St Finbarrs Hospital

Cork, Ireland

St Finbarrs Hospital

Cork, Ireland
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Cronin J.,St Finbarrs Hospital
Health Promotion International | Year: 2016

Recent studies suggest that time spent sitting is associated with greater risks of all causes of mortality and cardiovascular disease even for those who live a healthy lifestyle. As part of a healthier worksite initiative, we conducted a worksite walkability audit and staff survey of a large hospital-based administrative campus with a high proportion of health staff working in largely office-based roles. The US Centre for Disease Control (CDC) Healthier Worksite Initiative Walkability Audit Tool was used to audit 20 walking segments. The audit further examined the walkability of segments most likely to be used by outpatients and the families of residents visiting and attending the campus. The second phase of this research involved an employee electronic survey to understand staff requirements from a workplace physical activity initiative. Overall, the campus scored a medium risk to walkability on the CDC audit tool. This means that with some key minor alterations the walking route could be made safe and attractive for walking. There was a 20% (n = 151) response rate to the staff survey with 66% of respondents sitting at their desk for most of the day with the majority spending 5-7 h a day sitting at work. Evidence suggests that reducing sedentary time may be important to public health. The worksite is an ideal location for targeting a large number of individuals. Key public health messages that promote daily recommended physical activity targets should also carry additional messages about reducing occupational sitting time. © The Author 2015. Published by Oxford University Press. All rights reserved.

O'Caoimh R.,St Finbarrs Hospital | Svendrovski A.,McMaster University | Johnston B.C.,McMaster University | Gao Y.,St Finbarrs Hospital | And 5 more authors.
Journal of Clinical Epidemiology | Year: 2014

Objectives The Alzheimer's Disease Assessment Scale-cognitive section and its standardized version (SADAS-cog) are the current standard for assessing cognitive outcomes in clinical trials of dementia. This study compares a shorter cognitive instrument, the Quick Mild Cognitive Impairment (Qmci) screen, with the SADAS-cog as outcome measures in clinical trials. Study Design and Setting The SADAS-cog, Qmci, Clinical Dementia Rating (CDR) scale, and the Lawton-Brady activities of daily living (ADL) scale were assessed at multiple time points, over 1 year in a multicenter randomized clinical trial of 406 patients with mild to moderate Alzheimer's dementia. Correlations were estimated using regression at each time point, all time points, and mean values across time. Responsiveness was assessed using the standardized response mean (SRM). Results Regression for pooled time points showed strong and significant correlation between the SADAS-cog and Qmci (r = -0.75, P < 0.001). Correlations remained strong for mean values across time and at each time point. The SADAS-cog and Qmci also correlated with CDR and ADL scores. There was no difference in SRMs between the SADAS-cog and Qmci [t(357) = -0.32, P = 0.75]. Conclusion The Qmci correlated strongly with the SADAS-cog and both were equally responsive to deterioration. We suggest that clinicians and investigators can substitute the shorter Qmci for the SADAS-cog. © 2014 Elsevier Inc. All rights reserved.

O'Caoimh R.,University College Cork | Gao Y.,University College Cork | Svendrovski A.,Consulting Inc. | Healy E.,Center for Public Health Nursing | And 6 more authors.
BMC Geriatrics | Year: 2014

Background: Functional decline and frailty are common in community dwelling older adults, increasing the risk of adverse outcomes. Given this, we investigated the prevalence of frailty-associated risk factors and their distribution according to the severity of perceived risk in a cohort of community dwelling older adults, using the Risk Instrument for Screening in the Community (RISC). Methods: A cohort of 803 community dwelling older adults were scored for frailty by their public health nurse (PHN) using the Clinical Frailty Scale (CFS) and for risk of three adverse outcomes: i) institutionalisation, ii) hospitalisation and iii) death, within the next year, from one (lowest) to five (highest) using the RISC. Prior to scoring, PHNs stated whether they regarded patients as frail. Results: The median age of patients was 80 years (interquartile range 10), of whom 64% were female and 47.4% were living alone. The median Abbreviated Mental Test Score (AMTS) was 10 (0) and Barthel Index was 18/20 (6). PHNs regarded 42% of patients as frail, while the CFS categorized 54% (scoring ≥5) as frail. Dividing patients into low-risk (score one or two), medium-risk (score three) and high-risk (score four or five) using the RISC showed that 4.3% were considered high risk of institutionalization, 14.5% for hospitalization, and 2.7% for death, within one year of the assessment. There were significant differences in median CFS (4/9 versus 6/9 versus 6/9, p < 0.001), Barthel Index (18/20 versus 11/20 versus 14/20, p < 0.001) and mean AMTS scores (9.51 versus 7.57 versus 7.00, p < 0.001) between those considered low, medium and high risk of institutionalisation respectively. Differences were also statistically significant for hospitalisation and death. Age, gender and living alone were inconsistently associated with perceived risk. Frailty most closely correlated with functional impairment, r = -0.80, p < 0.001. Conclusion: The majority of patients in this community sample were perceived to be low risk for adverse outcomes. Frailty, cognitive impairment and functional status were markers of perceived risk. Age, gender and social isolation were not and may not be useful indicators when triaging community dwellers. The RISC now requires validation against adverse outcomes. © 2014 O'Caoimh et al.; licensee BioMed Central Ltd.

O'Caoimh R.,St Finbarrs Hospital | Gao Y.,St Finbarrs Hospital | Gallagher P.F.,University College Cork | Eustace J.,University College Cork | And 2 more authors.
Age and Ageing | Year: 2013

Introduction: the Qmci is a sensitive and specific test to differentiate between normal cognition (NC), mild cognitive impairment (MCI) and dementia. We compared the sensitivity and specificity of the subtests of the Qmci to determine which best discriminated NC, MCI and dementia.Objective: the objective was to determine the contribution each subtest of the Qmci makes, to its sensitivity and specificity in differentiating MCI from NC and dementia, to refine and shorten the instrument.Methods: existing data from our previous study of 965 subjects, testing the Qmci, was analysed to compare the sensitivity and specificity of the Qmci subtests.Results: all the subtests of the Qmci differentiated MCI from NC. Logical memory (LM) performed the best (area under the receiver operating curve of 0.80), registration the worst, (0.56). LM and verbal fluency had the largest median differences (expressed as percentage of total score) between MCI and NC, 20 and 25%, respectively. Other subtests did not have clinically useful differences. LM was best at differentiating MCI from NC, irrespective of age or educational status.Conclusion: the Qmci incorporates several important cognitive domains making it useful across the spectrum of cognitive impairment. LM is the best performing subtest for differentiating MCI from NC. © The Author 2013. Published by Oxford University Press on behalf of the British Geriatrics Society.

PubMed | University of Padua, Center for Research & Continuing Education, St Finbarrs Hospital, University of Hong Kong and 4 more.
Type: Journal Article | Journal: International journal of nursing practice | Year: 2016

Nurses knowledge regarding advance directives may affect their administration and completion in end-of-life care. Confidence among nurses is a barrier to the provision of quality end-of-life care. This study investigated nurses knowledge of advance directives and perceived confidence in end-of-life care, in Hong Kong, Ireland, Israel, Italy and the USA using a cross-sectional descriptive design (n=1089). In all countries, older nurses and those who had more professional experience felt more confident managing patients symptoms at end-of-life and more comfortable stopping preventive medications at end-of-life. Nurses in the USA reported that they have more knowledge and experience of advance directives compared with other countries. In addition, they reported the highest levels of confidence and comfort in dealing with end-of-life care. Although legislation for advance directives does not yet exist in Ireland, nurses reported high levels of confidence in end-of-life care.

O'Caoimh R.,St Finbarrs Hospital | Gao Y.,St Finbarrs Hospital | McGlade C.,St Finbarrs Hospital | Healy L.,St Finbarrs Hospital | And 3 more authors.
Age and Ageing | Year: 2012

Introduction: differentiating mild cognitive impairment (MCI) from normal cognition (NC) is difficult. The AB Cognitive Screen (ABCS) 135, sensitive in differentiating MCI from dementia, was modified to improve sensitivity and specificity, producing the quick mild cognitive impairment (Qmci) screen.Objective: this study compared the sensitivity and specificity of the Qmci with the Standardised MMSE and ABCS 135, to differentiate NC, MCI and dementia.Methods: weightings and subtests of the ABCS 135 were changed and a new section 'logical memory' added, creating the Qmci. From four memory clinics in Ontario, Canada, 335 subjects (154 with MCI, 181 with dementia) were recruited and underwent comprehensive assessment. Caregivers, attending with the subjects, without cognitive symptoms, were recruited as controls (n = 630).Results: the Qmci was more sensitive than the SMMSE and ABCS 135, in differentiating MCI from NC, with an area under the curve (AUC) of 0.86 compared with 0.67 and 0.83, respectively, and in differentiating MCI from mild dementia, AUC of 0.92 versus 0.91 and 0.91. The ability of the Qmci to identify MCI was better for those over 75 years.Conclusion: the Qmci is more sensitive than the SMMSE in differentiating MCI and NC, making it a useful test, for MCI in clinical practice, especially for older adults. © The Author 2012. Published by Oxford University Press on behalf of the British Geriatrics Society.

Power J.P.,St Finbarrs Hospital | El Chaar M.,University of Cambridge | Temple J.,University of Cambridge | Thomas M.,St Finbarrs Hospital | And 3 more authors.
Journal of Hepatology | Year: 2010

Background & Aims: Multi-transfused patients often receive treatments inducing various levels of immunodeficiency. Acute viral infections may then be attributed either to transfusion-transmitted infection (TTI) or reactivation of a past infection. Methods: A patient with chronic lymphocytic leukemia (CLL) who had >250 blood donor exposures developed acute Hepatitis B virus (HBV) infection. Routine donor testing for HB core antibodies (anti-HBc) was in place in the relevant period and investigations undertaken on the blood donors were negative. Results: Review of historical, molecular, and antigenic evidence demonstrated reactivation of a recovered HBV infection dating >30 years and the selection of a rare escape mutant that briefly replicated and caused acute liver disease. This mutant was unreactive with several HBsAg assays and poorly reactive with an HBV vaccine plasma. Correcting the C139Y substitution by site directed mutagenesis of recombinant surface proteins re-established assay reactivity. Conclusions: Fludarabine, but not Chlorambucil, appeared sufficiently immunosuppressive to trigger reactivation despite low levels of neutralizing antibodies. Differentiating between TTI and reactivation of HBV becomes more challenging with the increasing frequency of immunocompromised blood recipients. Chemotherapy with Fludarabine alone should be considered as carrying high risk of viral reactivation. Pre-treatment testing and peripheral blood sample archiving may be indicated in HBsAg negative patients. © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

PubMed | St Finbarrs Hospital
Type: Journal Article | Journal: Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin | Year: 2016

We report an outbreak of measles which started in April 2016 and which, by 13 June, has resulted in 22 confirmed and five probable measles cases occurring in four regions of Ireland. Genotype B3 was identified. We describe the identification, ongoing investigation and control measures being implemented. This outbreak occurs during a period of very low measles transmission in Ireland, with only one confirmed case (imported) notified in 2016 before this event.

PubMed | St Finbarrs Hospital
Type: Journal Article | Journal: Irish journal of medical science | Year: 2016

ARTERIAL portography is the study of the spleno-portal venous system by visceral arteriography. Four cases studied by this method are described to illustrate its value. In the management of portal hypertension, detailed knowledge of the cause of the hypertension and the availability of any veins that can be used for shunting purposes is essential; after a decompressive shunt has been performed, its exact status must be known, especially if the patient has gastrointestinal bleeding, or shows evidence of failing hepatic function. Arterial portography should give this information. It provides not only a practical alternative to splenoportography, but a more physiologic means of studying the portal circulation.

PubMed | Trinity College Dublin and St Finbarrs Hospital
Type: Journal Article | Journal: Irish journal of medical science | Year: 2016

The fatty acid pattern of fasting plasma lipids has been measured in patients admitted to hospital with tetanus. Measurements were made on admission and at intervals throughout the illness and on discharge of the subjects as clinically recovered.The linoleic acid content of fasting plasma lipids was markedly decreased on admission; it remained low, despite adequate intake even on clinical recovery.Palmitic palmitoleic and oleic acid content was increased resembling the pattern in essential fatty acid deficiency.This phenomenon of reduced linoleic acid and fatty acid pattern resembling that of essential lfatty acid deficiency may be common in severe illness but clinical recovery can occur without return of the pattern to normal.

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