Connolly Hospital Blanchardstown

About: Connolly Hospital Blanchardstown is a healthcare organization based out in Dublin, Ireland. It is known for research contribution in the topics: Population & Ambulatory blood pressure. The organization has 302 authors who have published 213 publications receiving 3858 citations. The organization is also known as: James Connolly Memorial Hospital.

Is the Irish bedside best

Abstract: The use of the bedside to teach the art of clinical medicine is controversial. Rising student numbers can limit patient availability. Studies examining inpatient attitudes to bedside teaching are few. We examined inpatients’ attitudes to bedside teaching of undergraduate medical students. The study was carried out in a 439-bed teaching hospital. A questionnaire, numerically scored (0–10), was prospectively administered to 102 consecutive patients involved in bedside teaching of undergraduate medical students. The results were available from 92 patients. Patients enjoyed the teaching process (mean score 9.13 ± 1.16) and benefited from a better understanding of their illness (7.11 ± 2.57). Patients appreciated their role in educating future doctors (mean score 9.52 ± 1.11) but demonstrated less confidence in their personal contribution to the teaching process (7.81 ± 1.89). Inpatients are very willing participants in bedside teaching of undergraduate medical students.

How should ambulatory blood pressure measurement be used in general practice

Abstract: Current guidelines on hypertension now accept that ambulatory blood pressure (BP) measurement (ABPM) is the measurement method of choice for diagnosing hypertension. The technique has been shown to be more accurate and more cost effective than office BP (OBPM) or selfmeasurement of BP (SBPM). The diagnostic superiority of ABPM derives mainly from the ability of the technique to identify sustained hypertension by allowing for the exclusion of whitecoat hypertension and by demonstrating the presence of masked hypertension. ABPM also offers diagnostic insights into nocturnal patterns of BP, and, despite less attention being given to nighttime BP in clinical practice, the increased risk of stroke with elevated nocturnal BP makes it important to assess the response to BPlowering medication during sleep. Surprisingly, although current guidelines give detailed recommendations on the diagnostic potential and use of ABPM, there are scant recommendations on the benefits and application of the technique for the initiation of BPlowering therapy in clinical practice and virtually no recommendations as to how it might be used to assess the efficacy of drug treatment and guide the prescribing physician on the most appropriate drug administration and dosage over time. Furthermore, the limited availability of ABPM to date has confined its use to the diagnosis of hypertension, rather than applying the technique to gauging more reliably the response to treatment, especially in patients at high risk, who may be taking a number of BPlowering drugs. The increasing approval of ABPM for reimbursement in many countries is an overdue and welcome initiative, which, although incurring substantial initial shortterm costs, will lead to improved BP control in the longer term and substantial savings in the prevention of the cardiovascular (CV) consequences of hypertension, most especially the prevention of stroke. However, we are now faced with a responsibility to use ABPM to achieve the maximum benefit, without applying the technique excessively. 2 | ABPM FOR THE DIAGNOSIS OF HYPERTENSION

A national house-staff audit of medical prophylaxis in medical patients for the PREVENTion of Venous ThromboEmbolism (PREVENT-VTE)

Abstract: We established a national audit to assess the thromboprophylaxis rate for venous thromoembolism (VTE) in at risk medical patients in acute hospitals in the Republic of Ireland and to determine whether the use of stickers to alert physicians regarding thromboprophylaxis would double the rate prophylaxis in a follow-up audit. 651 acute medical admission patients in the first audit and 524 in the second re-audit were recruited. The mean age was 66.5 yrs with similar numbers of male and female patients and 265 (22.6%) patients were active smokers. The first and second audits identified 549 (84%) and 487 (93%) of patients at-risk for VTE respectively. Of the at-risk patients, 163 (29.7%) and 132 (27.1%) received LMWH in the first and second audit respectively. Mechanical thromboprophylaxis was instigated in 75 (13.6%) patients in the first and 86 (17.7%) patients in the second audit. The placement of stickers in patient charts didn't produce a significant increase in the number of at risk patients treated in the second audit. There is unacceptably low adherence to the ACCP guidelines in Ireland and more complex intervention than chart reminders are required to improve compliance.

Gastropleural fistula: a complication of esophageal self-expanding metallic stent migration.

Abstract: phagia secondary to squamous cell carci− noma of the esophagus. A self−expanding metallic stent (SEMS) was inserted for symptomatic relief (l\" Fig. 1) and neoad− juvant chemoradiotherapy was com− menced. Treatment was suspended after only one cycle as the patient developed necrotizing fasciitis of her right buttock and thigh following an intramuscular in− jection. She declined further neoadjuvant therapy or surgery. Endoscopy and computed tomography (l\" Fig. 2) at 6 months showed a complete luminal response and distal migration of the SEMS into the stomach. Multiple at− tempts to remove the SEMS endoscopical− ly failed and open retrieval was planned. Before this could be undertaken, the pa− tient presented with epigastric and left− sided chest pain, dyspnea, and sepsis. Plain chest radiographs demonstrated a large, multiloculated left pleural effusion. The SEMS was visible lying vertically within the stomach (l\" Fig. 3). The patient deteriorated rapidly, developing multior− gan failure, and died. Autopsy confirmed that death was due to sepsis secondary to a left−sided empyema due to perforation of the fundus of the stomach and dia− phragm by the SEMS, forming a gastro− pleural fistula. There was no residual car− cinoma and there were no metastases. Gastropleural fistula following placement of a SEMS has not been previously de− scribed. SEMS migration is common, how− ever, and may occur following down−stag− ing of esophageal carcinoma with che− moradiotherapy [1]. Management of SEMS migration by endoscopic reinter− vention is effective [2] but, as in our case, not always possible. A conservative ap− proach is also widely reported, and mig− rated stents may remain in the stomach or pass spontaneously per rectum without complication [3]. Our patient had a complete pathological response to half the prescribed dose of chemoradiotherapy and thus had a good prognosis [4], but died as a result of a complication of a SEMS. We advocate ear− ly removal of migrated SEMS, especially in patients with a longer life expectancy. Endoscopy_UCTN_Code_CPL_1AH_2AD

Differences in expression of virulence genes amongst invasive and colonizing isolates of meticillin-resistant Staphylococcus aureus

Abstract: The prevalence of meticillin-resistant Staphylococcus aureus (MRSA) is an important global concern in healthcare due to potentially life-threatening infections and difficulties in treatment. The organism can colonize the mucosa, e.g. anterior nares, or cause invasive infections, e.g. bloodstream infections, through the coordinated expression of extracellular and cell-bound virulence factors (Goerke et al., 2000; Novick et al., 1993). The transcription profiles of virulence genes vary in vivo depending on the dynamic interaction between the host environment and the pathogen. Since the dynamic environment may be differentially altered in MRSA carriage compared to infection, the expression of S. aureus virulence genes may also vary. We previously found no significant correlation between the presence of 17 virulence genes and invasiveness of MRSA isolates (O’Donnell et al., 2008) and this nonassociation of specific genes or combinations of genes with invasive isolates is in agreement with other larger studies (Lindsay et al., 2006). The lack of a definitive correlation between invasive S. aureus strains and the carriage of virulence genes suggests that the expression, rather than carriage of virulence determinants in vivo, may mediate pathogenicity.