Cork University Hospital

Computed tomography (CT) plays a pivotal role in the diagnosis, severity assessment and recognition of complications in patients with acute pancreatitis (AP). Exposure to cumulative radiation dose increases the risk of malignancy. This study aims to retrospectively investigate imaging utilisation patterns in AP and quantify cumulative effective dose (CED), and identify predictors of high radiation exposure. Adults admitted with AP between 2012 and 2013 were retrospectively reviewed. All imaging over the subsequent 10 years was analysed, and CED was calculated from dose reports or estimated using diagnostic reference levels where required. High exposure was defined as CED > 100 mSv, a dose associated with an increased lifetime risk of malignancy. One hundred-thirteen patients were included with 3022 imaging studies (92 acute interstitial oedematous pancreatitis (AIOP), 21 necrotising pancreatitis (NP)), CT comprised approximately 18% of examinations but delivered > 85% of radiation. Median (IQR) CED was 19.5 mSv for AIOP and 43.3 mSv for NP (p = 0.004). CED exceeded 100 mSv in 4.3% (4/92) of AIOP and 19% (4/21) of NP patients. Overall, 7% (8/113) of the cohort exceeded a CED of 100 mSv. No significant associations were found between CED and aetiology, pseudocyst formation, or mortality. Over a decade of follow-up, 7% of patients with acute pancreatitis exceeded the 100 mSv threshold, with CT accounting for the vast majority of exposure. Necrotising pancreatitis was associated with significantly higher cumulative doses than interstitial disease. Given that up to 30% of patients develop recurrent pancreatitis, strategies to minimize radiation exposure are essential. Optimisation of CT protocols and wider use of non-ionising modalities, including magnetic resonance imaging (MRI) and endoscopic ultrasound where appropriate, may help balance diagnostic accuracy with radiation stewardship.

Computer-based learning (CBL) has emerged as a transformative approach in surgical education, with remote teaching (RT) and self-directed virtual teaching (SDVT) offering scalable and, flexible alternatives to traditional face-to-face instruction. This systematic review aims to qualitatively analyse the current evidence on RT and SDVT for surgical skill training. In July 2023, we conducted a structured search of PubMed, Cochrane Library, Scopus, and Web of Science. To enable a clear evaluation of CBL, particularly by examining retained knowledge, we included only randomized controlled trials (RCT) and prospective cohort studies. Data extraction followed a pretested Excel form, and qualitative synthesis adhered to PRISMA principles. Twenty seven studies (15 RCTs, 12 prospective cohorts) published between 2006 and 2023 met the inclusion criteria. Despite the heterogenicity of the included studies, key findings show that students completed RT achieved competency outcomes equivalent to traditional learning for basic suturing, knot-tying, and fundamental laparoscopic skills in most of the studies. SDVT matched traditional learning for basic tasks but underperformed in complex procedures. Hybrid models combining SDVT with real-time feedback enhanced learner autonomy, engagement and skill retention. Lastly, CBL modalities were well received by trainees, offering time- and cost advantages, as well as providing a teaching platform for low- and middle-income countries. CBL, through RT and SDVT, provides an effective adjunct to traditional surgical training, particularly for foundational technical skills. Integrating the flexibility of SDVT with synchronous feedback during RT can optimize psychomotor learning while maintaining instructional oversight. Future research should standardize outcome measures, assess long-term skill retention, and explore implementation in resource-limited settings.

Elective caesarean section is a common and painful procedure. Uncontrolled pain following caesarean section can profoundly and negatively on a wide range of patient and healthcare-centred outcomes. The aim of this systematic review was to update existing recommendations for postoperative pain management after elective caesarean section performed under neuraxial anaesthesia. A systematic review using the PROcedure SPEcific Postoperative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised trials evaluating the efficacy of analgesic, anaesthetic and surgical interventions were retrieved. Systematic reviews and meta-analyses of randomised controlled trials were also reviewed. Trials evaluating pain management for emergency surgical deliveries or caesarean section performed under general anaesthesia were not included. Sixty-one randomised controlled trials were included. For patients undergoing elective caesarean section performed under neuraxial anaesthesia, we recommend that clinicians administer intrathecal morphine 50-100 μg or diamorphine 300 μg pre-operatively, and paracetamol, non-steroidal anti-inflammatory drugs and dexamethasone after delivery. If a neuraxial opioid is not administered, clinicians should use one of a range of recommended fascial plane blocks; alternatively, the wound should be infiltrated with local anaesthetic. The postoperative regimen should include regular paracetamol and non-steroidal anti-inflammatory drugs, with opioids used for rescue. The surgical technique should include a Joel-Cohen incision. The peritoneum should not be closed. An analgesic regimen to manage pain safely and effectively after elective caesarean section based on up-to-date evidence is presented. Consideration has been given to balancing analgesic efficacy and potential adverse effects. Future research should determine the optimal dose of dexamethasone and epidural long-acting opioid, establish the most effective regional analgesic technique and develop standardised outcome sets to better compare techniques.

BackgroundHead-Mounted-Displays which have mixed reality capabilities have a range of functions which may improve medical training and address certain challenges facing universities worldwide. Devices such as the Microsoft HoloLens 2 device can facilitate provision of procedural tutorials from remote locations, provide tutors with a first-person perspective of a student’s field of view, and allow the insertion of holographic artefacts which can replicate in-person tutorials and facilitate vertical integration of curriculum elements. This study aimed to evaluate the feasibility, efficacy and usability of the Microsoft HoloLens 2 device in providing tutorials to medical students on peripheral intravenous cannulation from a remote location.MethodsMedical student volunteers were randomly allocated to an In-Person (IP) group and HoloLens (HL) group. Students in the IP group received a tutorial on intravenous cannulation in-person, the HL group received the tutorial remotely via the HoloLens. Both groups completed an initial metric- based competency assessment, received a period of metrics-based feedback which informed a period of deliberate practice, followed by a second competency assessment. Students in the HL group received a familiarisation session with the device, completed a Mental Rotations Test, provided feedback, completed a System Usability Scale (SUS) questionnaire and three students completed interviews. One additional student completed a Think Aloud session. ResultsSeventeen student volunteers were recruited. Sixteen students underwent block randomisation. One additional student completed the Think Aloud session. Baseline characteristics of the two groups were similar. Mean initial competency scores were similar for the HL and IP groups, both groups showed significant improvements in performance, and there was no significant difference between the groups’ post-feedback scores, (p= 0.11). Students SUS scores were mean 79.4 (Standard Deviation 13.1). Quantitative and qualitative feedback was relatively positive, but identified several usability and technological limitations, including the development of headaches and visual fatigue.ConclusionsThis study demonstrates that tutorials on intravenous cannulation which are delivered remotely using the HoloLens 2 device are feasible, show a similar improvement in student performance to in-person tutorials, and are relatively well received by students and tutors. The ability to deliver procedural tutorials to a remote location has the potential to be a significant asset to medical educators. However, it also highlights several usability issues, including the development of “cybersickness” symptoms which may be limiting factors in its widespread adoption by educational institutions, and warrants further investigation.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-026-08648-3.

The trajectory of sleep in the first year of age is highly dynamic and correlates with developmental progress from the neonatal to the infantile period. During this critical period of brain growth, sleep facilitates neural maturation and memory consolidation. This review article examines the current evidence regarding the relationship between sleep and neurodevelopment in the first year of age. Over the first year, total sleep time decreases, nocturnal sleep consolidates with less nocturnal awakenings, and daytime sleep decreases. The dominant sleep state shifts from active sleep in neonates to non-rapid eye movement sleep at 12 months. Specific electroencephalogram (EEG) features include tracé alternant in neonates and sleep spindles and K complexes in infants. Characteristics of sleep spindles serve as biomarkers for neurodevelopmental outcomes. Adequate sleep duration is associated with enhanced white matter development. Healthy sleep parameters are linked to improved memory, language, executive function, sensorimotor skills, and overall cognitive development, whereas abnormal sleep during infancy is associated with cognitive, behavioral, and emotional disturbances. Developmental brain disorders and certain medical conditions are also associated with sleep disruption, indicating a bidirectional relationship. Sleep evolves rapidly in the first year of age, and adequate quantity and quality of sleep are critical for neurodevelopment. IMPACT: Sleep evolves significantly and rapidly during the first year, serving critical and active processes for neuromaturation. These sleep changes occur concurrently with major neurodevelopmental progress. Certain medical conditions, environmental exposures, and socioeconomic factors can disrupt sleep, potentially resulting in neurodevelopmental delay. Additionally, neurodevelopmental disorders are frequently associated with disruption in normal sleep architecture, suggesting a bidirectional relationship between sleep disruption and abnormal neurodevelopment. Future research should explore the neurodevelopmental consequences of medical and socioeconomic conditions that disrupt sleep. It is also essential to identify interventions to mitigate cognitive and behavioral disturbance arising from sleep disruption and to protect sleep health.

Ankle fractures are a commonly encounter orthopaedic injury, with lateral malleolar fractures being the most common fracture pattern seen. Proximal fibular fracture with ankle twisting injuries, termed the Maisonneuve fracture, are much rarer, and are thought to account for 5% of surgical treated ankle fractures. Fracture of both proximal and distal fibular following twisting ankle injury is an extremely rare occurrence, with little reported cases in existing literature. We present one such case of a 45-year-old male who sustained both a proximal and distal fibular fracture following a twisting ankle injury with associated posterior malleolar fracture and anterolateral distal tibial tubercle (Tillaux-Chaput fracture). Both proximal and distal fractures were identified on presentation, and he underwent open reduction internal fixation with single cortical screw fixation of anterolateral distal tibial tubercle, lag screw to lateral malleolar and neutralization plate, and two tricortical syndesmotic screws. His post operative course was unremarkable, and he returned to work after nine weeks. Concurrent proximal and distal fibular fractures following ankle twisting injury is an extremely rare fracture pattern. This case highlights the necessity for thorough physical examination and radiological imaging for all ankle injuries while also highlighting the importance of preoperative computed tomography on surgical planning for ankle fractures.

Cryptococcus neoformans most commonly causes pulmonary and central nervous system infections, with skeletal involvement usually occurring as part of disseminated disease in profoundly immunocompromised hosts. We describe an HIV-negative man in his early 50s from South Africa with sarcoidosis, type 1 diabetes mellitus and chronic kidney disease who presented with a 1 month history of a localised swelling over the right anterior chest wall. CT demonstrated an expansile lesion of the right sixth anterior rib. Biopsy and culture confirmed C. neoformans with fluconazole non-susceptibility. The patient was treated with 12 months of voriconazole, achieving clinical and radiological resolution without surgical intervention.