The Adelaide and Meath Hospital Incorporating the National Childrens Hospital

Dublin, Ireland

The Adelaide and Meath Hospital Incorporating the National Childrens Hospital

Dublin, Ireland

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Ng E.S.,The Adelaide and Meath Hospital Incorporating the National Childrens Hospital
BMJ case reports | Year: 2013

We present a 23-year-old man who sustained an isolated fracture of the lateral process of the talus (LPT) in a head-on vehicle collision at a combined speed of 200 km/h. The driver of the other vehicle sustained fatal injuries at the scene. The LPT was openly reduced and fixed with successful outcome at 3 months. This case is unusual in the method of injury, in particular in relation to the isolated relatively minor injury sustained.


Ahmad S.,The Adelaide and Meath Hospital incorporating the National Childrens Hospital | Manecksha R.P.,The Adelaide and Meath Hospital incorporating the National Childrens Hospital | Cullen I.M.,The Adelaide and Meath Hospital incorporating the National Childrens Hospital | Flynn R.J.,The Adelaide and Meath Hospital incorporating the National Childrens Hospital | And 3 more authors.
Canadian Journal of Urology | Year: 2011

Introduction: Reliable quantification of prostate volume is important to correctly select patients with benign prostatic hyperplasia (BPH) most likely to benefit from medical therapy [e.g. 5 alpha-reductase inhibitors (5-ARIs)] and in selecting appropriate surgical approach. We aim to determine the reliability of digital rectal examination (DRE) in estimation of prostate volume which may be helpful in patient selection for 5-ARIs therapy. Materials and methods: Patients requiring transrectal ultrasound (TRUS) guided prostate biopsy were recruited in this prospective study. DRE was performed twice for each patient. Clinicians categorized prostate volume on DRE into small, medium and large, and estimated prostate volume. Volume estimated by DRE at the first examination was intentionally unavailable at second DRE. TRUS volumes were measured using 2101 Falcon ultrasound machine. Results: Comparative analysis of prostate volume (n = 248) by DRE and TRUS was performed. There was no significant difference between DRE-estimated prostate volume at the first and second examinations (p = 0.8). DRE-estimated volumes for prostates categorized as small, medium or large were underestimated in 59%, 58% and 53% of patients respectively. However, for clinical relevant volumes (> 30 cc), 94.5% patients were accurately estimated on DRE. Conclusions: We have shown that DRE had positive predictive value of 94% in identifying prostate above 30 cc. Hence, when considering treatment with 5-ARIs, DRE may be sufficient to identify suitable patients for 5-ARIs therapy. However, for prostate volumes between 25 cc-30 cc and above 80 cc, TRUS may be required. © The Canadian Journal of Urology™.


Power S.,The Adelaide and Meath Hospital Incorporating the National Childrens Hospital | Smyth N.,The Adelaide and Meath Hospital Incorporating the National Childrens Hospital | Duggan S.,The Adelaide and Meath Hospital Incorporating the National Childrens Hospital | Roddy M.,The Adelaide and Meath Hospital Incorporating the National Childrens Hospital | Feehan S.,The Adelaide and Meath Hospital Incorporating the National Childrens Hospital
e-SPEN | Year: 2010

Background & aims: The reported incidence of nasogastric feeding tube dislodgement is 40%. In many cases, repeated tube dislodgements result in having to initiate gastrostomy feeding or total parenteral nutrition. To address this problem we sourced a tube-securing device (nasal bridle) and commenced its insertion. In a prospective study we aimed to measure the success of bridle insertion and to assess its effectiveness in preventing inadvertent feeding tube removal. Methods: 26 patients with a history of repeated tube dislodgement had their nasogastric feeding tube secured with a bridle. In addition, 2 patients commencing nasojejunal feeding had their tubes secured as a prophylactic measure against dislodgement. Subjects were selected based on clinical judgement by the dietitian and doctor. A DVD demonstrating insertion technique was viewed by the practitioner prior to insertion. Results: The majority of tubes (84.8%) were successfully secured. In those with a history of tube dislodgement, the mean number of dislodged tubes prior to bridle insertion was 3.6 (range 1-6). Bridle insertion prevented further tube dislodgement in 85.8% of cases. Minor bleeding occurred in 18.2% of insertions. Conclusions: Bridles can be safely used to secure feeding tubes and can reduce the incidence of tube dislodgement. Bridle use has the potential to save valuable hospital resources. © 2010 European Society for Clinical Nutrition and Metabolism.


PubMed | The Adelaide and Meath Hospital incorporating the National Childrens Hospital
Type: Journal Article | Journal: Irish journal of medical science | Year: 2012

The most appropriate management of incidental prostate cancers diagnosed at transurethral resection of prostate has been debated. It is important to determine the long-term outcomes to establish an appropriate management in patients with incidental prostate cancer.We aim to determine 10-year survival and to identify the factors of worse prognosis of incidental prostate cancers diagnosed at transurethral resection of prostate.A retrospective analysis of patients with pT1a-pT1b prostate cancers diagnosed between 1998 and 2003. Medical notes, PSA and pathology results were reviewed. Overall and cancer specific survival was calculated at mean 10-year follow-up.Sixty patients with incidental prostate cancer were identified (pT1a = 18, pT1b = 42). Fifty-one percents of the patients were managed on a watchful waiting strategy with overall 84% survival and 9.7% cancer specific mortality. Twenty patients (all with pT1b) received hormone therapy. Overall survival in this cohort was 50% with 20% cancer specific mortality. Nine patients received curative therapy (Radical prostatectomy = 4, Radiotherapy = 5). In this group, overall survival was 88% with no cancer specific mortality.Stage pT1a disease and preoperative low PSA were associated with favourable survival. However, for pT1b and/or high Gleason score (7), mortality was comparatively higher. Hence, patients with high Gleason score and/or pT1b disease should be considered for curative therapy. Additionally, active surveillance may have a role in selected men with incidental prostate cancer.


PubMed | The Adelaide and Meath Hospital Incorporating the National Childrens Hospital
Type: | Journal: BMJ case reports | Year: 2013

We present a 23-year-old man who sustained an isolated fracture of the lateral process of the talus (LPT) in a head-on vehicle collision at a combined speed of 200 km/h. The driver of the other vehicle sustained fatal injuries at the scene. The LPT was openly reduced and fixed with successful outcome at 3 months. This case is unusual in the method of injury, in particular in relation to the isolated relatively minor injury sustained.


PubMed | The Adelaide and Meath Hospital Incorporating the National Childrens Hospital
Type: Journal Article | Journal: Irish journal of medical science | Year: 2012

The practice of fasting from midnight prior to surgery is an outdated one.The aim of this study was to assess the impact of an evidence-based protocol for reduced preoperative fasting on fasting times, patient safety, and comfort.A non-randomised case-control study of preoperative fasting times among adult surgical patients undergoing elective procedures was conducted. Consecutive patients were allocated to a reduced preoperative fasting protocol allowing fluids and solids up to 2 and 6 h prior to anaesthesia, respectively (n = 21). These were compared to control patients identified from an historic study of preoperative fasting times who followed the traditional fast from midnight (n = 29). Fasting times and details of patients subjective comfort were collected using an interview-assisted questionnaire. Incidence of intraoperative aspirations was obtained from anaesthetic records.Significant reductions in fasting times for fluids (p = 0.000) and solids (p = 0.000) were achieved following implementation of the fasting protocol. Less preoperative thirst (0.000), headache (0.012) and nausea (0.015) were reported by those who had a shorter fast. Intraoperative aspiration did not occur in either group.Implementation of this protocol for reduced preoperative fasting achieved an appreciable reduction in fasting times and enhanced patient comfort. Patient safety was not compromised. Further modifications of our protocols are necessary to meet the international best practice. We recommend its implementation across all surgical groups in our institution.


PubMed | The Adelaide and Meath Hospital Incorporating the National Childrens Hospital
Type: Comparative Study | Journal: The Canadian journal of urology | Year: 2011

Reliable quantification of prostate volume is important to correctly select patients with benign prostatic hyperplasia (BPH) most likely to benefit from medical therapy [e.g. 5 alpha-reductase inhibitors (5-ARIs)] and in selecting appropriate surgical approach. We aim to determine the reliability of digital rectal examination (DRE) in estimation of prostate volume which may be helpful in patient selection for 5-ARIs therapy.Patients requiring transrectal ultrasound (TRUS) guided prostate biopsy were recruited in this prospective study. DRE was performed twice for each patient. Clinicians categorized prostate volume on DRE into small, medium and large, and estimated prostate volume. Volume estimated by DRE at the first examination was intentionally unavailable at second DRE. TRUS volumes were measured using 2101 Falcon ultrasound machine.Comparative analysis of prostate volume (n = 248) by DRE and TRUS was performed. There was no significant difference between DRE-estimated prostate volume at the first and second examinations (p = 0.8). DRE-estimated volumes for prostates categorized as small, medium or large were underestimated in 59%, 58% and 53% of patients respectively. However, for clinical relevant volumes (> 30 cc), 94.5% patients were accurately estimated on DRE.We have shown that DRE had positive predictive value of 94% in identifying prostate above 30 cc. Hence, when considering treatment with 5-ARIs, DRE may be sufficient to identify suitable patients for 5-ARIs therapy. However, for prostate volumes between 25 cc-30 cc and above 80 cc, TRUS may be required.


PubMed | Adelaide and Meath Hospital and The Adelaide and Meath Hospital Incorporating the National Childrens Hospital
Type: | Journal: BMJ case reports | Year: 2016

Infection in a clavicle fracture is uncommon, but remains a challenging problem. A paucity of soft tissue coverage often combined with significant displacement and interfragmentary movement add complexity to an already difficult situation for effective infection treatment. External fixation in principle offers a means of achieving fracture stability, while the infection is being eradicated. We present the case of a closed clavicle fracture, initially treated conservatively, that presented 5weeks later with infection. The fracture was definitively treated with external fixation using a locking plate positioned superficially to the skin, plus negative pressure wound therapy and subsequent secondary closure and antibiotic therapy. This case illustrates a novel method of treatment in this unusual presentation that was well tolerated by the patient and resulted in a good clinical outcome.


PubMed | The Adelaide and Meath Hospital Incorporating the National Childrens Hospital
Type: | Journal: Journal of nutrition and metabolism | Year: 2012

Psoriasis is a chronic inflammatory skin condition with an increased risk of cardiovascular disease. This risk has been attributed to an association with many independent risk factors including obesity, hypertension, smoking, and dyslipidemia. Psoriasis patients also have lower levels of folate and conversely higher levels of homocysteine, which in itself is a risk factor for cardiovascular disease. It has been postulated that low folate levels in this group may be a direct cause of hyperhomocysteinemia and therefore a treatable risk factor by folate supplementation. This paper looks at the literature published to date on the relationship between psoriasis, homocysteine, and folate levels.


PubMed | The Adelaide and Meath Hospital incorporating the National Childrens Hospital, Materials Misericordiae University Hospital, Steno Diabetes Center, University College Dublin and 2 more.
Type: Journal Article | Journal: PloS one | Year: 2015

Type 2 diabetes has a long pre clinical asymptomatic phase. Early detection may delay or arrest disease progression. The Diabetes Mellitus and Vascular health initiative (DMVhi) was initiated as a prospective longitudinal cohort study on the prevalence of undiagnosed Type 2 diabetes and prediabetes, diabetes risk and cardiovascular risk in a cohort of Irish adults aged 45-75 years.Members of the largest Irish private health insurance provider aged 45 to 75 years were invited to participate in the study.already diagnosed with diabetes or taking oral hypoglycaemic agents. Participants completed a detailed medical questionnaire, had weight, height, waist and hip circumference and blood pressure measured. Fasting blood samples were taken for fasting plasma glucose (FPG). Those with FPG in the impaired fasting glucose (IFG) range had a 75gm oral glucose tolerance test performed.122,531 subjects were invited to participate. 29,144 (24%) completed the study. The prevalence of undiagnosed diabetes was 1.8%, of impaired fasting glucose (IFG) was 7.1% and of impaired glucose tolerance (IGT) was 2.9%. Dysglycaemia increased among those aged 45-54, 55-64 and 65-75 years in both males (10.6%, 18.5%, 21.7% respectively) and females (4.3%, 8.6%, 10.9% respectively). Undiagnosed T2D, IFG and IGT were all associated with gender, age, blood pressure, BMI, abdominal obesity, family history of diabetes and triglyceride levels. Using FPG as initial screening may underestimate the prevalence of T2D in the study population.This study is the largest screening study for diabetes and prediabetes in the Irish population. Follow up of this cohort will provide data on progression to diabetes and on cardiovascular outcomes.

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