Clinical audits are central to quality improvement in healthcare, yet practical real-world descriptions of how they are implemented, governed and sustained are limited. This paper describes the establishment, evolution and impact of the Irish Hip Fracture Database (IHFD) within the Irish healthcare system as an exemplar. Clinical audits compare clinical practice against defined standards to identify areas for improvement and showcase excellence. International literature provides limited insight into how they are governed and sustained. Using the IHFD, a mature national audit, this paper reviews its development, evolution and sustained momentum from 2013 to 2024. Longitudinal data were captured via the Hospital Inpatient Enquiry (HIPE) system, encompassing all eligible Irish acute hospitals. Included cases were patients aged ≥ 60 years with hip fractures, as defined by IHFD. Three organisational surveys (2016, 2020, 2024) were undertaken to assess hospital resources, care pathways, governance structures and audit supports. In total, 41,304 cases were included in the analysis. National coverage exceeded 90% from 2017. Demographic characteristics remain consistent. Improvements in data quality, adherence to Irish Hip Fracture Standards were observed, including geriatrician assessment (11% in 2013 to 86% in 2024) and bone health assessment (65% in 2013 to 90% in 2024). Service reconfigurations and resourcing to support hip fracture care occurred over this period. Engagement with the audit remained robust despite major challenges including COVID-19, a national cyberattack and ongoing health system reform. Sustained success of a national hip fracture clinical audit requires strong leadership, effective governance, clear clinical standards, accessible data and timely reporting. Continued relevance requires agility and alignment with evolving system needs.
Improvements in cancer survival are happening in the context of an ageing population who may experience age-related complications from cancer therapies and unique needs in cancer survivorship. The long-term survivorship trajectory in terms of function, participation and associated health indicators is poorly documented outside of the United States (U.S.). The overall aim of this study is to examine perceived physical performance limitations, participation restrictions and associated objective metrics among an Irish cohort of cancer survivors aged >50 years. A sub-cohort of data from Wave 1 of The Irish Longitudinal Study of Ageing (TILDA) (collected October 2009-February 2011) were analysed. Self-reported physical performance and participation restrictions, and related objective measures (timed-up-and-go, handgrip strength, dual manual task, gait speed, heel ultrasound T-scores and heel ultrasound stiffness index), were examined in those diagnosed with cancer <5 years ago (n = 157), >5 years ago (n = 208) and those without a history of cancer (n = 5526). Data were analysed using multivariate regression models using appropriate survey weights to reflect population estimates. Recent cancer survivors were 1.81 (95% CI: 1.08, 3.06) times more likely to report at least one physical performance limitation than individuals without a history of cancer. Furthermore, long-term survivors exhibited a higher risk of severe cumulative physical performance limitations (OR = 3.05, 95% CI: 1.31, 7.12) compared to individuals without a history of cancer. In multivariate analysis, osteoporosis risk was twice as high in long-term cancer survivors as assessed by both heel ultrasound T-scores (RRR 2.26 (95% CI: 1.29, 3.94)) and heel ultrasound stiffness index (RRR 2.21 (95% CI: 1.20, 4.08) compared to individuals without a history of cancer. Objective measures of physical performance were similar between groups. The findings indicate that, despite maintaining independent living, community-dwelling, Irish cancer survivors face elevated risks of physical performance limitations including cumulative burden of limitations, compared to community-dwelling adults without a history of cancer. Functional impairments are reflected in bone density metrics, signalling a cohort at risk of falls, fracture and loss of independence.
Equality, diversity and inclusion (EDI) are increasingly recognised as fundamental to healthcare education. Understanding who accesses professional programmes and how students experience belonging across academic and clinical learning environments is essential to equitable participation and preparation for diverse patient care. Evidence examining EDI within radiography education remains limited. A survey with open ended components was conducted with undergraduate and graduate-entry radiography students at a single Irish university. Data was collected on demographics, access routes, socioeconomic circumstances, sense of belonging and EDI-related experiences in university and clinical placement settings. Descriptive and inferential statistical analyses were undertaken. Open-text responses underwent systematic content analysis, with cross-verification. The cohort was predominantly female and White Irish. Most students lived at home and received parental financial support, indicating overall socioeconomic advantage, although a smaller subgroup reported financial vulnerability. Sense of belonging to the programme was highest among first-year students and lower in later year groups, while belonging to the wider university was lowest among minority students. Perceptions of class diversity differed between majority and minority groups. Negative EDI-related experiences were reported more frequently during clinical placements than on campus. This study reveals radiography students' demographic composition and EDI experiences in the Republic of Ireland. Early programme belonging and socioeconomic advantage were evident, but concealed vulnerability and clinical education challenges persist. Inclusive curricula and psychologically safe clinical learning environments are essential for equality and workforce diversity. Findings highlight the need for radiography educators and clinical supervisors to prioritise psychologically safe and inclusive clinical learning environments. Mandatory supervisor EDI training, structured pre-placement preparation, confidential reporting mechanisms, and targeted Year 2/3 team-building initiatives may help address disconnection and exclusion during placements.
To examine the relationships between subjective sleep quality, chronotype and social jetlag with perceived psychological stress in a sample of Irish adults. An observational cross-sectional study of 400 adults. Subjective sleep quality was assessed with the Pittsburgh Sleep Quality Index, chronotype and social jetlag were assessed with the Munich Chronotype Questionnaire, and psychological stress was measured with the Perceived Stress Scale. Correlational, groupwise and path analyses were applied to the data to examine the relationships between perceived stress and sleep variables, age and sex. Bivariate correlation analyses revealed statistically significant associations between both social jetlag and mid-sleep on free days and perceived stress (small effects), and moderate associations between subjective sleep quality and perceived stress. Groupwise analysis revealed that individuals in the high perceived stress group displayed greater social jetlag and poorer sleep quality, but no difference in chronotype, when compared to those with low or moderate stress. Path analysis revealed a moderate reciprocal relationship between subjective sleep quality and perceived stress, no direct effects of chronotype or social jetlag on perceived stress and a small indirect effect of average nightly sleep duration on perceived stress mediated through subjective sleep quality. Chronotype and social jetlag have minimal relationships with perceived stress, whilst subjective sleep quality has a moderate reciprocal relationship with perceived stress. The online version contains supplementary material available at 10.1007/s41105-026-00640-0.
Streptococcus suis is a major cause of respiratory and systemic diseases in post-weaned pigs, leading to significant production losses and animal welfare concerns. This study provides the first long-term national level analysis of Streptococcus suis-associated disease (SSAD) in the Republic of Ireland. We examined the pig diagnostic submissions, characterised serotype distribution, antimicrobial susceptibility, and co-infection patterns from 2010 to 2024. The findings confirm that serotypes 9 and 2 or 1/2 were most frequently associated with disease. We observed a significant shift in recent years where serotype 9 has surpassed serotype 2 or 1/2 in number of occurrences. S. suis was frequently co-detected with viral pathogens including porcine reproductive and respiratory syndrome virus (PRRSV), porcine circovirus type 2, and swine influenza virus (SIV), as well as bacterial pathogens such as Actinobacillus pleuropneumonia and Pasteurella multocida, typically from pneumonic lungs. While resistance to tetracycline and erythromycin was high (44.4% to 65.8%), isolates remained susceptible to first-line beta-lactam antibiotics such as penicillin (7.9% resistance), ampicillin (5.5% resistance) and amoxycillin/clavulanate (0% resistance). The observed heterogeneity between and within herds challenges successful implementation of vaccination and highlights the need for ongoing disease monitoring. These findings provide the first in-depth assessment of SSAD in Ireland's pig population which will offer valuable insights for future surveillance efforts, including genomic studies and supporting evidence-based strategies and vaccine selection for controlling S. suis in Irish pig sector.
To examine nurses' perspectives on current dysphagia screening practices in Irish residential long-term care settings (RLTCS), and to investigate barriers and facilitators to nursing-led dysphagia screening within this healthcare context. This study employed a qualitative descriptive design and was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Participants were recruited through purposive sampling from RLTCS located in the northeast of the Republic of Ireland. Eleven in-person focus group interviews were conducted with thirty-four nurses working in clinical and managerial roles. A semi-structured interview guide was utilised, and the data were subsequently analysed using reflexive thematic analysis. One central theme, comprising four subthemes, was developed. Nurses identified residents at risk of dysphagia through clinical judgement, drawing mainly on mealtime observations and residents' self-reports of swallowing difficulties. Adequate training to screen for dysphagia and effective interprofessional communication were highlighted as key facilitators in identifying at-risk residents. Limited access to speech and language therapists (SLTs), lack of dysphagia-specific guidelines and absence of validated swallow screening tests for this population were identified as major barriers. While nurses valued receiving in-service training in dysphagia, the practices employed to identify residents at risk often lack empirical support. Consequently, a substantial number of residents with dysphagia may remain undiagnosed. Limited access to SLT dysphagia services, combined with the absence of validated swallow screening tests for older adults in RLTCS, further impedes timely diagnosis and appropriate management of dysphagia.
This study investigated a variant, RPGR NM_001034853.2 c.1307G>A, p.[Gly436Asp, p?], in a large Irish pedigree with severe X-Linked Retinitis Pigmentosa (XLRP). The effect of the variant on RNA splicing was interrogated using in vitro functional analysis to provide evidence of disease causality. Three related individuals presenting with XLRP underwent target-capture sequencing, together with confirmatory Sanger sequencing and cascade analyses, to identify candidate variants. In silico investigations were undertaken using SpliceAI (version 1.3.1) and Alamut Visual software (version 2.13), among others. Functional analyses using in vitro midigene splice assays employing gateway expression vectors were undertaken. Variant and wildtype RNA were amplified by RT-PCR to investigate effects on splicing. RPGR c.1307G>A was subsequently reclassified using ACMG/AMP and ClinGen SVI recommendations. Midigene investigation confirmed a cryptic acceptor site is being utilised together with the cryptic branchpoint motif to excise intron 10 and 90 bases of exon 11, leading to a frameshift and the creation of a premature stop codon. No functional RPGR transcript is predicted to remain. Given evidence of aberrant splicing, the variant classification was upgraded to pathogenic. RPGR c.1307G>A leads to creation of a cryptic branchpoint within an exon, resulting in protein truncation with deleterious effect(s). To the best of our knowledge, this is the first variant that leads to creation of a cryptic branchpoint within an exon associated with any IRD. The results illustrate the importance of investigating the functional consequences of both coding and non-coding variants with a predicted impact on splicing to understand their pathogenicity.
Electronic (E)-scooters have become increasingly common in Ireland. This study provides the first Irish orthopaedic-focused analysis of paediatric E-scooter-related injuries over a six-year period. It assesses the impact of the legislation change in 2024 banning E-scooter use in those under 16 years of age. We conducted a retrospective analysis of e-scooter-related orthopaedic trauma presenting to our emergency department (ED). Ninety-eight paediatric patients were identified between January 2020 and August 2025. This period included fourteen months prior to and subsequent to the legislation change. Four primary outcomes were analysed: Injury Severity Score (ISS) > 16, surgical intervention, injuries per patient, and fractures per patient. Medical records and patient imaging were reviewed. There were 98 paediatric patients who presented to our ED with e-scooter-related orthopaedic trauma. The average age was 12 years old with a 3:1 male-to-female ratio. There was a notable rise in cases presenting in 2025. Post-legislation comparisons showed: an increase in major trauma, a 27% increase in injuries per patient, a stable fracture rate and a decline in surgical intervention. Post-legislation injury trends remain concerning. Despite legislation, injury rates rose, with widespread non-compliance. Upper limb injuries and traumatic brain injuries were common. Multidisciplinary care was often required. A national paediatric trauma database is needed to guide prevention and policy. Systemic reforms and targeted interventions are essential to mitigate this growing public health issue.
Broodmares are at increased risk of gastrointestinal colic. However, colic risk factors specific to this population have not been investigated. To investigate horse- and management-level risk factors for post-partum colic in a cohort of Thoroughbred broodmares in the United Kingdom and Ireland. Prospective, nested case-control study. Twenty-nine Thoroughbred stud farms in the United Kingdom and Ireland were recruited, and 1044 mares were followed over the 2021 and/or 2022 foaling seasons. Data were collected on signalment, medical and management history for post-partum colic mares and matched (3:1) controls. Multivariable analysis was conducted using conditional logistic regression. Due to strong collinearity between days post-partum and time spent stabled, two multivariable models were built. Days post-partum (Model 1: OR 0.9, 95% CI 0.8-0.9; p < 0.001) and increasing hours stabled (Model 2: OR 1.2, 95% CI 1.1-1.3; p < 0.001) were strongly associated with increased risk of post-partum colic. Colic risk was highest immediately post-partum, with reduction in likelihood of colic up to 50 days after foaling. NSAID use in the previous 28 days (Model 1: OR 6.2, 95% CI 2.0-65.5; Model 2: OR 4.1, 95% CI 1.1-15.0; p = 0.048) and a history of previous colic (Model 1: OR 7.4, 95% CI 1.2-7.9; Model 2: OR 5.3, 95% CI 1.7-17.1; p = 0.01) were also associated with increased colic risk. Calcium supplementation was associated with increased likelihood of post-partum colic in Model 1 only (OR 4.4, 95% CI 1.3-15.7; p = 0.04). Mares comprised a small sub-population of UK and Irish Thoroughbred broodmares. Pre-partum colic was not investigated. Maximising turnout in post-partum broodmares may reduce colic risk, immediately post-partum and up to 50 days. Broodmares who have recently received NSAIDs, have a history of colic or are receiving a calcium-based supplement may be at increased risk of post-partum colic.
While veterinary surgeons are known to have particularly high rates of injury compared to other sectors, little is known about the rates of injury among veterinary students. This study aims to understand animal-related injury rates, injury context and mechanisms, attitudes to reporting injuries, and resultant behaviour among UK and Irish veterinary students. A survey was distributed to students across all veterinary schools operating in the UK and Ireland in 2021. Questions explored participants' experience of injury through asking about their most recent and most severe injuries via quantitative and free-text questions. Data were analysed using descriptive statistics, logistic regression and qualitative content analysis. Five hundred thirty-three responses were included in the analyses. Overall, 47.5% of the students reported having been injured by an animal during the veterinary degree, and 35.5% of the students reported being injured within the last 12 months. Most recent injuries were caused by companion animals (38.0%), livestock (37.6%) and equids (23.5%). For their most severe injuries, 48.7% involved livestock, 28.7% companion animals and 22.1% equids. The content analysis highlighted that students normalised injuries and infrequently reported injuries to the university. It was very rare for students to take time off from their studies or placements due to course pressures. These findings reflect concerningly high levels of injury, which are being under-reported and reflect a culture of injury acceptance and expectation among students. Veterinary schools should consider lessons learned in other work environments that have been successful in changing safety culture.
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To assess feasibility of a randomised controlled trial (RCT) investigating effectiveness of 6 sessions of an EDucation and eXercise intervention delivered over 8 weeks (EDX-Ireland) for gluteal tendinopathy, against usual care. EDX-Ireland was modified from a 14-session EDucation and eXercise intervention (EDX), delivered over 8 weeks, previously evaluated in an Australian RCT. Feasibility parallel RCT. Participants were randomly assigned to physiotherapist-led EDX-Ireland or usual care. EDX-Ireland comprised 6 sessions of education, hip abductor strengthening and functional loading over 8 weeks, supported by a home exercise programme. Primary outcomes included success of different recruitment strategies and recruitment/retention rates. Secondary outcomes measured global rating of change and other clinical outcomes. Descriptive statistics (percentage, mean, standard deviations and 95% confidence intervals (CI)) are presented. Of 323 individuals who expressed interest in study participation, 119 completed physical examination screening and 65 met criteria and consented to participate (recruitment rate 55%). Sixty-five people (89% women; mean age 53.1 ± 9.3 years), were randomised to EDX-Ireland (n = 32) or usual care (n = 33). Eighty-three percent (n = 54) were recruited via social media/community, 3% (n = 2) from general practitioners and 14% (n = 9) from orthopaedic/rheumatology. Retention was 92% (95% CI 82-97%, n = 60) at 8-weeks, and 89% (95% CI 79-96%, n = 58) at 3-months. Feasibility thresholds were met. Effect size estimates indicate that 134 participants would be required for a future RCT. Pre-defined recruitment and retention thresholds were met, indicating that a RCT evaluating 6 sessions of physiotherapist-delivered education and exercise against usual care for gluteal tendinopathy is feasible. Clinicaltrials.gov (NCT05516563).
Variants in pre-messenger RNA (mRNA) processing genes account for ∼15% to 20% of autosomal dominant retinitis pigmentosa, causing severe vision loss. We provide an in-depth characterization of pre-mRNA-processing variants in the population, with a focus on genotype-phenotype correlations. Participants underwent next-generation sequencing, variant filtering and interpretation. Impact(s) on protein structure/function were predicted through AlphaFold, ColabFold, among others. Clinical information was collated and segregation analysis undertaken. Variants were classified according to American College of Medical Genetics and Genomics/Association for Molecular Pathology guidelines. A total of 635 patients with retinitis pigmentosa (RP) were screened. Notably, 36 different variants were identified in PRPF31, PRPF8, SNRNP200, PRPF3, RP9, and PRPF 6; 19 were classified as likely pathogenic/pathogenic. Thirteen of 36 variants were absent from PubMed, gnomAD, LOVD, and ClinVar, with an additional 10 not previously associated with retinal degeneration. Genotype-phenotypes correlations were illuminated; variants in PRPF genes caused more severe retinal degeneration than SNRNP200 variants. We provide a detailed overview of the genetic landscape of variants in pre-mRNA-processing factor genes in Ireland, accounting for 14% of genetically solved autosomal dominant retinitis pigmentosa cases. Results highlight significant genetic diversity between populations, mutational diversity inherent in inherited retinal degenerations and the role of variants in mRNA-processing genes as causative of devastating ocular disorders.
There has been a 70% increase in medical radiological examinations worldwide between 2000 and 2020. The number of consultant radiologists has not increased alongside the increasing number of imaging studies performed. The aim of this study was to compare the consultant radiologist workload within the radiology department at Galway University Hospital in 2009 to its current workload and calculate the optimum number of consultant radiologists to employ within this department. Details of the imaging studies performed within the department of radiology at Galway University Hospital between 2009 and 2024 were obtained from the departmental PACS. Calculation of the required number of consultant radiologists was performed based on "countable" and "non-countable" activity within the department and the relative value units read by individual consultants. Use of CT has doubled with 12900 studies in 2009 compared to 26118 in 2024 (p < 0.001). On call CT has increased also over time. 3913 MRI studies were performed in 2009 compared to 18147 in 2024 (p < 0.001). Increased workload has been demonstrated with ultrasound (13903 to 23805) and nuclear medicine (1468 to 1713, p < 0.001). There has also been an increase in the number of specialist studies such as cardiac imaging and prostate/breast MRI. There has been a 2.5-fold increase in IR activity over 15 years (p < 0.001). We have calculated that 50.57 consultant radiologist are required for this workload, a shortfall of 33.57 by current staffing levels. Utilisation of medical imaging is increasing exponentially at our centre in line with international trends. Current numbers of consultant radiologists are far short of those required to provide a safe and effective diagnostic and interventional radiological service.
In the absence of a national framework to inform hospital pharmacist practices, Irish standards of practice relating to education and research are unknown. A national service evaluation was undertaken to establish current standards of practice nationally relating to education and research activities within the hospital pharmacy and to identify barriers to standardising practices in these areas. An online questionnaire was distributed to pharmacy department managers between May and August 2025. Questions addressed (1) current education and research practices, including the types and extent of research being conducted; and (2) barriers to pharmacist engagement in education and research. The results were analysed descriptively. Fifty-five of 85 (65%) potential responses were received: 27% of departments had a dedicated pharmacist for education and 7% had a dedicated research role. Regarding gaps in pharmacist education, attainment of skillsets and knowledge required of advanced specialist practice was the gap that achieved the highest level of agreement; 75% of respondents agreed or strongly agreed regarding its lack within current education programmes. Sixty-four percent of respondents agreed or strongly agreed that clinical skills were also a gap within pharmacist education. Regarding research, of 28 specialty areas, 29% reported producing peer-reviewed research publications within the previous 18 months. Significant barriers to increased engagement in education and research practices across the hospital pharmacy were related to time, workload and the absence of both funding and standardised frameworks. We identified key infrastructural deficits in hospital pharmacist education, including essential and advanced specialist clinical skills. The findings support the need for a harmonised approach to continued pharmacist education and the requirement for dedicated funding to support the provision of high-quality patient care across clinical specialities. This should be supported by the development of a structured competency framework. Similar strategies are required to support improved engagement in pharmacist-led research.
The prevalence of hepatic neoplasms (carcinogenesis) in the common dab (Limanda limanda) flatfish was investigated using data collected between 2004 and 2020 from five biogeographic UK marine regions including the Northern North Sea, Southern North Sea, Irish Sea, Eastern Channel, and Western Channel and Celtic Sea. Our assessment considered age-related confounding effects, providing an improved estimation of how hepatic neoplasm prevalence differs between regions and over time. The data indicated a significant decline in prevalence in both the Irish Sea and Southern North Sea regions, with a similar decreasing trend observed when all marine regions were analysed collectively. However, a higher prevalence was noted in dab from the Irish Sea compared to other regions, indicating additional environmental pressures. We explored potential correlations between hepatic neoplasms and concentrations of hazardous substances in biota and sediment including polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs), and metals. Concentrations of PCBs in biota were positively associated with hepatic neoplasm prevalence overall, although was primarily influenced by the Irish Sea region containing a disproportionately higher number of fishing locations compared to other regions. Cadmium, iron, manganese, and lead concentrations in sediments had a statistically significant effect on neoplasm prevalence, although this was believed to be correlation, not causation. The results are discussed within the context of monitoring the biological effects of contaminants and the associated challenges of long-term monitoring strategies.
In recent years, mental health policy and legislation have changed dramatically, allowing for more human rights-based and recovery-orientated services to come into being. One example of this is the enactment of The Assisted Decision Making (Capacity) Act 2015 which allowed for conversations to begin within mental health about respecting the wishes of the person, even when they are in crisis. Within health discourse, this can be achieved through the creation of an advance healthcare directive. However, to date, within mental health services, clinicians, and service users do not have a recognised template that can be adapted for this purpose when a service user loses capacity to make decisions about their own life and care they receive. This paper proposes that Wellness Recovery Action Planning (WRAP), and particularly the crisis and post-crisis planning section of the programme should be used as a potential structure for such advance healthcare directives to be formulated. This is potentially plausible due to how engrained WRAP is in Irish mental health services, the evidence base backing for WRAP as well as the ease of use of the initiative to support overall well-being. As such, this paper has laid out how such plans can be used as an advance healthcare directive in an Irish setting and is also likely to be applicable internationally.
This article examines how the use of "draw and tell" as a research method can support adolescents in communities experiencing high levels of socio-economic disadvantage to articulate complex educational trajectories that are often underrepresented in academic literature. The paper presents the findings of qualitative data gathered as part of a wider research study situated in the Irish context which utilizes a multiple case-study approach to examine the role of literacy as a socio-cultural practice in students' educational trajectories from primary school to higher education. The study involved forty-one young people (aged 10-17) attending urban primary and secondary schools identified by the Irish government as experiencing the highest levels of socio-economic disadvantage under the Delivering Equality of Opportunity in Ireland (DEIS) program. "Draw and tell" sessions invited students to depict and narrate their experiences of using literacy skills such as reading, writing and speaking in school. "Draw and tell" sessions were audio-recorded and analyzed thematically using a reflexive, inductive approach. Three interrelated themes emerged within the findings: (1) "draw and tell" functioned as a catalyst for communication and empowerment, enabling students to use drawings as low-stakes mediating artifacts through which they could express complex feelings and emotions; (2) "draw and tell" acted as a tool for students to explore their sense of identity and belonging across the continuum of education; and (3) "draw and tell" provided a medium for young people to conceptualize care in education, highlighting their experiences of both instructional and relational forms of care. The findings demonstrate that "draw and tell" can democratize the research space with adolescent research participants, enabling agency to be redistributed in ways that conventional interview or survey approaches can fail to allow for. The paper argues for wider use of creative, youth-centered methodologies in research and policy in order to better understand and address the cumulative nature of educational inequality in communities experiencing high levels of socio-economic disadvantage.
Healthcare professionals work within an imperfect, multi-faceted system and cannot shoulder the burden of responsibility for unintentional patient harm. Patient safety governance aims to address the challenges of patient safety through monitoring systems and processes to provide assurance of patient safety and quality of care. The evidence suggests that healthcare staff demonstrate mixed views towards patient safety governance processes and varying attitudes towards hospital patient safety climates. This study aims to explore the insights of both healthcare staff and senior healthcare decision makers into patient safety governance and its associated patient safety processes. It aims to capture the attitudes of healthcare staff towards hospital patient safety climates. The researchers intend to identify the gaps in patient safety governance between praxis and theory, with the view of developing recommendations to address these gaps. This research study is convergent parallel in design, with two study strands occurring simultaneously. It is set in four Irish teaching hospitals located in one regional area. A methodological pluralistic approach, using both qualitative and quantitative methods, will be applied to allow the researchers to adopt the most suitable methodology for data collection, analysis and data interpretation to fulfil the study aims. The study consists of three groups. Qualitative methods will apply to Groups 1 and 2, where consenting participants will be given a choice to engage with a focus group or semi-structured interview. The data collected through these methods will be analysed using the six phases of reflexive thematic analysis. Quantitative methods will apply to Group 3, where consenting participants will complete an electronic questionnaire. The quantitative data will be described in statistical terms using the Stata Now statistical package. Data integration will occur during the data interpretation phase, using a weaving approach in a narrative format where the qualitative and quantitative data findings will be compared thematically. The intention of this study is to broaden the corpus of academic understanding into healthcare staff's insights of patient safety processes and their attitudes towards hospital patient safety climates comparatively to evidence-based best practice for patient safety governance. This study will be carried out using a methodological pluralistic approach, allowing the researchers to choose the most appropriate methods for data collection, analysis and interpretation. The researchers will then identify the current gaps in patient safety governance practice in a small group of Irish hospitals in one healthcare region. These gaps will then be assessed and explored with implementation plans developed to address the gaps, through decision makers and policy development within healthcare.
It has been over 60 years since the first kidney transplant in Ireland was carried out in 1964. We examined the Irish cohort of individuals with allografts functioning for more than 40 years. We sought to describe the features of these patients and identify clinical factors associated with ultra-long-term allograft survival. This retrospective analysis of the Irish National Kidney Transplant Registry included kidney transplants performed in Ireland between January 1st, 1970, and March 31st, 1983. Follow-up analysis was until March 31st, 2023. There were 428 transplants in 394 patients. Longitudinal data were available for 390 (98.9%) patients. Thirty-three (33/428, 7.7%) kidney transplant grafts survived for 40 years or more, with 25 grafts functioning at date of analysis. Multivariable analysis identified transplant type-living donor versus deceased donor (odds ratio [OR] 3.51, confidence interval [CI] 1.17-11.1, P = .027) as significantly associated with long-term graft survival. The median serum creatinine of patients with surviving transplants was 107 µmol/L (range 66-322 µmol/L). Non-melanoma skin cancer was common, affecting 22/33 (67%) patients. For ultra-long survivors, graft function is excellent if patients are maintained on low-level immunosuppression. Living donor transplantation, but not donor or recipient age or sex, was associated with improved graft survival.