University Hospital Waterford

Cancer treatment decision making (CTDM) presents important challenges among older adults due to variation in health and functional status, presence of comorbidities, differing goals/values, quality and quantity of life considerations, and limited inclusion in clinical trials. Nursing standards and guidelines call for competence in supporting CTDM and nurses advocate for greater involvement. However, clear understanding of the existing evidence to inform nursing practice is lacking. We aimed to map and synthesize evidence that provides insight into nursing practice in CTDM among older adults, with attention to nursing roles, required skills and competencies, potential barriers and facilitators, and outcomes studied. Following JBI (formerly Joanna Briggs Institute) methodology for scoping reviews, we included empirical articles that describe nursing contribution, individually or as part of a multidisciplinary team (MDT), related to CTDM for active (curative or non-curative) treatment among adults aged ≥60years diagnosed with cancer. Nine databases were searched systematically from inception to January 2024, no limits applied. Two independent reviewers screened identified records and full texts, then systematically extracted data from included articles. Basic qualitative content analysis was conducted on charted data. Of the 9582 records screened, 980 full texts were assessed for eligibility; 84 reports describing 78 studies were included. Conducted primarily in the United States or United Kingdom, studies described nursing interventions, nursing involvement in geriatric assessment and MDT meetings/clinics, and the perspectives of patients, family, and/or healthcare professionals. Although seldom the primary focus, researchers have highlighted the important roles of nurses in the CTDM process, before, during, and after consultations with physicians and MDT meetings, which require disease-specific knowledge and relational skills. MDT collaboration, training, dedicated time and space, adequate resources, and support from leadership are critical to promoting involvement, with potential impact on decision satisfaction and optimal treatment decisions. The value of nurses' involvement is endorsed by patients, family, and other healthcare professionals. Nurses play a vital role in CTDM among older adults, particularly in the MDT context. However, rigorous studies demonstrating the impact of nursing practice on CTDM outcomes among older adults are lacking. Further research is needed to inform nursing practice and interventions.

<h3>Background and Importance</h3> The European Statements of Hospital Pharmacy recommend <i>‘A European-wide framework for initial post graduate education and training in hospital pharmacy with an assessment of individual competence is essential’</i>.¹ To facilitate the development of evidence-informed recommendations for improving hospital pharmacist education, national data outlining current practice were required. <h3>Aim and Objectives</h3> Evaluate current standards of practice relating to education within hospital pharmacy. Outline perceived barriers to pharmacist engagement in education. <h3>Material and Methods</h3> A national online survey was developed and distributed to hospital pharmacy managers between May and August 2025 inclusive. The survey was distributed via various methods, including central emailing lists and contacts of the research team. Survey questions addressed Staffing structures. Current levels of education provided. Types of educational activities conducted. Perceived gaps in hospital pharmacist education. Barriers to engagement in pharmacist education. Responses results were analysed descriptively. <h3>Results</h3> Fifty-five (65%) pharmacy managers responded. Key findings included: Only 27% of participants reported having a pharmacist responsible for education. Almost two–thirds (63%) reported having a structured induction for pharmacists. Pharmacist induction included dispensary training (91%), clinical training (85%), and corporate induction (79%). Over three–quarters (79%) of inductions lasted &lt;6 weeks. Seventy percent (70%) provided ongoing departmental education, most through journal clubs (77%), case presentations (60%), and near–miss/error meetings (57%). Over two–thirds (69%) of institutions currently support pharmacists on postgraduate courses, mostly in clinical pharmacy (86%) Formal education was provided by pharmacy to nursing (88%), medical (76%) and allied health professionals (33%), as well as undergraduate (47%) and postgraduate (27%) pharmacy students. Perceived gaps in hospital pharmacy education included advanced practice, inpatient and outpatient medication reviews, and clinical skills. Reported barriers to hospital pharmacy education include lack of funding, time constraints, workload and lack of a structured competency framework specific to hospital pharmacy practice. <h3>Conclusion and Relevance</h3> Hospital pharmacy departments display significant commitment to, and engagement with, education activities nationally. Efforts to introduce a standardised hospital-specific competency framework for new-to-hospital pharmacists, and validated accreditation for advanced practice will help further facilitate this. <h3>References and/or Acknowledgements</h3> 1. The European Statements of Hospital Pharmacy. <i>European Journal of Hospital Pharmacy</i> 2014;<b>21</b>:256–258. <h3>Conflict of Interest</h3> Conflict of interest Corporate sponsored research or other substantive relationships: No conflicts of interest

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.

BackgroundHaemorrhoids are one of the most frequently encountered benign anorectal conditions that negatively impact patients’ quality of life. Excisional haemorrhoidectomy (closed or open) is a surgical procedure reserved for the treatment of third- and fourth-degree haemorrhoids, with considerable post-procedure pain reported. The aim of this study was to clarify the association between post operative metronidazole use (both oral and topical) and post-haemorrhoidectomy pain scores through systematic review and meta-analysis of randomised controlled trials (RCTs).MethodsThis study was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Prospective registration was performed on PROSPERO (CRD42024580928). A systematic review was performed for RCTs reporting post-haemorrhoidectomy pain scores between patients who received metronidazole and patients who received placebo. Meta-analysis was performed using RevMan version 5.4.ResultsSeventeen RCTs including 1297 participants were eligible for inclusion. Metronidazole administration was associated with significantly lower post-operative visual analogue scores (VAS) on day 1 (−1.18, p < 0.00001), day 2 (−1.15, p = 0.003), day 3 (−0.86, p < 0.00001), and day 7 post-operatively with a mean pain score difference of −1.72 (95% CI −2.27 to −1.18) (p < 0.00001). A significant difference in pain scores was seen on day 3 favouring topical metronidazole in comparison to the oral route (1.38, 95% CI [0.44, 2.32], p = 0.004).ConclusionThis review synthesises the best available evidence to support the use of metronidazole to reduce pain after excisional haemorrhoidectomy. While both oral and topical forms appear to be beneficial, topical administration appears to have a more effective analgesic effect from post-operative day 3.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00384-025-05066-7.

To evaluate the association of anatomical, clinical, and procedural factors with endovascular treatment failure, including both proximal and distal splenic artery embolization (SAE). In 11 centers, all patients following blunt splenic injury (BSI) were retrospectively evaluated, and those who had received SAE were selected. Data collected included: patient demographics and characteristics, mechanism and grading of BSI, endovascular management, and outcomes. Technical and clinical success were defined as successful embolization of the bleeding artery and stabilization of the haemodynamic status and laboratory data in 1 or 2 sessions, respectively. Rebleeding during follow-up and subsequent splenectomy were considered as treatment failure. The rate of complications related to the endovascular procedure was evaluated. The management of two hundred and forty-seven participants was evaluated. Technical and clinical success were 100% and 91.9% (227/247), respectively. A second embolization was performed in 5 cases. Rescue splenectomy occurred in 20 (8.1%) patients. Statistically significant associations were identified between endovascular treatment failure and GCS and the presence of other lesions at CT at patient presentation. No anatomical or procedural factors were found to be statistically significant; in the surgical group, a larger diameter of the splenic artery was observed. The complication rate was 15.2% (26/171), all relating to the vascular access, e.g., hematoma or pseudoaneurysm, and all managed conservatively. SAE is a safe and effective procedure; unsuccessful cases resulted statistically associated with some clinical factors, but no correlation with anatomical factors was observed.

Anastomotic techniques play a crucial role in arteriovenous fistula (AVF) construction and influence longevity. Whilst traditional suturing has been the standard of care for vascular access anastomosis creation, alternative methods such as vascular clips have emerged as a potential technique to improve technical outcomes and influence AVF patency. This systematic review and meta-analysis aims to evaluate the comparative efficacy of suture versus clip-based anastomosis techniques in AV fistula creation. Studies comparing suture and clip techniques for AV fistula formation were included. The primary outcome was primary patency at 1 year. Secondary outcomes include 2-year primary patency, primary assisted patency, secondary patency, overall failure, mean time to thrombosis, mean operating time and maturation rate. Data were pooled using a random-effects model and statistical significance was assessed at a threshold of p < 0.05. Nine studies were included. Data from 2964 patients were available for analysis. Clip anastomosis was associated with significantly higher 1-year primary patency compared to suture techniques (RR 1.13, 95% CI 1.03-1.23, p = 0.007). Two-year primary patency was also significantly improved in the clip group (RR 1.23, 95% CI 1.13-1.34, p = 0.00001). Mean time to thrombosis was significantly shorter in the suture group (MD 4.36, 95% CI 0.60-8.12, p = 0.02), indicating earlier failure relative to clips. Mean operating time was not statistically shorter in the clip group (RR -6.47, 95% CI -16.49 to 3.55, p = 0.21). Maturation rates were not statistically significant between the groups (RR 1.05, 95% CI 0.95-1.16, p = 0.31). This systematic review and meta-analysis demonstrates evidence that clip anastomosis may offer superior patency and longevity for AV fistula access when compared to standard of care. Studies were largely retrospective in nature and heterogeneity may influence results. Higher quality studies comparing clip and suture-based techniques are required to validate these outcomes.

Abstract Background Early Comprehensive Geriatric Assessment (CGA) and Multidisciplinary Team (MDT) intervention is one of 12 core principles of the Management of Major Trauma in Older Adults. At our Model 4 University Teaching Hospital, a designated Trauma Unit, all low-impact hip fracture patients aged 60 and above are seen by the Orthogeriatric Service, however due to staffing constraints, other older orthopaedic trauma patients are not routinely seen. In early 2025 we piloted an Older Persons Trauma Service, as part of an Aspire Fellowship programme, to provide Orthogeriatric care to older adults who had sustained a fracture, other than hip fracture, due to trauma. We emulated the care provided to hip fracture patients, i.e. CGA focusing on preventing future falls and fractures. Here we present some patient demographics of the pilot service. Methods Included patients were aged 75 and above, admitted under Orthopaedics on an Orthopaedic ward, with a fracture(s) (other than hip fracture) due to trauma. Patients were seen and followed by a Clinical Fellow and discussed at weekly MDT. CGA was conducted for all patients. Results Forty-one patients were reviewed during the c. 14-week pilot service. Average age was 82, Clinical Frailty Scale ranged from 1 to 7. Two thirds were female (n = 27) and 68% were from out of county (n= 28). The most common fractures were C-Spine fractures (24%), followed by ankle fractures (20%). Most injuries were from low falls. Feedback to date has been positive from patients, carers, and the MDT, and service evaluation is ongoing. Conclusion In this pilot service, 41 older trauma patients received CGA including falls and bone health assessment. Low falls were the leading cause of trauma, consistent with the results of the NOCA Major Trauma Audit 2021. Formal evaluation of the service is ongoing, however to date feedback has been encouraging.

Abstract Background Chronic obstructive pulmonary disease (COPD) is closely linked to osteoporosis and fragility fractures due to factors like chronic inflammation, glucocorticoid use, and vitamin D deficiency. Despite NOGG guidelines, FRAX® assessments and bone-protective therapies are underutilized in this population. This study aims to evaluate bone health and identify treatment gaps in osteoporosis management among COPD patients. Methods An observational, prospective study was conducted on all medical admission ≥ 60 years old (n=50) with COPD in an Irish University Hospital for a period of 4 weeks in February 2025. Data analysis was performed using WEKA Explorer 3.8.6. Chi2 test was utilised to check for significance (p&amp;lt;0.05). Results 50% of patients sustained some form of fracture with vertebral fractures predominated (24%), followed by rib (12%), wrist (12%), hip (6%) and others (50%). 24% of patients had ≥2 fractures, with 38% sustaining major fractures. Only 58% of patients had vitamin D level tested. Of these, 58.9% were deficient (≤20 ng/mL) and 13.7% receiving no Vitamin D supplementation. 4% had calcium deficiency, yet none received calcium supplementation. Using NOGG criteria, 20% of patients were deemed high and very high risk of Major osteoporotic fracture, but only 30% received anti-osteoporotic treatment (p = .005). Conclusion The high vertebral fracture prevalence aligns with COPD’s systemic inflammation and muscle-bone crosstalk dysfunction, which accelerate bone resorption. The low rate of osteoporosis therapy indicates under-recognition of fracture risk, highlighting actionable gaps in osteoporosis care for COPD patients while emphasizing the need for guideline-driven interventions to reduce fracture-related morbidity.

BackgroundParastomal varices are a rare but serious complication in patients with portal hypertension, characterised by bleeding that can be life-threatening in a predominantly comorbid population. Traditional surgical approaches to managing parastomal varices are associated with high morbidity and recurrence rates, prompting increased interest in minimally invasive techniques. This systematic review aims to evaluate the efficacy and safety of interventional radiology (IR) procedures, including transjugular intrahepatic portosystemic shunt (TIPS), sclerotherapy and embolisation, in managing parastomal varices.MethodsA comprehensive literature search was conducted across multiple databases, including MEDLINE, EMBASE and Web of Science, to identify studies published up to January 2025 that reported IR interventions for parastomal varices. Data were extracted on patient demographics, procedural success, recurrence rates and complications. A pooled proportions meta-analysis was performed.ResultsFive studies, encompassing 45 patients, met the inclusion criteria. The pooled technical success rate of IR procedures was 91.3%, with a clinical success rate of 80.5% over a mean follow-up of 618.4 days. The pooled mean proportion of rebleeding, predominantly minor and non-life-threatening, was 36.4%. TIPS showed the highest efficacy, but is traditionally associated with increased procedural risks compared to other interventional radiology methods.ConclusionIR offers a highly effective and safe alternative to traditional surgical management for parastomal varices in contemporary terms. The low recurrence and complication rates highlight the potential of IR ab initio as a first-line treatment; consequently, we advocate for its use, particularly in patients unsuitable for surgery in the minimally invasive era.Systematic review registrationPROSPERO CRD42024627470.

To (1) compare 5-year survivorship (avoiding repeat hip arthroscopy (HA)/total hip replacement conversion) between those undergoing routine capsular repair compared with where no repair was performed; (2) compare patient-reported outcome measures (PROMs) and achievability of metrics of clinically important improvement between these groups; and (3) evaluate the moderating influence of age and sex on outcomes. Review of prospectively collected data from an institutional hip preservation registry, of cases undergoing hip arthroscopy (HA) for femoroacetabular impingement between January 2011 and September 2018, with minimum 5-year follow-up, was undertaken. Cases undergoing routine interportal capsular repair (CR) were matched in a 1:1 ratio (age ± 2 years, sex, Tönnis grade) to hips with no capsular repair (NR). Exclusion criteria were dysplasia, Tönnis grade >1, age >50 years, and concomitant hip pathologies. Group survival was evaluated using Kaplan-Meier analysis and for levels of sex and age. Where revision surgery (repeat HA/total hip replacement) was avoided, PROMs (modified Harris Hip Score, University of California and Los Angeles Activity Scale [UCLA], Short Form 36 [SF-36]) were assessed at minimum 5 years, and proportion of cases achieving minimal clinically important difference (MCID) and substantial clinical benefit (SCB) determined. In total, 285 CR cases were matched with 285 NR cases. The average age was 27.0 ± 5.9 years, and most patients (90%) were male. The overall total hip replacement rate was 0.7% (0.4% NR; 0.9% CR, P = .619) and was not significantly different between groups when adjusting for sex (χ2 = 0.474, P = .491), or age (χ2 = 0.463, P = .496). The overall repeat HA rate was 12.0% (12.9% NR; 11.1% CR, P = .538), which was not significantly different between groups when adjusting for sex (χ2 = 0.479, P = .489), or age (χ2 = 0.448, P = .503). Significant improvement in all PROMs was noted for both the NR and CR groups (P < .001 for all). At 5 years postoperatively, SF-36 was marginally greater for the NR group (P = .006, r = 0.169). No significant difference between groups at 5 years postoperatively were found: modified Harris Hip Score (P = .476), UCLA (P = .188). A greater proportion of CR cases achieved MCID in UCLA (69.4% vs 56.5%, P = .032, Φ = 0.131). MCID achievement rates were similar between groups for all other PROMs (P > .05). A greater proportion of patients in the NR group achieved SCB in SF-36 (54.0% vs 41.9%, P = .049, Φ = 0.127). SCB achievement rates were similar between groups for all other PROMs (P > .05). Routine repair of an interportal capsulotomy makes no difference to survivorship at minimum 5 years post-HA compared with nonrepair, with marginal differences in PROMs, and achievability of MCID and SCB thresholds of clinically significant improvement. The impact of capsular management (repair/nonrepair) may be more apparent for specific patient cohorts rather than routine repair in all cases. Level III, retrospective matched comparative case series.