• Randomized controlled trial of the Pentax AWS, Glidescope, and Macintosh laryngoscopes in predicted difficult intubation.

      Malik, M A; Subramaniam, R; Maharaj, C H; Harte, B H; Laffey, J G; Department of Anaesthesia and Intensive Care Medicine, Galway University Hospitals, Galway, Ireland. (2009-11)
      The purpose of this study was to determine the potential for the Pentax AWS and the Glidescope to reduce the difficulty of tracheal intubation in patients at increased risk for difficult tracheal intubation, in a randomized, controlled clinical trial.
    • Rapamycin regulates autophagy and cell adhesion in induced pluripotent stem cells.

      Sotthibundhu, Areechun; McDonagh, Katya; von Kriegsheim, Alexander; Garcia-Munoz, Amaya; Klawiter, Agnieszka; Thompson, Kerry; Chauhan, Kapil Dev; Krawczyk, Janusz; McInerney, Veronica; Dockery, Peter; et al. (BioMed Central, 2016)
      Cellular reprogramming is a stressful process, which requires cells to engulf somatic features and produce and maintain stemness machineries. Autophagy is a process to degrade unwanted proteins and is required for the derivation of induced pluripotent stem cells (iPSCs). However, the role of autophagy during iPSC maintenance remains undefined.
    • Re: is the NHS best practice tariff for Type 1 Diabetes applicable in the Irish context?

      McGrath, R; Burke, H; Curley, F; Nelson, J; Geoghegan, R (Irish Medical Journal, 2015-07)
      We refer to the IMJ article â Is the NHS Best Practice Tariff for Type 1 Diabetes Applicable in the Irish Context?â 1 , we commend the focus of this article, in highlighting the importance of tight metabolic control in the paediatric population, despite the intrinsic challenges childhood and adolescence present in this regard. We too, have recently completed an audit of our service for the year 2013 and have found it to be a worthwhile exercise. The recently published report on the Irish Childhood Diabetes National Register confirms Ireland as a high incidence area of Type 1 Diabetes, with the incidence rate for Ireland lying in the top quartile for Europe. Indeed the incidence of Type 1 Diabetes in the Irish paediatric population has increased substantially from 16.3 to 27.5 per 100,000 per year between 1997 and 2008 2 . The Diabetes Control and Complications Trial and follow up studies indicate that, 5-7 years of poor glycaemic control, even during adolescence can result in an increased risk of micro- and macro-vascular complications in the subsequent decade. Hence reiterating the importance of intensive control in this population.
    • Readability and content of patient information leaflets for endoscopic procedures.

      Gargoum, F S; O'Keeffe, S T; Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland. (Irish journal of medical science, 2013-10-31)
      Informed consent requires good communication. Patient information leaflets (PILs) may be helpful, although some PILs are too hard to read for the average patient.
    • 'Ready-access' CT imaging for an orthopaedic trauma clinic.

      Cawley, D; Hennessy, A; Curtin, P; Bergin, D; Shannon, F; Department Trauma & Orthopaedics, Galway University Hospital, Newcastle Rd, Galway (2011-03)
      'Ready-Access' to CT imaging facilities in Orthopaedic Trauma Clinics is not a standard facility. This facility has been available at the regional trauma unit, in Merlin Park Hospital, Galway for the past four years. We reviewed the use of this facility over a 2-year period when 100 patients had CT scans as part of their trauma clinic assessment. The rate of CT scan per clinic was 0.6. The mean waiting time for a CT scan was 30 minutes. 20 (20%) new fractures were confirmed, 33 (33%) fractures were out-ruled, 25 (25%) fractures demonstrated additional information and 8 (8%) had additional fractures. 20 (20%) patients were discharged and 12 (12%) patients were admitted as a result of the CT scan. It adds little time and cost to CT scanning lists.
    • ‘Ready-access’ CT imaging for an orthopaedic trauma clinic

      Cawley, D; Hennessy, A (Irish Medical Journal, 2011-03)
    • Recovery of older patients undergoing ambulatory anaesthesia with isoflurane or sevoflurane.

      Mahajan, V A; Ni Chonghaile, M; Bokhari, S A; Harte, B H; Flynn, N M; Laffey, J G; National University of Ireland, Clinical Sciences Institute, and National Centre for Biomedical Engineering Sciences (NCBES), Department of Anaesthesia, Galway, Ireland. (2007-06)
      Delayed recovery of cognitive function is a well-recognized phenomenon in older patients. The potential for the volatile anaesthetic used to contribute to alterations in postoperative cognitive function in older patients following minor surgical procedures has not been determined. We compared emergence from isoflurane and sevoflurane anaesthesia in older surgical patients undergoing urological procedures of short duration.
    • Regional orthodontics: Class II division I malocclusion, a variety of orthodontic treatments.

      Hahessy, A; Hewson, A; Kavanagh, P; Keane, J; McCue, J; McNamara, C M; Regional Orthodontic Department, Merlin Park Hospital, Galway. (1996)
    • Retention of tracheal intubation skills by novice personnel: a comparison of the Airtraq and Macintosh laryngoscopes.

      Maharaj, C H; Costello, J; Higgins, B D; Harte, B H; Laffey, J G; Department of Anaesthesia, Galway University Hospitals, Ireland. (2007-03)
      Direct laryngoscopic tracheal intubation is a potentially lifesaving manoeuvre, but it is a difficult skill to acquire and to maintain. These difficulties are exacerbated if the opportunities to utilise this skill are infrequent, and by the fact that the consequences of poorly performed intubation attempts may be severe. Novice users find the Airtraq laryngoscope easier to use than the conventional Macintosh laryngoscope. We therefore wished to determine whether novice users would have greater retention of intubation skills with the Airtraq rather than the Macintosh laryngoscope. Twenty medical students who had no prior airway management experience participated in this study. Following brief didactic instruction, each took turns performing laryngoscopy and intubation using the Macintosh and Airtraq devices in easy and simulated difficult laryngoscopy scenarios. The degree of success with each device, the time taken to perform intubation and the assistance required, and the potential for complications were then assessed. Six months later, the assessment process was repeated. No didactic instruction or practice attempts were provided on this latter occasion. Tracheal intubation skills declined markedly with both devices. However, the Airtraq continued to provide better intubating conditions, resulting in greater success of intubation, with fewer optimisation manoeuvres required, and reduced potential for dental trauma, particularly in the difficult laryngoscopy scenarios. The substantial decline in direct laryngoscopy skills over time emphasise the need for continued reinforcement of this complex skill.
    • Review of acute cancer beds.

      Evans, D S; Kiernan, R; Corcoran, R; Glacken, M; O'Shea, M; Department of Public Health, HSE West, Merlin Park Hospital, Galway. (Irish Medical Journal (IMJ), 2012-01)
      A review of admissions to cancer services at University Hospital Galway (UHG) was undertaken to assess the appropriateness of hospital usage. All cancer specialty patients admitted from 26-28 May 2009 were reviewed (n = 82). Chi square tests, Exact tests, and One-way ANOVA were utilised to analyse key issues emerging from the data. Fifty (61%) were classified as emergencies. Twenty three (67%) occupied a designated cancer bed with 24 (30%) in outlying non-oncology wards. The mean length of stay was 29.3 days. Possible alternatives to admission were identified for 15 (19%) patients. There was no evidence of discharge planning for 50 (60%) admissions. There is considerable potential to make more appropriate utilisation of UHG for cancer patients, particularly in terms of reducing bed days and length of stay and the proportion of emergency cancer admissions, and further developing integrated systems of discharge planning.
    • A review of bed utilisation in the West of Ireland

      Evans, DS; Corcoran, R; Kiernan, R; Glacken, M (Irish Medical Journal, 2015-05)
      To ensure efficient use of Irish acute hospitals, the study aimed to assess the appropriateness of admission and days of care. The Appropriateness Evaluation Protocol (AEP) was applied to a stratified random sample of 286 medical and surgical, elective and non-elective patients from four acute hospitals in the west of Ireland. A total of 23 patients (8%) were inappropriately admitted. Of these, 15 (65%) could have been avoided. Of the 34 elective/booked admissions, seven (21%) were inappropriate in terms of location of surgery criteria. Over three quarters of elective patients (77%) were admitted one or more days prior to surgery which was not justified for 13 (57%) of these patients. Over a quarter of days of care (n = 73, 26%) were inappropriate. Evidence of discharge planning was found for 48% of patients. The study provides a benchmark to monitor progress. Existing policies and programmes should be implemented and monitored.
    • Risk assessment of patient records in radiotherapy

      Chadwick, L; Fallon, E.F.; Kelly, J; van der Putten, W.J. (The International Society for Quality in Health Care, 2009)
      The research examined factors influencing the completeness of patient information within the Electronic Patient Record (EPR) and hardcopy patient chart in the radiotherapy department of a large public hospital, which is part of the Irish Health Service Executive (HSE).
    • The risk of postpartum maternal hyperglycaemia in women with gestational diabetes is reduced by breastfeeding

      O'Reilly, MW; Avalos, G; Dennedy, MC; O'Sullivan, EP; Dunne, F; Endocrinology/Diabetes Mellitus, University College Hospital, Galway, Ireland. (2011-09)
      Background and aims: Gestational diabetes (GDM) is associated with adverse fetal and maternal outcomes. It identifies women at risk of pre-diabetes, type 2 diabetes (T2DM) and cardiovascular risk in later life. Recent studies have suggested that breastfeeding may confer a beneficial effect on postpartum maternal glucose tolerance in both women with GDM and normal glucose tolerance (NGT) in pregnancy. Materials and methods: We compared results from 300 women with GDM and 220 women with NGT according to IADPSG criteria using a 75g oral glucose tolerance test (OGTT) at 24-28 weeks gestation by repeating the 75g OGTT postpartum to reassess glucose status. We also tested for postpartum metabolic syndrome (MetS) according to international criteria. Binary logistic regression was used to identify maternal factors that increased the risk of persistent glucose intolerance. Postpartum lactation status was categorised as breastfeeding alone, bottle-feeding alone, or both. Results: 520 women were tested. OGTT results were classified as normal (FPG<5.6mmol/l; 2h<7.8mmol/l) or abnormal (IFG; 5.6-6.9, IGT; 2h 7.8-11.0, IFG+IGT; T2DM FPG≥7 ± 2h≥11.1). Six of 220 (2.7%) women with NGT in pregnancy had postpartum dysglycaemia compared to 57 of 300 women (19%) with GDM in pregnancy (P<0.001). Non-Caucasian ethnicity (OR 3.40, 95% CI 1.45-8.02, P=0.005), family history of T2DM (OR 2.14, 95% CI 1.06-4.32, P=0.034) and insulin use in pregnancy (OR 2.62, 95% CI 1.17-5.87, P=0.019) were all predictive of persistent dysglycaemia. MetS was present postpartum in 31 of 300 women (10.3%) with GDM compared to 18 (8.2%) of 220 women with NGT (P=0.4). The prevalence of persistent dysglycaemia was lower in women who breast-fed versus bottle-fed their babies, or employed both techniques (7.1% v 18.4% and 11.2%, respectively, p<0.001). Conclusion: In this Irish population the prevalence of persistent glucose intolerance in women with GDM in pregnancy is 19% compared to 2.7% in NGT women. Breast-feeding confers a beneficial effect on postpartum glucose tolerance. The precise mechanism behind this association is unclear and requires further study.
    • The role of interventional radiology in the management of deep venous thrombosis: advanced therapy.

      O'Sullivan, Gerard J; Section of Interventional Radiology, Department of Radiology, University College Hospital Galway, Newcastle Road, Galway, Ireland. gerard.osullivan2@hse.ie (Cardiovascular and interventional radiology, 2011-06)
      Deep vein thrombosis (DVT) is often managed with a health care pathway that funnels patients to anticoagulation therapy alone. This "usual treatment" is designed to stop propagation and embolisation of venous thrombus but not remove it. Surgical thrombectomy was once the only option in severe cases in which limbs were threatened, but thrombus removal is no longer restricted to emergency cases. Interventional radiologists are now using advanced endovascular techniques to achieve thrombus removal in a minimally invasive manner in a very short treatment time, thereby quickly restoring patency, relieving acute symptoms, and potentially limiting the subsequent development of postthrombotic syndrome when followed with anticoagulation and compression regimens. This article provides an overview of the interventions available for treating DVT. One of the newer "single-session" techniques is isolated pharmacomechanical thrombolysis, which is described here in detail with supporting cases.
    • Role of potassium and calcium channels in sevoflurane-mediated vasodilation in the foeto-placental circulation.

      Jarman, James; Maharaj, Chrisen H; Higgins, Brendan D; Farragher, Rachel F; Laffey, Christopher D; Flynn, Noel M; Laffey, John G; Department of Anaesthesia, Clinical Sciences Institute, National University of Ireland, Galway Ireland. john.laffey@nuigalway.ie. (2009)
    • Rupture of an expander prosthesis mimics axillary cancer recurrence.

      Ismael, T; Kelly, J; Regan, P J; Plastic Surgery Department, University College Hospital, Newcastle Road, Galway, Ireland. thamirss@hotmail.com (2005-10)
      Regional silicone gel migration from a ruptured breast implant has been reported at different locations including the upper extremity, chest wall muscles, axilla and back. We report a patient who presented with an axillary mass that mimicked a regional recurrence 5 years after breast cancer reconstruction with a latissimus dorsi musculocutaneous flap and silicon gel expander-prosthesis. Surgical exploration revealed that the mass contained silicone gel around the port of the breast expander that had ruptured. The mass was confluent with an intracapsular silicone leak through a tract along the tube of the expander port.