D O'Shea

Publications (20)48.6 Total impact

• Article: Changes in human dendritic cell number and function in severe obesity may contribute to increased susceptibility to viral infection.

  D O'Shea, M Corrigan, M R Dunne, R Jackson, C Woods, G Gaoatswe, P N Moynagh, J O'Connell, A E Hogan
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  ABSTRACT: Dendritic cells (DCs) are key immune sentinels linking the innate and adaptive immune systems. DCs recognise danger signals and initiate T-cell tolerance, memory and polarisation. They are critical cells in responding to a viral illness. Obese individuals have been shown to have an impaired response to vaccinations against virally mediated conditions and to have an increased susceptibility to multi-organ failure in response to viral illness. We investigated if DCs are altered in an obese cohort (mean body mass index 51.7±7.3 kg m(-2)), ultimately resulting in differential T-cell responses. Circulating DCs were found to be significantly decreased in the obese compared with the lean cohort (0.82% vs 2.53%). Following Toll-like receptor stimulation, compared with lean controls, DCs generated from the obese cohort upregulated significantly less CD83 (40% vs 17% mean fluorescence intensity), a molecule implicated in the elicitation of T-cell responses, particularly viral responses. Obese DCs produced twofold more of the immunosuppressive cytokine interleukin (IL)-10 than lean controls, and in turn stimulated fourfold more IL-4-production from allogenic naive T cells. We conclude that obesity negatively impacts the ability of DCs to mature and elicit appropriate T-cell responses to a general stimulus. This may contribute to the increased susceptibility to viral infection observed in severe obesity.International Journal of Obesity advance online publication, 26 February 2013; doi:10.1038/ijo.2013.16.
  International journal of obesity (2005) 02/2013; · 4.34 Impact Factor
• Article: Hypoglycaemia--more than skin deep.

  N Glynn, F Keane, D O'Shea, J Geoghegan, D Smith
  QJM: monthly journal of the Association of Physicians 11/2012; · 2.33 Impact Factor
• Article: Glucagon-like peptide-1 analogue therapy for psoriasis patients with obesity and type 2 diabetes: a prospective cohort study.

  T Ahern, A-M Tobin, M Corrigan, A Hogan, C Sweeney, B Kirby, D O'Shea
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  ABSTRACT: Background  Diabetes and obesity are more prevalent amongst psoriasis patients as is disturbance of the innate immune system. GLP-1 analogue therapy considerably improves weight and glycaemic control in people with type 2 diabetes and its receptor is present on innate immune cells. Objective  We aimed to determine the effect of liraglutide, a GLP-1 analogue, on psoriasis severity. Methods  Before and after 10 weeks of liraglutide therapy (1.2 mg subcutaneously daily) we determined the psoriasis area and severity index (PASI) and the dermatology life quality index (DLQI) in seven people with both psoriasis and diabetes (median age 48 years, median body mass index 48.2 kg/m(2) ). We also evaluated the immunomodulatory properties of liraglutide by measuring circulating lymphocyte subset numbers and monocyte cytokine production. Results  Liraglutide therapy decreased the median PASI from 4.8 to 3.0 (P = 0.03) and the median DLQI from 6.0 to 2.0 (P = 0.03). Weight and glycaemic control improved significantly. Circulating invariant natural killer T (iNKT) cells increased from 0.13% of T lymphocytes to 0.40% (P = 0.03). Liraglutide therapy also effected a non-significant 54% decrease in the proportion of circulating monocytes that produced tumour necrosis factor alpha (P = 0.07). Conclusion  GLP-1 analogue therapy improves psoriasis severity, increases circulating iNKT cell number and modulates monocyte cytokine secretion. These effects may result from improvements in weight and glycaemic control as well as from direct immune effects of GLP-1 receptor activation. Prospective controlled trials of GLP-1 therapies are warranted, across all weight groups, in psoriasis patients with and without type 2 diabetes.
  Journal of the European Academy of Dermatology and Venereology 06/2012; · 2.98 Impact Factor
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  Available from: Vincent O'Reilly

  Article: Glucagon-like peptide-1 (GLP-1) and the regulation of human invariant natural killer T cells: lessons from obesity, diabetes and psoriasis.

  A E Hogan, A M Tobin, T Ahern, M A Corrigan, G Gaoatswe, R Jackson, V O'Reilly, L Lynch, D G Doherty, P N Moynagh, B Kirby, J O'Connell, D O'Shea
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  ABSTRACT: The innate immune cells, invariant natural killer T cells (iNKT cells), are implicated in the pathogenesis of psoriasis, an inflammatory condition associated with obesity and other metabolic diseases, such as diabetes and dyslipidaemia. We observed an improvement in psoriasis severity in a patient within days of starting treatment with an incretin-mimetic, glucagon-like peptide-1 (GLP-1) receptor agonist. This was independent of change in glycaemic control. We proposed that this unexpected clinical outcome resulted from a direct effect of GLP-1 on iNKT cells. We measured circulating and psoriatic plaque iNKT cell numbers in two patients with type 2 diabetes and psoriasis before and after commencing GLP-1 analogue therapy. In addition, we investigated the in vitro effects of GLP-1 on iNKT cells and looked for a functional GLP-1 receptor on these cells. The Psoriasis Area and Severity Index improved in both patients following 6 weeks of GLP-1 analogue therapy. This was associated with an alteration in iNKT cell number, with an increased number in the circulation and a decreased number in psoriatic plaques. The GLP-1 receptor was expressed on iNKT cells, and GLP-1 induced a dose-dependent inhibition of iNKT cell cytokine secretion, but not cytolytic degranulation in vitro. The clinical effect observed and the direct interaction between GLP-1 and the immune system raise the possibility of therapeutic applications for GLP-1 in inflammatory conditions such as psoriasis.
  Diabetologia 07/2011; 54(11):2745-54. · 6.81 Impact Factor
• Article: Preadipocyte factor-1 is associated with metabolic profile in severe obesity.

  J O'Connell, L Lynch, A Hogan, T J Cawood, D O'Shea
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  ABSTRACT: Dysfunctional adipose tissue has been proposed as a key pathological process linking obesity and metabolic disease. Preadipocyte factor-1 (Pref-1) has been shown to inhibit differentiation in adipocyte precursor cells and could thereby play a role in determining adipocyte size, adipose tissue functioning, and metabolic profile in obese individuals. We hypothesized that adipose tissue from metabolically healthy obese (MHO) and matched metabolically unhealthy obese individuals would demonstrate distinct differences in relation to Pref-1 expression, adipocyte size, and inflammatory markers. This was a cross-sectional study, investigating obese patients undergoing bariatric surgery at a tertiary referral centre. Patients included 12 MHO and 17 age- and body mass index-matched metabolically unhealthy obese individuals. Main Outcome Measures: Pref-1, monocyte chemotactic protein-1, TNF-α, granulocyte colony-stimulating factor, IL-6, and adiponectin levels, macrophage numbers, and adipocyte size were measured in omental and subcutaneous adipose tissue. The MHO group had a lower level of Pref-1 (per 1000 adipocytes) in both subcutaneous [160 (136-177) versus 194 (153-355); P < 0.05] and omental adipose tissue [102 (32-175) versus 194 (100-350); P < 0.005]. This was associated with lower numbers of macrophages, lower levels of TNF-α, monocyte chemotactic protein-1, and granulocyte colony-stimulating factor, and higher levels of adiponectin. Omental Pref-1 showed strong correlations with adipocyte size (r = 0.67, P < 0.0005) and metabolic and adipokine parameters, including percent fatty liver (r = 0.62, P < 0.005), fasting glucose (r = 0.68, P < 0.0005), triglyceride (r = 0.60, P < 0.005), high-density lipoprotein cholesterol (r = -0.46, P < 0.05), and adiponectin (r = -0.71, P < 0.05). Adipose tissue in MHO individuals had lower levels of Pref-1, a known inhibitor of preadipocyte differentiation, and a more favorable inflammatory profile. These factors may be key to protecting this subgroup of obese individuals from the adverse metabolic profile associated with excess adiposity.
  The Journal of clinical endocrinology and metabolism 01/2011; 96(4):E680-4. · 6.50 Impact Factor
• Article: Urinary collagen IV and πGST: potential biomarkers for detecting localized kidney injury in diabetes--a pilot study.

  T J Cawood, M Bashir, J Brady, B Murray, P T Murray, D O'Shea
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  ABSTRACT: Urinary biomarkers can identify damage to specific parts of the nephron. We performed a cross-sectional study to characterise the pattern of diabetic nephropathy using urinary biomarkers of glomerular fibrosis (collagen IV), proximal tubular damage (α-glutathione-S-transferase, GST) and distal tubular damage (πGST). Clinical data from 457 unselected patients attending a hospital diabetes clinic were collected. Spot urine samples were analysed for albumin and creatinine. Biomarkers were measured by enzyme-linked immunosorbent assay, and corrected to urinary creatinine. All 3 biomarkers correlated weakly with albumin/creatinine ratios (Pearson correlation <0.2, p values <0.001). The most common abnormality was elevated urinary collagen IV (glomerular, 35%) compared to αGST (proximal tubule, 18%) or πGST (distal tubule, 15%). The proportion of patients with abnormal biomarker results increased across the normo-, micro- and macroalbuminuria groups, with collagen IV (26, 58, 65%) and πGST (11, 25, 35%) but not αGST. In patients with diabetes, these urinary biomarkers appear to identify renal damage that is related to, but distinct from, urine albumin/creatinine ratios. The markers of glomerular fibrosis and distal tubular damage related most closely to the degree of albuminuria. Longitudinal studies are now required to assess whether these biomarkers can detect early renal disease with greater specificity and sensitivity than the albumin/creatinine ratio.
  American Journal of Nephrology 01/2010; 32(3):219-25. · 2.54 Impact Factor
• Article: An examination of the prevalence of IDF- and ATPIII-defined metabolic syndrome in an Irish screening population.

  D F Waterhouse, A M McLaughlin, F Sheehan, D O'Shea
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  ABSTRACT: To investigate the prevalence of ATPIII- and IDF-defined metabolic syndrome (MetS) in an Irish screening population and to determine the calculated cardiovascular risk for each group. A total of 1,716 subjects were enrolled over a 12-month period. The ATPIII-defined prevalence of MetS in this population was 13.2%. Using IDF criteria, 21.4% of subjects were identified as having the MetS. Correlation between the two definitions was high; however, IDF criteria identified an additional 9.5% (n = 164) of the population as having MetS, which ATPIII criteria failed to recognise. We noted a higher prevalence of MetS in the studied population when defined by IDF criteria. However, those identified by IDF and not by ATPIII definition did not have a higher cardiovascular risk score by either Framingham or European Score than those without MetS. Thus, application of the ATPIII definition of MetS, may be the more practical.
  Irish Journal of Medical Science 02/2009; 178(2):161-6. · 0.58 Impact Factor
• Article: Type I immediate hypersensitivity reaction to cyanocobalamin but not hydroxycobalamin.

  F J Moloney, R Hughes, D O'Shea, B Kirby
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  ABSTRACT: We report a case of a 42-year-old woman with a background of autoimmune polyglandular syndrome, who developed a type I immediate hypersensitivity reaction to intramuscular cyanocobalamin. Intradermal testing showed a positive reaction to cyanocobalamin. The patient was subsequently treated with intramuscular hydroxycobalamin after negative intradermal testing to this alternative B(12) compound. A review of previously described cases of hypersensitivity to either compound provides a rationale for the management of this rare but serious side-effect.
  Clinical and Experimental Dermatology 08/2008; 33(4):412-4. · 1.20 Impact Factor
• Article: Factors that affect longevity of intravenous cannulas: a prospective study.

  M F Dillon, J Curran, R Martos, C Walsh, J Walsh, D Al-Azawi, C S Lee, D O'Shea
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  ABSTRACT: Few guidelines exist to guide medical personnel on the most successful means of achieving sustained intravenous cannulation. This study examines the impact of gauge and site of intravenous cannulas (IC) on the longevity of ICs in hospitalized patients. A prospective study was conducted on 500 ICs inserted into patients of St Vincent's Private hospital from December 2005 to June 2006. Patients were followed until the IC had been removed or changed. Statistical analysis was performed using Cox proportional hazards. Of the 500 ICs inserted, 37% were 18 g, 46% were 20 g and 18% were 22 g. Gauge of IC was the most significant predictor of increased longevity of IC (P = 0.0002, RR = 1.17, 95% CI 1.08-1.27). The median survival of 18, 20 and 22 g were 57 h (95% CI 49-72), 43 h (95% CI 36-48.5) and 29 h (95% CI 24-40.5), respectively. The site of IC placement influenced the longevity of ICs (P = 0.005, RR= 0.7, 95% CI 0.55-0.9), as did male gender (P = 0.03, RR = 0.76, 95% CI 0.6-0.97). However in subgroup analysis, the most marked effect on IC longevity was evident in those patients with 18 g placed in the forearm/wrist (median 72 h) with less marked changes in other site/gauge combinations. In contrast, 22 g ICs placed in the hand had a median lifespan of 29 h. IC gauge and site of placement are important factors in determining IC longevity. 18 g ICs placed in the forearm/wrist can considerably increase the longevity of ICs and should be attempted in patients who require sustained cannulation.
  QJM: monthly journal of the Association of Physicians 08/2008; 101(9):731-5. · 2.33 Impact Factor
• Article: Stroke in the very old.

  I Noone, D O'Shea, M Crowe
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  ABSTRACT: Prospective data on 614 consecutive stroke admissions was analysed. 262 (43%) were >80 years. 165 (63.5) were female. In the patients >80 years compared to patients <80 years, mortality was higher, 71 (27%/) v 33 (9%) and length of stay was longer (28.2 +/- 32.5 days v 24.4 +/- 27.5 days). More older patients (>80 years) were discharged to extended nursing care, 71 (27%) v 33 (9.3%), whilst less older patients were discharged home, 87 (33%) v 234 (66%). Prior to their stroke 65 (25%) and 39 (15%) of patients >80 years were dependent in activities of daily living or living in extended nursing care respectively, compared to 24 (6.8%) and 15 (4.2%) of patients <80 years. Existing or new onset atrial fibrillation was present in 118 (45%) of patients > or =80 years, compared to 76 (21.5%) in patients <80 years. Stroke in patient's > or =80 years occurs in over 40% of stroke admissions to our hospital and is associated with increased mortality and poor outcome. Stroke services must be developed to optimise stroke prevention and improve the poor outcome in this rapidly increasing population.
  Irish medical journal 01/2008; 101(1):8-9.
• Article: A prospective randomized controlled trial of lifestyle intervention on quality of life and cardiovascular risk score in patients with obesity and type 2 diabetes.

  A Tuthill, A Quinn, D McColgan, M McKenna, D O'Shea, T J McKenna
  Diabetes Obesity and Metabolism 12/2007; 9(6):917-9. · 3.38 Impact Factor
• Article: Weight changes in type 2 diabetes and the impact of gender.

  A Tuthill, M J McKenna, D O'Shea, T J McKenna
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  ABSTRACT: Many studies suggest that weight gain occurs during treatment of type 2 diabetes, irrespective of the treatment type. The aim of this study was to address the questions (i) whether weight gain is inevitable in patients treated for type 2 diabetes, and (ii) whether treatment escalation is prompted by a rise in glycaemic control [haemoglobin A 1c (HbA 1c)] or weight gain. A diabetes database was used to identify all patients with type 2 diabetes attending our clinic between 1 January 1990 and 31 December 2000. To facilitate further analysis, independent anonymized database resources were established. Data collected included height, weight, gender, HbA(1c), age and diabetes treatment at each visit. One thousand and eighty-four patients were included; after 6 months of treatment, patients' average weight had reduced by 1.0 kg (s.d. 4.6) (p < 0.001). Sixty per cent of the patients had either a decrease or no change in weight, while 40% demonstrated a weight gain. Women demonstrated more weight loss than men. After a mean follow-up of 50 months (s.d. 25.7), 439 patients (40%) who received treatment with diet alone, diet followed by metformin or metformin alone demonstrated a maintained weight reduction in addition to improved glycaemic control. A rise in HbA(1c) rather than weight gain prompted treatment change. This study provides evidence that weight gain is not a necessary consequence of the treatment of type 2 diabetes. Women were more successful than men in losing weight, and diet, with or without the addition of metformin, was the treatment type most usually associated with weight loss.
  Diabetes Obesity and Metabolism 11/2007; 10(9):726-32. · 3.38 Impact Factor
• Article: The occurrence of hypothyroidism following radioactive iodine treatment of toxic nodular goiter is related to the TSH level.

  H I Adamali, J Gibney, D O'Shea, M Casey, T J McKenna
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  ABSTRACT: Strategies to increase frequency of euthyroidism following radioactive (RAI) treatment of hyperthyroidism are required. To examine the role of TSH in development of hypothyroidism post RAI treatment in patients with Graves' disease (N = 98) or toxic nodular goiter, TNG (N = 88). This retrospective study examined thyroid status over a mean of 3.7 years post-RAI. Although RAI dose was significantly higher in TNG group, hypothyroidism occurred more frequently in Graves' disease (71.4 and 22.7%) P < 0.001. The TSH levels at the time of RAI treatment were lower in TNG patients who remained euthyroid, (0.4+/-0.1 vs. 1.2+/-0.5 mU/l, P < 0.0022). A higher frequency of euthyroidism occurs in patients with TNG than with Graves' disease following RAI, particularly when suppressed TSH levels were suppressed at time of RAI-treatment.
  Irish Journal of Medical Science 10/2007; 176(3):199-203. · 0.58 Impact Factor
• Article: Smoking and thyroid-associated ophthalmopathy: A novel explanation of the biological link.

  T J Cawood, P Moriarty, C O'Farrelly, D O'Shea
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  ABSTRACT: Cigarette smoking is the strongest modifiable risk factor for developing thyroid-associated ophthalmopathy (TAO), and the severity of TAO is related to the current number of cigarettes smoked per day. We aimed to establish the effects of cigarette smoke extract (CSE) on an in vitro model of TAO. Orbital tissue was taken during surgery from 10 patients with TAO and nine control subjects. Orbital fibroblasts were cultured and exposed to CSE, and intercellular adhesion molecule 1 (ICAM1) expression was measured by flow cytometry. Glycosaminoglycan production was measured by hyaluronic acid ELISA. Orbital fibroblasts were grown in adipogenic media with or without CSE and/or IL-1, and the degree of adipogenesis was quantified. Fibroblasts from patients with TAO and controls showed similar responses. ICAM1 expression was not affected by CSE. Hyaluronic acid production was stimulated by CSE in a dose-dependent manner (correlation coefficient, 0.978; P = 0.022), with 5% CSE causing an increase of 44% (P = 0.001). CSE increased adipogenesis in a dose-related manner, as did IL-1. The effects of CSE and IL-1 on adipogenesis were synergistic, with the degree of adipogenesis in the well containing both 5% CSE and 0.1 ng/ml IL-1 being double the magnitude of the sum of the values obtained from either stimulus alone (P < 0.001). Addition of an anti-IL-1 antibody to the well containing both 5% CSE and 0.1 ng/ml IL-1 reduced the degree of adipogenesis by 82% (P < 0.001). These findings may help explain how cigarette smoking has a detrimental effect in TAO and suggests that IL-1 may be an attractive therapeutic target in TAO.
  Journal of Clinical Endocrinology &amp Metabolism 02/2007; 92(1):59-64. · 6.50 Impact Factor
• Article: The effects of tumour necrosis factor-alpha and interleukin1 on an in vitro model of thyroid-associated ophthalmopathy; contrasting effects on adipogenesis.

  T J Cawood, P Moriarty, C O'Farrelly, D O'Shea
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  ABSTRACT: Cytokines are likely to play a key pathogenic role in thyroid-associated ophthalmopathy (TAO). Anti-cytokine therapy has been proposed to be a possible treatment for active TAO. We aimed to establish the effects of selected cytokines on intercellular adhesion molecule 1 (ICAM1) expression, glycosaminoglycan (GAG) production and adipogenesis in orbital fibroblasts (OFs) from patients with TAO. Orbital tissue was taken during surgery from eight patients with TAO and five control subjects. OFs were cultured and ICAM1 expression measured by flow cytometry. GAG production was measured by hyaluronic acid ELISA. OFs were grown in adipogenic media and the degree of adipogenesis quantified. Responses were similar in OFs from patients with and without TAO. Tumour necrosis factor-alpha (TNFalpha) and interleukin1 (IL1) (0.1 ng/ml) stimulated ICAM1 expression by eight- to ten-fold. Anti-cytokine agents inhibited the cytokine-upregulated ICAM1 expression by 90-99% (P<0.01). TNFalpha and IL1 (0.1 ng/ml) increased hyaluronic acid production by 44 and 95% (P<0.01) respectively. Anti-cytokine agents inhibited these responses by 79-138% (P<0.04).0.013 AU and -1.0; P<0.03) whilst IL1 (0.1 ng/ml) stimulated adipogenesis (+0.05 AU and +5.7; P<0.02) measured by oil-red-O extraction and visual assessment respectively. The anti-IL1 agent inhibited IL1-mediated adipogenesis by 69-106% (P<0.04). TNFalpha and IL1 stimulate ICAM1 expression and GAG production, but have opposite effects on adipogenesis in OFs in vitro. IL1 promotes adipogenesis and its effects can be blocked by anti-IL1 agents in vitro. These agents may be the anti-cytokine treatment of choice for clinical trials in active TAO.
  European Journal of Endocrinology 09/2006; 155(3):395-403. · 3.42 Impact Factor
• Article: Cystic fibrosis-related diabetes in adults.

  T J Cawood, M J McKenna, C G Gallagher, D Smith, W Y Chung, J Gibney, D O'Shea
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  ABSTRACT: We aimed to examine the differences between patients with cystic fibrosis-related diabetes (CFRD), and those with normal glucose handling in adults with cystic fibrosis (CF) in Ireland. We conducted a retrospective analysis of patients who attend the national referral centre for adult CF. Patients were diagnosed as having CFRD by the American Cystic Fibrosis Foundation criteria for diagnosis of CFRD. Of 259 patients, 150 were classifiable and 81 (54%) were classified as having CFRD. The groups with and without CFRD were not significantly different with regard to age (median 28.4 vs 26.0 years), sex (males 56% vs 55%) or BMI (median 20.9 vs 21.3 kg/m2). The group with CFRD had poorer lung function (mean % predicted FEV1 49.9 vs 66.4, P < 0.001), poorer bone mineral density (T-scores at the lumbar spine -1.95 vs -1.44, P < 0.05 and femur -1.19 vs -0.57, P < 0.01) and a greater proportion of PSEUDOMONAS AERUGINOSA positive sputum cultures (82.5% vs 64.2%, P < 0.05). No patients with CFRD carried the R1 17H mutation whilst 19% of the group without CFRD were heterozygous for this defect (P < 0.001). In conclusion, CFRD was highly prevalent in adults. The presence of CFRD was associated with poorer lung function, poorer bone mineral density and an increased prevalence of PSEUDOMONAS AERUGINOSA in sputum. The R1 17H mutation may be protective for CFRD.
  Irish medical journal 04/2006; 99(3):83-6.
• Article: Oral bisphosphonates improve Bone Mineral Density in adults with cystic fibrosis.

  T J Cawood, M J McKenna, C G Gallagher, D Smith, Y C Wen, J Gibney, J D Dodd, D O'Shea
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  ABSTRACT: In adults with Cystic Fibrosis (CF) we sought to establish the effect of oral bisphosphonate therapy. Bone densitometry measured by dual energy X-ray absorptiometry (DXA), and clinical patient data, were reviewed retrospectively. Eighty-one patients (median age 27 years) had baseline and follow-up DXA, with an interval of 19.2 +/- 7.1 months. Thirty-six patients were treated with bisphosphonates (alendronate=23 and risedronate=13). Median follow-up Bone Mineral Density in the bisphosphonate group was 3.7% greater at the lumbar spine (95%CI 1.9 to 5.7%, P<0.0005) and 2.4% greater at the femur (95%CI 0.8 to 3.9%, P<0.005) than the group not treated with bisphosphonates. Oral bisphosphonate therapy had a beneficial effect on BMD in adults with CF.
  Irish medical journal 10/2005; 98(9):270-3.
• Article: Front crawl drowning following previous syncopal episodes.

  S J Eustace, D O'Shea, M Crowe
  Irish Journal of Medical Science 03/1991; 160(2):52-3. · 0.58 Impact Factor
• Article: Enquiry about childcare responsibility should become routine in the assessment of the older patient.

  C O'Dwyer, A Moriarty, C Collins, D O'Shea
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  ABSTRACT: Currently elderly relatives are being asked to assist with informal childcare more frequently. This role can lead to an increase in stress and fatigue. In someone with cognitive impairment it can put both adult and child at risk. Two hundred people attending the Carew day hospital were asked if they had supervised children in the previous 12 months. People were excluded if they had cared for children >12 years of age, had a Mini Mental State Exam (MMSE) of <10 or were resident in a nursing home. Thirty-two (16%, 25 female) had looked after children. Average age 79 years. Seven had a short-term memory of 0/3. Five looked after them on a daily basis, two with an MMSE <24. Five looked after them longer than a 10-h period/overnight, one with an MMSE <24. Members of the multidisciplinary team who participate in the assessment of older people need to be aware of their increasing role in childcare. As a result of our findings we propose that the time has come to include a question about childcare as part of routine assessment of the older patient.
  Irish Journal of Medical Science 176(2):121-3. · 0.58 Impact Factor
• Article: Assessment and management of transient ischaemic attack--the role of the TIA clinic.

  C Fallon, I Noone, J Ryan, D O'Shea, R O'Laoide, M Crowe
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  ABSTRACT: As the risk of early stroke following transient ischaemic attack (TIA) is increasingly recognised, the management of patients presenting with symptoms suggestive of TIA presents a clinical challenge. Analysis of prospectively collected data on patients referred to a TIA clinic in St. Vincent's University Hospital, between January 2003 and July 2004. One-hundred-and-seventeen (117) patients (mean age 75.5 years) were assessed. The majority (79%) were referred from Accident and Emergency and 61% were seen within one week of referral. Seventy-two patients (62%) had a final diagnosis of cerebrovascular disease (56 TIA, 16 completed strokes), of whom five (7%) and four (5.5%) had severe (> 70%) and moderate (> 50%) symptomatic carotid artery stenosis, respectively, whilst seven patients (10%) had newly diagnosed atrial fibrillation, five of whom were anticoagulated. Non-cerebrovascular diagnoses were made in twenty-seven patients (24%). A TIA clinic, in co-ordination with Accident and Emergency Services, provides a safe and efficient alternative to hospital admission for patients with TIA symptoms and a low early stroke risk.
  Irish Journal of Medical Science 175(3):24-7. · 0.58 Impact Factor