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In the Republic of Ireland (ROI), BRCA1/BRCA2 genetic testing has been traditionally undertaken in eligible individuals, after pre-test counselling by a Clinical Geneticist/Genetic Counsellor. Clinical Genetics services in ROI are poorly resourced, with routine waiting times for appointments at the time of this pilot often extending beyond a year. The consequent prolonged waiting times are unacceptable where therapeutic decision-making depends on the patient's BRCA status. "Mainstreaming" BRCA1/BRCA2 testing through routine oncology/surgical clinics has been implemented successfully in other centres in the UK and internationally. We aimed to pilot this pathway in three Irish tertiary centres. A service evaluation project was undertaken over a 6-month period between January and July 2017. Eligible patients, fulfilling pathology and age-based inclusion criteria defined by TGL clinical, were identified, and offered constitutional BRCA1/BRCA2 testing after pre-test counselling by treating clinicians. Tests were undertaken by TGL Clinical. Results were returned to clinicians by secure email. Onward referrals of patients with uncertain/pathogenic results, or suspicious family histories, to Clinical Genetics were made by the treating team. Surveys assessing patient and clinician satisfaction were sent to participating clinicians and a sample of participating patients. Data was collected with respect to diagnostic yield, turnaround time, onward referral rates, and patient and clinician feedback. A total of 101 patients underwent diagnostic germline BRCA1/BRCA2 tests through this pathway. Pathogenic variants were identified in 12 patients (12%). All patients in whom variants were identified were appropriately referred to Clinical Genetics. At least 12 additional patients with uninformative BRCA1/BRCA2 tests were also referred for formal assessment by Clinical Geneticist or Genetic Counsellor. Issues were noted in terms of time pressures and communication of results to patients. Results from a representative sample of participants completing the satisfaction survey indicated that the pathway was acceptable to patients and clinicians. Mainstreaming of constitutional BRCA1/BRCA2 testing guided by age- and pathology-based criteria is potentially feasible for patients with breast cancer as well as patients with ovarian cancer in Ireland.

Background As genomic profiling of constitutional and tumour-derived DNA becomes increasingly critical in cancer risk estimation, prognostication and treatment, there is a growing need for clinicians involved in cancer care to up-skill in Cancer Genetics. In the Republic of Ireland (ROI), this is particularly crucial, given a paucity of vocationally trained Clinical Geneticists per capita compared to other European countries. Aims We aimed to assess the self-reported confidence of postgraduate medical/surgical trainees in ROI in requesting, interpreting, and managing genomic data in patients with cancer, and to assess their selfreported experience, and demand for future training in this area. Methods A cross-sectional survey of postgraduate trainees in four specialties (Medical and Radiation Oncology, Surgery, and Obstetrics and Gynaecology (O&G)), training in ROI, was undertaken. A bespoke electronic questionnaire was designed to capture data regarding preceding experience, and confidence across several hypothetical clinical scenarios involving genomic testing. The survey was circulated to eligible participants by training programme administrators, after relevant institutional ethical approval. Data was collected anonymously. Results The study cohort included 62 respondents. A paucity of cancer genetics training at every level was demonstrated, with “hardly any” or “none at all” reported by 47(76%), 62(100%), and 50(81%) during undergraduate, core specialty, and higher specialist training, respectively. A relative lack of confidence in all clinical scenarios was apparent, particularly among Surgery/O&G trainees. Most respondents would value more training in Cancer Genetics. Conclusions This study demonstrates an unmet need in dedicated Cancer Genetics training for postgraduate specialty trainees in ROI.

AimsPsychiatric disorders are increasingly prevalent and present as a comorbidity in many hospitalized patients. Studies have demonstrated that the presence of comorbid psychiatric conditions (CPC) is associated with worsened inpatient outcomes. Emergency surgical admissions and the impact of CPC on their outcomes has not been studied in Ireland to date. This study aims to provide a comprehensive analyses of the relationship between a wide range of psychiatric comorbidities and surgical presentations.MethodThe Hospital In-Patient Enquiry (HIPE) and prospectively maintained electronic patient records were used to identify all surgical emergency admissions between 31st August 2019 and 1st September 2020 to Mayo University Hospital, Ireland. Patient demographics, comorbidities, primary diagnoses, length of stay (LoS), discharge destination, and surgical interventions were recorded. Subgroup analyses were performed examining LoS variation in the type of surgical presentation. Physical comorbidities were scored using the Charlson Comorbidity Index (CCI). Statistical calculations were performed using SPSS.ResultA total of 995 admissions were recorded. The presence of CPC increased the overall mean LoS by 1.9 days (p = .002). This trend was observed in both operative and conservative management. Significant increase in LoS was noted in patients with a comorbid depression (2.4 days, p = .003), dementia (2.8 days, p = .019), and intellectual disability (6.7 days, p = .007). Subgroup analysis revealed greater LoS in patients with CPC diagnosed with non-specific abdominal pain (1.4 days, p = .019), skin and soft tissue infections (2.5 days, p = .040), bowel obstruction (4.3 days, p = .047), and medical disorders (18.6 days, p = .010). The odds of nursing home or convalescence as a discharge destination was 2.44 (95% CI: 1.37–4.35, p = 0.002) in patients with CPC and the odds of self-discharge against medical advice in this population was 4.89 (95% CI: 1.43–16.70, p = 0.005). No significant difference was observed in mortality and readmission rates.ConclusionPsychiatric comorbidities significantly impact length of hospital stay and influence discharge planning in surgical inpatients. Greater vigilance is required in providing care for patients with psychiatric comorbidities, particularly those with depression, dementia and intellectual disability. Better optimisation of facilities and a more personalised approach to patients with CPC are required to improve inpatient outcomes and resource allocation.

Background Open abdominal surgery is associated with high rates of wound complications . Surgical site infection (SSI) is associated with prolonged length of stay, delayed treatment and high rates of readmission (1, 3, 4). Negative pressure wound therapy over closed incisions (ciNPWT) is a novel approach to prevention of SSI. We reviewed the outcomes of studies comparing ciNPWT and standard therapy in open abdominal wounds to assess the efficacy of the current evidence base. Aim To assess the effect of negative pressure wound therapy used over closed incisions in open abdominal surgery. Methods Search of relevant terms was conducted on PubMed, Scopus and Cochrane to identify studies published between Jan 2006–Feb 2019. Studies were chosen based on specific inclusion criteria. Articles were screened to assess demographics, study design and outcomes. Results Seven retrospective and six prospective randomised controlled trials were identified for inclusion, totalling 3048 participants. 967 received ciNPWT and 2081 received standard treatment. Studies assessed a mix of surgeries (colorectal n = 6, pancreaticoduodenectomy n = 1, gynaecologic n = 1, acute care surgery n = 1, mixed open n = 2). ciNPWT was statistically significant in reducing SSI in 9 of 13 studies. Conclusion ciNPWT in open abdominal surgery has demonstrated promising results for reducing SSI rate in some trials however, patient selection remains unclear. Recent randomized controlled trials have failed to demonstrate benefit overall with use of ciNPWT in open abdominal surgery. Further multicentre prospective trials are needed for cost-benefit analysis and appropriate patient-selection.

Background The management of postoperative pain is paramount to facilitate the delivery of day case surgical programs. In recent years, the complexity of procedures carried out has increased to include laparoscopic cholecystectomy. The aim of this study was to evaluate the impact of laparoscopic-assisted 4-quadrant transversus abdominis plane (TAP) block vs periportal local anesthetic wound infiltration in managing postoperative pain. Study Design A prospective, randomized, double-blinded trial was conducted with patients undergoing elective laparoscopic cholecystectomy. Patients were randomized using computerized "random number table" into a test group that received laparoscopic-assisted TAP block with bupivacaine with periportal saline injection and a control group that received a laparoscopic-assisted TAP block with saline and periportal bupivacaine. All patients received intraperitoneal instillation of bupivacaine in the gallbladder bed. Postoperative pain scores were recorded using numerical rating scores at rest and coughing at dedicated time points. Statistical analysis was carried out using GraphPad Prism software, version 5 (GraphPad Software) and p Results Eighty patients (70 female and 10 male) were enrolled; 40 patients were randomized to each group. Age, American Society of Anesthesiologists score, operative time, and BMI were comparable between the groups. No adverse events were encountered with the administration of TAP blocks. Numerical rating scores were significantly reduced in the test group at 1, 3, and 6 hours at rest (p = 0.025, p = 0.03, and p = 0.007, respectively). Numerical rating score was significantly reduced at 1, 3, and 6 hours during coughing (p = 0.026, p = 0.02, and p = 0.03, respectively). Difference in postoperative analgesic requirements between both groups was statistically insignificant (p = 0.17). Conclusions This analysis has confirmed the therapeutic benefit of laparoscopically delivered TAP blocks in elective laparoscopic cholecystectomy.

Mesenteric venous thrombosis (MVT) is a rare but potentially fatal cause of mesenteric ischaemia. It presents insidiously and often diagnosis is made at emergency surgery. In half of the cases MVT develops without a causative factor, while in cases in which a pro-thrombotic state is found to exist MVT may be the first clinically detected consequence of that state. The myeloproliferative disorders (MPD) are known to contribute to the development of pro-thrombotic states. Recently, the JAK2 V617F mutation has been associated with the MPDs.We describe a case of MVT occurring secondary to an unsuspected MPD, in which the patient was subsequently found to carry this mutation. We highlight the necessity to screen for this mutation in cases of intra-abdominal thromboses so that appropriate systemic anticoagulation may be instituted, and the patient may be followed so as to detect the development of an overt MPD.