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Hegarty D, Barzel B. PO209 / #931 SLEEP QUALITY FOLLOWING SPINAL CORD STIMULATION FOR CHRONIC PAIN: INTERIM ANALYSIS. Neuromodulation 2022. [DOI: 10.1016/j.neurom.2022.08.381] [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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Kelly R, McMahon A, Hegarty D. Ionizing Radiation Dose Exposure to the Ocular Region of Pain Physicians During C-arm Guided Pain Interventions. Pain Physician 2018; 21:E523-E532. [PMID: 30282400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND The growth of interventional pain medicine in recent years has resulted in more procedures being carried out under fluoroscopic guidance. The proximity of the pain physician (PP) to ionization radiation (IR) potentially increases the risk of radiation exposure to the ocular region. A European directive has reduced the limits of occupational ocular dose 7.5-fold. OBJECTIVES The objectives of this study are to quantify the typical IR exposure in the ocular region of PP and to compare it to recommended international guidelines. STUDY DESIGN Three consultants involved in the pain unit service were enrolled in the study to reflect the dose implications involved with different caseloads, training obligations, and procedure types. All 3 consultants were experienced primary operators. SETTING The study was undertaken at the pain management suite in the South Infirmary Victoria University Hospital (SIVUH). Annually, this unit performs 2,800 fluoroscopic guide pain procedures. METHODS Thermoluminescent dosimeters (TLDs) calibrated to measure eye lens doses [Hp (0.07)] and whole-body doses (WBDs) were fitted to 3 pain consultants while they undertook imaging-guided pain procedures using mobile C-arm fluoroscopy over a 3-month period. The duration of radiation exposure, screening time (seconds), and procedure type were recorded. Radiation dose was calculated to estimate the effective radiation dose to the ocular region using (i) dose-area product (DAP) in milliGray per centimeter squared (mGycm2) and (ii) Air Kerma (AK) values in mGy. RESULTS IR doses were effectively recorded in 682 cases over 3 months and the data extrapolated. The estimated annual lens dose experienced by pain physicians performing fluoroscopy-guided procedures is less than the recommended international guidelines. A significant linear relationship between screening time and IR exposure was estimated (rs = 0.93, P < 0.01). LIMITATIONS In many centers, including our own, fluoroscopy procedures are undertaken by nonconsultant staff. Therefore, a small single-center cohort recruiting experienced consultant staff and not including pain fellows or registrars/residents with varying levels of experience is a limitation. CONCLUSION While IR to the ocular region was significantly less than the recommended European safety guidelines, the annual dose needs to be confirmed in pain physicians with a lesser degree of clinical experience. KEY WORDS Ionizing radiation, ocular, radiation protection, pain medicine, interventional.
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Affiliation(s)
- Raymond Kelly
- South Infirmary Victoria University Hospital, Cork, Ireland
| | - Aisling McMahon
- Department of Medical Physics, Cork University Hospital, Wilton, Cork, Ireland
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Goroszeniuk T, Shetty A, Munglani R, Hegarty D, Bhaskar A. The Effect of Peripheral Neuromodulation on Pain from the Sacroiliac Joint: A Retrospective Cohort Study. Pain Pract 2017; 17:982-982. [PMID: 28226403 DOI: 10.1111/papr.12567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 01/08/2017] [Accepted: 01/13/2017] [Indexed: 11/28/2022]
Abstract
We report here a retrospective review of the longer-term results of peripheral neuromodulation in 12 patients with significant chronic sacroiliac joint pain who had previously failed multiple conservative and interventional pain therapies. To allow for the assessment of meaningful longer-term outcome, implants for all 12 patients had been in place for a minimum of 18 months to a maximum of 36 months prior to the formal review. Compared to the preimplantation baseline, the longer-term follow-up revealed a significant and sustained reduction in visual analog scale pain scores from 8.7 ± 1.1 to 1.1 ± 1.0 (P < 0.001), with a 75% reduction in analgesia requirement, and improvement in pain impact on daily function from 94.1% ± 5.9% to 5.8% ± 6.0% (P < 0.001). These preliminary results merit a prospective randomized trial of peripheral neuromodulation.
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Affiliation(s)
| | - Ashish Shetty
- National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, U.K
| | - Rajesh Munglani
- Pain Management, Guys and St. Thomas' NHS Foundation Trust, London, U.K
| | - Dominic Hegarty
- Pain Management, Guys and St. Thomas' NHS Foundation Trust, London, U.K
- Department of Anaesthesia and Pain Medicine, Cork University Hospital, Wilton, Cork, Ireland
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Hegarty D. Clinical Outcome Following Radiofrequency
Denervation for Refractory Sacroiliac Joint
Dysfunction Using the Simplicity III Probe: A
12-Month Retrospective Evaluation. Pain Physician 2016. [DOI: 10.36076/ppj/2016.19.e129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Sacroiliac joint syndrome (SIJ) is diagnosed in 10% to 25% of cases of lower
back pain. The response to traditional radiofrequency (RF) denervation of the SIJ has being
inconsistent. The Simplicity III RF probe (Neruotherm. Inc.) offers a novel treatment option.
Objective: To evaluate the long-term clinical outcome (12 months) refractory SIJ syndrome in
terms of pain intensity and functional improvement. A 50% reduction in intensity pain intensity
(VAS) at 12 months was deemed clinically significant.
Study Design: A 12-month retrospective observational evaluation all of adults treated with
RF for refractory SIJ.
Setting: Chronic pain management center.
Methods: The medical records of all adults treated with this technique was retrospectively
reviewed. The primary outcome was pain intensity scores (VAS) over a 12 months period;
Secondary outcomes included Roland-Morris Functional scores (RMF), Brief Pain Inventory (BPI),
general health assessment (Sf12), and patient satisfaction scores (GPI), which were recorded
pre and post denervation.
Results: Pain Intensity improved by 4.7 points compared to pre-treatment representing a 61%
reduction in pain at 12 months (n=11, P < 0.001). Significant improvements in (a) RMF (P <
0.01, W2
= 0.63 (large effect size); (b) BPI (P < 0.001, W2
= 0.72 (strong effect size); and (c)
Sf12 (P < 0.01) were noted. Overall patients were satisfied with the outcome (GPI = 77.7%).
Limitations: The retrospective in nature of the study and the small sample size are limitations.
As it was our policy to monitor the progress of the individuals since the introduction of this
technique a reliable method of recording the baseline and outcome variables at each point of
contact was in place. Access to a complete set of variables in all individuals over a 12-month
period was therefore possible, which we feel contributes to the quality of the dataset.
Conclusion: By creating a consistent radiofrequency lesion between the sacral foramen
and the SIJ will reliably capture the innervation to the SIJ with significant long-term clinical
improvement. This technique should be considered earlier in the treatment algorithm of
individuals suffering from SIJ symptoms.
Key words: Sacroiliac Joint syndrome, radiofreqency denervation, Simplicity III probe, chronic
pain, long-term clinical outcome, Roland-Morris Functional scores (RMF), Brief Pain Inventory
(BPI), general health assessment (Sf12), patient satisfaction scores (GPI)
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Hegarty D. Clinical Outcome Following Radiofrequency Denervation for Refractory Sacroiliac Joint Dysfunction Using the Simplicity III Probe: A 12-Month Retrospective Evaluation. Pain Physician 2016; 19:E129-E135. [PMID: 26752481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Sacroiliac joint syndrome (SIJ) is diagnosed in 10% to 25% of cases of lower back pain. The response to traditional radiofrequency (RF) denervation of the SIJ has being inconsistent. The Simplicity III RF probe (Neruotherm. Inc.) offers a novel treatment option. OBJECTIVE To evaluate the long-term clinical outcome (12 months) refractory SIJ syndrome in terms of pain intensity and functional improvement. A 50% reduction in intensity pain intensity (VAS) at 12 months was deemed clinically significant. STUDY DESIGN A 12-month retrospective observational evaluation all of adults treated with RF for refractory SIJ. SETTING Chronic pain management center. METHODS The medical records of all adults treated with this technique was retrospectively reviewed. The primary outcome was pain intensity scores (VAS) over a 12 months period; Secondary outcomes included Roland-Morris Functional scores (RMF), Brief Pain Inventory (BPI), general health assessment (Sf12), and patient satisfaction scores (GPI), which were recorded pre and post denervation. REULTS Pain Intensity improved by 4.7 points compared to pre-treatment representing a 61% reduction in pain at 12 months (n=11, P < 0.001). Significant improvements in (a) RMF (P < 0.01, W2 = 0.63 (large effect size); (b) BPI (P < 0.001, W2 = 0.72 (strong effect size); and (c) Sf12 (P < 0.01) were noted. Overall patients were satisfied with the outcome (GPI = 77.7%). LIMITATIONS The retrospective in nature of the study and the small sample size are limitations. As it was our policy to monitor the progress of the individuals since the introduction of this technique a reliable method of recording the baseline and outcome variables at each point of contact was in place. Access to a complete set of variables in all individuals over a 12-month period was therefore possible, which we feel contributes to the quality of the dataset. CONCLUSION By creating a consistent radiofrequency lesion between the sacral foramen and the SIJ will reliably capture the innervation to the SIJ with significant long-term clinical improvement. This technique should be considered earlier in the treatment algorithm of individuals suffering from SIJ symptoms.
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Hegarty D, Shorten G. Multivariate prognostic modeling of persistent pain following lumbar discectomy. Pain Physician 2012; 15:421-434. [PMID: 22996854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Persistent postsurgical pain (PPSP) affects between 10% and 50% of surgical patients, the development of which is a complex and poorly understood process. To date, most studies on PPSP have focused on specific surgical procedures where individuals do not suffer from chronic pain before the surgical intervention. Individuals who have a chronic nerve injury are likely to have established peripheral and central sensitization which may increase the risk of developing PPSP. Concurrent analyses of the possible factors contributing to the development of PPSP following lumbar discectomy have not been examined. OBJECTIVE The aim of this study is to identify risk and protective factors that predict the course of recovery following lumbar discectomy and to develop an easily applicable preoperative multivariate prognostic model for the occurrence of PPSP in this patient cohort. STUDY DESIGN A prospective study of elective lumbar discectomy with a 3 month follow-up. SETTING University setting in Ireland. METHODS All ASA I-II patients, (n = 53, 18-65 years old), undergoing elective lumbar discectomy at a single institute were included and followed for a 3 month period postsurgery. Preoperative potential predictors were collected: age, gender, pain intensity (McGill score, visual analog scale [VAS], Present Pain Intensity), degree of dysfunction (Roland-Morris Function score), psychological status (pain catastrophizing, anxiety, and depression scores), health-related quality of life (SF-36), quantitative sensory testing (QST), inflammatory biomarkers, and a genetic pain profile. The proposed primary outcome was significant pain reduction (VAS > 70%) 3 months following surgery compared to the preoperative pain intensity. RESULTS A final prediction model was obtained using a multivariate logistic regression in combination with bootstrapping techniques for internal validation. Twenty (37.7%) patients developed PPSP. Independent predictor factors included age (odds ratio [OR] = 1.0 per year), present pain intensity (OR = 0.6), and degree of dysfunction (OR = 1.2). The concordance index C (.658) supports a good monotonic association (where perfect prediction is 1) and the Akaike's information criteria indicated a good fit of the model. Inclusion of additional measured parameters (QST, biomarker, or genotyping) did not improve the model. LIMITATIONS Before this internally validated model can be integrated into clinical practice, and used for patient counselling and quality assurance purposes, external validation studies are necessary. CONCLUSIONS We demonstrated that the occurrence of PPSP can be predicted using a small set of variables easily obtained at the preoperative visit. This a prediction rule that could further optimize perioperative pain treatment and reduce attendant complications by allowing the preoperative classification of surgical patients according to their risk of developing PPSP.
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Affiliation(s)
- Dominic Hegarty
- Department of Anaesthesia, Intensive Care and Pain Medicine, Cork University Hospital, Wilton, Cork, Ireland.
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Lean LL, Hegarty D, Harmon D. Analgesic effect of bilateral ultrasound-guided pudendal nerve blocks in management of interstitial cystitis. J Anesth 2012; 26:128-9. [PMID: 21976176 DOI: 10.1007/s00540-011-1243-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 09/16/2011] [Indexed: 10/17/2022]
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Abstract
Persistent post surgical pain is reported in 70% of patients following thoracotomy and
mastectomy. This pain is often neuropathic in nature and occasionally it is refractory to
traditional medical and interventional management. Neurostimulation of peripheral nerves can
be a highly effective clinical modality for the management of neuropathic pain. The placement
of a percutaneously sited electrode in the thoracic paravertebral plexus offers a new and novel
mode of managing refractory thoracic neuropathic pain.
We present 2 cases that demonstrate the effectiveness of this intervention in the long-term
management of this clinical dilemma. The first case presented is that of a 61-year-old female,
with unilateral neuropathic pain for 6 years following mastectomy refractory to traditional
interventions. Targeted field stimulation of the thoracic paravertebral plexus resulted in
significant improvement for 12 years. The second case is that of a 65-year-old male, with Type II
diabetes with neuropathic thoracic pain for 6 years following multiple rib fractures (T4-T7) who
responded positively to neurostimulation of the thoracic paravertebral plexus.
Both of these cases demonstrate a relative reduction in pain intensity (> 80%), the elimination of
oral analgesics, and improved functionality directly related to the novel use of this intervention.
Effective and reproducible pain relief is achieved by specifically using a low frequency (10 Hz)
and low amplitude (2 mA) stimulation technique. Equally important is that these cases highlight
the increased risk of inadvertent pleural puncture with the development of a pneumothorax
that can be associated with this intervention. Possible clinical, investigative and equipment
modifications that need to be considered are discussed.
The limitations include only 2 case reports, considered as the lowest level of evidence available
in the era of evidence-based medicine, and lack of utilization of multiple other modalities of
treatments utilized in managing neuropathic pain.
In conclusion, these cases demonstrate the effectiveness of peripheral nerve stimulation of the
thoracic paravertebral plexus in the long-term management of refractory neuropathic pain. They
also serve to underline the importance of clinical awareness in order to improve patient safety.
Key words: Peripheral nerve stimulation, thoracic paravertebral plexus, persistent post surgical
pain, neuropathic pain, pneumothorax
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Affiliation(s)
- Dominic Hegarty
- Department of Pain Management and Neuromodulation Centre, Guys and St Thomas’ NHS Foundation Trust, London, UK
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Hegarty D, Goroszeniuk T. Peripheral nerve stimulation of the thoracic paravertebral plexus for chronic neuropathic pain. Pain Physician 2011; 14:295-300. [PMID: 21587333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Persistent post surgical pain is reported in 70% of patients following thoracotomy and mastectomy. This pain is often neuropathic in nature and occasionally it is refractory to traditional medical and interventional management. Neurostimulation of peripheral nerves can be a highly effective clinical modality for the management of neuropathic pain. The placement of a percutaneously sited electrode in the thoracic paravertebral plexus offers a new and novel mode of managing refractory thoracic neuropathic pain. We present 2 cases that demonstrate the effectiveness of this intervention in the long-term management of this clinical dilemma. The first case presented is that of a 61-year-old female, with unilateral neuropathic pain for 6 years following mastectomy refractory to traditional interventions. Targeted field stimulation of the thoracic paravertebral plexus resulted in significant improvement for 12 years. The second case is that of a 65-year-old male, with Type II diabetes with neuropathic thoracic pain for 6 years following multiple rib fractures (T4-T7) who responded positively to neurostimulation of the thoracic paravertebral plexus. Both of these cases demonstrate a relative reduction in pain intensity (> 80%), the elimination of oral analgesics, and improved functionality directly related to the novel use of this intervention. Effective and reproducible pain relief is achieved by specifically using a low frequency (10 Hz) and low amplitude (2 mA) stimulation technique. Equally important is that these cases highlight the increased risk of inadvertent pleural puncture with the development of a pneumothorax that can be associated with this intervention. Possible clinical, investigative and equipment modifications that need to be considered are discussed. The limitations include only 2 case reports, considered as the lowest level of evidence available in the era of evidence-based medicine, and lack of utilization of multiple other modalities of treatments utilized in managing neuropathic pain. In conclusion, these cases demonstrate the effectiveness of peripheral nerve stimulation of the thoracic paravertebral plexus in the long-term management of refractory neuropathic pain. They also serve to underline the importance of clinical awareness in order to improve patient safety.
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Affiliation(s)
- Dominic Hegarty
- Department of Pain Management and Neuromodulation Centre, Guys and St Thomas' NHS Foundation Trust, London, UK.
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Hegarty D, O’Connor OJ, Moore M, O’Regan KN, Shorten G, Maher MM. Association between preoperative magnetic resonance imaging, pain intensity and quantitative sensory testing in patients awaiting lumbar diskectomy. J Med Imaging Radiat Oncol 2011; 55:4-10. [DOI: 10.1111/j.1754-9485.2010.02222.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gilligan P, Joseph D, Winder S, Keeffe FO, Oladipo O, Ayodele T, Asuquo Q, O'Kelly P, Hegarty D. DNW--"Did Not Wait" or "Demographic Needing Work": a study of the profile of patients who did not wait to be seen in an Irish emergency department. Emerg Med J 2009; 26:780-2. [PMID: 19850798 DOI: 10.1136/emj.2008.063388] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- P Gilligan
- Emergency department Beaumont Hospital, Beaumont Road, Dublin, D9, Ireland.
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Gilligan P, O'Kelly P, Hegarty D, Winder S. The Transit/Admission Lounge study. Ir Med J 2009; 102:19-21. [PMID: 19284013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In response to persistent overcrowding of Emergency Departments in Ireland, the Department of Health and Health Service Executive provided funding for "Transit Lounge" areas to be built. These lounges were to provide a location for patients to wait in beds pending the availability of a ward bed. This research was performed to assess the impact of such a lounge on the overcrowding of the Emergency Department and on patient outcomes. The time period from the opening of the Transit Lounge was compared with the same period a year earlier. The Transit Lounge delivers a comfortable place for patients to wait. It does not reduce Emergency Department overcrowding and has been associated with an increased time waiting for a ward bed. The solution to overcrowding is the creation of real capacity in the system so that ward beds are available in acute hospitals for the "unscheduled unwell".
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Affiliation(s)
- P Gilligan
- Department of Emergency Medicine, Beaumont Hospital, Dublin.
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Gilligan P, Gupta V, Singh I, Winder S, O'Kelly P, Hegarty D. Why are we waiting? A study of the patients' perspectives about their protracted stays in an emergency department. Ir Med J 2007; 100:627-629. [PMID: 18277733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The overcrowding of Emergency Departments compromises their critical function and the safety of patients and staff. This study asked the patients how the wait in overcrowded conditions impacted on them and the care they received and what they believed the reasons for the overcrowding were. A prospective questionnaire based structured interview study was performed. Over half (57.7%) of patients felt that the lack of inpatient beds and wards was the main reason that they experienced delays. An overwhelming 85.9% felt that the Health Authorities were not doing enough to address the overcrowding issue. Overcrowding of Emergency Departments has been identified as a major problem the solution is to be found in increasing the capacity of the acute hospital system according to the majority of our study population.
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Affiliation(s)
- P Gilligan
- The Emergency Department of Beaumont Hospital, Beaumont Road, Dublin.
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Gilligan P, Pountney A, Wilson B, Mehigan C, Kidney E, Jennings P, Cooper J, Hegarty D, Lee J, Khan A, Lumsden G, Godden D, Shepherd M, Allonby-Neve L, Broderick A, Carr S, Wilson S, O' Sullivan J. SOCRATES Episode II (synopsis of Cochrane reviews applicable to emergency services Episode II): the return of Series III. Emerg Med J 2007; 24:489-91. [PMID: 17582042 PMCID: PMC2658398 DOI: 10.1136/emj.2006.043679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- P Gilligan
- Beaumont Hospital, Beaumont Road, Dublin D9, Ireland.
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Gilligan P, Lee J, Khan A, Jennings P, Cooper J, Hegarty D, Lumsden G, Godden D, Pountney A, Wilson B, Shepherd M, Allonby-Neve L, Mehigan C, Kidney E, Broderick A, Carr S, Wilson S, O'Sullivan J. SOCRATES episode II (synopsis of cochrane reviews applicable to emergency services episode II): the return of the series II. Arch Emerg Med 2007; 24:115-7. [PMID: 17251619 PMCID: PMC2658187 DOI: 10.1136/emj.2006.038018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P Gilligan
- Beaumont Hospital, Beaumont Road, Dublin D9, Ireland.
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Gilligan P, Jennings P, Cooper J, Hegarty D, Lee J, Khan A, Lumsden G, Godden D, Pountney A, Wilson B, Shepherd M, Allonby-Neve L, Mehigan C, Kidney E, Broderick A, Carr S, Wilson S, O' Sullivan J. SOCRATES episode II: (synopsis of Cochrane Reviews applicable to emergency services episode II) the return of the series. Arch Emerg Med 2007. [DOI: 10.1136/emj.2006.037713] [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: 11/04/2022]
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Hegarty D. Chronic postoperative pain and inguinal herniorrhaphy. Br J Anaesth 2006; 96:538. [PMID: 16549630 DOI: 10.1093/bja/ael040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Gilligan P, Bhatarcharjee C, Knight G, Smith M, Hegarty D, Shenton A, Todd F, Bradley P. To lead or not to lead? Prospective controlled study of emergency nurses' provision of advanced life support team leadership. Emerg Med J 2005; 22:628-32. [PMID: 16113181 PMCID: PMC1726914 DOI: 10.1136/emj.2004.015321] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND OBJECTIVES In many emergency departments advanced life support (ALS) trained nurses do not assume a lead role in advanced resuscitation. This study investigated whether emergency nurses with previous ALS training provided good team leadership in a simulated cardiac arrest situation. METHODS A prospective study was conducted at five emergency departments and one nurses' association meeting. All participants went through the same scenario. Details recorded included baseline blood pressure and pulse rate, time in post, time of ALS training, and subjective stress score (1 = hardly stressed; 10 = extremely stressed). Scoring took into account scenario understanding, rhythm recognition, time to defibrillation, appropriateness of interventions, and theoretical knowledge. RESULTS Of 57 participants, 20 were ALS trained nurses, 19 were ALS trained emergency senior house officers (SHOs), and 18 were emergency SHOs without formal ALS training. The overall mean score for doctors without ALS training was 69.5%, compared with 72.3% for ALS trained doctors and 73.7% for ALS trained nurses. Nurses found the experience less stressful (subjective stress score 5.78/10) compared with doctors without ALS training (6.5/10). The mean time taken to defibrillate from the appearance of a shockable rhythm on the monitor by the nurses and those SHOs without ALS training was 42 and 40.8 seconds, respectively. CONCLUSION ALS trained nurses performed as well as ALS trained and non ALS trained emergency SHOs in a simulated cardiac arrest situation and had greater awareness of the potentially reversible causes of cardiac arrest. Thus if a senior or middle grade doctor is not available to lead the resuscitation team, it may be appropriate for experienced nursing staff with ALS training to act as ALS team leaders rather than SHOs.
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Gilligan P, Shepherd M, Lumsden G, Kitching G, Taylor A, Law H, Hegarty D, Khan A, Brenchley J, Jones J. SOCRATES 11 (synopsis of Cochrane reviews applicable to emergency services). Arch Emerg Med 2005; 22:656-7. [PMID: 16113193 PMCID: PMC1726934 DOI: 10.1136/emj.2004.019976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P Gilligan
- Emergency Medicine, Yorkshire Rotation, UK.
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Gilligan P, Hegarty D, Khan A, Shepherd M, Lumsden G, Kitching G, Taylor A, Law H, Brenchley J, Jones J. SOCRATES 9 (synopsis of Cochrane Reviews applicable to emergency services). Emerg Med J 2005; 22:510-1. [PMID: 15983092 PMCID: PMC1726846 DOI: 10.1136/emj.2004.019950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gilligan P, Jones J, Khan A, Hegarty D, Shepherd M, Lumsden G, Kitching G, Taylor A, Law H, Brenchley J. SOCRATES 10 (synopsis of Cochrane reviews applicable to emergency services). Arch Emerg Med 2005; 22:562-3. [PMID: 16046761 PMCID: PMC1726888 DOI: 10.1136/emj.2004.019968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- P Gilligan
- Emergency Medicine on The Yorkshire Rotation, UK
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Gilligan P, Kitching G, Taylor A, Law H, Brenchley J, Jones J, Hegarty D, Khan A, Shepherd M, Lumsden G. SOCRATES 7 (synopsis of Cochrane Reviews applicable to emergency services). Arch Emerg Med 2005; 22:368-9. [PMID: 15843712 PMCID: PMC1726791 DOI: 10.1136/emj.2004.019935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- P Gilligan
- Emergency Medicine, The Yorkshire Rotation, UK
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Gilligan P, Taylor A, Khan A, Jones J, Law H, Brenchley J, Hegarty D, Shepherd M, Lumsden G, Kitching G. SOCRATES 6 (Synopsis of Cochrane Reviews applicable to emergency services). Arch Emerg Med 2005; 22:277-8. [PMID: 15788834 PMCID: PMC1726746 DOI: 10.1136/emj.2004.019778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P Gilligan
- Emergency Medicine, The Yorkshire Rotation, UK
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Gilligan P, Shepherd M, Lumsden G, Law H, Brenchley J, Kitching G, Taylor A, Khan A, Jones J, Hegarty D. SOCRATES 4 (synopsis of Cochrane reviews applicable to emergency services). Emerg Med J 2005; 22:126-7. [PMID: 15662070 PMCID: PMC1726663 DOI: 10.1136/emj.2004.019620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- P Gilligan
- Emergency Medicine, The Yorkshire Rotation, UK
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Gilligan P, Lumsden G, Jones J, Brenchley J, Hegarty D, Khan A, Shepherd M, Kitching G, Taylor A, Law H. SOCRATES 5 (Synopsis of Cochrane Reviews applicable to Emergency Services). Arch Emerg Med 2005; 22:198-9. [PMID: 15735273 PMCID: PMC1726712 DOI: 10.1136/emj.2004.019760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P Gilligan
- Emergency Medicine on The Yorkshire Rotation, UK
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Gilligan P, Law H, Lumsden G, Brenchley J, Kitching G, Taylor A, Khan A, Shepherd M, Jones J, Hegarty D. SOCRATES 3 (synopsis of Cochrane reviews applicable to emergency services). Arch Emerg Med 2005; 22:50-2. [PMID: 15611547 PMCID: PMC1726536 DOI: 10.1136/emj.2004.019604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- P Gilligan
- Emergency Medicine on The Yorkshire Rotation, UK
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Gilligan P, Khan A, Shepherd M, Lumsden G, Kitching G, Taylor A, Law H, Brenchley J, Jones J, Hegarty D. SOCRATES 1 (synopsis of Cochrane reviews applicable to emergency services). Arch Emerg Med 2004; 21:584-5. [PMID: 15333538 PMCID: PMC1726421 DOI: 10.1136/emj.2004.017095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- P Gilligan
- Emergency Medicine on the Yorkshire Rotation, UK
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31
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Dillon P, Buckley F, O’Connor P, Hegarty D, Rath M. A comparison of different dairy cow breeds on a seasonal grass-based system of milk production. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s0301-6226(03)00041-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The case of a patient with an unusual medical condition and an occult pneumothorax is presented. The evidence for management of occult pneumothorax particularly in patients with underlying lung disease is reviewed and solutions to the acute clinical problems that may arise are suggested.
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Affiliation(s)
- P Gilligan
- Department of Accident and Emergency Medicine, The Leeds General Infirmary, Leeds, UK
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Affiliation(s)
- D Hegarty
- Orthodontic Department, University of Manchester, England
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34
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Kuo M, Hegarty D, Johnson A, Stevenson S. Early post-tonsillectomy morbidity following hospital discharge: do patients and GPs know what to expect? Health Trends 1994; 27:98-100. [PMID: 10154270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Tonsillectomy is a commonly performed operation; like many others there is increasing pressure for it to be performed as a day-case procedure, with no follow-up for the majority of patients. This paper presents the results of a prospective study of the incidence of post-tonsillectomy morbidity, the recognition of these symptoms by patients, and their management by general practitioners. The results indicate: a lack of awareness by patients of symptoms they might expect post-operatively, despite written and verbal information given; an over-prescription of antibiotics by general practitioners for normal post-operative symptoms such as throat pain, temporary voice changes and referred otalgia; and a failure by patients to recognise the importance of the potentially life-threatening complication of secondary haemorrhage from the tonsillar bed.
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Affiliation(s)
- M Kuo
- Queen Elizabeth Medical Centre, Edgbaston, Birmingham, UK
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