• Jehovah's Witness patients presenting with ruptured ectopic pregnancies: two case reports

      Murphy, Niamh C; Hayes, Niamh E; Ní Ainle, Fionnuala B; Flood, Karen M (2014-09-19)
      Abstract Introduction The management of emergencies in Jehovah’s Witnesses presents several challenges to obstetricians and gynaecologists. We present two cases of ectopic pregnancies in Jehovah’s Witnesses recently managed in our institution. This is the first case review series of its kind that we could identify. We feel it is of clinical importance for all physicians caring for Jehovah’s Witnesses. Case presentation The first patient was a 28-year-old Caucasian Irish woman who presented in a state of collapse and a ruptured ectopic pregnancy was suspected. She refused treatment and took her own discharge against the advice of senior hospital staff. She re-presented to our Emergency Room 6 hours later in hypovolaemic shock. She ultimately consented to blood products including plasma and platelets and underwent laparoscopic left-sided salpingectomy. This consent was queried postoperatively by her next-of-kin but the validity of her consent was clarified by the hospital legal team.The second patient was a 35-year-old Nigerian woman who presented to our Emergency Room with a 2-week history of intermittent vaginal bleeding and abdominal pain with a haemoglobin of 5.4g/dL. An ectopic pregnancy was diagnosed following assessment. She refused all blood products and underwent right-sided salpingectomy. Intravenous tranexamic acid was administered and cell salvage employed intraoperatively. Conclusions We feel that this case review series emphasises the importance of appropriate management of Jehovah’s Witnesses in our units. In both of the above cases, these women were in potentially life-threatening situations. Advances in haematology and pharmaceutical therapy contributed to their survival. We welcome these advances in the treatment of this patient population.
    • The journey through death and dying: families' experiences of end-of-life care in private nursing homes

      Duffy, Mel; Courtney, Eileen; Dublin City University (Dublin City University (DCU), 2014-06)
    • Just Caring: Equality & Access in Healthcare

      The Adelaide Hospital Society (The Adelaide Hospital Society, 2005-05)
    • Keeping Drugs out of Prisons

      Irish Prison Service (Irish Prison Service, 2018-03-21)
    • Keeping on the right side of the tracks

      Shaw, Yvonne (Irish Dental Association, 2017-01)
    • Ketamine: Future Treatment For Unresponsive Depression?

      Frere, M; Tepper, J (Irish Medical Journal, 2016-09)
    • The Ketogenic Diet: A Solution to Ireland’s Obesity Epidemic?

      Tepper, J; Frere, M (Irish Medical Journal, 2017-03)
    • Key performance indicators for mental health and substance use disorders: a literature review and discussion paper

      Henderson, Carla; Klimas, Jan; Dunne, Colum; Leddin, Des; Meagher, David; O'Toole, Thomas; Cullen, Walter; Graduate Entry Medical School, University of Limerick (taylor and francis, 2014-03-31)
    • Key Worker-Mediated Enhancement of Physical Health in First Episode Psychosis: Protocol For a Feasibility Study in Primary Care.

      McCombe, Geoff; Harrold, Aine; Brown, Katherine; Hennessy, Liam; Clarke, Mary; Hanlon, David; O'Brien, Sinead; Lyne, John; Corcoran, Ciaran; McGorry, Patrick; et al. (2019-07-10)
    • Knowledge, attitudes and beliefs of patients and carers regarding medication adherence: a review of qualitative literature

      Kelly, Maria; McCarthy, Suzanne; Sahm, Laura Jane (European Journal of Clinical Pharmacology, 2014-09)
    • Knowledge, Attitudes and Practices of Non-Consultant Hospital Doctors In The Immediate Post-Fall Period

      O’Reilly, D; Rutledge, N; Hurson, C; Clifford, G (Irish Medical Journal, 2018-04)
    • Labelled drug-related public expenditure in relation to gross domestic product (GDP) in Europe: a luxury good?

      Prieto, Luis; Interventions, Law and Policies Unit, European Monitoring Centre for Drug and Drug Addictions (EMCDDA), Cais do Sodré, 1249-289 Lisbon, Portugal. luis.prieto@lshtm.ac.uk (2010)
      "Labelled drug-related public expenditure" is the direct expenditure explicitly labelled as related to illicit drugs by the general government of the state. As part of the reporting exercise corresponding to 2005, the European Monitoring Centre for Drugs and Drug Addiction's network of national focal points set up in the 27 European Union (EU) Member States, Norway, and the candidates countries to the EU, were requested to identify labelled drug-related public expenditure, at the country level. This was reported by 10 countries categorised according to the functions of government, amounting to a total of EUR 2.17 billion. Overall, the highest proportion of this total came within the government functions of Health (66%), and Public Order and Safety (POS) (20%). By country, the average share of GDP was 0.023% for Health, and 0.013% for POS. However, these shares varied considerably across countries, ranging from 0.00033% in Slovakia, up to 0.053% of GDP in Ireland in the case of Health, and from 0.003% in Portugal, to 0.02% in the UK, in the case of POS; almost a 161-fold difference between the highest and the lowest countries for Health, and a 6-fold difference for POS. Why do Ireland and the UK spend so much in Health and POS, or Slovakia and Portugal so little, in GDP terms? To respond to this question and to make a comprehensive assessment of drug-related public expenditure across countries, this study compared Health and POS spending and GDP in the 10 reporting countries. Results found suggest GDP to be a major determinant of the Health and POS drug-related public expenditures of a country. Labelled drug-related public expenditure showed a positive association with the GDP across the countries considered: r = 0.81 in the case of Health, and r = 0.91 for POS. The percentage change in Health and POS expenditures due to a one percent increase in GDP (the income elasticity of demand) was estimated to be 1.78% and 1.23% respectively. Being highly income elastic, Health and POS expenditures can be considered luxury goods; as a nation becomes wealthier it openly spends proportionately more on drug-related health and public order and safety interventions.
    • Lack of association between folate-receptor autoantibodies and neural-tube defects.

      Molloy, Anne M; Quadros, Edward V; Sequeira, Jeffrey M; Troendle, James F; Scott, John M; Kirke, Peadar N; Mills, James L; School of Medicine, Trinity College, Dublin, Ireland. amolloy@tcd.ie (2009-07-09)
      BACKGROUND: A previous report described the presence of autoantibodies against folate receptors in 75% of serum samples from women with a history of pregnancy complicated by a neural-tube defect, as compared with 10% of controls. We sought to confirm this finding in an Irish population, which traditionally has had a high prevalence of neural-tube defects. METHODS: We performed two studies. Study 1 consisted of analysis of stored frozen blood samples collected from 1993 through 1994 from 103 mothers with a history of pregnancy complicated by a neural-tube defect (case mothers), 103 mothers with a history of pregnancy but no complication by a neural-tube defect (matched with regard to number of pregnancies and sampling dates), 58 women who had never been pregnant, and 36 men. Study 2, conducted to confirm that the storage of samples did not influence the folate-receptor autoantibodies, included fresh samples from 37 case mothers, 22 control mothers, 10 women who had never been pregnant, and 9 men. All samples were assayed for blocking and binding autoantibodies against folate receptors. RESULTS: In Study 1, blocking autoantibodies were found in 17% of case mothers, as compared with 13% of control mothers (odds ratio, 1.54; 95% confidence interval [CI], 0.70 to 3.39), and binding autoantibodies in 29%, as compared with 32%, respectively (odds ratio, 0.82; 95% CI, 0.44 to 1.50). Study 2 showed similar results, indicating that sample degradation was unlikely. CONCLUSIONS: The presence and titer of maternal folate-receptor autoantibodies were not significantly associated with a neural-tube defect-affected pregnancy in this Irish population.
    • Lack of MEF2A Delta7aa mutation in Irish families with early onset ischaemic heart disease, a family based study.

      Horan, Paul G; Allen, Adrian R; Hughes, Anne E; Patterson, Chris C; Spence, Mark; McGlinchey, Paul G; Belton, Christine; Jardine, Tracy C L; McKeown, Pascal P; Regional Medical Cardiology Centre, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK. paul_horan@lineone.net (2006)
      BACKGROUND: Ischaemic heart disease (IHD) is a complex disease due to the combination of environmental and genetic factors. Mutations in the MEF2A gene have recently been reported in patients with IHD. In particular, a 21 base pair deletion (Delta7aa) in the MEF2A gene was identified in a family with an autosomal dominant pattern of inheritance of IHD. We investigated this region of the MEF2A gene using an Irish family-based study, where affected individuals had early-onset IHD. METHODS: A total of 1494 individuals from 580 families were included (800 discordant sib-pairs and 64 parent-child trios). The Delta7aa region of the MEF2A gene was investigated based on amplicon size. RESULTS: The Delta7aa mutation was not detected in any individual. Variation in the number of CAG (glutamate) and CCG (proline) residues was detected in a nearby region. However, this was not found to be associated with IHD. CONCLUSION: The Delta7aa mutation was not detected in any individual within the study population and is unlikely to play a significant role in the development of IHD in Ireland. Using family-based tests of association the number of tri-nucleotide repeats in a nearby region of the MEF2A gene was not associated with IHD in our study group.
    • Lacking evidence for the association between frequent urine drug screening and health outcomes of persons on opioid agonist therapy.

      McEachern, Jasmine; Adye-White, Lauren; Priest, Kelsey C; Moss, Eloise; Gorfinkel, Lauren; Wood, Evan; Cullen, Walter; Klimas, Jan (2019-02-01)
      Opioid agonist therapy (OAT) is a first-line treatment for opioid use disorder (OUD); however, the efficacy and role of urine drug screening (UDS) in OAT has received little research attention. Prior evidence suggests that UDS frequency reflects philosophy and practice context rather than differences in patient characteristics or clinical need. Therefore, we reviewed the literature on the effect of and recommendations for the frequency of UDS on health outcomes for persons with OUD who receive OAT. We searched Medline and EMBASE for articles published from 1995-2017. Search results underwent double, independent review with discrepancies resolved through discussion with a third reviewer, when necessary. Additional articles were identified through snowball searching, hand searching (Google Scholar), and expert consultation. The Cochrane tool was used to assess risk of bias. Of the 60 potentially eligible articles reviewed, only one three-arm randomized open-label trial, comparing weekly and monthly UDS testing with take-home OAT doses, met our inclusion criteria. Our review identified an urgent gap in research evidence underpinning an area of clinical importance and that is routinely reported by patients as an area of concern.
    • Lap belt injuries in children.

      McGrath, N; Fitzpatrick, P; Okafor, I; Ryan, S; Hensey, O; Nicholson, A J (2010-07)
      The use of adult seat belts without booster seats in young children may lead to severe abdominal, lumbar or cervical spine and head and neck injuries. We describe four characteristic cases of lap belt injuries presenting to a tertiary children's hospital over the past year in addition to a review of the current literature. These four cases of spinal cord injury, resulting in significant long-term morbidity in the two survivors and death in one child, arose as a result of lap belt injury. These complex injuries are caused by rapid deceleration characteristic of high impact crashes, resulting in sudden flexion of the upper body around the fixed lap belt, and consequent compression of the abdominal viscera between the lap belt and spine. This report highlights the dangers of using lap belts only without shoulder straps. Age-appropriate child restraint in cars will prevent these injuries.
    • Laparoscopic nephrectomy: initial experience with 120 cases.

      Cheema, I A; Manecksha, R P; Murphy, M; Flynn, R; Urology Department, The Adelaide and Meath Hospital, Tallaght, Dublin 24. ijazacheema@hotmail.com (2010-02)
      Laparoscopic nephrectomy for both benign and malignant diseases of kidney is increasingly being performed. We report our experience with the first 120 consecutive laparoscopic nephrectomy performed in our hospital. It is the retrospective analysis of a prospectively maintained database of 4 years period. The parameters examined included age, gender, indications, operative time, blood loss, intraoperative and post operative complications. Mean age of surgery was 59 years (rang 19-84years). The indications for surgery included solid renal masses (71 patients), non-functioning kidneys (43), and collecting system tumours (6). The mean operating time was 132 minutes (range 75-270), average blood loss was 209 ml (range 0-1090) and average hospital stay was 4.7days (range 2-20). Bleeding, bowel injury and poor progression of laparoscopic procedure were the reasons in 7 (5.8%) cases converted to open surgery. There was 1 (0.8%) perioperative mortality. Eight (6.6%) patients developed post operative complications. Laparoscopic nephrectomy has inherent benefits and may be considered an alternate therapeutic option for kidney diseases with acceptable morbidity
    • Laparoscopic pyeloplasty.

      Cheema, I A; Manecksha, R P; Flynn, R (2010-01)
      We report our results and short term follow up of transperitoneal laparoscopic pyeloplasty for pelvi-ureteric junction (PUJ) obstruction. We have prospectively maintained a database to document our initial experience of 54 laparoscopic pyeloplasty. All procedures were carried out by one surgeon through a transperitoneal approach. The data extends from April 2005 to September 2008 and reports operative time, blood loss, complications, hospital stay, short term follow-up on symptomatic and radiological outcome. Fifty-four procedures were performed during the study period. Mean patient age was 29 years. Mean operating time was 133 minutes (range 65-300 minutes), and mean blood loss was 45 ml (range 20-300 ml). No intra operative complication occurred. Neither blood transfusion nor conversion to open surgery was required. Postoperative mean hospital stay was 3.4 days (range 3-14 days). There were 3 anastomotic leakages; 2 in the immediate postoperative period and 1 following removal of stent. They all required percutaneous drainage and prolonged stenting. Overall 47 (87%) patients have symptomatic relief and resolution of obstruction on renogram. Four (7%) patients developed recurrence. Three (5.5%) patients had symptomatic relief but have a persistent obstructive renogram. Laparoscopic pyeloplasty is an effective alternative treatment for symptomatic pelvi-ureteric junction obstruction. The results appear comparable to open pyeloplasty with decreased postoperative morbidity.