• 2016 WSES guidelines on acute calculous cholecystitis.

      Ansaloni, L; Pisano, M; Coccolini, F; Peitzmann, A B; Fingerhut, A; Catena, F; Agresta, F; Allegri, A; Bailey, I; Balogh, Z J; et al. (World journal of emergency surgery : WJES, 2016)
      Acute calculus cholecystitis is a very common disease with several area of uncertainty. The World Society of Emergency Surgery developed extensive guidelines in order to cover grey areas. The diagnostic criteria, the antimicrobial therapy, the evaluation of associated common bile duct stones, the identification of "high risk" patients, the surgical timing, the type of surgery, and the alternatives to surgery are discussed. Moreover the algorithm is proposed: as soon as diagnosis is made and after the evaluation of choledocholitiasis risk, laparoscopic cholecystectomy should be offered to all patients exception of those with high risk of morbidity or mortality. These Guidelines must be considered as an adjunctive tool for decision but they are not substitute of the clinical judgement for the individual patient.
    • 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias.

      Birindelli, Arianna; Sartelli, Massimo; Di Saverio, Salomone; Coccolini, Federico; Ansaloni, Luca; van Ramshorst, Gabrielle H; Campanelli, Giampiero; Khokha, Vladimir; Moore, Ernest E; Peitzman, Andrew; et al. (BioMed Central, 2017)
      Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.
    • Adult ileocolic intussusception secondary to ileocaecal valve polyp.

      Chugthai, Saqib Zeeshan; Atif, Abdul Hakeem; Chughtai, Jehan Zeb; Miptah, Najaa Hayatul; Couse, Neville; Letterkenny General Hospital, Surgery, 135 Foxhills, Letterkenny, County Donegal,, Ireland. (2012-01-31)
      Intussusception is relatively common in children, but it is a rare cause of abdominal pain and intestinal obstruction in adults. The aetiology, clinical presentation and management of this condition differs in adults and children. Preoperative clinical diagnosis is usually difficult due to the non-specific and intermittent nature of the symptoms. Ultrasound and computed tomography can be helpful in establishing the diagnosis. We present a case of adult ileocolic intussusception with classical radiological signs and operative findings. In adults the diagnosis of intussusception should be considered in a case of intermittent abdominal pain, especially with clinical signs of intermittent bowel obstruction.
    • Angioembolization for pelvic fractures.

      Letterkenny General Hospital, Letterkenny, Ireland. (2012-01-31)
    • Avascular necrosis of femoral heads post-adrenal surgery for Cushing's syndrome: a rare presentation.

      Letterkenny General Hospital, Letterkenny, Co. Donegal, Ireland,, modelian@gmail.com. (2012-01-31)
      Avascular necrosis (AVN) is a well-recognized complication of patients on high-dose steroids for a long time. Exogenous hypercortisolism is a well known cause of AVN and a number of cases have been reported. Cushing's syndrome describes hypercortisolism of any cause endogenous or exogenous. A variety of traumatic and non-traumatic factors contribute to the aetiology of AVN although exogenous glucocorticoids administration and alcoholism are among the most common non-traumatic causes. AVN secondary to endogenous hypercortisolism is rare and very few case reports are available describing this complication. No literature is available on AVN presenting post-adrenal surgery. Here we present a young woman who presented with avascular necrosis of both hips 1 year after adrenalectomy for Cushing's syndrome.
    • Bird fancier's lung in mushroom workers

      J Hayes,; M Barrett (Irish Medical Journal, 2015-04)
      Hypersensitivity pneumonitis has been described in mushrooms workers caused by exposure to mushroom or fungal spores in the compost used to grow mushrooms. We describe two mushroom workers who developed hypersensitivity pneumonitis due to exposure to avian proteins found in poultry manure which was used in producing mushroom compost. Both workers were employed in the compost production area. Both presented with typical features of HP. Both workers had negative serological and precipitin studies to Apergillus fumigatus, Saccarhopolyspora rectivirgula and thermophilic actinomycetes but had positive responses to poultry antibodies. Neither was exposed to mushroom spores. Both workers required initial therapy with corticosteroids. Relocation with avoidance of further exposure resulted in complete cure in one worker and change in work practice with the use of personal protections equipment resulted in the second worker clinical stabilisation. These are the first reported cases of bird fanciers lung in mushroom workers.
    • Breast cancer risk assessment and screening - Is it a persistent problem in a rural population?

      Johnston, Alison; Neary, Shane; Sugrue, Michael; Department of Breast Surgery, Breast Centre North West, Letterkenny University Hospital, Donegal Clinical Research Academy, Ireland (Remedy Publications LLC, 2017-08-09)
      Trend analysis of breast screening uptake in those meeting screening criteria that were newly diagnosed with breast cancer. Retrospective review of all breast cancer patients diagnosed between 2010 and 2014. Patients’ demographics, screening, risk assessment, pathological stages and surgical treatment utilization were recorded. 150 patients, mean ages 55.4 ± 10.2 years (range 29–90), were studied. Overall 65/150 (43.3%) had optimal screening pre cancer diagnosis and 85/150 (56.7%) suboptimal. The trend in optimal screening improved from 30% to 60% over the study period. The mean overall tumour size (excluding DCIS patients) in 131 patients was 32.8 mm; 26.9 mm in optimally and 38.5 mm in the suboptimally screened groups (p = 0.06 x2 df8). 113/150 (75.3%) diagnosed with early stage breast cancer and 37/150 (24.7%) late stage. Principally late stage at diagnosis was within the group with suboptimal screening; 100%, 100%, 63.6%, 75% and 60% respectively for years 2010–2014. This study identified improving trends in compliance with international screening and risk assessment guidelines. Failure to screen results in more advanced disease; further public health measures to engage appropriate screening may improve stage at presentation and breast cancer outcomes.
    • The Centricity Score: A Novel Measurement to Aid in Conservative Breast Cancer Surgery

      Sugrue, Ryan; McGowan, Katherine; McNamara, Cillian; Sugrue, Michael (Advances in Breast Cancer Research, 2014-10)
      Introduction: This study describes an intra-operative scoring system to advise the surgeon of the centricity of the tumour in the excised specimen. Methods: Spatial estimations were prospectively made in 10 consecutive patients undergoing wide local excision (WLE) using Bioptics intra-operative digital specimen imaging. The centricity score was defined as 100 – (ICD/SD × 100), where ICD is the inter-centre distance between the specimen’s centre and the tumour’s centre. Results: 10 patients with invasive breast cancer (T1b to T4a), mean age 56 years (range 44 - 71) were studied. The mean tumour and specimen diameter was 24 mm ± 10 (range 12 - 48) and 101 mm ± 22 (range 64 - 140). The mean centricity score was 86 ± 9 (range 65 - 95). Conclusion: This study successfully describes an intraoperative radiological spatial scoring system for patients undergoing WLE. Tumours were well centered in specimens with an overall score of 86/100. The centricity score could be used to guide excision and potentially set benchmarks for conservative breast surgery.
    • Cigarette use and cardiovascular risk in chronic kidney disease: an unappreciated modifiable lifestyle risk factor.

      Stack, Austin G; Murthy, Bhamidipati V R; Regional Kidney Centre, Department of Medicine, Letterkenny General Hospital,, Health Services Executive, County Donegal, Ireland. austin.stack@hse.ie (2012-01-31)
      Tobacco use is a major modifiable cardiovascular risk factor in the general population and contributes to excess cardiovascular risk. Emerging evidence from large-scale observational studies suggests that continued tobacco use is also an independent cardiovascular risk factor among patients with chronic kidney disease (CKD). The benefits of smoking cessation programs on improving the heath status of patients and reducing mortality are unequivocal in the general population. Despite this, there has been little effort in pursuing tobacco cessation programs in dialysis cohorts or those with lesser degrees of kidney impairment. Most of our attention to date has focused on the development of "kidney-specific" interventions that reduce rates of renal disease progression and improve dialysis outcomes. The purpose of this current review is to describe the epidemiology of tobacco use among patients with CKD, draw attention to its negative impact on cardiovascular morbidity and mortality, and finally highlight potential strategies for successful intervention. We hope that this study heightens the importance of tobacco use in CKD, stimulates renewed interest in the barriers and challenges that exist in achieving smoking cessation, and endorses the efficacy of intervention strategies and the immeasurable benefits of quitting on cardiovascular and noncardiovascular outcomes.
    • Combined Patients and Medical Related Cosmetic Breast Cancer Outcomes—A Preferred Approach to Outcomes Assessment

      Sugrue, Michael; Johnston, Alison; Degnim, Amy; Rubio, Isabel T.; Van den Tol, M. Petrouska; Djohan, Risal; Valentine, Mark; Mac Gregor, Geraldine; 1. Breast Centre North West, Letterkenny University Hospital, Donegal, Ireland 2. Donegal Clinical Research Academy, Donegal, Ireland. 3. Mayo Clinic, Rochester, NY, USA. 4. Vall d’Hebron Hospital Universitario, Barcelona, Spain. 5&6 University Medical Centre, Amsterdam, Netherlands (Advances in Breast Cancer Research, 2018-12)
      Introduction: Reducing positive margins and need for re-excision yet maintaining cosmesis is key in breast cancer surgery. This study describes the evaluation of early outcomes of a combined cosmetic assessment programme following breast conservation surgery (BCS). Methods: An ethically approved prospective study was conducted at Letterkenny University Hospital and a 15-month timeframe was chosen. All consecutive patients undergoing conservative breast surgery with complete local excision, from July 2015 to October 2016, were entered into the study. Patients undergoing mastectomy and reconstruction with either implant or autologous tissue were not included. 41 patients undergoing BCS were analysed. Objective and subjective cosmetic evaluations were carried out. Assessments used were the Breast Cancer Conservative Treatment—cosmetic results [BCCT.core 2.0] Software, a panel of 4 experts in breast surgery and the Breast Cancer Treatment Outcome Scale (BCTOS). Demographic and pathological data, breast excision weight, % breast volume excised (BVE), margin positivity, complications and re-excision were documented. Data was expressed as mean and standard deviation for normally distributed data and medians and inter quartile range for non-normal data. Scores were also dichotomised to excellent/good and fair/poor and results were analysed. Results: 41 patients’ mean age is 55 ± 13 years. Mean breast volume was 768.3 cm3 ± 440; BVE weighed 78.6g ± 42.6 (18.9 - 214.4) and %BVE 11.3% ± 5.2% (5.1 - 23.3). Re-excision rate was 2/41 (4.9%) all for positive margins. 0/41 infections or haematomas occurred.
    • Community-based health efforts for the prevention of falls in the elderly.

      Hanley, Alan; Silke, Carmel; Murphy, John; Department of Medicine, Letterkenny General Hospital, Letterkenny, Co Donegal,, Ireland. alan.hanley@gmail.com (2012-01-31)
      Falls are a major public health problem in the elderly population. The associated health care cost is great. It has therefore become an important public health matter to evaluate those interventions that might be effective in reducing the risk of falls. Risk factors that predict an increased risk of falling are described. We discuss interventions that can be employed in the community to reduce the risk of falls and associated injuries by discipline, including physiotherapy, occupational therapy, and physician-led interventions. We also discuss the cost-effectiveness of such interventions.
    • Compression fractures of the vertebrae during a "bumpy" boat ride.

      Chukwunyerenwa, C K; O'Rourke, P; Orthopaedic Unit, Letterkenny General Hospital, Letterkenny, Co. Donegal,, Republic of Ireland. Chukwunyerenwa@yahoo.com (2012-01-31)
      INTRODUCTION: Compression fracture of the vertebrae is common, often the result of falls from height and motor vehicle accidents in the younger age groups. It can occur following minor trauma in the elderly and in those with osteoporosis. MATERIALS AND METHODS: We present an interesting case of compression fracture of the vertebral bodies occurring simultaneously in a couple during a boat ride while on holiday. One individual had fracture of the T8, while the other fractured the L1 vertebrae. Both injuries were treated conservatively with Taylor braces. CONCLUSION: We highlight one of the potential hazards of this recreational activity, and the almost identical fracture pattern in this couple.
    • A consultant paediatrician led and public health nurse (PHN) provided Community Enuresis Clinic as a model of care.

      Noone, D; van der Spek, N; Waldron, M; Cavan General Hospital, Cavan Town, Co Cavan. dnoone@O2.ie (2011-02)
      A dedicated Community Enuresis Clinic was established in 2004 in Cavan and Monaghan. The service was audited using ERIC (Education and Resources for Improving Childhood Continence) guidelines. There were 106 males and 47 females, giving an M: F ratio of 2.3:1. Monosymptomatic Nocturnal Enuresis (MNE) accounted for 127 (83%). Adequate follow-up was available for 108 children with MNE and in this group Initial Success was 49% (ERIC target 50%). 71% were dry at 1 year. There was a dropout rate of 20% in the MNE group (ERIC minimum standard < 25%). We believe the structure of this community based clinic and its approach to MNE management has been successful.
    • Engaging life in two Irish nursing home units for people with dementia: Quantitative comparisons before and after implementing household environments.

      Morgan-Brown, Mark; Newton, Rita; Ormerod, Marcus; a SURFACE Inclusive Design Research Centre, School of the Built Environment, The University of Salford , Salford , UK. (Aging & mental health, 2012-09-03)
      Objectives: This study compares the Social Engagement and Interactive Occupation of residents with dementia in two Irish nursing homes, before and after conversion to a household model environment. The changes were an open plan design and a functioning unit kitchen, supported by a homemaker role and operational policies which reduced task-based work in favour of person-centred care offering choice. Method: A snapshot observation method was used to obtain quantitative data of resident activity using the Assessment Tool for Occupation and Social Engagement (ATOSE). Residents were assessed for four hours, on seven different weekdays, over a six-week period both pre- and post-renovation. The exception to this was the assessment of the traditional model unit (TMU) for Nursing Home 1 which was reduced to four days due to the early start of the building work. Results: The results were consistent for both nursing homes and data were aggregated. Residents spent more time in the communal living spaces and were more likely to be active and engaged in the household model units (HMUs) compared to the TMUs. Using the independent t-test, these changes were found to be highly significant (p < 0.001). Conclusion: Creating an HMU increased the Interactive Occupation and Social Engagement of residents in the communal areas of the two nursing homes. The physical environment change, in conjunction with supportive staff procedures and organizational initiatives, improved the well-being of residents with dementia. The outcomes must be viewed in context with financial implications.
    • European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique.

      Masud, Tahir; Blundell, Adrian; Gordon, Adam Lee; Mulpeter, Ken; Roller, Regina; Singler, Katrin; Goeldlin, Adrian; Stuck, Andreas (Oxford University Press, 2014-09)
      the rise in the number of older, frail adults necessitates that future doctors are adequately trained in the skills of geriatric medicine. Few countries have dedicated curricula in geriatric medicine at the undergraduate level. The aim of this project was to develop a consensus among geriatricians on a curriculum with the minimal requirements that a medical student should achieve by the end of medical school.
    • Evaluation of an innovative recruitment initiative on the attitudes of medical students

      O’Connor, K; Thekiso, T; Douglas, L; Barry, H; Flynn, D; McCarthy, A; Swanwick, G (Irish Medical Journal, 2013-05)
    • Evaluation of the patient generated index as a measure of quality-of-life in people with severe traumatic brain injury.

      Hogan, Mark; Nangle, Niamh; Morrison, Todd G; McGuire, Brian E; School of Psychology, National University of Ireland, Galway, Ireland. markf.hogan@hse.ie (2013)
      Quality-of-life (QoL) measures may be useful in quantifying the personal impact of an acquired brain injury and as an indicator of the effectiveness of service provision. This study investigated the validity of the patient generated index (PGI) as a measure of QoL with a sample of adults who had sustained a severe traumatic brain injury.
    • Evidence based road safety? The Driving Standards Agency's schools programme

      Cochrane Injuries Group Driver Education Reviewers; Achara, Shirley; Adeyemi, Bola; Dosekun, Efunbo; Kelleher, Suzanne; Lansley, Marilyn; Male, Ian; Muhialdin, Nermin; Reynolds, Lucy; Roberts, Ian; et al. (2001-07)
      Presentation at the third Interdisciplinary Evidence Based Policies and Indicator Systems Conference, July 2001