• Did Not Wait Patient Management Strategy (DNW PMS) Study.

      Emergency Department, Beaumont Hospital, Beaumont Road, Dublin, Ireland. (2012-02-01)
      Objectives This study was undertaken to assess the usefulness of senior emergency medicine specialists' review of all 'did not wait' (DNW) patients' triage notes and the recall of at-risk patients. Methods A prospective study of all DNW patients was performed from 1 January to 31 December 2008. Following a daily review of charts of those who failed to wait to be seen, those patients considered to be at risk of adverse outcome were contacted by the liaison team and advised to return. Data were gathered on all DNW patients on the Oracle database and interrogated using the Diver solution. Results 2872 (6.3%) of 45 959 patients did not wait to be seen. 107 (3.7%) were recalled on the basis of senior emergency medicine doctor review of the patients' triage notes. Variables found to be associated with increased likelihood of being recalled included triage category (p<0.001), male sex (p<0.004) and certain clinical presentations. The presenting complaints associated with being recalled were chest pain (p<0.001) and alcohol/drug overdose (p=0.001). 9.4% of DNW patients required admission following recall. Conclusion The systematic senior doctor review of triage notes led to 3.7% of patients who failed to wait being recalled. 9.4% of those recalled required acute admission. The daily review of DNW patients' triage notes and the recalling of at-risk patients is a valuable addition to our risk management strategy.
    • Differences in expression of virulence genes amongst invasive and colonizing isolates of meticillin-resistant Staphylococcus aureus.

      Abu Othman, Amalina; Humphreys, Hilary; O'Neill, Eoghan; Fitzgerald-Hughes, Deirdre (2011-02)
    • Differences in the structure of outpatient diabetes care between endocrinologist-led and general physician-led services.

      O Donnell, Máire; de Siún, Anna; O Mullane, Monica; Smith, Diarmuid; Bradley, Colin; Finucane, Francis; Dinneen, Sean (2013-11-25)
      Despite a shift in diabetes care internationally from secondary to primary care, diabetes care in the Republic of Ireland remains very hospital-based. Significant variation in the facilities and resources available to hospitals providing outpatient diabetes care have been reported in the UK. The aim of this study was to ascertain the structure of outpatient diabetes care in public hospitals in the Republic of Ireland and whether differences existed in services provided across hospitals.
    • Differential diagnosis of hyponatraemia.

      Thompson, Chris; Berl, Tomas; Tejedor, Alberto; Johannsson, Gudmundur; Academic Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont Road, Dublin 9, Ireland. christhompson@beaumont.ie (2012-03)
      The appropriate management of hyponatraemia is reliant on the accurate identification of the underlying cause of the hyponatraemia. In the light of evidence which has shown that the use of a clinical algorithm appears to improve accuracy in the differential diagnosis of hyponatraemia, the European Hyponatraemia Network considered the use of two algorithms. One was developed from a nephrologist's view of hyponatraemia, while the other reflected the approach of an endocrinologist. Both of these algorithms concurred on the importance of assessing effective blood volume status and the measurement of urine sodium concentration in the diagnostic process. To demonstrate the importance of accurate diagnosis to the correct treatment of hyponatraemia, special consideration was given to hyponatraemia in neurosurgical patients. The differentiation between the syndrome of inappropriate antidiuretic hormone secretion (SIADH), acute adrenocorticotropic hormone (ACTH) deficiency, fluid overload and cerebral salt-wasting syndrome was discussed. In patients with SIADH, fluid restriction has been the mainstay of treatment despite the absence of an evidence base for its use. An approach to using fluid restriction to raise serum tonicity in patients with SIADH and to identify patients who are likely to be recalcitrant to fluid restriction was also suggested.
    • Differential effects of antihypertensive treatment on left ventricular diastolic function: an ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) substudy.

      Tapp, Robyn J; Sharp, Andrew; Stanton, Alice V; O'Brien, Eoin; Chaturvedi, Nishi; Poulter, Neil R; Sever, Peter S; Thom, Simon A McG; Hughes, Alun D; Mayet, Jamil; et al. (2010-04-27)
      We hypothesized that an amlodipine-based regimen would have more favorable effects on left ventricular (LV) diastolic function.
    • The diminishing role of biochemistry in subarachnoid haemorrhage diagnosis.

      Tormey, W P; McBrierty, D; O'Shea, P (Irish Medical Journal (IMJ), 2011-11)
    • Direct binding and activation of protein kinase C isoforms by steroid hormones.

      Alzamora, Rodrigo; Harvey, Brian J; Department of Molecular Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Smurfit Building, Beaumont Hospital PO Box 9063, Dublin 9, Ireland. AlzamoraR@dom.pitt.edu (2008-10)
      The non-genomic action of steroid hormones regulates a wide variety of cellular responses including regulation of ion transport, cell proliferation, migration, death and differentiation. In order to achieve such plethora of effects steroid hormones utilize nearly all known signal transduction pathways. One of the key signalling molecules regulating the non-genomic action of steroid hormones is protein kinase C (PKC). It is thought that rapid action of steroids hormones results from the activation of plasma membrane receptors; however, their molecular identity remains elusive. In recent years, an increasing number of studies have pointed at the selective binding and activation of specific PKC isoforms by steroid hormones. This has led to the hypothesis that PKC could act as a receptor as well as a transducer of the non-genomic effects of these hormones. In this review we summarize the current knowledge of the direct binding and activation of PKC by steroid hormones.
    • Disinfection is not the same as cleaning.

      Dancer, Stephanie J; Humphreys, Hilary; Carling, Philip (2011-07)
    • Disorders of water homeostasis in neurosurgical patients.

      Hannon, Mark J; Finucane, Francis M; Sherlock, Mark; Agha, Amar; Thompson, Christopher J; Academic Department of Endocrinology, Beaumont Hospital, Dublin 9, Ireland. christhompson@beaumont.ie. (2012-05)
      Context: Disorders of water balance are common in neurosurgical patients and usually manifest as hypo- or hypernatremia. They are most commonly seen after subarachnoid hemorrhage, traumatic brain injury, with intracranial tumors, and after pituitary surgery. Setting: We reviewed the experience of endocrine evaluation and management of disorders of salt and water balance in a large cohort of inpatients attending the national neurosciences referral centre in Dublin, Ireland, and compared this experience with findings from other studies. Patients: The study group included unselected neurosurgical patients admitted to our centre and requiring endocrine evaluation. Interventions: We conducted investigations to determine the underlying mechanistic basis for disorders of salt and water balance in neurosurgical patients and treatment to restore normal metabolism. Main Outcome Measures: Morbidity and mortality associated with deranged salt and water balance were measured. Results: The underlying pathophysiology of disordered water balance in neurosurgical patients is complex and varied and dictates the optimal therapeutic approach. Conclusions: A systematic and well-informed approach is needed to properly diagnose and manage disorders of salt and water balance in neurosurgical patients.
    • Disseminated lymphoma presenting as acute thigh pain and renal failure.

      Brown, Catherine; Walshe, J Joseph; Department of Nephrology, Beaumont Hospital, Dublin, Ireland. catherinebrownis@gmail.com (2009)
      A 66-year-old diabetic man presented with severe right thigh swelling and pain together with acute renal failure. At autopsy, this was found to be due to disseminated high grade B cell lymphoma invading the psoas muscle and multiple organs, including the kidneys. The unique presentation of this case emphasizes the need for increased awareness of the variety of ways in which lymphoma can manifest itself.
    • DNA microarray genotyping and virulence and antimicrobial resistance gene profiling of methicillin-resistant Staphylococcus aureus bloodstream isolates from renal patients.

      McNicholas, Sinead; Shore, Anna C; Coleman, David C; Humphreys, Hilary; Hughes, Deirdre Fitzgerald; Department of Clinical Microbiology, RCSI Education and Research Centre, Smurfit , Building, Beaumont Hospital, Dublin 9, Ireland. (2012-02-01)
      Thirty-six methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates from renal patients were genetically characterized by DNA microarray analysis and spa typing. The isolates were highly clonal, belonging mainly to ST22-MRSA-IV. The immune evasion and enterotoxin gene clusters were found in 29/36 (80%) and 33/36 (92%) isolates, respectively.
    • DNW--"did not wait" or "demographic needing work": a study of the profile of patients who did not wait to be seen in an Irish emergency department.

      Gilligan, P; Joseph, D; Winder, S; Keeffe, F O'; Oladipo, O; Ayodele, T; Asuquo, Q; O'Kelly, P; Hegarty, D; Emergency department Beaumont Hospital, Beaumont Road, Dublin, D9, Ireland. peadargilligan@beaumont.ie (2009-11)
      Patients who fail to wait for medical assessment in the emergency department (ED) have been referred to in the international literature as "did not wait" (DNW) or "left without being seen" (LWBS) patients or, indeed, simply as "walkouts". This is taken as a performance indicator internationally. In common with many countries, Ireland has very considerable problems in the delivery of ED care due largely to inadequate resources and the inappropriate use of EDs as holding bays for admitted patients. This is the first study of this size to profile the DNW phenomenon in Ireland.
    • "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.
    • Do guidelines for the prevention and control of methicillin-resistant Staphylococcus aureus make a difference?

      Humphreys, H; Department of Clinical Microbiology, The Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland. hhumphreys@rcsi.ie (2009-12)
      Many countries have national guidelines for the prevention and control of methicillin-resistant Staphylococcus aureus (MRSA) that are similar in approach. The evidence base for many recommendations is variable, and often, in the drafting of such guidelines, the evidence is either not analysed or not specifically reviewed. Guidelines usually recommend screening and early detection, hand hygiene, patient isolation or cohorting, and decolonization. Although many components of a prevention and control programme appear to be self-evident, e.g. patient isolation, the scientific base underpinning these is poor, and scientifically rigorous studies are required. Nonetheless, where measures, based on what evidence there is and on common sense, are implemented, and where the necessary resources are provided, MRSA can be controlled. In The Netherlands and in other low-prevalence countries, these measures have largely kept healthcare facilities MRSA-free. In MRSA-endemic countries, such as Spain and Ireland, national guidelines are often not fully implemented, owing to apparently inadequate resources or a lack of will. However, recent studies from France and Australia demonstrate what is possible in high-prevalence countries when best practice is effectively implemented, with potentially major benefits for patients, the respective health services, and society.
    • 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”.
    • 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.
    • Doctors' handovers in hospitals: a literature review

      Raduma-Tomas, M. A.; Flin, R.; Yule, S.; Williams, D. (2011)
      Aim To review studies on hospital doctors' handovers to identify the methods and main findings. Method A literature search of electronic databases Medline and Embase (via Ovid) was conducted against a set of inclusion criteria. Results A total of 32 papers were identified. The most common methods of studying handovers were observations and interviews, which typically focused on the sign-out (ie, handover meeting). This is just one stage of the handover process: pre- and posthandover phases were rarely examined. Although providing useful descriptive information, the studies rarely evaluated the quality of handover practices. While communication is generally recognised as the critical component, there has been little training of this skill. Conclusion The handover literature does not fully identify where communication failures typically occur or influencing conditions, thus hampering the design of effective handover training and tools. A systematic analysis of all the stages of doctors' handovers is required.
    • Does a positive pretransplant crossmatch affect long-term outcome in liver transplantation?

      Al-Sibae, Mohamad R; Koffron, Alan J; Raofi, Vandad; Division of Transplant and Hepatobiliary Surgery, William Beaumont, Hospital/Oakland University Medical School, Royal Oak, MI 48073, USA. (2012-02-01)
      Despite the historical success of liver transplantation in the face of a positive lymphocytic crossmatch, increased incidence of acute cellular rejection and graft loss have been reported in this setting. Given the potential adverse effects of antirejection treatment, especially in hepatitis C virus-positive recipients, identification of predisposing factors could allow for better surveillance, avoidance of rejection, and potentially better graft outcomes.
    • Does generalized joint hypermobility predict joint injury in sport? A review.

      Donaldson, Peter R; Michigan Orthopaedic Institute William Beaumont Hospital Royal Oak, Michigan. (2012-02-01)
      OBJECTIVE: To determine whether persons with generalized joint hypermobility have an increased risk of lower limb joint injury during sport. DATA SOURCES: PubMed, CINAHL, EMBASE, and SportDiscus were searched through February 2009, without language restrictions, using terms related to risk; hip, ankle, and knee injuries; and joint instability. Reference lists of included studies and relevant reviews were searched by hand. STUDY SELECTION: Selection criteria were peer-reviewed studies with a prospective design that used an objective scale to measure generalized joint hypermobility; the participants were engaged in sport activity, and the injury data were quantitative and based on diagnosis by a health professional, were self-reported, or resulted in time lost to athletic participation. The studies were screened by 1 researcher and checked by a second. Study methods were independently assessed by 2 investigators using the 6-point scale for prognostic studies developed by Pengel. Disagreements were resolved through discussion. Of 4841 studies identified, 18 met inclusion criteria. Of these, 8 were included in random-effects meta-analyses. DATA EXTRACTION: The data extracted by 2 reviewers included participant and sport characteristics and details of joint hypermobility and injury measurements. More detailed data for 4 investigations were obtained from the study authors. Where possible, hypermobility was defined as >/=4 of 9 points on the British Society of Rheumatology Scale (BSRS). MAIN RESULTS: Lower limb joint injuries (3 studies, 1047 participants) occurred in 14% of participants. Using the BSRS of joint hypermobility, any lower limb injury was not associated with hypermobility [odds ratio (OR), 1.43; 95% confidence interval (CI), 0.56-3.67]. Using the original authors' definitions, hypermobility was associated with risk of knee joint injuries (OR, 2.62; 95% CI, 1.04-6.58) in 5 studies. In 4 studies in which the BSRS could be used (1167 participants; incidence of injury, 8.65%), the association was not significant (OR, 3.98; 95% CI, 0.95-16.55). In 4 studies involving contact sporting activities, BSRS hypermobility was associated with knee joint injury (OR, 4.69; 95% CI, 1.33-16.52). In 5 studies of ankle joint injuries (1361 participants; incidence of injury, 8.74%), generalized joint hypermobility was not associated with risk of injury whether the BSRS was used (OR, 1.28; 95% CI, 0.62-2.63) or the authors' definitions of hypermobility. Hip joint injury data (1 study; 51 male rugby players) showed no increase in risk with increasing BSRS joint mobility (OR, 1.33; 95% CI, 0.12-14.94). The methodologic quality of the studies varied. CONCLUSIONS: Generalized joint hypermobility was associated with knee joint injury, especially among players participating in contact sports. It was not associated with ankle injury or overall with lower limb joint injuries. Findings may have been obscured by the differences between studies in methods of measurement and by the inclusion of a wide range of sports.
    • Dosimetric effect of intrafraction motion and residual setup error for hypofractionated prostate intensity-modulated radiotherapy with online cone beam computed tomography image guidance.

      Adamson, Justus; Wu, Qiuwen; Yan, Di; Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan,, USA. (2012-02-01)
      PURPOSE: To quantify the dosimetric effect and margins required to account for prostate intrafractional translation and residual setup error in a cone beam computed tomography (CBCT)-guided hypofractionated radiotherapy protocol. METHODS AND MATERIALS: Prostate position after online correction was measured during dose delivery using simultaneous kV fluoroscopy and posttreatment CBCT in 572 fractions to 30 patients. We reconstructed the dose distribution to the clinical tumor volume (CTV) using a convolution of the static dose with a probability density function (PDF) based on the kV fluoroscopy, and we calculated the minimum dose received by 99% of the CTV (D(99)). We compared reconstructed doses when the convolution was performed per beam, per patient, and when the PDF was created using posttreatment CBCT. We determined the minimum axis-specific margins to limit CTV D(99) reduction to 1%. RESULTS: For 3-mm margins, D(99) reduction was