• 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).
    • The effects of the European Working Time Directive on surgical training: the basic surgical trainee's perspective.

      Kelly, B D; Curtin, P D; Corcoran, M; Department of Urology, Galway University Hospital, Galway, Republic of Ireland., Drbriankelly@hotmail.com (2012-01-31)
      BACKGROUND: On the 1 August 2009, the implementation of European Working Time Directive became European law and was implemented in Galway University Hospital (GUH). AIMS: The aim of the study is to ascertain the opinion of the 25 surgical SHOs in GUH on the effect of the implementation of an EWTD compliant roster had on the quality of their training. METHODS: A questionnaire was circulated to all 25 surgical SHOs. RESULTS: Twenty-two (88%) SHOs report a reduction in the quality of their training. 18 (72%) report a reduction in the development of their operative skills. The SHOs believed the EWTD Rotas would encourage Irish graduates to train abroad. CONCLUSIONS: Surgical training faces a challenge with the implementation of EWTD Rotas. Major changes need to be made to the surgical training structure to train surgeons to the highest standard and to retain Irish-trained surgeons in the Irish healthcare system.
    • Electroconvulsive therapy in the Republic of Ireland, 1982.

      Latey, R. H.; Fahy, T. J.; Regional Hospital Galway. University Department of Psychiatry.; Royal College of Psychiatrists. Irish Division. (Galway University Press, 1982)
      Electroconvulsive Therapy (ECT) is the induction of seizure activity in the brain by the passage of a small electric current between two electrodes placed on the scalp. The patient is invariably asleep under the influence of a rapidly acting anaesthetic agent. The epileptic convulsion or fit (which is an indication of satisfactory treatment effect) is modified to a series of muscular twitching by a muscle relaxant administered intravenously by the anaesthetist once the patient is asleep. The treatment procedure takes about five minutes with about an hour of sleep needed for complete recovery afterwards. The commonest indication for ECT is severe depressive illness or other serious mental disturbance where other treatments have failed or are unsuitable. A series of individual treatments. at intervals of one or more days, is commonly needed before relief of symptoms occurs. The treatment is widely acknowledged to be safe and has been in use for over forty years. With the introduction of effective antipsychotic and antidepressant drugs in the 1950s, ECT has been used less frequently and more selectively than in the past. However, there is little likelihood that ECT will be displaced by drugs or other treatments of comparable safety in the foreseeable future. Several recent studies of exceptional scientific rigour have helped to dispel residual doubts about the efficacy of ECT, although the details of the moile of action of the treatment are still not fully understood. . In recent years, ECT has attracted criticism from civil rights groups in the United States and more recently in the United Kingdom. Allegations were made of too frequent use of ECT, harmful consequences of the treatment and/or misuse of ECT to control anti-social behaviour tn detained patients. Public anxiety was not lessened by the impact ofthe popular film "One Flew Over the Cuckoo's Nest" which depicted ECT, unmodified by anaesthetics or muscle relaxants, as a barbaric and cruel treatment for the control of undesirable behaviour. Pressure from civil rights groups in Ihe U.S.A. finally led to a series of legal decisions which had the effect of prescribing the treatment or so restricting its use in certain States as to make it unavailable to patients. Anticipating similar developments on this side of the Atlantic, the Royal College of Psychiatrists commissioned a major survey by John Pippard and Les Ellam in 1981 of Electroconvulsive Treatment in Great Britain:Thls was the first such survey to include field visits to ECT clinics. These authors showed that ECT was used selectively in the United Kingdom but the authors found much to criticise in the way of obsolete equipment, poor facilities for patients, abdication of consultant responsibility (inexpert junior psychiatrists often administering the treatment) and sometimes scant regard for the privacy and feelings of patients. . The present survey was undertaken on behalf of the Irish Division of the Royal College of Psychiatrists. A major objective was to replicate (and possibly validate) the British findings and in the process to audit professional opinion and practice and to determine rates of ECT prescribing in this country. The methods used were broadly similar to those of the British survey. Rating scales andqueSlionnaires, in particular, were identical in the two studies. Thus, opinions of Irish psychiatrists were elicited by postal questionnaire, field visits were made to all ECT centres and clinics and a large sample of patients was documented prospectively over a three-month period by their psychiatrists. Statistics of ECT prescribing were collected and analysed in relation to national patterns of hospitalisation for mental illness. Finally, evidence was sought of any change in practice which might have taken place as an effect of the research.
    • Endotracheal intubation in patients with cervical spine immobilization: a comparison of macintosh and airtraq laryngoscopes.

      Maharaj, Chrisen H; Buckley, Elma; Harte, Brian H; Laffey, John G; Department of Anaesthesia, University College Hospital, Galway, Ireland. (2007-07)
      The Airtraq laryngoscope (Prodol Ltd., Vizcaya, Spain) is a novel single-use tracheal intubation device. The authors compared ease of intubation with the Airtraq and Macintosh laryngoscopes in patients with cervical spine immobilization in a randomized, controlled clinical trial.
    • Endovascular repair of early rupture of Dacron aortic graft--two case reports.

      Sultan, Sherif; Heskin, Leonie; Oaikhinan, Kenneth; Hynes, Naimh; Akhter, Yousaf; Courtney, Donald; Western Vascular Institute, Department of Vascular and Endovascular Surgery, University College Hospital, Galway, Ireland. sherifsultan@esatclear.ie (Vascular and endovascular surgery, 2005)
      Complications after open aortic surgery pose a challenge both to the vascular surgeon and the patient because of aging population, widespread use of cardiac revascularization, and improved survival after aortic surgery. The perioperative mortality rate for redo elective aortic surgery ranges from 5% to 29% and increases to 70-100% in emergency situation. Endovascular treatment of the postaortic open surgery (PAOS) patient has fewer complications and a lower mortality rate in comparison with redo open surgical repair. Two cases of ruptured abdominal aortic aneurysm (AAA) were managed with the conventional open surgical repair. Subsequently, spiral contrast computer tomography scans showed reperfusion of the AAA sac remnant mimicking a type III endoleak. These graft-related complications presented as vascular emergencies, and in both cases endovascular aneurysm repair (EVAR) procedure was performed successfully by aortouniiliac (AUI) stent graft and femorofemoral crossover bypass. These 2 patients add further merit to the cases reported in the English literature. This highlights the crucial importance of endovascular grafts in the management of such complex vascular problems.
    • Enhancing amine terminals in an amine-deprived collagen matrix.

      Tiong, William H C; Damodaran, Gopinath; Naik, Hemantkumar; Kelly, John L; Pandit, Abhay; National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Republic of Ireland. (ACS Publications, 2008-10-21)
      Collagen, though widely used as a core biomaterial in many clinical applications, is often limited by its rapid degradability which prevents full exploitation of its potential in vivo. Polyamidoamine (PAMAM) dendrimer, a highly branched macromolecule, possesses versatile multiterminal amine surface groups that enable them to be tethered to collagen molecules and enhance their potential. In this study, we hypothesized that incorporation of PAMAM dendrimer in a collagen matrix through cross-linking will result in a durable, cross-linked collagen biomaterial with free -NH 2 groups available for further multi-biomolecular tethering. The aim of this study was to assess the physicochemical properties of a G1 PAMAM cross-linked collagen matrix and its cellular sustainability in vitro. Different amounts of G1 PAMAM dendrimer (5 or 10 mg) were integrated into bovine-derived collagen matrices through a cross-linking process, mediated by 5 or 25 mM 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC) in 5 mM N-hydroxysuccinimide (NHS) and 50 mM 2-morpholinoethane sulfonic acid buffer at pH 5.5. The physicochemical properties of resultant matrices were investigated with scanning electron microscopy (SEM), collagenase degradation assay, differential scanning calorimetry (DSC), Fourier transform infrared (FTIR) spectra, and ninhydrin assay. Cellular sustainability of the matrices was assessed with Alamar Blue assay and SEM. There was no significant difference in cellular behavior between the treated and nontreated groups. However, the benefit of incorporating PAMAM in the cross-linking reaction was limited when higher concentrations of either agent were used. These results confirm the hypothesis that PAMAM dendrimer can be incorporated in the collagen cross-linking process in order to modulate the properties of the resulting cross-linked collagen biomaterial with free -NH 2 groups available for multi-biomolecular tethering.
    • Evaluating the optimum rest period prior to blood collection for fractionated plasma free metanephrines analysis

      Griffin, T.P.; Casey, R.; Wall, D.; Bell M.; O'Shea, P.M. (Practical Laboratory Medicine, 2016-05)
      The high diagnostic accuracy of plasma metanephrines (PMets) in the di-agnosis of Phaeochromocytoma/Paraganglioma (PPGL) is well established. Considerable controversy exists regarding optimum sampling conditions for PMets. The use of reference intervals that do not compromise diagnostic sensitivity is recommended. However, the optimum rest period prior to sampling has yet to be clearly established. The aim of this study was to evaluate PMets concentrations in paired blood samples collected following 30 and 40 min seated-rest prior to sampling, in patients in whom it was clinically rea-sonable to suspect that PPGL may be present.
    • An evaluation of a Low-Dose-Rate (LDR) brachytherapy procedure using a systems engineering & error analysis methodology for health care (SEABH) - (SAVE)

      Chadwick, Liam; Fallon, Enda F; van der Putten, W.J.; National University of Ireland, Galway, Galway University Hospitals (Human Factors and Ergonomics Society, 2012-03-12)
      Health Care Failure Modes and Effects Analysis (HFMEA®) is an established tool for risk assessment in health care. A number of deficiencies have been identified in the method. A new method called Systems and Error Analysis Bundle for Health Care (SEABH) was developed to address these deficiencies. SEABH has been applied to a number of medical processes as part of its validation and testing. One of these, Low Dose Rate (LDR) prostate Brachytherapy is reported in this paper. The case study supported the validity of SEABH with respect to its capacity to address the weaknesses of (HFMEA®).
    • Evaluation of intubation using the Airtraq or Macintosh laryngoscope by anaesthetists in easy and simulated difficult laryngoscopy--a manikin study.

      Maharaj, C H; Higgins, B D; Harte, B H; Laffey, J G; Department of Anaesthesia, University College Hospital Galway, Ireland. (2006-05)
      The Airtraq Laryngoscope is a novel intubation device which allows visualisation of the vocal cords without alignment of the oral, pharyngeal and tracheal axes. We compared the Airtraq with the Macintosh laryngoscope in simulated easy and difficult laryngoscopy. Twenty-five anaesthetists were allowed up to three attempts to intubate the trachea in each of three laryngoscopy scenarios using a Laerdal Intubation Trainer followed by five scenarios using a Laerdal SimMan Manikin. Each anaesthetist then performed tracheal intubation of the normal airway a second time to characterise the learning curve. In the simulated easy laryngoscopy scenarios, there was no difference between the Airtraq and the Macintosh in success of tracheal intubation. The time taken to intubate at the end of the protocol was significantly lower using the Airtraq (9.5 (6.7) vs. 14.2 (7.4) s), demonstrating a rapid acquisition of skills. In the simulated difficult laryngoscopy scenarios, the Airtraq was more successful in achieving tracheal intubation, required less time to intubate successfully, caused less dental trauma, and was considered by the anaesthetists to be easier to use.
    • Evaluation of the Airtraq and Macintosh laryngoscopes in patients at increased risk for difficult tracheal intubation.

      Maharaj, C H; Costello, J F; Harte, B H; Laffey, J G; Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland. (2008-02)
      The Airtraq, a novel single use indirect laryngoscope, has demonstrated promise in the normal and simulated difficult airway. We compared the ease of intubation using the Airtraq with the Macintosh laryngoscope, in patients at increased risk for difficult tracheal intubation, in a randomised, controlled clinical trial. Forty consenting patients presenting for surgery requiring tracheal intubation, who were deemed to possess at least three characteristics indicating an increased risk for difficulty in tracheal intubation, were randomly assigned to undergo tracheal intubation using a Macintosh (n = 20) or Airtraq (n = 20) laryngoscope. All patients were intubated by one of three anaesthetists experienced in the use of both laryngoscopes. Four patients were not successfully intubated with the Macintosh laryngoscope, but were intubated successfully with the Airtraq. The Airtraq reduced the duration of intubation attempts (mean (SD); 13.4 (6.3) vs 47.7 (8.5) s), the need for additional manoeuvres, and the intubation difficulty score (0.4 (0.8) vs 7.7 (3.0)). Tracheal intubation with the Airtraq also reduced the degree of haemodynamic stimulation and minor trauma compared to the Macintosh laryngoscope.
    • Evaluation of the self care to wellness programme (SCWP)

      Evans, David S; McSharry, Kathy; Lynott, Jackie; Department of Public Health Health Service Executive West, Health Service Executive CHO2, Centre for Independent Living Mayo (2017-03)
      The HSE is committed to supporting people to self-manage long term health conditions. The Self Care to Wellness Programme (SCWP) is a community based self-management training programme for those with long term health conditions which commenced in county Mayo in January 2015. It is a joint partnership between the HSE, Mayo Centre of Independent Living (CIL), Disability Federation of Ireland (DFI) and the Multiple Sclerosis Society (MS). The six week Programme follows the Stanford Model for Chronic Disease Self Management (Lorig et al. 1999). The aim of the study was to obtain feedback from Programme participants in terms of its impact on managing their condition. All those that attended the programme between January and December 2015 were invited to complete a questionnaire at the beginning and six months after completing the Programme. The study utilised a number of validated measures, in addition to open ended questions to allow respondents to elaborate on their responses.
    • The evolution of spinal surgery in the west of Ireland, 2005-2013.

      O’Sullivan, M D; Abdallah, D; Jadaan, M; Rahall, E; Devitt, A; McCabe, JP (Irish Medical Journal, 2016-04)
      The aim of this study was to determine the changes in both the short and long term, in the trends within the practice of spinal surgery in Galway University Hospitals (GUH) over a seven year period, January 2005 – January 2013. The absolute number of spinal surgery cases has increased from 147 in 2005, to 257 cases by 2013. Multiple level spine surgery accounts for 51% (131) of all cases by 2013, which is an increase from 31% (45) in 2005. On analysis of the trends within spinal surgery during the study period, a statistically significant (p<0.05) increase in all aspects of spinal surgery was noted, with the exception of surgeries for single level, lumbar and infection pathology respectively. The average waiting time for lumbar decompression and instrumentation climbed for an average of 1.3 months in 2008 to 12.1 months by 2012.The volume and complexity of spinal surgery has increased during the study period, in the West of Ireland.
    • Expanding access to rheumatology care: the rheumatology general practice toolbox.

      Conway, R; Kavanagh, R; Coughlan, R J; Carey, J J (Irish Medical Journal, 2015-02)
      Management guidelines for many rheumatic diseases are published in specialty rheumatology literature but rarely in general medical journals. Musculoskeletal disorders comprise 14% of all consultations in primary care. Formal post-graduate training in rheumatology is limited or absent for many primary care practitioners. Primary care practitioners can be trained to effectively treat complex diseases and have expressed a preference for interactive educational courses. The Rheumatology General Practice (GP) Toolbox is an intensive one day course designed to offer up to date information to primary care practitioners on the latest diagnostic and treatment guidelines for seven common rheumatic diseases. The course structure involves a short lecture on each topic and workshops on arthrocentesis, joint injection and DXA interpretation. Participants evaluated their knowledge and educational experience before, during and after the course. Thirty-two primary care practitioners attended, who had a median of 13 (IQR 6.5, 20) years experience in their specialty. The median number of educational symposia attended in the previous 5 years was 10 (IQR-5, 22.5), with a median of 0 (IQR 0, 1) in rheumatology. All respondents agreed that the course format was appropriate. Numerical improvements were demonstrated in participant's confidence in diagnosing and managing all seven common rheumatologic conditions, with statistically significant improvements (p < 0.05) in 11 of the 14 aspects assessed. The Rheumatology Toolbox is an effective educational method for disseminating current knowledge in rheumatology to primary care physicians and improved participant's self-assessed competence in diagnosis and management of common rheumatic diseases.
    • An experimental investigation of the hemodynamic variations due to aplastic vessels within three-dimensional phantom models of the Circle of Willis.

      Fahy, Paul; McCarthy, Peter; Sultan, Sherif; Hynes, Niamh; Delassus, Patrick; Morris, Liam; Galway Medical Technologies Centre (GMedTech), Department of Mechanical and Industrial Engineering, Galway Mayo Institute of Technology, Galway, Ireland. (Annals of biomedical engineering, 2013-09-10)
      A complete circle of Willis (CoW) is found in approximately 30-50% of the population. Anatomical variations, such as absent or surgically clamped vessels, can result in undesirable flow patterns. These can affect the brain's ability to maintain cerebral perfusion and the formation of cerebral aneurysms. An experimental test system was developed to simulate cerebral physiological conditions through three flexible 3D patient-specific models of complete and incomplete CoW geometries. Flow visualizations were performed with isobaric dyes and the mapped dye streamlines were tracked throughout the models. Three to seven flow impact locations were observed for all configurations, corresponding to known sites for aneurysmal formation. Uni and bi-directional cross-flows occurred along the communicating arteries. The greatest shunting of flow occurred for a missing pre-communicating anterior (A1) and posterior (P1) cerebral arteries. The anterior cerebral arteries had the greatest reduction (15-37%) in efferent flow rates for missing either a unilateral A1 or bilateral P1 segments. The bi-directional cross-flows, with multiple afferent flow mixing, observed along the communicating arteries may explain the propensity of aneurysm formation at these sites. Reductions in efferent flow rates due to aplastic vessel configurations may affect normal brain function.