Connolly Hospital Blanchardstown

Stiffness is a common and poorly tolerated complication of elbow trauma. Hinged elbow braces are commonly utilized to allow safe early mobilisation to prevent stiffness. Braces control the range of elbow flexion and extension while providing relative protection against valgus and varus forces. The maximal instability of the elbow is typically in extension so braces usually limit extension while allowing the maximum degree of flexion. The functional elbow range is from 30° to 130°, but up to 150° of flexion is required for phone use. Many hinged elbow braces only accommodate 120° of flexion, potentially precipitating stiffness in flexion. To evaluate if a fully unlocked hinged brace restricts elbow flexion. We included 30 elbows in 15 healthy candidates. Maximum flexion for each participant was measured using a digital protractor. Measurements were repeated with the hinged elbow brace applied. Demographic and morphometric data, including age, height, weight, BMI, mid-forearm circumference and mid-upper arm circumference were recorded. The application of the brace resulted in a reduction in flexion compared to measurements taken out of brace. A Paired sample t-test revealed a mean difference of 30.0° (p < 0.001). Reduction in flexion did not correlate with age, BMI, gender, or upper and forearm measurements. Hinged braces limit flexion. Surgeons should be aware of the limitations of such braces. An appropriate physiotherapy protocol including exercises out of brace allowing safe full flexion may be required to avoid post-operative stiffness and the resultant decreased patient satisfaction.

The authors declare that no conflict of interest could be perceived as prejudicing the impartiality of the research reported. Data sharing does not apply to this article as no new data were created or analyzed in this study.

Abstract Background Older adults who are homebound, those who rarely or never leave home without assistance, represent a growing and under-recognised population. They experience high levels of multimorbidity, functional decline, and mortality, yet their needs remain poorly integrated into health systems. This review aimed to summarise the determinants, characteristics, and outcomes of being homebound to identify care gaps and propose directions for future research. Methods We conducted a scoping review in accordance with PRISMA-ScR guidelines. A systematic search of four databases (PubMed, Embase, Web of Science, and CINAHL) was performed. English-language, peer-reviewed studies involving adults who are homebound were included. Data extraction captured study setting, population, design, and key findings. Thematic analysis was performed and categorised by consensus. Results Of 6,406 studies screened, 159 were included. Prevalence of homebound status ranged from 4% to 65%, reflecting differences across populations and settings. Risk factors included advanced age, female sex, cognitive impairment, depression, frailty, social isolation, and substance misuse. Once homebound, individuals faced multiple unmet needs: untreated dental disease, malnutrition, falls, medication-related harm, and limited access to rehabilitation and mental health services. Functional dependence and high symptom burden were common. Caregiver burden was substantial, with some studies reporting depressive symptoms in over half of carers. Homebound status was associated with increased emergency department visits, hospitalization, and early mortality. Studies of home-based primary care showed improved continuity, reduced hospital use, and better end-of-life care. However, service delivery remained inconsistent and often excluded allied health and social care. No studies addressed the prevalence or care needs of homebound individuals in Ireland, highlighting a lack of national data. Conclusion This scoping review maps the fragmented literature on older adults who are homebound. It highlights complex medical, functional, and social vulnerabilities and identifies substantial care gaps. Ireland’s homebound population must be assessed to inform equitable, integrated, person-centred care.

Abstract Homebound older adults have high rates of multimorbidity, frailty, and functional decline, yet their care needs remain inadequately addressed. Using data from a scoping review we will identify and discuss care gaps in this vulnerable and growing population. The review followed the PRISMA-ScR framework, conducting systematic searches in PubMed, Embase, Web of Science, and CINAHL. A total of 159 studies met inclusion criteria. Two independent reviewers screened titles and abstracts, with a third resolving discrepancies. Six researchers extracted data using a standardized tool, capturing study characteristics, population details, and key findings. Themes were identified through consensus, resulting in four overarching categories. Studies highlight a need to address unmet care needs in dental care, nutrition, and fall prevention among the homebound. Over 90% of populations studied required dental treatment, yet fewer than 10% received care. Malnutrition was widespread, increasing frailty and hospitalization risk, yet nutritional interventions remain underutilized. Despite high fall rates, evidence on prevention strategies remains limited. Cognitive impairment and mental health conditions, particularly depression, were highly prevalent, yet access to neuropsychology services remained limited. Frailty and functional dependence were pervasive, contributing to high healthcare utilization, including emergency department visits and hospitalizations. Care gaps in advance care planning, social support, and rehabilitation were identified as barriers to improving quality of life. During the symposium, we will discuss how these gaps highlight an urgent need to transform care for homebound older adults. Expanding home-based medical care is essential to improving outcomes, reducing hospitalizations, and ensuring equitable, person-centered care.

Geographic distribution of healthcare workers is an issue most countries are challenged with. Regionalisation of surgical training in Ireland has emerged as a hot topic over the past number of years in an effort to address the balance between professional progression, adequacy of surgical training and personal responsibility/circumstance. This issue has been reported on within the NHS, but the way in which it may apply to Irish surgical specialties is now being considered. Our aim was to examine the sentiments of Irish Trauma and Orthopaedic trainees towards a number of issues as they pertain to regionalisation of training. We distributed a questionnaire amongst the HST Trauma and Orthopaedic group of trainees and assimilated the results. We found that 69.1% of trainees felt the current structure of the Irish Trauma and Orthopaedic training system was fit for purpose. Ninety percent of respondents said the current structure of the training scheme puts strain on their personal life and work-life balance. When asked if trainees felt that regionalisation of the training programme would benefit their training, 43.9% replied no, 31% yes and 26.2% were unsure. When asked if, overall, the trainee would be in favour of a regionalised training structure for Trauma and Orthopaedics, 43% said 'No', 40% said 'Yes' and 17% were unsure. An equilibrium of professional surgical progression, optimal patient care and work-life balance is a goal held in the highest regard amongst key stakeholders of Irish surgical training. The solution amongst the various surgical subspecialties may not be a one-size-fits-all approach in pursuit of the optimisation of this balance. Further engagement of key stakeholders in how surgical training will evolve over time is crucial in order to achieve this.

Introduction: Cystic fibrosis (CF) is an inherited disease caused by mutations in the CF transmembrane conductance regulator gene (CFTR). It is characterized by progressive decline in lung function, often driven by chronic respiratory infections, particularly with Staphylococcus aureus and Pseudomonas aeruginosa. MicroRNAs (miRNAs), small noncoding regulatory RNAs that negatively regulate protein expression by binding to mRNA, are altered in people with CF and potentially contribute to the pulmonary manifestations of CF. The management of CF lung infections is further complicated by the formation of bacterial biofilms and the emergence of antimicrobial resistance which renders conventional treatments ineffective. Methods: In silico analysis identified hsa-miR.101.3p as a promising miRNA with potential targets including genes associated with beta-lactam resistance and biofilm formation in P. aeruginosa, as well as genes involved in the overall growth of S. aureus. To facilitate delivery, miRNA mimic DNA oligonucleotides were conjugated to DNA tetrahedrons (DNAtds). The structural integrity of the DNAtd-miRNA complexes was confirmed via transmission electron microscopy, characterized by nanoparticle tracking analysis, and successful bacterial uptake was verified using fluorescence microscopy. Results: DNAtd-miR.101.3p significantly reduced the viability of both S. aureus and P. aeruginosa. Furthermore, DNAtd-miR.101-3p enhanced the activity of the beta-lactam antibiotic cefotaxime against both non-mucoid and mucoid planktonic and biofilm-forming P. aeruginosa. The mechanisms involve DNAtd-miR.101.3p targeting of ampC, fleN, and pslK. Conclusion: DNAtd-miR.101.3p displays unique inhibition properties against P. aeruginosa and S. aureus in the exponential phase of bacterial growth in vitro and increases the rate of the bactericidal activity of cefotaxime against P. aeruginosa.

<h3>Background</h3> Primary PCI (PPCI) for ST-elevation myocardial infarction (STEMI) remains a cornerstone of acute cardiovascular care. However, the sustainability of the national PPCI rota, particularly the impact on workforce wellbeing and future service delivery, remains unclear. <h3>Objective</h3> To characterise the demographics, workload distribution, and perspectives of PPCI operators in Ireland with respect to service sustainability and personal impact. <h3>Methods</h3> A national survey was distributed to all on-call PPCI operators in Ireland assessing demographics, call frequency, post-call recovery and perceived workforce sufficiency. Responses were collected anonymously and then descriptively analysed. <h3>Results</h3> Of 57 eligible PPCI operators, 48 responded (figure 1) (84% response rate), comprising 96.5% males (n = 46) and 3.5% females (n = 2). Median age was 46 years (range 35–64). The distribution of respondents per centre was: SJH (12/12), MMUH (14/16), UHL (7/8), CUH (5/7), WUH (3/6), UHG (5/7), and LUH (1/1) (figure 2). PPCI call frequency varied widely both across and within centres, ranging from 1:4 to 1:14. Overall, 46% of operators were on a 1:4 to 1:7 rota, 10% on 1:8 to 1:10, and 44% on 1:11 to 1:15. Notably, 96% of respondents reported no protected time post-call while 53% reported that PPCI call impacted their physical or mental health and/or personal life. 37.5% felt the call frequency was excessive; 46% believed there were insufficient PPCI operators at their centre. Additionally, 48% indicated that PPCI duties limited their ability to take leave, and over 58% stated fatigue significantly impaired their post-call clinical functioning. Although most found it feasible to arrange call cover, this typically required a swap. With respect to service planning, 11 operators anticipate opting out by 2030, with this number rising to 23 by 2035. However since 2020, 21 new operators have joined the rota. When asked about an appropriate opt-out age, 38% suggested 55, 46% preferred 60, and 2 respondents favoured 50. Respondents were asked what changes they wanted implemented to the PPCI rota. Key recommendations included protected post-call rest, fairer distribution of general duties, increased staffing, non-punitive leave cover, rota participation by all public interventionalists with step-down options, split holiday cover, alignment with EU work-time standards, and improved coordination with local hospitals. <h3>Conclusion</h3> The current Irish PPCI service relies on a small, male dominated workforce with considerable variability in call frequency. The high burden of fatigue and reported impact on wellbeing highlight the need for structured rota reform, succession planning, and post-call recovery strategies to sustain national PPCI delivery.

Abstract Introduction Prior stroke is one of the biggest risk factors for future stroke events. Secondary prevention medications are key to reducing subsequent vascular events, and guidelines recommend use of antithrombotics, antihypertensives and lipid lowering drugs. We carried out a retrospective study of adherence to these medications in a post stroke population. Methods Consecutive patients admitted with acute stroke to a Dublin hospital between July 2022 and November 2023 were invited to participate. Participant interviews were carried out at 1 year post stroke to collect demographic and clinical information and evaluate care needs. Functional ability was graded using the Modified Rankin Scale (mRS). Adherence to three key categories of secondary preventative drugs was assessed using the 4-item Morisky Medication Adherence Scale, and participants were asked to show all current medications, which were compared to the discharge prescription. Results Interviews were conducted with 197 participants 1 year post stroke. Mean age was 68.8 years and 66% were male. Ethnicity was as follows: 79% white Irish, 11% other white, 5% African, 5% Arabic/Asian/others. Twelve (6%) were living in nursing homes while 68% were functionally independent with mRS 0–2. High adherence to all prescribed medicines was reported at 79% and was higher for antihypertensives and antithrombotics (87%) than for lipid-lowering drugs (78%). There were no statistically significant differences in self-reported adherence between gender or race subgroups. Adherence was better for participants who were functionally dependent by mRS (71% vs 97%, p &amp;lt; 0.0001) and those who had an involved caregiver (69% vs 89%, p &amp;lt; 0.0001). Discussion Self-reported adherence to medication was high in this cohort but one fifth were not adherent to important secondary prevention medications 1 year after a stroke. Adherence was higher for those who had more disabling strokes and an involved caregiver. No race or gender disparities in adherence were observed in our population.