Publications by authors named "John Donnellan"

13 Publications

  • Page 1 of 1

Is Routine Preprocedural Bloodwork Needed for Elective Central Venous Access Device Removals in Children without Bleeding Dyscrasias?

J Vasc Interv Radiol 2020 Feb 26;31(2):276-281.e1. Epub 2019 Dec 26.

Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.

Purpose: To assess the utility of routine preprocedural bloodwork during elective removal of central venous access devices (CVADs) with respect to bleeding complications.

Materials And Methods: Patients who underwent removal of a CVAD (tunneled central venous catheter [CVC] or port) by the interventional radiology service between January 2009 and December 2013 were retrospectively reviewed. Removals for infection or malfunction, without preprocedural bloodwork, with another concurrent procedure at the time of CVAD removal, or in patients with a bleeding dyscrasia were excluded. Peripherally inserted central catheter removals and temporary CVAD removals were also excluded. Routine preprocedural bloodwork included hemoglobin, platelet count, partial thromboplastin time, and International Normalized Ratio. Postprocedural complications were classified according to the Society of Interventional Radiology clinical practice guidelines.

Results: There were 802 CVAD removals in 777 patients (351 female, 426 male). Average patient age was 8.6 years (range, 5 wk to 19 y). In total, 246 permanent CVCs and 556 ports were removed. A total of 802 cases had preprocedural bloodwork. Of the 49 patients who had a bleeding complication after the procedure (6.1%; 49 of 802), 44 had normal findings on preprocedural bloodwork and 5 had abnormal findings. There was no statistically significant difference in bleeding complications between those with normal and abnormal bloodwork results (P = .7740).

Conclusions: Routine bloodwork is not necessary before elective CVAD removal in children without a bleeding dyscrasia. Most children have normal findings on preprocedural bloodwork, and the incidence of postprocedural bleeding is low and not determined by bloodwork results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2019.10.012DOI Listing
February 2020

Clinical Impact of Chronic Venous Changes Induced by Central Lines in Children: A Cohort with Abnormal Venograms.

J Vasc Interv Radiol 2019 May 27;30(5):715-723. Epub 2019 Mar 27.

Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, M5G 1X8, Canada.

Purpose: To explore the hypothesis that central venous stenosis/obstructions (CVS/O) in children are influenced by prior central venous access devices (CVADs) and are associated with future risk for thromboses.

Material And Methods: A convenience sample of 100 patients with abnormal venography (stenosis, collaterals, occlusions) documented during peripherally inserted central catheter (PICC) placements were identified from consecutive PICC placements (January 2008 to November 2012). The patients (41 males, 59 females, median age 2.7 years, median weight 11 kg) were categorized based on venographic presence (Group A, n = 53) or absence (Group B, n = 47) of visible connection to the superior vena cava. Each patient's CVAD history, before and after venography, was analyzed (until October 2016).

Results: Before venogram, Group B patients were associated with a higher number of previous CVADs, larger diameter devices, greater incidence of malposition, and more use of polyurethane catheters than Group A patients (P < .001). An ipsilateral PICC was successfully placed in 98% of Group A, compared to 32% of Group B (P < .001). After venogram, significantly more Doppler ultrasounds (DUS) were performed and thromboses diagnosed in Group B (57% and 36%) compared to Group A (21% and 8%) (P < .003; P = .001), respectively.

Conclusions: Previous catheter characteristics influenced the severity of venographic changes of CVS/O (Group B). Group B was associated with more subsequent symptomatic thromboses. This information may assist parents and referring physicians to anticipate potential adverse sequelae from CVS/O on the child's venous health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jvir.2018.08.034DOI Listing
May 2019

Imaging Features of Common Pediatric Intracranial Tumours: A Primer for the Radiology Trainee.

Can Assoc Radiol J 2018 Feb 22;69(1):105-117. Epub 2017 Dec 22.

Division of Neuroradiology, Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.carj.2017.10.006DOI Listing
February 2018

Hallway Conversations in Physics.

AJR Am J Roentgenol 2017 07 12;209(1):W44-W46. Epub 2017 Apr 12.

1 The Hospital for Sick Children Toronto, ON, Canada

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2214/AJR.17.18064DOI Listing
July 2017

Out of Hours Emergency Computed Tomography Brain Studies: Comparison of Standard 3 Megapixel Diagnostic Workstation Monitors With the iPad 2.

Can Assoc Radiol J 2015 Nov 18;66(4):363-7. Epub 2015 Sep 18.

Department of Radiology, Tallaght Hospital, Dublin, Ireland.

Purpose: The purpose was to compare performance of diagnostic workstation monitors and the Apple iPad 2 (Cupertino, CA) in interpretation of emergency computed tomography (CT) brain studies.

Methods: Two experienced radiologists interpreted 100 random emergency CT brain studies on both on-site diagnostic workstation monitors and the iPad 2 via remote access. The radiologists were blinded to patient clinical details and to each other's interpretation and the study list was randomized between interpretations on different modalities. Interobserver agreement between radiologists and intraobserver agreement between modalities was determined and Cohen kappa coefficients calculated for each. Performance with regards to urgent and nonurgent abnormalities was assessed separately.

Results: There was substantial intraobserver agreement of both radiologists between the modalities with overall calculated kappa values of 0.959 and 0.940 in detecting acute abnormalities and perfect agreement with regards to hemorrhage. Intraobserver agreement kappa values were 0.939 and 0.860 for nonurgent abnormalities. Interobserver agreement between the 2 radiologists for both diagnostic monitors and the iPad 2 was also substantial ranging from 0.821-0.860.

Conclusions: The iPad 2 is a reliable modality in the interpretation of CT brain studies in them emergency setting and for the detection of acute and chronic abnormalities, with comparable performance to standard diagnostic workstation monitors.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.carj.2015.03.006DOI Listing
November 2015

Delayed contrast-enhanced MRI to localize Botox after cystoscopic intravesical injection.

Int Urol Nephrol 2015 Jun 19;47(6):893-8. Epub 2015 Apr 19.

Department of Urology, Tallaght Hospital, Tallaght, Dublin, 24, Ireland,

Purpose: There is a lack of studies to show localization of botulinum toxins (BoNT) within bladder wall and/or absorption rates. Our study examined the later distribution of BoNTA/gadolinium within the bladder wall by performing a delayed MRI scan after intravesical injection. This potentially may help to explain the level and mechanism at which BoNT may be producing its effect.

Methods: A prospective study enrolled 20 consecutive patients with neuropathic or idiopathic overactive bladders. The Aim of the study was to perform MRI 3 h post procedure. Botox 100-200 IU was reconstituted with 19 ml saline and 1 ml of gadolinium contrast. Intradetrusor injections were administered using a rigid 21F cystoscope with a total of 20 injections into bladder wall, including two into the trigone. The depth of injection was approximately 2 mm, without raising a bleb. One radiologist reviewed films and reported on the number of bladder walls with contrast, location, the presence of extravesical extravasation, contrast in distal ureter(s), and bladder wall thickness.

Results: Ninety percentage of patients had contrast within bladder wall. There was a variation in the number of bladder walls involved; 85 % had contrast seen in at least two walls. Also, a variation was noted in the extent of extravasation; 80 % showed some evidence.

Conclusions: Diffusion of BoNT after intravesical injection is very common once bladder wall is breeched. Precise injection localization into muscle layer may not be as relevant to outcome as previously assumed. The assumption in our study that localization and diffusion of contrast also represents the localization of BoNT is open to critique as BoNT diffusion is potentially slower (Mehnert et al. in World J Urol 27(3):397-403, 2009). The absence of systemic symptoms after the injection in our series supports guidelines concerning the safety of procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11255-015-0976-2DOI Listing
June 2015

A moral compass for management decision making: a healthcare CEO's reflections.

Authors:
John J Donnellan

Front Health Serv Manage 2013 ;30(1):14-26

New York University's Robert F. Wagner Graduate School of Public Service, USA.

Ethical behavior is good for business in any organization. In healthcare, it results in better patient care, a more committed and satisfied staff, more efficient care delivery, and increased market share. But it requires leaders who have a broad view of the role that ethics programs--and an effective, sustained ethical culture--play. Ethical organizations have integrated and shared ethical values and practices, an effective ethics infrastructure, ongoing ethics education for staff at every level, ethical and morally courageous leaders, and a culture that is consistent with the organization's values. The mission, vision, and values statements of these organizations have been successfully translated into a set of shared values--a moral compass that guides behavior and decision making.
View Article and Find Full Text PDF

Download full-text PDF

Source
December 2013

Correlation between subcutaneous knee fat thickness and chondromalacia patellae on magnetic resonance imaging of the knee.

Can Assoc Radiol J 2013 Aug 9;64(3):182-6. Epub 2012 Aug 9.

Department of Radiology, Adelaide and Meath Hospital Incorporating the National Children's Hospital, Dublin, Ireland.

Purpose: Chondromalacia patellae is a common cause of anterior knee pain in young patients and can be detected noninvasively with magnetic resonance imaging (MRI). The purpose of our study was to evaluate the correlation between subcutaneous fat thickness around the knee joint on axial MRIs as a surrogate marker of obesity, with the presence or absence of chondromalacia patellae.

Methods: A retrospective review was conducted of knee MRIs in 170 patients who satisfied the inclusion criteria. Imaging was performed over a 12-month period on a 1.5T MRI system with a dedicated extremity coil. Two radiologists experienced in musculoskeletal imaging assessed each examination in consensus for the presence or absence of chondromalacia patellae and graded positive studies from 0 (absent) to 3 (full cartilage thickness defect). Measurement of subcutaneous knee fat thickness was obtained on the medial aspect of the knee.

Results: MRI findings of chondromalacia patellae were present in 33 patients (19.4%), of which, there were 11 grade 1 lesions (33.3%), 9 grade 2 lesions (27.3%), and 13 grade 3 lesions (39.4%). The mean subcutaneous knee fat thickness was significantly higher in the chondromalacia patellae group for all grades compared with the normal group (P < .001), and there was a significant correlation between subcutaneous knee fat thickness and grades of chondromalacia patellae (R = 0.48 [95% confidence interval, 0.38-0.68]; P < .001). Female patients had thicker subcutaneous knee fat and more severe grades of chondromalacia patellae.

Conclusion: Subcutaneous knee fat thickness as a surrogate marker of obesity was positively associated with the presence and severity of chondromalacia patellae on MRI.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.carj.2012.04.003DOI Listing
August 2013

Spontaneous steinstrasse from multiple ureteric calculi.

Br J Hosp Med (Lond) 2012 Aug;73(8):474

Department of Radiology, Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin, Ireland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.12968/hmed.2012.73.8.474DOI Listing
August 2012

West of Ireland facial injury study. Part 2.

Br J Oral Maxillofac Surg 2012 Oct 17;50(7):e99-e103. Epub 2012 Mar 17.

Department of Oral & Maxillofacial, University Hospital, Galway, Ireland.

The pattern, presentation, and volume of facial injury in the west of Ireland are subjectively different from those in the United Kingdom. We know of no prospective regional study of facial injury in Ireland to date, and nationally there is no system in place to collect data on injury. The epidemiology of facial trauma has important implications for the development of health services, the education and training of clinicians, workforce planning, prevention of injury, and promotion of health. Over 1 week we did a multicentre prospective data collection study involving all emergency departments in the west of Ireland. All patients who attended with facial injuries were included (n=325), and those with injuries solely of the scalp and neck were excluded. The proforma recorded a patient's characteristics, details of injury and presentation, treatment and follow-up. It also included relation with sport, alcohol, assault, and animals. Eighty-two fractures were suspected, of which 46% were nasal. Accidents caused 75% of injuries and sport caused 27%. Fractures were sustained by 63% (n=5) of those wearing helmets while playing hurling, but by only 22% of those who were not. Helmets did, however, reduce the total number of injuries. Injuries were associated with alcohol (23%), assault (14%), falls (38%), and motor vehicle crashes (11%). Because of the differences in aetiology, different avenues and methods are required to prevent injury. Staff in emergency departments will need training in this area, given the large proportion of facial trauma in the region.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjoms.2011.09.026DOI Listing
October 2012

West of Ireland facial injury study. Part 1.

Br J Oral Maxillofac Surg 2012 Oct 20;50(7):631-5. Epub 2011 Dec 20.

Department of Oral & Maxillofacial, University Hospital, Galway, Ireland.

The pattern, presentation, and volume of facial injury in the west of Ireland are subjectively different from that in the United Kingdom. We know of no prospective regional study of facial injury in Ireland to date, and nationally there is no system in place to collect data on injury. The epidemiology of facial trauma has important implications for the development of health services, the education and training of clinicians, workforce planning, prevention of injury, and promotion of health. Over one week we did a multicentre prospective data collection study involving all emergency departments in the west of Ireland. All patients who attended with facial injuries were included, and those with injuries solely of the scalp and neck were excluded. The proforma recorded patients' characteristics, details of injury and presentation, treatment and follow-up. It also included relation with sport, alcohol, assault, and animals. During the study period 325 patients were injured (5% of attendances at emergency departments in the region). The mean was 29.8%, and 68% were male. Falls caused 39% of injuries, sport 27%, and assault 14%. Sixteen percent of patients were treated in oral and maxillofacial surgery departments, and 16% in plastics, and ear, nose and throat (ENT) departments combined. There were 166 serious injuries. The busiest 24h were from Saturday at 09:00. Forty-five percent presented between 1 and 2h after injury. Different approaches and methods may be needed to prevent injury because of differences in aetiology, and staff in emergency departments will need training in this area, given the large proportion of facial injuries in the region.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjoms.2011.09.025DOI Listing
October 2012

An executive-driven ethical culture: healthcare executives play a key role in setting the tone for ethics.

Healthc Exec 2009 Nov-Dec;24(6):44-6

Rural Ethics Initiatives, Dartmouth Medical School, Hanover, NH, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
December 2009