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Thomas N, Stankard A, Cosgrave N, Conlon B, Monahan P, Halpin T, Britton D, Byrne P, McShane S, Sohail I, Grogan AM, Reilly A, Thapa A, Alsubaie N, Rane P, O'Connor J, Gray S, Kaja A, Gehani K, Kovalyshyn V, O'Brien H. 92 CONTINUING TO ‘BE HIP’: ORTHOGERIATRIC SERVICE IMPROVEMENTS IN 2021. Age Ageing 2022. [PMCID: PMC9620584 DOI: 10.1093/ageing/afac218.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Scotland first demonstrated that adherence to nationally agreed hip fracture standards improve patient survival, reduces the duration of admission, and reduces the need for high dependency care. Our study aims to assess adherence to the Irish Hip Fracture Standards (IHFS) in our hospital for 2021 amidst the COVID-19 pandemic, translating to improved clinical outcomes for our patients. Methods The IHF database was retrospectively analysed, comparing quarters 1-4 in 2021 with our 2020 results. Results IHFS1, patient time to the ward < 4hours, was maintained at 67% in 2021 versus 71% overall in 2020. There was improvement in IHFS2, time to surgery within 48 hours, up to 73% in 2021 versus 66% in 2020. IHFS3 was 4% in 2021 versus 3% overall in 2020. Further improvements were noted for IHFS4, with 95% of patients reviewed by a Geriatrician in 2021 versus 87% in 2020. IHFS5 also improved with 97% of patients receiving a bone health assessment in 2021 versus 87% in 2020. Moreover, IHFS6, improved with 97% of patients undergoing a specialised falls assessment in 2021 versus 87% in 2020. Conclusion The improvement in 2021 figures is reflective of the return of redeployed services during the COVID-19 pandemic inclusive of the Orthogeriatric Service, the Fracture Liaison Service Advanced Nurse Practitioner, the Trauma Co-ordinator, and the specialist Orthopaedic ward complete with its Orthopaedic nurses and Multi-Disciplinary Team, and improved Emergency Department pathways. These continued improvements in the IHFS further emphasise that success is dependent on a team that is joined at the hip
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Affiliation(s)
- N Thomas
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - A Stankard
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - N Cosgrave
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - B Conlon
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - P Monahan
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - T Halpin
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - D Britton
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - P Byrne
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - S McShane
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - I Sohail
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - AM Grogan
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - A Reilly
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - A Thapa
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - N Alsubaie
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - P Rane
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - J O'Connor
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - S Gray
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - A Kaja
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - K Gehani
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - V Kovalyshyn
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - H O'Brien
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
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Stankard A, Thomas N, Cosgrave N, Conlon B, Monaghan P, Halpin T, English D, Byrne P, McShane S, Sohail I, Grogan AM, Reilly A, Thapa A, Alsubaie N, Rane P, O'Connor J, Gray S, Kaja A, Gehani K, Kovalyshyn V, O'Brien H. 258 RISING TO THE CHALLENGE: ORTHOGERIATRIC SERVICE IMPROVEMENT AND COVID-19. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Nationally agreed hip fracture standards have contributed to the improvement of outcomes in hip fracture patients. In 2020, our hospital was awarded “The Golden Hip” for achieving highest compliance with Irish Hip Fracture Standards (IHFS) nationally for 2019.
Methods
Data from the Irish Hip Fracture Database (IHFD)was retrospectively analysed to assess our performance in 2020 versus 2019 in hip fracture patients over sixty. Multiple quality improvement interventions were put in place throughout 2019 to ensure improvement in IHFS1-6 compliance: Creation of the Hip Fracture Pathway Subgroup, IHFS 1 Breaches Audit, Orthogeriatric input at Orthopaedic inductions, weekly Multi-disciplinary Team meetings, a Nutritional Hip Fracture Pathway and addition of the Fracture Liaison Service Advanced Nurse Practitioner.
Results
There were 239 hip fracture patients in 2020 vs 249 in 2019. IHFS1 compliance improved with the percentage of patients admitted to the Orthopaedic ward within 4 hours increasing to 71% in 2020 from 56% in 2019. There was improvement in IHFS2-time to surgery <48 hours- 66% in 2020 vs 60% in 2019. IHFS3-pressure ulcer rate-was at the national average, 3% in 2020 vs 2% in 2019. IHFS4 (reviewed by a Geriatrician), IHFS5 (received a bone health assessment) and IHFS6 (received a specialised falls assessment) were lower overall; 87% in 2020 vs 98% in 2019. For all quarters (Q),43% of patients met all IHFS in our hospital in 2020 vs 32% in 2019, resulting in €90,000 in Best Practice Tariff funding.
Conclusion
Lower results for IHFS 4,5 and 6 reflect the arrival of the COVID-19 pandemic which led to redeployment of the Orthogeriatric Service and redeployment of the MDT from end of Q1 to Q3. When services in 2020 were preserved,1 in 2 hip fracture patients met all IHFS, vs 1 in 3 patients in 2019. Despite the pandemic, we continued to achieve the highest level of IHFS compliance nationally, being awarded a second consecutive “Golden Hip” for 2020.
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Affiliation(s)
- A Stankard
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - N Thomas
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - N Cosgrave
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - B Conlon
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - P Monaghan
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - T Halpin
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - D English
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - P Byrne
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - S McShane
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - I Sohail
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - AM Grogan
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - A Reilly
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - A Thapa
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - N Alsubaie
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - P Rane
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - J O'Connor
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - S Gray
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - A Kaja
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - K Gehani
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - V Kovalyshyn
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
| | - H O'Brien
- Our Lady Of Lourdes Hospital , Drogheda, Ireland
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Lu K, Pedersen B, Rosa RL, Krogh-Johansen H, Conlon B, Muhlebach M. 503 Bacterial characteristics and metabolism of persistent methicillin-resistant Staphylococcus aureus infection. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)01193-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Dockery F, Glynn A, Franks K, Carey JJ, O'Gradaigh D, Kenny P, Askin D, Butler E, Sweeney B, Conlon B, McGregor B, Lannon R, Rooney B, Pillai I, Fitzgerald C. Fracture liaison services in Ireland-how do we compare to international standards? Osteoporos Int 2022; 33:1089-1096. [PMID: 34981131 DOI: 10.1007/s00198-021-06251-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
UNLABELLED In this first na tional survey of public hospitals in The Republic of Ireland, we found fracture liaison services (FLS) to be heterogeneous, limited in many cases and poorly supported. A national strategy is urgently needed to support the implementation and operation of an FLS, and thus help reduce the burden of fragility fractures for patients and the healthcare system. INTRODUCTION Fragility/low-trauma fractures are a global concern, whose incidence is rising as the population ages. Many are preventable, and people with a prior fragility fracture are at particularly high risk of further fractures. This patient group is the target of the International Osteoporosis Foundation (IOF) Capture the Fracture campaign, advocating global adoption of fracture liaison services (FLS), with the aim of preventing secondary fragility fractures. We wished to determine the current availability and standards of an FLS in Ireland, ahead of the launch of a National FLS database. METHODS We devised a questionnaire encompassing the thirteen IOF standards for an FLS and asked all 16 public hospitals with an orthopaedic trauma unit in Ireland, to complete for the calendar year 2019 in patients aged ≥ 50 years. RESULTS All sites returned the questionnaire, i.e. 100% response rate. Nine hospitals stated that they have an FLS, additionally one non-trauma hospital running a FLS responded, and were included. These 10 FLS had identified and managed 3444 non-hip fractures in the year 2019. This figure represents 19% of the expected non-hip fragility fracture numbers occurring annually in Ireland. Implementation of the IOF standards was very variable. All sites reported being inadequately resourced to provide a high-quality service necessary to be effective. CONCLUSION The existence and functioning of FLS in Ireland are heterogeneous and suboptimal. A national policy to support the implementation of this programme in line with international standards of patient care is urgently needed.
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Affiliation(s)
| | - A Glynn
- Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - K Franks
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - J J Carey
- University Hospital Galway, Galway, Ireland
| | - D O'Gradaigh
- University Hospital Waterford, Waterford, Ireland
| | - P Kenny
- Connolly Hospital, Dublin, Ireland
| | - D Askin
- Tallaght University Hospital, Dublin, Ireland
| | - E Butler
- Beaumont Hospital, Dublin, Ireland
| | - B Sweeney
- St. Vincent's University Hospital, Dublin, Ireland
| | - B Conlon
- Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - B McGregor
- Letterkenny University Hospital, Donegal, Ireland
| | - R Lannon
- St. James' Hospital, Dublin, Ireland
| | - B Rooney
- Sligo University Hospital, Sligo, Ireland
| | - I Pillai
- Tipperary University Hospital, Tipperary, Ireland
| | - C Fitzgerald
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Stankard A, Conlon B, O'Brien H. 250 EXPANSION OF THE ORTHOGERIATRIC SERVICE: EARLY EXPERIENCES. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Abstract
Background
The introduction of hip fracture standards has led to improvement in outcomes for hip fracture patients. Other osteoporotic fragility fractures also lead to significant morbidity. They are associated with a high risk of future hip fracture. The Orthogeriatric Service at a model 3 hospital was expanded to proactively undertake comprehensive geriatric assessment(CGA) for patients over 65 with non-hip fragility fractures(NHFF) admitted to the Orthopaedic Ward. Electronic discharge summaries were created for all patients. This study aimed to characterise patients reviewed by Orthogeriatrics and review discharge summary documentation of CGA.
Methods
Patients reviewed by Orthogeriatrics during the period Jan-June 2021 were retrospectively analysed. Discharge summaries of these patients were retrospectively reviewed. The prevalence of documentation of frailty status, delirium screening and bone health plan was recorded.
Results
A total(n = 126) of 91 patients with hip fractures and 35 with NHFF were included. Other fracture types were excluded. The mean age of hip fracture patients was 82.43 compared to 78.2 in the NHFF group. 71%(n = 65) of hip fracture patients were female compared to 80% (n = 28) of NHFF. 80%(n = 73) of hip fracture patients were reviewed within 48 hours of admission, compared to 65%(n = 23) of NHFF. 52.7%(n = 48)of hip fracture patients had frailty status documented on their discharge summary, compared to 37.1%(n = 13) of NHFF. Delirium screening was documented for 58.2%(n = 53) of the hip fracture patients, compared to 40%(n = 14) of NHFF. Bone health plans were documented for 62.6%(n = 57) of hip fracture patients compared to 60%(n = 21) of NHFF.
Conclusion
Expansion of the Orthogeriatric Service to proactively review all NHFF patients will lead to reduced incidence of repeat fracture for this population. A lower percentage of NHFF patients had clear discharge documentation of CGA outcomes and a lower percentage were reviewed within 48 hours. Expansion of hip fracture standards to include all fragility fracture patients should be considered to incentivise improved care for all.
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Affiliation(s)
- A Stankard
- Our Lady of Lourdes Hospital , Drogheda, Ireland
| | - B Conlon
- Our Lady of Lourdes Hospital , Drogheda, Ireland
| | - H O'Brien
- Our Lady of Lourdes Hospital , Drogheda, Ireland
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Davey N, McFeely A, Doyle P, Stankard A, Coveney S, Alsubie N, O'Connor J, Conlon B, Monahan P, Byrne P, Britton D, Halpin T, McShane S, Sohail I, Lynch O, Basit M, NiBhuachalla B, Mulroy M, O'Brien H. 103 ORTHOGERIATRIC SERVICES IN THE FACE OF COVID-19. Age Ageing 2021. [PMCID: PMC8690012 DOI: 10.1093/ageing/afab219.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Nationally agreed standards improve the level of care delivered to all older, frail, multi-morbid patients presenting with hip fractures. Dedicated Orthogeriatric services allow for these standards to be achieved in a multi-disciplinary team (MDT) setting. As the COVID-19 pandemic reached our shores, the model of care set out by the Irish Hip Fracture Standards (IHFS) was under threat. Our dedicated Orthopaedic Trauma ward became an acute COVID ward and the Orthogeriatric service was re-deployed to acute medicine for Quarter 2. Methods Using the Irish Hip Fracture Database, local data was analysed and compared with national data from Quarter 1 to 4 (Q1–4) in 2020. Results When comparing local IHFS’s with national figures, ongoing challenges and future goals are highlighted. In 2020, there were 222 hip fracture patients (mean age 81.8 years) in our hospital. Standard 1, time to the ward <4 hours, stands at 71% locally (national average 33%). Standard 2, time to theatre <48 hours, is an ongoing challenge and remains at 66% (national average 75%). Standard 3, pressure ulcer rate, was the same as the national average at 3%. Standards 4, 5 and 6 in our hospital stand at 87% (national averages of 82%, 91% and 85% respectively). In Q1, 56%, or over 1 in every 2 patients with hip fractures, met all of the Irish Hip Fracture Standards in our hospital. In Q2, only 18% of patients met all of the IHFS’s. Q3 saw improvements with 47% of all hip fracture patients achieving all IHFS’s. Q4 showed maintenance with 45% of all patients achieving all IHFS’s. Conclusion These findings highlight the need for a dedicated Orthogeriatric Service and Orthopaedic ward at all times. Going forward with the risk of future waves and the emergence of new variants, every effort should be made to maintain a comprehensive orthogeriatric service to minimise a negative impact on patient care.
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Affiliation(s)
- N Davey
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - A McFeely
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - P Doyle
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - A Stankard
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - S Coveney
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - N Alsubie
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - J O'Connor
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - B Conlon
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - P Monahan
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - P Byrne
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - D Britton
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - T Halpin
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - S McShane
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - I Sohail
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - O Lynch
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - M Basit
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - B NiBhuachalla
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - M Mulroy
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
| | - H O'Brien
- Our Lady of Lourdes Hospital Drogheda, Drogheda, Ireland
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Greenwald M, Rowe S, Conlon B, Wolfgang M. 485: Nitric oxide produced during Pseudomonas aeruginosa denitrification increases tobramycin killing of tolerant cells. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 emerged in December 2019 in Wuhan, China, and was declared a global health emergency of international concern by the World Health Organization on 30th January 2020. It has resulted in almost 600 000 deaths to date worldwide. Sudden sensorineural hearing loss is a known complication of a number of viral infections, but there is little in the literature to date on its association with coronavirus disease 2019. CASE REPORT This paper presents the case of a 30-year-old female staff nurse who contracted coronavirus disease 2019 and presented to our department with a significant unilateral sensorineural hearing loss confirmed on audiogram. She was treated with a course of oral steroids, but unfortunately there was no improvement in her hearing. CONCLUSION This case report is important as it highlights the importance of having a low index of suspicion when patients present with a variety of symptoms not previously associated with coronavirus disease 2019. The paper also discusses the controversy surrounding the use of steroids in the management of this disease.
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Affiliation(s)
- B Lang
- Department of Otorhinolaryngology and Head and Neck Surgery, St James University Hospital, Dublin, Ireland
| | - J Hintze
- Department of Otorhinolaryngology and Head and Neck Surgery, St James University Hospital, Dublin, Ireland
| | - B Conlon
- Department of Otorhinolaryngology and Head and Neck Surgery, St James University Hospital, Dublin, Ireland
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Abstract
BACKGROUND During 2009, there were 3.3 million outpatient attendances at outpatient clinics across Ireland. Up to 20 % of these are directed towards ENT services. AIMS To determine the compliance rate of general practitioners with the ICGP referral guidelines. METHODS One-hundred referrals received were compared to the ICGP standardised form and graded accordingly. Each referral letter was graded to a maximum of 37 points. RESULTS The average score recorded for referrals was 16/37. The referrer detail section scored the highest with a mean of 75.42 % (paediatric referrals) and 72.9 % (adult referrals). The clinical information provided demonstrated compliance rates of 34 % (paediatrics) and 35 % (adults). In total, only 32 letters made any reference to findings on examination. Both paediatric and adult referrals scored an average of 42 % when patients' details are considered. CONCLUSION This study demonstrates poor compliance rates with the introduced ICGP standardised referral form, which has implications for the accurate grading of referral letters received.
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Affiliation(s)
- J C Oosthuizen
- The Adelaide and Meath, Incorporating the National Children's Hospital, Dublin, Ireland,
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10
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O’Neill JP, Young O, Conlon B. Major otology day case surgery: viable, cost efficient and safe. Ir J Med Sci 2011; 180:841-4. [DOI: 10.1007/s11845-011-0739-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 07/09/2011] [Indexed: 10/17/2022]
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Cashman EC, Conlon B. Unravelling Menieres disease: an approach to diagnosis & management. Ir Med J 2009; 102:101-102. [PMID: 19552286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Mackle T, Conlon B. Foreign bodies of the nose and ears in children. Should these be managed in the accident and emergency setting? Int J Pediatr Otorhinolaryngol 2006; 70:425-8. [PMID: 16125254 DOI: 10.1016/j.ijporl.2005.07.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2004] [Revised: 07/01/2005] [Accepted: 07/09/2005] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study reviews the management of children with foreign bodies in the nose or ear in an attempt to see whether these children can be successfully managed in the Accident and Emergency (A & E) Department or whether they should be directly referred to the Otolaryngology service. METHODS The records of all children with a foreign body in either the nose or ear who presented to the Accident and Emergency Department at The National Children's Hospital over a 2-year period were reviewed. RESULTS 82 children presented with a foreign body in the nose and 53 (65%) were successfully managed in the A & E Department. In contrast, of the 58 children with a foreign body in the ear only 4 (7%) were successfully removed in the A & E Department. CONCLUSION Most foreign bodies in the nose can be successfully removed in the Accident and Emergency Department. In contrast there is a high failure rate in removal of foreign bodies from the ear in the A & E Department and these should be referred directly to the ENT service.
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Affiliation(s)
- T Mackle
- Department of Otorhinolaryngology, The Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland.
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Abstract
One hundred and eight parotidectomies performed by a single consultant were reviewed. Eighty-five patients had primary parotid disease, 23 patients had extra-parotid primaries. Pleomorphic adenoma was the most common histological diagnosis. In patients with primary parotid disease, a post-operative temporary facial nerve palsy was noted in 15 patients, with a further four developing a permanent palsy. Patients with metastatic disease to the parotid had a poor prognosis.
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Affiliation(s)
- M Harney
- Department of Otolaryngology, St. James's Hospital, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
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Kim MH, Conlon B, Ebinger M, Bruckman D, Kronick S, Lowell M, Morady F, Armstrong WF, Eagle KA. Clinical outcomes and costs associated with a first episode of uncomplicated atrial fibrillation presenting to the emergency room. Am J Cardiol 2001; 88:A7, 74-6. [PMID: 11423064 DOI: 10.1016/s0002-9149(01)01592-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M H Kim
- Cardiovascular Division, Washington University, St. Louis, Missouri 63110, USA.
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15
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Conlon B. Antimicrobial resistance. N Z Med J 1999; 112:58. [PMID: 10091898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Abstract
Inherited bleeding disorders are frequently considered an absolute contraindication to tonsillectomy and other ENT procedures. Over a 15-year period we have performed ten elective tonsillectomies and five bilateral myringotomies on children with inherited bleeding disorders. All procedures were carried out with the close co-operation of the Haematology Department in the hospital. All patients underwent uneventful surgery. One patient returned after tonsillectomy with a secondary haemorrhage which did not require surgical intervention. We present our team approach to the management of these children and demonstrate that necessary surgical intervention can be undertaken safely in this select group of patients.
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Affiliation(s)
- B Conlon
- Department of Otolaryngology, National Children's Hospital, Dublin, Republic of Ireland
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