withdrawal of obsolete tests. (2) Within laboratory. This is largely based around using minimum retest interval rules to prevent duplicate testing. (3) Post laboratory. This involves liaising with clinical teams to review the influence of test results on patient care.
    • S.A.F.E. huddle in the emergency department

      Fitzgerald, Shona; O'Donnell, Barbara; Healy, Anne; McLoughlin, Darren; Shona Fitzgerald, Barbara O'Donnell, Anne Healy, Darren McLoughlin, Emergency Department, Mercy University Hospital, Grenville Place, Cork, Ireland. (2022-06-23)
      Background / Problem Identified: A high volume of patients with undifferentiated diagnoses attend the Emergency Department complicated by high acuity and risk of deterioration. This risk increased during the pandemic when the department was divided into single rooms for isolation reducing the level of visual observation. The challenge was keeping these patients safe behind the closed doors. We needed to enhance communication within the multidisciplinary team to create a safer environment for both staff and patients. The issue of unrecognised deterioration or failure to escalate is identified as a risk to patient safety.
    • Comparison of sodium levels between GEM 5000 Blood Gas Analysers and Abbott c8000 Architect Analyser in patients admitted to ED in MUH

      Yates, Stephanie; Barden, Eithne; Louw, Michael; Lagali, Angeline; Stephanie Yates, Eithne Barden, Michael Louw, Angeline Lagali, Biochemistry, Mercy University Hospital, Grenville Place, Cork, Ireland. (2022-06-23)
      Background / Problem Identified: Sodium is the major cation of extracellular fluid; it plays an essential role in the normal distribution of water and in the maintenance of osmotic pressure in extracellular fluid compartments. Here in MUH, sodium levels are reported using the GEM 5000 Blood Gas Analyser, as a point of care test in the ED. They also form part of a renal panel and are reported in the Biochemistry lab using the c8000 Abbott Architect, using whole blood and serum/li-heparin samples respectively. The c8000 uses Integrated Chip Technology (ICT), Ion Selective Electrode, diluted (Indirect) to measure sodium, whereas the Gem 5000 uses potentiometric sensors to measure sodium (Direct). Hypo and Hypernatremia are the most common electrolyte disorders. Therefore precise and reliable sodium measurements are crucial for correct treatment of the patient. In recent years, several studies have showed a discrepancy in sodium levels between direct and indirect methods. In general, clinicians consider the two methods to be interchangeable and there is a lack of awareness of the associated discrepancy between methods.
    • Multidisciplinary quality improvement plan: Introduction of use of Passy Muir speaking valve in line with mechanical ventilation in patients with tracheostomy in ICU setting in MUH

      Ferris, Finola; O'Sullivan, Keith; Murphy, Dervla; Marshall, Teresa; O'Mahony, Michellle; O'Croinin, Donall; Hanna, Elaine; Friel, Tara; Finola Ferris, Speech & Language Therapy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Keith O'Sullivan, Physiotherapy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Dervla Murphy, Physiotherapy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Teresa Marshall, Department of Nursing, Mercy University Hospital, Grenville Place, Cork, Ireland; Michelle O'Mahony, Anaesthesia Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Donal Ó CróinÍn, Anaesthesia Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Elaine Hanna, Department of Nursing, Mercy University Hospital, Grenville Place, Cork, Ireland; Tara Friel, Speech & Language Therapy Department, Mercy University Hospital, Grenville Place, Cork, Ireland (2022-06-23)
      Background / Problem Identified: What is a tracheostomy tube? A tracheostomy tube is an artificial airway inserted through the neck into the trachea to allow a more direct access for ventilation. What is a Passy Muir speaking valve? A Passy Muir speaking valve is a one-way valve which can be placed over the end of tracheostomy hub to redirect airflow into the upper airways when the tracheostomy cuff is deflated, allowing air to flow through vocal folds and facilitating verbal communication in patients with tracheostomy. What is mechanical ventilation? Mechanical ventilation is the technique through which gas is moved towards and from the lungs through an external device connected directly to a patient. What is involved in using a speaking valve in line with mechanical ventilation? Speaking valves can be used in line with ventilators but requires deflation of tracheostomy cuff to allow leaked expiratory air to travel through the vocal folds to facilitate speech. This has implications in measuring expired tidal volume and potential loss of lung volume. Project Background: Increased numbers of patients requiring tracheostomy in last 2 years in MUH. More complex cohort of patients requiring tracheostomy with prolonged length of weaning from mechanical ventilation and protracted ICU stay. Implications of protracted ICU admission: - significant impact to patient with increased risk of ICU delirium - psychological impacts to patient including frustration, anxiety, low mood, poor engagement with rehabilitation. - increased morbidity. - impacts negatively on patient flow and bed management. - high financial cost to MUH - impacts on staff morale. Current practice in MUH: Speaking valves are utilised in patients with tracheostomy who have weaned from mechanical ventilation but have not yet been decannulated (tracheostomy tube removal). This results in a period when patients are conscious, alert and unable to communicate verbally. Practices in larger critical care facilities have progressed to use of speaking valves in line with ventilators (SVILV). Benefits of speaking valve: Benefits of speaking valve (on ventilated/non-ventilated patients) are well recognised. These include restoration of speech, improved swallow function and reduced aspiration risk. Benefits of SVILV: Benefits include primarily earlier restoration of verbal communication. In addition, it can expedite weaning from mechanical ventilation by re-establishing physiological PEEP (Positive End Expiratory Pressure) which improves arterial oxygenation, improved secretion management by enabling a stronger, more effective cough and increased end expiratory lung impedance.
    • Compliance with venous thromboembolism protocol in surgical patients in Mercy University Hospital quality improvement project

      Shehata, Danny; Cagney, David; McGreal, Gerald; Danny Shehata, David Cagney, Gerald McGreal, Vascular Surgery, Mercy University Hospital, Grenville Place, Cork, Ireland. (2021-09-30)
      Background / Problem Identified : 63% of all venous thromboembolic (VTE) events occur in the hospital setting, of which 70% may be preventable with appropriate VTE prophylaxis. Local and national quality improvement initiatives have led to development of a generic VTE prophylaxis protocol for hospital inpatients which can be found on page 3 of the hospital drug kardex. This quality improvement project aims to assess and improve the compliance amongst Non-Consultant Hospital Doctors (NCHDs) with completion of the VTE Protocol and as well as the appropriate prescription of VTE prophylaxis amongst surgical patients in Mercy University Hospital.
    • A large upper abdominal mass in an adolescent with high Ca 19.9: a case report.

      O'Connell, Robert M; O'Sullivan, Adrian (2022-04-27)
      Mucinous cystic neoplasms of the liver are uncommon cystic lesions of the liver, most commonly seen in women in the fifth decade of life. We present a case of a 16-year-old girl with an incidentally discovered abdominal mass while undergoing a tonsillectomy. Investigation revealed a multiloculated, septated 17 × 17 × 11 cm cystic lesion arising from the left lobe of the liver, with displacement of the remaining upper abdominal viscera. Serum Ca19.9 was significantly elevated at 2256 U/ml (range 0–37), but other bloods including liver function tests, alphafoetoprotein and carcinoembryonic antigen were within normal limits. We proceeded to open formal left hemi-hepatectomy. Histology was consistent with a diagnosis of mucinous cystic neoplasm with low-grade intra-epithelial neoplasia.
    • Ageing well at home: advice to help you age well in your community [updated September 2022]

      Moloney, Elizabeth; Gillman, Ciara; O’Brien, Gillian; Mercy University Hospital, Grenville Place, Cork (Mercy University Hospital, Cork Kerry Community Healthcare, 2022-09)
      The aim of this booklet is to help you age well and avoid becoming frail through general health and wellbeing advice. COVID-19 has made it more difficult to engage in normal social and physical group activities. We have had to adapt our lifestyles and regular social connections. This booklet reflects the hope we all feel as normal routines return. Included is information about a range of activities, services and agencies available in your community to help you age well. As healthcare workers, we want to support you to live well at home. By remaining active and engaged in your local community, you can delay the onset of frailty. This booklet encourages you to look after your health and wellbeing and to feel positive about the future. Now is the time to invest in your physical and mental health so you can reap the benefits in years to come.
    • Oncology/haematology patients use of an acute oncology specialist nursing service to avoid emergency department admission

      Creedon, Stephanie; O'Mahony, Valerie; Stephanie Creedon, Valerie O'Mahony, St Therese’s Oncology Day Unit & St Bernadette’s Ward, Mercy University Hospital, Grenville Place, Cork, Ireland (2022-06-23)
      Background / Problem Identified: In 2021 347 new patients were referred to St Therese’s Oncology Day Unit and St Bernadette’s Ward for systemic anti-cancer treatment (SACT). Most of these patients will experience side effects which can be mild, moderate, or severe. In 2020 the National Cancer Control Program (NCCP) funded a 1.0 WTE Acute Oncology Service (AOS) CNS with the primary role of being the first point of contact for patients experiencing SACT side effects. The overall aim of the AOS CNS role is: Provide Telephone Triage to assess and advise Oncology Haematology patients experiencing SACT side effects using the UKONS 24-hour triage tool (a symptom-based oncology assessment tool using NCI-CTTAE (see diagram). Provide a rapid access pathway for Oncology/Haematology patients to address acute side effects from SACT. Ensure patients receive appropriate nursing and medical interventions to avoid Emergency Department attendance and reduce Hospital admissions and length of inpatient stay. An evaluation of the Acute Oncology Service in April 2021 highlighted our patients experiencing side effects from SACT continued to contact St Therese’s Ward, their GP or attend the Emergency Department for advice and management. The advice they received was impromptu and not consistent. Patients continued attending the Emergency Department for medical assessment. The AOS CNS didn’t have a dedicated space to admit patients for review. There was no clear AOS patient pathway. Combined these factors contributed to the underutilization of the Acute Oncology Service from its introduction in August 2020 until review in April 2021.
    • Non invasive ventilation BiPAP pathway

      Farrell, Aisling; O'Keeffe, Michelle; Curran, David; O'Connor, Terry; Aisling Farrell, Michelle O’Keeffe, David Curran, Terry O’Connor, Respiratory Department, Mercy University Hospital, Grenville Place, Cork, Ireland (2019-06-06)
      Background / Problem Identified: Respiratory failure is a syndrome in which the respiratory system fails in one of both of its gas exchange functions. Type 2 failure is defined by a PaO2 of <8 kPa and a PaCO2 of >6 kPa. The use of Bi Level Positive Airway Pressure (BiPAP) has been shown to be an effective treatment option for people with Type 2 respiratory Failure. The aim of this audit was determine if patients with T2RF were correctly diagnosed and appropriately treated with BiPAP as per hospital protocol.
    • Patient empowerment: a key enabler to improve patients experience of hospital discharge

      O'Keeffe, Anne; Hayes, Eileen; Anne O'Keeffe, Emergency Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Eileen Hayes, St. John's Hospital Limerick, Ireland. (2019)
      The National Patient Experience Survey (2017) found lower levels of satisfaction with hospital discharge. Poor communication was the primary cause for this finding. A thorough review of the survey resulted in the identification of four key areas pertaining to discharge that patients had a knowledge deficit namely Diagnosis, Drugs, Aftercare and ‘Your’ Follow-up. This resulted in the development of the D-day mnemonic/concept. Communication is a two way process between the healthcare provider (HCP) and the patient. This facilitates shared decision making and an equal partnership that is truly person centered. Patient empowerment is prerequisite to this as proposed by the mantra ‘no decision about me, without me’ (Kings Fund, 2011). Enabling patients to participate as equal partners is a challenge for HCP’s as it conflicts with paternalism, the dominant decision making healthcare model (Coulter et al, 2008). The National Healthcare Charter (HSE, 2012) ‘its safer to ask’ encourages patients to ask questions about their care. Patient utilisation of the charter was not evident in the findings of the national patient experience survey. To this end we developed a ‘D-day patient information leaflet’ containing cue questions targeting the d-day knowledge deficits. Due to the time constraints of this project we focused on two of the four D-day knowledge deficits namely Aftercare and ‘Your’ follow-up.
    • Acute stroke unit booklet: Bridging the information gap between patients, relatives and providers

      Saramago, Inês; Inês Saramago, Acute Stroke Unit, Mercy University Hospital, Cork, Ireland (2019-07-07)
      Background / Problem Identified: Following a stroke, patients are often confronted with many impairments, which can trigger many questions from their relatives. Establishing clear and regular communication with the relatives can be challenging when using a multidisciplinary team approach. Also, the ability to retain all the information and new medical terminology by both patients and their relatives can be limited during this stressful time. The aim of the acute stroke unit booklet is to provide medical and practical information relevant to the acute stroke patients, and their relatives, admitted to the acute stroke unit in St. Finbarr’s Ward, Mercy University Hospital. Measurement Methods / Design / Strategy: The development of the Acute Stroke Unit Booklet was carried out in two phases. Phase I, a review of the published Stroke unit Booklets from UK and Irish Hospitals/Organizations was conducted. MDT opinions and suggestions were also sought. In phase II, the booklet was formally validated by inviting the MDT to assess each relevant section of the booklet for adequacy, coverage and readability of the content. Results / Lessons learned / Limitations: The 44 page booklet was organized into 13 sections. The MDT section incorporates 7 departments and every department provided feedback. The booklet was primarily distributed and explained to acute stroke patients. Where the patient’s cognitive status was significantly impacted, the booklet was then assigned to the patients’ relatives. Conclusions / Reflections: A simple, illustrated information booklet designed for acute stroke patients and their relatives using clear and plain language is an effective mean to maintain communication between patients, relatives and providers. A similar approach focusing on aphasic stroke patients and cognitively impaired stroke patients could be adopted for the development of other accessible information booklets.