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Leahy A, O’Shaughnessy I, Barry L, Gabr A, Shanahan E, O'Connor M, Galvin R, Robinson K. 299 OLDER PERSONS’ EXPERIENCES AND PERSPECTIVES OF COMPREHENSIVE GERIATRIC ASSESSMENT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.262] [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: 11/13/2022] Open
Abstract
Abstract
Background
There is an abundance of evidence to demonstrate the positive impacts of Comprehensive Geriatric Assessment (CGA) on clinical and process outcomes for older adults across settings of care. However, it is unclear how older adults themselves view CGA and their experiences of the care process. The aim of this qualitative evidence synthesis is to explore the experiences and perspectives of older adults of CGA.
Methods
A comprehensive literature search was completed across MEDLINE, CINAHL, PsycINFO, PsycARTICLES and Social Sciences Full Text. Qualitative or mixed methods studies that included qualitative data on the perspectives and experiences of older adults of CGA were included. The methodological quality of the included studies was appraised using the Critical Appraisal Skills Programme checklist for qualitative research. Findings were synthesised using thematic analysis
Results
Nine studies were included in the synthesis, including studies where CGA was completed in hospital, outpatient assessment unit and home settings. Divergent experiences of CGA were reported. Older adults reported experiences of being respected and listened to during CGA and attention paid to all their issues and priorities. Good communication by healthcare providers was central to these positive experiences (theme 1). In contrast, experiences of being unclear about the aim of CGA or perceived benefits of CGA, feeling that the outcome of CGA did not align with their priorities (theme 2) and not feeling involved in decision making during CGA (theme 3) were also commonly reported.
Conclusion
Findings indicate that CGA is a process by which older adults can felt respected and paid attention to. However, scope exists to further improve older adults’ experiences of CGA. Enhanced healthcare provider communication and facilitation of older adult involvement in decision-making are priority areas for improvement. Further research should focus on exploring other stakeholder groups experiences of CGA including caregivers and healthcare professionals.
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Affiliation(s)
- A Leahy
- Health Research Institute School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, , Limerick, Ireland
- University Hospital Limerick Department of Ageing and Therapeutics, , Limerick, Ireland
| | - I O’Shaughnessy
- Health Research Institute School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, , Limerick, Ireland
| | - L Barry
- University of Limerick School of Nursing and Midwifery, Faculty of Education and Health Sciences, , Limerick, Ireland
| | - A Gabr
- University Hospital Limerick Department of Ageing and Therapeutics, , Limerick, Ireland
| | - E Shanahan
- University Hospital Limerick Department of Ageing and Therapeutics, , Limerick, Ireland
| | - M O'Connor
- University Hospital Limerick Department of Ageing and Therapeutics, , Limerick, Ireland
| | - R Galvin
- Health Research Institute School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, , Limerick, Ireland
| | - K Robinson
- Health Research Institute School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, , Limerick, Ireland
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Leahy A, Corey G, Purtill H, O'Neill A, Devlin C, Barry L, Cummins N, Shanahan E, Shchetkovsky D, Ryan D, O'Connor M, Galvin R. 303 SCREENING INSTRUMENTS TO PREDICT ADVERSE OUTCOMES FOR UNDIFFERENTIATED OLDER ADULTS ATTENDING THE EMERGENCY DEPARTMENT: RESULTS OF SOAED PROSPECTIVE COHORT STUDY. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.266] [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
Frailty screening facilitates the stratification of older adults at most risk of adverse events for urgent assessment and subsequent intervention in the acute or community setting. We assessed the validity of the ISAR (Identification of Seniors at Risk), Rockwood Clinical Frailty Scale (CFS), PRISMA-7 and InterRAI-ED at predicting adverse outcomes at 30 days and six months among older adults presenting to the ED.
Methods
A prospective cohort study of consecutive older adults (≥65 years) who presented to the ED at a University Hospital was conducted. The ISAR, CFS, PRISMA-7 and InterRAI-ED were performed by an experienced ED research nurse. Blinded follow-up telephone interviews were completed at 30 days and six months to assess the incidence of mortality, ED re-attendance, hospital readmission, functional decline and nursing home admission. The sensitivity and specificity of the screening tools were calculated using 2×2 tables.
Results
419 patients were recruited with 49% female and a mean age of 76.9 years (SD 7.15). The prevalence of frailty varied across the screening tools (ISAR, 47% vs InterRAI-ED, 63%). At 30-days, mortality rate was 5.4%, ED re-attendance 16.9%, hospital readmission 13.6%, functional decline 47.1% and nursing home admission 7.3%. Older adults who screened positive for frailty demonstrated an increased risk of all adverse outcomes at 30 days and 6 months, regardless of frailty screening tool administered. All tools had a relatively high sensitivity but low specificity. The ISAR was the only tool which was statistically significant at predicting all outcomes at 30 days.
Conclusion
The ISAR, CFS, PRISMA-7 and InterRAI-ED demonstrated modest validity at predicting adverse outcomes at 30 days and 6 months. We would recommend the implementation of one of these frailty screening tools in Irish EDs to support clinicians in identifying older adults most likely to benefit from specialised geriatric assessment and intervention in the hospital or community setting.
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Affiliation(s)
- A Leahy
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University Hospital Limerick Department of Ageing and Therapeutics, , Limerick, Ireland
| | - G Corey
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - H Purtill
- University of Limerick Department of Mathematics & Statistics, , Limerick, Ireland
| | - A O'Neill
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - C Devlin
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - L Barry
- University of Limerick School of Nursing and Midwifery, Faculty of Education and Health Sciences, , Limerick, Ireland
| | - N Cummins
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - E Shanahan
- University Hospital Limerick Department of Ageing and Therapeutics, , Limerick, Ireland
| | - D Shchetkovsky
- University Hospital Limerick Department of Emergency Medicine, , Limerick, Ireland
| | - D Ryan
- University Hospital Limerick Department of Emergency Medicine, , Limerick, Ireland
| | - M O'Connor
- University Hospital Limerick Department of Ageing and Therapeutics, , Limerick, Ireland
| | - R Galvin
- University of Limerick School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
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Mohamed A, Leahy A, Gabr A, Mannion M, Cassarino M, Carrol I, Hayes C, Peters C, Shanahan E, O'Connor M, Galvin R. 353 FACTORS ASSOCIATED WITH ADVERSE OUTCOMES IN OLDER ADULTS DIRECTLY DISCHARGED FROM THE EMERGENCY DEPARTMENT. Age Ageing 2022. [DOI: 10.1093/ageing/afac218.310] [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: 11/12/2022] Open
Abstract
Abstract
Background
Older adults attend the Emergency Department (ED) frequently. Over 40% are directly discharged from the ED. The risk of adverse outcomes is high following discharge including unplanned ED return, institutionalisation, and mortality. The purpose of this study was to highlight factors that predict these adverse outcomes.
Methods
A secondary analysis was completed of SOAED (a prospective cohort study examining screening instruments to predict adverse outcomes for undifferentiated older adults attending the ED) and OPTIMEND (randomised control trial examining the effectiveness of an intervention by a team of Health and Social Care Professionals along with usual care and compared this to standard ED care alone). Inclusion criteria were adults aged 65 years and over presenting to ED at a University Teaching Hospital with medical complaints and a Manchester Triage System category 2–5.
Results
Three-hundred and nine patients were discharged directly from ED (mean age 80 years; 58% female). 96 patients re-attended ED within 6 months. 66 patients were re-hospitalised within 6 months. 16 patients died within six months of discharge. 63% of the discharged patients screened positive for frailty measured by PRISMA-7 (3 or more). Relative risk ratio analysis confirmed that the risk of revisiting a hospital was 1.241 times for patients that scored frail compared to those who scored not frail. The risk of mortality was 1.075 times for patients that scored frail compared to those who scored not frail. The risk of being admitted to a nursing home was 1.146 times for patients that scored frail compared to those who scored not frail.
Conclusion
Older people have a high ED re-attendance rate of 31% after an index visit. Frailty (scored on PRISMA-7) is a significant predictor of adverse outcomes. Focused screening and intervention for frail patients who attend the ED should be a priority.
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Affiliation(s)
- A Mohamed
- Therapeutics and Ageing , Limerick, Ireland
| | - A Leahy
- Therapeutics and Ageing , Limerick, Ireland
| | - A Gabr
- Therapeutics and Ageing , Limerick, Ireland
| | - M Mannion
- Therapeutics and Ageing , Limerick, Ireland
| | | | - I Carrol
- Therapeutics and Ageing , Limerick, Ireland
| | - C Hayes
- Therapeutics and Ageing , Limerick, Ireland
| | - C Peters
- Therapeutics and Ageing , Limerick, Ireland
| | - E Shanahan
- Therapeutics and Ageing , Limerick, Ireland
| | - M O'Connor
- Therapeutics and Ageing , Limerick, Ireland
| | - R Galvin
- Therapeutics and Ageing , Limerick, Ireland
- School of Allied Health University Limerick , Limerick, Ireland
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4
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O'Shaughnessy Í, Robinson K, O'Connor M, Conneely M, Ryan D, Steed F, Carey L, Leahy A, Shanahan E, Quinn C, Galvin R. 941 EFFECTIVENESS OF ACUTE GERIATRIC UNIT CARE AMONG HOSPITALISED OLDER ADULTS WITH ACUTE MEDICAL COMPLAINTS: A META-ANALYSIS. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Older adults are clinically heterogeneous and are at increased risk of adverse outcomes during hospitalisation due to the presence of multiple comorbid and complex conditions. This systematic review and meta-analysis aims to update and synthesise the totality of research evidence on the effectiveness of acute geriatric unit (AGU) care for older adults admitted to hospital with acute medical complaints.
Method
MEDLINE, CINAHL, CENTRAL, and Embase databases were systematically searched from 2008 to February 2021. Screening, data extraction, and quality grading were undertaken by two reviewers. Only trials with a randomised design comparing AGU care and conventional care units were included. Meta-analyses were performed in Review Manager 5.4 and the Grading of Recommendations, Assessment, Development and Evaluations framework was used to assess the certainty of evidence for outcomes reported. The primary outcome measure was incidence of functional decline between baseline two-week prehospital admission status and discharge and at follow-up.
Results
11 trials recruiting 7,496 participants across three countries were included. AGU care was associated with a 23% reduction in functional decline at six-month follow-up (risk ratio (RR) 0.77, 95% confidence interval (CI) 0.64–0.92; moderate certainty evidence), and significant cost savings (mean difference (MD) -538.01USD, 95% CI -571.05USD—-504.96USD; low certainty evidence). No differences were found in functional decline at hospital discharge or at three-month follow-up, length of hospital stay, the likelihood of living at home, mortality, hospital readmission, cognitive function, or patient satisfaction with the index admission.
Conclusion
AGU care improves clinical and process outcomes for older adults admitted to hospital with acute medical complaints. Future research should focus on greater inclusion of clinical and patient reported outcome measures including quality of life. Use of such measures may lead to a greater focus on patient-centered care and service provision priorities.
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Affiliation(s)
- Í O'Shaughnessy
- Faculty of Education and Health Sciences , Ageing Research Centre, Health Research Institute, , Ireland
- University of Limerick , Ageing Research Centre, Health Research Institute, , Ireland
| | - K Robinson
- Faculty of Education and Health Sciences , Ageing Research Centre, Health Research Institute, , Ireland
- University of Limerick , Ageing Research Centre, Health Research Institute, , Ireland
| | - M O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick , Ireland
- School of Medicine , Faculty of Education and Health Sciences, , Ireland
- University of Limerick , Faculty of Education and Health Sciences, , Ireland
| | - M Conneely
- Faculty of Education and Health Sciences , Ageing Research Centre, Health Research Institute, , Ireland
- University of Limerick , Ageing Research Centre, Health Research Institute, , Ireland
| | - D Ryan
- School of Medicine , Faculty of Education and Health Sciences, , Ireland
- University of Limerick , Faculty of Education and Health Sciences, , Ireland
- Emergency Department, University Hospital Limerick , Ireland
| | - F Steed
- Medicine Directorate, University Hospital Limerick , Ireland
| | - L Carey
- Department of Occupational Therapy, University Hospital Limerick, Irl
| | - A Leahy
- Department of Ageing and Therapeutics, University Hospital Limerick , Ireland
| | - E Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick , Ireland
| | - C Quinn
- Department of Ageing and Therapeutics, University Hospital Limerick , Ireland
| | - R Galvin
- Department of Ageing and Therapeutics, University Hospital Limerick , Ireland
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5
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Leahy A, Corey G, O’Neill A, Higginbotham O, Devlin C, Barry L, Cummins N, Shanahan E, Shchetkovsky D, Ryan D, O'Connor M, Galvin R. 1081 A COMPARISON OF THE ISAR TOOL AND THE CLINICAL FRAILTY SCALE TO PREDICT MORTALITY AND ED REATTENDANCE IN A COHORT OF ED ATTENDER. Age Ageing 2022. [DOI: 10.1093/ageing/afac126.086] [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
Frailty Screening is one method by which we can risk stratify older adults to urgent assessment in the Emergency Department. The ISAR (Identification of Seniors at Risk) and Rockwood Clinical Frailty Scale are two frailty screening tools. We assessed the validity of these tools at predicting adverse outcomes for older adults presenting to the Emergency Department.
Method
This was a prospective cohort study. Patients over 65 were recruited, baseline.
demographics were obtained and a research nurse assessed them using both the Clinical Frailty Scale and ISAR. Patients were assessed by telephone interviews at one month and six months. The outcome measures assessed were mortality, ED re-attendance, hospital readmission, functional decline and institutionalisation.
Results
419 patients were recruited. 53.3% (223) were male with a median age of 76 (IQR = 10). The median ISAR and CFS score was 2,5 respectively at baseline. The mortality rate was 5.4% and rate of ED re-attendance was 16.9% at one month. The relative risk of ED re-admission with an ISAR score >/= 2 more was 1.84 (1.12, 3.02) and CFS > 4 was 1.85 (1.08, 3.16). The ISAR tool >/= 2, had a sensitivity of 74.29 (95% CI = 62.44, 83.99) and specificity of 41.18 (95% CI = 35.90, 46.61) when used as a diagnostic tool for ED re-admission at one month. The CFS > 4 had a sensitivity of 71.43 (95% CI = 57.79, 82.70) and specificity of 45.23 (95% CI = 39.33, 51.23) for the same outcome.
Conclusion
The ISAR tool >/= 2 was the more sensitive at predicting ED reattendance at one month in comparison to the Clinical Frailty Scale. We would advocate using this tool in the ED setting to highlight those at greatest risk of adverse outcomes and those most likely to benefit from Comprehensive Geriatric Assessment.
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Affiliation(s)
- A Leahy
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - G Corey
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - A O’Neill
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - O Higginbotham
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - C Devlin
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - L Barry
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- School of Nursing and Midwifery , Faculty of Education and Health Sciences, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, , Limerick, Ireland
| | - N Cummins
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
| | - E Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - D Shchetkovsky
- Department of Emergency Medicine, University Hospital Limerick , Limerick, Ireland
| | - D Ryan
- Department of Emergency Medicine, University Hospital Limerick , Limerick, Ireland
| | - M O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - R Galvin
- School of Allied Health , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
- University of Limerick , Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, , Limerick, Ireland
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Mustafa W, O'Byrne R, Okpaje B, Gabr A, Ali B, Mohamed A, Cameron S, Leahy A, Fernandes L, Mannion M, Ryan P, Ryan S, Peters C, Shanahan E, Galvin R, O'Connor M. 233 BISPHOSPHONATES: ANOTHER COMPLEX DRUG TO PRESCRIBE. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.233] [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
Bisphosphonates provide effective treatment for osteoporosis. They accumulate a bone reservoir lasting for 3 years and beyond. The 2021 NICE guidelines recommend a medication review and a ‘drug holiday’ after 5 years of oral bisphosphonate therapy for low-fracture risk patients. Continuing treatment for high risk individuals is advised: age=/>75, previous hip or vertebral fracture, one or more fractures during treatment, recent DEXA scan with T score =/<−2.5, and/or current treatment with oral glucocorticoids. This retrospective audit aimed to assess compliance with NICE guidelines in a primary care setting.
Methods
Data were collected using the Health One online medical record system in an urban general practice. Inclusion criteria: all patients =/> 65 years old, prescribed oral bisphosphonate therapy for osteoporosis for >5 years. Exclusion criteria: deceased, did not attend clinic >1 year, patients on bisphosphonate treatment for conditions other than osteoporosis.
Results
137 patients with a history of bisphosphonate therapy were identified. 76 patients were on bisphosphonate treatment for greater than 5 years. Of the 76 patients, 33 were classified as low-fracture risk and appropriately commenced a drug holiday, while 22 correctly remained on bisphosphonates due to a high fracture risk. The remaining 21 patients inappropriately continued therapy without receiving a medication review, repeat DEXA or fracture-risk assessment.
Conclusion
One third of patients on bisphosphonates beyond 5 years were not assessed for a drug holiday. The aim of a bisphosphonate ‘drug holiday’ is to reduce poly-pharmacy and prevent rare but serious long-term adverse events (such as atypical fractures, osteonecrosis of the jaw, gastric cancer and atrial fibrillation). Factors which had an impact on inappropriate prescribing should be assessed. Incorporating computer-based prescribing alerts could support safe prescribing practices.
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Affiliation(s)
- W Mustafa
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - R O'Byrne
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - B Okpaje
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - A Gabr
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - B Ali
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - A Mohamed
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - S Cameron
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - A Leahy
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - L Fernandes
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - M Mannion
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - P Ryan
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - S Ryan
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - C Peters
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - E Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
| | - R Galvin
- School of Allied Health , HRI, , Limerick, Ireland
- University of Limerick , HRI, , Limerick, Ireland
| | - M O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick , Limerick, Ireland
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7
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Mannion M, Gabr A, Cunningham N, Leahy A, Paulose S, O'Brien I, Saleh A, Prendiville T, Okpaje B, Mohamed A, Ali B, Ryan R, Lyons D, Quinn C, Peters C, Shanahan E, Kennedy C, McManus J, Galvin R, O'Connor M. 235 THROMBOLYSIS DOSING AND WEIGHT ESTIMATION IN ACUTE STROKE: A SINGLE CENTRE AUDIT. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.235] [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
Stroke is a leading cause of death and disability. Thrombolysis with intravenous (IV) alteplase is the mainstay management of ischaemic stroke. It has a narrow therapeutic window with a high potential for adverse outcomes such as intracranial haemorrhage. The efficacy of alteplase is time and dose dependent with weight-based dosing. National clinical guidelines recommend a dose of 0.9 mg/kg, up to a maximum of 90 mg. (Irish Heart Foundation Council for Stroke 2015). In most hospitals in Ireland however, patients are not weighed prior to thrombolysis. Time pressure and lack of available suitable equipment are factors.
Methods
This retrospective clinical audit evaluated the dosing of alteplase, estimated and actual weight for a convenience sample of stroke thrombolysis patients treated between 2016–2020 at an Irish University Teaching Hospital.
Results
107 patients were audited (62 males, 45 females). Actual and estimated weights were available in 92/107. Weight was not documented (n = 15) due to severe stroke/palliative management (n = 6) or omission (n = 9). 21% (19/92) received the correct dose of 0.9 mg/kg. A further 54% (50/92) received a dose within the range of 0.81–0.99 mg/kg (±10%). 25% received a dose outside this range (> ± 10%). 11% (10/92) were under-thrombolysed and 14% (13/92) over-thrombolysed. 17/92 patients had an intracranial haemorrhage. 35% (n = 6/17) of patients who had an intracranial haemorrhage received a higher dose of thrombolysis (>10%).
Conclusion
A quarter of patients received inappropriate dosing of alteplase that was outside the range of ±10% of 0.9 mg/kg. While stroke thrombolysis must be completed urgently, an accurate weight should be determined to avoid errors in dosing. A process evaluation of stroke thrombolysis would provide information on how best to incorporate an objective means of weight measurement without delaying treatment.
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Affiliation(s)
- M Mannion
- Mid West Intern Network, UL Hospital Group , Limerick, Ireland
| | - A Gabr
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - N Cunningham
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - A Leahy
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - S Paulose
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - I O'Brien
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - A Saleh
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - T Prendiville
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - B Okpaje
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - A Mohamed
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - B Ali
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - R Ryan
- Planning , Performance & Business Information Department, , Limerick, Ireland
- University Hospital Limerick Group , Performance & Business Information Department, , Limerick, Ireland
| | - D Lyons
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - C Quinn
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - C Peters
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - E Shanahan
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - C Kennedy
- Department of Therapeutics & Clinical Pharmacology, Trinity College Dublin , Dublin, Ireland
| | - J McManus
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
| | - R Galvin
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - M O'Connor
- Department of Medicine , Division of Ageing and Therapeutics, , Limerick, Ireland
- University Hospital Limerick , Division of Ageing and Therapeutics, , Limerick, Ireland
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Antonenko A, Shanahan E, Slattery N, Leahy A, Gabr A, Condon J, Ahern E, O'Connor M. 246 IMPROVING LUMBAR PUNCTURE TECHNIQUE AMONG INTERN TRAINEES TO ENHANCE QUALITY OF CARE FOR PATIENTS. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.246] [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
Lumbar puncture (LP) is a common procedure performed on older adults in acute medical settings. A higher peri-procedural risk has been shown in older patients. Non-consultant doctors (NCHDs) often lack confidence and competence in performing LP. Simulation based training using task trainers has been shown to improve confidence, preplanning skills and technique.
Methods
A simulation based teaching session was developed in a university teaching hospital (training structure was adapted from the LP training guide published in MedEdPortal). Small group teaching (with 6–8 learners) was delivered to 25 NCHDs with no prior exposure or experience with lumbar puncture completion. Trainees completed one LP simulation without practice to mastery level. On-demand and post-performance feedback was delivered to learners. An assessment checklist was completed by the supervisor. Learners completed an anonymised quantitative and qualitative questionnaire using Qualtrics XM software at a later date to evaluate self-perceived teaching outcomes.
Results
16 doctors completed the questionnaire (64% response rate). 55% rated the LP workshop as a ‘strongly positive’ impact on their learning, while 18% indicated a ‘positive’ impact on a 5-point Likert scale. 19% of trainees reported they were ‘very comfortable’ at performing the procedure post training, with 56.5% ‘comfortable’ to perform an LP in their clinical practice. Qualitative learner feedback included ‘more hands on practice’ on the mannequin, ‘smaller groups for the workshops’ and ‘more practice tips’ during the simulation workshop.
Conclusion
This pilot study demonstrated interest and positive feedback for the LP simulation training from novice doctors with improved self-assessed confidence. Formal development of an LP simulation training curriculum is underway. The impact of this training on patient care should be assessed in practice.
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Affiliation(s)
- A Antonenko
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
| | - E Shanahan
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
| | - N Slattery
- Intern Network, University Hospital Limerick , Limerick, Ireland
| | - A Leahy
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
| | - A Gabr
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
| | - J Condon
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
| | - E Ahern
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
| | - M O'Connor
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
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Mohamed A, Gabr A, Cassarino M, Leahy A, Ali B, Okpaje B, Saleh A, Mannion M, Carroll I, Hayes C, Peters C, Shanahan E, O'Connor M, Galvin R. 236 PREDICTORS OF ADVERSE OUTCOMES IN OLDER PATIENTS DISCHARGED DIRECTLY FROM THE EMERGENCY DEPARTMENT. Age Ageing 2021. [DOI: 10.1093/ageing/afab219.236] [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
Over 40% of older patients are discharged directly from the Emergency Department (ED) and this cohort is at increased risk of adverse outcomes.
The purpose of this study was to explore the factors that predict future adverse outcomes in this cohort to inform practice, resource planning and policy.
Methods
A secondary analysis of the OPTIMEND, a single-centre, randomized-controlled trial was completed. OPTIMEND examined the effectiveness of an intervention by a team of Health and Social Care Professionals along with usual care and compared this to standard ED care alone (Dec 2018-May 2019). The inclusion criteria were adults aged 65 years and over presenting to the ED at a University Teaching Hospital with medical complaints and a Manchester Triage System category 2–5.
Results
220 patients were included (median age 79 years; 62% female). Median length of stay in ED was 5.5 hrs. 70 patients re-attended the ED within 6 months with 43 re-hospitalised within 6 months. 9 patients died within six months of discharge.
Multivariant logistic regression was completed. Age was the only independent predictor of mortality within six months of discharge {Odds Ratio (OR) 1.15, p = 0.044}. Past hospitalisation (<6 months) was associated with a lower likelihood of ED re-attendance, and rehospitalization within six months of discharge (OR: 0.452 p = 0.022; OR:0.442, p = 0.046; respectively). Clinical Frailty Score was associated with a significantly higher likelihood of rehospitalization (OR:1.48, p = 0.031) but not with ED revisits (OR: 1.235, p = 0.165).
Conclusion
Older people have a high ED re-attendance rate of 33% after an index visit with 20% hospitalized subsequently. Frailty is a significant predictor of rehospitalisation. Rapid and targeted intervention for frail patients who reattend the ED should be a priority for the integrated care program to enhance admission avoidance.
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Affiliation(s)
- A Mohamed
- Department of ageing and therapeutics , Limerick, Ireland
| | - A Gabr
- Department of ageing and therapeutics , Limerick, Ireland
| | - M Cassarino
- Department of ageing and therapeutics , Limerick, Ireland
| | - A Leahy
- Department of ageing and therapeutics , Limerick, Ireland
| | - B Ali
- Department of ageing and therapeutics , Limerick, Ireland
| | - B Okpaje
- Department of ageing and therapeutics , Limerick, Ireland
| | - A Saleh
- Department of ageing and therapeutics , Limerick, Ireland
| | - M Mannion
- Department of ageing and therapeutics , Limerick, Ireland
| | - I Carroll
- Department of ageing and therapeutics , Limerick, Ireland
| | - C Hayes
- Department of ageing and therapeutics , Limerick, Ireland
| | - C Peters
- Department of ageing and therapeutics , Limerick, Ireland
| | - E Shanahan
- Department of ageing and therapeutics , Limerick, Ireland
| | - M O'Connor
- Department of ageing and therapeutics , Limerick, Ireland
| | - R Galvin
- Department of ageing and therapeutics , Limerick, Ireland
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Okpaje B, Gabr A, Mohamed A, Teoh TK, Mustafa W, Saleh A, Ali B, Leahy A, Stapelton P, O'Connell N, Power L, O'Connell S, O'Brien A, Shanahan E, Peters C, Galvin R, O'Connor M. 234 THE IMPACT OF OLDER AGE ON CLINICAL OUTCOMES DURING THE FIRST WAVE OF THE COVID-19 PANDEMIC. Age Ageing 2021. [PMCID: PMC8690045 DOI: 10.1093/ageing/afab219.234] [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: 11/12/2022] Open
Abstract
Background Severe acute respiratory coronavirus 2 (SARS-CoV-2) was first recorded in Ireland in February 2020. Several studies have explored the association between age and SARS-CoV-2, showing that there were poorer outcomes in older people. Our objective was to evaluate the impact of age on outcomes such as hospital length of stay, mortality, and re-hospitalisation. Methods We performed a single-centre, retrospective observational cohort study, using an electronic microbiology database of recorded index admissions of SARS-CoV-2 positive patients aged 65 years and older during SARS-CoV-2 wave one (March 1st to May 31st 2020). PCR testing of nasopharyngeal and/or sputum samples was used to confirm positivity. Our clinical outcomes measured included hospital length of stay, mortality and re-admission rate within 6 months. Results 153 patients 65 years and above were admitted. The male to female ratio was 1.3 with 90% admitted medically. 79 patients were aged between 65–79 years; 84 patients ≥80 years; and 12 patients ≥90 years. Mortality was 25%, 31% and 42%, respectively. Median length of stay remained 14 days for ages 65–89 rising to 17.5 days for those ≥90 years. Re-hospitalisation rates at 6 months were similar for ages 65–79 and 89–89 years at 42% and 40%, respectively. One patient (14%) over 90 years was re-hospitalised. Conclusion SARS-CoV-2 has disproportionately impacted on general medical services treating older hospitalised people. In our centre, mortality for patients ≥65 years was 28.1% which compared favourably with 35.6% internationally as outlined by Victor et al. (2020) based on Spanish data. Treatment of SARS-CoV-2 is not futile in older patients with 58% of nonagenarians and 69% of octogenarians surviving, however re-hospitalisation rates are high at 40%. A targeted approach to discharge support via integrated care may ameliorate this.
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Affiliation(s)
- B Okpaje
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - A Gabr
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - A Mohamed
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - T K Teoh
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
| | - W Mustafa
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - A Saleh
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - B Ali
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - A Leahy
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - P Stapelton
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
| | - N O'Connell
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
| | - L Power
- Department of Microbiology, University Hospital Limerick, Limerick, Ireland
| | - S O'Connell
- Department of Infectious Diseases, University Hospital Limerick, Limerick, Ireland
| | - A O'Brien
- Department of Respiratory Medicine, University Hospital Limerick, Limerick, Ireland
| | - E Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - C Peters
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - R Galvin
- Department of Allied Health, University of Limerick, Limerick, Ireland
| | - M O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
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Leahy A, Corey G, O'Neill A, Higginbotham O, Devlin C, Barry L, Cummins N, Gabr A, Shanahan E, Shchetkovsky D, Ryan D, O'Connor M, Galvin R. 240 A COMPARISON OF THE ISAR AND THE CLINICAL FRAILTY SCALE TO PREDICT MORTALITY AND ED RE-ATTENDANCE IN OLDER ED ATTENDERS. Age Ageing 2021. [DOI: 10.1093/ageing/afab216.240] [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
Frailty Screening is one method by which we can risk stratify older adults to urgent assessment in the Emergency Department. The ISAR (Identification of Seniors at Risk) and Rockwood Clinical Frailty Scale (CFS) are two frailty screening tools. We assessed the validity of these tools at predicting adverse outcomes for older adults presenting to the Emergency Department.
Methods
This was a prospective cohort study. Patients over 65 were recruited, baseline demographics were obtained and a research nurse assessed them using both the CFS and ISAR. Patients were assessed by telephone interviews at one month and six months. The outcome measures assessed were mortality, ED re-attendance, hospital readmission, functional decline and institutionalisation.
Results
419 patients were recruited. 53.3% (223) were male with a median age of 76 (IQR = 10). At baseline, the median ISAR was 2 and CFS was 5. The mortality rate was 5.4% and the rate of ED re-attendance was 16.9% at one month. The relative risk of ED re-admission with an ISAR score ≥ 2 was 1.84 (1.12, 3.02) and CFS > 4 was 1.85 (1.08, 3.16). The ISAR tool ≥2 had a sensitivity of 74% (95% CI = 62.44, 83.99) and specificity of 41% (95% CI = 35.90, 46.61) when used as a diagnostic tool for ED re-admission at one month. The CFS > 4 had a sensitivity of 71% (95% CI = 57.79, 82.70) and specificity of 45% (95% CI = 39.33, 51.23) for ED re-attendance.
Conclusion
The ISAR tool ≥2 was more sensitive at predicting ED reattendance at one month in comparison to the CFS. We advocate to use this tool in the ED setting to highlight those at greatest risk of adverse outcomes and those most likely to benefit from Comprehensive Geriatric Assessment.
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Affiliation(s)
- A Leahy
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - G Corey
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - A O'Neill
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - O Higginbotham
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - C Devlin
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - L Barry
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - N Cummins
- School of Allied Health, University of Limerick , Limerick, Ireland
| | - A Gabr
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
| | - E Shanahan
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
| | | | - D Ryan
- Department of Emergency Medicine , Limerick, Ireland
| | - M O'Connor
- Department of Therapeutics and Ageing, University Hospital Limerick , Limerick, Ireland
| | - R Galvin
- School of Allied Health , HRI, , Limerick, Ireland
- University of Limerick , HRI, , Limerick, Ireland
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12
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Nezgovorova V, Ferretti CJ, Taylor BP, Shanahan E, Uzunova G, Hong K, Devinsky O, Hollander E. Potential of cannabinoids as treatments for autism spectrum disorders. J Psychiatr Res 2021; 137:194-201. [PMID: 33689997 DOI: 10.1016/j.jpsychires.2021.02.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/27/2021] [Accepted: 02/22/2021] [Indexed: 01/04/2023]
Abstract
Current treatments for autism spectrum disorders (ASD) are limited in efficacy and are often associated with substantial side effects. These medications typically ameliorate problem behaviors associated with ASD, but do not target core symptom domains. As a result, there is a significant amount of research underway for development of novel experimental therapeutics. Endocannabinoids are arachidonic acid-derived lipid neuromodulators, which, in combination with their receptors and associated metabolic enzymes, constitute the endocannabinoid (EC) system. Cannabinoid signaling may be involved in the social impairment and repetitive behaviors observed in those with ASD. In this review, we discuss a possible role of the EC system in excitatory-inhibitory (E-I) imbalance and immune dysregulation in ASD. Novel treatments for the core symptom domains of ASD are needed and phytocannabinoids could be useful experimental therapeutics for core symptoms and associated domains.
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Affiliation(s)
- V Nezgovorova
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - C J Ferretti
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - B P Taylor
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - E Shanahan
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - G Uzunova
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - K Hong
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA
| | - O Devinsky
- New York University Comprehensive Epilepsy Center, New York, NY, USA
| | - E Hollander
- Autism and Obsessive-Compulsive Spectrum Program, Psychiatry Research Institute at Montefiore- Einstein (PRIME), Albert Einstein College of Medicine, Bronx, New York, USA.
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Shanahan E, Carew S, Costelloe A, Sheehy T, Kiernan T, Peters C, Lyons D, O’Connor M. 108ABNORMAL DIURNAL BLOOD PRESSURE VARIABILITY IN PATIENTS WITH RECENT DELIRIUM. Age Ageing 2019. [DOI: 10.1093/ageing/afy204.01] [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: 11/14/2022] Open
Affiliation(s)
- E Shanahan
- University Hospital Limerick
- University of Limerick
| | - S Carew
- University Hospital Limerick
| | | | | | - T Kiernan
- University Hospital Limerick
- University of Limerick
| | | | - D Lyons
- University Hospital Limerick
- University of Limerick
| | - M O’Connor
- University Hospital Limerick
- University of Limerick
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14
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Halverson G, Shanahan E, Santiago I, Mabile R, Thurrell T, Strupp A, Wolf C, Spruell P, Moulds M. The First Reported Case of Anti-Do^b Causing an Acute Hemolytic Transfusion Reaction. Vox Sang 2017. [DOI: 10.1159/000462510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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15
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Bhatt N, Sheridan G, Connolly M, Kelly S, Gillis A, Conlon K, Lane S, Shanahan E, Ridgway P. Postoperative exercise training is associated with reduced respiratory infection rates and early discharge: A case-control study. Surgeon 2017; 15:139-146. [DOI: 10.1016/j.surge.2015.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 11/24/2022]
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16
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Crickmer M, Johnson M, Shanahan E, O'Shea B. Are Adults Attending GPs Able to Check Their Own Weight? Ir Med J 2016; 109:457. [PMID: 28124856] [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: 06/06/2023]
Abstract
Studies have shown self-weighing behaviour is associated with weight loss and maintenance of previous losses. In this cross-sectional survey of 151 patients, 98 (65.0%) participants were overweight or obese, and 59 (31.9%) participants did not self-weigh. Healthcare teams should advise patients on weighing practices to control obesity.
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Affiliation(s)
- M Crickmer
- University of Limerick Graduate Entry Medical School
| | - M Johnson
- University of Limerick Graduate Entry Medical School
| | - E Shanahan
- University of Limerick Graduate Entry Medical School
- Farranfore Medical Centre, Co Kerry
| | - B O'Shea
- Bridge Medical Centre, Station Rd, Newbridge, Co. Kildare
- Department of Public Health and Primary Care, Trinity College of Dublin
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17
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Shanahan E, Henderson C, Butler A, Lenehan B, Sheehy T, Costelloe A, Carew S, Peters C, O'Connor M, Lyons D, Ryan J. Dedicated Orthogeriatric Service Saves the HSE a Million Euro. Ir Med J 2016; 109:385. [PMID: 27685479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hip fracture is common in older adults and is associated with high morbidity, mortality and significant health care costs. A pilot orthogeriatrics service was established in an acute hospital. We aimed to establish the cost effectiveness of this service. Length of hospital stay, discharge destination and rehabilitation requirements were analysed for a one year period and compared to patients who received usual care prior to the service. We calculated the costs incurred and savings produced by the orthogeriatric service. Median length of stay was reduced by 3 days (p < 0.001) saving €266,976. There was a 19% reduction in rehabilitation requirements saving €192,600. Median rehabilitation length of stay was reduced by 6.5 days saving €171,093. Reductions in long term care requirements led to savings of €10,934 per week. Costs to establish such a service amount to €171,564. The introduction of this service led to improved patient outcomes in a cost effective manner.
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Affiliation(s)
- E Shanahan
- Department of Geriatric Medicine, University Hospital Limerick, Dooradoyle, Co Limerick
| | - C Henderson
- Department of Geriatric Medicine, University Hospital Limerick, Dooradoyle, Co Limerick
| | - A Butler
- Department of Orthopaedics, University Hospital Limerick, Dooradoyle, Co Limerick
| | - B Lenehan
- Department of Orthopaedics, University Hospital Limerick, Dooradoyle, Co Limerick
| | - T Sheehy
- Department of Clinical Age Assessment, University Hospital Limerick, Dooradoyle, Co Limerick
| | - A Costelloe
- Department of Clinical Age Assessment, University Hospital Limerick, Dooradoyle, Co Limerick
| | - S Carew
- Department of Clinical Age Assessment, University Hospital Limerick, Dooradoyle, Co Limerick
| | - C Peters
- Department of Geriatric Medicine, University Hospital Limerick, Dooradoyle, Co Limerick
| | - M O'Connor
- Department of Geriatric Medicine, University Hospital Limerick, Dooradoyle, Co Limerick
| | - D Lyons
- Department of Geriatric Medicine, University Hospital Limerick, Dooradoyle, Co Limerick
| | - J Ryan
- Department of Geriatric Medicine, University Hospital Limerick, Dooradoyle, Co Limerick
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18
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O'Conor J, Shanahan E, Cullen W, O'Gorman C. Paediatrics and Child Health in General Practice: the trainees' perspective. Ir Med J 2016; 109:366. [PMID: 27685699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- J O'Conor
- Convent Street Clinic, Listowel, Co Kerry
| | - E Shanahan
- Farranfore Medical Centre, Killarney, Co Kerry
| | - W Cullen
- Graduate Entry Medical School, University of Limerick, Limerick
| | - C O'Gorman
- Graduate Entry Medical School, University of Limerick, Limerick
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19
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Bhatt N, Sheridan G, Connolly M, Kelly S, Gillis A, Conlon K, Lane S, Shanahan E, Ridgway PF. Postoperative exercise training is associated with early discharge: A case-control study. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.04.003] [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: 11/27/2022]
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20
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Shanahan E, Keenan R, Cunningham N, O'Malley G, O'Connor M, Lyons D, Peters C. Acute stroke unit improves stroke management-four years on from INASC. Ir Med J 2015; 108:51-53. [PMID: 25803957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Irish Heart Foundation carried out the Irish National Audit of Stroke Care (INASC) in 2008. Management practices were significantly poorer than those in the UK Sentinel audits. Since then an acute stroke unit has been established in University Hospital Limerick. A stroke database was established. 12 key indicators of stroke management audited by INASC were identified. Results were compared to those in INASC. 89 stroke patients were admitted. 8 of the 12 key indicators scored significantly better than in INASC. 92.5% had a brain scan within 24hrs (INASC-40%, p = < 0.001). 100% of ischaemic strokes received anti-thrombotics (INASC-85%, p = 0.001). 94% had rehab goals agreed by MDT (22% in INASC p = 0.0000). 55% were treated in stroke unit (2% in INASC, p = 0.0000). MDT input improved with regard to physiotherapy (87% vs 43% in INASC, p = < 0.02) and SALT (74% vs 26%, p = < 0.02). Stroke management has significantly improved from 2008, however some deficiencies remain.
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Blase J, DeClerque J, Israel D, Kanotra S, Perry J, Shanahan E, Wilburn A. A surveillance pilot study of unintended pregnancy and contraceptive failure in three Kentucky Title X family planning clinics. Contraception 2012. [DOI: 10.1016/j.contraception.2012.04.020] [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: 11/25/2022]
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22
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Horgan S, Crowley J, Feely J, McAdam B, Shanahan E, Vaughan C. Prevalence of dyslipidaemia in statin-treated patients in Ireland: Irish results of the DYSlipidaemia International Study (DYSIS). Ir J Med Sci 2011; 180:343-9. [PMID: 21400212 DOI: 10.1007/s11845-011-0702-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Accepted: 02/26/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Statins are proven to reduce cardiovascular risk; however, substantial risk remains in patients on statin therapy. Persisting dyslipidaemia is likely to play a contributory role. AIM To assess the prevalence of persisting lipid abnormalities in patients treated with statins. METHODS DYSIS was a cross-sectional study of 22,063 patients in Europe and Canada. 900 Irish patients participated. All patients were ≥ 45 years and treated with statins for ≥ 3 months. Data were collected from the patients' records. ESC guidelines were used to classify risk and to define lipid levels. RESULTS Mean age was 66.1 years with women representing 40.7%. 78.6% were high-risk patients; that is 53.9% with cardiovascular disease (CVD), 20.1% with diabetes and 15.9% with a SCORE risk ≥ 5%. Total cholesterol was not at goal in 34.4% of all patients. LDL-C was elevated in 30.8% of all patients and in 30% at high risk. Low HDL-C was found in 34.7% of high-risk patients compared to 16.9% of patients with an ESC score <5%. In diabetics without CVD, low HDL-C and elevated TGs were found in 46 and 44.3%, respectively. CONCLUSIONS Despite statin therapy, a significant number of patients have persistent dyslipidaemia. While LDL-C targets are suboptimal in three out of ten patients, the prevalence of low HDL-C and high TGs in high-risk patients is greater than one in three. A more integrated approach to the treatment of patients with dyslipidaemia is warranted. Clinical trials are needed to assess the impact of therapies that raise HDL-C and lower elevated TGs.
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Affiliation(s)
- S Horgan
- Adelaide and Meath Hospital, Incorporating the National Children's Hospital, Dublin, Ireland.
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Foley E, Mc Dermott TED, Shanahan E, Phelan D. Transient isolated lingual nerve neuropraxia associated with general anaesthesia and laryngeal mask use: two case reports and a review of the literature. Ir J Med Sci 2009; 179:297-300. [PMID: 19437092 DOI: 10.1007/s11845-009-0347-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 04/16/2009] [Indexed: 12/01/2022]
Abstract
BACKGROUND Transient, isolated lingual nerve neuropraxia is a rare complication following general anaesthesia. Reports implicate airway manipulation and we describe two new cases associated with laryngeal mask airway (LMA) and review the related English language literature. RESULTS Unilateral numbness and loss of taste on the anterior tongue were the characteristic symptoms. Collation of literature data (median and range) with that from the new cases showed: patient age was 38 (20-61) years and female to male ratio was 1.2:1. Surgery time was 62.5 (20-150) min and symptom duration was 28 (7-120) days. CONCLUSION Lingual neuropraxias reported have been transient and patients can be advised, despite disturbing symptoms, that recovery is anticipated in about 1 month. Lingual neuropraxia reports are becoming more frequent, perhaps associated with increasing LMA use. Research is recommended as modification to LMA cuff volume, pressure and/or position within the oral cavity might ameliorate the entity.
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Affiliation(s)
- E Foley
- Department of Anaesthesia and Intensive Care, Mater Hospital, Dublin, Ireland.
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Manning P, Greally P, Shanahan E. Asthma control and management: a patient's perspective. Ir Med J 2005; 98:231-2, 234-5. [PMID: 16445140] [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: 05/06/2023]
Abstract
Irish asthma guidelines, published in 2000, are based on the Global Initiative for Asthma (GINA) international asthma management guidelines and provide recommendations for optimal asthma management and control. Using the same methodology as employed in the Asthma Insights and Reality in Europe (AIRE) survey, which assessed whether specific goals of asthma management based on GINA were being realised, 400 patients with current asthma in Ireland were interviewed in the Asthma Insights and Reality in Ireland (AIRI) survey to determine their healthcare utilisation, symptom severity, activity limitations and level of asthma control. Of those surveyed, acute services were utilised by a significant number of respondents. Over the previous year, 27% had either an emergency visit to the hospital or their general practitioner (GP) and 7% were hospitalised for asthma. In terms of asthma control, 19% experienced sleep disturbance at least once a week, 29% missed work or school and 37% of respondents experienced symptoms during physical activity over the previous 4-week period. Based on these findings, the level of asthma control and asthma management in Ireland falls short of recommended national and international asthma guidelines.
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Affiliation(s)
- P Manning
- Medical Committee of Asthma Society of Ireland, 26 Mountjoy Square, Dublin 1.
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Affiliation(s)
- J G Millar
- Department of Pediatrics, Cornell University Medical College, New York, New York, USA
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Carson KD, Grimes SB, McGinley JM, Thornton MT, Mulhall J, Bourke AM, McCrory C, Marsh B, Hone R, Phelan D, White M, Fabry J, Hughes D, Carson K, Donnelly M, Shanahan E, Fitzpatrick GJ, Bourke M, Warde D, Buggy D, Hughes N, Taylor A, Dowd N, Markham T, Blunnie W, Nicholson G, O’Leary E, Cunningham AJ, Dwyer R, McMechan S, Cullen C, Dempsey G, Wright G, MacKenzie G, Anderson J, Adgey J, Walsh M, O’Callaghan P, Graham I, O’Hare JA, Geoghegan M, Iman N, Shah P, Chander R, Lavin F, Daly K, Johnston PW, Imam Z, Adgey AAJ, Rusk RA, Richardson SG, Hale A, Kinsella BM, FitzGerald GA, King G, Crean P, Gearty G, Cawley T, Docherty JR, Geraghty J, Osborne H, Upton J, D’Arcy G, Stinson J, Cooke T, Colgan MP, Hall M, Tyrrell J, Gaffney K, Grouden M, Moore DJ, Shanik G, Feely J, Delanty N, Reilly M, Lawson JA, Fitzgerald DJ, Reilly MP, McAdam BF, Bergin C, Walshe MJ, Herity NA, Allen JD, Silke B, Singh HP, O’Neill S, Hargrove M, Coleman E, Shorten E, Aherne T, Kelly BE, Hill DH, McIlrath E, Morrow BC, Lavery GG, Blackwood B, Fee JPH, Kevin L, Doran M, Tansey D, Boylan I, McShane AJ, O’Reilly G, Tuohy B, Grainger P, Larkin T, Mahady J, Malone J, Condon C, Donoghue T, O’Leary J, Lyons JF, Tay YK, Tham SN, Khoo Tan HS, Gibson G, O’Grady A, Leader M, Walshe J, Carmody M, Donohoe J, Murphy GM, O’Connor W, Barnes L, Watson R, Darby C, O’Moore R, Mulcahy F, O’Toole E, O’Briain DS, Young MM, Buckley D, Healy E, Rogers S, Ni Scannlain N, McKenna MJ, McBrinn Y, Murray B, Freaney R, Barrett E, Razza Q, Abuaisha F, Powell D, Murray TM, Powell AM, O’Mongain E, O’Neill J, Kernan RP, O’Connor P, Clarke D, Fearon U, Cunningham SK, McKenna TJ, Hayes F, Heffernan A, Sheahan K, Harper R, Johnston GD, Atkinson AB, Sheridan B, Bell PM, Heaney AP, Loughrey G, McCance DR, Hadden DR, Kennedy AL, McNamara P, O’Shaughnessy C, Loughrey HC, Reid I, Teahan S, Caldwell M, Walsh TN, McSweeney J, Hennessy TP, Caldwell MTP, Byrne PJ, Hennessy TPJ, El-Magbri AA, Stevens FM, O’Sullivan R, McCarthy CF, Laundon J, Heneghan MA, Kearns M, Goulding J, Egan EL, McMahon BP, Hegarty F, Malone JF, Merriman R, MacMathuna P, Crowe J, Lennon J, White P, Clarke E, Prabhakar MC, Ryan E, Graham D, Yeoh PL, Kelly P, McKeogh D, O’Keane C, Kitching A, Mulligan E, Gorey TF, Mahmud N, O’Connell M, Goggins M, Keeling PWN, Weir DG, Kelleher D, McDonald GSA, Maguire D, O’Sullivan G, Harvey B, Cherukuri A, McGrath JP, Timon C, Lawlor P, O’Shea J, Buckley M, English L, Walsh T, O’Morain C, Lavelle SM, Kanagaratnam B, Harding B, Murphy B, Kavanagh J, Kerr D, Lavelle E, O’Gorman T, Liston S, Fitzpatrick C, Fitzpatrick P, Turner M, Murphy AW, Cafferty D, Dowling J, Bury G, Kaf Al-Ghazal S, Zimmermann E, O’Donoghue J, McCann J, Sheehan C, Boissel L, Lynch M, Cryan B, Fanning S, O’Meara D, Fennell J, Byrne PM, Lyons D, Mulcahy R, Pooransingh A, Walsh JB, Coakley D, O’Neill D, Ryall N, Connolly P, Namushi R, Lawler M, Locasciulli A, Bacigalupo A, Humphries P, McCann SR, Pamphilon D, Reidy M, Madden M, Finch T, Borton M, Barnes CA, Lawlor SE, Gardiner N, Egan LJ, Orren A, Doherty J, Curran C, O’Hanlon D, Kent P, Kerin M, Maher D, Given HF, Lynch S, McManus R, O’Farrelly C, Madrigal L, Feighery C, O’Donoghue D, Whelan CA, Rea IM, Stewart M, Campbell P, Alexander HD, Crockard AD, Morris TCM, Maguire H, Davidson F, Kaminski GZ, Butler K, Hillary IB, Parfrey NA, Crowley B, McCreary C, Keane C, O’Reilly M, Goh J, Kennedy M, Fitzgerald M, Scott T, Murphy S, Hildebrand J, Holliman R, Smith C, Kengasu K, Riain UN, Cormican M, Flynn J, Glennon M, Smith T, Whyte D, Keane CT, Barry T, Noone D, Maher M, Dawson M, Gilmartin JJ, Gannon F, Eljamel MS, Allcut D, Pidgeon CN, Phillips J, Rawluk D, Young S, Toland J, Deveney AM, Waddington JL, O’Brien DP, Hickey A, Maguire E, Phillips JP, Al-Ansari N, Cunney R, Smyth E, Sharif S, Eljamel M, Pidgeon C, Maguire EA, Burke ET, Staunton H, O’Riordan JI, Hutchinson M, Norton M, McGeeney B, O’Connor M, Redmond JMT, Feely S, Boyle G, McAuliffe F, Foley M, Kelehan P, Murphy J, Greene RA, Higgins J, Darling M, Byrne P, Kondaveeti U, Gordon AC, Hennelly B, Woods T, Harrison RF, Geary M, Sutherst JR, Turner MJ, DeLancey JOL, Donnelly VS, O’Connell PR, O’Herlihy C, Barry-Kinsella C, Sharma SC, Drury L, Lewis S, Stratton J, Ni Scanaill S, Stuart B, Hickey K, Coulter-Smith S, Moloney A, Robson MS, Murphy M, Keane D, Stronge J, Boylan P, Gonsalves R, Blankson S, McGuinness E, Sheppard B, Bonnar J, MacDonagh-White CM, Kelleher CC, Newell J, White O, Young Y, Hallahan C, Carroll K, Tipton K, McDermott EW, Reynolds JV, Nolan N, McCann A, Rafferty R, Sweeney P, Carney D, O’Higgins NJ, Duffy MJ, Grimes H, Gallagher S, O’Hanlon DM, Strattan J, Lenehan P, Robson M, Cusack YA, O’Riordain D, Mercer PM, Smyth PPA, Gallagher HJ, Moule B, Cooke TG, McArdle CS, Burke C, Vance A, Saidtéar C, Early A, Eustace P, Maguire L, Cullinane ABP, Prosser ES, Coca-Prados M, Harvey BJ, Saidléar C, Orwa S, Fitzsimons RB, Bradley O, Hogan M, Zimmerman L, Wang J, Kuliszewski M, Liu J, Post M, Premkumar, Conran MJ, Nolan G, Duff D, Oslizlok P, Denham B, O’Connell PA, Birthistle K, Hitchcock R, Carrington D, Calvert S, Holmes K, Smith DF, Hetherton AM, Mott MG, Oakhill A, Foreman N, Foot A, Dixon J, Walsh S, Mortimer G, O’Sullivan C, Kilgallen CM, Sweeney EC, Brayden DJ, Kelly JG, McCormack PME, Hayes C, Johnson Z, Dack P, Hosseini J, O’Connell T, Hemeryck L, Condren L, McCormack P, McAdam B, Lawson J, Keimowitz R, O’Leary A, Pilkington R, Adebayo GI, Gaffney P, McGettigan P, McManus J, O’Shea B, Wen Y, Killalea S, Golden J, Swanwick G, Clare AW, Mulvany F, Byrne M, O’Callaghan E, Byrne H, Cannon N, Kinsella T, Cassidy B, Shepard N, Horgan R, Larkin C, Cotter D, Coffey VP, Sham PC, Murray LH, Lane A, Kinsella A, Murphy P, Colgan K, Sloan D, Gilligan P, McEnri J, Ennis JT, Stack J, Corcoran E, Walsh D, Thornton L, Temperley I, Lawlor E, Tobin A, Hillary I, Nelson HG, Martin M, Ryan FM, Christie MA, Murray D, Keane E, Holmes E, Hollyer J, Strangeways J, Foster P, Stanwell-Smith R, Griffin E, Conlon T, Hayes E, Clarke T, Fogarty J, Moloney AC, Killeen P, Farrell S, Clancy L, Hynes M, Conlon C, Foley-Nolan C, Shelley E, Collins C, McNamara E, Hayes B, Creamer E, LaFoy M, Costigan P, Al fnAnsari N, Cunney RJ, Smyth EG, Johnson H, McQuoid G, Gilmer B, Browne G, Keogh JAB, Jefferson A, Smith M, Hennessy S, Burke CM, Sreenan S, Power CK, Pathmakanthan S, Poulter LW, Chan A, Sheehan M, Maguire M, O’Connor CM, FitzGerald MX, Southey A, Costello CM, McQuaid K, Urbach V, Thomas S, Horwitz ER, Mulherin D, FitzGerald O, Bresnihan B, Kirk G, Veale DJ, Belch JJF, Mofidi A, Mofidi R, Quigley C, McLaren M, Veale D, D’Arrigo C, Couto JC, Woof J, Greer M, Cree I, Belch J, Hone S, Fenton J, Hamilton S, McShane D. National Scientific Medical Meeting 1994 Abstracts. Ir J Med Sci 1994. [DOI: 10.1007/bf02943102] [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: 10/21/2022]
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Halverson G, Shanahan E, Santiago I, Mabile R, Thurrell T, Strupp AM, Wolf CF, Spruell P, Moulds MK. The first reported case of anti-Dob causing an acute hemolytic transfusion reaction. Vox Sang 1994; 66:206-9. [PMID: 8036791 DOI: 10.1111/j.1423-0410.1994.tb00311.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [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: 01/28/2023]
Abstract
The antibodies of the Dombrock blood group system have only rarely been encountered in transfusion practice, and anti-Dob has not previously been implicated in an acute hemolytic transfusion reaction. We have encountered the first such case involving a chronically transfused black female with hemoglobin SS disease and multiple antibodies in her serum. During a previous admission for sickle cell crisis, the patient received 3 units of compatible blood with no untoward effects. Serum obtained 21 days later contained, in addition to the known antibodies, anti-S plus an unidentified antibody showing characteristics of HTLA. Blood lacking the E, K1, Fy(a), Jk(b) and S antigens was obtained, and 2 least incompatible units were transfused. While administering the second unit, the patient complained of fever and low back pain, and hemoglobinemia was detected. Anti-Dob was identified in the post-reaction samples by absorption-elution tests, and the patient was confirmed to be Do(a+b-). The first unit transfused during this hemolytic episode tested Do (b+). This case, and a similar case involving anti-Doa reported in 1986, strengthens the belief that Dombrock antibodies are clinically significant and illustrates the need for their differentiation, prior to transfusion from less clinically significant HTLA antibodies.
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Affiliation(s)
- G Halverson
- Blood Bank and Transfusion Service, New York Hospital-Cornell Medical Center, New York, NY 10021
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