• Screening for developmental dysplasia of the hip: current practices in Ireland.

      O'Grady, M J; Mujtaba, G; Hanaghan, J; Gallagher, D; Department of Paediatrics, Mayo General Hospital, Castlebar, Co, Mayo, Republic, of Ireland. michael_ogrady2001@hotmail.com (2012-01-31)
      OBJECTIVE: To ascertain the current approach to screen for developmental dysplasia of the hip in the Republic of Ireland. METHODS: Two-pronged prospective and retrospective study. (1) Postal questionnaire to consultant paediatricians responsible for the routine neonatal care of infants in the Irish Republic in June 2006. (2) Retrospective database review to identify infants undergoing radiological follow-up and their outcome. RESULTS: All maternity units surveyed responded. Most units (84%) were dependent on radiographs at 4-6 months for imaging hips, only two units primarily used ultrasound (10.5%). We estimate that neonatal hip examination is performed by an experienced examiner in less than 30% of routine newborn examinations. On retrospective analysis, 94% of radiographs performed were normal. CONCLUSIONS: The most effective interventions, selective ultrasound and examination by an experienced clinician are not widely practiced. There is a need for the development of national guidelines based on available resources.
    • Scrotal metastases from colorectal carcinoma: a case report.

      McWeeney, Doireann M; Martin, Sean T; Ryan, Ronan S; Tobbia, Iqdam N; Donnellan, Paul P; Barry, Kevin M; Department of Surgery, Mayo General Hospital, Castlebar, Co, Mayo, Ireland., doireannmcweeney@gmail.com. (2012-01-31)
      ABSTRACT: A 72-year-old man presented with a two month history of rectal bleeding. Colonoscopy demonstrated synchronous lesions at 3 cm and 40 cm with histological analysis confirming synchronous adenocarcinomata. He developed bilobar hepatic metastases while undergoing neoadjuvant chemoradiotherapy. Treatment was complicated by Fournier's gangrene of the right hemiscrotum which required surgical debridement. Eight months later he re-presented with an ulcerating lesion on the right hemiscrotum. An en-bloc resection of the ulcerating scrotal lesion and underlying testis was performed. Immunohistological analysis revealed metastatic adenocarcinoma of large bowel origin. Colorectal metastasis to the urogenital tract is rare and here we report a case of rectal carcinoma metastasizing to scrotal skin.
    • Seatbelt injury causing small bowel devascularisation: case series and review of the literature.

      O'Dowd, Vincent; Kiernan, Christine; Lowery, Aoife; Khan, Waqar; Barry, Kevin; Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland. (2012-01-31)
      The use of seatbelts has increased significantly in the last twenty years, leading to a decrease in mortality from road traffic accidents (RTA). However, this increase in seatbelt use has also led to a change in the spectrum of injuries from RTA; abdominal injuries, particularly intestinal injuries have dramatically increased with the routine use of seatbelts. Such intestinal injuries frequently result from improper placement of the "lap belt". We present 3 cases in which passengers wearing a seatbelt sustained significant devascularisation injuries to the small bowel requiring emergency surgical intervention. A high index of suspicion is crucial in such cases to prevent delays in diagnosis that can lead to severe complications and adverse outcomes. It is evident that while advocating seatbelt use, the importance of education in correct seatbelt placement should also be a focus of public health strategies to reduce RTA morbidity and mortality.
    • Squamous cell carcinoma of the anal canal.

      Martin, F T; Kavanagh, D; Waldron, R; Department of Colorectal Surgery, Mayo General Hospital, Castlebar, Co. Mayo,, Ireland. fiachra1978@yahoo.com (2012-01-31)
      Squamous cell carcinoma ofthe anal canal represents 1.5% of all malignancies affectingthe gastrointestinal tract. Over the past 20 years dramatic changes have been seen in both the epidemiological distribution of the disease and in the therapeutic modalities utilised to manage it. CLINICAL MANAGEMENT: Historically abdominoperineal resection had been the treatment of choice with local resection reserved for early stage disease. Work by Nigro et al. has revolutionised how we currently manage carcinoma of the anal canal, demonstrating combined modality chemoradiotherapy as an appropriate alternative to surgical resection with the benefit of preserving sphincter function. Surgery is then reserved for recurrent disease with salvage abdominoperineal resection. This article reviews current literature and highlights the changing therapeutic modalities with selected clinical cases
    • Staff attitudes to an ultrasound-guided peripheral nerve block room for orthopaedic patients

      Moore, DM; Duggan, M (Irish Medical Journal, 2014-09)
      Ultrasound-guided peripheral nerve blocks have well recognised benefits in orthopaedic patients. Some hospitals, to maximise these benefits, establish dedicated â block roomsâ to deliver this service. Orthopaedic surgery makes up a large proportion of our hospitals work load, and many of these patients would benefit from ultrasound-guided peripheral nerve blocks. We analysed the attitudes of key staff in our hospital towards the establishment of a block room. Sixty questionnaires were distributed and 47 (78%) were completed. Orthopaedic surgeons (n=6) were concerned ultrasound-guided peripheral nerve blocks would delay theatre lists (83%), and cause patients pain (67%) and increased anxiety (67%). Anaesthetists (n=10) and Nurses (n=30) were concerned there was insufficient experience in their departments to deliver this service (80% and 77%, respectively). However, 91% of all staff believed funding should be available for a block room. Our survey has identified areas of concern, and deficiencies that we must address before proceeding with the development of such a service.
    • Successful Introduction of Ring-Fenced Inpatient Surgical Beds in a General Hospital Setting

      Coyle, D; Lowery, AJ; Khan, W; Waldron, R; Barry, K (Irish Medical Journal, 2012-09)
    • A Survey of Clinical Uncertainty from the Paediatric Basic Specialist Trainee Perspective

      O’Neill, MB; Sarani, ZA; Nicholson, AJ; Elbadry, M; Deasy, AM (Irish Medical Journal, 2017-06)
      This study was undertaken to evaluate uncertainty from the Basic Specialist Trainee perspective. The survey of trainees explored 1) factors in decision making, 2) the personal impact of uncertainty, 3) the responses to both clinical errors and challenges to their decision making and 4) the potential strategies to address uncertainty. Forty-one (93%) of trainees surveyed responded. Important factors in decision making were clinical knowledge and senior colleague’s opinion. Sixty percent experienced significant anxiety post call as a consequence of their uncertainty. When errors are made by colleagues, the trainee’s response is acceptance (52.5%), and sympathy (32%).Trainees are strongly influenced by the opinions of senior colleagues often changing their opinions having made confident decisions. Solutions to address uncertainty include enhanced knowledge translation, and to a lesser extent, enhanced personal awareness and resilience awareness. To enhance the training experience for BST and lessen the uncertainty experienced these strategies need to be enacted within the training milieu.
    • Utilisation of clinical networks to facilitate elective surgical workload; a preliminary analysis

      Burke, T; Waters, P; Waldron, RM; Joyce, K; Khan, I; Khan, W; Kerin, M; Barry, K; Mayo General Hospital and Galway University Hospital (Irish Medical Journal, 2015-12)
      Clinical networks have potential to increase elective surgical workload for benign conditions in non-cancer centres. The aims of this study were to determine outcomes for elective laparoscopic cholecystectomy in our unit and to evaluate early experience in managing benign surgical workload referred from the tertiary centre within our clinical network. An analysis of cholecystectomies performed at Mayo General Hospital was conducted (2003-2013). A review of elective procedures more recently referred from Galway University Hospital (GUH) waiting lists was also conducted. 1937 consecutive cholecystectomies were performed with an overall laparoscopic conversion rate of 1.7% (33/1875). The total major complication rate was 0.93% (18/1937). 151 selected procedures originating from GUH have been performed since December 2013 without adverse events. Laparoscopic cholecystectomy can be performed in significant volume in the general hospital environment. This and other appropriate benign surgical procedures may be performed outside of tertiary units according to network agreements.
    • Variations in the presentation of aphasia in patients with closed head injuries.

      Kavanagh, Dara Oliver; Lynam, Conor; Duerk, Thorsten; Casey, Mary; Eustace, Paul W; Department of Surgery, Mayo General Hospital, Castlebar, Co Mayo, Ireland. (2012-01-31)
      Impairments of speech and language are important consequences of head injury as they compromise interaction between the patient and others. A large spectrum of communication deficits can occur. There are few reports in the literature of aphasia following closed head injury despite the common presentation of closed head injury. Herein we report two cases of closed head injuries with differing forms of aphasia. We discuss their management and rehabilitation and present a detailed literature review on the topic. In a busy acute surgical unit one can dismiss aphasia following head injury as behaviour related to intoxication. Early recognition with prolonged and intensive speech and language rehabilitation therapy yields a favourable outcome as highlighted in our experience. These may serve as a reference for clinicians faced with this unusual outcome.
    • Withholding truth from patients.

      O'Sullivan, Elizabeth; Mayo General Hospital, Castlebar, Co Mayo. lizosul@eircom.net (2012-01-31)
      The issue of whether patients should always be told the truth regarding their diagnosis and prognosis has afforded much debate in healthcare literature. This article examines telling the truth from an ethical perspective. It puts forward arguments for and against being honest with patients, using a clinical example to illustrate each point.