Publications by authors named "Barry L"

Objectives: Findings regarding the effects of vitamin D supplementation on diabetes risk are inconclusive. Because inflammation and vitamin D levels are interconnected, we hypothesized that higher inflammation levels moderate the effects of vitamin D deficiency on diabetes risk.

Design, Setting, Participants, And Measurements: UK Biobank participants without pre-existing diabetes at baseline were included (N = 336,500).

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Background: Multidisciplinary comprehensive geriatric assessment (CGA) improves outcomes in hospitalised older adults but there is limited evidence on its effectiveness in the emergency department. We aimed to assess the benefits of CGA in the emergency department for older adults living with frailty.

Methods: In this randomised controlled trial, we enrolled older adults (≥75 years) who presented to the emergency department with medical complaints at University Hospital Limerick (Limerick, Ireland).

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Background: In emergency care settings, screening for disease or risk factors for poor health outcomes among older adults can identify those in need of specialist and early intervention. The aim of this study was to identify barriers and facilitators to implementing older person-centred screening in emergency care settings in the Mid-West of Ireland.

Methods: This study employed a qualitative descriptive design underpinned by the theoretical domains framework (TDF).

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Background: Frailty is a risk factor for presentation to the ED, in-hospital mortality, prolonged hospital stays and functional decline at discharge. Profiling the prevalence and level of frailty within the acute hospital setting is vital to ensure evidence-based practice and service development within the construct of frailty. The aim of this cross-sectional study was to establish the prevalence of frailty and co-morbidities among older adults in an acute hospital setting.

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Introduction: Previous studies have demonstrated the benefits of tranexamic acid (TXA) administration in combination with packed red blood cell (PRBC) transfusion in trauma patients without increasing the risk of venous thromboembolism (VTE). However, the effect of TXA in combination with whole blood (WB) has not been studied. Injury, abbreviated injury severity scores (ISS and AIS) and the need for blood transfusions are historically associated with VTE.

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The synchronous occurrence of primary endometrioid endometrial adenocarcinoma and primary squamous cell carcinoma of the cervix is exceedingly rare. Ovarian and endometrial cancers represent the most frequently observed forms of synchronous gynaecological malignancies. In contrast, in less than 1 % of cases, endometrial cancer coexists with primary cervical cancer.

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Article Synopsis
  • - The study identifies the significant long-term psychological and quality-of-life impacts on adults diagnosed with Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), beyond the well-documented physical effects.
  • - Through in-depth interviews with 18 adults, two main themes emerged: 'Psychosocial Impacts' and 'Chronicity of Sequelae', highlighting how SJS/TEN changes patients' views on life and affects their overall well-being.
  • - The research concludes that understanding the chronic nature of SJS/TEN is crucial for improving patient care and emphasizes the need for better psychological support and coordinated healthcare pathways after hospital discharge.
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Background: Revision shoulder arthroplasty (SA) is a surgical procedure performed to address complications or failures of primary total SA. However, limited evidence exists regarding the functional outcomes and longevity of implants following revision.

Methods: A retrospective analysis was conducted on patients who underwent revision SA for failed primary arthroplasty at a single institution between 2009 and 2021 with a minimum of 2-years follow-up.

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Background: Systems for quality and safety assurance in organ donation and transplantation are vital, especially those that seek to minimize donor disease transmission. Australia has developed a national vigilance and surveillance system to identify, review, and analyze actual and potential donor-derived infections and other disease transmissions.

Methods: The system involves notification of incidents to the Australian Organ and Tissue Authority for review by a Vigilance and Surveillance Expert Advisory Committee (VSEAC).

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Background: Although overall health and social care expenditures among persons with dementia are larger than for other diseases, the resource and cost implications of a comorbid diagnosis of dementia in acute hospitals in the U.S. are largely unknown.

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The acute management of deep burns to the dorsum of the hand and fingers represents a challenge for the reconstructive surgeon. The exposure of osteo-tendinous structures often requires flap coverage, in a context where loco-regional or free flaps are not always feasible. The aims of reconstruction are to preserve a maximum of digital length, provide supple tissue, obtain protective sensitivity, and achieve a functional hand at 1 year.

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Background: As total shoulder arthroplasty (TSA) expands to younger patients, it is crucial to weigh the benefits of early intervention against potential complications and implant longevity in patients under 60 years of age. This study examines mid-term outcomes in this patient subset.

Methods: Between 2009 and 2019, a retrospective analysis was conducted on 50 patients (25 male, 25 female) who underwent anatomic TSA (TSA) under the age of 60 with minimum 5 years follow-up.

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Background: The Health Care for Reentry Veterans (HCRV) program was established to support community reintegration for veterans after incarceration. Yet, it is unclear how those with and without HCRV contact differ. We sought to evaluate differences in medical and psychiatric conditions and healthcare utilization among mid-to late-life reentry veterans who did and did not receive HCRV outreach.

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Article Synopsis
  • Increased body mass index (BMI) may affect outcomes and complications after shoulder surgeries (aTSA and rTSA), but its long-term impact on these procedures is not fully known.
  • A study tracked 466 patients who underwent TSA from 2009 to 2020, categorizing them by BMI into underweight/normal weight, overweight, and obese, while analyzing their demographics, comorbidities, and functional outcomes.
  • Results showed significant improvements in range of motion and strength post-surgery across all BMI groups, with no notable differences in patient-reported outcomes or survival rates based on BMI.
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Solid organ transplants (SOT) have evolved into life-saving interventions for end-stage diseases affecting vital organs. Advances in transplantation techniques, donor selection, and immunosuppressive therapies have enhanced outcomes, leading to a growing demand for SOT. Patients with a solid organ transplant are living long enough to develop the same pathologies which are indicated for joint replacement surgery in the general population.

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Background: This study aimed to explore the process, clinical, and patient-reported outcomes of older adults who received an interdisciplinary Comprehensive Geriatric Assessment (CGA) in the emergency department (ED) over a six-month period after their initial ED attendance.

Patients And Methods: A prospective cohort study recruited older adults aged ≥65 years who presented to the ED of a university teaching hospital in Ireland. Baseline assessment data comprising a battery of demographic variables and validated indices were obtained at the index ED attendance.

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Background: It has been suggested that the Lethal Triad be modified to include hypocalcemia, coined as the Lethal Diamond. Hypocalcemia in trauma has been attributed to multiple mechanisms, but new evidence suggests that traumatic injury may result in the development of hypoCa independent of blood transfusion. We hypothesize that hypocalcemia is associated with increased blood product requirements and mortality.

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Study Objectives: The application of a pericervical uterine artery tourniquet is a useful method of reducing intraoperative haemorrhage during abdominal myomectomy. However, the utilization of a single combined pericervical uterine artery and infundibulopelvic ligament tourniquet is a more effective and influential method of temporarily occluding the uterine vasculature to decrease intraoperative blood loss, reducing the requirement for blood products, the risk of conversion to hysterectomy, and patient morbidity and mortality during fertility-sparing leiomyoma surgery. Our objective of this retrospective review was to assess the effectiveness of the combined uterine artery and infundibulopelvic ligament tourniquet, which we coin as the "Hangman's uterine tourniquet", in reducing intraoperative blood loss during abdominal myomectomy, thereby reducing the need for blood products.

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Gliomatosis peritonei (GP) is a rare condition characterised by mature glial nodules that implant in the peritoneum, lymph nodes, or omentum. GP is typically associated with mature or immature ovarian teratomas and usually affects adolescent females. Although neuroglia may be a standard feature of mature ovarian teratomas, widespread peritoneal glial nodules, ascites, and pleural effusion are rare, particularly in the paediatric population.

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 Representing approximately 22% of cervical spine injuries, upper cervical spine injuries are becoming more frequent with the increase in road traffic accidents. The purpose of our study is to evaluate the results of our surgical series and to compare them with the literature.  In this monocentric retrospective study of over three years (June 2019-May 2022), all the patients with traumatic injuries of the upper cervical spine with a surgical treatment and a minimum of 12 months follow-up were included.

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Background: A validated scale is needed for objective and reproducible comparisons of marionette lines before and after treatment in clinical studies.

Objective: To describe the development and validation of a 5-point photonumeric marionette lines scale.

Methods: The scale was developed to include an assessment guide, verbal descriptors, and real and morphed subject images for each scale grade.

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Elderly patients represent a large cohort of patients requiring gynaecological surgery for benign and malignant indications. In recent years, several conventional gynaecological procedures have shifted towards minimally invasive alternatives such as laparoscopy, hysteroscopy, and robotic surgery. A recent Surveillance, Epidemiology, and End Results (SEER) analysis compared the outcomes of 25,000 women undergoing laparotomy versus laparoscopic approach to hysterectomy and found that laparoscopy is associated with a shorter duration of hospitalization (three days versus five days), less postoperative complications (76%), less requirement for blood transfusion, reduced operational costs, faster recovery, and an overall safer surgical experience.

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Background: Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS).

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Background: Innovations in models of care for older adults living with frailty presenting to the emergency department (ED) have become a key priority for clinicians, researchers and policymakers due to the deleterious outcomes older adults experience due to prolonged exposure to such an environment. This study aimed to develop a set of expert consensus-based statements underpinning operational design, outcome measurement and evaluation of a Frailty at the Front Door (FFD) model of care for older adults within an Irish context.

Methods: A modified real-time Delphi method was used.

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