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Showing papers by "Connolly Hospital Blanchardstown published in 2020"



Journal ArticleDOI
12 Jun 2020
TL;DR: Variation was observed in both the volume and nature of trauma presentations during the COVID-19 lockdown, and a reduction was seen in the number of injuries resulting from outdoor activities, which could represent an unintended consequence of the prolonged period of lockdown.
Abstract: Aims Europe has found itself at the epicentre of the COVID-19 pandemic. Naturally, this has placed added strain onto healthcare systems internationally. It was feared that the impact of the COVID-1...

31 citations


Journal Article
TL;DR: In this paper, the authors explore whether 25OHD levels might be associated with an increased risk of the development of ARDS due to SARS-CoV-2 infection and hypothesize that nutrition might also play a role.
Abstract: Male gender, age over 40 years, cancer, diabetes mellitus, and chronic respiratory and cardiovascular disease have each been associated with increased severity of disease, including ARDS, after SARS-CoV-2 infection. We hypothesize that nutrition might also play a role. Vitamin D (25OHD) deficiency has previously been linked to a greater susceptibility to viral infection, ARDS, and pneumonia.3,4 Since 25OHD deficiency is both highly prevalent and easily treatable and the morbidity, mortality, and costs of SARS-CoV-2 related ARDS are great, we wanted to explore whether 25OHD levels might be associated with an increased risk of the development of ARDS due to SARS-CoV-2.

27 citations


Posted ContentDOI
12 Jun 2020-medRxiv
TL;DR: This study demonstrates COVID-19 impact on nursing home (NH) residents and staff and a significant correlation between the proportion of staff with symptomatic COvid-19 and resident numbers with confirmed/suspected CO VID-19.
Abstract: Background: SARS-CoV-2 has disproportionately affected nursing home (NH) residents. In Ireland, the first NH case of COVID-19 occurred on 16/03/2020. A national point-prevalence testing program of all NH residents and staff took place from 18/04/2020-05/05/2020. Aims: To examine characteristics of NHs across three Community Health Organisations (CHOs) in Ireland, proportions with COVID-19 outbreaks, staff and resident, symptom-profile and resident case-fatality. Methods: Forty-five NHs surveyed across three CHOs requesting details on occupancy, size, COVID-19 outbreak, timing of outbreak, total symptomatic/asymptomatic cases, and outcomes for residents from 29/02/2020-22/05/2020. Results: Surveys were returned from (62.2%, 28/45) of NHs (2043 residents, 2303 beds). Three-quarters (21/28) had COVID-19 outbreaks (1741 residents, 1972 beds). Median time from first case of COVID-19 in Ireland to first case in these NHs was 27.0 days. Resident COVID-19 incidence was (43.9%, 764/1741): laboratory-confirmed (40.1%, 710/1741) with (27.2%, 193/710 asymptomatic), and clinically-suspected (3.1%, 54/1741). Resident case-fatality was (27.6%, 211/764) for combined laboratory-confirmed/clinically-suspected COVID-19. Similar proportions of residents in NH with an early outbreak (<28days) versus a later outbreak developed confirmed/suspected COVID-19. A lower proportion of residents in NHs with early outbreaks had recovered compared to those with late outbreaks (37.4% vs 61.7%; X2=56.9, p<0.001). Among 675 NH staff across twenty-four sites who had confirmed/suspected COVID-19 (23.6%, 159/675) were asymptomatic. There was a significant correlation between the proportion of staff with symptomatic COVID-19 and resident numbers with confirmed/suspected COVID-19 (Spearmans rho=0.81, p<0.001). Conclusion: This study demonstrates COVID-19 impact on NH residents and staff. High infection rates lead to challenges in care provision.

17 citations


Journal ArticleDOI
TL;DR: This study confirms a steep decline in training opportunities in open cholecystectomy, but also raises concern about a Dunning-Kruger effect as the majority felt "somewhat comfortable" or "very comfortable" in converting to open surgery.

14 citations


Journal ArticleDOI
TL;DR: Prevalence of autoimmune diseases is increased in adult CD patients compared with the general population, however, concomitant autoimmune thyroidal diseases became less common over time in women.
Abstract: BackgroundCoeliac disease (CD) is associated with an increased risk of other immune-mediated conditions.Aim: To investigate the prevalence of coexistent immune-mediated diseases in CD patients, and...

14 citations



Journal ArticleDOI
TL;DR: This work provides a test menu for clinical laboratories to ensure the effective monitoring, management and prognostication of COVID-19 patients in hospital and recommends regular testing with vigilance paid to the rate and trajectory of change in each of these parameters.
Abstract: Coronavirus disease 2019 (COVID-19), is a respiratory illness caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The Clinical Blood Sciences Laboratory (CBSL) plays a key role in supporting the monitoring and management of patients with COVID-19 disease. To provide a comprehensive CBSL testing protocol to support the medical management of SARS-CoV-2 infection. Description of the biochemical, haematological and immunological tests that have a role in the assessment and monitoring of patients with COVID-19 infection. We provide a test menu for clinical laboratories to ensure the effective monitoring, management and prognostication of COVID-19 patients in hospital. Given the rapidity with which patients with COVID-19 disease can deteriorate, we recommend regular testing with vigilance paid to the rate and trajectory of change in each of these parameters.

11 citations


Journal ArticleDOI
TL;DR: Patients reported a significant disease-related impairment of physical function and subsequent deterioration in mental health as a result of hip osteoarthritis, and patients with worse hip function are more willing to proceed with surgery than those with superior hip function.
Abstract: Background:COVID-19 has placed a huge burden on healthcare systems which has led to widespread cancellation elective surgical care. Ireland is recovering from the first wave of COVID-19 and as such...

9 citations


Journal ArticleDOI
TL;DR: The high rate of antimicrobial resistance in patients admitted with urosepsis poses a challenge in prescribing the most appropriate antibiotics, and it is crucial that prescribers follow local antibiotic guidelines for the treatment of u rosepsis and are cognisant of the risk of specific patient groups presenting with u Rosepsis due to MDR organisms.
Abstract: Urosepsis accounts for up to 20–30% of all sepsis cases; however, increasing antimicrobial resistance is posing a significant threat to patient’s outcomes. The aim of this study was to look at the prevalence of multi-drug resistant (MDR) organisms in patients admitted with urosepsis and their effect on the treatment and outcome of patients in our hospital. A total of 2679 urine cultures and 654 blood cultures performed in Connolly Hospital Emergency Department were reviewed between 2016 and 2018. Patients were included if they had a matching urine culture and blood culture performed within 24 h of admission. We compared patient demographics and underlying co-morbidities between patients admitted with urosepsis secondary to MDR organisms and non-MDR organisms. Our study included 85 patients admitted with urosepsis. The most common causative pathogen was Escherichia coli, and 34.1% (n = 29) of pathogens were classified as an MDR organism. Patients admitted with urosepsis from long-term care facilities were 2.3 times more likely to have urosepsis due to a MDR organism compared with patients admitted from the community. Patients admitted with urosepsis secondary to a MDR organism were also more likely to have co-morbidities such as diabetes and dementia. The high rate of antimicrobial resistance in patients admitted with urosepsis poses a challenge in prescribing the most appropriate antibiotics. It is crucial that prescribers follow local antibiotic guidelines for the treatment of urosepsis and are cognisant of the risk of specific patient groups presenting with urosepsis due to MDR organisms.

6 citations


Journal ArticleDOI
TL;DR: Exposure to discrete traumatic perinatal events experienced by women under their care contributes to burnout among midwives and a modest negative linear relationship exists between personal and work-related burnout and increasing age.
Abstract: BACKGROUND Little is known about the prevalence of burnout among Irish midwives and how traumatic perinatal events in work contributes to this. AIMS To establish the prevalence of burnout among midwives in Ireland and whether exposure to traumatic perinatal events in work contributes to this. METHODS A cross-sectional study utilizing a designed questionnaire was carried out in a tertiary-referral maternity hospital involving all clinical midwives (n = 248). Demographic details and frequency of perinatal events deemed traumatic were recorded. The extent of distress was documented on two visual analogues read in combination to reflect the impact of the distressing events. Burnout severity was assessed using the Copenhagen Burnout Inventory. RESULTS The response rate was 55% (n = 137). Mean scores for personal, work-related and patient-related burnout were 56.0, 55.9 and 34.3, respectively. Over 90% of respondents experienced exposure to a traumatic event in work in the previous year, with 58% reporting a frequency of monthly or greater. No significant relationship was demonstrated between frequency of trauma and burnout; however, the extent of distress experienced was positively related to burnout in each domain (R2 = 0.18, 0.15 and 0.09, respectively, P < 0.01). A modest negative linear relationship exists between personal and work-related burnout and increasing age (ρ = -0.25 and -0.27, P < 0.01). A significant difference in work-related burnout score was evident between midwives with less experience and more experienced colleagues (P < 0.01). CONCLUSIONS Burnout is common among midwives. Exposure to discrete traumatic perinatal events experienced by women under their care contributes to this.

Journal ArticleDOI
TL;DR: This study provides a baseline of data regarding the attitudes towards dementia and perceived dementia knowledge for hospital staff in Irish acute hospitals, and can inform educational initiatives that target different hospital staff, in order to increase awareness and knowledge.
Abstract: Little is known about staff’s attitudes in Irish acute hospital settings towards people living with dementia and their perceived dementia knowledge. The aim of this study was to understand the general level of dementia knowledge and attitudes towards dementia in different types of hospital staff, as well as to explore the potential influence of previous dementia training and experience (having a family member with dementia) and the potential moderating effects of personal characteristics. This data was required to plan and deliver general and targeted educational interventions to raise awareness of dementia throughout the acute services. A cross-sectional survey was carried out among a diverse range of hospital staff (n = 1795) in three urban acute general hospitals in Ireland, including doctors, nurses, healthcare attendants, allied professionals, and general support staff. Participants’ perceived dementia knowledge and attitudes were assessed as well as their previous dementia training and experience. To measure participant’s attitude towards dementia, the validated Approaches to Dementia Questionnaire (ADQ) was used. Hospital staff demonstrated positive attitudes towards people living with dementia, and believed they had a fair to moderate understanding of dementia. Both ‘having previous dementia training’ and ‘having a relative living with dementia’ predicted attitude towards dementia and perceived dementia knowledge. Interestingly, certain personal staff characteristics did impact dementia training in predicting attitude towards dementia and perceived dementia knowledge. This study provides a baseline of data regarding the attitudes towards dementia and perceived dementia knowledge for hospital staff in Irish acute hospitals. The results can inform educational initiatives that target different hospital staff, in order to increase awareness and knowledge to improve quality of dementia care in Irish hospitals.

Journal ArticleDOI
19 Apr 2020-BMJ Open
TL;DR: This study provides epidemiological estimates of type 1 diabetes across age groups in Ireland, with the majority of prevalent cases in adults, with a significant positive linear trend for age.
Abstract: Objectives The aim of this study is to estimate the prevalence and incidence of type 1 diabetes in the Irish population using a national pharmacy claims database in the absence of a national diabetes register. Design National, population-based, retrospective, cross-sectional study. Setting Community care with data available through the Health Service Executive Pharmacy Claims Reimbursement Scheme from 2011 to 2016. Participants Individuals with type 1 diabetes were identified by coprescription of insulin and glucometer test strips without any prolonged course (>12 months) of oral hypoglycaemic agents prior to commencing insulin. Those claiming prescriptions for long-acting insulin only, without any prandial insulin, were excluded from the analysis. Incidence was estimated based on the first claim for insulin in 2016, with no insulin use in the preceding 12 months. Main outcome measures Prevalence of type 1 diabetes in children ( 14 years). Results There were 20 081 prevalent cases of type 1 diabetes in 2016. The crude prevalence was 0.42% (95% CI 0.42% to 0.43%). Most prevalent cases (n=17 053, 85%) were in adults with a prevalence of 0.48% (95% CI 0.47% to 0.48%). There were 1527 new cases of type 1 diabetes in 2016, giving an incidence rate of 32 per 100 000 population/year (95% CI 30.5 to 33.7). There was a significant positive linear trend for age, for prevalence (p Conclusions This study provides epidemiological estimates of type 1 diabetes across age groups in Ireland, with the majority of prevalent cases in adults. Establishing a national diabetes register is essential to enable updated epidemiological estimates of diabetes and for planning of services in Ireland.

Journal ArticleDOI
07 Dec 2020
TL;DR: The Exeter V40 cemented femoral stem demonstrates excellent functional outcomes and survival when used in a high volume non-designer centre, and is comparable to those of its serially validated predecessor, the Exeter Universal stem.
Abstract: Aims The Exeter V40 cemented femoral stem was first introduced in 2000. The largest single-centre analysis of this implant to date was published in 2018 by Westerman et al. Excellent results were r...

Journal ArticleDOI
TL;DR: A “drip, ship, retrieve and leave” model enables the treatment of large numbers of patients with large vessel occlusion acute ischaemic stroke with thrombectomy within a national stroke service and system of care which would not otherwise be facilitated.
Abstract: Background and purpose Healthcare systems are challenged to provide access to thrombectomy in acute stroke patients. Either the “drip and ship” or “mothership” models result in increased numbers of patients in the endovascular stroke centre (ESC). We describe our approach for a “drip, ship, retrieve and leave” model repatriating patients immediately or within 24 hours of thrombectomy. Methods We included consecutive patients who underwent thrombectomy from January 2016 to June 2018. Patients from local region primary stroke centres (PSC) are immediately repatriated and those from remote region PSCs are admitted for 24 hours before repatriation. Key parameters recorded included clinical, radiological and timeline data as well as 90-day modified Rankin Scale (mRS). Patients who stayed beyond the intended time period in the ESC were analysed. Results From January 2016 to June 2018, 435 patients were transferred, with 352 patients in the local region group and 83 in the remote region group. The median NIHSS was 16 with a median ASPECTS of 9. Good functional outcome was seen in 47% of patients with a mortality rate of 19%. The local region group that were repatriated at the intended time period had a 90-day mRS 0–2 of 47% compared with 20% of those admitted to the ESC (P=0.006). Mortality rates were 20% and 27% respectively (P=0.377). The remote region group, repatriated at 24 hours9 post-emergency endovascular thrombectomy had 90-day mRS 0–2 of 65% compared with 41% in the group admitted (P=0.042). Mortality rates were 4% and 22% respectively (P=0.007). Conclusion This model enables the treatment of large numbers of patients with large vessel occlusion acute ischaemic stroke with thrombectomy within a national stroke service and system of care which would not otherwise be facilitated.

Journal ArticleDOI
TL;DR: Risk factors for ED attendance after URS include prolonged pre-stent dwell time, stone size ≥ 13 mm, treatment for a positive preoperative urine culture, mid-ureteric stone location and female gender.
Abstract: We sought to determine the rate of emergency department (ED) attendance for complications after ureterorenoscopy (URS) for stone disease and to identify risk factors for ED attendance after URS. An analysis of all patients undergoing URS over 12 months at a single institution was performed. Patient demographics, preoperative and intraoperative variables associated with postoperative complications and subsequent ED attendance were collected. Logistic regression analyses were performed to determine predictors of URS complications presenting to ED. In total, 202 ureteroscopies were performed on 142 patients for urolithiasis. The mean age was 50.73 ± 13.93 and 66% were male. The incidence of re-presentation to ED was 14.8% (n = 30). Patients presented with postoperative pain (n = 10; 4.95%), pyrexia (n = 9; 4.46%), urinary tract infection (UTI) (n = 7, 3.47%), haematuria (n = 3, 1.49%) and urosepsis (n = 1; 0.5%). Significant risk factors for ED attendance included preoperative stent dwell time > 30 days (P = 0.004), recently treated positive preoperative urine culture (P < 0.0001), stone size ≥ 13 mm (P = 0.043), stone location mid-ureter (P = 0.036) and female gender (P = 0.005). The following factors did not predict ED attendance, stent omission, access sheath utilization and operation duration. Risk factors for ED attendance after URS include prolonged pre-stent dwell time, stone size ≥ 13 mm, treatment for a positive preoperative urine culture, mid-ureteric stone location and female gender. Urologists should be aware of these findings to decrease the risk of emergency re-presentation after elective URS surgery.

Journal ArticleDOI
TL;DR: The European Respiratory Society International Congress 2019 as mentioned in this paper focused on the importance of quality control of pulmonary function testing and quality assurance of quality of care for allied respiratory professionals, including respiratory physiologists, respiratory physiotherapists, and respiratory nurses.
Abstract: This article provides an overview of outstanding sessions that were (co)organised by the Allied Respiratory Professionals' Assembly during the European Respiratory Society International Congress 2019 in Madrid, Spain. Session content was mainly targeted at allied respiratory professionals such as respiratory physiologists, respiratory physiotherapists and respiratory nurses, and is summarised in this document. Short take-home messages related to pulmonary function testing highlight the importance of quality control. Furthermore, novel findings regarding the assessment of functional status call attention to bodily factors that can affect functional status. Regarding pulmonary rehabilitation, data were presented about the use of equipment and type of exercise training in COPD and lung cancer. Recent developments in physical activity-related research give insight in enablers of physical activity after hospital admission. The importance of integrated respiratory care was also highlighted, with the occupational therapist, nurse, and nutritional and psychological counsellor playing a pivotal role, which relates directly to research in the field of respiratory nursing that formulates the need for more nursing led-interventions in the future. To conclude, this review provides readers with valuable insight into some of the emerging and future areas affecting clinical practice of allied healthcare professionals.

Journal ArticleDOI
TL;DR: The integrated hip fracture referral pathway, incorporating bypass of the referring hospital, represents a multidisciplinary care pathway for the management of patients with fractured neck of femur and can have potential benefits including improved patient outcomes, allowing the optimal allocation of resources and providing training opportunities.
Abstract: The incidence of hip fractures is expected to increase over the coming years, placing a greater burden on limited resources. A high volume of patients is brought to hospitals that do not have the resources necessary to provide definitive care. Optimal care involves a coordinated and integrated system of trauma care. The hip fracture care pathway introduced between a referring peripheral hospital and our institution represents a coordinated multidisciplinary approach to patient care. To describe and report on the outcomes over an 18-month period of the integrated hip fracture care pathway between referring peripheral hospitals and our institution. A retrospective analysis of the prospectively maintained hip fracture database over an 18-month period. Between March 2017 and September 2018, 86 consecutive patients were referred to our institution through a new referral pathway. Of these, 69 patients came from the Emergency Department of the referring hospital and 17 arrived via bypass. All 86 patients were managed on a specialist orthopaedic ward. The average length of stay was 4.28 days, with maximum of 13 and minimum of 2 days. Over 84% of patients underwent definitive treatment within 48 h of a diagnosed hip fracture. The fragmented approach to the management of trauma patients both in a pre-hospital and hospital care setting is a cause for concern. Our integrated hip fracture referral pathway, incorporating bypass of the referring hospital, represents a multidisciplinary care pathway for the management of patients with fractured neck of femur and can have potential benefits including improved patient outcomes, allowing the optimal allocation of resources and providing training opportunities.

Journal ArticleDOI
30 Jul 2020-Cureus
TL;DR: The case of a 28-year-old woman with meningococcal septicaemia complicated with extensive bilateral upper and lower limb SPG is presented.
Abstract: Symmetrical peripheral gangrene (SPG) is a rare complication of septicaemia and disseminated intravascular coagulation (DIC) characterised by distal ischaemia in two or more extremities without large vessel obstruction. SPG has high mortality and morbidity rates, though consensus guidelines for management have yet to be produced. We herein present the case of a 28-year-old woman with meningococcal septicaemia complicated with extensive bilateral upper and lower limb SPG. We discuss the various management options of SPG. While reported cases are scarce in the literature, early recognition of sepsis and prompt withdrawal of vasoconstrictors in an intensive care setting, combined with timely heparinisation, appear to be the most common management strategy thus far.

Journal ArticleDOI
TL;DR: Real-world data support the effectiveness and safety of vedolizumab in the treatment of IBD and give valuable insight into predictors of treatment outcomes, as well as strengthening the available body of evidence on the use of VDZ.
Abstract: Introduction: Vedolizumab (VDZ) is a monoclonal antibody designed to inhibit α4β7 integrin and result in gut-selective anti-inflammatory activity. Real-world data are important in providing informa...

Journal ArticleDOI
29 Oct 2020
TL;DR: It is anticipated that the qualitative synthesis will provide a deeper understanding of the experiences of ESD which may serve to inform practice as well as assist in the development of new ESD services.
Abstract: Early supported discharge (ESD) facilitates a person with a stroke to be discharged from the acute hospital environment earlier than conventional care to continue their rehabilitation within the home with members of the multi-disciplinary team. A number of quantitative studies have highlighted benefits of ESD including a reduction in the length of inpatient stay, cost savings, as well as reducing long term dependency. This systematic review and qualitative synthesis explores the perspectives and experiences of those involved in ESD including people with stroke, family members, caregivers as well as the healthcare professionals involved in the delivery of the service. A comprehensive literature search will be completed in the following databases CINAHL, PubMed Central, Embase, Medline, PsycINFO, Sage, Academic Search Complete, Directory of Open Access Journals, The Cochrane Library, PsycARTICLES and Scopus. Qualitative or mixed methods studies that include qualitative data on the perspectives and experiences of people with stroke, family members, caregivers and healthcare professionals of an ESD service will be included. Methodological quality will be appraised using the ten-item Critical Appraisal Skills Programme checklist for qualitative research by two independent reviewers with a third reviewer involved should differences of opinion arise. Findings will be synthesised using thematic synthesis. It is anticipated that the qualitative synthesis will provide a deeper understanding of the experiences of ESD which may serve to inform practice as well as assist in the development of new ESD services. PROSPERO registration: CRD42020135197 – 28/04/2020

Journal ArticleDOI
08 Dec 2020
TL;DR: An alarming and repeated trend of early opioid prescribing in the initial acute setting is found and further education of healthcare professionals and patients is urgently required to prevent this group becoming victims of the growing global opioid epidemic.
Abstract: Background:Headaches represent a significant proportion of referrals to any neurology consult service, of which many are migrainous. Regular use of opioids can lead to medication overuse headache i...

Journal Article
P A Boland1, S T Quidwai1, R Mitru1, E McCarthy1, M Aremu1 
TL;DR: Foreign body ingestion is an uncommon cause of sigmoid colon perforation secondary to an ingested chicken bone which may mimic more common surgical presentations such as diverticulitis.
Abstract: Presentation We describe an unusual presentation of sigmoid colon perforation secondary to an ingested chicken bone. Diagnosis The patient presented with a 4 day history of abdominal pain and distension. On examination there were signs of peritonism. Inflammatory markers were raised. Computed tomography revealed a linear density projecting through the wall of the colon. Treatment The patient underwent emergency laparotomy and a Hartmann's procedure. A chicken bone was found to be the causative foreign object. Conclusion Foreign body ingestion is an uncommon cause of sigmoid perforation which may mimic more common surgical presentations such as diverticulitis.

Journal ArticleDOI
TL;DR: A large number of patients with suspected or confirmed cases of sepsis in the Republic of Ireland have had no prior history of septicaemia, suggesting that the condition may be untreatable.
Abstract: Background: Sepsis is a life-threatening illness that requires early recognition and treatment. In Ireland, mortality, while improving, remains at 17% for adults and in a range of 2–4% in children ...

Journal ArticleDOI
01 Aug 2020-BMJ Open
TL;DR: The prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department (ED) patients with acute bacterial skin and skin structure infections (ABSSSIs) are determined and the predictors are identified worthy of future investigation.
Abstract: Objective To determine the prevalence and predictors of oral to intravenous antibiotic switch among adult emergency department (ED) patients with acute bacterial skin and skin structure infections (ABSSSIs). Design Multicentre, pilot cohort study. Setting Three urban EDs in Dublin, Ireland. Participants Consecutive ED patients aged >16 years old with ABSSSIs between March 2015 and September 2016. Intervention Oral flucloxacillin 500 mg–1 g four times a day (alternative in penicillin allergy). Primary and secondary outcome measures The primary outcome was to determine the prevalence and predictors of oral to intravenous antibiotic switch. Secondary outcomes were to determine the prevalence and predictors of receiving an extended course of oral antibiotic treatment and measurement of interobserver reliability for clinical predictors at enrolment. Results Overall, 159 patients were enrolled of which eight were lost to follow-up and five were excluded. The majority of patients were male (65.1%) and Conclusion The prevalence of oral to intravenous antibiotic switch in this pilot study is 8.9% (95% CI 4.8% to 14.7%). We identify the predictors of oral to intravenous switch worthy of future investigation. Trial registration number NCT02230813.