• Youth mental health in the time of COVID-19.

      Power, Emmet; Hughes, S; Cotter, D; Cannon, M (2020-07-02)
      Youth mental health is a rapidly developing field with a focus on prevention, early identification, treatment innovation and service development. In this perspective piece, we discuss the effects of COVID-19 on young people's mental health. The psychosocial effects of COVID-19 disproportionately affect young people. Both immediate and longer-term factors through which young people are affected include social isolation, changes to the delivery of therapeutic services and almost complete loss of all structured occupations (school, work and training) within this population group. Longer-term mechanisms include the effects of the predicted recession on young people's mental health. Opportunities within this crisis exist for service providers to scale up telehealth and digital services that may benefit service provision for young people's mental health in the future.
    • Ethical triage during the COVID-19 pandemic: a toolkit for neurosurgical resource allocation.

      Hulsbergen, Alexander F C; Eijkholt, Marleen M; Balak, Naci; Brennum, Jannick; Bolger, Ciarán; Bohrer, Anna-Margarete; Feldman, Zeev; Holsgrove, Daniel; Kitchen, Neil; Mathiesen, Tiit I; et al. (2020-05-14)
      Background: The COVID-19 pandemic confronts healthcare workers, including neurosurgeons, with difficult choices regarding which patients to treat. Methods: In order to assist ethical triage, this article gives an overview of the main considerations and ethical principles relevant when allocating resources in times of scarcity. Results: We discuss a framework employing four principles: prioritizing the worst off, maximizing benefits, treating patients equally, and promoting instrumental value. We furthermore discuss the role of age and comorbidity in triage and highlight some principles that may seem intuitive but should not form a basis for triage. Conclusions: This overview is presented on behalf of the European Association of Neurosurgical Societies and can be used as a toolkit for neurosurgeons faced with ethical dilemmas when triaging patients in times of scarcity.
    • Protocol for the EARCO Registry: a pan-European observational study in patients with α-antitrypsin deficiency.

      Greulich, Timm; Altraja, Alan; Barrecheguren, Miriam; Bals, Robert; Chlumsky, Jan; Chorostowska-Wynimko, Joanna; Clarenbach, Christian; Corda, Luciano; Corsico, Angelo Guido; Ferrarotti, Ilaria; et al. (2020-03-02)
      The EARCO Registry is a non-interventional, multicentre, pan-European, longitudinal observational cohort study enrolling patients with AATD. Data will be collected prospectively without interference/modification of patient's management by the study team. The major inclusion criterion is diagnosed severe AATD, defined by an AAT serum level <11 µM (50 mg·dL-1) and/or a proteinase inhibitor genotype ZZ, SZ or compound heterozygotes or homozygotes of other rare deficient variants. Assessments at baseline and during the yearly follow-up visits include lung function testing (spirometry, body plethysmography and diffusing capacity of the lung), exercise capacity, blood tests and questionnaires (symptoms, quality of life and physical activity). To ensure correct data collection, there will be designated investigator staff to document the data in the case report form. All data will be reviewed by the EARCO database manager.
    • Beaumont Hospital and National Ambulance Service: Pathfinder Service

      Corcoran, Grace; Kenna, Lawrence; Beaumont Hospital, National Ambulance Service (Beaumont Hospital, 2020-02-26)
      Presentation on integration of ambulance service and Beaumont Hospital ED.
    • Diagnostic Accuracy of Prion Disease Biomarkers in Iatrogenic Creutzfeldt-Jakob Disease.

      Llorens, Franc; Villar-Piqué, Anna; Hermann, Peter; Schmitz, Matthias; Calero, Olga; Stehmann, Christiane; Sarros, Shannon; Moda, Fabio; Ferrer, Isidre; Poleggi, Anna; et al. (2020-02-12)
      Human prion diseases are classified into sporadic, genetic, and acquired forms. Within this last group, iatrogenic Creutzfeldt-Jakob disease (iCJD) is caused by human-to-human transmission through surgical and medical procedures. After reaching an incidence peak in the 1990s, it is believed that the iCJD historical period is probably coming to an end, thanks to lessons learnt from past infection sources that promoted new prion prevention and decontamination protocols. At this point, we sought to characterise the biomarker profile of iCJD and compare it to that of sporadic CJD (sCJD) for determining the value of available diagnostic tools in promptly recognising iCJD cases. To that end, we collected 23 iCJD samples from seven national CJD surveillance centres and analysed the electroencephalogram and neuroimaging data together with a panel of seven CSF biomarkers: 14-3-3, total tau, phosphorylated/total tau ratio, alpha-synuclein, neurofilament light, YKL-40, and real-time quaking induced conversion of prion protein. Using the cut-off values established for sCJD, we found the sensitivities of these biomarkers for iCJD to be similar to those described for sCJD. Given the limited relevant information on this issue to date, the present study validates the use of current sCJD biomarkers for the diagnosis of future iCJD cases.
    • Doctors don't Do-little: a national cross-sectional study of workplace well-being of hospital doctors in Ireland.

      Hayes, Blánaid; Prihodova, Lucia; Walsh, Gillian; Doyle, Frank; Doherty, Sally (2019-03-10)
      Objectives: To measure levels of occupational stress, burn-out, work-life balance, presenteeism, work ability (balance between work and personal resources) and desire to practise in trainee and consultant hospital doctors in Ireland. Design: National cross-sectional study of randomised sample of hospital doctors. Participants provided sociodemographic data (age, sex), work grade (consultant, higher/basic specialist trainee), specialty, work hours and completed workplace well-being questionnaires (Effort-Reward Imbalance (ERI) Scale, overcommitment, Maslach Burnout Inventory) and single item measures of work ability, presenteeism, work-life balance and desire to practise. Setting: Irish publicly funded hospitals and residential institutions. Participants: 1749 doctors (response rate of 55%). All hospital specialties were represented except radiology. Results: 29% of respondents had insufficient work ability and there was no sex, age or grade difference. 70.6% reported strong or very strong desire to practise medicine, 22% reported good work-life balance, 82% experienced workplace stress, with effort greatly exceeding reward, exacerbated by overcommitment. Burn-out was evident in 29.7% and was significantly associated with male sex, younger age, lower years of practice, lower desire to practise, lower work ability, higher ERI ratio and greater overcommitment. Apart from the measures of work ability and overcommitment, there was no sex or age difference across any variable. However, ERI and burn-out were significantly lower in consultants than trainees. Conclusions: Hospital doctors across all grades in Ireland had insufficient work ability, low levels of work-life balance, high levels of work stress and almost one-third experienced burn-out indicating suboptimal work conditions and environment. Yet, most had high desire to practise medicine. Measurement of these indices should become a quality indicator for hospitals and research should focus on the efficacy of a range of individual and organisational interventions for burn-out and occupational stress.
    • "Do as we say, not as we do?" the lifestyle behaviours of hospital doctors working in Ireland: a national cross-sectional study.

      O' Keeffe, Anthony; Hayes, Blánaid; Prihodova, Lucia (BMC Public Health, 2019-02-11)
      This study was conducted to assess the lifestyle behaviours of a national sample of hospital doctors working in Ireland. We also sought to compare the prevalence of these behaviours in doctors to the general Irish population. This was a national cross-sectional study of a randomised sample of hospital doctors working in Irish publicly funded hospitals and residential institutions. The final cohort consisted of 1749 doctors (response rate of 55%). All hospital specialties were represented except radiology. The following data were collected: sociodemographic data (age, sex), work grade (consultant, trainee) average hours worked over a two-week period, specialty and lifestyle behaviours (smoking, alcohol, physical activity). Lifestyle data for the general population was provided by the Healthy Ireland 2015 study. Half of participants were men (50.5%). Just over half of the sample were consultants (54.3%), with 45.7% being trainees. 9.3% of doctors surveyed were smokers, 88.4% consumed alcohol and 24.5% were physically inactive. Trainees were more likely to smoke and be physically inactive when compared to consultants. Smoking rates amongst doctors were lower than the general population (9.3% -v- 23%). Doctors were more likely to consume alcohol than the general population (88.4% -v- 71.7%) but less likely to engage in binge drinking on a typical drinking occasion (12.8% -v- 39.5%). Doctors were more compliant than the general population with minimum exercise targets (75.5% -v- 70.5%), but less likely to engage in health enhancing physical activity (19.1% -v- 33%). While the prevalence of health behaviours amongst hospital doctors in Ireland compares favourably to the general population, their alcohol consumption and engagement in health enhancing physical activity suggest room for improvement. Continued health promotion and education on the importance of personal health behaviours is essential.
    • The Doctor Can See You Now: A Key Stakeholder Study Into The Acceptability Of Ambulance Based Telemedicine.

      Gilligan, P; Bennett, A; Houlihan, A; Padki, A; Owens, N; Morris, D; Chochliouros, I; Mohammed, A; Mutawa, A; Eswararaj, M A; et al. (Irish Medical Journal, 2018-06)
      Using telecommunications technology it would be possible to link a patient and paramedic to a Doctor in the Emergency Department (ED) at the point of first patient contact. A questionnaire-based study on telemedicine in the pre-hospital environment involving patients, paramedics, doctors and nurses in the ED, was performed to assess if they would want and accept telemedicine in pre-hospital emergency care. When asked 98.5% (55) of patients, 89% (11) of doctors, 76% (14) of nurses and 91% (42) of ambulance personnel saw the potential of an audio-visual link from the pre-hospital environment to the ED. The potential benefits were felt to be in diagnosis of time-dependent illnesses, time management, increased hospital preparedness for incoming patients and increased triage efficiency. Stakeholder enthusiasm for pre-hospital telemedicine must be met with the technological requirements to provide such a service. As noted by one patient a pre-hospital audio-visual link to the ED could be “potentially a life saving service”.
    • Seasonal Variation in the Emergency Department Prevalence Of Sepsis

      McNevin, C; McDowell, R; Ni Shearcaigh, A; Wakai, A (Irish Medical Journal, 2018-05)
      The incidence and mortality of sepsis and severe sepsis in hospitalised patients is seasonal and consistently highest during the winter. The primary aim of this study was to measure the seasonal variation in the prevalence of emergency department (ED) patients with sepsis. This cross-sectional study was performed over two four-week periods in the summer and in the winter, respectively. The clinical records of all patients presenting to the ED during the study periods were retrospectively screened to determine if they met the criteria for “uncomplicated” sepsis and severe sepsis or septic shock. The prevalence of “uncomplicated” sepsis was higher in the winter (43.9 per 1000) compared to the summer (30.7 per 1000). The prevalence of severe sepsis or septic shock was also higher in the winter (17.7 per 1000) compared to the summer (11.7 per 1000). This quantitatively demonstrates the increased ED burden of sepsis in the winter that can be used to inform healthcare planning and resource allocation.
    • Needs of informal caregivers across the caregiving course in amyotrophic lateral sclerosis: a qualitative analysis.

      Galvin, Miriam; Carney, Sile; Corr, Bernie; Mays, Iain; Pender, Niall; Hardiman, Orla (BMJ Open, 2018-01-27)
      Amyotrophic lateral sclerosis (ALS), also known as motor neuron disease (MND), is a debilitating terminal condition. Informal caregivers are key figures in ALS care provision. The physical, psychological and emotional impact of providing care in the home requires appropriate assistance and support. The objective of this analysis is to explore the needs of informal ALS caregivers across the caregiving course.
    • Isolated Unilateral Pulmonary Artery Agenesis complicated by Symptomatic Aspergilloma

      Daly, A; Gunaratnam, C; Redmond, K C; Eaton, D (Irish Medical Journal, 2017-11)
      Isolated unilateral pulmonary artery agenesis is a rare diagnosis. Poor blood flow to the lung parenchyma renders the tissue susceptible to opportunistic infections. We present the unusual case of isolated unilateral pulmonary artery agenesis complicated by aspergilloma. Management options and considerations are discussed.
    • The Avocado Hand

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

      Osuafor, C N.; Greene, B; El-Kininy, N; Donegan, C (Irish Medical Journal, 2017-11)
      Dysphagia is a risk factor for adverse health outcomes like aspiration, recurrent chest infections and malnutrition. Here, we describe a case of an 82-year-old lady who presented with a two-month history of dysphagia after an anterior odontoid screw fixation for a type II odontoid process fracture. This case highlights the importance of a multidisciplinary approach to patient care.
    • Hospital Resource Utilisation by Patients with Community-Acquired Pneumonia

      McCarthy, S; O’Donnell, S; Costello, R W; Humphreys, H (Irish Medical Journal, 2017-09)
      Little data is available on the resource utilisation of patients admitted with Community-Acquired Pneumonia (CAP) in Ireland. A retrospective review of 50 randomly-selected patients admitted to Beaumont Hospital with CAP was undertaken. The mean length of stay of patients with CAP was 12 days (+/- 16 days). All patients were emergency admissions, all had a chest x-ray, a C-reactive protein blood test, and occupied a public bed at some point during admission. Common antimicrobial therapies were intravenous (IV) amoxicillin/clavulanic acid and oral clarithromycin; 60% received physiotherapy. The estimated mean cost of CAP per patient was €14,802.17. Costs arising from admission to hospital with CAP are substantial, but efforts can be undertaken to ensure that resources are used efficiently to improve patient care such as discharge planning and fewer in-hospital ward transfers
    • Impact of somatic PI3K pathway and ERBB family mutations on pathological complete response (pCR) in HER2-positive breast cancer patients who received neoadjuvant HER2-targeted therapies.

      Toomey, Sinead; Eustace, Alexander J; Fay, Joanna; Sheehan, Katherine M; Carr, Aoife; Milewska, Malgorzata; Madden, Stephen F; Teiserskiene, Ausra; Kay, Elaine W; O'Donovan, Norma; et al. (BioMed Central, 2017-07-27)
      The Cancer Genome Atlas analysis revealed that somatic EGFR, receptor tyrosine-protein kinase erbB-2 (ERBB2), Erb-B2 receptor tyrosine kinase 3 (ERBB3) and Erb-B2 receptor tyrosine kinase 4 (ERBB4) gene mutations (ERBB family mutations) occur alone or co-occur with somatic mutations in the gene encoding the phosphatidylinositol 3-kinase (PI3K) catalytic subunit (PIK3CA) in 19% of human epidermal growth factor receptor 2 (HER2)-positive breast cancers. Because ERBB family mutations can activate the PI3K/AKT pathway and likely have similar canonical signalling effects to PI3K pathway mutations, we investigated their combined impact on response to neoadjuvant HER2-targeted therapies.
    • A Case of Autoimmune Pancreatitis Presenting as a Deterioration in Glycaemic Control in a Patient with Pre-Existing Type 2 Diabetes

      Forde, H; Slattery, D; Swan, N; Smith, D (Irish Medical Journal, 2017-05)
      Autoimmune pancreatitis (AIP) was first described in 1961 and accounts for 5-6% of cases of chronic pancreatitis, though the prevalence is increasing with increasing awareness of the disease1,2. There are two types of autoimmune pancreatitis with different clinical and pathological features. Type 1 AIP is an IgG4 related disease and tends to occur in elderly patients in the 7th decade, with a male preponderance3. Type 1 AIP is associated with other organ involvement and commonly affects the biliary system3. In contrast, Type 2 AIP occurs in patients in the 5th-6th decade of life and other organ involvement is uncommon3. Both types of AIP respond well to steroids with reported remission rates of 99% and 92% for Type 1 and Type 2 AIP respectively4. Case report: A 69-year-old man was referred to the diabetes clinic with poor glycaemic control despite escalation of oral hypoglycaemic therapy. He had been diagnosed with Type 2 diabetes mellitus (T2DM) 1 year previously, having presented with polyuria, one stone weight loss and a HbA1c of 12%. His past medical history included asthma, benign prostatic hypertrophy, treated hypertension, B12 deficiency and gallstone cholecystitis. At presentation to the diabetes clinic, his BMI was 24kg/m2 with a HbA1c of 8.1% on Gliclazide 120mg daily and Pioglitazone 15mg daily. A previous trial of Metformin and Saxagliptin had been ineffective at lowering blood glucose levels. He was commenced on Insulin Detemir once daily to optimise diabetes control. In view of the significant weight loss and hyperglycaemia despite multiple agents, computerised tomography (CT) of the pancreas was arranged. This revealed pancreatic duct dilatation within an atrophic pancreatic tail. Magnetic Resonance Cholangiopancreatography (MRCP) demonstrated a prominence in the pancreatic head and neck region which appeared malignant when further imaged with endoscopic ultrasound (EUS).
    • Home enteral nutrition recipients: patient perspectives on training, complications and satisfaction

      Boland, Karen; Maher, Niamh; O'Hanlon, Carmel; O'Sullivan, Maria; Rice, Niamh; Smyth, Martina; Reynolds, John V (BMJ, 2016-10)
      The equitable provision of home enteral nutrition (HEN) in the community can have a transformative effect on patient experience and family life for adults and children alike. While optimising quality of life in HEN patients can be challenging, the initiation of HEN positively impacts this measure of healthcare provision.1 Quality of life scores have been shown to improve in the weeks after hospital discharge, and HEN is physically well tolerated. However, it may be associated with psychological distress, and sometimes reluctance among HEN patients to leave their homes.2 Globally, HEN can attenuate cumulative projected patient care costs through a reduction in hospital admission and complications including hospital acquired infections.3 In an era where the cost of disease related malnutrition and associated prolonged hospital stay is being tackled in our healthcare systems, the role of HEN is set to expand. This is a treatment which has clear clinical and social benefits, and may restore some independence to patients and their families. Rather than the indications for HEN being focused on specific diagnoses, the provision of months of quality life at home for patients is adequate justification for its prescription.4 Previously, a review of HEN service provision in 39 cases demonstrated that patients want structured follow-up after hospital discharge, and in particular, would like one point of contact for HEN education and discharge.5 Management structures, funding challenges and the need for further education, particularly within the primary care setting may limit optimal use of HEN. The Irish Society for Clinical Nutrition and Metabolism (IrSPEN) aims to develop a national guideline document, drawing on international best practice, forming a template and standards for local policy development in the area of HEN service provision, training and follow-up. The first step in guideline development was to investigate patient experience for adults and children alike. Care needs and supports may differ in these distinct populations. The unmet needs of carers of older adults on HEN have been documented,6 although multidisciplinary interventions and evolution of standards for successful discharge will benefit all affected patients and their families. The aim of this study, therefore, was to survey domiciliary HEN clients, to document and analyse user experience, attitudes and complications associated with HEN.
    • DVT presentations to an emergency department: a study of guideline based care and decision making

      Lillis, D; Lloyd, C; O’Kelly, P; Kelada, S; Kelly, S; Gilligan, P (Irish Medical Journal, 2016-02)
      Pre-test probability scoring and blood tests for deep venous thrombosis (DVT) assessment are sensitive, but not specific leading to increased demands on radiology services. Three hundred and eighty-five patients presenting to an Emergency Department (ED), with suspected DVT, were studied to explore our actual work-up of patients with possible DVT relating to risk stratification, further investigation and follow up. Of the 205 patients with an initially negative scan, 36 (17.6%) were brought for review to the ED Consultant clinic. Thirty-four (16.6%) patients underwent repeat compression ultrasound with 5 (2.4%) demonstrating a DVT on the second scan. Repeat compression ultrasound scans were performed on 34 (16.6%) patients with an initially negative scan, with essentially the same diagnostic yield as other larger studies where 100% of such patients had repeat scanning. Where there is ongoing concern, repeat above-knee compression ultrasound within one week will pick up a small number of deep venous thromboses.
    • Vaccination in Renal Transplant Patients (VcRtp study)

      Rathore, F; Berzan, E; Magee, C (Irish Medical Journal, 2016-02)
      Adverse outcomes of influenza & pneumococcal infections in solid organ transplant recipients have been well documented. Vaccinations are therefore recommended by multiple guidelines. Despite emerging evidence of the safety & effectiveness among immunosuppressed patients, most vaccines are still underutilized, we conducted a survey among the renal transplant patients in Beaumont Hospital to determine the awareness and uptake of vaccinations. Questionnaires were handed to patients during a clinic visit over a span of 2 weeks and 250 questionnaires were posted out to randomly selected transplant patients, The Questionnaire addressed various aspects including the awareness of importance of vaccinations, source of information, if they were up to date with the vaccines & where did they receive it?
    • Secondary prevention after ischaemic stroke: the ASPIRE-S study

      Brewer, Linda; Mellon, Lisa; Hall, Patricia; Dolan, Eamon; Horgan, Frances; Shelley, Emer; Hickey, Anne; Williams, David (BMC Neurology, 2015-10-23)