• Urethral stricture secondary to self-instrumentation due to delusional parasitosis: a case report

      Ismail, Muhammad F; Cassidy, Eugene M (2015-09-15)
      Abstract Introduction Delusional parasitosis is a rare psychiatric disorder which often presents with dermatological problems. Delusional parasitosis, which involves urethral self-instrumentation and foreign body insertion, is exceptionally rare. This is the first case report to date that provides a detailed presentation of the urological manifestation of delusional parasitosis with complications associated with repeated self-instrumentation and foreign body insertion, resulting in stricture formation and requiring perineal urethrostomy. Case presentation A 45-year-old Irish man was electively admitted for perineal urethrostomy with chronic symptoms of dysuria, haematuria, urethral discharge, and intermittent urinary retention. He reported a 4-year history of intermittent pain, pin-prick biting sensations, and burrowing sensations, and held the belief that his urethra was infested with ticks. He also reported a 2-year history of daily self-instrumentation, mainly injecting an antiseptic using a syringe in an attempt to eliminate the ticks. He was found to have urethral strictures secondary to repeated self-instrumentation. A foreign body was found in his urethra and was removed via cystoscopy. On psychiatric assessment, he displayed a fixed delusion of tick infestation and threatened to surgically remove the tick himself if no intervention was performed. The surgery was postponed due his mental state and he was started on risperidone; he was later transferred to an acute in-patient psychiatric unit. Following a 3-week admission, he reported improvement in his thoughts and distress. Conclusions Delusional parasitosis is a rare psychiatric disorder. Self-inflicted urethral foreign bodies in males are rare and have high comorbidity with psychiatric disorders; hence, these patients have a low threshold for referral for psychiatric assessment. The mainstay treatment for delusional parasitosis is second-generation antipsychotic drugs.
    • The use of a chaperone in obstetrical and gynaecological practice.

      Afaneh, I; Sharma, V; McVey, R; Murphy, C; Geary, M; The Rotunda Hospital, Parnell Square, Dublin 1. iyadafaneh@physicians.ie (2010-05)
      The aim of this study was to assess the use of a chaperone in obstetrical and gynaecological practice in Ireland and to explore patients' opinions. Two questionnaires were designed; one for patients and the other one was sent to 145 gynaecologists in Ireland. One hundred and fifty two women took part in this survey of whom 74 were gynaecological and 78 were obstetric patients. Ninety five (65%) patients felt no need for a chaperone during a vaginal examination (VE) by a male doctor. On the other hand 34 (23%) participating women would request a chaperone if being examined by a female doctor. Among clinicians 116 (80%) responded by returning the questionnaire. Overall 60 (52%) always used a chaperone in public practice, in contrast to 24 (27%) in private practice. The study demonstrated that most patients do not wish to have a chaperone during a VE but a small proportion would still request one regardless of the examiner's gender. Patients should be offered the choice of having a chaperone and their opinion should be respected and documented.
    • Use of a highly-sensitive cardiac troponin I assay in a screening population for hypertrophic cardiomyopathy: a case-referent study

      McGorrian, Catherine M; Lyster, Sarah; Roy, Andrew; Tarrant, Heloise; Codd, Mary; Doran, Peter; Fitzgibbon, Maria; Galvin, Joseph; Mahon, Niall G (2013-09-11)
      Abstract Background Hypertrophic cardiomyopathy (HCM) is a genetic condition, and relatives of affected persons may be at risk. Cardiac troponin biomarkers have previously been shown to be elevated in HCM. This study examines the new highly-sensitive cardiac troponin I (hsTnI) assay in a HCM screening population. Methods Nested case–control study of consecutive HCM sufferers and their relatives recruited from May 2010 to September 2011. After informed consent, participants provided venous blood samples and clinical and echocardiographic features were recorded. Associations between the natural log (ln) of the contemporary troponin I (cTnI) and hsTnI assays and markers of cardiac hypertrophy were examined. Multiple regression models were fitted to examine the predictive ability of hsTnI for borderline or definite HCM. Results Of 107 patients, 24 had borderline and 19 had definite changes of HCM. Both TnI assays showed significant, positive correlations with measures of cardiac muscle mass. After age and sex adjustment, the area under the receiver operator characteristic (AUROC) curve for the outcome of HCM was 0.78, 95% CI [0.65, 0.90], for ln(hsTnI), and 0.66, 95% CI [0.51, 0.82], for ln(cTnI) (p=0.11). Including the hsTnI assay in a multiple-adjusted “screening” model for HCM resulted in a non-significant improvement in both the AUROC and integrated discrimination index. Conclusions Both cTnI and hsTnI show a graded, positive association with measures of cardiac muscle mass in persons at risk of HCM. Further studies will be required to evaluate the utility of these assays in ECG- and symptom-based identification of HCM in at-risk families.
    • Use of analgesics in intentional drug overdose presentations to hospital before and after the withdrawal of distalgesic from the Irish market

      Corcoran, Paul; Reulbach, Udo; Keeley, Helen S; Perry, Ivan J; Hawton, Keith; Arensman, Ella (2010-03-18)
      Abstract Background Distalgesic, the prescription-only analgesic compound of paracetamol (325 mg) and dextropropoxyphene (32.5 mg) known as co-proxamol in the UK, was withdrawn from the Irish market as of January 2006. This study aimed to evaluate the impact of the withdrawal of distalgesic in terms of intentional drug overdose (IDO) presentations to hospital emergency departments (EDs) nationally. Methods A total of 42,849 IDO presentations to 37 of the 40 hospitals EDs operating in Ireland in 2003-2008 were recorded according to standardised procedures. Data on sales of paracetamol-containing drugs to retail pharmacies for the period 1998-2008 were obtained from IMS Health. Results The withdrawal of distalgesic from the Irish market resulted in an immediate reduction in sales to retail pharmacies from 40 million tablets in 2005 to 500,000 tablets in 2006 while there was a 48% increase in sales of other prescription compound analgesics. The rate of IDO presentations to hospital involving distalgesic in 2006-2008 was 84% lower than in the three years before it was withdrawn (10.0 per 100,000). There was a 44% increase in the rate of IDO presentations involving other prescription compound analgesics but the magnitude of this rate increase was five times smaller than the magnitude of the decrease in distalgesic-related IDO presentations. There was a decreasing trend in the rate of presentations involving any paracetamol-containing drug that began in the years before the distalgesic withdrawal. Conclusions The withdrawal of distalgesic has had positive benefits in terms of IDO presentations to hospital in Ireland and provides evidence supporting the restriction of availability of means as a prevention strategy for suicidal behaviour.
    • Use of autologous bone graft in anterior cervical decompression: morbidity & quality of life analysis.

      Heneghan, Helen M; McCabe, John P; Department of Surgery, Clinical Science Institute, National University of Ireland Galway, Galway, Ireland. helenheneghan@hotmail.com (2009)
      BACKGROUND: Autologous iliac crest graft has long been the gold standard graft material used in cervical fusion. However its harvest has significant associated morbidity, including protracted postoperative pain scores at the harvest site. Thus its continued practice warrants scrutiny, particularly now that alternatives are available. Our aims were to assess incidence and nature of complications associated with iliac crest harvest when performed in the setting of Anterior Cervical Decompression (ACD). Also, to perform a comparative analysis of patient satisfaction and quality of life scores after ACD surgeries, when performed with and without iliac graft harvest. METHODS: All patients who underwent consecutive ACD procedures, with and without the use of autologous iliac crest graft, over a 48 month period were included (n = 53). Patients were assessed clinically at a minimum of 12 months postoperatively and administered 2 validated quality of life questionnaires: the SF-36 and Cervical Spine Outcomes Questionnaires (Response rate 96%). Primary composite endpoints included incidence of bone graft donor site morbidity, pain scores, operative duration, and quality of life scores. RESULTS: Patients who underwent iliac graft harvest experienced significant peri-operative donor site specific morbidity, including a high incidence of pain at the iliac crest (90%), iliac wound infection (7%), a jejunal perforation, and longer operative duration (285 minutes vs. 238 minutes, p = 0.026). Longer term follow-up demonstrated protracted postoperative pain at the harvest site and significantly lower mental health scores on both quality of life instruments, for those patients who underwent autologous graft harvest CONCLUSION: ACD with iliac crest graft harvest is associated with significant iliac crest donor site morbidity and lower quality of life at greater than 12 months post operatively. This is now avoidable by using alternatives to autologous bone without compromising clinical or technical outcome.
    • The use of complementary and alternative medicine by patients with diabetes mellitus in Bahrain: a cross-sectional study.

      Khalaf, Abeer J; Whitford, David L; Department of Family & Community Medicine, Royal College of Surgeons in Ireland - Medical University of Bahrain, PO Box 15503, Busaiteen, Kingdom of Bahrain. dwhitford@rcsi-mub.com (2010)
      CAM use is widespread, especially among patients with diabetes. The Gulf States have a high prevalence of diabetes, alongside a long tradition of CAM use. The aim of this study is to establish the prevalence of CAM use among patients with diabetes mellitus in Bahrain and to examine the characteristics of the CAM users.
    • The use of complementary and alternative medicine in an Irish cohort of people with an iatrogenic hepatitis C infection: Results from a health and lifestyle survey

      Coughlan, Barbara M.; Thornton, Lelia M.; Murphy, Niamh; Tait, Michele A.; Flanagan, Paula C.; Kenny-Walsh, Elizabeth E.; O’Lorcain, Piaras P.; UCD School Of Nursing, Midwifery and Health Systems, University College Dublin (Complementary Therapies in Medicine, 2014-06)
    • The use of modified diets by adults with temporomandibular disorders: systematic review and meta-analysis

      Gilheaney, Órla; Kerr, Patrick; Walshe, Margaret (Irish Dental Association, 2018-10)
    • Use of traditional Chinese medicine in Singapore children: perceptions of parents and paediatricians.

      Loh, C H; Medical School, Brookfield Health Sciences Complex, University College Cork, College Road, Cork, Ireland. seanchloh@gmail.com (2009-12)
      INTRODUCTION: In a country dominated by western healthcare, interest in traditional Chinese medicine (TCM) is growing. The increasing popularity of TCM, occasionally used with conventional medicine, needs to be assessed, especially in a vulnerable paediatric population. This paper sought to evaluate the use of TCM in children, mainly to determine the common conditions they seek TCM, the pattern of acupuncture or herbal usage for various age groups, the extent of concurrent usage of TCM and conventional medicine, and the reasons for TCM use. Paediatricians' perceptions of TCM will allow us to gauge the acceptability of TCM by those who practise conventional medicine. These are assessed in another arm of this study, with a set of predictive characteristics for their personal TCM use, their perceptions of herb/acupuncture safety, and their own referral to TCM eventually determined. METHODS: An anonymous questionnaire was administered on 300 parents awaiting consultation at a large TCM clinic. Next, a separate qualitative questionnaire survey form was posted to 100 paediatricians. RESULTS: Herb usage in children is very common (84.3 percent) and 80 percent of parents admitted concurrent usage of TCM and conventional medicine for their children. Drug-herb interactions was an issue of concern for paediatricians. Paediatricians with a higher level of self-reported TCM knowledge were more likely to refer for a cure. CONCLUSION: This was the first study to determine the characteristics of children attending a large TCM clinic in a country which is dominated by western healthcare. It also provided insight into the perceptions of TCM among paediatricians in Singapore. Specifically, it gave us an idea of the predictor traits that determine their referral patterns to TCM and their perceptions of herb and acupuncture safety.
    • The usefulness of budgets in the healthcare sector

      Byrne, Michael; Health Service Executive (HSE) West Roscommon PCCC (2007)
    • Using case study within a sequential explanatory design to evaluate the impact of specialist and advanced practice roles on clinical outcomes: the SCAPE study

      Lalor, Joan G; Casey, Dympna; Elliott, Naomi; Coyne, Imelda; Comiskey, Catherine; Higgins, Agnes; Murphy, Kathy; Devane, Declan; Begley, Cecily (2013-04-08)
      Abstract Background The role of the clinical nurse/midwife specialist and advanced nurse/midwife practitioner is complex not least because of the diversity in how the roles are operationalised across health settings and within multidisciplinary teams.This aim of this paper is to use The SCAPE Study: Specialist Clinical and Advanced Practitioner Evaluation in Ireland to illustrate how case study was used to strengthen a Sequential Explanatory Design. Methods In Phase 1, clinicians identified indicators of specialist and advanced practice which were then used to guide the instrumental case study design which formed the second phase of the larger study. Phase 2 used matched case studies to evaluate the effectiveness of specialist and advanced practitioners on clinical outcomes for service users. Data were collected through observation, documentary analysis, and interviews. Observations were made of 23 Clinical Specialists or Advanced Practitioners, and 23 matched clinicians in similar matched non-postholding sites, while they delivered care. Forty-one service users, 41 clinicians, and 23 Directors of Nursing or Midwifery were interviewed, and 279 service users completed a survey based on the components of CS and AP practice identified in Phase 1. A coding framework, and the generation of cross tabulation matrices in NVivo, was used to make explicit how the outcome measures were confirmed and validated from multiple sources. This strengthened the potential to examine single cases that seemed ‘different’, and allowed for cases to be redefined. Phase 3 involved interviews with policy-makers to set the findings in context. Results Case study is a powerful research strategy to use within sequential explanatory mixed method designs, and adds completeness to the exploration of complex issues in clinical practice. The design is flexible, allowing the use of multiple data collection methods from both qualitative and quantitative paradigms. Conclusions Multiple approaches to data collection are needed to evaluate the impact of complex roles and interventions in health care outcomes and service delivery. Case study design is an appropriate methodology to use when study outcomes relate to clinical practice.
    • Using Co-Design to Develop a Collective Leadership Intervention for Healthcare Teams to Improve Safety Culture.

      Ward, Marie E; De Brún, Aoife; Beirne, Deirdre; Conway, Clare; Cunningham, Una; English, Alan; Fitzsimons, John; Furlong, Eileen; Kane, Yvonne; Kelly, Alan; et al. (MDPI, 2018-06-05)
      While co-design methods are becoming more popular in healthcare; there is a gap within the peer-reviewed literature on
    • Using electronic mail to improve MMR uptake amongst third level students.

      Cooney, F; Ryan, A; Schinaia, N; Breslin, A; Department of Public Health Medicine, HSE West, Donegal/Sligo/Leitrim Area, Bridgewater House, Rockwood Parade, Sligo. fionnuala.cooney@hse.ie (2010-03)
      This study assessed the usefulness of email in informing third level students about special MMR clinics being provided on campus during a mumps outbreak in the North West of Ireland. Email messages were sent directly to students, informing them of the clinics, inviting them to make a clinic appointment by email and providing details of walk-in clinics. At the clinics, all 177 attendees were asked to fill out a questionnaire and the response rate was 89% (n=158). Regarding the main sources of information about the vaccination clinics, email was selected by 117 (74%) students, word-of-mouth by 27 (17%), posters/leaflets by 8 (5%), and other sources by 6 (4%). Use of email as a source of information was rated as very good/excellent by 115 (73%), as good by 35 (22%) and poor/fair by 8 (5%). This study demonstrates that email is a useful and acceptable way of informing third level students about immunisation clinics in an outbreak situation.
    • Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain.

      Toomey, Elaine; Matthews, James; Hurley, Deirdre A (BMJ open, 2017-08-04)
      Despite an increasing awareness of the importance of fidelity of delivery within complex behaviour change interventions, it is often poorly assessed. This mixed methods study aimed to establish the fidelity of delivery of a complex self-management intervention and explore the reasons for these findings using a convergent/triangulation design.
    • Using PM2.5 concentrations to estimate the health burden from solid fuel combustion, with application to Irish and Scottish homes

      Galea, Karen S; Hurley, J F; Cowie, Hilary; Shafrir, Amy L; Sánchez Jiménez, Araceli; Semple, Sean; Ayres, Jon G; Coggins, Marie (2013-06-19)
      Abstract Background This study estimates the potential population health burden from exposure to combustion-derived particulate air pollution in domestic settings in Ireland and Scotland. Methods The study focused on solid fuel combustion used for heating and the use of gas for cooking. PM2.5 (particulate matter with an aerodynamic diameter < 2.5 μm) was used as the pollutant mixture indicator. Measured PM2.5 concentrations in homes using solid fuels were adjusted for other sources of PM2.5 by subtracting PM2.5 concentrations in homes using gas for cooking but not solid fuel heating. Health burden was estimated for exposure indoors 6 pm - midnight, or all day (24-hour), by combining estimated attributable annual PM2.5 exposures with (i) selected epidemiological functions linking PM2.5 with mortality and morbidity (involving some re-scaling from PM10 to PM2.5, and adjustments ‘translating’ from concentrations to exposures) and (ii) on the current population exposed and background rates of morbidity and mortality. Results PM2.5 concentrations in coal and wood burning homes were similar to homes using gas for cooking, used here as a baseline (mean 24-hr PM2.5 concentrations 8.6 μg/m3) and so health impacts were not calculated. Concentrations of PM2.5 in homes using peat were higher (24-hr mean 15.6 μg/m3); however, health impacts were calculated for the exposed population in Ireland only; the proportion exposed in Scotland was very small. The assessment for winter evening exposure (estimated annual average increase of 2.11 μg/m3 over baseline) estimated 21 additional annual cases of all-cause mortality, 55 of chronic bronchitis, and 30,100 and 38,000 annual lower respiratory symptom days (including cough) and restricted activity days respectively. Conclusion New methods for estimating the potential health burden of combustion-generated pollution from solid fuels in Irish and Scottish homes are provided. The methodology involves several approximations and uncertainties but is consistent with a wider movement towards quantifying risks in PM2.5 irrespective of source. Results show an effect of indoor smoke from using peat (but not wood or coal) for heating and cooking; but they do not suggest that this is a major public health issue.
    • Using postal questionnaires to evaluate physical activity and diet behaviour change: case study exploring implications of valid responder characteristics in interpreting intervention outcomes

      Cole, Judith A; Gillespie, Paddy; Smith, Susan M; Byrne, Molly; Murphy, Andrew W; Cupples, Margaret E (2014-10-15)
      Abstract Background Patient reported outcome measures (PROMs) are used to evaluate lifestyle interventions but little is known about differences between patients returning valid and invalid responses, or of potential for bias in evaluations. We aimed to examine the characteristics of patients who returned valid responses to lifestyle questionnaires compared to those whose responses were invalid for evaluating lifestyle change. Methods We conducted a secondary data analysis from the SPHERE Study, a trial of an intervention to improve outcomes for patients with coronary heart disease in primary care. Postal questionnaires were used to assess physical activity (Godin) and diet (DINE) among study participants at baseline and 18 month follow-up. Three binary response variables were generated for analysis: (1) valid Godin score; (2) valid DINE Fibre score; and (3) valid DINE Total Fat score. Multivariate analysis comprised generalised estimating equation regression to examine the association of patients’ characteristics with their return of valid responses at both timepoints. Results Overall, 92.1% of participants (832/903) returned questionnaires at both baseline and 18 months. Relatively fewer valid Godin scores were returned by those who left school aged <15 years (36.5%) than aged 18 and over (50.5%), manual workers (39.5%) than non-manual (49.5%) and those with an elevated cholesterol (>5 mmol) (34.7%) than those with a lower cholesterol (44.4%) but multivariate analysis identified that only school leaving age (p = 0.047) was of statistical significance.Relatively fewer valid DINE scores were returned by manual than non-manual workers (fibre: 80.8% v 86.8%; fat: 71.2% v 80.0%), smokers (fibre: 72.6% v 84.7%; fat: 67.5% v 76.9%), patients with diabetes (fibre: 75.9% v 82.9%; fat: 66.9% v 75.8%) and those with cholesterol >5 mmol (fat: 68.2% v 76.2%) but multivariate analysis showed statistical significance only for smoking (fibre: p = 0.013; fat: p = 0.045), diabetes (fibre: p = 0.039; fat: p = 0.047), and cholesterol (fat: p = 0.039). Conclusions Our findings illustrate the importance of detailed reporting of research methods, with clear information about response rates, respondents and valid outcome data. Outcome measures which are relevant to a study population should be chosen carefully. The impact of methods of outcome measurement and valid response rates in evaluating healthcare requires further study.