Desmond Oneill | Trinity College Dublin (original) (raw)

Papers by Desmond Oneill

Background: Venous thromboembolism (VTE) is a well-recognized and preventable complication of acu... more Background: Venous thromboembolism (VTE) is a well-recognized and preventable complication of acute stroke. Although graduated compression stockings reduce the risk of VTE for patients undergoing operation, their benefit in acute stroke remains uncertain. Methods: The relationship between symptomatic VTE (sVTE) and use of stockings using observational data from the Tinzaparin in Acute Ischemic Stroke Trial, which compared 10 days of treatment with tinzaparin (175 IU/kg Ϫ1 or 100 IU/kg Ϫ1) with aspirin (300 mg), was assessed using logistic regression adjusted for known VTE risk factors and treatment. Results: sVTE Occurred in 28 patients (1.9%; 18 with deep vein thrombosis and 13 with pulmonary embolism) within 15 days of enrollment in 1479 patients. Patients wearing one or two stockings for any period of time during the first 10 days (n ϭ 803) had a nonsignificant increase (odds ratio 2.45, 95% confidence interval 0.95-6.32) in the risk of sVTE. In contrast, those wearing bilateral stockings for 10 days (n ϭ 374) had a nonsignificant reduction in the odds of sVTE as compared with those who wore no stockings or wore them for less than 10 days (odds ratio 0.65, 95% confidence interval 0.26-1.65). Mild stroke and treatment with tinzaparin were associated with a reduced risk of VTE. Conclusions: Bilateral graduated compression stockings may reduce the incidence of VTE by one third for patients with acute ischemic stroke. However, the uncertainty in this finding, low frequency of sVTE, potential for stockings to cause harm, and cost of stockings highlight the need for a large randomized controlled trial to examine the safety and efficacy of stockings in acute stroke.

Bmj British Medical Journal, 2008

Irish Medical Journal, 2013

Bmj British Medical Journal, 2007

Irish Medical Journal, 1998

Journal of the Royal Society of Medicine, 1992

Occupational Therapy in Health Care, 2015

While a clinical pre-selection screening process for a stroke patient&amp... more While a clinical pre-selection screening process for a stroke patient's suitability for driving has been acknowledged, little is known about the factors or processes influencing this screening typically conducted by clinicians practicing at a generalist level. This study explored this clinical stratification process through the use of semi-structured interviews with senior occupational therapists (n = 17) and stroke physicians (n = 7) using qualitative description methodology. The findings revealed a trichotomy stratification of stroke patients for driving in the clinical setting; those who are fit to drive, unfit to drive, and a "maybe" group who need more detailed assessment and observation. Factors that had a major influence on this clinical-based stratification of driving suitability were client's levels of awareness, insight, and impulsivity. A period of prolonged contact with the client was preferential to guide the stratification decision in order for clinicians to build a comprehensive picture of the person. A mix of assessment approaches including standardized assessment but with increased emphasis on naturalistic observation of functional performance underpinned the clinical stratification process. This study uncovers some of the factors and processes influencing the early clinical-based stratification of driving suitability after stroke, and highlights the contribution of the generalist practitioner in the assessment of fitness to drive continuum.

Irish Journal of Medical Science

Age and ageing, Jan 23, 2015

T.S. Eliot once proposed that there were two sorts of problems in life. One prompted the question... more T.S. Eliot once proposed that there were two sorts of problems in life. One prompted the question, 'What are we going to do about it?' and the other provoked the questions, 'What does it mean? How does one relate to it?' Geriatric medicine, an eminently practical specialty, has concentrated with good effect on the former but with notable exceptions has yet to devote significant time to the latter. Into this breach has developed an innovative and exciting movement in gerontology to provide a deeper and more comprehensive insight into the meaning of ageing. Largely encompassed by the terms of cultural, humanistic and narrative gerontology, their intent and methodologies in many ways mirror the relationship between the medical humanities, narrative medicine and medicine.

Irish medical journal, 2012

Irish medical journal, 2010

BMJ (Clinical research ed.), 2003

Background: Venous thromboembolism (VTE) is a well-recognized and preventable complication of acu... more Background: Venous thromboembolism (VTE) is a well-recognized and preventable complication of acute stroke. Although graduated compression stockings reduce the risk of VTE for patients undergoing operation, their benefit in acute stroke remains uncertain. Methods: The relationship between symptomatic VTE (sVTE) and use of stockings using observational data from the Tinzaparin in Acute Ischemic Stroke Trial, which compared 10 days of treatment with tinzaparin (175 IU/kg Ϫ1 or 100 IU/kg Ϫ1) with aspirin (300 mg), was assessed using logistic regression adjusted for known VTE risk factors and treatment. Results: sVTE Occurred in 28 patients (1.9%; 18 with deep vein thrombosis and 13 with pulmonary embolism) within 15 days of enrollment in 1479 patients. Patients wearing one or two stockings for any period of time during the first 10 days (n ϭ 803) had a nonsignificant increase (odds ratio 2.45, 95% confidence interval 0.95-6.32) in the risk of sVTE. In contrast, those wearing bilateral stockings for 10 days (n ϭ 374) had a nonsignificant reduction in the odds of sVTE as compared with those who wore no stockings or wore them for less than 10 days (odds ratio 0.65, 95% confidence interval 0.26-1.65). Mild stroke and treatment with tinzaparin were associated with a reduced risk of VTE. Conclusions: Bilateral graduated compression stockings may reduce the incidence of VTE by one third for patients with acute ischemic stroke. However, the uncertainty in this finding, low frequency of sVTE, potential for stockings to cause harm, and cost of stockings highlight the need for a large randomized controlled trial to examine the safety and efficacy of stockings in acute stroke.

Bmj British Medical Journal, 2008

Irish Medical Journal, 2013

Bmj British Medical Journal, 2007

Irish Medical Journal, 1998

Journal of the Royal Society of Medicine, 1992

Occupational Therapy in Health Care, 2015

While a clinical pre-selection screening process for a stroke patient&amp... more While a clinical pre-selection screening process for a stroke patient's suitability for driving has been acknowledged, little is known about the factors or processes influencing this screening typically conducted by clinicians practicing at a generalist level. This study explored this clinical stratification process through the use of semi-structured interviews with senior occupational therapists (n = 17) and stroke physicians (n = 7) using qualitative description methodology. The findings revealed a trichotomy stratification of stroke patients for driving in the clinical setting; those who are fit to drive, unfit to drive, and a "maybe" group who need more detailed assessment and observation. Factors that had a major influence on this clinical-based stratification of driving suitability were client's levels of awareness, insight, and impulsivity. A period of prolonged contact with the client was preferential to guide the stratification decision in order for clinicians to build a comprehensive picture of the person. A mix of assessment approaches including standardized assessment but with increased emphasis on naturalistic observation of functional performance underpinned the clinical stratification process. This study uncovers some of the factors and processes influencing the early clinical-based stratification of driving suitability after stroke, and highlights the contribution of the generalist practitioner in the assessment of fitness to drive continuum.

Irish Journal of Medical Science

Age and ageing, Jan 23, 2015

T.S. Eliot once proposed that there were two sorts of problems in life. One prompted the question... more T.S. Eliot once proposed that there were two sorts of problems in life. One prompted the question, 'What are we going to do about it?' and the other provoked the questions, 'What does it mean? How does one relate to it?' Geriatric medicine, an eminently practical specialty, has concentrated with good effect on the former but with notable exceptions has yet to devote significant time to the latter. Into this breach has developed an innovative and exciting movement in gerontology to provide a deeper and more comprehensive insight into the meaning of ageing. Largely encompassed by the terms of cultural, humanistic and narrative gerontology, their intent and methodologies in many ways mirror the relationship between the medical humanities, narrative medicine and medicine.

Irish medical journal, 2012

Irish medical journal, 2010

BMJ (Clinical research ed.), 2003