• 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?
    • Vacuolar cerebellopathy, the molecular autopsy and multiple acyl-CoA dehydrogenase deficiency

      Jansen, M; Bourke, W; Howley, R; Crushell, E; Sheahan, K; Farrell, M (2011-01)
    • The vegetative state.

      Staunton, H; Department of Neurological Sciences, RCSI, Beaumont Hospital, Dublin. hugh@iol.ie (2009-05)
    • VEGF expression in non-small cell lung cancer: Correlation with effectors of arachidonic acid metabolism

      Cathcart, Mary Clare; Gately, Kathy; Kay, Elaine; Cummins, Robert; Pidgeon, Graham P; O'Byrne, Kenneth J (2011-06)
    • Ventriculoperitoneal shunt-related infections caused by Staphylococcus epidermidis: pathogenesis and implications for treatment.

      Stevens, Niall T; Greene, Catherine M; O'Gara, James P; Bayston, Roger; Sattar, Muhammad T A; Farrell, Michael; Humphreys, Hilary; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Education & Research Centre, Beaumont Hospital, Dublin 9, Ireland. nstevens@rcsi.ie (2012-12)
      The insertion of medical devices, such as intraventricular shunts, is often complicated by infection leading to ventriculitis. Frequently, such infections result from colonisation and subsequent biofilm formation on the surfaces of the shunts by Staphylococcus epidermidis. The pathogenesis of neurosurgical shunt-related infection is complex with interactions between the pathogen, the device and the unique local immunological environment of the central nervous system (CNS). An ability to form biofilm, the main virulence determinant of Staphylococcus epidermidis, facilitates protection of the organism from the host defences while still initiating an immunological response. The presence of the blood brain barrier (BBB) and the biofilm itself also complicates treatment, which presents many challenges when managing shunt infections. A greater understanding of the interplay between S. epidermidis and the CNS could potentially improve the diagnosis, treatment and management of such infections. This review describes the pathogenesis, treatment and implications of S. epidermidis ventriculoperitoneal shunt-related infections, concentrating on recent research and the implications for treatment.
    • Vestibular function testing.

      Lang, E E; McConn Walsh, R; Department of Otolaryngology Head and Neck Surgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland, emerlang@eircom.net. (2010-06)
      Vestibular symptoms of vertigo, dizziness and dysequilibrium are common complaints which can be disabling both physically and psychologically. Routine examination of the ear nose and throat and neurological system are often normal in these patients. An accurate history and thorough clinical examination can provide a diagnosis in the majority of patients. However, in a subgroup of patients, vestibular function testing may be invaluable in arriving at a correct diagnosis and ultimately in the optimal treatment of these patients.
    • Videos: acute hyperglycaemia induced microvascular injury and haemorrhage in an experimental model.

      Casey, R G; Gang, C; Bouchier-Hayes, D J; Surgical Research Department, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. rowcasey@rcsi.ie (2008-12)
    • Viral oncogenesis and its role in nonmelanoma skin cancer.

      Tuttleton Arron, S; Jennings, L; Nindl, I; Rosl, F; Bouwes Bavinck, J N; Seçkin, D; Trakatelli, M; Murphy, G M; Department of Dermatology, University of California, San Francisco, CA, U.S.A. Department of Dermatology, Beaumont Hospital, Dublin 9, Ireland Division of Viral Skin Carcinogenesis Division of Viral Transformation Mechanisms, German Cancer Research Centre, Heidelberg, Germany Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands Department of Dermatology, Faculty of Medicine, Başkent University, Ankara, Turkey Department of Dermatology, Papageorgiou Hospital, Medical School of Aristotle University, Thessaloniki, Greece. (2011-06)
      In recent years, the contribution of viruses to cutaneous oncogenesis has steadily gained recognition. The archetype is human herpesvirus 8, which is well established as the causative agent in Kaposi sarcoma. Other viruses believed to play a role in nonmelanoma skin cancer include human papillomavirus and the recently described Merkel cell polyomavirus. We review the mechanisms by which these three viruses interact with the host cell, ultraviolet radiation and immunosuppression to result in carcinogenesis.
    • Virtual reality simulation in endovascular surgical training.

      Tsang, J S; Naughton, P A; Leong, S; Hill, A D K; Kelly, C J; Leahy, A L; Department of Vascular Surgery, RCSI, Beaumont Hospital, Dublin, Ireland. jutsang@rcsi.ie (2008-08)
      Shortened trainingtimes duetothe European Working Time Directive (EWTD) and increased public scrutiny of surgical competency have led to a move away from the traditional apprenticeship model of training. Virtual reality (VR) simulation is a fascinating innovation allowing surgeons to develop without the need to practice on real patients and it may be a solution to achieve competency within a shortened training period.
    • A vision-based system for hand washing quality assessment with real-time feedback

      Ameling, Stefan; Li, Johnson; Zhou, Jiang; Ghosh, Anarta; Lacey, Gerard; Creamer, Eilish; Humphreys, Hilary (2012-06-15)
    • Vitamin D receptor agonists inhibit pro-inflammatory cytokine production from the respiratory epithelium in cystic fibrosis.

      McNally, P; Coughlan, C; Bergsson, G; Doyle, M; Taggart, C; Adorini, L; Uskokovic, M R; El-Nazir, B; Murphy, P; Greally, P; et al. (2011-07-22)
      BACKGROUND: 1,25-Dihydroxycholecalciferol (1,25(OH)(2)D(3)) has been shown to mitigate epithelial inflammatory responses after antigen exposure. Patients with cystic fibrosis (CF) are at particular risk for vitamin D deficiency. This may contribute to the exaggerated inflammatory response to pulmonary infection in CF. METHODS: CF respiratory epithelial cell lines were exposed to Pseudomonas aeruginosa lipopolysaccharide (LPS) and Pseudomonas conditioned medium (PCM) in the presence or absence of 1,25(OH)(2)D(3) or a range of vitamin D receptor (VDR) agonists. Levels of IL-6 and IL-8 were measured in cell supernatants, and cellular total and phosphorylated IκBα were determined. Levels of human cathelicidin antimicrobial peptide (hCAP18) mRNA and protein were measured in cells after treatment with 1,25(OH)(2)D(3). RESULTS: Pretreatment with 1,25(OH)(2)D(3) was associated with significant reductions in IL-6 and IL-8 protein secretion after antigen exposure, a finding reproduced with a range of low calcaemic VDR agonists. 1,25(OH)(2)D(3) treatment led to a decrease in IκBα phosphorylation and increased total cellular IκBα. Treatment with 1,25(OH)(2)D(3) was associated with an increase in hCAP18/LL-37 mRNA and protein levels. CONCLUSIONS: Both 1,25(OH)(2)D(3) and other VDR agonists significantly reduce the pro-inflammatory response to antigen challenge in CF airway epithelial cells. VDR agonists have significant therapeutic potential in CF.
    • Warfarin use in hemodialysis patients: what is the risk?

      Phelan, P J; O'Kelly, P; Holian, J; Walshe, J J; Delany, C; Slaby, J; Winders, S; O'Toole, D; Magee, C; Conlon, P J; et al. (2011-03)
      Background: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. Methods: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. Results: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). Conclusions: This study confirms the higher bleeding risk associated with HD/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. Summary: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A secondary finding was that INR variability was significantly higher in HD patients than non-HD patients on warfarin.
    • Warfarin use in hemodialysis patients: what is the risk?

      Phelan, P J; O'Kelly, P; Holian, J; Walshe, J J; Delany, C; Slaby, J; Winders, S; O'Toole, D; Magee, C; Conlon, P J; et al. (2012-02-01)
      BACKGROUND: There is a paucity of data concerning the risks associated with warfarin in hemodialysis (HD) patients. We compared major bleeding episodes in this group with HD patients not receiving warfarin and with a cohort of non-HD patients receiving warfarin. METHODS: A retrospective review of 141 HD patients on warfarin (HDW), 704 HD patients not on warfarin (HDNW) and 3,266 non-dialysis warfarin patients (NDW) was performed. Hospital admissions for hemorrhagic events and ischemic strokes were examined as was hospital length of stay and blood product use. INR variability was also assessed. RESULTS: The incidence rates for major hemorrhage per 100 patient years was 10.8 in the HDW group as compared to 8.0 in the HDNW (p = 0.593) and 2.1 in the NDW (p < 0.001) groups. Mean units of red blood cell transfusions required was higher in patients on dialysis with no significant difference between HDW and HDNW groups. The risk of ischemic stroke per 100 patient years was 1.7 in the HDW group as compared to 0.7 in the HDNW groups (p = 0.636) and 0.4 in the NDW (p = 0.003). The HDW group had higher inter-measurement INR variability compared to the NDW group (p = 0.034). In patients with atrial fibrillation, HDW group had a higher incidence of ischemic stroke than the NDW group (2.2 versus 0.4 events per 100 patient years; p = 0.024). CONCLUSIONS: This study confirms the higher bleeding risk associated with HD/ESRD but suggests that warfarin use in these patients may not add significantly to this risk. We also demonstrated high rates of ischemic stroke in HD patients despite warfarin use. SUMMARY: Our study compares the frequency of major hemorrhage and secondarily, ischemic stroke in HD patients receiving or not receiving warfarin, with non-HD patients receiving warfarin. The major finding was that frequency of hemorrhage was higher in HD patients receiving warfarin than in non-HD patients receiving warfarin, but not different in HD patients with or without warfarin. A secondary finding was that INR variability was significantly higher in HD patients than non-HD patients on warfarin.
    • What do gastroenterology trainees want: recognition, remuneration or recreation?

      Harewood, G C; Pardi, D S; Hansel, S L; Corr, A E; Aslanian, H; Maple, J; Department of Gastroenterology and Hepatology, Beaumont Hospital, Dublin, Ireland, harewood.gavin@gmail.com. (2010-07-27)
      BACKGROUND: Occupational psychologists have identified three factors important in motivating physicians: financial reward, academic recognition, time off. AIM: To assess motivators among gastroenterology (GI) trainees. METHODS: A questionnaire was distributed to GI trainees to assess their motivators: (1) work fewer hours for less lucrative rate, (2) reduction in salary/increase in hours for academic protected time, and (3) work longer hours for higher total salary, but less lucrative hourly rate. RESULTS: Overall, 61 trainees responded; 52% of trainees would work shorter hours for less lucrative rate; 60% would accept a disproportionate reduction in salary/increase in hours for academic protected time; 54% would work longer hours for more money but less lucrative rate. Most trainees (93%) accepted at least one scenario. CONCLUSIONS: Most GI trainees are willing to modify their job description to align with their personal values. Tailoring job descriptions according to these values can yield economic benefits to GI Divisions.
    • What do gastroenterology trainees want: recognition, remuneration or recreation?

      Harewood, G C; Pardi, D S; Hansel, S L; Corr, A E; Aslanian, H; Maple, J; Department of Gastroenterology and Hepatology, Beaumont Hospital, Dublin,, Ireland. harewood.gavin@gmail.com (2012-02-01)
      BACKGROUND: Occupational psychologists have identified three factors important in motivating physicians: financial reward, academic recognition, time off. AIM: To assess motivators among gastroenterology (GI) trainees. METHODS: A questionnaire was distributed to GI trainees to assess their motivators: (1) work fewer hours for less lucrative rate, (2) reduction in salary/increase in hours for academic protected time, and (3) work longer hours for higher total salary, but less lucrative hourly rate. RESULTS: Overall, 61 trainees responded; 52% of trainees would work shorter hours for less lucrative rate; 60% would accept a disproportionate reduction in salary/increase in hours for academic protected time; 54% would work longer hours for more money but less lucrative rate. Most trainees (93%) accepted at least one scenario. CONCLUSIONS: Most GI trainees are willing to modify their job description to align with their personal values. Tailoring job descriptions according to these values can yield economic benefits to GI Divisions.
    • What's in the cin bin?

      Donnellan, F; Pankratieva, E; Murray, F E (2010-07)
    • When the bone in your swallow is your own.

      Ramphul, Navin; Gilligan, Peadar; Beaumont Hospital, Beaumont Road, Dublin 9, Republic of Ireland., navinramphul@eircom.net (2012-02-01)