• Increased use of multidisciplinary treatment modalities adds little to the outcome of rectal cancer treated by optimal total mesorectal excision.

      Chang, Kah Hoong; Smith, Myles J; McAnena, Oliver J; Aprjanto, Arifin S; Dowdall, Joe F; Department of Surgery, Galway University Hospital, National University of Ireland, Galway, Republic of Ireland. (2012-10)
      Total mesorectal excision (TME) is the standard surgical treatment for rectal cancer. The roles of chemotherapy and radiotherapy have become more defined, accompanied by improvements in preoperative staging and histopathological assessment. We analyse our ongoing results in the light of changing patterns of treatment over consecutive time periods.
    • Increasing reporting of adverse events to improve the educational value of the morbidity and mortality conference.

      McVeigh, Terri P; Waters, Peadar S; Murphy, Ruth; O'Donoghue, Gerrard T; McLaughlin, Ray; Kerin, Michael J; Department of Surgery, Galway University Hospital, Galway, Ireland. terri.mcveigh@gmail.com (2013-01)
      The aim of this study was to investigate the impact of a validated complication proforma on surgical Morbidity and Mortality (M&M) conference reporting.
    • Independent tunability of the double-mode-locked cw dye laser.

      Bourkoff, E; Whinnery, J R; Dienes, A (1979-06-01)
      We report a new configuration that enables the double-mode-locked cw dye laser to be independently tunable. In addition, the output coupling at each of the two wavelengths can be independently specified. A series of oscillographs shows some interesting features unique to double mode locking and also shows the effects of varying the two cavity lengths with respect to each other.
    • An innovative community based cardiac diagnostics service prevents hospital attendances. [Presentation]

      Nolan, Paul; Harrington, O; Barton, J; MacNeill, BD; Crowley, JJ; Nash, PJ; Daly, K; Galway University Hospitals (Health Service Executive (HSE), 2014-02-28)
    • Introduction of an Oral Fluid Challenge Protocol in the Management of Children with Acute Gastroenteritis: A Regional Hospital Experience.

      Umana, E; Rana, A; Maduemem, K; Moylett, E (Irish Medical Journal, 2018-06)
      Oral rehydration therapy (ORT) remains the ideal first line therapy for acute gastroenteritis (AGE). Our aim was to assess the impact of introducing an Oral Fluid Challenge (OFC) protocol on outcomes such as intravenous fluid use and documentation in our institution. A single centre study with data collected retrospectively pre-implementation (April 2015) of the OFC protocol and post implementation (April 2016). Consecutive sampling of the first 55 patients presenting with GE like symptoms and underwent OFC were recruited. One hundred and ten patients were included in this study with 55 patients per cycle. The rates of IVF use decreased from 22% (12) in cycle one to 18% (10) in cycle two. There was an improvement in documentation by 26% (14) for level of dehydration and 52% (31) for OFC volume from cycle one to two. Overall, the addition of the OFC protocol to the management of patients with uncomplicated AGE would help streamline and improve care.
    • Investigating the role of healthcare accessibility and socio-economic background on the decision to attend for screening for gestational diabetes mellitus in Ireland

      Owens, L; Cullinane, J; Gillespie, P; Avalos, G; O'Sullivan, EP; O'Reilly, M; Dennedy, C; Dunne, F; Department of Medicine, National University of Ireland, Galway 2Department of Economics, National University of Ireland, Galway (Diabetic Pregnancy Study Group, 2011)
      Gestational diabetes mellitus (GDM) is associated with increased maternal and neonatal morbidity and mortality. We investigated the role of healthcare centre accessibility on the decision to attend for screening, employing geographic information systems (GIS), econometric and simulation techniques. In particular, we focus on the extent to which ‘travel distance to screening site’ impacts upon the individual’s screen uptake decision, whether significant geographic inequalities exist in relation to accessibility to screening, and the likely impact on uptake rates of providing screening services at a local level. We also aimed to assess whether Irish women of lower socio-economic status were less likely to attend for screening for Diabetes in Pregnancy than their higher status counterparts. This study was completed through the Atlantic Diabetes in Pregnancy (DIP) partnership, which offers universal screening for Gestational Diabetes at 24-28 weeks gestation. Data was collected on all women who delivered in 5 antenatal centres along the Irish Atlantic Seaboard between 2007-2009. Patients were ‘geocoded’, in order to provide precise spatial (x,y) coordinates for their residential locations. This facilitates geographic information systems -based route analysis of travel distances for each individual to their nearest screening site. We then model the decision to attend for screening, where control variables include travel distance to screening site, a range of other site accessibilityrelated variables, as well as a number of individual-level variables relating to personal, socioeconomic, clinical and lifestyle characteristics. The socio-economic status is based on the deprivation score derived from the 2006 Census of Population for the Republic of Ireland. The Deprivation Index is constructed from a combination of various indicators; education, employment, percentage skilled/unskilled workers, demographic information, lone parents and number of persons/room. 9,043 pregnant women offered screening, 5,218 (58%) of whom participated in testing. The probability of attending for screening was reduced by 1.8% [95% CI: 1.3% to 2.3%] for every additional 10kms required to travel for screening (p=0.000). We also find significant variation in uptake rates across hospitals after controlling for travel distance and other factors, suggesting that accessibility and quality-of-service are also important determinants of overall uptake rates. Using the deprivation index 60% of those who scored 1 (most affluent) attended for screening, 58% in score 2, 56% in score 3, 53% in score 4 and 46% in the score 5 (most deprived) group attended, p=0.0001. This shows a clear decrease in attendance levels in those who are deemed to be more disadvantaged. The most disadvantaged women overall were 40% less likely to attend than their most affluent counterparts (OR0.6, 95%CI {0.55-0.71},p=0.001). Accessibility to healthcare centres and socio-economic background both affect the decision to attend for screening for Gestational Diabetes Mellitus in Ireland.
    • Investigating the role of healthcare centre accessibility on the decision to attend for screening for gestational diabetes mellitus in Ireland [presentation]

      Cullinan, John; Dunne, F; Gillespie, Paddy; Owens, Lisa; John Cullinan (National University of Ireland, Galway. School of Economics), Paddy Gillespie (National University of Ireland, Galway. School of Economics), Lisa Owens (National University of Ireland, Galway. School of Medicine) and Fidelma Dunne (National University of Ireland, Galway. School of Medicine) (2011)
      Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy and is associated with several serious maternal and neonatal complications and conditions. Screening practices for GDM vary within and across European countries, with some offering universal screening to all pregnant women and others only to selective high risk groups. In Ireland, no single policy with respect to GDM screening is implemented nationally and a debate exists as to what form such a policy should take. Within this context, the Atlantic Diabetes in Pregnancy (ATLANTIC DIP) network was established in 2005 to provide robust information on pregnancy outcomes for women with diabetes. The network includes five healthcare centres along the Atlantic seaboard and provides testing for all pregnant women at 24-28 weeks using a 75g Oral Glucose Tolerance Test. The centres are linked using a clinical information system which allows for data to be captured within a central database, containing a comprehensive range of data on screening uptake rates, maternal characteristics, outcomes for mothers and infants, healthcare resource usage over the course of pregnancy, as well as the postal address of each individual. At present it contains observations on 9,043 pregnant women offered the screening, 5,218 (58%) of whom participated in testing. This paper uses the ATLANTIC DIP dataset to investigate the role of healthcare centre accessibility on the decision to attend for screening, employing geographic information systems (GIS), econometric and simulation techniques. In particular, we focus on the extent to which ‘travel distance to screening site’ impacts upon the individual’s screen uptake decision, whether significant geographic inequalities exist in relation to accessibility to screening, and the likely impact on uptake rates of providing screening services at a local level. In order to do so, the postal addresses contained within the ATLANTIC DIP dataset are first ‘geocoded’, in order to provide precise spatial (x,y) coordinates for patients’ residential locations. This facilitates GIS-based route analysis of travel distances for each individual to their nearest screening site. We then model the decision to attend for screening, where control variables include travel distance to screening site, a range of other site accessibility-related variables, as well as a number of individual-level variables relating to personal, socio-economic, clinical and lifestyle characteristics. Overall, our model suggests that after controlling for these different factors, the probability of attending for screening is reduced by 1.8% [95% CI: 1.3% to 2.3%] for every additional 10kms required to travel for screening (p=0.000). We also find significant variation in uptake rates across hospitals after controlling for travel distance and other factors, suggesting that accessibility and quality-of-service are also important determinants of overall uptake rates. The uptake model allows us to also estimate ‘two-part’ and ‘bivariate probit with sample selection’ models of the risk factors associated with GDM, which provide strong evidence of a socio-economic gradient in the prevalence of GDM in Ireland. Altogether, the findings have important implications for the provision of GDM screening services in Ireland.
    • Ipsilateral transversus abdominis plane block provides effective analgesia after appendectomy in children: a randomized controlled trial.

      Carney, John; Finnerty, Olivia; Rauf, Jassim; Curley, Gerard; McDonnell, John G; Laffey, John G; Department of Anaesthesia, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. john.laffey@nuigalway.ie (2010-10)
      The transversus abdominis plane (TAP) block provides effective postoperative analgesia in adults undergoing major abdominal surgery. Its efficacy in children remains unclear, with no randomized clinical trials in this population. In this study, we evaluated its analgesic efficacy over the first 48 postoperative hours after appendectomy performed through an open abdominal incision, in a randomized, controlled, double-blind clinical trial.
    • The Irish DAFNE Study Protocol A cluster randomised trial of group versus individual follow up after structured education for Type 1 Diabetes

      Dinneen, S.F; O'Hara, M.C; Byrne, M; Irish DAFNE Study Group (BioMed Central Trials, 2009-09-23)
    • Iron status and chronic kidney disease predict restless legs syndrome in an older hospital population.

      Quinn, Colin; Uzbeck, Mateen; Saleem, Imran; Cotter, Paul; Ali, Javed; O'Malley, Grainne; Gilmartin, J J; O'Keeffe, Shaun T; Departments of Geriatric Medicine, Merlin Park University Hospital, Galway, Ireland. (2011-03)
      Iron deficiency is important in the pathogenesis of restless legs syndrome (RLS), and serum ferritin measurement, using a cutoff of 45-50ng/ml, is widely recommended as the optimal screening test for iron deficiency in RLS. Serum ferritin often increases with inflammation, and a higher cutoff may be better in those with acute and chronic inflammatory conditions, including those with chronic kidney disease (CKD).
    • Is it important to classify ischaemic stroke?

      Iqbal, M; Bilal, S; Sarwar, S; Counihan, T; University College Hospital, Newcastle Rd, Galway. mudassir213@hotmail.com (2012-02)
      Thirty-five percent of all ischemic events remain classified as cryptogenic. This study was conducted to ascertain the accuracy of diagnosis of ischaemic stroke based on information given in the medical notes. It was tested by applying the clinical information to the (TOAST) criteria. Hundred and five patients presented with acute stroke between Jan-Jun 2007. Data was collected on 90 patients. Male to female ratio was 39:51 with age range of 47-93 years. Sixty (67%) patients had total/partial anterior circulation stroke; 5 (5.6%) had a lacunar stroke and in 25 (28%) the mechanism of stroke could not be identified. Four (4.4%) patients with small vessel disease were anticoagulated; 5 (5.6%) with atrial fibrillation received antiplatelet therapy and 2 (2.2%) patients with atrial fibrillation underwent CEA. This study revealed deficiencies in the clinical assessment of patients and treatment was not tailored to the mechanism of stroke in some patients.
    • Is neonatal group B streptococcal infection preventable?

      Azam, M; Allen, N M; O'Donovan, D; Moylett, E; Department of Paediatrics, Galway University Hospital, Newcastle Road, Galway. (2011-05)
      Early onset group B streptococcal (EOGBS) infection causes significant neonatal morbidity and mortality. We determined the incidence of EOGBS at Galway University Hospital (GUH) and examined any "missed opportunities" for preventing neonatal infection between 2004 and 2009. Our obstetric approach is risk-based. The incidence was 0.45/1,000 live-births; one death and one with neurological sequelae. A single mother received IAP; however we could not determine any potential for reducing cases of EOGBS by improving current IAP usage.
    • Is post-mortem evaluation of cardiac rhythm management devices useful?

      Nolan, PG; Hynes, S; Tuohy, S; McNeill, BD; Nash, PJ; Crowley, J; Curran, S; Daly, K; Galway University Hospitals (Health Service Executive (HSE), 2014-02-28)
    • Isolated pharmacomechanical thrombolysis plus primary stenting in a single procedure to treat acute thrombotic superior vena cava syndrome.

      O'Sullivan, Gerard J; Mhuircheartaigh, Jennifer Ni; Ferguson, David; Delappe, Eithne; O'Riordan, Conor; Browne, Ann Michelle; Section of Interventional Radiology, Department of Radiology, and, University College Hospital, Newcastle Road, Galway, Ireland. gerard.osullivan2@hse.ie (Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2010-02)
      To report a combined procedure that opens the acutely thrombosed superior vena cava (SVC) to rapidly alleviate symptoms in seriously ill patients with SVC syndrome.
    • Isolated pharmacomechanical thrombolysis using the Trellis system

      O’Sullivan, GJ; Galway University Hospital (2010)
      While anticoagulation remains the current gold standard for treating acute deep vein thrombosis,1 there is a growing body of evidence that rapid thrombus removal results in better short- and long-term outcomes.2–5 This is a practical guide to achieve rapid thrombus removal with isolated pharmacomechanical thrombolysis using the Trellis® peripheral infusion system. Although it may sound obvious, it is surprising how often a supposedly ‘acute’ deep vein thrombosis is, in fact, chronic or acute-on-chronic. This may sound like a trivial distinction, but it has wide-reaching implications for treatment. Primarily, and fundamentally, thrombus older than 14–21 days becomes fibrin-depleted,6 so techniques to achieve fibrinolysis, on their own, are likely to fail.7 Previous episodes of cellulitis, bruising, cramping, heaviness, spider-vein development, and so on are important clues to make the physician consider the possibility that this presentation is not purely the result of an acute deep vein thrombosis.8 Patients rarely connect seemingly distant events with the acute problem. They may consider long-term unilateral or bilateral leg swelling as their normal state without realizing this often implies an episode of prior deep vein thrombosis and the current acute deep vein thrombosis reflects thrombosis of the veins peripheral to a stenotic or obstructive underlying lesion. This is most obvious with iliac vein compression syndrome,9 but there are other pathologies that may cause a similar venous stenotic lesion.10 In patients who have experienced a recent onset of cough or shortness of breath, including more chronic symptoms such as those ascribed to asthma, a computed tomography (CT) pulmonary angiogram should be performed as the initial part of the CT venogram. General symptoms such as malaise or weight loss should prompt a search for a malignancy; in women, recurrent abortions together with a deep vein thrombosis would suggest a systemic pro-coagulant disorder.11
    • Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: prospective cohort study.

      O'Donnell, Martin; Mente, Andrew; Rangarajan, Sumathy; McQueen, Matthew J; O'Leary, Neil; Yin, Lu; Liu, Xiaoyun; Swaminathan, Sumathi; Khatib, Rasha; Rosengren, Annika; et al. (BMJ, 2019-03-13)
      To evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (<2.0 g sodium, >3.5 g potassium) in adults.
    • Kernicterus with abnormal high-signal changes bilaterally in the globus pallidus: A case report.

      Culleton, S; Kok, HK; Barras, C; Looby, S; Brennan, P; Asadi,H (Irish Medical Journal, 2018-04)
      Kernicterus is a relatively rare consequence of hyperbilirubinemia. There is an important role for MRI imaging for this entity in the appropriate clinical context as there are distinct signal changes in the globus pallidus. A case report and image findings are presented
    • Kicking off a Retropharyngeal Abscess

      Rana, A; Heffernen, L; Binchy, J (Irish Medical Journal, 2019-03)
      Retropharyngeal abscesses (RPA) are deep neck space infections that can pose an immediate life-threatening emergency, such as airway obstruction. [1] The potential space can become infected by bacteria spreading from a contiguous area [2] or direct inoculation from penetrating trauma. [3] Infection is often polymicrobial (most commonly group A beta-hemolytic streptococci). [4