The Mater Misericordiae University Hospital (commonly known as the Mater /ˈmætər/) (Irish: Ospidéal an Mater Misercordiae) is a major teaching hospital, based at Eccles Street, Phibsborough, on the northside of Dublin, Ireland. It is managed by Ireland East Hospital Group.
INTRODUCTION:Effective teamwork in the operating theatre is essential for safety and optimal patient outcomes. Extensive research has examined this topic from the perspectives of anaesthesiology consultant and surgeons; however, limited attention has been given to anaesthesiology trainees. Hence, this study explores anaesthesiology trainees' attitudes towards communication and leadership in the operating theatre. METHODS:A questionnaire-based study was conducted among anaesthesiology trainees in Irish hospitals. The questionnaire was adapted from the Operating Room Management Attitudes Questionnaire (OMRAQ). Data collected included demographics, trainee attitudes toward communication and leadership, perceptions of team dynamics and communication-related errors. Responses were analysed through descriptive statistical analysis. RESULTS:A total of 74 trainees responded. The majority expressed a strong preference for collaborative leadership and open communication, with 95% of trainees supporting junior staff participation in decision making. However, 69% reported a lack of pre-operative briefings and 84% stated that post-operative debriefings were uncommon, demonstrating pitfalls in theatre communication. Furthermore, 85% acknowledged making errors due to poor communication, with over half reporting witnessing such errors from other members of theatre. Trainees supported the need for confidential error-reporting systems but expressed hesitation about openly reporting incidents. CONCLUSION:Anaesthesiology trainees value teamwork and communication but perceive significant gaps between best practices and current hospital procedures. These findings highlight the need for systemic interventions, including structured communication training, leadership development, and the promotion of psychological safety within theatre. Addressing these areas could improve communication dynamics, reduce medical errors, and enhance patient safety.
BACKGROUND:Anastomotic leak is a serious complication in colorectal surgery. Indocyanine green fluorescence angiography (ICGFA) is an adjunctive digital method of assessing bowel perfusion intraoperatively. We assessed whether ICGFA use during surgery reduces postoperative anastomotic leak exclusively using data from randomised controlled trials (RCTs). METHODS:In this systematic review and meta-analysis, we searched PubMed, ScienceDirect, Scopus, Web of Science, Embase, and the Cochrane Collaboration databases from inception to July 19, 2025, for English-language RCTs comparing additive intraoperative ICGFA with standard surgeon perfusion assessment alone in patients undergoing colorectal resection with primary anastomosis according to prespecified criteria and PRISMA guidelines. Summary-level data were extracted by two reviewers. The primary outcome was overall anastomotic leak rate. The Jadad scale (Oxford quality scoring system) was used to assess trial quality, the Cochrane Risk of Bias (RoB 2) tool for RCTs was used to assess risk of bias, and GRADE was used to assess strength of evidence. Meta-regression and trial sequential analyses were performed. This study is registered with PROSPERO, CRD420250652639. FINDINGS:719 records were initially identified, with 387 remaining after screening and 184 sought for full eligibility screening, of which nine were eligible RCTs (with 4754 patients) for analysis. ICGFA significantly reduced overall anastomotic leak (risk ratio 0·66 [95% CI 0·56-0·78], p<0·0001; number needed to treat [NNT]=24), with trial sequential analysis showing that the required information size (2183) was exceeded overall. ICGFA reduced both anastomotic leak requiring intervention (risk ratio 0·73 [95% CI 0·60-0·89], p=0·0020; NNT=39) and anastomotic leak not requiring intervention (0·48 [0·31-0·72], p=0·0004, NNT=35). Significant benefit was observed for left-sided resections (risk ratio 0·62 [95% CI 0·51-0·74], p<0·0001; NNT=19), rectal resections (0·62 [0·51-0·76], p<0·0001; NNT=19), and low anterior resections (0·62 [0·48-0·79], p<0·0001; NNT=13), in which the required information size was also exceeded, but not for right-sided resections. In the meta-regression analysis, among all tested covariates, only patient BMI significantly modified the ICGFA treatment effect, with an increasing protective effect with increasing BMI (coefficient -0·0153 [95% CI -0·0251 to -0·0056], p=0·0020). Evidence was graded as high certainty for overall, left-sided, rectal, asymptomatic, and 30-day anastomotic leaks, and moderate certainty for clinically significant anastomotic leak. INTERPRETATION:Intraoperative use of ICGFA reduces anastomotic leak rates in left-sided and rectal colorectal resections. Given the evidence available now, further general efficacy trials are no longer required and research should shift to implementation and defined targeted subgroup ICGFA role definition (ie, in non-rectal left-sided resections). FUNDING:None.
Placenta accreta spectrum (PAS) is a life-threatening obstetric condition associated with increasing cesarean delivery rates worldwide. Existing classifications, such as the World Health Organization International Statistical Classification of Diseases and Health-Related Problems and the International Federation of Gynecology and Obstetrics system, describe depth of invasion and histopathological features but do not adequately predict surgical outcomes or guide individualized management. The PAS topographic classification describes the anatomical extent of uterine wall remodeling and the presence of uterovesical adhesions, allowing surgical teams to anticipate intraoperative complexity, organ involvement, and appropriate therapeutic strategies. Although successfully applied in selected centers, its broader evaluation across diverse healthcare settings is lacking. We designed a prospective, multicenter, international cohort study enrolling patients with a high prenatal suspicion of PAS. Eligible patients are aged ≥ 18 years, undergoing surgery after 20 weeks’ gestation, and managed by multidisciplinary PAS teams familiar with the topographic classification. Standardized prenatal ultrasound staging and intraoperative surgical staging are required, with photographic and video documentation. Surgical strategies include one-step conservative surgery, total hysterectomy, and modified subtotal hysterectomy, guided by intraoperative classification. The primary outcome is intraoperative blood loss, measured using a standardized protocol. Secondary outcomes include intraoperative complications, operative time, treatment type, and usability assessments of the classification through structured surveys. Data are collected in REDCap with external review of imaging records. This study will provide the first prospective, multicenter evaluation of the PAS topographic classification, assessing its correlation with clinical outcomes and its feasibility across hospitals with varying resources and surgical expertise. Preliminary results indicate successful implementation in both high- and low-volume centers, with promising adoption of prenatal ultrasound staging and surgical protocols. The collaborative, image-based, and open-access methodology aims to strengthen the reliability of PAS research by harmonizing surgical strategies and allowing external supervision. Ultimately, this project will generate robust multicenter data to inform individualized management strategies and support the integration of the topographic classification into routine clinical practice worldwide. ClinicalTrials.gov Identifier: NCT05922397. Registered on 21 May 2023.
BACKGROUND:Right atrial appendage aneurysm, or giant right atrial appendage, is extremely rare, with very few cases reported in scientific literature. We sought to systematically review the published cases of right atrial appendage aneurysm in terms of age, sex, clinical presentation, electrocardiography, imaging (chest X-ray, echocardiography, CT/cardiac magnetic resonance), and outcome. METHODOLOGY:An electronic search for case reports, case series, and related articles published until March 2025 was carried out, and clinical data were extracted and analysed. RESULTS:Forty-four cases of right atrial appendage aneurysm were identified with a clear male prevalence (68.2%) and commonly presenting in the third decade of life. Palpitation (27.3%) and dyspnoea (18.2%) were the most common clinical presentations, whereas 40.9% of right atrial appendage aneurysm patients were asymptomatic. Electrocardiography was done in 77.3% of the sample. It displayed an atrial arrhythmia (atrial fibrillation or flutter, atrial tachycardia, supraventricular tachycardia) in 31.8%. A chest X-ray was done in 65.9%. Echocardiography was the most common diagnostic modality (93.2%). Right atrial appendage aneurysm diagnosis was confirmed on CT and/or MRI in 79.5%. The mean size of the right atrial appendage aneurysm was 93 × 70 mm. In 12 patients (27.3%), an associated congenital cardiac abnormality was found, mostly in the form of an atrial septal defect/patent foramen ovale (22.7%). Half of the patients (50.0%) were treated surgically, whilst 47.8% were treated medically with close follow-up. One patient experienced right atrial appendage aneurysm reduction in size after atrial septal defect device closure. One death (2.3%) was reported also. CONCLUSION:Although very uncommon, right atrial appendage aneurysm can be linked to considerable morbidity. Surgical removal is recommended for patients who are symptomatic.
BackgroundDoxycycline post-exposure prophylaxis (DoxyPEP) has emerged as a biomedical strategy to reduce bacterial sexually transmitted infections (STIs), yet implementation remains contested due to antimicrobial resistance concerns and limited clinical guidance in many European settings. Evidence on clinician readiness to prescribe DoxyPEP is limited. This study examined awareness, attitudes and prescribing practices among sexual health clinicians in the Republic of Ireland.MethodsA cross-sectional anonymous online survey was conducted among sexual health clinicians in early 2026. Survey items were informed by the Theoretical Framework of Acceptability (TFA). Descriptive statistics summarised responses. Group differences were assessed using χ2 tests, independent-samples t-tests, one-way ANOVA and non-parametric tests where appropriate. Pearson correlations explored relationships between implementation constructs.Results101 clinicians participated (60 doctors, 33 nurses, 8 other professionals). Awareness of DoxyPEP was high (95%) and 64% of doctors and nurses reported prior prescribing or recommendation. Current local guidance was variable, with only 28% reporting formal guidance, but willingness to prescribe with national guidance was high (82%) and did not differ between professional groups or specialties.No significant differences were observed between doctors and nurses across knowledge or acceptability domains. Among doctors, implementation perceptions varied by specialty: GU/HIV clinicians reported higher knowledge, perceived effectiveness, intervention coherence and self-efficacy than infectious diseases clinicians and general practitioners.Self-reported knowledge was strongly associated with intervention coherence (r = -0.601, p < .001) and self-efficacy (r = 0.600, p < .001). Ethicality emerged as the only independent predictor of willingness to prescribe (OR = 5.77, 95% CI 2.47-13.47). Concern about antimicrobial resistance was widespread (81%).ConclusionIrish clinicians demonstrate high awareness and substantial readiness to prescribe DoxyPEP. Implementation readiness appears shaped more by ethical acceptability and professional confidence than knowledge alone. National guidance, education and antimicrobial stewardship frameworks will be essential to support safe and equitable integration of DoxyPEP into sexual health services.
