Marie Twomey

St. Luke's Hospital, Rathgar, Dublin, Leinster, Ireland

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Publications (6)8.27 Total impact

  • Elaine Wallace · Marie Twomey · Ray Victory · Maeve O'Reilly
    Journal of palliative care 04/2013; 29(1):49-51. · 0.68 Impact Factor
  • Elaine Wallace · Marie Twomey · Maeve O'Reilly
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    ABSTRACT: Central venous access devices (CVADs) play an essential role in the care of critically ill children. Significant challenges exist for teams in managing CVADs particularly in a community setting. The authors aimed to assess the experience of general practitioners (GPs) caring for children with CVADs. From 200 CVADs inserted in a pediatric hospital in 2009, 50 patients were randomly selected and 44 GPs were forwarded a questionnaire. Twenty (46%) GPs responded. The main reasons (n = 22) for using CVADs were medication administration (n = 11), nutrition (n = 6), and blood sampling (n = 5). Thirteen (65%) GPs had no education in CVAD management and 14 (70%) were unaware of existing guidelines. Those identified by GPs as having primary responsibility for care of CVADs in the community included hospital/pediatric teams (n = 9), parents (n = 3), GPs (n = 2), public health nurses (n = 1), and palliative care ("home care") teams (n = 1). The main challenges (n = 15) identified by GPs were lack of education (n = 4), line management difficulties (n = 3), infection risk (n = 3), infrequent exposure to CVADs (n = 3), and poor communication (n = 1). GPs felt that these challenges could be addressed through: education (n = 8), increased manpower and community support (n = 1), and improved communication (n = 1). This study highlights the inconsistency and challenges for GPs surrounding CVAD use in children. Further education and support is necessary to assist GPs in their use particularly when providing end-of-life care for children in the community.
    Pediatric Hematology and Oncology 05/2012; 29(5):446-9. DOI:10.3109/08880018.2012.684135 · 1.10 Impact Factor
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    ABSTRACT: The authors present a case of unilateral mydriasis in a teenager prescribed transdermal hyoscine hydrobromide (scopolamine) for chemotherapy induced nausea and vomiting. The authors discuss the ocular side-effects associated with this particular drug and delivery system and the potential use of transdermal hyoscine as an antiemetic agent in this group.
    Case Reports 03/2012; 2012. DOI:10.1136/bcr.08.2011.4697
  • Elaine M Wallace · Maeve O'Reilly · Marie Twomey
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    ABSTRACT: Background: Seizures are a common complication in patients with central nervous system (CNS) tumors. Optimal management is unclear with no defined guidelines and pharmacological management poses many controversies. Due to a hypothesized lack of consistency, we aimed to retrospectively review seizure management in patients with high-grade CNS tumors in our institution. METHODS: The medical records of patients with high-grade CNS tumors referred to the specialist palliative medicine service in our institution from January-June 2008 were retrospectively reviewed. Seizure incidence, antiepileptic drug (AED) choice, neurology input, medication interactions, and appropriate drug level monitoring were assessed. RESULTS: Twenty-seven patients were included for analysis. Fifteen (56%) were female. The mean age was 58.8 years (range 31-82 years). Three (11%) patients presented with seizures and 8 (30%) developed seizures subsequently. Eight (73% of those with seizures) were on monotherapy AED. Six different agents were used as first-line agents. Phenytoin was the most common AED used (n = 4). Three (27%) patients were on combination AEDs. Five (45.5%) patients had been seen by neurology and 6 (54.5%) had appropriate drug level monitoring performed. Six (55%) patients had potential AED-non-AED interactions. None of the patients had instructions documented in the clinical notes against driving. Conclusion: Seizure management in patients with CNS tumors is not consistent and remains very much a neglected area. Appropriate choice of AED is crucial. Physicians should be aware of potential drug interactions. Ownership and regular follow-up of this group is required to ensure optimum patient management.
    The American journal of hospice & palliative care 02/2012; 29(8). DOI:10.1177/1049909111434367 · 1.38 Impact Factor
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    B Hannon · V Jennings · E J Nolloy · M Twomey · M O'Reilly
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    ABSTRACT: Background: Trisomy 18 is the second most common autosomal trisomy in liveborn infants, characterised by severe psychomotor and growth retardation.The median survival is 19 days, with only 5-8% surviving their first year of life. Despite recognising that trisomy 18 is almost invariably associated with death in infancy or early childhood, there is a dearth of published data regarding the palliative care needs of these patients.It is estimated that there are 20 -25 new cases of trisomy 18 in Ireland annually, although the lack of a national database makes it difficult to confirm incidence rates.Aims: To assess the referral rate of trisomy 18 to a Palliative Care service, review symptom burden and outcomes in terms of life expectancy & place of death.Methods: A retrospective chart review of all cases referred over a ten-year period (2001-2010).Results: 20 referrals were made. All had classical physical characteristics of trisomy 18. The most common reasons for referral were feeding & breathing difficulties, irritability and assistance with discharge planning. Mean age at death was 64 days.Discussion: This is the first study to review the specific palliative care needs of infants born with trisomy 18, to show that successful home discharge is possible & to comment on place of death.A national database is needed to identify infants diagnosed with trisomy 18, & to ensure correct resource allocation.Neonatal pathways for babies with trisomy 18 could provide a framework for decision making & care planning, from diagnosis to bereavement support.
    Pediatric Research 11/2011; 70:411-411. DOI:10.1038/pr.2011.636 · 2.31 Impact Factor
  • Journal of pain and symptom management 02/2011; 41(2):e1-3. DOI:10.1016/j.jpainsymman.2010.10.255 · 2.80 Impact Factor