• Emergence of MRSA in positive blood cultures from patients with febrile neutropenia--a cause for concern.

      Morris, Patrick G; Hassan, Tidi; McNamara, Mairead; Hassan, Astrid; Wiig, Rebecca; Grogan, Liam; Breathnach, Oscar S; Smyth, Edmond; Humphreys, Hilary; Department of Oncology, Beaumont Hospital, Dublin 9, Dublin, Ireland. (2008-09)
      Febrile neutropenia (FN) causes considerable morbidity in patients on cytotoxic chemotherapy. Recently, there has been a trend towards fewer Gram-negative and more Gram-positive infections with increasing antibiotic resistance. To assess these patterns, data from a supra-regional cancer centre in Ireland were reviewed.
    • Emergency appendicectomy in the era of laparoscopy: a one-year audit.

      Al Hilli, Z; Prichard, R S; Roche-Nagle, G; Leader, M; McNamara, D A; Deasy, J; Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland. zalhilli@rcsi.ie (2009-12)
      Appendicectomy for acute appendicitis is the commonest emergency surgical operation. With widespread acceptance of minimal access surgery most appendicectomies are now performed laparoscopically.
    • Emergency percutaneous transcatheter embolisation of acute arterial haemorrhage.

      Keeling, A N; McGrath, F P; Thornton, J; Brennan, P; Lee, M J; Department of Academic Radiology, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. aoifekeeling@hotmail.com (2010-09)
      The purpose of this study was to review indications, source of haemorrhage, method of embolisation and clinical outcome in patients referred to Interventional Radiology for the emergency management of acute arterial haemorrhage.
    • Emerging therapies for thyroid carcinoma.

      Walsh, S; Prichard, R; Hill, A D K; Department of Surgery, RCSI Smurfitt Building, Beaumont Hospital, Dublin 9,, Ireland. (2012-02-01)
      Thyroid carcinoma is the most commonly diagnosed endocrine malignancy. Its incidence is currently rising worldwide. The discovery of genetic mutations associated with the development of thyroid cancer, such as BRAF and RET, has lead to the development of new drugs which target the pathways which they influence. Despite recent advances, the prognosis of anaplastic thyroid carcinoma is still unfavourable. In this review we look at emerging novel therapies for the treatment of well-differentiated and medullary thyroid carcinoma, and advances and future directions in the management of anaplastic thyroid carcinoma.
    • Encapsulating peritoneal sclerosis: experience of a tertiary referral center.

      Phelan, P J; Walshe, J J; Al-Aradi, A; Garvey, J P; Finnegan, K; O'Kelly, P; McWilliams, J; Ti, J P; Morrin, M M; Morgan, N; et al. (2010-05)
      Encapsulating peritoneal sclerosis (EPS) is arguably the most serious complication of chronic peritoneal dialysis (PD) therapy with extremely high mortality rates. We aimed to establish the rates of EPS and factors associated with its development in a single center.
    • Endoscopic tissue diagnosis of cholangiocarcinoma.

      Harewood, Gavin C; Division of Gastroenterology and Hepatology, Beaumont Hospital, Dublin, Ireland. harewood.gavin@gmail.com (2008-09)
      The extremely poor outcome in patients with cholangiocarcinoma, in large part, reflects the late presentation of these tumors and the challenging nature of establishing a tissue diagnosis. Establishing a diagnosis of cholangiocarcinoma requires obtaining evidence of malignancy from sampling of the epithelium of the biliary tract, which has proven to be challenging. Although endoscopic ultrasound-guided fine needle aspiration performs slightly better than endoscopic retrograde cholangiopancreatography in diagnosing cholangiocarcinoma, both endoscopic approaches demonstrate disappointing performance characteristics.
    • Endovascular abdominal aortic aneurysm repair in kidney transplant recipients: Case series.

      Hseino, Hazem; McGrath, Frank; Hickey, David; Hill, Arnold D K; Moneley, Daragh; Division of Vascular Surgery, Department of Surgery, Beaumont Hospital, Dublin 9, Ireland. (2011-04)
    • Endovascular repair of para-anastomotic aortoiliac aneurysms.

      Tsang, Julian S; Naughton, Peter A; Wang, Tim T; Keeling, Aoife N; Moneley, Daragh S; Lee, Michael J; Kelly, Cathal J; Leahy, Austin L; Department of Vascular Surgery, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland. julianst@yahoo.com (2009-11)
      The purpose of this study is to evaluate the use of endovascular stent grafts in the treatment of para-anastomotic aneurysms (PAAs) as an alternative to high-risk open surgical repair. We identified all patients with previous open aortic aneurysm repair who underwent infrarenal endovascular aneurysm repair (EVAR) at our institution from June 1998 to April 2007. Patient demographics, previous surgery, and operative complications were recorded. One hundred forty-eight patients underwent EVAR during the study period and 11 patients had previous aortic surgery. Of these 11 redo patients, the mean age was 62 years at initial surgery and 71 years at EVAR. All patients were male. Initial open repair was for rupture in five (45%) patients. The average time between initial and subsequent reintervention was 9 years. All patients were ASA Grade III or IV. Fifty-five percent of the PAAs involved the iliac arteries, 36% the abdominal aorta, and 9% were aortoiliac. Ten patients had endovascular stent-grafts inserted electively, and one patient presented with a contained leak. Aorto-uni-iliac stent-grafts were deployed in seven patients, and bifurcated stent-grafts in four patients. A 100% successful deployment rate was achieved. Perioperative mortality was not seen and one patient needed surgical reintervention to correct an endoleak. Endovascular repair of PAAs is safe and feasible. It is a suitable alternative and has probably now become the treatment of choice in the management of PAAs.
    • Endovascular treatment of a symptomatic isolated infrarenal aortic stenosis.

      Rogoveanu, Radu; Rajendran, Simon; Lee, Michael; Moneley, Daragh; Department of Vascular Surgery, Beaumont Hospital, Dublin, Ireland. (2012)
    • Enhancing quality, safety and efficiency of epilepsy care in Ireland using information and communications technology

      O'Byrne, P; Varley, J; Dunleavy, B; Delanty, N; Normand, C; Grimson, J; Fitzsimons, M (2010-06)
    • Enquiries to a poisons centre from out-of-hours services

      Casey, P B; Tracey, J A; Cassidy, N; Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. (2009-06)
    • Ensemble based system for whole-slide prostate cancer probability mapping using color texture features.

      DiFranco, Matthew D; O'Hurley, Gillian; Kay, Elaine W; Watson, R William G; Cunningham, Padraig; School of Computer Science and Informatics, University College Dublin, Ireland. (2011)
      We present a tile-based approach for producing clinically relevant probability maps of prostatic carcinoma in histological sections from radical prostatectomy. Our methodology incorporates ensemble learning for feature selection and classification on expert-annotated images. Random forest feature selection performed over varying training sets provides a subset of generalized CIEL*a*b* co-occurrence texture features, while sample selection strategies with minimal constraints reduce training data requirements to achieve reliable results. Ensembles of classifiers are built using expert-annotated tiles from training images, and scores for the probability of cancer presence are calculated from the responses of each classifier in the ensemble. Spatial filtering of tile-based texture features prior to classification results in increased heat-map coherence as well as AUC values of 95% using ensembles of either random forests or support vector machines. Our approach is designed for adaptation to different imaging modalities, image features, and histological decision domains.
    • Enzyme-linked immunoassay for plasma-free metanephrines in the biochemical diagnosis of phaeochromocytoma in adults is not ideal.

      Department of Chemical Pathology, Beaumont Hospital, Dublin, Ireland. (2012-02-01)
      Abstract Background: The aim of the study was to define the analytical and diagnostic performance of the Labor Diagnostica Nord (LDN) 2-Met plasma ELISA assay for fractionated plasma metanephrines in the biochemical diagnosis of phaeochromocytoma. Methods: The stated manufacturer's performance characteristics were assessed. Clinical utility was evaluated against liquid chromatography tandem mass spectrometry (LC-MS/MS) using bias, sensitivity and specificity outcomes. Samples (n=73) were collected from patients in whom phaeochromocytoma had been excluded (n=60) based on low probability of disease, repeat negative testing for urinary fractionated catecholamines and metanephrines, lack of radiological and histological evidence of a tumour and from a group (n=13) in whom the tumour had been histologically confirmed. Blood collected into k(2)EDTA tubes was processed within 30 min. Separated plasma was aliquoted (x2) and frozen at -40 degrees C prior to analyses. One aliquot was analysed for plasma metanephrines using the LDN 2-Met ELISA and the other by LC-MS/MS. Results: The mean bias of -32% for normetanephrine (ELISA) when compared to the reference method (LC-MS/MS) makes under-diagnosis of phaeochromocytoma likely. The sensitivity of the assay (100%) was equal to the reference method, but specificity (88.3%) lower than the reference method (95%), making it less than optimum for the biochemical diagnosis of phaeochromocytoma. Conclusions: Plasma-free metanephrines as measured by Labor Diagnostica Nord (LDN) 2-Met ELISA do not display test characteristics that would support their introduction or continuation as part of a screening protocol for the biochemical detection of phaeochromocytoma unless the calibration problem identified is corrected and other more accurate and analytically specific methods remain unavailable.
    • Eosinophil peroxidase signals via epidermal growth factor-2 to induce cell proliferation.

      Walsh, Marie-Therese; Connell, Katie; Sheahan, Anita M; Gleich, Gerald J; Costello, Richard W; Department of Medicine, Education and Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland. mtwalsh@rcsi.ie (2011-11)
      Eosinophils exert many of their inflammatory effects in allergic disorders through the degranulation and release of intracellular mediators, including a set of cationic granule proteins that include eosinophil peroxidase. Studies suggest that eosinophils are involved in remodeling. In previous studies, we showed that eosinophil granule proteins activate mitogen-activated protein kinase signaling. In this study, we investigated the receptor mediating eosinophil peroxidase-induced signaling and downstream effects. Human cholinergic neuroblastoma IMR32 and murine melanoma B16.F10 cultures, real-time polymerase chain reaction, immunoprecipitations, and Western blotting were used in the study. We showed that eosinophil peroxidase caused a sustained increase in both the expression of epidermal growth factor-2 (HER2) and its phosphorylation at tyrosine 1248, with the consequent activation of extracellular-regulated kinase 1/2. This, in turn, promoted a focal adhesion kinase-dependent egress of the cyclin-dependent kinase inhibitor p27(kip) from the nucleus to the cytoplasm. Eosinophil peroxidase induced a HER2-dependent up-regulation of cell proliferation, indicated by an up-regulation of the nuclear proliferation marker Ki67. This study identifies HER2 as a novel mediator of eosinophil peroxidase signaling. The results show that eosinophil peroxidase, at noncytotoxic levels, can drive cell-cycle progression and proliferation, and contribute to tissue remodeling and cell turnover in airway disease. Because eosinophils are a feature of many cancers, these findings also suggest a role for eosinophils in tumorigenesis.
    • The epidemiology and type of medication errors reported to the National Poisons Information Centre of Ireland.

      Cassidy, Nicola; Duggan, Edel; Williams, David J P; Tracey, Joseph A; The National Poisons Information Centre, Beaumont Hospital, Dublin, Ireland., nicolacassidy@beaumont.ie (2012-02-01)
      INTRODUCTION: Medication errors are widely reported for hospitalised patients, but limited data are available for medication errors that occur in community-based and clinical settings. Epidemiological data from poisons information centres enable characterisation of trends in medication errors occurring across the healthcare spectrum. AIM: The objective of this study was to characterise the epidemiology and type of medication errors reported to the National Poisons Information Centre (NPIC) of Ireland. METHODS: A 3-year prospective study on medication errors reported to the NPIC was conducted from 1 January 2007 to 31 December 2009 inclusive. Data on patient demographics, enquiry source, location, pharmaceutical agent(s), type of medication error, and treatment advice were collated from standardised call report forms. Medication errors were categorised as (i) prescribing error (i.e. physician error), (ii) dispensing error (i.e. pharmacy error), and (iii) administration error involving the wrong medication, the wrong dose, wrong route, or the wrong time. RESULTS: Medication errors were reported for 2348 individuals, representing 9.56% of total enquiries to the NPIC over 3 years. In total, 1220 children and adolescents under 18 years of age and 1128 adults (>/= 18 years old) experienced a medication error. The majority of enquiries were received from healthcare professionals, but members of the public accounted for 31.3% (n = 736) of enquiries. Most medication errors occurred in a domestic setting (n = 2135), but a small number occurred in healthcare facilities: nursing homes (n = 110, 4.68%), hospitals (n = 53, 2.26%), and general practitioner surgeries (n = 32, 1.36%). In children, medication errors with non-prescription pharmaceuticals predominated (n = 722) and anti-pyretics and non-opioid analgesics, anti-bacterials, and cough and cold preparations were the main pharmaceutical classes involved. Medication errors with prescription medication predominated for adults (n = 866) and the major medication classes included anti-pyretics and non-opioid analgesics, psychoanaleptics, and psychleptic agents. Approximately 97% (n = 2279) of medication errors were as a result of drug administration errors (comprising a double dose [n = 1040], wrong dose [n = 395], wrong medication [n = 597], wrong route [n = 133], and wrong time [n = 110]). Prescribing and dispensing errors accounted for 0.68% (n = 16) and 2.26% (n = 53) of errors, respectively. CONCLUSION: Empirical data from poisons information centres facilitate the characterisation of medication errors occurring in the community and across the healthcare spectrum. Poison centre data facilitate the detection of subtle trends in medication errors and can contribute to pharmacovigilance. Collaboration between pharmaceutical manufacturers, consumers, medical, and regulatory communities is needed to advance patient safety and reduce medication errors.
    • Epidemiology of amyotrophic lateral sclerosis in the island of Ireland from 1995-2010

      Byrne, S; Elamin, M; Fitzgerald, T; Perry, I; Lynch, C; Donaghy, C; Hardiman, O (2011-11)
    • Epidemiology of traumatic brain injury (TBI) in the Republic of Ireland

      McEvoy, L; Collins, N; Geoghegan, L; Taleb, F; Phillips, J; Beaumont Hospital, Beaumont Road, Dublin 9, Ireland. (2010-04)
    • Epilepsy care in general practice.

      Varley, J; Fitzsimons, M; Delanty, N; Collins, C; Boland, M; Normand, C; Epilepsy Programme, Beaumont Hospital, Dublin 9. jarlathvarley@beaumont.ie (2009-06)
      Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.
    • Epilepsy in Ireland: towards the primary-tertiary care continuum.

      Varley, Jarlath; Delanty, Norman; Normand, Charles; Coyne, Imelda; McQuaid, Louise; Collins, Claire; Boland, Michael; Grimson, Jane; Fitzsimons, Mary; Epilepsy Programme, Beaumont Hospital, Dublin 9, Ireland. Jarlathvarley@beaumont.ie (2010-01)
      Epilepsy is a chronic neurological disease affecting people of every age, gender, race and socio-economic background. The diagnosis and optimal management relies on contribution from a number of healthcare disciplines in a variety of healthcare settings.
    • ER stress in colorectal cancer

      Ryan, D; Hector, S; Concannon, C; Prehn, J; McNamara, D; Kay, E (Wiley-Blackwell, 2011-06)