• Day-case tonsillectomy: practical solution or practical impossibility.

      Kharytaniuk, N; Ali, R; Sharafa, A; Keogh, I J (Irish Medical Journal, 2015-01)
      The use of day case surgery is on the rise. In order to improve efficiency and reduce cost, it has been proposed that tonsillectomy could be undertaken as a day-case procedure in Ireland. A retrospective, chart-based study was carried out. The medical and social criteria of all patients who underwent tonsillectomy during a twelve-month period were evaluated. Individual, local and national factors were identified and international comparisons were made. Of 161 patients included, 43 (27%) were considered suitable for day case tonsillectomy (DCT). The distance/time criteria from hospital excluded 64% of patients. The diagnosis of obstructive sleep apnoea was the single most common medical reason for exclusion. Support structures were deficient. Local factors must be considered before any policy or targets are developed for DCT. Patient safety is the fundamental tenet. Currently, the infrastructure and the support required for a patient-focused, safe efficient DCT are deficient, and need investment.
    • Demographics, nature and treatment of orthopaedic trauma injuries occurring in an agricultural context in the West of Ireland.

      Byrne, F J; Waters, P S; Waters, S M; Hynes, S; Ní Thuairisg, C P; O'Sullivan, M; Department of Orthopaedics and Trauma Surgery, Merlin Park Hospital, Galway, Ireland. fergbyrne@gmail.com (2011-03)
      Farming is a major industry in the West of Ireland. This prospective study examined the age profile, nature and treatment of orthopaedic injuries occurring in agricultural surroundings presenting at the Orthopaedic Unit of Merlin Park Hospital, Galway.
    • Determination of the efficacy and side-effect profile of lower doses of intrathecal morphine in patients undergoing total knee arthroplasty.

      Hassett, Patrick; Ansari, Bilal; Gnanamoorthy, Pachaimuthu; Kinirons, Brian; Laffey, John G; Department of Anaesthesia, Galway University Hospitals and National University of Ireland, Galway, Ireland. john.laffey@nuigalway.ie. (2008)
    • Determination of the optimal stylet strategy for the C-MAC videolaryngoscope.

      McElwain, J; Malik, M A; Harte, B H; Flynn, N H; Laffey, J G; Department of Anaesthesia, Galway University Hospitals, National University of Ireland, Ireland. (2010-04)
      The C-MAC videolaryngoscope is a novel intubation device that incorporates a camera system at the end of its blade, thereby facilitating obtaining a view of the glottis without alignment of the oral, pharyngeal and tracheal axes. It retains the traditional Macintosh blade shape and can be used as a direct or indirect laryngoscope. We wished to determine the optimal stylet strategy for use with the C-MAC. Ten anaesthetists were allowed up to three attempts to intubate the trachea in one easy and three progressively more difficult laryngoscopy scenarios in a SimMan manikin with four tracheal tube stylet strategies: no stylet; stylet; directional stylet (Parker Flex-It); and hockey-stick stylet. The use of a stylet conferred no advantage in the easy laryngoscopy scenario. In the difficult scenarios, the directional and hockey-stick stylets performed best. In the most difficult scenario, the median (IQR [range]) duration of the successful intubation attempt was lowest with the hockey-stick stylet; 18 s (15-22 [12-43]) s, highest with the unstyletted tracheal tube; 60 s (60-60 [60, 60]) s and styletted tracheal tube 60 s (29-60 [18-60]) s, and intermediate with the directional stylet 21 s (15-60 [8-60]) s. The use of a stylet alone does not confer benefit in the setting of easy laryngoscopy. However, in more difficult laryngoscopy scenarios, the C-MAC videolaryngoscope performs best when used with a stylet that angulates the distal tracheal tube. The hockey-stick stylet configuration performed best in the scenarios tested.
    • Diabetes in pregnancy in an Irish setting

      O Sullivan, EP; Dunne, F (Modern Medicine, 2010)
    • Diabetic retinopathy in pregnancy: a population-based study of women with pregestational diabetes.

      Egan, Aoife M; McVicker, Lyle; Heerey, Adrienne; Carmody, Louise; Harney, Fiona; Dunne, Fidelma P (Journal of diabetes research, 2015-04)
      The aim of this observational study was to evaluate screening and progression of diabetic retinopathy during pregnancy in women with pregestational diabetes attending five antenatal centres along the Irish Atlantic seaboard. An adequate frequency of screening was defined as at least two retinal evaluations in separate trimesters. Progression was defined as at least one stage of deterioration of diabetic retinopathy and/or development of diabetic macular edema on at least one eye. Women with pregestational diabetes who delivered after 22 gestational weeks (n = 307) were included. In total, 185 (60.3%) had an adequate number of retinal examinations. Attendance at prepregnancy care was associated with receiving adequate screening (odds ratio 6.23; CI 3.39-11.46 (P < 0.001)). Among those who received adequate evaluations (n = 185), 48 (25.9%) had retinopathy progression. Increasing booking systolic blood pressure (OR 1.03, CI 1.01-1.06, P = 0.02) and greater drop in HbA1c between first and third trimesters of pregnancy (OR 2.05, CI 1.09-3.87, P = 0.03) significantly increased the odds of progression. A significant proportion of women continue to demonstrate retinopathy progression during pregnancy. This study highlights the role of prepregnancy care and the importance of close monitoring during pregnancy and identifies those patients at the highest risk for retinopathy progression.
    • Distance as a risk factor for amputation in patients with diabetes: A case-control study

      Gallagher, D; Jordan, V; Gillespie, P; Cullinan, J; Dinneen, S (Irish Medical Journal, 2014)
      We studied the association between amputation and distance of patientsâ residences to a diabetes care centre. We performed a case-control study matching each case (amputation) with 5 controls (no amputation) by age and sex. We compared the distance of residence to the diabetes centre, duration and type of diabetes, haemoglobin-A1c levels and foot examination findings for cases and controls. We analysed the association between distance and the strongest predictors of amputation. Sixty-six cases of amputation and 313 controls were identified. Distance of residence was 12.1km greater for cases (p=0.028). In multivariate analysis, only diabetes duration (OR/year 1.07, 1.03 to 1.11) and neuropathy (OR 10.73, 4.55 to 25.74) were significantly associated with amputation. Patients with neuropathy resided 9.7km further than those without neuropathy (p=0.01). Patients requiring amputation reside at greater distances from the diabetes centre, possibly due to higher rates of neuropathy
    • Does topical wound oxygen (TWO2) offer an improved outcome over conventional compression dressings (CCD) in the management of refractory venous ulcers (RVU)? A parallel observational comparative study.

      Tawfick, W; Sultan, S; Western Vascular Institute (WVI), Department of Vascular and Endovascular Surgery, University College Hospital Galway (UCHG), Galway, Ireland. wael.tawfick@hse.ie (European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery, 2009-07)
      Topical wound oxygen (TWO(2)) may help wound healing in the management of refractory venous ulcers (RVU). The aim of this study was to measure the effect of TWO(2) on wound healing using the primary end-point of the proportion of ulcers healed at 12 weeks. Secondary end-points were time to full healing, percentage of reduction in ulcer size, pain reduction, recurrence rates and Quality-Adjusted Time Spent Without Symptoms of disease and Toxicity of Treatment (Q-TWiST).
    • Double paddle free fibular flap for reconstruction of the composite facial tumour in patient with Fanconi's anaemia.

      Alkaabi, Malaka; Regan, Padraic J; Kelly, Jack; Mc Cann, Patrick J; Ismael, Thamir S (2009-11)
    • Driving healthcare change through collaboration between researchers and health and social care professionals.[Poster}

      Burke, M.; Carroll, C.; Hodgins, M.; Lyons, R.; McDarby, G.; Power, M.; NUI Galway (Health Service Executive (HSE), 2014-02-28)
    • Drop weld thermal injuries to the middle ear.

      Keogh, I J; Portmann, D; Academic Department of Oto-Rhino-Laryngology, National University of Ireland Galway, Newcastle Road, Galway, Ireland. ivanj.keogh@hse.ie (Revue de laryngologie - otologie - rhinologie, 2009)
      Drop weld injuries to the tympanic membrane and middle ear caused by hot sparks or molten slag are a rare but significant injury. Steel workers and welders who are regularly exposed to flying sparks and molten metal slag are predisposed. This type of transtympanic thermal injury occurs when the slag literally drops into the external auditory canal and burns through the tympanic membrane. A spectrum of severity of injury occurs which includes chronic tympanic membrane perforation, chronic otorrhoea, facial nerve injury and deafness. Chronic tympanic membrane perforation is the most common sequelae and is perhaps one of the most challenging of all perforations to repair The combination of direct thermal injury and foreign body reaction results in continuing or recurrent suppuration. The foreign body reaction is due to the embedding of metal slag in the promontorial mucosa. We present a case of drop weld injury to the left tympanic membrane, resulting in chronic middle ear inflammation, otorrhoea and tympanic perforation. CAT scan clearly demonstrated a metallic promontorial foreign body with localised bone erosion. We emphasise the importance of removing these foreign bodies and recommend a cartilage reinforced underlay tympanoplasty technique to repair these perforations. Transtympanic thermal trauma is a preventable occupational injury, which is best, avoided by earplugs and increased awareness.
    • Dual-energy X-ray absorptiometry diagnostic discordance between Z-scores and T-scores in young adults.

      Carey, John J; Delaney, Miriam F; Love, Thomas E; Cromer, Barbara A; Miller, Paul D; Richmond, Bradford J; Manilla-McIntosh, Martha; Lewis, Steven A; Thomas, Charles L; Licata, Angelo A; et al. (Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry, 2009)
      Diagnostic criteria for postmenopausal osteoporosis using central dual-energy X-ray absorptiometry (DXA) T-scores have been widely accepted. The validity of these criteria for other populations, including premenopausal women and young men, has not been established. The International Society for Clinical Densitometry (ISCD) recommends using DXA Z-scores, not T-scores, for diagnosis in premenopausal women and men aged 20-49 yr, though studies supporting this position have not been published. We examined diagnostic agreement between DXA-generated T-scores and Z-scores in a cohort of men and women aged 20-49 yr, using 1994 World Health Organization and 2005 ISCD DXA criteria. Four thousand two hundred and seventy-five unique subjects were available for analysis. The agreement between DXA T-scores and Z-scores was moderate (Cohen's kappa: 0.53-0.75). The use of Z-scores resulted in significantly fewer (McNemar's p<0.001) subjects diagnosed with "osteopenia," "low bone mass for age," or "osteoporosis." Thirty-nine percent of Hologic (Hologic, Inc., Bedford, MA) subjects and 30% of Lunar (GE Lunar, GE Madison, WI) subjects diagnosed with "osteoporosis" by T-score were reclassified as either "normal" or "osteopenia" when their Z-score was used. Substitution of DXA Z-scores for T-scores results in significant diagnostic disagreement and significantly fewer persons being diagnosed with low bone mineral density.
    • The economic costs of falls and fractures in people aged 65 and over in Ireland technical report to NCAOP/HSE/DOHC

      Gannon, Brenda; O'Shea, Eamon; Hudson, Eibhlin; Irish Centre for Social Gerontology, National University of Ireland Galway. (Health Service Executive (HSE), 2007-04)
    • The economics of mental health care in Ireland

      O'Shea, Eamon; Kennelly, Brendan; Irish Centre for Social Gerontology, NUI Galway (Mental Health Commission, 2008)
    • The effectiveness of a structured education pulmonary rehabilitation programme for improving the health status of people with chronic obstructive pulmonary disease (COPD): The PRINCE Study.

      Murphy, K; Casey, D; Devane, D; Cooney, A; McCarthy, B; Mee, L; Newell, John; O'Shea, E; Kirwan, C; Murphy, AW; et al. (2011-11)
    • Effectiveness of out-patient pulmonary rehabilitation in Galway

      McDonnell, MJ; Sulaiman, I; Duignan, N; McDonagh, C; Frawley, T; O'Reagan, A; Gilmartin, JJ; Finan, K; Rutherford, R (2011-11-16)
    • Effects of an eight-week supervised, structured lifestyle modification programme on anthropometric, metabolic and cardiovascular risk factors in severely obese adults.

      Crowe, Catherine; Gibson, Irene; Cunningham, Katie; Kerins, Claire; Costello, Caroline; Windle, Jane; O Shea, Paula M; Hynes, Mary; McGuire, Brian; Kilkelly, Katriona; et al. (BMC Endocrine Disorders, 2015-08)
      Lifestyle modification is fundamental to obesity treatment, but few studies have described the effects of structured lifestyle programmes specifically in bariatric patients. We sought to describe changes in anthropometric and metabolic characteristics in a cohort of bariatric patients after participation in a nurse-led, structured lifestyle programme.
    • The effects of normalizing hyperhomocysteinemia on clinical and operative outcomes in patients with critical limb ischemia.

      Waters, Peadar S; Fennessey, Paul J; Hynes, Niamh; Heneghan, Helen M; Tawfick, Wael; Sultan, Sherif; Western Vascular Institute, University College Hospital Galway, Ireland. (Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2012-12)
      To assess the outcome of patients with medically treated hyperhomocysteinemia (HHC) requiring intervention for critical limb ischemia (CLI).