Supervisor View Full Details 2nd

• epidemiology/population health research
• Other

Epidemiology/Population Health Research

• Medicine
• Public Health

• Cardiology
• Clinical Trials
• Dementia
• Neurology
• Pharmacology
• Vascular Medicine
• Other

Clinical Pharmacology and Therapeutics

The research interests of the Department of Geriatric and Stroke Medicine include Pharmacoepidemiology and Patient Safety, Stroke and Vascular Medicine. In collaboration with the Department of Psychology the Department led a 2-year Health Research Board (HRB) funded project (ASPIRE-S) which assessed adherence to the secondary preventive measures and rehabilitation guidelines in patients with Ischaemic Stroke. We are currently completing a follow-up study to assess 5-year outcome. The department has a particular interest in the effect of stroke on cognitive outcome. The department collaborated on the ESCAPE study, a multicentre international study, the purpose of which was to understand whether endovascular clot removal can be added to the current standard of care to improve outcome from stroke.

In the field of patient safety, the Department also led the first study of adverse events (INAES) in Ireland and we have recently been provided with funding to complete a follow-up study (INAES-2). We are currently completing a study on the rate of admisions to hospital due to adverse drug reactions (ADRs) in older patients.

I am a co-director with Prof Peter Kelly of the Irish Stroke Clinical Trials network (https://hrb-sctni.ie/) which is co-ordinating a number of trials in the stroke field.

Relevant publications
1.Holodinsky JK, Patel AB, Thornton J, Kamal N, Jewett LR, Kelly PJ, Murphy S, Collins R, Walsh T, Cronin S, Power S, Brennan P, O'hare A, McCabe DJ, Moynihan B, Looby S, Wyse G, McCormack J, Marsden P, Harbison J, Hill MD, Williams D. Drip and ship versus direct to endovascular thrombectomy: The impact of treatment times on transport decision-making.Eur Stroke J. 2018 Jun;3(2):126-135. doi: 10.1177/2396987318759362. Epub 2018 Feb 14
2.Gaynor E, Williams D et al. Cognitive Impairment, Vulverability, and Mortality Post Ischaemic Stroke: A Five- Year Follow-Up of the Action on Secondary Prevention Interventions and rehabilitation in Stroke (ASPIRE-S) Cohort. J Stroke Cerebrovasc Dis.2018 May 23
3.Rafter N, Hickey A, Conroy RM, Condell S, O’Connor P, Vaughan D, Walsh G, Williams DJ. The Irish National Adverse Events Study (INAES): the frequency and nature of adverse events in Irish hospitals-a retrospective record review study. BMJ Qual Saf. 2016 Feb 9
4.Goyal M, Demchuk A, Menon B, Eesa M, Rempel J, Thornton J, Roy D, Jovin T, Willinsky R, Sapkota B, Dowlatshahi D, Frei D, Kamal N, Montanera W, Poppe A, Ryckborst K, Silver F, Shuaib A, Tampieri D, Williams D, Bang O, Baxter B, Burns P, Choe H, Heo Ji-Hoe, Holmstedt C, Jankowitz B, Kelly M, Linares G, Mandzia J, Shankar J, Sohn S ,Swartz R, Barber P, Coutts S, Smith E, Morrish W, Weill A, Subramaniam S, Mitha A, Wong J, Lowerison M, Tolulop S, and Hill M for the ESCAPE Trial Investigators. Randomised Assessment of Rapid Endovascular Treatment of Ischaemic Stroke N Engl J Med 2015;372:1019-1030.

Ongoing Projects

Project 1-INAES 2
Adverse events (AEs) are unintended injuries or complications that are caused by healthcare management, rather than a patient’s underlying disease, which lead to death, disability at the time of hospital discharge, prolonged hospital stay or subsequent hospitalisation. The first Irish National Adverse Events Study (INAES) determined the prevalence and nature of AEs in Irish hospitals using in-patient admissions from 2009. The INAES reviewed the medical charts of 1574 patient admissions to 8 acute Irish hospitals using an internationally standardised 2-stage methodology. AEs were classified according to their nature, preventability, severity and impact on the patient.

The study showed that one-in-eight patients (12.2%) experienced an AE as a result of hospital care in 2009, broadly in line with international figures where AE rates ranged from 3-17% of hospital admissions. Over 70% of events were considered preventable and added an average of 6.1 days in hospital, representing an expenditure of €5,550 per event in 2009. However, these figures represent a baseline from before the establishment of the National Clinical Programmes (initiated by the professional bodies and the HSE in 2009 to improve and standardise care throughout the health system), and prior to the effects of the economic recession and subsequent cuts to the healthcare budget in Ireland.

This project (INAES-2) proposes to determine current rates of AEs in Irish acute hospitals and to establish whether the implementation of the Clinical Programmes has influenced the overall AE frequency. INAES-2 will also be able to compare AE rates with those reported in the recently updated National Incident Management System (NIMS). A key goal of INAES- 2 is to provide the Irish healthcare sector with a data collection tool capable of being used by hospitals and frontline staff to determine local adverse event prevalence rates.

Other Potential Projects
- Developing an efficient and effective pathway for delivering acute stroke care in Ireland
- There will be the opportunity to develop further research projects from a number of on-going studies within the Irish Stroke Clinical Trials Network (https://hrb-sctni.ie/)