St James's Hospital Research Articles

Design, build and implementation of a solution for prescribing, monitoring and administration of insulin within an inpatient electronic patient record - the st james's hospital experience

Design, build and implementation of a solution for prescribing, monitoring and administration of insulin within an inpatient electronic patient record - the st james's hospital experience

Assessing our adherence to bone protection standards in metastatic prostate cancer in the largest Irish center: Are we falling behind?

e24145 Background: Prostate cancer ranks as the second most prevalent cancer in men globally, often necessitating androgen deprivation therapy (ADT) as part of its treatment. While ADT effectively diminishes testosterone levels, a vital factor in prostate cancer cell growth, it concurrently poses a notable side effect – an accelerated rate of bone loss. This heightened bone loss elevates the vulnerability of patients to osteoporosis and fractures. The optimization of bone health entails early identification of patients susceptible to osteoporosis and fractures, the implementation of preventative measures, and prompt interventions to mitigate bone loss and fracture risks. Methods: The audit aims to evaluate adherence to established guidelines, such as those outlined by the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO), concerning the assessment and optimization of bone health. A retrospective analysis was performed on the medical records of prostate cancer patients who underwent Androgen Deprivation Therapy (ADT) at St James Hospital in Dublin. Pertinent data, encompassing patient demographics, duration of ADT, documentation of bone health assessment, frequency of Bone Mineral Density (BMD) testing, utilization of preventive measures (e.g., calcium and vitamin D supplementation), and any interventions for bone health optimization (such as bisphosphonate therapy and denosumab), was systematically collected. Results: A comprehensive review encompassed 57 patients, revealing that 38 patients (67%) exhibited metastatic disease. Among them, 42 patients (74%) presented with castrate-sensitive disease. Out of the total, 24 patients (42%) underwent a baseline Dual-Energy X-ray Absorptiometry (DEXA) scan. Results indicated that 12 patients were diagnosed with Osteoporosis, 9 with Osteopenia, and 3 with normal Bone Mineral Density (BMD). At baseline, 26 patients (46%) initiated Calcium and Vitamin D supplements, while 12 patients (21%) commenced Bisphosphonates/Denosumab based on DEXA scan outcomes. Notably, 8 (14%) patients experienced a skeletal/bone-related event which is much higher than reported in literature. Conclusions: The findings are intended to guide healthcare professionals in optimizing bone health strategies, with the ultimate goal of improving patients' quality of life and minimizing the risk of fractures and related complications. Identified areas for improvement in clinical practices will be addressed by implementing recommended recommendations, aiming to enhance patient care, decrease the risk of osteoporosis and fractures, and overall improve patient outcomes. A re-audit is planned to monitor ongoing adherence to guidelines and assess the impact of interventions implemented as a result of this study.

Assessing the relevance and requirement of a prostate cancer passport: A patient-centric survey.

e23037 Background: Prostate cancer, a prevalent malignancy among men worldwide, necessitates a multifaceted approach to its management, encompassing diagnosis, treatment, and post-treatment care. The absence of a consolidated and accessible cancer information for prostate cancer patients prompts an exploration into the necessity and potential benefits of a dedicated Prostate Cancer Passport. This survey-based study seeks to elucidate patient perspectives and assess the demand for it. Methods: We Surveyed prostate cancer patients attending St James Hospital Medical Oncology OPD and day ward. The survey methodology integrated a diverse cohort of individuals representing varying demographics, encompassing age groups and socio-economic backgrounds. Questions were structured to gauge patient awareness, preferences, and perceived benefits associated with the adoption of a Prostate Passport. The survey was structured to gauge patient awareness levels regarding existing health record systems, preferences for a specialized Prostate Cancer Passport, and anticipated benefits associated with its implementation Furthermore, the survey seeked to elucidate potential concerns, barriers to adoption, and the anticipated impact on patient-provider interactions. Results: The survey’s findings indicate a significant interest among participants in the implementation of a specialized platform like the Prostate Passport, with more than 65% expressing enthusiasm about its potential benefits in improving healthcare management. However, 20% of patients reported not receiving any prostate cancer information booklet from their healthcare providers. Additionally, 30% of participants expressed dissatisfaction with communication with their medical team, while over 40% lacked confidence in their understanding of prostate cancer. Nevertheless, concerns related to data security were raised by more than 25% of patients, and approximately 23% identified potential barriers to adoption, such as interoperability with existing healthcare systems and ease of access across different healthcare settings. However, concerns regarding data security were highlighted by over 25% of patients and about 23% of patients identified interoperability with existing healthcare systems, and ease of access across various healthcare settings as potential barriers to adoption. Conclusions: The survey outcomes offer valuable perspectives on the distinct requirements and preferences of individuals facing prostate cancer. This data is crucial for customizing the Prostate Cancer Passport's design and functionalities to effectively cater to those needs. Our initial iteration of the prostate cancer passport has been completed and will be distributed to our oncology patients in the upcoming week. We plan to conduct a feedback survey in six months to gather insights and further enhance the passport based on user experiences.

Pride in Death.

Background: While all ageing populations share common concerns as they plan for old age and end of life, many older LGBTQIA+ people face significant additional challenges.
 Prevailing social, religious, and cultural attitudes which existed in Ireland until relatively recently, mean older LGBTQIA+ people grew up in society where asserting their identity often led to exclusion and isolation.
 Planning for end of life can make things easier but these factors create barriers for older LGBTQIA+ people who may fear that asserting their identity will lead to discrimination or neglect.
 Research has demonstrated while many LGBTQIA+ people feel uncomfortable disclosing their sexual orientation to health care professionals and allied health staff they are also considerably more likely to rely on formal support services as they get older due to diminished support networks in comparison to their heterosexual peers.
 During Palliative Care Week we encourage people to have tender conversations about death, dying and bereavement and what it means to them. Therefore we sought to engage and have honest conversations with the LGBTQIA+ community at a death cafe type event, to understand key issues for the community, relating to death and dying, and what really matters to them in planning ahead for their end of life care. 
 Who Was Engaged: AIIHPC leads Palliative Care Week and engaged with LGBT Ireland as the gateway organisation to the LGBTQIA+ community. We also engaged with the Irish Hospice Foundation (IHF) who has expertise in advance care planning. Liz Gleeson from Shapes of Grief also joined as a facilitator given her expertise on bereavement. Bettina Korn also joined as a facilitator given her expertise as an end of life coordinator at St James Hospital and an LGBT Champion.
 Impact:
 - LGBTQIA+ Bereavement Support Groups are needed in the Republic of Ireland. LGBTQIA+ people suffer from ambiguous and complicated grief, making the creation of specific bereavement support groups essential.
 - Intergenerational Networks. Younger and older LGBTQIA+ people want connect with one another. Currently spaces outside pubs are lacking.
 - Creation of LGBTQIA+ Reference Group to co-design health information resources. LGBTQIA+ people do not see themselves reflected in the health information provided and are thus, less likely to inform themselves.
 - Need for creativity around funeral planning outside of religious rituals that mutes the voice of the individual.
 Learning for an International Audience: By having honest conversations with people from different communities, we gain insight into their real needs. Sounds simple enough but open and honest conversations can only take place in a safe space where trust exists. Trust can be gained by working with gateway organisations of underrepresented communities, to ensure services are co-designed with the true individual at heart.
 Next Steps:
 - LGBTQIA+ death cafe being held on 8th of December in Dublin.
 - Training of IHF Bereavement Support Line by LGBT Ireland
 - Engaging with other gateway organisations of underrepresented communities such as homeless, refugees, people with disabilities, amongst others to provide a safe space for conversations to take place.

Development and Initial Implementation of a Clinical Monitoring Strategy in a Non-regulated Trial: a research note from the ReStOre II Trial.

Data and Safety Monitoring is integral to quality assurance of clinical trials. Although monitoring is a core legal component of regulated clinical trials, non-regulated trials are not mandated to incorporate monitoring. Consequently, the monitoring process has been underutilised and underreported in this setting. This research report outlines the development and plans for implementing a bespoke Clinical Monitoring Strategy within the ' Rehabilitation Strategies Following Oesophagogastric and Hepatopancreaticobiliary Cancer (ReStOre II) Trial', a non-regulated trial comparing a 12-week multidisciplinary programme of rehabilitation to standard care in a cohort of 120 cancer survivors. This research note provides a detailed overview of the ReStOre II Clinical Monitoring Strategy and describes the development of the strategy pre and post awarding of the grant. The strategy consists of the establishment and implementation of a comprehensive trial governance structure, inclusive of a Trial Management Group, Trial Steering Committee Meeting, and Independent Data Monitoring Committee. In addition, external trial monitoring by the Clinical Research Facility at St James's Hospital. Three monitoring visits will be conducted during the trial; i) site initiation visit, ii) interim monitoring visit, and iii) close our visit. The Clinical Monitoring Strategy has been finalised and is currently being implemented within the ReStOre II Trial. Two site initiation visits and one interim monitoring visit have been completed to date. This research note provides a template for implementation of a Clinical Monitoring Strategy in a non-regulated clinical trial. ReStOre II Trial: https://clinicaltrials.gov/ct2/show/NCT03958019.

Psychosocial impact of being diagnosed with mild cognitive impairment: patient and carer perspective.

Mild cognitive impairment (MCI) may represent an intermediate, prodromal phase of dementia. Although persons with MCI (PwMCI) are able to function independently, they often experience reduced ability to carry out their usual activities. This can result in social, emotional and functional challenges. To explore the understanding and psychosocial impact of receiving a diagnosis of MCI on patients and carers. A cross-sectional cohort study was conducted at St James's Hospital Memory Clinic involving patients who attended the clinic for assessment from 1 January 2020 to 30 April 2021 and received a diagnosis of MCI. We completed questionnaires with patients and a nominated family member or friend of each patient (FwMCI). Forty-seven PwMCI participated in the study, and 36 nominated family members and/or friends completed the FwMCI questionnaire. In our cohort of PwMCI, most of the participants were not aware of their diagnosis; only 21% used the term MCI, and only 25% attributed their problems to a pathological cause. The majority of participants had no recollection of any discussion around the likelihood of progression. One-third of participants expressed relief that they did not have dementia. Most PwMCI reported positive psychological well-being and did not endorse symptoms of depression or anxiety. There was slight discordance of illness perception among the PwMCI-FwMCI dyads. Forty-seven per cent of FwMCI reported at least a mild degree of carer burden on the Zarit Burden Scale. Patients' awareness of being diagnosed with MCI is relatively limited. Public education campaigns raising awareness about MCI can help influence the 'illness representation' for MCI and enable people to seek timely advice and support.

Co-developing, piloting, and evaluating a translational simulation (TS) delivery model for the promotion of psychological trauma-informed care (TIC) to improve service delivery within acute hospital settings: A Research Protocol

Background: Over 70% of the general population have experienced at least one psychologically traumatic event in their lifetime, with 30.5% experiencing four or more events. Recognising the prevalence and potentially injurious effects of psychological trauma among healthcare workers and patients alike is considered important to ensure patient engagement, quality of care, positive health outcomes, as well as improved staff wellness, and more resilient health systems. Aim: The current project aims to improve the experience of both patients and staff in two acute hospital settings in St James’ Hospital (SJH): the Emergency Department (ED) and Acute Medical Assessment Unit (AMAU). This will be achieved through the development of a translational simulation improvement programme for trauma-informed care (TS4TIC). The objective of trauma-informed care (TIC) in the acute hospital setting is to reduce the impact of previous trauma on the care experience. Methods: Underpinned the Institute for Healthcare Improvement (IHI) Model for Improvement we will (i) co-design a TIC improvement programme for use in acute hospital settings using translational simulation (TS) approaches, (ii) implement TS4TIC in two acute hospital settings, and (iii) co-evaluate the effectiveness and acceptability of TS4TIC using co-defined outcome, process, and balancing indicators measured across iterative Plan, Do, Study, Act (PDSA) cycles. Expected Outcome: The project’s completion will result in a co-designed, open access TS4TIC Toolkit, consisting of a suite of TS scenarios and accompanying monitoring and training resources to guide the adaptation of this approach for use in other acute healthcare settings nationally and internationally.

Time-to-Event Analysis of Factors Influencing Delay in Discharge from a Subacute Complex Discharge Unit during the First Year of the Pandemic (2020) in an Irish Tertiary Centre Hospital.

Our study aimed to analyse delaying factors amongst patients with a length of stay (LOS) > 15 days during the COVID-19 pandemic using time-to-event analysis. A total of 390 patients were admitted between March 2020-February 2021 to the subacute complex discharge unit in St James's Hospital: 326 (83.6%) were >65 years of age and 233 (59.7%) were female. The median (IQR) age was 79 (70-86) years with a median (IQR) of 19.4 (10-41) days. A total of 237 (60.7%) events were uncensored, with LOS > 15 days, of which 138 (58.2%) were female and 124 (52.32%) had >4 comorbidities; 153 (39.2%) were censored into LOS ≤ 15 days, and death occurred in 19 (4.8%). Kaplan-Meier's plot compared factors causing a delay in discharge to the single factors: age, gender, and multimorbidity. A multivariate Cox regression analysis adjusted to age, gender, and multimorbidity predicted factors affecting LOS. Further research is required to explore multimorbidity as a risk factor for mortality in patients with prolonged LOS within a complex discharge unit and target gender-specific frailty measures to achieve high-quality patient management.

Blood Pressure Signal Entropy as a Novel Marker of Physical Frailty: Results from the FRAILMatics Clinical Cohort.

In this study we investigated the association between information entropy in short length blood pressure signals and physical frailty status, in a group of patients aged 50+ recruited from the Falls and Syncope Unit at the Mercer's Institute for Successful Ageing in St James's Hospital, Dublin, Ireland. This work is an external clinical validation of findings previously derived in a population-based cohort from The Irish Longitudinal Study on Ageing (TILDA). The hypothesis under investigation was that dysregulation (as quantified by entropy) in continuous non-invasive blood pressure signals could provide a clinically useful marker of physical frailty status. We found that in the 100 patients investigated, higher entropy in continuously measured resting state diastolic blood pressure was associated with worse physical frailty score, as measured by the Frailty Instrument for primary care of the Survey of Health, Ageing and Retirement in Europe (SHARE-FI). Since physical frailty is defined as a pre-disability state and hence it can be difficult for clinicians to identify at an early stage, the quantification of entropy in short length cardiovascular signals could provide a clinically useful marker of the physiological dysregulations that underlie physical frailty, potentially aiding in identifying individuals at higher risk of adverse health outcomes.

Investigation of the Suitability of a Commercial Radiation Sensor for Pretherapy Dosimetry of Radioiodine Treatment Patients.

Radioiodine (I-131) therapy is routinely used to treat conditions of the thyroid. Dosimetry planning in advance of I-131 therapy has been shown to improve patient treatment outcomes. However, this pretherapy dosimetry step requires multiple outpatient appointments and is not feasible for patients living at greater distances. Here, the feasibility of a commercially available smartphone-operated radiation sensor (Smart Geiger Pro, Technonia) for at-home patient pretherapy dosimetry has been investigated. The influence of both treatment-specific parameters (radioisotope activity, gamma photon energy, patient size) and external factors (sensor placement and motion) on the ability of the radiation sensor to accurately quantify radiation dose rates has been studied. The performance limits of the radiation sensor have been identified. A preliminary trial of the sensor on four I-131 patients prior to their therapy, conducted at the Nuclear Medicine/Endocrinology departments of St James's Hospital Dublin, is also presented. A comparable performance between the low-cost radiation sensor and that of a hospital-grade thyroid uptake probe is reported. This work demonstrates the potential of low-cost commercially available radiation sensors as a solution for at-home pretherapy dosimetry for long distance patients, or indeed for hospitals who wish to implement dosimetry at reduced cost. Recommended conditions for optimum sensor performance use are presented.

Blood Transfusion Ameliorates Free Haem-Induced Loss of Thrombomodulin and Endothelial Cell Activation in Paediatric Sickle Cell Anaemia

Background Sickle cell anaemia (SCA) is responsible for major paediatric morbidity including risk of stroke in up to 10% of children. Mainstays of therapy include hydroxyurea (HU) and chronic blood transfusion (BT), with BT considered gold standard for stroke prevention. However, the biological mechanisms through which BT is significantly superior to HU in reducing stroke risk have not been clearly defined. SCA complications are due in part to free haem-mediated damage, leading to endothelial cell (EC) activation, tissue factor (TF) expression and release of von Willebrand Factor (VWF), which binds platelets and sickle RBCs. Recently loss of EC Thrombomodulin (TM) has been shown to promote EC activation and VWF release and soluble TM (sTM) plays a role in disseminated intravascular coagulation and COVID-19. Hypothesis We hypothesize free haem alters EC TM expression, promoting EC activation and VWF release. Intravascular hemolysis and free haem may be reduced in children on chronic BT, maintaining EC quiescence and enhancing protection against stroke compared with HU. Methods Following ethical approval and informed consent 180 SCA children (median age 12 years, 49% male) were recruited. Steady-state plasma samples were collected prior to BT (n=84) or at outpatient clinic for HU (n=96). Paired crisis samples were obtained in a subset of HU (n=30). EC activation markers and Weibel Palade Body (WPB) proteins were evaluated by ELISA, VWF multimers were assessed by 1.8% agarose gels and ADAMTS13 activity assessed by FRET. Free haem levels were quantified and thrombin generation (TG) assays performed. Factor VIII:C was measured in the National Coagulation Centre at St James's Hospital. Human umbilical vein endothelial cells (HUVEC) were exposed to cell-free haem (Hemin), hydroxyurea, cytokines (IL-1β and TNFα) or patient plasma; VWF was measured in the supernatant and HUVEC TM expression assessed by flow cytometry. Results VWF:Ag and VWF propeptide (VWFpp) levels were significantly increased in HU compared to BT children, suggesting acute EC activation (median plasma VWF:Ag levels 1.29 v 1.03 IU/ml; p=0.0005, median VWFpp levels 1.63 v 1.17 IU/ml p=0.006). Furthermore, plasma levels of other WPB stored proteins were also significantly elevated in the HU cohort, including Angiopoietin-2 (Ang-2) (4214 v 2337 pg/ml, p<0.0001 and Osteoprotegerin (OPG) (1825 v 1507 pg/ml p=0.006). Abnormalities of high-, intermediate- and low molecular weight VWF multimers were noted in HU but not BT. While putative inhibitors of ADAMTS13 were increased in HU, including Platelet Factor 4 and Interleukin-6, ADAMTS13 activity did not differ between groups. FVIII:C levels were significantly elevated in 65% of the total cohort and were higher in HU than BT (1.62 IU/ml v 1.30 IU/ml p<0.0001). Free haem levels were increased in HU versus BT (12.5 v 9.5μM p=0.0003), as well as levels of LDH and reticulocyte %, pointing to increased intravascular hemolysis. EC markers and FVIII:C correlated strongly with hemolytic indices. In addition to increased EC activation, increased endogenous thrombin potential (ETP), peak thrombin and velocity index were observed in HU versus BT, pointing to enhanced TG, possibly driven by elevated circulating TF. TG parameters correlated with plasma FVIII:C levels. Exposure of HUVEC to free haem in vitro resulted in a significant decrease in surface TM expression and increased VWF secretion (p<0.05). Conversely exposure to hydroxyurea or cytokines did not alter TM expression. Exposure of HUVEC to plasma from crisis but not paired steady-state plasma induced EC activation and VWF release compared with control plasma. Importantly, free haem levels ≥20 μM were observed in 25% HU children in steady state and 40% in crisis, compared with 0% of BT. Furthermore, significantly elevated sTM levels in SCA children with a history of cerebrovascular disease compared to those without (5.7 v 4.6 ng/ml p=0.02), suggesting that sTM may predict end-organ dysfunction. Conclusions We have shown in a large cohort of SCA children that EC activation, TG and intravascular haemolysis are increased in HU-treated children compared with BT. Free haem induces loss of EC TM and VWF release in vitro, leading to EC activation. Elevated sTM levels were a biomarker of end-organ damage. These data suggest that reduction of free haem in children undergoing regular BT is a key mechanism through which EC quiescence is maintained in paediatric SCA.

Motivators and barriers to blood donation among potential donors of African and Caucasian ethnicity.

Minority blood donation, especially from individuals of African ethnicity, is a focus for many countries with diverse populations. As the need for antigen-negative RBC transfusions for patients with Sickle Cell Disease (SCD) continues to grow, inclusion of more African blood donors is essential to ensure this demand is met. This study aims to explore barriers and motivators to blood donation and awareness of SCD among potential donors of diverse ethnic backgrounds in Ireland. Following ethical approval, patients attending the National Sickle Cell Disease and Thalassemia service at St James's Hospital were invited to share an online anonymous survey within their local communities to achieve snowball-sampling. 387 respondents completed the survey, including 311 non-donors (median age 25 years, 67% female). Ethnic backgrounds included: African or African-Irish (59%), White or Caucasian (25%), Asian (8%), Hispanic or Latino (3%), Middle Eastern (3%), Multiracial or Biracial (2%). The most commonly identified barrier overall was lack of information on blood donation. African respondents were significantly more likely to report lack of information and malaria-related barriers than Caucasians. Motivators also varied across ethnic groups, with African respondents more likely to donate to help someone within their own community or for religious motivators. Awareness of SCD was higher among African respondents. While some barriers to blood donation are shared across all ethnic groups including lack of information, notable differences exist between Caucasian and African respondents. Specific actions to recruit and retain African blood donors should focus on these key areas.

Biomarker development in amyotrophic lateral sclerosis: Challenges and viable strategies.

European Journal of NeurologyVolume 29, Issue 7 p. 1867-1868 COMMENTARY Biomarker development in amyotrophic lateral sclerosis: Challenges and viable strategies Peter Bede, Corresponding Author Peter Bede bedep@tcd.ie orcid.org/0000-0003-0492-4772 Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland Department of Neurology, St James's Hospital, Dublin, Ireland Correspondence Peter Bede, Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland. Email: bedep@tcd.ie Contribution: Conceptualization (equal), Writing - original draft (equal)Search for more papers by this authorJasmin Lope, Jasmin Lope Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland Contribution: Conceptualization (equal), Writing - original draft (equal)Search for more papers by this author Peter Bede, Corresponding Author Peter Bede bedep@tcd.ie orcid.org/0000-0003-0492-4772 Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland Department of Neurology, St James's Hospital, Dublin, Ireland Correspondence Peter Bede, Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland. Email: bedep@tcd.ie Contribution: Conceptualization (equal), Writing - original draft (equal)Search for more papers by this authorJasmin Lope, Jasmin Lope Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland Contribution: Conceptualization (equal), Writing - original draft (equal)Search for more papers by this author First published: 25 April 2022 https://doi.org/10.1111/ene.15372 See paper by Y. M. Falzone et al. on page 1930 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume29, Issue7July 2022Pages 1867-1868 RelatedInformation

Study protocol for the St James's Hospital, Tallaght University Hospital, Trinity College Dublin Allied Researchers' (STTAR) Bioresource for COVID-19

Background: The current coronavirus disease 2019 (COVID-19) pandemic began in Ireland with the first confirmed positive case in March 2020. In the early stages of the pandemic clinicians and researchers in two affiliated Dublin hospitals identified the need for a COVID-19 biobanking initiative to support and enhance research into the disease. Through large scale analysis of clinical, regional, and genetic characteristics of COVID-19 patients, biobanks have helped identify, and so protect, at risk patient groups The STTAR Bioresource has been created to collect and store data and linked biological samples from patients with SARS-CoV-2 infection and healthy and disease controls. Aim: The primary objective of this study is to build a biobank, to understand the clinical characteristics and natural history of COVID-19 infection with the long-term goal of research into improved disease understanding, diagnostic tests and treatments. Methods: This is a prospective dual-site cohort study across two tertiary acute university teaching hospitals. Patients are recruited from inpatient wards or outpatient clinics. Patients with confirmed COVID-19 infection as well as healthy and specific disease control groups are recruited. Biological samples are collected and a case report form detailing demographic and medical background is entered into the bespoke secure online Dendrite database. Impact: The results of this study will be used to inform national and international strategy on health service provision and disease management related to COVID-19. In common with other biobanks, study end points evolve over time as new research questions emerge. They currently include patient survival, occurrence of severe complications of the disease or its therapy, occurrence of persistent symptoms following recovery from the acute illness and vaccine responses.

Study protocol for theSt James's Hospital, Tallaght University Hospital, Trinity College Dublin Allied Researchers' (STTAR) Bioresource for COVID-19.

Background: The current coronavirus disease 2019 (COVID-19) pandemic began in Ireland with the first confirmed positive case in March 2020. In the early stages of the pandemic clinicians and researchers in two affiliated Dublin hospitals identified the need for a COVID-19 biobanking initiative to support and enhance research into the disease. Through large scale analysis of clinical, regional, and genetic characteristics of COVID-19 patients, biobanks have helped identify, and so protect, at risk patient groups The STTAR Bioresource has been created to collect and store data and linked biological samples from patients with SARS-CoV-2 infection and healthy and disease controls. Aim: The primary objective of this study is to build a biobank, to understand the clinical characteristics and natural history of COVID-19 infection with the long-term goal of research into improved disease understanding, diagnostic tests and treatments. Methods: This is a prospective dual-site cohort study across two tertiary acute university teaching hospitals. Patients are recruited from inpatient wards or outpatient clinics. Patients with confirmed COVID-19 infection as well as healthy and specific disease control groups are recruited. Biological samples are collected and a case report form detailing demographic and medical background is entered into the bespoke secure online Dendrite database. Impact: The results of this study will be used to inform national and international strategy on health service provision and disease management related to COVID-19. In common with other biobanks, study end points evolve over time as new research questions emerge. They currently include patient survival, occurrence of severe complications of the disease or its therapy, occurrence of persistent symptoms following recovery from the acute illness and vaccine responses.

Study Protocol for the St James's Hospital, Tallaght University Hospital, Trinity College Dublin Allied Researchers' (STTAR) Bioresource for COVID-19

Study Protocol for the St James's Hospital, Tallaght University Hospital, Trinity College Dublin Allied Researchers' (STTAR) Bioresource for COVID-19

Clinical characteristics of two groups commonly referred to an Irish hypertension service-patients with resistant hypertension and young adults with hypertension.

The management of hypertension is primarily performed in primary care settings in many health systems. However, two groups of patients often require specialist input: patients with resistant hypertension (RH) and young adults with hypertension. To elucidate these groups by examining the characteristics of patients attending an Irish hypertension service, thus informing future management of hypertension. Patients were recruited at consecutive hypertension clinics at St James Hospital, Dublin from July to September 2019. Following patient consent, patient data were recorded to identify patient characteristics as well as the results of investigations, blood pressure (BP) measurements and the anti-hypertensive treatment of the study participants which were then analysed. Two hundred thirty-six patients were included in the study. Compared to those without RH, the RH group were more likely to be obese (OR 2.59 [95% CI 1.06 to 6.33]), to have cardiovascular disease (OR 3.07 [95% CI 1.56 to 6.02]) and to have a non-dipping BP pattern (OR 3.86 [95% CI 1.57 to 9.47]). Young adults comprised 27% of the cohort. Forty-seven percent of these patients were obese, 15.9% had hypertension in pregnancy and 22.2% had chronic headaches. Despite being prescribed less anti-hypertensives (1.41 vs 2.28; p < 0.05), the majority of young patients had a BP less than 140/90mmHg, comparing favourably with older patients (OR 2.25 [95% CI 1.20 to 4.27]). This contemporary study highlights the high prevalence of obesity among RH patients and young adults with hypertension. Findings suggest that programs to combat hypertension must include interventions to address obesity.

Comparison of risk scoring systems for critical care patients with upper gastrointestinal bleeding: predicting mortality and length of stay.

Upper gastrointestinal bleeding (UGIB) is a common reason for intensive care admission. While there exist a number of UGIB scoring systems which are used to predict mortality, there are limited studies assessing the discriminative value of these scores in intensive care unit (ICU) patients. The purpose of this study was to analyse five different UGIB scoring systems in predicting ICU mortality and length of stay and compare them to two commonly used ICU mortality scoring systems. We retrospectively identified all patients requiring ICU admission for UGIB to St James's Hospital over an 18-month period. We calculated their AIM65, Glasgow- Blatchford score, pre- and post-Rockall score, ABC, APACHE II and SOFA scores. We used area under the receiver operating characteristic curve (AUROC) to compare the predictive values of these six scoring systems for ICU and hospital mortality as well as ICU length of stay greater than seven days. APACHE II showed excellent discriminative value in predicting mortality in ICU patients (AUROC: 0.87; CI: 0.75-0.99) while the SOFA score showed good discriminative value (AUROC: 0.71; CI: 0.50-0.93). None of the UGIB scoring systems predicted mortality in these patients. All scoring systems showed poor discriminative value in predicting ICU length of stay. We were not able to validate any of these UGIB scoring systems for mortality or length of stay prediction in ICU patients. This study supports the validity of APACHE II as a clinical tool for predicting mortality in ICU patients with UGIB.

Dublin's homeless crisis – is this reflected in emergency department psychiatry referrals?

AimsThis study seeks to explore the prevalence and impact of homelessness in an adult sample of psychiatry referrals over a one-month period via the Emergency Department at St. James's Hospital.BackgroundHomelessness has now reached a crisis point in Ireland. In July 2019, there were 10,275 people documented as homeless nationwide, with the number of homeless families increasing by 178% since June 2015. The majority of individuals registered as homeless are located in Dublin. St. James's Hospital (SJH) provides psychiatric care to a population of 136,704 people across Dublin South-City within areas of significant deprivation according to the most recent social deprivation index.MethodAll Emergency Department psychiatry referrals over a one-month period were recorded. Month of study was randomly generated. Data were collected from electronic records. Socio-demographic information was analysed. Data were anonymised and recorded using Microsoft Excel. Current homelessness statistics were accessed from the Department of Housing, Planning, and Local Government and compared to the data collected.ResultDuring the month of the Study (March 2019), 4315 adults accessed emergency homeless accommodation in Dublin. Of the 109 psychiatry referrals received through the Emergency Department at SJH during this time, over a quarter (28%) of those referred reported themselves to be homeless or living in temporary accommodation. An additional 5% were documented as living in residential or sheltered care at time of assessment. All of the referred homeless patients were unemployed (n = 30). 50% of homeless patients were referred to psychiatry following expressed thoughts or acts of self-harm. Illicit drug abuse was associated with 73% of referrals. Alcohol abuse was associated with 47%. Of those who were referred, under a quarter (23%) were assessed as having a major mental illness, and in the majority of these cases, illicit drug and alcohol abuse were compounding factors in exacerbating symptomatology. Of those referred, 66% had previously been reviewed by psychiatry during prior ED presentations and 60% of homeless presenters reported that they had previously been, or were currently linked in with community mental health teams.ConclusionFrequently, vulnerable patients most in need of social and psychiatric care, such as homeless people with addiction issues, are eclipsed from accessing supports. The high proportion of patients reporting to be homeless is cause for concern and suggests the need for tailored and integrated multi-disciplinary assessments and interventions at an Emergency Department level.

Evaluation of the risk factors for venous thromboembolism post splenectomy – A ten year retrospective cohort study in St James’s hospital

BackgroundSplenectomy is a surgical intervention for a variety of indications; benign and malignant. Complications of this procedure include Venous thromboembolism (VTE) and infection. The incidence of VTE post-surgery has been reported between 0.8%–3% depending on the type of surgery. A higher incidence of abdominal VTE was reported post splenectomy (6–11%). However, there is limited literature regarding the risk factors for post splenectomy VTE and the optimal strategy for thromboprophylaxis. ObjectiveThe primary objective of the study was to evaluate the incidence of VTE post splenectomy and to identify the pre-operative, intra-operative and post-operative risk factors. The secondary objective was to assess the local compliance with post-splenectomy prophylactic antibiotics and vaccination protocols. MethodsWe conducted a retrospective observational study. All patients who had a splenectomy in St James's Hospital between January 2007 and June 2017 were included and reviewed. Statistical analysis was carried out using SPSS statistical package. Results85 patients were involved in the study. The main indications for splenectomy were benign haematology, malignant haematology, solid tumours, traumatic and spontaneous rupture. 6/85 patients developed VTE (7.06%).High BMI ≥ 30 was associated with increased risk of VTE (p = 0.007), while the use of post-operative prophylactic anticoagulation was associated with reduced risk (p = 0.005). Other factors including age >50 years, female gender, presence of active malignancy and splenomegaly were associated with increased VTE risk with no statistical significance. All VTE's occurred in elective versus emergency splenectomy. Laparoscopic splenectomy was associated with higher risk of VTE than open splenectomy. 97% of patients were prescribed prophylactic antibiotics on discharge, but only 88% had received recommended vaccinations. ConclusionVenous thromboembolism is common post splenectomy. Our data showed that BMI ≥30 was associated with a statistically significant increased risk of VTE, while the use of prophylactic anticoagulation was associated with reduced risk. Further prospective studies with larger samples are warranted and a splenectomy care plan may be helpful.