• Management of diabetes in pregnancy

      Dunne, F; Noctor, E; Galway University Hospital (2011)
    • Management of Diabetic Ketoacidosis in the insulin analogue era

      Matiullah, S; Ryan, J; Tuohy, S (Irish Journal of Medical Science, 2010)
    • Management of Paediatric Buckle (Torus) Wrist Fractures in Irish Emergency Departments: A National Survey

      Abdelhady, A; Ahmed, A; Umana, E; O’Donnell, J; University Hospital Galway (Irish Medical Journal, 2018-07)
      Buckle fractures are the most common wrist fractures reported in the paediatric age group. National Institute for Clinical Excellence (NICE) recommends using a non-rigid immobilisation with no follow up for these patients and appropriate discharge advice. A telephone survey was conducted to assess the variation in practice in Irish hospitals regarding the mpediatrianagement of buckle fractures. Twenty eight centres that manage paediatric patients with trauma were contacted. This survey demonstrates that over 70% (>20) of centres in Ireland are managing buckle fractures using the traditional approach of backslab cast and follow-up in fracture clinic. Despite relevant research and NICE guideline recommendations, there is a slow adoption of current evidence among Irish hospitals which points to a need for a national consensus on management of buckle fractures.
    • Maternal obesity in pregnancy

      Dunne, F; Dennedy, MC; Galway University Hospital (Springer, 2012)
    • Maxillofacial osseous reconstruction using the angular branch of the thoracodorsal vessels.

      Dolderer, Jürgen H; Kelly, Jack L; McCombe, David; Burt, Jamie; Pfau, Matthias; Morrison, Wayne A; Department of Plastic, Hand and Reconstructive Surgery, BG-Trauma-Center, Eberhard-Karls-University Tuebingen, Tuebingen, Germany. drdolderer@hotmail.com (Thieme Publications, 2010-09)
      Mandibular and maxillary resections can produce complex three-dimensional defects requiring skeletal, soft tissue, and epithelial reconstruction. The subscapular vascular axis offers a source of skin, bone, and muscle on a single pedicle for microvascular flap transfer. We reviewed four cases where the subscapular vascular pedicle was used as a source of tissue for complex facial reconstructions in maxillofacial defects. Reconstruction of these complex defects was performed with a latissimus dorsi muscle or myocutaneous flap in combination with the lateral border of the scapula, harvested on the angular branch of the thoracodorsal vessels. There were three cases of maxillectomy and one case of partial mandibulectomy for malignant tumors. In each case, the angular branch of the thoracodorsal artery supplied 6 to 8 cm of the lateral border of the scapula and a latissimus dorsi myocutaneous flap was used for soft tissue reconstruction. Follow-up ranged from 9 months to 3 years and in all cases there was successful bony union. Shoulder movement was normal. This series encourages the further use of subscapular axis flaps as flexible sources of combined myocutaneous and osseous flaps on a single vascular pedicle in cases of complex maxillofacial reconstruction.
    • Meconium Ileus in Two Irish Newborns: The Presenting Feature of Cystic Fibrosis

      Smith, A.; Ryan, E; O’Keeffe, D; O’Donovan, D. (Irish Medical Journal, 2019-03)
      Cystic Fibrosis (CF) is the most common genetically inherited disease in Ireland1. Approximately 1/ 2,300 infants per year are born with CF in Ireland2. Newborn bloodspot screening (NBS) screening for CF was introduced to Ireland in 20113. NBS screening for CF is associated with improved lung function, nutritional status and increased survival into early adulthood4. Therefore early recognition and management of this chronic condition is vital to ensuring optimal patient management.
    • Medical record weight (MRW): a new reliable predictor of hospital stay, morbidity and mortality in the hip fracture population?

      Calpin, P; Taheny, K; Baker, JF; Green, J; McCabe, JP (Irish Medical Journal, 2016-11)
      We sought to compare the weight of patient’s medical records (MRW) to that of standardised surgical risk scoring systems in predicting postoperative hospital stay, morbidity, and mortality in patients with hip fracture. Patients admitted for surgical treatment of a newly diagnosed hip fracture over a 3-month period were enrolled. Patients with documented morbidity or mortality had significantly heavier medical records. The MRW was equivalent to the age-adjusted Charlson co-morbidity index and better than the American Society of Anaesthesiologists physical status score (ASA), the Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM,) and Portsmouth-POSSUM score (P-POSSUM) in correlation with length of hospital admission, p = .003, 95% CI [.15 to .65]. Using logistic regression analysis MRW was as good as, if not better, than the other scoring systems at predicting postoperative morbidity and 90-day mortality. Medical record weight is as good as, or better than, validated surgical risk scoring methods. Larger, multicentre studies are required to validate its use as a surgical risk prediction tool, and it may in future be supplanted by a digital measure of electronic record size. Given its ease of use and low cost, it could easily be used in trauma units globally.
    • Medical speciality choice: does personality matter?

      Lydon, S; O'Connor, P; McVeigh, T; Offiah, C; Byrne, D (Irish Medical Journal, 2015-03)
      There has been increasing interest in the personalities of doctors. This study examined whether personality differed based upon gender, level of training or medical speciality among 200 physicians and 134 medical students. Post-internship doctors scored significantly higher on conscientiousness (p = .001) than those pursuing basic medical training. Among those pursuing basic medical training, females scored significantly higher than males on agreeableness (p < .001) and conscientiousness (p = .001). Among post-internship respondents, females scored significantly higher on agreeableness (p = .004). There were no personality differences between post-internship doctors working in different specialities. However, among those pursuing basic medical training, those interested in person-focused medical specialities scored significantly higher on extraversion (p < .001), conscientiousness (p = .001), and lower on neuroticism (p = .01) than those who had no strong preference. These results suggest that there is no unique personality profile associated with medical practice, or medical speciality. Instead, it appears that medical school may shape personality.
    • Methylphenidate-induced erections in a prepubertal child.

      Kelly, B D; Lundon, D J; McGuinness, D; Brady, C M; Department of Urology, Galway University Hospital, Ireland. drbriankelly@hotmail.com (2013-02)
      Methylphenidate is a medication used routinely in the management of attention deficit hyperactivity disorder. We report a case of a prepubertal child who developed unwanted erections after commencing a response-adjusted dosing regimen of sustained release methylphenidate. Despite priapism being a rare adverse reaction associated with methylphenidate, physicians and parents need to be aware as it can have significant long-term complications.
    • Microsurgical replantation of an ear with no venous repair.

      Hussey, A J; Kelly, J I; Department of Plastic, Reconstructive and Hand Surgery, University College Hospital, Galway, Ireland. (Informa Healthcare, 2010-02)
      Replantation of an avulsed ear was completely successful with only arterial repair (to the superficial temporal artery) and the use of medicinal leeches.
    • A mixed methods study exploring the factors and behaviours that impact on glycaemic control following a structured education programme: the Irish DAFNE Study

      Casey, D; Meehan, B; O'Hara, MC; Byrne, M; Dineen, SF; Murphy, K; 1School of Nursing and Midwifery, NUI Galway, Galway, Ireland, Qualitative Data Analysis Projects, QDA Training, Pembroke Lane, Dublin 4, Ireland, Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Psychology, NUI Galway, Galway, Ireland (2016-04)
      INTRODUCTION Diabetes is now the commonest non-communicable illness in the world and is associated with significant morbidity and mortality; over 371 million people worldwide have diabetes (IDF 2012a). It is associated with microvascular and macrovasular complications. As there is no diabetes registry in Ireland, it is difficult to establish the true prevalence rates. However, the International Diabetes Federation estimates that there are 191,380 people with diabetes in Ireland (with a prevalence of 6.1% in the population), approximately 7-9% of whom have type 1 diabetes (T1D) (IDF 2012b). Some of the longer-term complications of diabetes can be avoided by maintaining good glycaemic control. Glycosylated haemoglobin (HbA1c) is used to identify the average plasma glucose concentration over a period of approximately 3 months. Best practice would recommend testing HbA1c every 3 months if the person is trying to improve their glycaemic control or every 6 months if glycaemic control is already achieved and they want to maintain it. HbA1c goals usually determine how tight people with type 1 diabetes have to run their blood sugar, which is usually individualised to the person’s treatment needs. Current guidelines recommend a target HbA1c of between 53 mmol/ mol (7%) and 59 mmol/ mol (7.5%) (ADA 2013). Landmark trials such as the Diabetes Complications and Control Trial demonstrated that poorer glycaemic control (higher HbA1c) was associated with an increased risk of some of the complications of diabetes such as retinopathy, however, tighter control (lower HbA1c) was associated with an increase in the frequency of severe hypoglycaemia (Kilpatrick et al 2008). Hypoglycaemia can be very debilitating to those who experience it and can negatively impact on people’s quality of life (Lawton et al 2013). The challenge in day-to-day management of T1D is to find a balance between an acceptable low level of HbA1c without frequent hypoglycaemia.
    • Moderate and extreme maternal obesity.

      Abdelmaboud, M O; Ryan, H; Hession, M; Avalos, G; Morrison, J J; Department of Obstetrics Gynaecology, University Hospital, Newcastle Road, Galway. (Irish Medical Journal (IMJ), 2012-05)
      The aim of this study was to investigate the prevalence of moderate and extreme obesity among an Irish obstetric population over a 10-year period, and to evaluate the obstetric features of such pregnancies. Of 31,869 women delivered during the years 2000-2009, there were 306 women in the study group, including 173 in the moderate or Class 2 obese category (BMI 35-39.9) and 133 in the extreme or Class 3 obese category (BMI > or = 40).The prevalence of obese women with BMI > or = 35 was 9.6 per 1000 (0.96%), with an upward trend observed from 2.1 per 1000 in the year 2000, to 11.8 per 1000 in the year 2009 (P = 0.001). There was an increase in emergency caesarean section (EMCS) risk for primigravida versus multigravid women, within both obese categories (P < 0.001). However, there was no significant difference in EMCS rates observed between Class 2 and Class 3 obese women, when matched for parity. The prevalence of moderate and extreme obesity reported in this population is high, and appears to be increasing. The increased rates of abdominal delivery, and the levels of associated morbidity observed, have serious implications for such women embarking on pregnancy.
    • Natural history of Crohn’s disease: is the tide beginning to turn?

      Ó Maoláin, M; Egan, LJ (Irish Medical Journal, 2011-03)
    • Natural history of fetal trisomy 18 after prenatal diagnosis.

      Burke, Annette L; Field, Katie; Morrison, John J; Galway University Hospital, National University of Ireland Galway, Newcastle Road, Galway, Ireland. (2013-03)
      To evaluate the natural fetal and neonatal outcome for pregnancies with an established prenatal diagnosis of fetal trisomy 18, and a parental decision for continuation of the pregnancy.
    • Non-motor complications associated with restless legs syndrome

      Lucey, Rebbeca; Browne, Patrick; Counihan, Timothy (Nursing in General Practice, 2015-01)
      Restless legs syndrome (RLS), or Willis-Ekbom Disorder, is a common neurological disorder involving an irresistible need to move the limbs, usually associated with abnormal burning or itching sensations in the extremities.1 These abnormal sensations are provoked by rest or inactivity and, at least, temporarily relieved by movement.2 While the legs are the most commonly affected limbs, it often spreads to other parts of the body, particularly the arms.3 Phantom limbs can also be affected.4 It affects between 7.2% and 11% of the population in Europe and North America5 and is twice as common in females as males.6
    • Nonoperative active management of critical limb ischemia: initial experience using a sequential compression biomechanical device for limb salvage.

      Sultan, Sherif; Esan, Olubunmi; Fahy, Anne; Department of Vascular and Endovascular Surgery, Western Vascular Institute, University College Hospital Galway, Galway, Ireland. sherifsultan@esatclear.ie (Vascular, 2008)
      Critical limb ischemia (CLI) patients are at high risk of primary amputation. Using a sequential compression biomechanical device (SCBD) represents a nonoperative option in threatened limbs. We aimed to determine the outcome of using SCBD in amputation-bound nonreconstructable CLI patients regarding limb salvage and 90-day mortality. Thirty-five patients with 39 critically ischemic limbs (rest pain = 12, tissue loss = 27) presented over 24 months. Thirty patients had nonreconstructable arterial outflow vessels, and five were inoperable owing to severe comorbidity scores. All were Rutherford classification 4 or 5 with multilevel disease. All underwent a 12-week treatment protocol and received the best medical treatment. The mean follow-up was 10 months (SD +/- 6 months). There were four amputations, with an 18-month cumulative limb salvage rate of 88% (standard error [SE] +/- 7.62%). Ninety-day mortality was zero. Mean toe pressures increased from 38.2 to 67 mm Hg (SD +/- 33.7, 95% confidence interval [CI] 55-79). Popliteal artery flow velocity increased from 45 to 47.9 cm/s (95% CI 35.9-59.7). Cumulative survival at 12 months was 81.2% (SE +/- 11.1) for SCBD, compared with 69.2% in the control group (SE +/- 12.8%) (p = .4, hazards ratio = 0.58, 95% CI 0.15-2.32). The mean total cost of primary amputation per patient is euro29,815 ($44,000) in comparison with euro13,900 ($20,515) for SCBD patients. SCBD enhances limb salvage and reduces length of hospital stay, nonoperatively, in patients with nonreconstructable vessels.
    • Novel use of hand fracture fixation plates in the surgical stabilisation of flail chest.

      Dunlop, Rebecca L E; Tiong, William; Veerasingam, Devendran; Kelly, John L; Department of Plastic and Reconstructive Surgery, University College Hospital, Galway, Ireland. rebeccapollard@doctors.org.uk (Elsevier Ltd., 2010-01)
      Plastic surgeons specialize in working closely with other surgical colleagues to help solve clinical problems. In this case, we performed surgical stabilisation of a large flail chest fragment in conjunction with the cardiothoracic surgical team, using the mini-plating set more commonly used for hand fracture fixation. The use of this fixation system for flail chest has not previously been described, but offers advantages over other reported methods, primarily by dispensing with the need for an extensive thoracotomy incision and by providing robust stabilisation without the presence of prominent hardware.
    • An online management information system for objective structured clinical examinations

      Kropmans,Thomas JB; O’Donovan, Barry GG; Cunningham, David; Murphy, Andrew W; Flaherty, Gerard; Nestel, Debra; Dunne, Fidelma P; Galway University Hospital (Canadian Center of Science and Education, 2012-01-01)
      Objective Structured Clinical Examinations (OSCE) are adopted for high stakes assessment in medical education. Students pass through a series of timed stations demonstrating specific skills. Examiners observe and rate students using predetermined criteria. In most OSCEs low level technology is used to capture, analyse and produce results. We describe an OSCE Management Information System (OMIS) to streamline the OSCE process and improve quality assurance. OMIS captured OSCE data in real time using a Web 2.0 platform. We compared the traditional paper trail outcome with detailed real time analyses of separate stations. Using a paper trail version only one student failed the OSCE. However, OMIS identified nineteen possibly ‘incompetent’ students. Although there are limitations to the design of the study, the results are promising and likely to lead to defendable judgements on student performance.
    • Optimal patient positioning for ligamentotaxis during balloon kyphoplasty of the thoracolumbar and lumbar spine.

      Cawley, D T; Sexton, P; Murphy, T; McCabe, J P; Department of Orthopaedic and Trauma Surgery, Merlin Park Hospital, Galway University Hospitals, Galway, Ireland. derekcawley@hotmail.com (2011-06)
      Percutaneous balloon kyphoplasty aims to restore vertebral height, correct angular deformity and stabilize the spine in the setting of vertebral compression fractures. The patient is positioned prone with supports under the iliac crests and upper thorax to allow gravity to extend the spine. In the treatment of lumbar fractures, we evaluated patient positioning with the contribution of hip extension to increase anterior ligamentotaxis, thus facilitating restoration of vertebral height. Our positioning technique created a mean anterior height increase from 72% to 78% of the average height of the cranial and caudal vertebrae (p=0.037). Balloon inflation did not significantly further increase anterior or posterior vertebral height, or Cobb angle.