• Practise what you preach: health behaviours and stress among non-consultant hospital doctors.

      Feeney, Sinéad; O'Brien, Kevin; O'Keeffe, Neasa; Iomaire, Anna Nic Con; Kelly, Maureen E; McCormack, John; McGuire, Genevieve; Evans, David S (2016-02)
      High rates of psychological distress, depression and suicide have been reported among doctors. Furthermore, many doctors do not access healthcare by conventional means. This study aimed to increase understanding regarding non-consultant hospital doctors' (NCHDs') response to stress and barriers to accessing supports, and identify possible solutions. Medical manpower departments in 58 hospitals distributed a 25-item questionnaire to 4,074 NCHDs; we received 707 responses (response rate, 17.4%). 60% of NCHDs were unable to take time off work when unwell; 'letting teammates down' (90.8%) and 'difficulty covering call' (85.9%) were the leading reasons. 'Being too busy' (85%), 'self-prescription' (66.6%) and 'self-management' (53.1%) were ranked highest in deterring NCHDs from visiting a general practitioner (GP). 22.9% of NCHDs would not attend a GP with anxiety or depression until they began to feel hopeless, helpless or suicidal. 12.2% would not seek help at all. 55% of respondents (n = 330) had to move away from partners or dependants due to work, negatively affecting the social supports of 82.9%. Possible practical solutions were explored. NCHDS are a vulnerable population and have a particularly challenging lifestyle. Key recommendations include improved GP and counselling access for NCHDs, and addressing the culture of self-treatment and poor health behaviours through undergraduate and postgraduate education.
    • Preparing new doctors for clinical practice: An evaluation of pre-internship training

      Byrne, D; P O’Connor; Lydon, S; Kerin, MJ (Irish Medical Journal, 2012-12)
    • The prevalenace of metabolic syndrome 5 years post partum in patients with a history of GDM

      Noctor, E; Crowe, C; Carmody, LA; Wickham, B; Avalos G; Gaffney, G; O'Shea, P; Dunne, F; NUI Galway (Royal Academy of Medicine in Ireland, 2011)
    • Prevalence and implications of abnormal glucose tolerance in pregnancy in Ireland

      O Sullivan, EP; Avalos, G; O Reilly, M (Diabetologia, 2010)
    • The Prevalence and Management of Metabolic Acidosis of Chronic Kidney Disease

      Ahmed, A.R.; Satti, M.M.; Abdalla, A.E.; Giblin, L.; Lappin, D. (Irish Medical Journal, 2019-10)
      Emerging evidence supports initiating oral sodium bicarbonate (OSB) at a serum bicarbonate (HCO3) level of less than 22mmol/L. We look to identify the prevalence of metabolic acidosis of chronic kidney disease (MA-CKD) and its management with OSB at a regional university hospital.
    • The prevalence of diabetes, pre-diabetes and metabolic syndrome in Irish travellers and the impact of lifestyle modification

      Slattery, D; Brennan, M; Canny, C; O'Shea, P; Dennedy, MC; Dunne, F; Galway University Hospitals (Royal Academy of Medicine in Ireland, 2011)
    • A prospective clinical, economic, and quality-of-life analysis comparing endovascular aneurysm repair (EVAR), open repair, and best medical treatment in high-risk patients with abdominal aortic aneurysms suitable for EVAR: the Irish patient trial.

      Hynes, Niamh; Sultan, Sherif; Department of Vascular Surgery, Western Vascular Institute at the University College Hospital Galway, Ireland. (Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists, 2007-12)
      To report the results of a trial comparing endovascular aneurysm repair (EVAR) to open repair (OR) and best medical therapy (BMT) involving high-risk patients with abdominal aortic aneurysms (AAA) suitable for EVAR.
    • Prospective evaluation of outcome measures in free-flap surgery.

      Kelly, John L; Eadie, Patricia A; Orr, David; Al-Rawi, Mogdad; O'Donnell, Margaret; Lawlor, Denis; Department of Plastic Surgery, University College Hospital, Galway, Newcastle, Ireland. (2004-08)
      Free-flap failure is usually caused by venous or arterial thrombosis. In many cases, lack of experience and surgical delay also contribute to flap loss. The authors prospectively analyzed the outcome of 57 free flaps over a 28-month period (January, 1999 to April, 2001). The setting was a university hospital tertiary referral center. Anastomotic technique, ischemia time, choice of anticoagulant, and the grade of surgeon were recorded. The type of flap, medications, and co-morbidities, including preoperative radiotherapy, were also documented. Ten flaps were re-explored (17 percent). There were four cases of complete flap failure (6.7 percent) and five cases of partial failure (8.5 percent). In patients who received perioperative systemic heparin or dextran, there was no evidence of flap failure (p = .08). The mean ischemia time was similar in flaps that failed (95 +/- 29 min) and in those that survived (92 +/- 34 min). Also, the number of anastomoses performed by trainees in flaps that failed (22 percent), was similar to the number in flaps that survived (28 percent). Nine patients received preoperative radiotherapy, and there was complete flap survival in each case. This study reveals that closely supervised anastomoses performed by trainees may have a similar outcome to those performed by more senior surgeons. There was no adverse effect from radiotherapy or increased ischemia time on flap survival.
    • A prospective study of risk factors for foot ulceration: The West of Ireland Diabetes Foot Study.

      Hurley, L; Kelly, L; Garrow, Ap; Glynn, Lg; McIntosh, C; Alvarez-Iglesias, A; Avalos, G; Dinneen, Sf; Diabetes Centre, Galway University Hospitals and Galway Primary Community and Continuing Care, Health Services Executive West. (2013-09-25)
      BackgroundThis is the first study to examine risk factors for diabetic foot ulceration in Irish general practice.AimTo determine the prevalence of established risk factors for foot ulceration in a community-based cohort, and to explore the potential for estimated glomerular filtration rate (eGFR) to act as a novel risk factor.DesignA prospective observational study.MethodsPatients with diabetes attending 12 (of 17) invited general practices were invited for foot screening. Validated clinical tests were carried out at baseline to assess for vascular and sensory impairment and foot deformity. Ulcer incidence was ascertained by patient self-report and medical record. Patients were re-assessed 18 months later. ResultsOf 828 invitees, 563 (68%) attended screening. On examination 23-25% had sensory dysfunction and 18-39% had evidence of vascular impairment. Using the Scottish Intercollegiate Guidelines Network risk stratification system we found the proportion at moderate and high risk of future ulceration to be 25% and 11% respectively. At follow-up 16/383 patients (4.2%) developed a new foot ulcer (annual incidence rate of 2.6%). We observed an increasing probability of abnormal vascular and sensory test results (pedal pulse palpation, doppler waveform assessment, 10g monofilament, vibration perception and neuropathy disability score) with declining eGFR levels. We were unable to show an independent association between new ulceration and reduced eGFR [Odds ratio 1.01; p=0.64].ConclusionsOur data show the extent of foot complications in a representative sample of diabetes patients in Ireland. Use of eGFR did not improve identification of patients at risk of foot ulceration.
    • Prostate cancer risk assessment tools in an unscreened population

      Lundon, D. J.; Kelly, B. D.; Foley, R.; Loeb, S.; Fitzpatrick, J. M.; Watson, R. W. G.; Rogers, E.; Durkan, G. C.; Walsh, K. (World Journal of Urology, 2014-08)
    • The provision of diabetes care in nursing homes in Galway city and county: a survey of nursing homes

      Hurley, Lorna; Dinneen, Sean; Galway Primary Community & Continuing Care & the Diabetes and Endocrinology Service, University Hospital Galway (Galway Primary Community & Continuing Care & the Diabetes and Endocrinology Service, University Hospital Galway, 2014-03)
      In addition to the increasing prevalence of diabetes, our population is growing older and living longer. This survey aimed to determine the care provided to residents with diabetes in Nursing Homes. All 44 Nursing Homes in County Galway were sent postal surveys and 75% (n=33) responded. Of these, 18% (n=6) were Health Service Executive (HSE) Nursing Homes and 82% (n=27) were private Nursing Homes. Nursing Homes had an average of 38.2 residents, 5.2 of whom had diabetes. This equates to a prevalence of 14%. 42% of Nursing Homes had a policy on diabetes management, 56% had access to diabetes care guidelines and 97% had diabetes care plans. Retinal screening, dietetic and chiropody/podiatry services were accessed by 70%, 89% and 97% respectively. A third of residents with diabetes were managed on insulin. Titration of insulin was performed in collaboration with the diabetes specialist (60%) and/or the GP (60%) while 20% report titration of insulin in-house without additional support. One third of Nursing Homes do not keep a record of the residents’ blood test results. These are held by the GP. Management of hypoglycaemia was reported to be a frequent or very frequent occurrence in 19% of homes. One third of residents with diabetes attend the diabetes outpatient clinic and the rate was highest in private Nursing Homes (p=0.01). 36% of Nursing Homes had staff with diabetes training. Access to education was the most cited opportunity for improving diabetes care (88%), followed by access to services (67%). A focus group and interviews were carried out with Nursing Home managers to further explore the data and issues arising. Findings from this qualitative research highlight variations in the level and standard of diabetes care provided in nursing homes. Level of support from general practice varies depending on the GP. Ancillary services provided in-house are usually from private sources with transport being identified as a barrier to accessing public ancillary services. Although education and training is provided in-house by a variety of sources preferences for education by practicing specialists and tailored to the people with diabetes in specific homes were expressed. This is the first report on the status of diabetes care in Nursing Homes in an Irish setting and may help inform policy.
    • Psychological stress associated with diabetes during pregnancy

      Lydon, K; McGuire, B; Owens, L (Irish Journal of Medical Science, 2010)
    • Pulmonary artery leiomyosarcoma: an unusual cause of shortness of breath.

      Flaherty, G; McCarthy, P; Mortimer, G; Department of Medicine, University Hospital, Galway and National University of Ireland, Galway, Ireland. gerard.flaherty@nuigalway.ie (2011-03)
      Primary leiomyosarcomas of the pulmonary artery are very rare tumours with 30 cases reported in the English literature. Herein, we report the first case with evidence of a renal metastasis.
    • Pulse width optimisation of ICD defibrillation waveforms is both a safeand effective programming strategy at time of implant [poster]

      Nolan, PG; McFadden, C; MacNeill, BD; Crowley, J; Nash, PJ; Daly, K; Galway University Hospitals (Health Service Executive (HSE), 2014-02-28)
    • A quantitative assessment of facial protection systems in elective hip arthroplasty.

      Hirpara, Kieran Michael; O'Halloran, Emily; O'Sullivan, Michael; Merlin Park Hospital, Galway, Ireland. kie_hirpara@hotmail.com (2011-06)
      We aimed to assess the risk to surgeons of blood splatter during total hip arthroplasty. Hoods from personal protection systems used in 34 consecutive total hip replacements were collected and the area of blood splatter was measured and compared to goggles and visors. Thirty one primary THA's (13 cemented, 4 hybrid, 14 uncemented) and 3 revisions (1 hybrid, 2 uncemented) were collected. Splashes were detected on all of the masks with a mean of 034% cover. Splatter was greatest for the operating surgeon, followed by the first assistant, though the difference was not statistically significant. Operating personnel were at greater risk of contamination during uncemented arthroplasty (p < 0.0001; 95% CI). On average 50.60% and 45.40% of blood cover was outside the area protected by goggles and visors respectively. There was a significant difference between the Personal Protection Systems (PPS) and goggles (p = 0.0231; 95% CI) as well as between the PPS and visors (p = 0.0293; 95% CI).