Definitions and resistance rate difference
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 22, 2017 Category: Journals (General) Source Type: research

Proceedings of the RAMI Section of Healthcare Informatics Students Meeting, Friday 17th June 2016, Setanta House, Dublin
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 21, 2017 Category: Journals (General) Source Type: research

The effect of candesartan on pentraxin-3 plasma levels as marker of endothelial dysfunction in patients with essential arterial hypertension
ConclusionsCandesartan decreases PTX3 and hs-CRP plasma levels more powerful than other classes of antihypertensive drugs (beta blockers, calcium channel blockers, and diuretics), so we may assume that candesartan has a more potent action in reversing endothelial dysfunction and that it offers a higher vascular protection than other classes of antihypertensive drugs. We are suggesting that this new biochemical marker, PTX3, might be better and more specific marker for endothelial dysfunction, than hs-CRP. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 21, 2017 Category: Journals (General) Source Type: research

Dysphagia screening in acute stroke care among non-consultant hospital doctors
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 21, 2017 Category: Journals (General) Source Type: research

25th Sylvester O ’Halloran Perioperative Scientific Symposium, 2017
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 14, 2017 Category: Journals (General) Source Type: research

Impact of Xpert MRSA/SA blood culture PCR assay on management of positive blood cultures in obstetric patients: a retrospective audit
ConclusionThis study has shown a reduction in the median duration of intravenous antimicrobials and admission; however, larger multi-centre studies are needed to evaluate this potential benefit further. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 14, 2017 Category: Journals (General) Source Type: research

Susan Bewley (Ed.): My life as a woman and a doctor —Beulah Bewley
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 14, 2017 Category: Journals (General) Source Type: research

Five year trends in maternal smoking behaviour reported at the first prenatal appointment
We examined clinical and sociodemographic data computerised routinely for women who presented for prenatal care at the hospital between 2011 and 2015. Multinomial logistic regression was used to determine the maternal characteristics, health behaviours and psychiatric history associated with smoking behaviours.ResultsOf the 42,509 women the mean age was 31.4  ± 5.5 years, mean Body Mass Index (BMI) was 25.6 ± 5.1 kg/m2, and 39.5% were nulliparas. Overall, 52.6% reported they had never smoked, 34.9% were ex-smokers, 10.5% smoked ≤10 cigarettes per day, 1.9% smoked ≥11 cigare...
Source: Irish Journal of Medical Science - February 11, 2017 Category: Journals (General) Source Type: research

UCD School of Medicine Summer Student Research Awards, SSRA 2016
(Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 10, 2017 Category: Journals (General) Source Type: research

Simultaneous bilateral total hip arthroplasties in nonagenarians
AbstractTotal hip arthroplasty (THA) is an effective and durable treatment option for hip osteoarthritis (OA). As life expectancy continues to increase, so too will the demand for joint arthroplasty in the 10th decade of life, frequently in cases involving osteoarthritis of both hips. Simultaneous bilateral total hip arthroplasty (SBTHA) is a valuable therapeutic option in appropriately selected patients with bilateral degenerative hip disease, although its use in the very elderly is poorly reported on in the literature. A case of bilateral hip OA successfully treated with SBTHA in a nonagenarian is presented and the liter...
Source: Irish Journal of Medical Science - February 9, 2017 Category: Journals (General) Source Type: research

A regional analysis of epidermal growth factor receptor ( EGFR ) mutated lung cancer for HSE South
ConclusionThe incidence ofEGFR mutation in our cohort of NSCLC is 9% which is consistent with mutation incidence reported in other countries. The rate ofEGFR mutation in our population is slightly below that reported internationally, but treatment outcomes are consistent with published data. Real-world patient data have important contributions to make with regard to quality measurement, incorporating patient experience into guidelines and identifying safety signals. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 9, 2017 Category: Journals (General) Source Type: research

Circulating levels of fibroblast growth factor 21 in early-stage diabetic kidney disease
AbstractAims/purposeFibroblast growth factor 21 (FGF21), a hepatoadipokine with pleiotropic metabolic regulatory actions, is emerging as a novel biomarker of progressive nephropathy. We sought to evaluate circulating FGF21 and its association with clinical and biochemical characteristics as well as the urinary albumin excretion (UAE) rates in a population of patients with type 2 diabetes (T2D) with or without microalbuminuria and their matched healthy controls.MethodsCross-sectionally, 130 consecutive individuals comprising patients with T2D with (n = 44) or without (n = 44) microalbuminuria and their h...
Source: Irish Journal of Medical Science - February 8, 2017 Category: Journals (General) Source Type: research

A retrospective review of farm injuries presenting to an Irish hospital emergency department in 2013
ConclusionOur study has identified high-risk mechanisms of injury, which should alert clinicians to the potential for significant injury. In addition, our findings could be used to help policy makers promote safety and awareness through public health policies that target high-risk practices with appropriate training and legislation. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 8, 2017 Category: Journals (General) Source Type: research

Melanoma diagnosis and management after the introduction of a pigmented lesion clinic in the Mid-West of Ireland
AbstractBackgroundA pigmented lesion clinic (PLC) was introduced and Consultant Dermatology posts were increased in the Mid-West of Ireland with the aim of improving early detection of melanoma.Methods We analysed retrospectively the invasive melanomas excised in the Mid-West of Ireland over a 2-year period prior to (2010 –2011) and after (2013–2014) the advent of the PLC.ResultsThe number of melanomas excised almost doubled from 54 (2010 –2011) to 107 (2013–2014). There was a significant rise in the rate of excision biopsies performed by Dermatologists compared to non-dermatology clinicians from 19 to 56% (p 
Source: Irish Journal of Medical Science - February 8, 2017 Category: Journals (General) Source Type: research

Obstetric outcomes of recurrent pregnancy loss patients diagnosed w ıth inherited thrombophilia
AbstractBackgroundRecurrent pregnancy loss (RPL) is defined by two or more failed pregnancies. The relation between RPL and inherited thrombophilia requires anticoagulant therapy during pregnancy. However the obstetric outcomes have not been well defined in these RPL patients diagnosed with inherited thrombophilia, who have been given anticoagulant therapy.AimTo investigate the obstetric outcomes in pregnant women with RPL who are given low molecular weight heparin (LMWH) and low-dose aspirin due to diagnosis of inherited thrombophilia.Methods A hundred and eight  RPL women were diagnosed with inherited thrombophilia,...
Source: Irish Journal of Medical Science - February 7, 2017 Category: Journals (General) Source Type: research

Enhanced recovery in lower limb arthroplasty in the Irish setting
AbstractBackgroundIn the current economic climate of staff shortages and bed closures, orthopaedic surgeons must look for system efficiencies. Enhanced Recovery Programmes (ERP) have the potential not only to reduce length of stay (LOS) and concurrent costs but also to improve patient outcomes. The aim of this paper is to evaluate the effect of ERP for primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) on length of stay (LOS) in the Irish Setting.MethodsA single-surgeon retrospective case –control study was conducted comparing those who underwent primary lower limb arthroplasty before and after th...
Source: Irish Journal of Medical Science - February 7, 2017 Category: Journals (General) Source Type: research

Chemical cardioversion of recent-onset atrial fibrillation in the emergency department using vernakalant hydrochloride achieves safe and rapid restoration of sinus rhythm and facilitates same day discharge
ConclusionsVernakalant hydrochloride has provided a quick, safe, and practical means of achieving rapid restoration of sinus rhythm in our ED population with stable recent-onset AF who would otherwise not have undergone routine electrically cardioversion and same day discharge. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 6, 2017 Category: Journals (General) Source Type: research

The relationship between the latency period, infection markers, and oxidant and antioxidant states in women with preterm premature rupture of membranes
AbstractBackgroundA major cause of perinatal morbidity and mortality has been reported to be preterm premature rupture of membranes (PPROM). Our objective was to evaluate oxidant –antioxidant balance, infection parameters, time interval between rupture of membranes and delivery (latency period), and the relationship among all these parameters.MethodsSeventy-five cases with PPROM between 24 and 34 gestational weeks were included in the study. A control group of 41 women who gave birth at term were considered as the control group. The relationship among maternal plasma total oxidative stress (TOS), malondialdehyde (MDA...
Source: Irish Journal of Medical Science - February 6, 2017 Category: Journals (General) Source Type: research

A cost analysis of the establishment of a dedicated orthopaedic outpatient injection clinic at a single institution
ConclusionThe creation of a dedicated orthopaedic injection clinic resulted in considerable cost savings at our institution. We propose this may be a more cost-efficient model for delivery of injections in the orthopaedic setting. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 4, 2017 Category: Journals (General) Source Type: research

Posterior reversible encephalopathy syndrome in pregnancy: a retrospective series of 36 patients from mainland China
ConclusionsPatients with pregnancy-related PRES may present with atypical neuroimaging findings. Moreover, our data supported the view that nearly all imaged patients with eclampsia had clinical and radiologic findings of PRES. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 2, 2017 Category: Journals (General) Source Type: research

Inadvertent parathyroidectomy during thyroid surgery
ConclusionInadvertent parathyroidectomy is a potential risk during thyroid surgery but post-operative hypocalcaemia as a result is rare. Malignancy and more extensive surgery appear to carry an increased risk for this complication. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 2, 2017 Category: Journals (General) Source Type: research

Development and evaluation of a centralised computerised registry for ureteric stents: completing the audit cycle
ConclusionThis study demonstrates that a centralised computerised ureteric stent registry is superior to a conventional logbook for monitoring ureteric stent activity. We propose the introduction a centralised nationalised ureteric stent registry for eliminating the potential for prolonged or forgotten ureteric stents. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 2, 2017 Category: Journals (General) Source Type: research

Clinical outcomes following spinal fracture in patients with ankylosing spondylitis
ConclusionPatients with ankylosing spondylitis are at risk of spinal fracture and associated spinal cord injury after relatively minor trauma. Delayed diagnosis places the patient at risk of neurological compromise, and thus a high index of suspicion is needed when assessing this patient group. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - February 1, 2017 Category: Journals (General) Source Type: research

Towards a building typology and terminology for Irish hospitals
ConclusionThis typology and terminology define the main components of Irish hospital building design to create a shared understanding around design, and support stakeholder engagement, as part of any collaborative design process. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 30, 2017 Category: Journals (General) Source Type: research

Prescribing error at hospital discharge: a retrospective review of medication information in an Irish hospital
ConclusionsThe study identified the time of discharge as a point at which prescribing errors are likely to occur. This has implications for patient safety and provider work load in both primary and secondary care. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 30, 2017 Category: Journals (General) Source Type: research

Analysis of sentinel node positivity in primary cutaneous melanoma: an 8-year single institution experience
AbstractBackgroundSentinel lymph node biopsy (SLNB) is a standard method for determining the pathologic status of the regional lymph nodes.AimsThe aim of our study was to determine the incidence and clinicopathologic factors predictive of SLN positivity, and to evaluate the prognostic importance of SLNB in patients with cutaneous melanoma.MethodsWe performed a retrospective analysis of a prospectively maintained database of all patients who underwent SLNB for primary melanoma at our institution from 2005 to 2012. Statistical analysis was performed usingχ2 and Fischer exact test.ResultsIn total, 318 patients underwent S...
Source: Irish Journal of Medical Science - January 28, 2017 Category: Journals (General) Source Type: research

Evaluation of spinal cord stimulation on the symptoms of anxiety and depression and pain intensity in patients with failed back surgery syndrome
This study examined the efficacy of SCS on alleviating the symptoms of anxiety and depression associated with chronic pain as well as pain intensity in a group of patients with FBSS.MethodsA convenience sample (n = 26) was selected for participation. Questionnaires [Hospital Anxiety and Depression Scale (HADS) and Brief Pain Inventory Short Form (BPI-SF)] were completed and examined pre and post spinal cord implant.ResultsAnalysis of the data 1  year following SCS indicates that there was a statistical significant improvement in the symptoms of depression and anxiety reported as well as pain intensity in all...
Source: Irish Journal of Medical Science - January 28, 2017 Category: Journals (General) Source Type: research

Parent ’s use of the Internet in the search for healthcare information and subsequent impact on the doctor–patient relationship
ConclusionsParents showed a willingness to learn about diseases and treatments, and felt that the Internet was a good resource to do so. This study shows that open discussion about Internet usage between parents and doctors is not common and carers feel at risk of judgment should they admit to Internet usage. The Internet should be seen as a positive adjunct to patient education which can improve understanding, thus strengthening the doctor –patient relationship. The Internet will never replace the role of healthcare professionals but must be seen as an integral part of a multi-disciplinary approach. (Source: Irish J...
Source: Irish Journal of Medical Science - January 27, 2017 Category: Journals (General) Source Type: research

Clinical utility of abdominal and pelvic ultrasound in the evaluation of right iliac fossa pain in females
ConclusionThe results herein reflect findings from high volume emergency surgical departments, demonstrating that unfocussed abdominal and pelvic ultrasounds are not an appropriate use of resources in reproductive women with RIF pain. Clinically relevant extra-pelvic US findings account for less than 1%, rarely contributing to the acute presentation. The appendix was only visualised in 6% of patients, suggesting that a focussed appendiceal and pelvic US would better assist diagnosis with a higher yield and increased sensitivity and specificity. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 27, 2017 Category: Journals (General) Source Type: research

The role of 3D printing in preoperative planning for heart transplantation in complex congenital heart disease
ConclusionThe ongoing advances in medical image procurement and 3D processing software and printing technology will continue to enhance preoperative planning and thereby improve patient care. We demonstrate the pivotal role played by such technologies in advancing spatial comprehension of complex aberrant anatomy. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 25, 2017 Category: Journals (General) Source Type: research

A single centre experience of zero-ischaemia laparoscopic partial nephrectomy in Ireland
ConclusionZero ischaemia laparoscopic partial nephrectomy appears to be a safe and oncologically satisfactory procedure for the management of small localised kidney tumours. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 25, 2017 Category: Journals (General) Source Type: research

Belfast Limb Arterial and Skeletal Trauma (BLAST): the evolution of punishment shooting in Northern Ireland
ConclusionDue to the unique political situation of Northern Ireland, there has been significant development of surgical experience in GSW management. Historically, single knee-capping injuries were prevalent. However, these shootings have evolved into targeted injuries resulting in significant trauma as demonstrated by this case series. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 21, 2017 Category: Journals (General) Source Type: research

Dynamic sentinel node biopsy for penile cancer: an initial experience in an Irish Hospital
ConclusionFurther cases and longer follow-up will define the accuracy of this technique in the Irish population. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 19, 2017 Category: Journals (General) Source Type: research

Empirically derived weights for GMS capitation payments to General Practitioners
In this study, evidence-based weights were generated and compared to current payment weights.MethodsFour datasets on GP utilisation were interrogated.ResultsEvidence-based weights indicated that over 70s had higher payments per consultation than other groups. Considerable intra-age band differences in capitation payment were detected.Discussion and conclusionThe results suggest that there is a need for a comprehensive review of the current payments system. Current age bands should be narrowed. The implications for the efficiency and equity of general practice in Ireland are discussed. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 18, 2017 Category: Journals (General) Source Type: research

Neurosarcoidosis: clinical presentations and changing treatment patterns in an Irish Caucasian population
ConclusionsThis series highlights the diverse nature of neurosarcoidosis. Early introduction of aggressive therapy with corticosteroids and steroid-sparing agents appears to improve clinical outcome. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 18, 2017 Category: Journals (General) Source Type: research

Waterborne outbreak of cryptosporidiosis in the South East of Ireland: weighing up the evidence
ConclusionsThe Health Service Executive (HSE) concluded that this outbreak was “probably associated with water” produced at WTP A based on (1) descriptive epidemiological evidence suggesting water-related illness and excluding other obvious explanations; and (2) water treatment failure at WTP A. WTP A was closed to facilitate an upgrade. No boil water notice was required a s a supplementary supply was available. The upgrade was completed and the incident closed in 2013. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 13, 2017 Category: Journals (General) Source Type: research

Medicines containing codeine: perspectives of medical professionals in the Republic of Ireland
ConclusionPolicy should examine the need for greater public health awareness on codeine use and should examine the role of OTC and internet sales in the development of dependence. Further consideration should be given to training and support for those who prescribe addictive medicines in practice. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 9, 2017 Category: Journals (General) Source Type: research

Can oral isotretinoin be safely initiated and monitored in primary care? A case series
ConclusionThis study suggests that oral isotretinoin can be safely initiated and monitored by a GP with a special interest in dermatology and experience in prescribing systemic retinoids. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 9, 2017 Category: Journals (General) Source Type: research

The impact of mode of presentation on distress in patients with early stage breast cancer
ConclusionOver 50% of patients with screen-detected or symptomatic breast cancer experience high levels of distress. Consideration should be made for the routine use of distress screening in this population. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 7, 2017 Category: Journals (General) Source Type: research

A retrospective study of neurocombing for the treatment of trigeminal neuralgia without neurovascular compression
ConclusionsThis study demonstrated that neurocombing is an attractive, effective, safe and durable treatment option for TN when NVC is absent. Further study is needed to explain the complicated and exact mechanism of pain relief by neurocombing. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 6, 2017 Category: Journals (General) Source Type: research

Antibiotic resistance patterns of Escherichia coli urinary isolates and comparison with antibiotic consumption data over 10  years, 2005–2014
AbstractIntroductionEscherichia coli is a common cause of urinary tract infections (UTI). Reviews of antibiotic resistance of this organism can inform choice of empiric treatment of UTI and other infections and strategies for combating antimicrobial resistance. We reviewed laboratory and hospital pharmacy records to assess trends in non-susceptibility rates and the effect of antimicrobial stewardship interventions.MethodsA retrospective observational study of isolates ofE. coli from MSU samples at a Dublin teaching hospital from inpatients and community, obtained from January 2005 to December 2014. Susceptibility to a pane...
Source: Irish Journal of Medical Science - January 4, 2017 Category: Journals (General) Source Type: research

What is the future for General Surgery in Model 3 Hospitals?
ConclusionsThese data indicated that an impending General Surgery consultant manpower crisis can only be averted in Model 3 Hospitals by either major change in the emphasis of surgical training or a significant reorganisation of surgical services. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 4, 2017 Category: Journals (General) Source Type: research

Development and implementation of a ‘Mental Health Finder’ software tool within an electronic medical record system
ConclusionsThe finder is a feasible and promising methodology for large-scale data collection on mental health problems in primary care. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 3, 2017 Category: Journals (General) Source Type: research

Radiotherapy for the treatment of thyroid eye disease —a prospective comparison: Is orbital radiotherapy a suitable alternative to steroids?
AbstractBackground and aimsTo evaluate the efficacy of orbital radiotherapy (OR) for the treatment of thyroid eye disease (TED).MethodsThirty-five consecutive patients with active TED with contraindications to steroid therapy received a course of OR. Bilateral retrobulbar irradiation was performed with a total dose of 20  Gy. 7-points clinical activity score (7-CAS), ocular motility, visual acuity (VA), exophthalmos and eyelid retraction were prospectively evaluated at 3, 6 and 12 months and compared with baseline data.ResultsThere was a statistically significant improvement in 7-CAS at 3, 6 and 12  months p...
Source: Irish Journal of Medical Science - January 3, 2017 Category: Journals (General) Source Type: research

Nitrate-rich beetroot juice selectively lowers ambulatory pressures and LDL cholesterol in uncontrolled but not controlled hypertension: a pilot study
ConclusionsOur results support the existing data suggesting an anti-hypertensive effect of nitrate-containing beetroot juice, but only among those with uncontrolled hypertension. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - January 3, 2017 Category: Journals (General) Source Type: research

Renal transplantation outcomes following heart and heart –lung transplantation
ConclusionsThe overall outcome of renal transplantation following previous non-renal solid organ transplantation is excellent considering the medical complexity and co-morbidities of this patient population. Renal transplantation represents an important treatment option for ESKD in non-renal solid organ transplant recipients. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 31, 2016 Category: Journals (General) Source Type: research

Vinorelbine induced perforation of a metastatic gastric lesion
ConclusionThis case represents a rare complication of breast cancer chemotherapy, the subsequent significant benefit the patient received from treatment is consistent with the chemosensitivity to therapy that also resulted in gastric perforation. Five years after gastric perforation she resumed palliative chemotherapy after progression on sequential hormonal therapies. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 30, 2016 Category: Journals (General) Source Type: research

Patient acceptability and experiences of therapeutic switching of proton pump inhibitors within the National Preferred Drugs initiative in Ireland
ConclusionsThe majority of patients in our study were satisfied to have their medication switched. However, prescribers should be mindful that 1 in 5 patients encountered problems as a result of the switching process. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 30, 2016 Category: Journals (General) Source Type: research

Optic neuritis secondary to antiandrogen therapy
ConclusionKnown side-effects of cyproterone acetate include retinal vascular disorder and retinal vein thrombosis, but an association with optic neuritis had not been described to date. There was a temporal relationship between cessation of the medication and improvement in visual symptoms. This implies that discontinuation of the offending drug constitutes the basis of treatment in drug-induced optic neuropathy. (Source: Irish Journal of Medical Science)
Source: Irish Journal of Medical Science - December 30, 2016 Category: Journals (General) Source Type: research

Chlamydia pneumoniae induces interleukin-12 responses in peripheral blood mononuclear cells in asthma and the role of toll like receptor 2 versus 4: a pilot study
AbstractBackgroundChlamydia pneumoniae causes respiratory infection in adults and children, and has been associated with asthma exacerbations and induction of Immunoglobulin (Ig) E responses. We previously reported thatC. pneumoniae enhances T helper (Th) 2 responses of peripheral blood mononuclear cells (PBMC) from asthmatic patients. It is likely that toll like receptor (TLR)-2 and TLR-4 mediate cytokine responses and host defense against  C. pneumoniae. Thus, we sought to determine whether engagement of TLR-2 or TLR-4 may induce IL-12 production in ourC. pneumoniae model.MethodsPBMC (1.5  × 106) fro...
Source: Irish Journal of Medical Science - December 29, 2016 Category: Journals (General) Source Type: research