Now showing items 41-60 of 1710

    • 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      PIP (Poly Implant Prothèse, France) implants were readily employed for breast reconstruction until withdrawn from the market in 2010.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)
    • Neonatal Therapeutic Hypothermia in Ireland: Annual Report: 2018 Aggregate Report 2016–2018

      Meaney, S.; McGinley, J.; Corcoran, P.; McKenna, P.; Filan, P.; Greene, R.A.; Murphy, J. (National Perinatal Epidemiology Centre, 2020-02)
      This is the Neonatal Therapeutic Hypothermia in Ireland report for 2018. It is a collaborative initiative undertaken by the National Clinical Programme for Paediatrics and Neonatology (NCPPN), the National Perinatal Epidemiology Centre (NPEC) and the National Women and Infants Health Programme (NWIHP). The Therapeutic Hypothermia steering committee has overseen the governance of the project. This report serves as a valuable resource to Medical, Midwifery and Nursing staff who are striving to make quality changes in the services we deliver to mothers and their babies. The recently formed National Neonatal Encephalopathy Action Group reflects this. The group comprises representatives from the Department of Health, the States Claims Agency, and the Health Service Executive, the NWIHP, the NPEC, Clinical Leads and patient advocates. The group acknowledges the long-lasting consequences caused by Neonatal Encephalopathy. The group aims to reduce avoidable instances of Neonatal Encephalopathy through the identification of known causes and risk factors and plans to drive initiatives to eliminate or mitigate them. The aspiration is a reduction in cases requiring therapeutic hypothermia intervention in our national maternity units/ hospitals. This working group has been endorsed by the Minister for Health Mr Simon Harris.
    • Neonatal Therapeutic Hypothermia in Ireland Annual Report | 2016-2017

      Meaney, S.; McGinley, J.; Horkan, S.; Corcoran, P.; Greene, R.A.; Murphy, J. (National Perinatal Epidemiology Centre, 2018-11)
      This report contains maternal and infant data pertaining to Neonatal Therapeutic Hypothermia (TH) in Ireland for the period of 2016/2017. Anonymised data was collected on maternal characteristics, history of antenatal care and delivery. Data were collected on infant characteristics, resuscitation, assessment, hospital transfers, their 72-hour clinical course, rewarming, feeding and outcomes.
    • Severe maternal morbidity in Ireland annual report 2019

      Leitao, S.; Manning, E.; Corcoran, P.; San Lazaro Campillo, I.; Greene, R.A. (National Perinatal Epidemiology Centre, 2021-04)
      The eighth report from the National Clinical Audit of Severe Maternal Morbidity (SMM) in Ireland reports on 375 cases of SMM occurring in all 19 Irish maternity units in 2019. The SMM rate is a composite rate of a group of clearly defined severe maternal morbidities. Over two thirds of the women who experienced SMM in 2019 were diagnosed with one morbidity (n=253, 67.5%); 25% (n=95) were diagnosed with two morbidities; 6% (n=24) with three SMMs; 0.5% (n=2) with four morbidities; and 0.3% (n=1) with five morbidities. The SMM rate has shown a steady increase since the reference year of 2011. From 2011 to 2019, the SMM rate has increased by 68% from 3.85 to 6.47 per 1,000 maternities. The incidence has changed from one case of SMM for every 260 maternities in 2011 to one case in 155 maternities in 2019.
    • Neonatal Therapeutic Hypothermia in Ireland: Annual Report: 2019 Aggregate Report 2016-2019

      Meaney, S.; McGinley, J.; Corcoran, P.; McKenna, P.; Filan, P.; Greene, R.A.; Murphy, J. (National Perinatal Epidemiology Centre, 2021-04)
      This is the Neonatal Therapeutic Hypothermia report for 2019. The working partnership between the National Perinatal Epidemiology Centre, the National Women and Infant Health Programme and the National Clinical Programme for Paediatrics and Neonatology continues to be productive. This year marks the third published report. The Therapeutic Hypothermia (TH) steering committee continues to oversee the governance of this project and its members remain committed to the building of a national register for TH cases in Republic of Ireland. The electronic register was launched in early March 2020 and this system was utilised for the 2019 TH data collection. The data was collected and verified by the National TH Co-ordinator who visited the maternity units. The findings are accurate and applicable to clinical practice. This year, for the first time, data was collected on the Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III) assessment of the infants. This developmental assessment is undertaken when the infant is aged two years. This assessment provides information on the longerterm outcome of the infant cohort.
    • Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture.

      Khojaly, Ramy; Mac Niocaill, Ruairí; Shahab, Muhammad; Nagle, Matthew; Taylor, Colm; Rowan, Fiachra E; Cleary, May (2021-05-27)
      Background: Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and weight-bearing limitation may lead to poorer clinical outcomes. Traditional non-weight-bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates. Methods: A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 h versus non-weight-bearing (NWB) and immobilisation in a cast for 6 weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes include wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance. Discussion: Traditional management of operatively treated ankle fractures includes an extended period of non-weight-bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual care condition. It is hoped that these results will contribute to the modern management of ankle fractures.
    • Zn-Containing Membranes for Guided Bone Regeneration in Dentistry.

      Toledano, Manuel; Vallecillo-Rivas, Marta; Osorio, María T; Muñoz-Soto, Esther; Toledano-Osorio, Manuel; Vallecillo, Cristina; Toledano, Raquel; Lynch, Christopher D; Serrera-Figallo, María-Angeles; Osorio, Raquel (2021-05-29)
      Barrier membranes are employed in guided bone regeneration (GBR) to facilitate bone in-growth. A bioactive and biomimetic Zn-doped membrane with the ability to participate in bone healing and regeneration is necessary. The aim of the present study is to state the effect of doping the membranes for GBR with zinc compounds in the improvement of bone regeneration. A literature search was conducted using electronic databases, such as PubMed, MEDLINE, DIMDI, Embase, Scopus and Web of Science. A narrative exploratory review was undertaken, focusing on the antibacterial effects, physicochemical and biological properties of Zn-loaded membranes. Bioactivity, bone formation and cytotoxicity were analyzed. Microstructure and mechanical properties of these membranes were also determined. Zn-doped membranes have inhibited in vivo and in vitro bacterial colonization. Zn-alloy and Zn-doped membranes attained good biocompatibility and were found to be non-toxic to cells. The Zn-doped matrices showed feasible mechanical properties, such as flexibility, strength, complex modulus and tan delta. Zn incorporation in polymeric membranes provided the highest regenerative efficiency for bone healing in experimental animals, potentiating osteogenesis, angiogenesis, biological activity and a balanced remodeling. Zn-loaded membranes doped with SiO2 nanoparticles have performed as bioactive modulators provoking an M2 macrophage increase and are a potential biomaterial for promoting bone repair. Zn-doped membranes have promoted pro-healing phenotypes.
    • The environmental impact of personal protective equipment in a pre and post COVID era in the ENT clinic.

      Farrell, Eric; Smyth, David (2021-05-27)
      Purpose: The use of single use plastic items and plastic wrapping has increased over the last number of decades. Outside of the medical field there has been a conscious drive to reduce single use plastic and reuse items to reduce the amount of waste we produce. We undertook this investigation to quantify our plastic waste production and generate ideas to reduce this volume. Methodology: Data was collected from a University Hospital ENT outpatient department via real-time recording methods using standard data collection forms. We measured plastic unit usage pre and post COVID restrictions and compared this to our number of patient encounters. Projections of plastic usage were determined via a hypothetical resumption of patient services model. Results: In total there were 440 patients included. In period one the mean units of plastic used per day was 65.1 (median 67; range 27-84). In the second period, the mean number of plastic units was 23.4 (median 22; range 1-7). Blue nitrile gloves and masks were the most commonly used single use items. The hypothetical projection model predicted a 147.6% increase in single use items following the introduction of COVID precautions. Conclusion: We have a duty of care not only to our patients but future generations of patients and the environment which we share. Single use items and excessive plastic wrapping have benefits in terms of convenience and sterility, but these conveniences can be easily extended to reusable types to limit our volume of waste, reduce our waste management costs and protect our environment.
    • Correction to: Is postoperative non-weight-bearing necessary? INWN Study protocol for a pragmatic randomised multicentre trial of operatively treated ankle fracture.

      Khojaly, Ramy; Niocaill, Ruairí Mac; Shahab, Muhammad; Nagle, Matthew; Taylor, Colm; Rowan, Fiachra E; Cleary, May (2021-06-21)
    • Disease Behaviour During the Peri-Diagnostic Period in Patients with Suspected Interstitial Lung Disease: The STARLINER Study.

      Wijsenbeek, Marlies S; Bendstrup, Elisabeth; Valenzuela, Claudia; Henry, Michael T; Moor, Catharina C; Jouneau, Stéphane; Fois, Alessandro G; Moran-Mendoza, Onofre; Anees, Syed; Mirt, Mirela; et al. (2021-06-11)
      Introduction: Disease behaviour may guide diagnosis and treatment decisions in patients with interstitial lung disease (ILD). STARLINER aimed to characterise disease behaviour in patients with suspected ILD during the peri-diagnostic period using real-time home-based assessments. Methods: STARLINER (NCT03261037) was an international, multicentre study. Patients ≥ 50 years old with suspected ILD were followed throughout the peri-diagnostic period, consisting of a pre-diagnostic period (from enrolment to diagnosis) and a post-diagnostic period (from diagnosis to treatment initiation). Study length was variable (≤ 18 months). The primary endpoint was time-adjusted semi-annual forced vital capacity (FVC) change measured during the peri-diagnostic period using daily home spirometry in patients with idiopathic pulmonary fibrosis (IPF). Secondary outcomes included changes in FVC (home spirometry) in patients with non-IPF ILD, changes in FVC (site spirometry), changes in physical functional capacity measured by daily home accelerometry and site 6-min walk distance (6MWD), and changes in patient-reported outcomes (PROs) in IPF or non-IPF ILD. Results: Of the 178 patients enrolled in the study, 68 patients were diagnosed with IPF, 62 patients were diagnosed with non-IPF ILD, 9 patients received a non-ILD diagnosis and 39 patients did not receive a diagnosis. Technical and analytical issues led to problems in applying the prespecified linear regression model to analyse the home FVC data. Time-adjusted median (quartile [Q]1, Q3) semi-annual FVC change during the peri-diagnostic period measured using home and site spirometry, respectively, was - 147.7 (- 723.8, 376.2) ml and - 149.0 (- 314.6, 163.9) ml for IPF and 19.1 (- 194.9, 519.0) ml and - 23.4 (- 117.9, 133.5) ml in non-IPF ILD. A greater decline in steps per day was observed for IPF versus non-IPF ILD, whereas an increase in 6MWD was observed for patients with IPF versus a decline in 6MWD for patients with non-IPF ILD. No clear patterns of disease behaviour were observed for IPF versus non-IPF ILD for PROs. Conclusions: Despite home spirometry being feasible for most patients and centres, technical and analytical challenges in the home-based assessments prevented firm conclusions regarding disease behaviour. This highlights that further optimisation of the technology and analysis methods is required before widespread implementation.
    • Evaluation of Microdissection Testicular Sperm Extraction (mTESE), Outcomes and Predictive Factors in Ireland: The Gold Standard for Men with Non-Obstructive Azoospermia.

      Rohan, Pat; Daly, Niamh; O'Kelly, Aoife; O'Leary, Martin; Dineen, Tim; Shah, Nigam; Daly, Padraig; Waterstone, John; Cullen, Ivor (2021-04)
      In this study, sperm retrieval rate (SRR) was 47.06%. (16/34). The mean age in those who had retrieved sperm at mTESE was 37.9±2.6 years. Johnson Score (JS) and FSH were statistically different between successful and unsuccessful mTESE groups (p=0.017*10-5 and p=0.004, respectively). Optimal cutoff values for FSH, T and JS were 15 IU/L, 13 nmol/L and 5, respectively. The pregnancy rate was 63.64% (7/11) among men who went on to use mTESE sperm in an ICSI cycle.
    • Anaplastic thyroid cancer: outcomes of trimodal therapy.

      Houlihan, Orla A; Moore, Richard; Jamaluddin, Muhammad F; Sharifah, Adrinda; Redmond, Henry Paul; O'Reilly, Seamus; Feeley, Linda; Sheahan, Patrick; Rock, Kathy (2021-06-09)
      Backround: The purpose of this study is to assess the impact of trimodal therapy [surgery, chemotherapy and external beam radiotherapy (EBRT)] in patients with anaplastic thyroid cancer (ATC) treated with curative intent. Materials and methods: Retrospective review of patients with ATC treated at a tertiary referral centre between January 2009 and June 2020. Data were collected regarding demographics, histology, staging, treatment and outcomes. Results: Seven patients (4 female) were identified. Median age was 58 years (range 52-83 years). All patients received EBRT with concurrent doxorubicin. Six patients received surgery followed by chemoradiotherapy (CRT), and one underwent neoadjuvant CRT followed by surgery. Median radiological tumour size was 50mm (range 40-90 mm). Six patients had gross extrathyroidal extension and three had N1b disease. Prescribed radiotherapy schedules were 46.4 Gy in 29 bidaily fractions (n = 2, treated 2010), 60 Gy in 30 daily fractions (n = 2), 66 Gy in 30 fractions (n = 2) and 70 Gy in 35 fractions (n = 1; patient received neoadjuvant CRT). CRT was discontinued early for two patients due to toxicities. At median follow up of 5.8 months, 42.9% (3/7) patients were alive and disease-free. Only one patient developed a local failure. Three patients died from distant metastases without locoregional recurrence. Conclusions: Despite poor prognosis of ATC, selected patients with operable tumours may achieve high locoregional control rates with trimodal therapy, with possibility of long-term survival in select cases.
    • Colonic Metastasis of Primary Lung Cancer.

      Bhutta, Salman Idrees; Ahmed, Yasar; Zahid, Talal; Rehman, Habib Ur; Nur, Mutaz M; Mahmood, Tariq; Calvert, Paula (2021-06-17)
      The colon is an uncommon secondary site for metastasis of lung adenocarcinoma. Distinguishing primary colonic carcinoma from metastatic spread of lung carcinoma can be difficult. We present a case of a patient with lung adenocarcinoma who, on abdominal computed tomography scan examination, was found to have a sigmoid tumor that was thought to represent a synchronous primary colorectal adenocarcinoma. Histological examination of endoscopic sigmoid tumor biopsies confirmed this to be metastasis from the lung adenocarcinoma. The patient subsequently developed major rectal bleeding and deteriorated significantly. This case also illustrates the poor prognosis association with colorectal metastasis of lung cancer.
    • An investigation of psychological responses to COVID-19 in Irish healthcare workers: longitudinal quantitative and nested qualitative study.

      Fortune, Donal G; Richards, Helen L; Wormald, Andrew; O Connor, Kieran; McKiernan, Margaret; Najt, Pablo; O Dwyer, Amanda; O Dea, Edmond; Burke, Paul; Eustace, Joseph (2021-02-03)
      COVID-19 is an unprecedent occurrence in modern times and individuals who work within healthcare settings, face a broad array of challenges in responding to this worldwide event. Key information on the psychosocial responses of such healthcare workers (HCWs) in the context of COVID-19 is limited and in particular there is a need for studies that utilise longitudinal methods, an overarching theoretical model, and use of a cohort of participants within a defined geographical area across acute and community settings. The work packages making up the current research project use quantitative and qualitative methods to examine the psychological sequelae for HCWs in the context of COVID-19 in geographically adjacent healthcare areas (South and Mid-West of Ireland) across four time points (induction, 3 months, 6 months, and 1 year follow-up). The quantitative arm of the project (WP 1) utilises the Common-Sense Model of Self-Regulation (CSM-SR) and examines a number of key psychological factors pertinent to this model including perceptions about COVID-19 and infection more generally, coping, formal and informal support and a number of impact variables including mood, sleep quality, and perceptions of stigma. The qualitative study (WP 2) will address HCWs experiences of working during the pandemic, ascertain any additional areas of psychological functioning, environmental and workplace factors and resources that may be utilised by HCWs and that are not assessed by the quantitative study protocol, focusing particularly on those staff groups typically underrepresented in previous studies.
    • A qualitative study of the views of healthcare professionals on providing vaccines information to patients.

      Loftus, Ruth; Sahm, Laura J; Fleming, Aoife (2021-06-21)
      Background Healthcare professionals (HCPs) such as pharmacists, general practitioners and practice nurses are a trusted source of vaccines information for patients in primary care. Global regulators have highlighted the key role of HCPs in fostering confidence in COVID-19 vaccines. Objective This study aims to gain insight into the views and experiences of HCPs on providing vaccines information to patients. Setting Primary care general practice surgeries and community pharmacies in Ireland. Methods Qualitative, semi-structured interviews were conducted with 14 HCPs (five General practitioners [GPs], four practice nurses and five community pharmacists) identified through purposive and convenience sampling. The interviews were analysed by inductive thematic analysis. Main outcome measure Participants' views and experiences of providing vaccines information to patients. Results Five key themes were identified: roles and responsibilities, perception of risk, perception of the public, building a relationship, and emotion. HCPs were motivated by duty and care for their patients. They respected patient autonomy and were driven by their concern for public health. HCPs were influenced by their perception of risk and their perceptions of the public. HCPs practiced patient-centred care by providing tailored vaccines information. They favoured an approach of providing patients with information and support to make their own decision. The topic was emotive; HCPs empathised with patients but were also frustrated by their perceived inability to change some patients' views. Conclusion The provision of vaccines information by HCPs to patients is multifactorial with participants mindful of patient autonomy and the HCP role to support vaccinations as a public health priority. Participants suggested that education and support on vaccines communication would enable them to support the vaccines uptake in their practice.
    • Factors associated with SARS-CoV-2 infection in patients attending an acute hospital ambulatory assessment unit.

      Ronan, Geoffrey; Kumar, Lakshman; Davey, Mary; O Leary, Catriona; McAleer, Sarah; Lynch, Jenny; Lavery, Ros; Campion, John; Ryan, Joseph; O'Donoghue, P J; et al. (2021-04-06)
      To describe the factors associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in mild-to-moderate patients attending for assessment. This observational study was conducted in a Model 4 tertiary referral center in Ireland. All patients referred for SARS-CoV-2 assessment over a 4-week period were included. Patient demographics, presenting symptoms, comorbidities, medications, and outcomes (including length of stay, discharge, and mortality) were collected. Two hundred and seventy-nine patients were assessed. These patients were predominantly female (62%) with a median age of 50 years (SD 16.9). Nineteen (6.8%) patients had SARS-CoV-2 detected. Dysgeusia was associated with a 16-fold increased prediction of SARS-CoV-2 positivity (p = .001; OR, 16.8; 95% CI, 3.82-73.84). Thirteen patients with SARS-COV-2 detected (68.4%) were admitted, in contrast with 38.1% (99/260) of patients with SARS-CoV-2 non-detectable or not tested (p = .001). Female patients were more likely to be hospitalized (p = .01) as were current and ex-smokers (p = .05). We describe olfactory disturbance and fever as the main presenting features in SARS-CoV-2 infection. These patients are more likely to be hospitalized with increased length of stay; however, they make up a minority of the patients assessed. "Non-detectable" patients remain likely to require prolonged hospitalization. Knowledge of predictors of hospitalization in a "non-detectable" cohort will aid future planning and discussion of patient assessment in a SARS-CoV-2 era.
    • How do delirium motor subtypes differ in phenomenology and contributory aetiology? a cross-sectional, multisite study of liaison psychiatry and palliative care patients.

      Glynn, Kevin; McKenna, Frank; Lally, Kevin; O'Donnell, Muireann; Grover, Sandeep; Chakrabarti, Subho; Avasthi, Ajit; Mattoo, Surendra K; Sharma, Akhilesh; Gosh, Abhishek; et al. (2021-04-14)
      Objectives: To investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology. Design: Cross-sectional study. Setting: International study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings. Participants: 1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV). Primary and secondary outcome measures: Hyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory. Results: Hypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p<0.001) and had a lower overall burden of delirium symptoms than the other motor subtypes. Hyperactive delirium was associated with younger age, drug withdrawal and the DEC category other systemic aetiologies (p<0.001). Mixed delirium showed the greatest symptom burden and was more often associated with drug intoxication and metabolic disturbance (p<0.001). All three delirium motor subtypes had similar levels of impairment in attention and visuospatial functioning but differed significantly when compared with no subtype (p<0.001). Conclusions: This study indicates a pattern of aetiology and symptomatology of delirium motor subtypes across a large international sample that had previously been lacking. It serves to improve our understanding of this complex condition and has implications in terms of early detection and management of delirium.
    • Successful maintenance of process and outcomes for oesophageal cancer surgery in Ireland during the first wave of the COVID-19 pandemic.

      Bolger, Jarlath C; Donlon, Noel E; Butt, Waqas; Neary, Colm; Al Azzawi, Mohammed; Brett, Orla; King, Sinead; Downey, Eithne; Arumugasamy, Mayilone; Murphy, Thomas; et al. (2021-03-16)
      Introduction: The emergence of the novel coronavirus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the coronavirus disease COVID-19 has impacted enormously on non-COVID-19-related hospital care. Curtailment of intensive care unit (ICU) access threatens complex surgery, particularly impacting on outcomes for time-sensitive cancer surgery. Oesophageal cancer surgery is a good example. This study explored the impact of the pandemic on process and short-term surgical outcomes, comparing the first wave of the pandemic from April to June in 2020 with the same period in 2019. Methods: Data from all four Irish oesophageal cancer centres were reviewed. All patients undergoing resection for oesophageal malignancy from 1 April to 30 June inclusive in 2020 and 2019 were included. Patient, disease, and peri-operative outcomes (including COVID-19 infection) were compared. Results: In 2020, 45 patients underwent oesophagectomy, and 53 in the equivalent period in 2019. There were no differences in patient demographics, co-morbidities, or use of neoadjuvant therapy. The median time to surgery from neoadjuvant therapy was 8 weeks in both 2020 and 2019. There were no significant differences in operative interventions between the two time periods. There was no difference in operative morbidity in 2020 and 2019 (28% vs 40%, p = 0.28). There was no in-hospital mortality in either period. No patient contracted COVID-19 in the perioperative period. Conclusions: Continuing surgical resection for oesophageal cancer was feasible and safe during the COVID-19 pandemic in Ireland. The national response to this threat was therefore successful by these criteria in the curative management of oesophageal cancer.
    • Quantifying the impact of COVID-19 on chronic pain services in the Republic of Ireland.

      Mullins, Cormac Francis; Harmon, Dominic; O'Connor, Therese (2021-02-05)
      Introduction: During the COVID-19 pandemic, most medical services were shut down and resources were redistributed. Closures included pain management departments where many staff were redeployed. The aim of this study was to assess the impact of COVID-19 on chronic pain services in the Republic of Ireland. Methods: An online survey was sent to pain consultants working in public hospitals in the Republic of Ireland between the 22nd and 28th September 2020. Results: We received responses from 18 consultants from all 15 public hospitals in the Republic of Ireland with chronic pain services. Procedural volume during lockdown fell to 26% of pre-COVID levels. This had recovered somewhat by the time of the survey to 71%. Similarly, in-person outpatient clinic volume fell to 10% of per-COVID numbers and recovered to 50%. On average, 39% of public hospital activity was made up for by the availability of private hospitals. This varied significantly across the country. The use of telemedicine increased significantly during the pandemic. Before COVID, on average, 13% of outpatient clinic volume was composed of telephone or video consultations. This increased to 46% at the time of the survey. Conclusion: This survey of consultant pain physicians in the Republic of Ireland has revealed how chronic pain services have been affected during the pandemic and how they have evolved.