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.

Early repatriation post-thrombectomy: a model of care which maximises the capacity of a stroke network to treat patients with large vessel ischaemic stroke.

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.

The effect of inclement weather on ankle fracture management in an Irish trauma unit

Abstract: Ireland is unfamiliar with extreme weather conditions. Such conditions occurred in winter 2009–2010 and 2010–2011, with much of the country being affected by snow and ice. We reviewed the effect that these conditions had on the treatment of ankle fractures in our trauma unit. The study period was from November until February for four consecutive years from 2008–2009 until 2011–2012. We compared two winters with extreme weather with two winters with regular weather conditions. Information from Met Eireann was compared with demographics from patient records to differentiate ice-related injuries from non-ice-related injuries. Ankle fractures were classified using the Lauge-Hansen classification. We compared waiting times in A&E, waiting times for theatre, delays relating to injury severity, and overall length of stay for both groups. We identified 44 ice-related injuries and 67 non-ice-related injuries. Ice-related injuries trended towards more severe fracture configurations using the Lauge-Hansen classification. Patients sustaining ankle injuries during inclement weather were significantly younger than patients sustaining injuries during regular weather conditions. There were no other significant differences between the two groups. Ice-related injuries trended towards a greater severity of fracture configuration. We identified no significant increase in the time to treatment or overall length of stay of patients sustaining ankle fractures during these times. Ice-related injuries did not have greater rates of complications. These results are a testament to the trauma staff in this unit who absorbed the increased workload without compromising patient care.

Point of Care Echocardiography in an Irish Critical Care Unit

Abstract: Aims We sought to evaluate the clinical impact of a 6 month transthoracic echocardiography (TTE) teaching programme in a critical care unit. Methods An observational single centre study. Four critical care doctors, 2 fellows and 2 consultants were trained to use TTE. The study was conducted over 2 six month study periods; period 1 before echocardiography training and period 2 following echocardiography training. Results An increased number of TTE examinations were performed following echocardiography training, 47 TTE studies during period 1 and 144 TTE studies during period 2. The commonest indications for TTE examination were assessment of ventricular function, wall motion abnormalities and cardiac tamponade. The percentage of TTE studies leading to a change in clinical management were similar during both periods, 30% period 1 and 34% period 2. During period 2 the majority of TTE’s leading to management change were performed by critical care doctors who frequently manipulated vasoactive medications and administered fluid therapy. Conclusions A 6 month echocardiography training programme led to an increase number of TTE studies independently performed by critical care doctors with resultant clinical impact in one third of cases.

Spurious HbA1c results in patients with diabetes treated with dapsone

Abstract: Measurement of glycated haemoglobin (HbA1c) has been utilised in assessing long-term control of blood glucose in patients with diabetes, as well as diagnosing diabetes and identifying patients at increased risk of developing diabetes in the future. HbA1c reflects the level of blood glucose to which the erythrocyte has been exposed during its lifespan, and there are a number of clinical situations affecting the erythrocyte life span in which HbA1c values may be spuriously high or low and therefore not reflective of the true level of glucose control. In the present case series, we describe the particulars of three patients with diabetes who had spuriously low HbA1c levels as a result of dapsone usage. Furthermore, we discuss the limitations of HbA1c testing and the mechanisms by which it may be affected by dapsone in particular. Learning points: Various conditions and medications can result in falsely low HbA1c. Dapsone can lead to falsely low HbA1c by inducing haemolysis and by forming methaemoglobin. Capillary glucose measurement, urine glucose measurements and fructosamine levels should be used as alternatives to HbA1c for monitoring glycaemic control if it was falsely low or high. Patient Demographics: Adult, Female, Male, Other, Ireland Clinical Overview: Pancreas, Diabetes, Insulin, Diabetes mellitus type 1, Diabetes mellitus type 2, Anaemia, Haemolysis*, Methemoglobinemia*, Dermatitis herpetiformis*, Coeliac disease*, Hyperglycaemia, Hypoglycaemia, Urticarial rash*, Granuloma Diagnosis and Treatment: Diabetes mellitus type 1, Diabetes mellitus type 2, Haemolysis*, Methemoglobinemia*, Coeliac disease, Dermatitis herpetiformis*, Polydipsia, Polyuria, Weight loss, Hypoglycaemia, Hyperglycaemia, Rash, Anaemia, Haemoglobin A1c, Fructosamine*, Glucose (blood), GADA, Methaemoglobin*, Haptoglobin*, Mean corpuscular volume*, Haemoglobin , Bilirubin, Reticulocyte count*, Lactate dehydrogenase, Antibiotics, Dapsone*, Metformin, Gliclazide, Sulphonylureas, Dapagliflozin, SGLT2 inhibitors, Insulin Publication Details: Unusual effects of medical treatment, September, 2019 Background HbA1c reflects the level of blood glucose to which the erythrocyte has been exposed during its lifespan, and there are a number of clinical situations affecting the erythrocyte life span in which HbA1c values may be spuriously high or low and therefore not reflective of the true level of glucose control. In the present case series, we describe the particulars of three patients with diabetes who had spuriously low HbA1c levels as a result of dapsone usage. Furthermore, we discuss the limitations of HbA1c testing and the mechanisms by which it may be affected by dapsone in particular.