• Fracture Patients’ Attitudes towards Online Health Information & a ‘Prescribed’ Fracture Website

      Clesham, JG; Galbraith, SR; Kearns, ME. O’ Sullivan (Irish Medical Journal, 2018-04)
      Following musculoskeletal injury patient education is essential to help patients understand their treatment. Many attend the orthopaedic fracture clinic with multiple questions related to their diagnosis and treatment.
    • Survey of Smartphone Use among Anaesthetists In Saolta University Health Care Group

      Kinirons, Alhomary, B. (Irish Medical Journal, 2018-03)
      Recent centuries have witnessed a revolution in technology which has made significant contributions to improve the quality of many aspects of our lives, including healthcare systems. Among these rapidly advancing technologies, smartphones stand out as an example of valuable devices that have dramatically changed the healthcare domain and the clinical practice. There is substantial evidence of the role of smartphones and medical applications in the daily practice of healthcare professionals. In one market research, it was estimated that 72% of US physicians use smartphones, and this number was expected to rise to 81% by 20121. This increasing popularity of smartphones can be attributed to the numerous benefits associated with their use. For instance, they can provide immediate access to a wealth of medical and health information via internet, emails and instant messages. Furthermore, they can lead to improved communications between healthcare professionals, and hence improved patient care2. An essential feature of smartphones is the integrated software applications (apps). These apps can either be preinstalled on the device or can be web apps that are accessed and downloaded via the internet. It is estimated that over 300,000 apps were developed between 2007 and 20103, and developers categorise a subset of these applications as medical apps. The utilisation of these medical apps by health care personnel, including anaesthetists has evolved recently.
    • Strength in Numbers: an international consensus conference to develop a novel approach to care delivery for young adults with type 1 diabetes, the D1 Now Study

      O’Hara, Mary Clare; Hynes, L.; O’Donnell, M.; Keighron, C.; Allen, G.; Caulfield, A.; Duffy, C.; Long, M.; Mallon, M.; Mullins, M.; et al. (BioMed Central, 2017-12-04)
      Abstract: Background A 3-day international consensus meeting was hosted by the D1 Now study team in Galway on June 22–24, 2016 called “Strength In Numbers: Teaming up to improve the health of young adults with type 1 diabetes”. The aim of the meeting was to bring together young adults with type 1 diabetes, healthcare providers, policy makers and researchers to reach a consensus on strategies to improve engagement, selfmanagement and ultimately outcomes for young adults living with type 1 diabetes. Methods This diverse stakeholder group participated in the meeting to reach consensus on (i) a core outcome set (COS) to be used in future intervention studies involving young adults with type 1 diabetes, (ii) new strategies for delivering health services to young adults and (iii) potential digital health solutions that could be incorporated into a future intervention. Results A COS of 8 outcomes and 3 key intervention components that aim to improve engagement between young adults with type 1 diabetes and service providers were identified. A digital health solution that could potentially compliment the intervention components was proposed. Conclusion The outputs from the 3-day consensus conference, that held patient and public involvement at its core, will help the research team further develop and test the D1 Now intervention for young adults with type 1 diabetes in a pilot and feasibility study and ultimately in a definitive trial. The conference represents a good example of knowledge exchange among different stakeholders for health research and service improvement.
    • Formation of a type 1 diabetes young adult patient and public involvement panel to develop a health behaviour change intervention: the D1 Now study

      O’Hara, Mary Clare; Cunningham, Áine; Keighron, Cameron; Allen, Gary; Caulfield, Antony; Duffy, Ciara; Long, Michelle; Mallon, Madeleine; Mullins, Monica; Tonra, Garret; et al. (BioMed Central, 2017-10-23)
      Abstract: Background Research indicates that young adults (18–25 year olds) with type 1 diabetes (T1D) often disengage from health services and their general diabetes management. Involving young adults with T1D in co-designing research to develop a behaviour change intervention to improve engagement with health services could potentially improve overall self management and health. A local youth mental health organisation called Jigsaw, Galway developed a very successful model for involving users in service design and development. Based on this model, the aim was to form a Young Adult Panel (YAP) of 18–25 year olds with T1D and involve them in all aspects of a study to develop an intervention to improve health and wellbeing for young adults with T1D called D1 Now. Methods Recruitment of young adults was achieved through a multimedia campaign. A consultation event was organised, followed by interviews with interested young adults. A panel of 8 members was selected. Following initial training for YAP members in committee skills and an introduction to different research methods and terms, YAP members participated in different stages of the research process. They were represented on the research study steering group and attended research meetings. They developed research materials, reviewed and interpreted research findings and helped develop the online platform to enhance engagement between young adults and their diabetes healthcare providers. They contributed to an international consensus conference on health services delivery for young adults with T1D and wrote specific sections of a further grant application to test out the new intervention. Results As a direct result of the YAP, a meaningful dialogue has opened up between healthcare providers and young adults within the D1 Now research team. Their involvement has led to a better understanding of what needs to be achieved in order to improve health service delivery. They have been active members in co-designing a health behaviour change. intervention to improve engagement between young adults with T1D and healthcare providers which will be evaluated in future research. Conclusion Through the formation of the YAP, we have demonstrated that involving young adults with T1D in healthcare research is feasible and productive.
    • Antimicrobial-resistant faecal organisms in algae products marketed as health supplements

      Ryan; Molloy, M; Evans, L; Quinn, A; Burke, E; McGrath, E; Cormican, M (2017-09)
      Dietary supplements are increasingly popular in Irish society. One of these is blue-green algae which is used with a variety health benefits in mind. A batch of Chlorella powder was found to be contaminated with Salmonella species in Ireland in 2015. This prompted additional testing of a total of 8 samples of three different products (Chlorella, Spirulina and Super Greens), for other faecal flora and antimicrobial resistance in any bacteria isolated. All 8 samples cultured enteric flora such as Enterococci, Enterobacteriaceae and Clostridium species. Antimicrobial susceptibility testing revealed one isolate with extended-spectrum β-lactamase (ESBL) activity and one with carbapenemase activity. Clinicians caring for vulnerable patients should be aware of the potential risk of exposure to antimicrobial resistant bacteria associated with these products
    • Food Allergy Emergencies in Children – To what extent are Early Years Services Prepared? A cross-sectional survey

      MacGiobuin, S; Stitt, V; Philbin, D; Higgins, B; McGuire, G; Marie O’Regan, A; Kelly, M (Irish Medical Journal, 2017-08)
      Food allergies are common in preschool children. This study’s aims are to establish prevalence, to clarify management practices, levels of preparedness and the perceived role of General Practitioners amongst Early Years Services providers. This study is an anonymous, quantitative, cross sectional study. An online questionnaire was distributed to 282 Early Years Service providers. Data were analysed using SPSS. Response rate was 35% (n=98). Prevalence of food allergy was 3% (n=119). Allergic reactions to food had occurred on site in 16% (n=15). Written emergency action plans were available in 47% of facilities (n=46). Medications were not kept on site in 63% (n=62) of facilities. General practitioners were felt to have an important role in the management of food allergies by 76% of respondents (n=61). This study identifies significant areas for improvement in the management of food allergic child in Early Years Services
    • Survivorship care for postmenopausal breast cancer patients in Ireland: What do women want?

      Meade, Elizabeth; McIlfatrick, Sonja; Groarke, Ann Marie; Butler, Eimear; Dowling, Maura (Elsevier, 2017-06)
      The aim of this study was to identify the concerns of postmenopausal breast cancer patients in Ireland and inform the development of a survivorship care plan.
    • The Selfie Wrist – Selfie induced trauma

      Lyons, RF; Kelly, JC; Murphy, CG (Irish Medical Journal, 2017-06)
      The selfie phenomenon has exploded worldwide over the past two years. Selfies have been linked to a large number of mortalities and significant morbidity worldwide. However, trauma associated with selfies including fractures, is rarely publicised. Here we present a case series of upper extremity trauma secondary to selfies across all age groups during the summer period. Four cases of distal radius and ulna trauma in all age groups were reported. This case series highlights the dangers associated with taking selfies and the trauma that can result.
    • I Still Haven’t Found What I’m Looking For….. Bono, Google and Glaucoma Awareness

      Lyons, C; Ellard, R; McElnea, E; Townley, D (Irish Medical Journal, 2017-05)
      The effect of celebrity diagnosis on public awareness of health conditions has already been well documented. In October 2014, Bono, the lead singer with U2, revealed publicly for the first time that he has glaucoma. This study aimed to analyze the impact of Bono’s announcement on public awareness of glaucoma using Google Search trends as an indicator of public interest in the disease. Google Trends was used to examine Google Search activity for the term ‘Glaucoma’ between 2009 and 2015 in both Ireland and the United Kingdom. Trend analyses were performed using Microsoft Excel Version 14.3.5. Increased Google Search activity for ‘Glaucoma’ in October 2014 was found in both Ireland and the United Kingdom. A five-fold increase from the mean Google Search activity for this term was found in Ireland and a two-fold increase from the mean Google Search activity for this term was found in the United Kingdom. No such increase in Google Search activity occurred during each country’s 2014 Glaucoma Awareness week. Google Trends is useful in medical research as a means of assessing public awareness of, and/or interest in, health related topics. Current approaches to glaucoma related health promotion in both Ireland and the United Kingdom have failed to yield an increase in on-line Google Search activity. While there was an increase in interest in glaucoma it is unclear whether this led to an increase in health seeking behaviour.
    • Satisfaction rates with the current Special Type Consultation (STC) reimbursement scheme among General Practitioners – A Mixed Methods Study.

      Kiely, A; O’Meara, S; Fitzgerald, N; Regan, AM; Durcan, P; McGuire, G; Kelly, ME (Irish Medical Journal, 2017-03)
      The Special Type Consultation (STC) scheme is a fee-for-service reimbursement scheme for General Practitioners (GPs) in Ireland. Introduced in 1989, the scheme includes specified patient services involving the application of a learned skill, e.g. suturing. This study aims to establish the extent to which GPs believe this scheme is appropriate for current General Practice. This is an embedded mixed-methods study combining quantitative data on GPs working experience of and qualitative data on GPs attitudes towards the scheme. Data were collected by means of an anonymous postal questionnaire. The response rate was 60.4% (n=159.) Twenty-nine percent (n=46) disagreed and 65% (n=104) strongly disagreed that the current list of special items is satisfactory. Two overriding themes were identified: economics and advancement of the STC process. This study demonstrates an overwhelming consensus among GPs that the current STC scheme is outdated and in urgent need of revision to reflect modern General Practice.
    • 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.
    • Aggressive Recurrence of Oral Squamous Cell Carcinoma in a patient with Fanconi’s Anaemia (FA)

      Nolan, M.; Courtney, R.; Sexton, P.; Barry, T.; McCann, P.J. (Irish Medical Journal, 2017-03)
      Fanconi’s Anaemia is a rare autosomal recessive disease for which the incidence of head and neck cancer can be increased 700-fold1. We report a case of a 31-year old Caucasian male with FA who initially presented in July 2007 with oral squamous cell carcinoma for which he received radical surgery and radiotherapy. He was disease-free until August 2015 when he presented with an extremely aggressive recurrence.
    • Trends in the Fractures and Fatalities of Farmyard Injuries in Ireland: A 10 year analysis

      Lee, MJ; Cawley, DT; Ng, JP; Kaar, K (Irish Medical Journal, 2017-01)
      The farming and agricultural sector remains one of Ireland’s primary industries. Fatality rates remain higher than the European average. The aim of this study was to analyze the national trend in hospital in-patient admissions for farmyard related fractures and related fatalities in Ireland from 2005 to 2014. Relevant socioeconomic trends were used for comparison. There were 2,064 farm-related fractures and 187 fatalities recorded over the same period. Despite a decrease in incidence of farmyard fractures over 2005-2014, fatality rates have increased indicating the alarming continued occupational hazards and severity of sustained injuries.
    • Shiitake Flagellate Dermatitis: the First Case Reported in Ireland

      Byrne, N; Foley, C; Cotter, M; O’Gorman, S; Storan, Eoin R; Marren, P (Irish Medical Journal, 2017-01)
      Shiitake (Lentinula edodes) is the second most commonly consumed mushroom worldwide1. It is used in Asian medicine for its anticarcinogenic, antihypertensive and lipid lowering properties2. Furthermore, extracts of these mushrooms are used in over-the-counter dietary supplements designed to improve the immune system1. The first case of shiitake mushroom induced flagellate dermatitis was described in Japan in 1977 and it is now being reported in the western world3. After literary review and consultation with the Irish National Poisons Information Centre, we believe this is the first reported case of shiitake flagellate dermatitis in Ireland
    • 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.
    • A systematic review of interventions to improve outcomes for young adults with Type 1 diabetes.

      O'Hara, M C; Hynes, L; O'Donnell, M; Nery, N; Byrne, M; Heller, S R; Dinneen, S F (Wiley, 2016-10-20)
      Many young adults with Type 1 diabetes experience poor outcomes. The aim of this systematic review was to synthesize the evidence regarding the effectiveness of interventions aimed at improving clinical, behavioural or psychosocial outcomes for young adults with Type 1 diabetes.
    • High Prevalence of Stress Urinary Incontinence in Adult Patients with Bronchiectasis

      Duignan, N; McDonnell, MJ; Mokoka, MC; Rutherford, RM (Irish Medical Journal, 2016-07)
      Stress urinary incontinence (SUI) is frequently under-reported in patients with chronic lung disease and may have negative psychosocial consequences. We conducted a prospective study to determine the prevalence, severity and treatment outcomes of SUI in female bronchiectasis patients referred for airway clearance techniques. Nineteen out of 40 (48%) patients reported SUI symptoms. Of these, 14 (74%) reported a reduced quality of life secondary to SUI. Following personalised intervention, symptom improvement was observed in 13/19 (68%). Five out of 19 (26%) required specialist referral for further continence care. No associations with lung disease severity and SUI were noted. SUI is common in adult female bronchiectasis patients and should be routinely screened for to improve patients’ overall quality of life.
    • Perampanel: An audit of clinical experience using the epilepsy electronic patient record.

      Ryan, E; Colleran, N; Cullinane, P; Fitzsimons, M; Flynn, C; Delanty, N; Hennessy, M (Irish Medical Journal, 2016-07)
      Perampanel is a non-competitive antagonist of AMPA glutamate receptors on post synaptic neurons. The aim of this study was to conduct an audit of the experience of perampanel treatment in Ireland based on the interrogation of the national epilepsy electronic patient record (EPR). A retrospective audit was compiled which reviewed the progress of patients who had been treated across two regional epilepsy centres. The EPR was used to identify patients and collect information relevant to their perampanel therapy. Collected data was entered into a statistical package for social sciences for analysis using descriptive statistics. 70 patients were identified for inclusion in this audit. Partial onset epilepsy was the predominant epilepsy syndrome treated with perampanel. Eight milligrams daily was the maximum dose achieved in 31.45% (n=22). Complex partial seizures demonstrated the best seizure response to perampanel, which was optimal at doses of 4mgs to 8mgs once daily. Treatment was discontinued primarily due to side effect profile (28.5%; n=20). The common side effects reported were behavioural alteration, sedation and dizziness. Abnormal thoughts were identified in 4.2% (n=3). Overall perampanel has been shown to be an effective adjunct. The EPR was demonstrated as an effective tool for audit and research.
    • 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.
    • 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.