• The future role for colposcopy in Europe.

      Leeson, Simon C; Alibegashvili, Tamar; Arbyn, Marc; Bergeron, Christine; Carriero, Carmine; Mergui, Jean-Luc; Nieminen, Pekka; Prendiville, Walter; Redman, Charles W E; Rieck, Gudrun C; et al. (2014-01)
      Improvements in the performance of cervical screening may be limited by the diagnostic performance of colposcopy. Nonetheless, colposcopy remains the best available tool to assess women considered at high risk for having or developing cervical cancer. The provision and role of colposcopy across Europe is variable. Introduction of vaccination against human papillomavirus (HPV) types 16 and 18 as well as the possible switch to HPV-based screening is likely to change the profiles of women presenting to colposcopy services and provide management difficulties for the colposcopist.The standard of colposcopy in Europe can be maintained or improved despite a variable availability of screening. The prevalence of cervical intraepithelial neoplasia grade 3 may decrease for women having had HPV vaccination. The incidence of cervical intraepithelial neoplasia grade 3 and cervical cancer in second and subsequent rounds of HPV-based screening are likely to decrease compared to cytology-based screening. In HPV-based screening, the numbers of women with no detectable or minor abnormalities at colposcopy and with screen-detected glandular disease are likely to increase. We have considered how these issues will affect states that have varying implementation of organized cervical screening programs and varying degrees of implementation of HPV testing or vaccination.The development of quality assurance across Europe accompanying these program changes is discussed.
    • HPV testing and vaccination in Europe.

      Leeson, Simon C; Alibegashvili, Tamar; Arbyn, Marc; Bergeron, Christine; Carriero, Carmine; Mergui, Jean-Luc; Nieminen, Pekka; Prendiville, Walter; Redman, Charles W E; Rieck, Gudrun C; et al. (2014-01)
      Current cytology-based screening has a moderate sensitivity to detect cervical intraepithelial neoplasia grade 3 (CIN 3) and cervical cancer even in those states providing rigorous quality control of their cervical screening programs. The impact of vaccination against human papillomavirus (HPV) types 16 and 18 as well as the incorporation of HPV testing on the detection of CIN 3 and cancer is discussed. HPV testing used as a triage for atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions, test of cure after treatment, and HPV-based primary screening may improve current cervical screening programs.HPV testing as a triage test for ASCUS seems to offer an improved sensitivity, with a similar specificity as compared to repeat cytology for diagnosing high-grade CIN and has been recommended throughout most EU states. HPV testing as a triage test for low-grade squamous intraepithelial lesions has a low specificity and is not recommended in most member states. HPV test of cure offers an improved sensitivity compared to cytology for women with persistent cervical precancer after treatment. HPV-based cervical cancer screening is more effective than screening with cytology. The effects of HPV-based screening depend on the organization of the program and on adherence to algorithms for screening triage. Otherwise, it is likely that HPV-based screening will increase the referral rate to colposcopy including more women with no detectable cervical lesion. HPV vaccination will require many years to evaluate any beneficial effects on cervical cancer incidence and mortality.
    • The impact of surgery for vulval cancer upon health-related quality of life and pelvic floor outcomes during the first year of treatment: a longitudinal, mixed methods study.

      Jones, Georgina L; Jacques, Richard M; Thompson, Joanne; Wood, Hilary J; Hughes, Jane; Ledger, William; Alazzam, Mo'iad; Radley, Stephen C; Tidy, John A (John Wiley & Sons, 2016-06)
      To measure the long-term impact of surgical treatment for vulval cancer upon health-related quality of life and pelvic floor outcomes during the first year of therapy.
    • Non-small-cell lung cancer: unusual presentation in the gluteal muscle.

      Al-Alao, Bassel Suffian; Westrup, Jennifer; Shuhaibar, Maher Nicolas; Department of Cardiothoracic Surgery, UPMC Beacon Hospital, Sandyford, Dublin 18, Ireland. Bassel.Al-Alao@BeaconHospital.ie (2011-05)
      Lung cancer is one of the most commonly diagnosed cancers in both men and women worldwide. It is also one of the most common forms of cancer in Ireland, accounting for about 20% of all deaths from cancer each year. Early detection of lung cancer is infrequent, and most cases are not diagnosed and treated until they are at an advanced stage. Distant metastases in lung cancer commonly involve the adrenal glands, liver, bones, and central nervous system; they are only rarely seen in the skeletal system. We report a rare case of metastasis to the gluteal muscle as the initial presentation of lung cancer.
    • A nutraceutical approach (Armolipid Plus) to reduce total and LDL cholesterol in individuals with mild to moderate dyslipidemia: Review of the clinical evidence.

      Barrios, Vivencio; Escobar, Carlos; Cicero, Arrigo Francesco Giuseppe; Burke, David; Fasching, Peter; Banach, Maciej; Bruckert, Eric; Beacon Hospital (Elsevier, 2017-02)
      Compelling evidence supports the effectiveness of the reduction of total and LDL cholesterol (TC and LDL-C) in primarily preventing cardiovascular events, within the framework of life-long prevention programs mainly consisting in lifestyle changes. Pharmacological treatment should be introduced when lifestyle changes, including use of nutraceuticals, have failed. ESC/EAS guidelines list a number of nutraceutical compounds and functional foods which have been individually studied in randomized, controlled clinical trials (RCTs). To date only a proprietary formulation of three naturally occurring substances with putative complementary lipid-lowering properties - red yeast rice, policosanol and berberine - combined with folic acid, astaxanthin, and coenzyme Q10 (Armolipid Plus(®)) has been extensively investigated in several RCTs, 7 of which were placebo-controlled, 2 were ezetimibe comparators and 4 were "real life" studies comparing diet and Armolipid Plus to diet alone. The trials included mostly patients with mild to moderate dyslipidemia, treated for 6-48 weeks. The trials also included special populations and patients in whom statins were contraindicated or who could not tolerate them. Armolipid Plus has proved to be able to achieve significant reductions in TC (11-21%) and in LDL-C (15-31%) levels, which is equivalent to expectations from low dose statins. In patients intolerant to statins, who do not achieve their therapeutic target with ezetimibe, Armolipid Plus can achieve a further 10% improvement in TC and LDL-C. The safety and tolerability of Armolipid Plus were excellent, thought likely due to the intentional combination of low doses of its active ingredients: low enough not to be associated with untoward effects, but high enough to exert therapeutic effects in combination with other complementary substances. Consequently, in the event of intolerance to statins, Armolipid Plus offers an effective alternative, which is devoid of the safety risks associated with synthetic pharmacological therapy. In conclusion Armolipid Plus, in addition to dietary measures, could be a rational choice for individuals with mild to moderate hyperlipidemia and for all dyslipidemic patients in whom statins are not indicated or who cannot tolerate them.
    • Patient knowledge of risk factors 18 months after a nurse-led vascular intervention

      Tone, J M; Gallagher, P; Agha, A; Thompson, C J (2011)
      Background and aims: Eighteen months after the completion of a vascular risk intervention study, the authors aimed to ascertain whether participants who attended the intensive, nurse-led group had better retention of knowledge of diabetes and heart disease compared with those who had undergone standard diabetes care. Method: A knowledge-based questionnaire was sent to participants who completed the vascular risk intervention study, 94 from the intensive, nurse-led group and 94 from the standard care group. Results: A response rate of 75% was achieved. Although more participants in the intensive group achieved recommended vascular risk targets, there was no increase in retained knowledge of vascular risks. A high proportion of the total cohort could not quantify targets for blood pressure (67.2%), cholesterol (65.1%) or HbA1c (68.1%). Conclusion: In this cohort of people with type 2 diabetes, knowledge retention regarding treatment targets was poor. Education programmes should stress awareness of vascular risk factors and diabetes.
    • Predictability of corneal flap thickness in laser in situ keratomileusis using a 200 kHz femtosecond laser.

      Cummings, Arthur B; Cummings, Brendan K; Kelly, Gabrielle E; Wellington Eye Clinic and UPMC Beacon Hospital, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. abc@wellingtoneyeclinic.com (2013-03)
      To compare the intended versus the resultant thickness of laser in situ keratomileusis (LASIK) flaps created with a new femtosecond laser and to report the 3-month postoperative refractive outcomes.
    • Remembering the importance of preventing blood-borne infections in the critical care setting.

      Leonard, Lenora; Timmins, Fiona; Infection Prevention & Control Nurse Specialist, UPMC Beacon Hospital Dublin, Dublin, Ireland. (2013)
    • Stereotactic radiosurgery for the treatment of brain metastases; results from a single institution experience.

      Burke, D; Mascott, C; Rock, L; Callinan, S; Mihai, A; Thirion, P; Armstrong, J G; UPMC Beacon Cancer Centre, UPMC Beacon Hospital, Sandyford, Dublin, 18, Ireland. burkedfb@gmail.com (2013-09)
      Stereotactic radiosurgery is frequently used for the treatment of brain metastases. This study provides a retrospective evaluation of patients with secondary lesions of the brain treated with stereotactic radiosurgery (SRS) at our institution.