Kilcreene Orthopaedic Hospital

Sciatic nerve palsy is a recognised complication of primary total hip replacement. In our unit this complication was rare with an incidence of < 0.2% in the past ten years. We describe six cases of sciatic nerve palsy occurring in 355 consecutive primary total hip replacements (incidence 1.69%). Each of these palsies was caused by post-operative haematoma in the region of the sciatic nerve. Cases, which were recognised early and surgically-evacuated promptly, showed earlier and more complete recovery. Those patients for whom the diagnosis was delayed, and who were therefore managed expectantly, showed little or no recovery. Unexpected pain and significant swelling in the buttock, as well as signs of sciatic nerve irritation, suggest the presence of haematoma in the region of the sciatic nerve. It is, therefore, of prime importance to be vigilant for the features of a sciatic nerve palsy in the early post-operative period as, when recognised and treated early, the injury to the sciatic nerve may be reversed.

BACKGROUND: Quality improvement (QI) Programmes, like the Productive Ward: Releasing-time-to-care initiative, aim to 'engage' and 'empower' ward teams to actively participate, innovate and lead quality improvement at the front line. However, little is known about the relationship and impact that QI work has on the 'engagement' of the clinical teams who participate and vice-versa. OBJECTIVE: This paper explores and examines the impact of a large-scale QI programme, the Productive Ward, on the 'work engagement' of the nurses and ward teams involved. DESIGN/METHODS: Using the Utrecht Work Engagement Scale (UWES), we surveyed, measured and analysed work engagement in a representative test group of hospital-based ward teams who had recently commenced the latest phase of the national 'Productive Ward' initiative in Ireland and compared them to a control group of similar size and matched (as far as is possible) on variables such as ward size, employment grade and clinical specialty area. RESULTS: 338 individual datasets were recorded, n=180 (53.6%) from the Productive Ward group, and n=158 (46.4%) from the control group; the overall response rate was 67%, and did not differ significantly between the Productive Ward and control groups. The work engagement mean score (±standard deviation) in the Productive group was 4.33(±0.88), and 4.07(±1.06) in the control group, representing a modest but statistically significant between-group difference (p=0.013, independent samples t-test). Similarly modest differences were observed in all three dimensions of the work engagement construct. Employment grade and the clinical specialty area were also significantly related to the work engagement score (p<0.001, general linear model) and (for the most part), to its components, with both clerical and nurse manager grades, and the elderly specialist areas, exhibiting substantially higher scores. CONCLUSIONS: The findings demonstrate how QI activities, like those integral to the Productive Ward programme, appear to positively impact on the work engagement (the vigour, absorption and dedication) of ward-based teams. The use and suitability of the UWES as an appropriate measure of 'engagement' in QI interventions was confirmed. The engagement of nurses and front-line clinical teams is a major component of creating, developing and sustaining a culture of improvement.

BACKGROUND: Concerns about patient safety and reducing harm have led to a particular focus on initiatives that improve healthcare quality. However Quality Improvement (QI) initiatives have in the past typically faltered because they fail to fully engage healthcare professionals, resulting in apathy and resistance amongst this group of key stakeholders. Productive Ward: Releasing Time to Care (PW) is a ward-based QI programme created to help ward-based teams redesign and streamline the way that they work; leaving more time to care for patients. PW is designed to engage and empower ward-based teams to improve the safety, quality and delivery of care. METHODS: The main objective of this study was to explore whether PW sustains the 'engagement' of ward-based teams by examining the longitudinal effect that the national QI programme had on the 'work-engagement' of ward-based teams in Ireland. Utilising the Utrecht Work Engagement Scale questionnaire (UWES-17), we surveyed nine PW (intervention) sites from typical acute Medical/Surgical, Rehabilitation and Elderly services (representing the entire cohort of a national phase of PW implementation in Ireland) and a cohort of matched control sites. The numbers surveyed from the PW group at T1 (up to 3 months after commencing the programme) totalled 253 ward-team members and 249 from the control group. At T2 (12 months later), the survey was repeated with 233 ward-team members from the PW sites and 236 from the control group. RESULTS: Overall findings demonstrated that those involved in the QI initiative had higher 'engagement' scores at T1 and T2 in comparison to the control group. Total 'engagement' score (TES), and its 3 dimensions, were all significantly higher in the PW group at T1, but only the Vigour dimension remained significantly higher at T2 (p = 0.006). CONCLUSION: Our results lend some support to the assertions of the PW initiative itself and suggest that when compared to a control group, ward-based teams involved in the QI programme are more likely to be 'engaged' by it and its associated improvement activities and that this is maintained over time. However, only the Vigour dimension of 'engagement' remained significantly higher in the PW over time.

The modified Wilson osteotomy for hallux valgus is a double oblique osteotomy through the metatarsal shaft. The distal fragment is displaced laterally and plantarward. The lateral displacement corrects the varus position of the metatarsal, while the plantar displacement prevents the distal fragment from tilting dorsally into a metatarsus elevatus deformity that could produce metatarsalgia. Seventy-four cases of hallux valgus treated by this method were reviewed five years postoperatively. Sixty-six cases (89%) were graded as satisfactory and eight (11%) as unsatisfactory. Roentgenographic analysis in 61 cases showed the operation had reduced the hallux valgus angle by an average of 15 degrees and the intermetatarsal angle by an average of 4 degrees. The operation shortened the first metatarsal by an average of 5 mm. Although this caused callosities on the forefoot, it did not produce metatarsalgia. The operation is technically uncomplicated and yields a high percentage of satisfactory results.

Purpose – This paper reviews the Lean Healthcare and Productive Ward: releasing time to care (RTC) literature and extracts the reported effects and impacts experienced by employees who implement it. The purpose of this paper is to identify and investigate the strength of the connection between the two models and explores the implications for leadership and implementation. Design/methodology/approach – This study reviewed the Lean Healthcare and Productive Ward: RTC literature using strict systematic inclusion criteria. A qualitative content analysis was used to identify key characteristics of reported employee experience, effect or impact. Themes and categories were ranked by the number of citations and presented. Findings – This study outlines the similar employee effects and impacts that exist between Lean-type improvement initiatives and the Productive Ward: RTC programme. It discusses the three top themes of: Empowerment, Leadership and Engagement and explores the opportunities for leadership. It also identifies one key difference between the two initiatives, the socio-cultural effect and impact which is strongly reported with Lean-type improvement initiatives. The socio-cultural element is discussed and presented as one of the fundamental aspects of Lean and the original Toyota production system. Originality/value – This study brings new insights for leaders involved in Lean-type improvement initiatives which are currently being imported into healthcare and provides a comprehensive list of reported employee impacts and effects of value to healthcare leaders attempting to establish an environment and culture of improvement.

Background . Day of surgery admission (DOSA) is becoming standard practice as a means of reducing cost in total joint arthroplasty. Aims . The aim of our study was to audit the use of DOSA in a specialty hospital and identify reasons for cancellation. Methods . A retrospective study of patients presenting for hip or knee arthroplasty between 2008 and 2013 was performed. All patients were assessed at the preoperative assessment clinic (PAC). Results . Of 3195 patients deemed fit for surgery, 114 patients (3.5%) had their surgery cancelled. Ninety-two cancellations (80%) were due to the patient being deemed medically unsuitable for surgery by the anaesthetist. Cardiac disease was the most common reason for cancellation ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M1"> <mml:mi>n</mml:mi> <mml:mo>=</mml:mo> <mml:mn fontstyle="italic">27</mml:mn> </mml:math> ), followed by pulmonary disease ( <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML" id="M2"> <mml:mi>n</mml:mi> <mml:mo>=</mml:mo> <mml:mn fontstyle="italic">22</mml:mn> </mml:math> ). 77 patients (67.5%) had their operation rescheduled and successfully performed in our institution at a later date. Conclusion . DOSA is associated with a low rate of cancellations on the day of surgery. Patients with cardiorespiratory comorbidities are at greatest risk of cancellation.

Nonunion and delayed union are serious consequences in the treatment of fractures. Bone graft has been a mainstay of treatment for nonunion and delayed union. But with rapid development of the endoscopic procedure, bone grafting can be performed after curettage of fibrous tissue around the fracture gap and sclerotic fracture end under direct visual control of the endoscope. This technical note provides procedures for this technique.

INTRODUCTION: Not using a tourniquet could improve early postoperative pain, range of motion (ROM), length of stay (LOS), and thromboembolic risk in patients undergoing total knee arthroplasty (TKA). Our aim was to compare these factors, intraoperative blood loss, and gender-related outcomes in patients undergoing primary TKA with or without a tourniquet. METHODS: We performed a retrospective cohort study of 97 patients undergoing TKA with or without tourniquet from 2018 to 2020. Revisions and bilateral TKAs were excluded. Blood loss was estimated using a validated formula. Postoperative pain was tested using the visual analogue scale (VAS). ROM and quadriceps lag were assessed by a physiotherapist on a postoperative day 2 and discharge. The index of suspicion for a thromboembolic event was defined as the number of embolic-related investigations ordered in the first 6 months post-surgery. The Shapiro-Wilk test was used to assess the distribution of the data, Mann-Whitney for the continuous variables, and Fischer's test for the categorical ones. RESULTS AND DISCUSSION: There was a significant difference in blood loss. The non-tourniquet group lost on average 32% more blood (1291 mL vs. 878 mL, p<0.001 two-tailed). We found no difference in pain, ROM, LOS, and quadriceps lag on day 2 and at discharge. There was one thromboembolic event in the tourniquet group, but the thromboembolic index of suspicion did not differ (p=0.53). With tourniquet use, women had a significantly lower day 2 maximum flexion than men (71.56° vs. 84.67°, p=0.02). In this retrospective cohort study, the results suggest that tourniquet use is associated with lower blood loss and similar postoperative pain, range of motion, quadriceps lag, length of stay, and thromboembolic risk. There might be some differences between how men and women tolerate a tourniquet, with women having worse short-term outcomes compared to men.

Perceived reductions in both productivity and timber quality in faster growing Washington and Oregon Sitka spruce seed sources have led to the widespread use of Queen Charlotte Islands (QCI) sources in Irish forestry. The belief is that the more northerly sources provide slower and more consistent growth, superior wood qualities, increased stability and protection against frost damage. However, none of these assertions is supported by results from over 40 years of provenance testing in Sitka spruce in Ireland. The widely held belief that QCI origins are less prone to late spring frost damage is not supported by field trial results. The use of Washington origins will result in at least a one Yield Class (2 m-3 ha-l year-l ) increase in wood production over QCI origins without any significant increase in frost risk. Therefore, the continued planting of large amounts of QCI origins in Ireland is not justified. For commercial plantations of Sitka spruce in Ireland, Washington and Oregon sources are the recommended sources.

BACKGROUND: The sensitivity of cobalt (Co) and chromium (Cr) ion-levels in detecting poorly performing metal-on-metal hip implants is low. This study proposes that serial changes in ion-levels are a more accurate marker of arthroplasties at risk. METHODS: Serial metal ion-levels and implant data of 285 patients with ASR resurfacing or replacement were studied. Patient and implant characteristics were analysed using univariate and multivariate analyses. RESULTS: 111 (39%) had revision surgery. Time since index surgery (p<0.001), acetabular inclination (p<0.001), their interaction (p<0.001) and femoral head size (p = 0.01) were significant variables. Head size (≤51 mm) had lower Co and Cr levels (p = 0.01). Cr/Co showed marginal decrease over time in the unrevised group and no decrease prerevision. CONCLUSIONS: Repeated measurement of ion-levels were higher in the revision group suggesting that serial measurements rather than absolute values may have a role to play in predicting implant failure.

Abstract Headsprout Early Reading is a computer-based program designed on behavioral principles to enhance the basic skills that underpin the initial development of reading. In a within and between groups design, and using primary schools within Northern Ireland that had a currently high proportion of disadvantaged pupils, children who were behind their peers in progress with reading were randomly allocated to an intervention group ( n = 79), where the target was to work through 80 reading training episodes within a school year, or a teaching as usual group ( n = 44). Reading skills were assessed in all children before, at the midpoint, and after the intervention using a flashcard-based phonics identification test with three levels of difficulty, and before and after intervention using a standardized reading assessment, which generated a sentence reading age and a phonics reading age. Both groups showed increased scores on all measures over the 6 months of the study, but the intervention group showed markedly greater improvement. Importantly, the mean scores on sentence reading age and phonics reading age for the intervention group increased by over 17 months and 12.1 months, respectively, as opposed to 7.6 months and 7.8 months with the control group. These findings also validated the use of the flashcard-based phonics identification test with this population. This study indicates that widespread use of Headsprout Early Reading in mainstream education could be highly effective.

Abstract Background Globally there are few countries facilitating undergraduate programmes to train nurses specifically to support people with intellectual disabilities. In Ireland, eight Higher Education Institutions (HEIs) in partnership with associated health care providers (AHCPs) facilitate undergraduate Nursing (Intellectual Disability) degree programmes. Practice placements are a core element of these programmes whereby students complete several hours in these learning environments as part fulfilment of their degree requirements. Because people with intellectual disability who traditionally accessed services in congregated settings, are now increasingly accessing mainstream services, new placement types are emerging. This study aimed to describe practice placements, areas of the registered nurse in intellectual disability (RNID) specialist support and other learning opportunities accessed by undergraduate students on Bachelor of Science Nursing (Intellectual Disability) programmes across eight HEIs in Ireland. Methods A survey design involving a Placement Opportunities Tool (POT) developed through expert group meetings and consensus was utilised. Following ethical approval, Qualtrics XM software was enlisted to distribute the online survey to eight HEIs in Ireland. Excel and SPSS were engaged to undertake descriptive statistical analysis. Findings A total of five fully complete and one partially complete POT were included in the data analysis. Findings demonstrate that majority of placements are accessed in traditional Intellectual Disability services with students having less access to placements either in mainstream services or with RNID specialists. Conclusions This study details placement accessed by nursing students (Intellectual Disability) and associated areas of RNID specialist support. There is an urgent need to develop undergraduate student placements which reflect the contemporary lives of people with an intellectual disability. HEIs, AHCPs, nursing regulators, support persons and people with intellectual disabilities need to collaborate to develop practice placements enabling students to access learning experiences embedded in the realities of people living with intellectual disability who are integrating into their communities.

본 연구는 RDA 및 ISBD 자원유형 기술방안을 비교하여 KCR4 자원유형 기술을 위한 방안을 마련하고자 하였다. RDA 혹은 ISBD 규칙의 내용유형(내용형식), 매체유형을 비교하기 위해 테스트 및 설문조사를 실시하였다. 그 결과 ISBD에 비해 RDA가 내용유형 기술에서 일관성과 정확성이 높았다. 특히, RDA 내용유형 리스트는 상세한 용어로 구성되어 있어 자원의 내용을 풍부하게 표현할 수 있었지만, ISBD는 내용한정어를 결합하여 기술해야 하기 때문에 오류가 많았다. 결과적으로 RDA 및 ISBD로 내용유형 기술시 고려할 사항은 다음과 같았다. 첫째, RDA의 내용유형 용어 리스트가 보다 구체화되어야 한다. 둘째, ISBD 내용한정어 기술에 관한 명확한 세부 규정이 마련되어야 한다. 셋째, RDA와 ISBD 매핑표에서 ISBD의 내용형식에 내용한정어가 기술되어 있지만 정확한 매핑을 위해서는 일부 수정이 필요하다. 넷째, 국내 자원유형 기술방식에서 RDA와 같이 일관성과 정확성이 높은 용어리스트를 사용할 필요가 있다. 본 연구는 KCR4 내용유형 및 매체유형 기술방식으로 적합한 용어리스트를 모색하기 위해 2개 규칙의 자원유형 기술방법을 비교분석하고 고려사항을 제안하였다는데 그 의의가 있겠다. This study was to compare the description of content types(content forms) and media types of RDA and ISBD in order to revise GMD of KCR4. Test and survey were conducted as the research methods for comparing content types and media types description of RDA and ISBD. As a result, RDA content types description is better than ISBD in aspects of uniformity and correct rates. Especially, detailed list of content types in RDA could make the resources to be expressed completely, but content forms with adding the content qualification in ISBD could make the resource to be expressed with many errors. Therefore, there were some considerations to describe content types. First, content types terms in RDA need to be specified more. Second, some detailed rules need to be regulated on the combination of content qualification of ISBD. Third, the mapping tables between RDA content types and ISBD content forms need to be revised. Fourth, RDA content types list will be more applicable in KCR4 based on the uniformity and correct rates in the test. This study will contribute to analyze and suggest RDA and ISBD terms list of content types and media types for KCR4.

Venous Thromboembolism (VTE) is the term used to describe the formation of Deep Vein Thrombosis (DVT) followed by its frequent sequelae Pulmonary Embolism (PE). VTE is an issue of substantial concern in trauma and orthopaedic surgery

Because of its large natural range, lodgepole pine (Pinus contorta) provides a wide range of provenances for use on a range of sites. Unfortunately no one provenance of lodgepole pine combines good stem wood production with acceptable stem form. For this reason compromises must be accepted. South Coastal types provide rapid volume production with poor stem form, while North Coastal types provide good stem form with reduced volume production. Natural hybrids between coastal and interior provenances from the lower Skeena River in British Columbia and artificial interprovenance hybrids between South Coastal and Skeena River sources combine good stem form with acceptable wood production rates. Both are available in commercial quantities either from registered seed stands (lower Skeena River material) or seed orchards (interprovenance hybrids). Provenance recommendations for specific site types and end uses are provided.

Background Researching modifiable preoperative risk factors is essential for improving outcomes following total joint replacement (TJR). This study explores whether preoperative sleep performance influences pain and recovery in the early postoperative period. Methods This prospective observational study was conducted at an academic elective orthopedic hospital, recruiting patients undergoing total hip replacement (THR) and total knee replacement (TKR). Preoperative sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). Measured outcomes included pain, oral morphine use, day of crutch mobility, independent bed transfer, and hospital length of stay. Results No statistically significant associations were found between preoperative PSQI scores and primary outcomes, although sex differences existed in THR patients regarding early postoperative pain. The correlation between PSQI and hospital stay was weakly positive for THR (r = 0.223, p = 0.082) and negligible for TKR (r = 0.041, p = 0.807). PSQI showed no significant correlation with early mobility (THR: r = 0.111, p = 0.391; TKR: r = 0.115, p = 0.491) or postoperative morphine use (THR: r = 0.108, p = 0.403; TKR: r = 0.170, p = 0.309). Female THR patients had higher pain scores on days 0 and 1 and poorer PSQI scores. Conclusions Preoperative sleep hygiene was not associated with hospital stay, mobility, or pain in the immediate postoperative period after TJR. However, sleep may impact long-term recovery, highlighting the need for further research on modifiable preoperative factors and sex differences in post-TJR rehabilitation.

Small-scale fisheries (SSF) play a critical role in income generation, social development, environmental conservation, maintenance of tenure rights, as well as communities’ culture and way of life. Beyond the traditional seafood value chain, SSF encompasses several associated activities. This study adopts a qualitative approach to document social enterprise experiences within SSF. Specifically, it explores the environmentally friendly production of handicrafts created from fishery residues, such as mollusk shells, within a framework of fair and socially equitable trade. This value chain is predominantly led by women—a group historically marginalized, particularly within fisheries. As a result, the women involved experience empowerment through income generation and skills development within their communities. The study further concludes that ongoing psychological support, as well as technical training, guidance, and the promotion of their work, is essential for sustainable impact. Finally, it is recommended that these activities be integrated into the broader fishery value chain framework.

Digital Transformation from a Sustainability Perspective: The Contribution of Smart City Applications to Energy Efficiency

Women's medicine explores the key role played by British female doctors in the production and circulation of contraceptive knowledge and the handling of sexual disorders between the 1920s and 1970s at the transnational level, taking France as a point of comparison. This study follows the path of a set of women doctors as they made their way through the predominantly male-dominated medical landscape in establishing birth control and family planning as legitimate fields of medicine. This journey encompasses their practical engagement with birth control and later family planning clinics in Britain, their participation in the development of the international movement of birth control and family planning and their influence on French doctors. Drawing on a wide range of archived and published medical materials, this study sheds light on the strategies British female doctors used, and the alliances they made, to put forward their medical agenda and position themselves as experts and leaders in birth control and family planning research and practice.

Digital Transformation from a Sustainability Perspective: The Contribution of Smart City Applications to Energy Efficiency