• 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
    • Learning and performance of tracheal intubation by novice personnel: a comparison of the Airtraq and Macintosh laryngoscope.

      Maharaj, C H; Costello, J F; Higgins, B D; Harte, B H; Laffey, J G; Department of Anaesthesia, University College Hospital Galway, Ireland. (2006-07)
      Direct laryngoscopic tracheal intubation is taught to many healthcare professionals as it is a potentially lifesaving procedure. However, it is a difficult skill to acquire and maintain, and, of concern, the consequences of poorly performed intubation attempts are potentially serious. The Airtraq Laryngoscope is a novel intubation device which may possess advantages over conventional direct laryngoscopes for use by novice personnel. We conducted a prospective trial with 40 medical students who had no prior airway management experience. Following brief didactic instruction, each participant took turns in performing laryngoscopy and intubation using the Macintosh and Airtraq devices under direct supervision. Each student was allowed up to three attempts to intubate in three laryngoscopy scenarios using a Laerdal Intubation Trainer and one scenario in a Laerdal SimMan Manikin. They then performed tracheal intubation of the normal airway a second time to characterise the learning curve for each device. The Airtraq provided superior intubating conditions, resulting in greater success of intubation, particularly in the difficult laryngoscopy scenarios. In both easy and simulated difficult laryngoscopy scenarios, the Airtraq decreased the duration of intubation attempts, reduced the number of optimisation manoeuvres required, and reduced the potential for dental trauma. The Airtraq device showed a rapid learning curve and the students found it significantly easier to use. The Airtraq appears to be a superior device for novice personnel to acquire the skills of tracheal intubation.
    • Lentiviral vector mediated modification of mesenchymal stem cells & enhanced survival in an in vitro model of ischaemia.

      McGinley, Lisa; McMahon, Jill; Strappe, Padraig; Barry, Frank; Murphy, Mary; O'Toole, Daniel; O'Brien, Timothy; Regenerative Medicine Institute and Department of Medicine, National University, of Ireland, Galway and Galway University Hospital, University Road, Galway,, Ireland. timothy.obrien@nuigalway.ie. (2012-01-31)
      INTRODUCTION: A combination of gene and cell therapies has the potential to significantly enhance the therapeutic value of mesenchymal stem cells (MSCs). The development of efficient gene delivery methods is essential if MSCs are to be of benefit using such an approach. Achieving high levels of transgene expression for the required period of time, without adversely affecting cell viability and differentiation capacity, is crucial. In the present study, we investigate lentiviral vector-mediated genetic modification of rat bone-marrow derived MSCs and examine any functional effect of such genetic modification in an in vitro model of ischaemia. METHODS: Transduction efficiency and transgene persistence of second and third generation rHIV-1 based lentiviral vectors were tested using reporter gene constructs. Use of the rHIV-pWPT-EF1-alpha-GFP-W vector was optimised in terms of dose, toxicity, cell species, and storage. The in vivo condition of ischaemia was modelled in vitro by separation into its associated constituent parts i.e. hypoxia, serum and glucose deprivation, in which the effect of therapeutic gene over-expression on MSC survival was investigated. RESULTS: The second generation lentiviral vector rHIV-pWPT-EF1-alpha-GFP-W, was the most efficient and provided the most durable transgene expression of the vectors tested. Transduction with this vector did not adversely affect MSC morphology, viability or differentiation potential, and transgene expression levels were unaffected by cryopreservation of transduced cells. Over-expression of HSP70 resulted in enhanced MSC survival and increased resistance to apoptosis in conditions of hypoxia and ischaemia. MSC differentiation capacity was significantly reduced after oxygen deprivation, but was preserved with HSP70 over-expression. CONCLUSIONS: Collectively, these data validate the use of lentiviral vectors for efficient in vitro gene delivery to MSCs and suggest that lentiviral vector transduction can facilitate sustained therapeutic gene expression, providing an efficient tool for ex vivo MSC modification. Furthermore, lentiviral mediated over-expression of therapeutic genes in MSCs may provide protection in an ischaemic environment and enable MSCs to function in a regenerative manner, in part through maintaining the ability to differentiate. This finding may have considerable significance in improving the efficacy of MSC-based therapies.
    • Living with relapsed myeloma: Symptoms and self-care strategies.

      Cormican, Orlaith; Dowling, Maura (2018-04-01)
      Aims and Objectives To explore which symptoms relapsed myeloma patients experience and what self‐care strategies are used. Methods This was a qualitative study utilising focus group interviews (n = 4) with relapsed myeloma patients (n = 15) and carers (n = 9). The focus groups were analysed and guided by thematic analysis. Results Three major themes with subthemes were identified following analysis of the interview data: “difficult symptoms; “self‐care” and “feeling vulnerable.” These findings indicate the challenges relapsed myeloma patients experience with ongoing symptoms and highlight the importance of continuity of care. Conclusions Symptom management for myeloma patients remains complex due to the array of treatments given. These patients require holistic care and thorough regular assessments to help them cope with the adverse effects on their physical and psychological health. For patients with a long‐term diagnosis of myeloma, self‐management workshops and regular education sessions may be of benefit.
    • Locally advanced rectal cancer: a cooperative surgical approach to a complex surgical procedure.

      Owens, P; Lynch, N; Curtin, M; Devitt, A (Irish Medical Journal, 2015-01)
      Single stage en bloc abdominoperineal resection and sacrectomy, with a myocutaneous flap closure is a relatively uncommon procedure. Our case study of a 77 year old man with a locally invasive rectal adenocarcinoma highlights the complex intraoperative management of such a patient.
    • Low back pain post partum - A case report.

      De Búrca, Neasa; Physiotherapy Department, University Hospital Galway, Galway, Ireland. (2012-02-23)
      Sacral stress fracture is an unusual source of low back pain and can be easily confused with a number of other clinical conditions seen in physiotherapy clinics. The purpose of this case report is to describe the case of a patient presenting with low back pain post partum illustrating pertinent aspects of differential diagnosis and issues of management. A 31 year old female presented complaining of low back pain since the birth of her second child 11 months earlier. Subjective and objective examination led the Therapist to consider a diagnosis of sacral stress fracture. This diagnosis was confirmed by MRI. Three months after presenting to physiotherapy the patient was pain free and had returned to all aspects of her daily life without any difficulties. Clinicians must be aware of the less common pathologies in any hypotheses development. A careful history and physical examination and broad hypotheses generation will ensure that patients are accurately diagnosed and receive appropriate and effective treatments.
    • 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)