Desmond O'Neill

Tallaght Hospital, Tallaght, Leinster, Ireland

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Publications (158)1203.03 Total impact

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    ABSTRACT: People with dementia are among the most frequent service users in the acute hospital. Despite this, the acute hospital is not organized in a manner that best addresses their needs. Methods We examined acute dementia care over a three year period from 2010-2012 in a 600 bed university hospital, to clarify the service activity and costs attributable to acute dementia care. Results 929 patients with dementia were admitted during the study period, accounting for 1,433/69,718 (2%) of all inpatient episodes, comprising 44,449/454,169 (10%) of total bed days. The average length of stay (LOS) was 31.0 days in the dementia group and 14.1 days in those over 65 years without dementia. The average hospital care cost was almost three times more (€13,832) per patient with dementia, compared to (€5,404) non-dementia patients, accounting for 5% (almost €20,000,000) of the total hospital casemix budget for the period. Discussion Service activity attributable to dementia care in the acute hospital is considerable. Moreover, given the fact that a significant minority of cognitive impairment goes unrecognized after acute admissions, it is likely that this is under-representative of the full impact of dementia in acute care. While the money currently being spent on acute dementia care is considerable, it is being used to provide a service that does not meet its users needs adequately. It is clear that acute hospitals need to provide a more 'dementia friendly' service for acutely unwell older persons. © The Author 2015. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    QJM: monthly journal of the Association of Physicians 05/2015; DOI:10.1093/qjmed/hcv085 · 2.46 Impact Factor
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    ABSTRACT: To the Editor,Baxter et al. provide a helpful review on the impact of work-related challenges that may be associated with elderly anesthesiologists. The authors also offer proposed assessments and possible solutions to ensure patient care is not compromised.1 This paper reflects broader concerns over a lack of preparedness among professional bodies associated with a range of liberal professions where their members may continue practice into later life without support from formal occupational health services.2 This is particularly important for medical specialities where there is a heavy reliance on psychomotor skills and rapid responses to emergent situations and where senior specialists are frequently required to attend out of hours to deal with complex clinical cases.For this reason, it is essential that professional and regulatory bodies draw on emerging developments in research on older workers from the field of occupational health.3 The concept of “promotion of work ability” pione ...
    Canadian Journal of Anaesthesia 12/2014; 62(3). DOI:10.1007/s12630-014-0296-5 · 2.50 Impact Factor
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    Hilary Moss, Claire Donnellan, Desmond O'Neill
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    Hilary Moss, Claire Donnellan, Desmond O'Neill
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    ABSTRACT: To assess the impact of hospitalization on arts engagement among older people; and to assess perceptions of whether hospitals are aesthetically deprived environments. A Survey of Aesthetic and Cultural Health was developed to explore the role of aesthetics before, during and after hospital. Study participants were n = 150 hospital in-patients aged >65. Descriptive and inferential statistics were used to analyze the data. Attendance at arts events was an important part of life for this sample and a large drop off was noted in continuation of these activities in the year post-hospital stay. Physical health issues were the main causes but also loss of confidence and transport issues. Film, dance, and music were the most popular arts for this sample prior to hospital stay. Noise pollution caused by other patients, lack of control over TV/radio, and access to receptive arts in hospital (reading and listening to music) were important issues for patients in hospital. This study identifies a trend for decreasing exposure to arts beginning with a hospital stay and concludes that older people may need encouragement to resume engagement in arts following a hospital stay. There is relatively limited evidence regarding the nature of, and potential benefit from, aesthetics in healthcare and limited studies with rigorous methodology, and further research is needed to understand the aesthetic preferences of older people in hospital. Copyright © 2014 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.
    Journal of the American Medical Directors Association 12/2014; 16(2). DOI:10.1016/j.jamda.2014.10.019 · 4.78 Impact Factor
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    ABSTRACT: Objectives: The Beers (2012) criteria and the screening tool of older persons' potentially inappropriate prescriptions (STOPP) criteria are often used to identify potentially inappropriate medication (PIM) use in elderly patients. The aim of this study is to determine the prevalence of PIM use in nursing home residents (NHRs) aged >= 65 years presenting to the Emergency Department (ED); to compare the Beers and STOPP criteria and to identify the potential role of PIMs in ED attendances. Setting: The ED of an urban tertiary referral hospital. Participants: Acutely unwell long-term care NHRs seeking medical assistance at the ED. Design and Measurements: This is a retrospective cohort study. Demographic and clinical data were retrieved from the ED electronic record system, from the clinical records, and transfer letters for all NHRs who attended the ED in 2011. Beers 2012 and STOPP criteria were used to identify PIMs. Results: Of 195 NHRs identified, 165 were included. The mean age (+/- standard deviation) was 82.5 (+/- 7.7) years; 110 (66.7%) were female and 157 (95.2%) were prescribed at least 1 PIM by either criterion. One hundred forty patients (84.8%) received a PIM according to STOPP criteria and 147 (89.1%) according to the Beers criteria. In the majority of patients (148; 89.7%), there was a difference in the medications Beers and STOPP identified as inappropriate. Fifty patients (30.3%) were considered to have a link between their attendance at ED and the PIM prescribed when assessed subjectively. Objective assessment using the WHO-UMC criteria found 7 (4.2%) had a 'probable' link and 45 (27.3%) a 'possible' link. Conclusions: These results show a high rate of PIM prescribing in this cohort. The use of criteria such as Beers and STOPP may be a useful guide for physicians coordinating the long-term care of NHRs and may have the potential to reduce attendances at ED. (C) 2014 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
    Journal of the American Medical Directors Association 10/2014; 15(11). DOI:10.1016/j.jamda.2014.08.008 · 4.78 Impact Factor
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    ABSTRACT: The importance of thrombin generation in the pathogenesis of TIA or stroke and its relationship with cerebral microembolic signals (MES) in asymptomatic and symptomatic carotid stenosis has not been comprehensively assessed.
    Journal of Neurology Neurosurgery & Psychiatry 07/2014; 86(4). DOI:10.1136/jnnp-2013-307556 · 5.58 Impact Factor
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    ABSTRACT: The analysis of routinely collected hospital data informs the design of specialist services for at-risk older people.
    QJM: monthly journal of the Association of Physicians 06/2014; DOI:10.1093/qjmed/hcu111 · 2.46 Impact Factor
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    ABSTRACT: The impact of commencing or changing antiplatelet therapy on von Willebrand factor antigen (VWF:Ag) and von Willebrand factor propeptide (VWF:Ag II) levels has not been comprehensively assessed following TIA or ischaemic stroke. In this pilot, longitudinal, observational analytical study, VWF:Ag and VWF:Ag II levels were simultaneously quantified in platelet poor plasma by ELISA in patients within 4 weeks of TIA or ischaemic stroke (baseline), and then 14 days (14d) and >90 days (90d) after altering antiplatelet therapy. Ninety-one patients were recruited. Eighteen were initially assessed on no antiplatelet therapy, and then after 14d (N = 17) and 90d (N = 8) on aspirin monotherapy; 21 patients were assessed on aspirin and after 14d and 90d on clopidogrel; 52 were assessed on aspirin monotherapy, and after 14d and 90d on aspirin and dipyridamole combination therapy. VWF:Ag, VWF:Ag II levels and VWF:Ag/VWF:Ag II ratio were unchanged at 14d and 90d in the overall study population (p ≥ 0.1). VWF:Ag and VWF:Ag II levels remained stable at 14d and 90d after commencing aspirin (p ≥ 0.054), and after changing from aspirin to clopidogrel (p ≥ 0.2). Following the addition of dipyridamole MR to aspirin, there was a significant reduction in VWF:Ag levels at 14d (p = 0.03) and 90d (p = 0.005), but not in VWF:Ag II levels (p ≥ 0.3). The addition of dipyridamole to aspirin led to a persistent reduction in VWF:Ag but not in VWF:Ag II levels, suggesting that dipyridamole may inhibit release of platelet-derived VWF:Ag following TIA or ischaemic stroke.
    Journal of Neurology 04/2014; 261(7). DOI:10.1007/s00415-014-7362-3 · 3.84 Impact Factor
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    ABSTRACT: The objective of this study was to survey general practitioners (GPs) in Ireland regarding their experience with elder abuse. A random sample of 800 GPs were mailed a survey in March 2010, with a reminder in May 2010, yielding a 24% response rate. The majority, 64.5%, had encountered elder abuse, with 35.5% encountering a case in the previous year. Most were detected during a home visit. Psychological abuse and self-neglect were most common. Most GPs in Ireland have encountered cases of elder abuse, most were willing to get involved beyond medical treatment, and 76% cited a need for more education.
    Journal of Elder Abuse & Neglect 04/2014; 26(3):291-299. DOI:10.1080/08946566.2013.827955
  • Desmond O'Neill
    The Lancet 04/2014; 383(9924):1205. DOI:10.1016/S0140-6736(14)60595-X · 39.21 Impact Factor
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    ABSTRACT: Background and purposevon Willebrand factor propeptide (VWF:Ag II) is potentially a more sensitive marker of acute endothelial activation than von Willebrand factor antigen (VWF:Ag). These biomarkers have not been simultaneously assessed in asymptomatic versus symptomatic carotid stenosis patients. The relationship between endothelial activation and cerebral microembolic signals (MESs) detected on transcranial Doppler ultrasound is unknown.Methods In this multicentre observational analytical study, plasma VWF:Ag and VWF:Ag II levels in patients with ≥50% asymptomatic carotid stenosis were compared with those from patients with ≥50% symptomatic carotid stenosis in the ‘early’ (≤4 weeks) and ‘late’ (≥3 months) phases after transient ischaemic attack or ischaemic stroke. Endothelial activation was also longitudinally assessed in symptomatic patients during follow-up. Transcranial Doppler ultrasound monitoring classified patients as MES-positive or MES-negative.ResultsData from 31 asymptomatic patients were compared with those from 46 early symptomatic and 35 late phase symptomatic carotid stenosis patients, 23 of whom had undergone carotid intervention. VWF:Ag II levels were higher in early (12.8 μg/ml; P < 0.001), late (10.6 μg/ml; P = 0.01) and late post-intervention (10.6 μg/ml; P = 0.038) symptomatic patients than asymptomatic patients (8.9 μg/ml). VWF:Ag levels decreased in symptomatic patients followed up from the early to late phase after symptom onset (P = 0.048). Early symptomatic MES-negative patients had higher VWF: Ag II levels (13.3 vs. 9.0 μg/ml; P < 0.001) than asymptomatic MES-negative patients.Conclusions Endothelial activation is enhanced in symptomatic versus asymptomatic carotid stenosis patients, in early symptomatic versus asymptomatic MES-negative patients, and decreases over time in symptomatic patients. VWF:Ag II levels are a more sensitive marker of endothelial activation than VWF:Ag levels in carotid stenosis. The potential value of endothelial biomarkers and concurrent cerebral MES detection at predicting stroke risk in carotid stenosis warrants further study.
    European Journal of Neurology 04/2014; 21(7). DOI:10.1111/ene.12403 · 3.85 Impact Factor
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    Hilary Moss, Desmond O'Neill
    The Lancet 03/2014; 383(9922):1032-3. DOI:10.1016/S0140-6736(14)60507-9 · 39.21 Impact Factor
  • QJM: monthly journal of the Association of Physicians 03/2014; 107(6). DOI:10.1093/qjmed/hcu059 · 2.46 Impact Factor
  • Robert Briggs, Desmond O'Neill
    Clinical medicine (London, England) 03/2014; 14(2):200-2. DOI:10.7861/clinmedicine.14-2-200 · 1.69 Impact Factor
  • European Congress of Radiology, Vienna, Austria; 03/2014
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    ABSTRACT: The 'accuracy' of age, blood pressure, clinical features, duration and diabetes (ABCD(2)) scoring by non-stroke specialists referring patients to a daily Rapid Access Stroke Prevention (RASP) service is unclear, as is the accuracy of ABCD(2) scoring by trainee residents. In this prospective study, referrals were classified as 'confirmed TIAs' if the stroke specialist confirmed a clinical diagnosis of possible, probable or definite TIA, and 'non-TIAs' if patients had a TIA mimic or completed stroke. ABCD(2) scores from referring physicians were compared with scores by experienced stroke specialists and neurology/geriatric medicine residents at a daily RASP clinic; inter-observer agreement was examined. Data from 101 referrals were analysed (mean age=60.0years, 58% male). The median interval between referral and clinic assessment was 1day. Of 101 referrals, 52 (52%) were 'non-TIAs': 45 (86%) of 52 were 'TIA mimics' and 7 (14%) of 52 were completed strokes. There was only 'fair' agreement in total ABCD(2) scoring between referring physicians and stroke specialists (κ=0.37). Agreement was 'excellent' between residents and stroke specialists (κ=0.91). Twenty of 29 patients scored as 'moderate to high risk' (score 4-6) by stroke specialists were scored 'low risk' (score 0-3) by referring physicians. ABCD(2) scoring by referring doctors is frequently inaccurate, with a tendency to underestimate stroke risk. These findings emphasise the importance of urgent specialist assessment of suspected TIA patients, and that ABCD(2) scores by non-stroke specialists cannot be relied upon in isolation to risk-stratify patients. Inter-observer agreement in ABCD(2) scoring was 'excellent' between residents and stroke specialists, indicating short-term training may improve accuracy.
    Journal of the neurological sciences 07/2013; 332(1-2). DOI:10.1016/j.jns.2013.05.030 · 2.26 Impact Factor
  • International Psychogeriatrics 07/2013; 25(12):1-2. DOI:10.1017/S1041610213000999 · 1.89 Impact Factor
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    ABSTRACT: Nursing home (NH) residents represent the frailest group of older people, and providing gerontologically attuned care that addresses these frailties is often a challenge within the emergency department (ED). This study sought to prospectively profile acutely unwell NH residents in order to clarify some of the challenges of providing emergency care to this group. Over an 18-week period, we prospectively reviewed all NH residents presenting to the ED of an urban university teaching hospital. Relevant data were retrieved by direct physician review (as part of a comprehensive geriatric assessment in the ED), collateral history from NH staff and primary carers, and review of electronic records. There were 155 ED visits by 116 NH residents. Their mean age was 80.3 (±9.6) years. High pre-morbid levels of dependency were reflected by a mean Barthel Index of 34.1 (±20) and almost two-thirds had a pre-existing diagnosis of dementia. One-third of visits were during 'normal' working hours. Patients were reviewed by their regular NH doctor pre-transfer for 36% of visits. Using accepted international criteria, over half of the visits were deemed 'potentially preventable'. Unwell NH residents have complex medical needs. The decision to refer these patients to the ED is often made by 'out of hours' general practitioners and their initial care in the ED is directed by physicians with limited experience in geriatric medicine. Most referrals to the ED are potentially preventable but this would require enhancements to the package of care available in NHs.
    QJM: monthly journal of the Association of Physicians 07/2013; 106(9). DOI:10.1093/qjmed/hct136 · 2.46 Impact Factor
  • Desmond O'Neill
    BMJ (online) 06/2013; 346:f3606. DOI:10.1136/bmj.f3606 · 16.38 Impact Factor

Publication Stats

850 Citations
1,203.03 Total Impact Points

Institutions

  • 2012–2015
    • Tallaght Hospital
      Tallaght, Leinster, Ireland
    • University College Cork
      Corcaigh, Munster, Ireland
  • 1998–2014
    • The Adelaide and Meath Hospital Ireland
      Dublin, Leinster, Ireland
  • 1989–2014
    • Trinity College Dublin
      • • Department of Medical Gerontology
      • • School of Psychology
      • • Department of Clinical Medicine
      Dublin, Leinster, Ireland
  • 2008–2012
    • Royal College of Surgeons in Ireland
      • Department of Molecular and Cellular Therapeutics
      Dublin, Leinster, Ireland
  • 2011
    • Ireland's Health Services
      Dublin, Leinster, Ireland
  • 2009
    • Dublin Dental University Hospital
      Dublin, Leinster, Ireland
  • 2005
    • The Bracton Centre, Oxleas NHS Trust
      Дартфорде, England, United Kingdom
  • 1989–2001
    • St. James's Hospital
      • • Mercer's Institute for Research on Ageing
      • • MedEl Directorate
      Dublin, L, Ireland
  • 1999
    • Beth Israel Deaconess Medical Center
      • Division of Gerontology
      Boston, MA, United States