Now showing items 21-40 of 1701

    • 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.
    • Using the AMAU pathway as an alternative to the “admission-to-investigate” pathway

      José María Martínez Ávila, James Ryan, Hannah O’Sullivan, Síofra Bennett, Abbey Murphy, Conor Martin, Acute Medical Assessment Unit, Mercy University Hospital, Grenville Place, Cork, Ireland (2021-09-30)
      Background / Problem Identified: Acute Medical Assessment Units (AMAU) were created with the main goal of providing medical patients with prompt, consultant-led decision making. According to the 2010 HSE National Acute Medicine Programme, a decision should be made regarding admission or discharge for AMAU patients (time to decision) in less than 6 hours. The aim of our Acute Medical Assessment Unit is to provide a service that enables early patient assessment and prioritisation of investigations leading to a reduced patient experience time (PET) on the emergency department floor. The AMAU will also provide an alternative pathway for follow-up in patients not requiring acute admission – with scheduled follow up of planned investigations in the AMAU clinic or Virtual Ward. Complementary investigations play a key role in decision making. Prioritisation of urgent investigations to determine acute management (Priority 2 e.g. CTPA for a suspected PE with a high Wells’ score) and less urgent investigations (Priority 3 e.g. endoscopy for gastritis) can be decided and followed-up via the AMAU. Lack of timely access to these investigations can lead to an undue delay in patient flow and obstruct potentially safe patient discharges. The Mercy AMAU was restructured in July 2020. This resulted in the addition of a fixed medical SHO, CNM2, and clerical officer; along with 2 Consultants who supervise the unit. There is additional support provided with an SHO and Medical Registrar from another team. A GP referral pathway was introduced to further expedite patient assessment in November 2020. This AMAU Audit aims to ascertain to what extent the AMAU activity reduces the number of hospital admissions that are required to facilitate access to timely investigations.
    • A novel education programme to improve confidence and knowledge levels regarding medications in an inpatient population

      Ryan, Joseph; Balfour, Timothy; Joseph Ryan, Timothy Balfour, Medicine, Mercy University Hospital, Grenville Place, Cork, Ireland. (2019-06-06)
      Background / Problem Identified: HIQA report Feb 2018: One in five patients has an adverse event after discharge from hospital, with the majority of these relating to medicines. HIQA report on Medication safety Sept 2017: 58% reported the purpose of a new medication was explained in a way that they could understand. Personal experience of admitting patients (particularly in out of hours setting). Aims of this project were: To increase confidence and knowledge with regards regular medications. To assess patient confidence levels regarding current medications. To assess patient knowledge with regards to purpose and frequency of medications. To identify sources of information used by patients with regards medications
    • Electronic referrals to speech & language therapy (SLT): Design and implementation of an electronic referral system in MUH

      Galvin, Sheena; Curtis, Ross; Friel, Tara; Sheena Galvin, Tara Friel, Speech & Language Therapy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Ross Curtis, ICT Department, Mercy University Hospital, Grenville Place, Cork, Ireland (2020-07-07)
      Background / Problem Identified: Since the establishment of the Speech & Language Therapy (SLT) service in MUH in 2005, internal inpatient referrals to the service have been made using paper referral forms. The paper-based referral system was audited for quality, safety and efficiency in 2018, in the context of increasing referral rates to SLT. A number of issues of concern were identified within this audit, across the domains of quality and safety, economic costs and data use/security. 1. Quality and safety issues: Delayed receipt of referrals E.g. 25% of referrals were delayed in reaching the SLT service in 2017 and this increased to 36% (267 patients) in 2018. Paper referrals often lacked essential information. These issues resulted in inaccurate and inequitable triage of referrals and provision of services, leading to delayed hospital discharge in some cases. 2. Economic costs: Opportunity costs in terms of staff time: NCHDs, SLTs, nursing staff and clerical staff time was lost in generating referrals, collecting referrals from wards, checking the status of referrals, duplicating referrals and restocking referral forms on wards. The paper referral system workflow encompassed 15 steps, from the SLT viewpoint alone. 3. Data use & security issues: Incomplete referral information limited the scope for data analysis which impacted on service audit, planning and development (Harman and Cornelius, 2017). Manual data analysis of paper forms led to inefficiency and human errors in data analysis. Hardcopy referral waiting lists were kept in storage in the SLT department, representing a data protection risk associated with storage of confidential information (Data Protection Commissioner, 2017, Health Service Executive, 2013, Burke and Weill, 2013, Harman and Cornelius, 2017, Hoyt et al., 2012). Measurement Methods / Design / Strategy: In order to address the above quality and risk issues, a health information technology solution was implemented in March 2019 in the form of an Electronic Referral system. The design and implementation of the E-referral system encompassed a number of phases, all based on the HSE change management approach; 1. Stakeholders were identified: A change in referral processes was found to affect the SLT department, ICT department, NCHDs and Consultants, ward clerks, ward CNMs, patient flow service and the hospital stores department. 2. In-house technology solutions were explored: The existing Social work E-referral system was reviewed. The Social work manager shared learning from the design and implementation phases involved in rolling out the social work E-referral system. 3. Literature review: Current literature on the implementation of internal referral systems in acute care settings was reviewed. 4. System design & end-user consultation: The NCHD committee 2017-2018 was consulted on system design in order to design a user-friendly system and to promote end user buy-in the change initiative. A member of NCHD committee with background qualifications in IT provided support to SLT and ICT department in the design of the system. The ICT department redesigned the existing social work referral system in order to capture the data required by the SLT service. 5. Education & training: Stakeholders were informed in January 2019 regarding the new system via emails to Consultants, NCHDs, CNMs and patient flow, presentations at intern education session, information handouts on wards and communication to ward clerks. 6. System testing: The E-referral system was tested on St. Finbarr’s ward for a seven day period in February 2019. Changes to the system were made by the ICT department in response to feedback from stakeholders. 7. Implementation: The E-referral system was rolled out to all clinical areas March 2019. 8. Gathering of feedback and audit. Results / Lessons learned / Limitations: A number of beneficial results were noted in practice, which echo the findings in current literature on the subject. These benefits can be described across the three areas of quality and safety improvements, economic benefits and data security and data use improvements. 1. Improvements in service quality & patient safety - Completeness and legibility of referral information enables accurate triage and equitable prioritisation of referrals, ensuring that patients are seen for SLT assessments in order of most urgent clinical need (for example, a dysphagia assessment in the case of a patient who is nil by mouth) (Kim-Hwang et al., 2010, Adaba and Kebebew, 2018, Bates and Gawande, 2003, Ash et al., 2004). - Delayed referral rates have dropped to 0%. Referrals are received immediately by the system, in chronological order and can be triaged as such (Shaw and de Berker, 2007). - Delayed hospital discharges no longer occur as a result from delays in the receipt of referrals (Bates and Gawande, 2003). - Increased numbers of patients can be seen by the SLT service as a result of the time saved by the new system. 2. Economic Benefits –hospital costs, staff time & productivity - NCHDs do not have to search for hardcopy forms on each ward. - Automated completion of demographic information and tick box options ensures that each referral takes less than 2 minutes to complete and submit. - Feedback from NCHDs on the wards is that the system is an improvement on the paper-based one, in terms of ease of use and time efficiency. - The system confirms when referrals have been submitted- NCHDs and nurses do not have to contact SLTs to check if referral was received, or submit multiple referrals. - Stores department do not have to order or deliver paper referral cards. - Ward clerks do not need to monitor and reorder stocks of referral cards for wards. - The E-referral system workflow reduces the steps required for an SLT to process a new referral to 7 steps (down from 15). - SLT time saved over the course of a year on referral processing is 65 hours, which can now be used to see 130 extra patients. This represents a cost saving of 2,340.32EU. - The system automates the process of calculating SLT response times to referrals. Time saved over the course of a year on such data analysis is 24 hours, which can now be used to see 48 extra patients. It also represents a cost saving of 864.16EU. 3. Data use & data security improvements - Complete referral information has resulted in improved scope for SLT service analysis, planning and development. - Efficiency and accuracy of data analysis has been achieved (Adaba and Kebebew, 2018, Bates and Gawande, 2003). - The system can be used as an activity management tool, as SLT response-times to referrals can be analysed automatically. - Referral data is now computerised and therefore stored on the hospital’s server, ensuring maximum security of digital information. - There is no longer a need for duplication of referral information into spreadsheets to calculate referral delay times and SLT response times to referrals, as this is automated within the new system. Conclusions / Reflections This project showcases the internal resources and skills available in MUH with which a health information technology solution can be implemented to address organisational inefficiencies, quality and safety issues (Burke, 2013). However, as a ‘frontline ownership’ model was adopted for the most part, the project developed across a two-year time period, which is a lengthy timeframe for a project of this nature. If carrying out a similar initiative, top-down project sponsorship and championing by senior management may be beneficial in securing protected resources with which to complete a similar project in a shorter timeframe. Based on the positive results on service efficiency and patient safety outlined above, there is a strong case to be made for rolling this system out across other clinical services, such as HSCP services, medical/surgical consults for inpatients and MDT referrals. Indeed, it could be used to streamline processes and collect data on operational services also, such as catering requests or requests for continuous supervision on wards. Reflection and stakeholder consultation upon completion of the project revealed a number of additional features that could be incorporated into practice, in order to maximise efficiency. For example, the E-referral system generates unique referral ID numbers. These could be quoted in the healthcare record, instead of printing and filing copies of referrals. It would also maximise transparency and accountability re the processing of referrals.
    • Ageing well at home: advice to help you age well in your community [Updated version Sept 2022]

      Moloney, Elizabeth; Gillman, Ciara; O’Brien, Gillian; Mercy University Hospital, Grenville Place, Cork (Mercy University Hospital, Cork Kerry Community Healthcare, 2022-09-22)
      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.
    • Healthcare workers use of psychological support resources during COVID-19; a mixed methods approach utilising Pillar Integration Analysis.

      Richards, Helen L; Eustace, Joseph; O' Dwyer, Amanda; Wormald, Andrew; Curtin, Yvonne; Fortune, Dónal G (2022-04-27)
      Objectives We sought to examine healthcare workers (HCWs) utilisation of formal and informal psychological support resources in the workplace during the first and third waves of the COVID-19 pandemic in Ireland. Methods A convergent mixed methods approach was undertaken. Four hundred and thirty HCWs in the Mid West and South of Ireland responded to an online survey in terms of their use of psychological support resources during Wave 1 (April/May 2020) of COVID-19. Thirty-nine HCWs undertook in depth interviews at Wave 3 (January/February 2021), and a further quantitative survey was distributed and completed by 278 HCWs at this time. Quantitative data arising at Wave 1 and Wave 3, were synthesised with Qualitative data collected at Wave 3. A Pillar Integration Process (PIP) was utilised in the analysis of the quantitative and qualitative data. Results Five pillars were identified from the integration of results. These were: a) the primacy of peer support, b) the importance of psychologically informed management, c) a need to develop the organisational well-being ethos, d) support for all HCWs, and e) HCWs ideas for developing the well-being path. These pillars encapsulated a strong emphasis on collegial support, an emphasis on the need to support managers, a questioning of the current supports provided within the healthcare organisations and critical reflections on what HCWs viewed as most helpful for their future support needs. Conclusions HCWs who utilised supportive resources indicated ‘in house’ supports, primarily collegial resources, were the most frequently used and perceived as most helpful. While formal psychological supports were important, the mechanism by which such psychological support is made available, through utilising peer support structures and moving towards psychologically informed supervisors and workplaces is likely to be more sustainable and perceived more positively by HCWs.
    • KBG syndrome mimicking genetic generalized epilepsy.

      Murphy, M J; McSweeney, N; Cavalleri, G L; Greally, M T; Benson, K A; Costello, D J; CUH (2022-04-20)
      KBG syndrome is a rare autosomal dominant disorder characterised by short stature, craniofacial dysmorphism and other developmental skeletal and dental anomalies such as macrodontia [1]. The acronym KBG was chosen to represent the initial of the surnames of the three original families described and epileptic seizures are a common feature [1,2,3]. In addition shyness, anxiety, autistic spectrum disorders and hearing loss have all been reported and most affected patients exhibit developmental delay and intellectual disability [1,4,5]. Although considered polygenic in nature, Genetic Generalized Epilepsy (GGE) typically occurs sporadically [6]. Early descriptions reported high concordance rates among monozygotic twins [7,8]. Descriptive reports highlighted consistent clinical and electroencephalographic (EEG) similarities in twin pairs. Because the clinical and EEG phenotypes are often striking and collectively pathognomonic, GGE is less frequently misdiagnosed compared to other subtypes of epilepsy. Nonetheless, GGE can be erroneously misdiagnosed in Glut-1 deficiency, CHD-2 mutations and focal epilepsy with a midline dipole [9,10]. We report a pair of monozygotic twins who were initially diagnosed with GGE on clinical and EEG grounds. Whole exome trio testing was undertaken in their teenage years when their epilepsy proved drug-resistant and atypical clinical features became more prominent. Mutations in the ANKRD11 gene confirmed a diagnosis of KBG syndrome. We report that mutations in the ANKRD11 gene may produce a clinical syndrome that closely simulates sporadic GGE.
    • Urethral cancer managed with phallus preserving surgery: a case report.

      Walsh, Emily; Kelly, Niall; Daly, Padraig; Shah, Nigam; Cullen, Ivor (2021-02-19)
      Background: Primary urethral carcinoma (PUC) is rare and accounts for < 1% of all genito-urinary cancers. There is a male predominance of 3:1 and a peak incidence in the 7th and 8th decades. The aetiology of this cancer is similar to penile cancer, and the human papilloma virus (HPV) is thought to be an essential factor in tumorigenesis. Urethral cancer should be diagnosed and staged with a combination of tumour biopsy, MRI, and CT with treatment involving a multimodal approach. Contemporary management emphasises phallus-preserving surgery where feasible. Case presentation: Here, we describe a case of distal urethral carcinoma, which presented as a metastatic groin mass and identifying the primary lesion proved challenging. Diagnostic flexible cystoscopy identified a tiny lesion in the navicular fossa, which was biopsied and confirmed to be a squamous cell carcinoma. The patient then underwent phallus preserving surgery, including distal urethrectomy with bilateral inguinal lymph node dissections. The final stage was pT1N1M0, and adjuvant chemotherapy was started. The distal urethrectomy involved the surgical creation of a hypospadic meatus in the midshaft of the penis. Normal voiding and sexual function were preserved. Conclusions: Urethral cancer is a rare malignancy and clinicians should bear in mind that early diagnosis of this disease can be very difficult depending on the anatomical location of the tumour. Treatment currently favours penis-preserving surgery.
    • Uropathogenic Biofilm-Forming Capabilities are not Predictable from Clinical Details or from Colonial Morphology.

      Whelan, Shane; O'Grady, Mary Claire; Corcoran, Dan; Finn, Karen; Lucey, Brigid (2020-04-30)
      Antibiotic resistance is increasing to an extent where efficacy is not guaranteed when treating infection. Biofilm formation has been shown to complicate treatment, whereby the formation of biofilm is associated with higher minimum inhibitory concentration values of antibiotic. The objective of the current paper was to determine whether biofilm formation is variable among uropathogenic Escherichia coli isolates and whether formation is associated with recurrent urinary tract infection (UTI), and whether it can be predicted by phenotypic appearance on culture medium A total of 62 E. coli isolates that were reported as the causative agent of UTI were studied (33 from patients denoted as having recurrent UTI and 29 from patients not specified as having recurrent UTI). The biofilm forming capability was determined using a standard microtitre plate method, using E. coli ATCC 25922 as the positive control. The majority of isolates (93.6%) were found to be biofilm formers, whereby 81% were denoted as strong or very strong producers of biofilm when compared to the positive control. Through the use of a Wilcox test, the difference in biofilm forming propensity between the two patient populations was found to not be statistically significant (p = 0.5). Furthermore, it was noted that colony morphology was not a reliable predictor of biofilm-forming propensity. The findings of this study indicate that biofilm formation is very common among uropathogens, and they suggest that the biofilm-forming capability might be considered when treating UTI. Clinical details indicating a recurrent infection were not predictors of biofilm formation.
    • Inside the skin of a patient with diabetes: fostering cognitive empathy through insulin pump simulation.

      Ryan, Paul MacDaragh (2021-02-26)
      In order to best treat a patient, the carer must be able to clearly see their point of view. In the case of the complexities of insulin pump therapy, physicians may not fully understand the common challenges that drive patients to non-adherence. The author undertook a three-day simulation using wearable technology to explore this experience. This form of simulation represents a simple yet effective means by which to foster cognitive empathy in undergraduate and postgraduate medical education settings alike.
    • Axillary artery and brachial plexus injury secondary to blunt trauma.

      Foley, James; Elamien, Ahmed; McCann, Brendan (2021-03-13)
      Rupture of the axillary artery in the absence of a fracture of dislocation is a rare traumatic event. An associated injury to the brachial plexus may accompany an axillary artery injury but has rarely been reported in the literature. We present the case of an elderly female, who fell onto an outstretched arm and sustained an axillary artery rupture, combined with a brachial plexus injury. The patient in this case did well post-operatively. The challenge in these cases is early recognition and diagnosis of a vascular injury. A significant mechanism of injury needs to alert the clinician to the possibility of such injuries and if suspected, early investigation and surgical exploration should be initiated to prevent limb ischemia. Subsequently, if the neurological symptoms do not improve, consideration must be given to the possibility of a nerve injury and early recognition and management to prevent long-term functional deficits.
    • Long-Term Surveillance and Laparoscopic Management of Zinner Syndrome.

      Kelly, Niall P; Fuentes-Bonachera, Adrian; Shields, William P; Cullen, Ivor M; Daly, Padraig J (2021-03-09)
      Zinner syndrome was first described in 1914 and represents the triad of unilateral renal agenesis and ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Seminal vesicle cysts are often asymptomatic but can also present with pain, haematospermia, or other lower urinary tract symptoms. Treatment strategies include observation and surgical excision. We present the laparoscopic management of an enlarged seminal vesicle cyst, consistent with Zinner syndrome, 14 years after the initial diagnosis. A 58-year-old male patient was diagnosed with a left-sided seminal vesicle cyst while undergoing assessment for renal transplant due to progressively worsening renal function in his solitary right kidney. The otherwise asymptomatic cyst enlarged from the time of initial diagnosis in 2004 (11.3 cm × 9.7 cm × 13.1 cm) to nearly double the size in 2018 (12.8 cm × 11.9 cm × 14.2 cm). This cyst size ultimately precluded renal transplant, and the patient was referred for excision. Laparoscopic excision of the cyst was performed, histopathology confirmed seminal vesicle cyst tissue, and there has been no recurrence of the cyst to date. The patient remains active on the renal transplant waitlist. Zinner syndrome is a rare syndrome, with the seminal vesicle cysts being managed by observation or surgical excision. We report the longest documented observation of a seminal vesicle cyst, culminating in a safe and successful laparoscopic excision.
    • Severe maternal morbidity in Ireland annual report 2017

      Leitao, S.; Manning, E.; Corcoran, P.; Greene, R.A.; National Perinatal Epidemiology Centre (National Perinatal Epidemiology Centre, 2019-08)
      The sixth report from the National Clinical Audit of Severe Maternal Morbidity (SMM) in Ireland reports on 391 cases of SMM occurring in all 19 Irish maternity units in 2017.
    • Severe maternal morbidity in Ireland annual report 2018

      Leitao, S.; Manning, E.; Corcoran, P.; Campillo, I.; Cutliffe, A.; Greene, R.A.; National Perinatal Epidemiology Centre (National Perinatal Epidemiology Centre, 2020-08)
      The seventh report from the National Clinical Audit of Severe Maternal Morbidity (SMM) in Ireland reports on 401 cases of SMM occurring in all 19 Irish maternity units in 2018.
    • Bare necessities? The utility of full skin examination in the COVID-19 era.

      O'Connor, C; Gallagher, C; O'Connell, M; Bourke, J; Murphy, M; Bennett, M (2021-03-18)
      Full skin examination (FSE) may improve the detection of malignant melanoma (MM). The objective of this study was to assess the safety of targeted lesion examination (TLE) compared with FSE in our Pigmented Lesion Clinic (PLC). Patients attending the PLC were randomized in a 2 : 1 ratio to FSE (intervention) or TLE (standard care). Demographic details and risk factors were documented, and the time taken to perform FSE and TLE was noted. Of 763 participants, 520 were assigned to FSE and 243 were assigned to TLE. On average, FSE took 4.02 min and TLE took 30 s to perform. Of the 520 participants assigned to FSE, 37 (7.1%) had incidental findings, of whom 12 patients (2.3%) had additional lesions biopsied. No additional melanomas were detected that would have been missed by use of the standard protocol. This study suggests that in low-risk patients referred to a PLC with a lesion of concern, the possibility of missing incidental cutaneous malignancies using lesion-directed examination is low.
    • Staff-Care by Chaplains during COVID-19.

      Tata, Beba; Nuzum, Daniel; Murphy, Karen; Karimi, Leila; Cadge, Wendy (2021-03-17)
      The aim of this study was to understand how chaplains delivered spiritual care to staff during the Covid-19 pandemic. The researchers analyzed data collected from an International Survey of Chaplain Activity and Experience during Covid-19 (N = 1657). The findings revealed positive changes that emerged and new practices evolved around the use of technology as useful tools for maintaining contact with staff.
    • Skin deep: Cutaneous manifestation of PIP implant rupture.

      Casey, Máire-Caitlín; Kelly, Edward Jason (2021-03-19)
      PIP (Poly Implant Prothèse, France) implants were readily employed for breast reconstruction until withdrawn from the market in 2010. These implants have an early and increased risk of rupture compared to non-PIP implants. This report outlines a significant cutaneous manifestation of PIP-implant rupture not previously described in the literature. This patient developed significant cutaneous xanthomatous inflammation with sinus tract formation that has yet to resolve despite explantation. Further investigation is warranted to elucidate the aetiology of this clinical sign and the optimal management of the cutaneous manifestation.
    • Fulvestrant-Big Mac Index: Defining Inequality in Oncology.

      O'Reilly, David; Abu Al-Saud, Yassmeen; O'Reilly, Seamus; Ronayne, Cian (2021-04)