This Month’s IMJ

June 2018 Vol 111, Number 6

IMJ Commentary

Medical Negligence Costs are Unsustainable

JFA Murphy


Medical Professionalism: Promoting Patient and Physician Safety

D Slattery

Original Papers

Quality Improvement of Clinical Handover in a Liaison Psychiatry Department: A Three-Phase Audit

 L Alexander, N Bechan, S Brady, L Douglas, S Moore, R Shelley

Alexander et al describe an intervention that improved clinical handover.  It consisted of an 11 item handover checklist.

A Review of the Parenteral Nutrition Supply Service in an Irish Neonatal Unit

 Smith A, Glynn AC , Shankar A , McDermott C, McCallion N

Smith et al report on the impact of a 5 day rather than a 7 day patient specific parenteral nutrition (PSPN).  Education, training and improvements in stock bags help in part to overcome the disadvantages.

The Doctor Can See You Now: A Key Stakeholder Study Into The Acceptability Of Ambulance Based Telemedicine.

 P Gilligan, A Bennett, A Houlihan, A Padki, N Owens, D Morris, I Chochliouros, A Mohammed, A Mutawa, M A Eswararaj, S Gannon, A Alrmawi, J Zuhair Gasem, P P Natalie Sheung, Claire Tynan, Ruth Little, Willie Merriman, Ahjoku Amadi-Obi, L Kenna, D A Alim, C O’Donnel

Gilligan et al explore the feasibility of a telelink between a patient, a paramedic and an ED doctor.  98.5% of patients,  89% of doctors, 76% of nurses and 91% of ambulance personnel saw the potential in an audio-visual link.

Subtrochanteric Femur Fractures in an Irish Trauma Centre over 9 years: How the Impact of Hospital Coding on Diagnosis of Subtrochanteric Femur Fractures Leads to Inaccurate Occurrence Rates

 EI Coveney, Harriz E, Gibney B, JF Quinlan

Coveney et al report that 1701 patients were admitted with hip fractures.  Using ICD-10 coding 48 cases were coded with a subtrochanteric fracture.  However when the AO/OTA classification is applied the revised number was 8 cases.

Screening For Gestational Diabetes Mellitus Selectively in a University Maternity Hospital

O’Malley EG, O’Duill M, McArdle C, Kennedy RAK, Reynolds CM, Turner MJ   

O’Malley et al audited selective screening with an oral glucose tolerance test (OGTT).  Based on national recommendations 46.5% had maternal risk factors, and 6.5% had fetal risk factors.  9 women with risk facts did not have an OGTT.

Case Reports

Extramammary Paget ’s disease Of Glans Penis, A Rare Case Report

 Inder M S, O’Kelly F, Sheikh M, O’Hare K, Barbara M L, Thornhill J A

Inder et al report a case of extramammary Padget’s disease of the penis.  The presentation was distal penile pain and blood per urethra.

Scombrotoxic Fish Poisoning Secondary to Tuna Ingestion

Ferris HA, Ryan FM, Byrne K, Fleming E, O’ Sullivan H, Hamilton D

Ferris et al report a case of scombrotoxic fish poisoning following ingestion of tuna.  21 individuals ate tuna and 12 of them promptly became unwell within 2.5 hours of ingestion.  Fish species such as tuna contains histidine which converts to histamine when inadequately chilled.  One of affected patients required antihistamine medication

A Combination Of Surgery And Methotrexate For Successful Treatment Of A Caesarean Scar Ectopic Pregnancy.

WG Tadesse, G Von Bunau

Tadesse and Bunau describe the management of a caesarean scar ectopic pregnancy (CSEP).  At diagnostic laparoscopy the gestational sac was aspirated and then injected with methotrexate.

Short Reports

Introduction of an Oral Fluid Challenge Protocol in the Management of Children with Acute Gastroenteritis: A Regional Hospital Experience.

 E Umana, A Rana, K Maduemem , E Moylett 

Umana et al report on the efficacy of an oral fluid challenge protocol (OFC).  The rates of intravenous fluid use decreased from 22% in cycle 1 to 18% in cycle 2.


Case Series

The Triangular Sign, a Useful Diagnostic Marker for Biliary Atresia: A Case Series of Three Irish Infants

Smith A, Shankar A, Collins A, Tarrant A,  Boyle MA

Smith et al describe the triangular cord (TC) sign in cases of biliary atresia.  It is a triangular shaped echogenic density at the portal vein bifurcation.

Occasional Piece

Food Insecurity and Tuberculosis: Policy Urgently Needs To Play Catch-Up

D A. Cassidy, L C. Ivers


Beulah Bewley DBE, FRCPCH, FFPHM , FRCP (Sept 2nd 1929 – Jan 20th 2018)

Letters to the Editor

The Light at the End of the Tunnel: A Case of Dysautonomia Associated With Melkersson-Rosenthal Syndrome

EA Donlon, K O’Connell, R Varini, MG Khan, J Lynch

Peripheral White Blood Cell Differential Counts In Children With UTI, Is There A Link?

Rutledge E, Whitla L, Coghlan D, Nadeem M

Influenza Vaccine Attitudes in Amateur GAA Club Footballers.

Mortimer B. O’Connor

The Opportunities for Medical Education Internationalisation in the Republic of Ireland

Y Finn