Irish National Research Articles

154 ANALYSIS OF ELIGIBILITY FOR THROMBOLYSIS IN ISCHAEMIC STROKE PRESENTATIONS IN A UNIVERSITY TEACHING HOSPITAL IN 2021

Abstract Background Since the National Institute of Neurological Disorders and Stroke (NINDS) tissue-type Plasminogen Activator (tPA) trial was published in 1995, thrombolysis has been a mainstay of treatment for ischaemic stroke presenting within the appropriate age-adjusted timeframe, in the absence of contraindications. In the Irish National Audit of Stroke (INAS) National Report 2020, a nationwide thrombolysis rate of 10.6% (Range of 4-22%) was achieved. Aims: (1) This study was designed to compare this centre’s rate in 2021; (2) Identifying any missed potentially suitable presentations. Methods A retrospective chart review of 2021 stroke presentations in this centre was performed using medical admission notes and electronic emergency department records. Excluding haemorrhagic causes, we looked at the presenting National Institutes of Health Stroke Scale (NIHSS), the presenting timeframe and any contraindications of thrombolysis therapy, in order to identify any potentially missed eligible presentations. We also compared the percentage of thrombolysed patients in this centre to the national average. Results Of the 425 stroke presentations, 74 (17.4%) were excluded as intra-cerebral haemorrhages. Of the remaining 351 presentations, 32 (9.1%) underwent thrombolysis therapy. 225 (64.1%) were not eligible for therapy due to a low or recovering NIHSS (score 0-4). A further 72 (20.5%) with a NIHSS>5, were outside of the window of thrombolysis therapy. Of the remaining presentations, 13 (3.7%) were unsuitable due to anticoagulation use. The final 9 presentations (2.6%) were unsuitable due to other contraindications (previous intracranial haemorrhage, baseline modified Rankin ≥ 4). 18 (5.1%) of non-thrombolysed presentations had no contraindications to thrombolysis therapy aside from late presentation (excluding wake-up events). Conclusion While this centre’s thrombolysis percentage is lower than the national average in 2020, a review of presentations suggests no eligible candidates were missed. Therefore, variations in thrombolysis rates across Irish hospitals may reflect case mix variations rather than decision variations.

156 A SIGN IN TIME…; WHAT IMPACT DOES THE INTRODUCTION OF SIGNAGE HAVE FOR DEMENTIA PATIENTS? – A STAFF PERSPECTIVE

Abstract Background Dementia is often seen as a presenting or existing medical condition for older adults attending hospital services. There are over 64,000 people in Ireland living with dementia. A hospital-wide environmental audit of an acute Irish hospital was completed using the Irish National Audit of Dementia tool. A priority action from this audit was the introduction of new dementia-friendly signage in key patient areas across the hospital, including nurses’ stations, toilets and bedrooms. Methods Random selection was used to distribute staff questionnaires, gathering their perceptions on the effectiveness of this signage. These questionnaires were multiple-choice based. Results Forty-six questionnaires were completed across 11 wards and from at least 4 different disciplines. Over 70% of staff members noticed the signage prior to survey completion. Twenty-eight percent of staff members felt that patients required less prompting to topographically orientate themselves. Over 75% of staff felt signage helped improve overall orientation by either a small, moderate or significant amount. Over 40% of staff feel their ward is dementia-friendly. Conclusion The implementation of dementia-friendly signage has had a positive impact on in-patients with dementia, by improving orientation and by promoting independence levels with this group. Dementia-friendliness of the hospital has improved but further exploration in this area is required.

91 MONITORING FOR CLINICAL DETERIORATION; NURSES EXPERIENCE USING MODIFIED IRISH NATIONAL EARLY WARNING SYSTEM IN AN OLDER PERSON RESIDENTIAL CARE SERVICE

Abstract Background We are a 140-bed Care of the Older Person facility. Approximately 50% of Sepsis cases occur in this demographic. The Irish National Early Warning System (INEWS) is an early warning system to assist staff recognise and respond appropriately to clinical deterioration. Currently there is no INEWS for Older Person Residential Services. Challenges for treatment relating to deterioration in our service are; detecting ‘new confusion’, access to doctors, treatment options available and the necessity to transfer a resident to the Acute Care sector if intravenous antibiotics were required. We used the National Clinical Guideline INEWS Version 2 (2020) to develop a clinical monitoring and escalation protocol. This was rolled out December 2021. Methods A Nurses Opinion survey was carried out to determine Nurses experience with using the locally modified Early Warning System. Results There was a 63% (n=35) response rate. 100% reported improvement in identifying clinical deterioration in a timely manner and effective monitoring for deteriorating residents. 96% reported improvement in confidence with monitoring unwell residents, confidence with transfer out decisions and referring the resident to the doctor for review. 91% noted improvement in communicating residents’ condition to doctors. 87% improvement in clinical practice when monitoring vital signs. 82% improved communication using the ISBAR. On reviewing clinical documentation for all residents who had deteriorated post implementation there was a significant improvement in monitoring and documentation. 23% stated increased time and staffing levels were required for monitoring of residents. 9% stated doctors didn’t always understand the INEWS. Conclusion Implementation of the modified INEWS has resulted in considerably improved clinical monitoring, documentation, & Nurses confidence. Significant challenges remain including ethical issues with decision to transfer out a resident for treatment. Recommendations are upskilling of Health Care Assistants to carry out vital signs monitoring, robust advanced healthcare decision making and implementation of an INEWS for Older Person Services.

Songs without Sunrise: Irish Victorian Poetry and the Risorgimento

While the Risorgimento had a profound impact on the shape of English literature, this geopolitical crisis did not leave a similar imprint on Irish literature. Historical circumstances can explain why the nineteenth-century struggle for the unification of Italy did not lead to rapprochement between Italy and Ireland: support for the Italian cause put Irish nationalists in opposition with Catholic interests at home, while in the eyes of Italian nationalists the Irish question weakened the function of Britain as a liberalising power. Even so, a few Irish poets did address the Risorgimento. This article shows how poems by Thomas Davis, James Clarence Mangan, Jane Francesca Elgee, and Aubrey de Vere express a variety of positions (isolationism, catastrophism, liberalism, realism) that are informed by a complex constellation of geopolitical factors. By means of a series of close readings, the present inquiry aims to shed new light on the geopolitical form of Irish poetry in the Victorian age.

Lifetime alcohol-use prevalence and correlated factors among street children in Iran.

Several studies on street children in Iran reported a high prevalence of alcohol consumption among this group. This study assessed the prevalence of lifetime alcohol use and correlated factors among street children in Iran. We conducted a cross-sectional survey among 856 street children from six provinces of Iran. Behavioral data were collected by trained interviewers using a structured questionnaire. Our target outcome was lifetime alcohol use. We examined associations between individual variables and lifetime alcohol use using the chi-square. A multiple logistic regression model included variables with a p-value<.2. Lastly, we reported the adjusted odds ratio (an OR) point estimate and 95% confidence interval (95% CI) as the effect measure. Mean age and standard deviation (SD) of alcohol drinkers were 14.94±2.16. Overall, 16.6% (CI95%: 14.38%, 19.55%) of participants reported lifetime alcohol use, and almost 60% of children reported alcohol use over three past months. In the final model, factors that were independently associated with alcohol use included the 15-18 age range (AOR 2.35, 95% CI 1.48-3.73), Iranian nationality (AOR 3.36, 95% CI 2.07-5.45), working longer than 5 years in the streets (AOR 2.90, 95% CI 1.72-4.88), father's drug use (AOR 1.93, 95% CI 1.22-3.01), and illiteracy (AOR 1.65, 95% CI 1.03-2.66). The results of the present study demonstrated that preventive plans for alcohol use among street children must be addressed using the services provided by governmental and nongovernmental organizations.

Review of Smyllie’s Ireland: Protestants, Independence, and the Man Who Ran the Irish Times (2019), by Caleb Wood Richardson

The first scholarly book-length account of Robert Maire Smyllie, editor of The Irish Times between 1934­ and 1954 and the central figure in a literary coterie to which Brian O’Nolan belonged, treats Smyllie as a lens on the historical experience of southern Irish Protestants in the twentieth century rather than providing a biography. Nevertheless, Richardson goes far beyond existing accounts to present the details of underexplored areas, such as Smyllie’s teaching of Irish or travels in Czechoslovakia. Richardson picks his way through the mass of Smyllie’s journalism by drawing out fresh perspectives on the Protestant orientation towards several interlocking themes, such as localism, censorship, British patriotism, Irish nationalism, and cultural patronage. Smyllie’s relationship to Brian O’Nolan’s Cruiskeen Lawn column receives most of a chapter dedicated to southern Irish Protestants as ‘Gaels.’ The book is a clarion call for scholars to turn to Smyllie as an important context for O’Nolan.

A Clustering Approach to Meal-Based Analysis of Dietary Intakes Applied to Population and Individual Data

ABSTRACTBackgroundExamination of meal intakes can elucidate the role of individual meals or meal patterns in health not evident by examining nutrient and food intakes. To date, meal-based research has been limited to focus on population rather than individual intakes, without considering portions or nutrient content when characterizing meals.ObjectivesWe aimed to characterize meals commonly consumed, incorporating portions and nutritional content, and to determine the accuracy of nutrient intake estimates using these meals at both population and individual levels.MethodsThe 2008–2010 Irish National Adult Nutrition Survey (NANS) data were used. A total of 1500 participants, with a mean ± SD age of 44.5 ± 17.0 y and BMI of 27.1 ± 5.0 kg/m2, recorded their intake using a 4-d weighed food diary. Food groups were identified using k-means clustering. Partitioning around the medoids clustering was used to categorize similar meals into groups (generic meals) based on their Nutrient Rich Foods Index (NRF9.3) score and the food groups that they contained. The nutrient content for each generic meal was defined as the mean content of the grouped meals. Seven standard portion sizes were defined for each generic meal. Mean daily nutrient intakes were estimated using the original and the generic data.ResultsThe 27,336 meals consumed were aggregated to 63 generic meals. Effect sizes from the comparisons of mean daily nutrient intakes (from the original compared with generic meals) were negligible or small, with P values ranging from <0.001 to 0.941. When participants were classified according to nutrient-based guidelines (high, adequate, or low), the proportion of individuals who were classified into the same category ranged from 55.3% to 91.5%.ConclusionsA generic meal–based method can estimate nutrient intakes based on meal rather than food intake at the sample population and individual levels. Future work will focus on incorporating this concept into a meal-based dietary intake assessment tool.

Rabbi Shlomo Mashiah and His “Shirah”: Modern Immigration and Mystic Redemption

Abstract This article considers the ways traditional love of Zion was expressed through immigration in the Mashhadi community due to encounters with new phenomena like the Bukharan Jews’ immigration to the land of Israel, Russian and British imperialism, and early stirrings of Iranian nationalism and constitutionalism, as well as early Zionist activity in Palestine. It is viewed through the prism of a piyyut written by Rabbi Shlomo Mashiah, one of the prominent Kabbalists in Jerusalem at the beginning of the twentieth century, and a member of one of the earliest groups of immigrants from Iran. I analyze the piyyut, written in messianic traditional language, and show that some of the terms may have had a political meaning, or at least were used a few decades later in political Zionist contexts. Thus, although Zionism is not supposed to be a characteristic of Iranian Jewish immigration before 1917, and the piyyut is messianic in language, I argue that it carries new, modern overtones, and shows the transformation of traditional language.

Challenges for implementation of inter-sectoral efforts to improve outbreak response using consolidated framework for implementation research; Iran’s COVID-19 experience

BackgroundThe recurrence of emerging infectious diseases reminds us that rapid response to related outbreaks require coordinated inter-sectoral/ organizational and trans-disciplinary approaches. This study examined the challenges for implementation of inter-sectoral efforts to improve COVID-19 pandemic response in Iran using the consolidated framework for implementation research (CFIR).MethodsWe conducted a qualitative content analysis of in-depth interviews between March 2020 and February 2021 in Tehran, Iran. Participants included health professionals and experts involved in the prevention, treatment and control of COVID-19 pandemic from different levels of the health system (macro: Ministry of Health and Iranian National Institute of Health Research; meso: universities of medical sciences and health services; and micro: hospitals), selected using purposive sampling. Recorded interviews were transcribed verbatim and coded using a deductive approach (CFIR constructs).ResultsIn total, 12 interviews with the participants were conducted; and eight themes emerged as the most important challenges for implementation of inter-sectoral efforts to improve outbreak response in COVID-19. These challenges include lack of proper intervention sources, complexity, poor networking with external organizations, cultural issues, inadequate availability of resources, inadequate access to knowledge and information about inter-sectoral collaboration implementation, and planning issues for it.ConclusionsImplementing inter-sectoral efforts to improve outbreak response require addressing several implementation challenges. There should be effective leadership and command system, prioritizing the problem, having proper intra-sector collaboration, adequate supervisory, strong social capital, managers and officials’ positive beliefs and organizational culture towards inter-sectoral collaboration, sufficient knowledge and information about the implementation, and providing proper programs to implement inter-sectoral collaboration. These findings recall the need to develop and in particular, implement a specific infra-structure through a well-designed program at the government level to strengthen this approach.

Kevin L. Schwartz. Remapping Persian Literary History, 1700–1900

Kevin L. Schwartz. <i>Remapping Persian Literary History, 1700–1900</i>

Mana Kia. Persianate Selves: Memories of Place and Origin Before Nationalism

Mana Kia. <i>Persianate Selves: Memories of Place and Origin Before Nationalism</i>

Physical Degeneracy and Racial Fitness in Prewar Ireland

Physical Degeneracy and Racial Fitness in Prewar Ireland Conor Heffernan (bio) With certain people the physical degeneracy of the present generation is a pet theme. Those who are always talking of it are also fond of detecting the blemishes in their own countrymen…. irish examiner, 29 october 19101 The deleterious effects of town life upon the people of these counties are, according to an eminent medical authority, principally responsible for our physical degeneracy. kerry weekly reporter, 7 april 19062 The general adoption by the Irish people of whole meal … would not only benefit the race physically but would also tend to revive the milling industry of the country. r. d. cole, 21 february 19113 Fears of physical degeneration or deterioration took many forms in Ireland before the Great War. Understanding physical degeneracy as the pervasive belief that a particular society's physical health or "racial stock" was weaker than in previous generations, this article studies degeneracy in Irish thought during this period. While degeneracy was often taken as a catchall term for physical, moral, and other behaviors "outside" cultural norms, to isolate physical degeneracy as a topic of study negates the nuances concerning physical health and appearance that for many commentators were of utmost concern.4 As will become clear, physical degeneracy was often treated as [End Page 225] a stand-alone topic in social, political, and cultural debates. Newspapers regularly spoke of declining Irish health, Irish nationalists railed against such claims, and many physicians used degeneration as an easy explanation for social ills. In short, the idea of physical degeneration or deterioration clearly existed in Ireland during this period. Actually, it thrived, and yet the power that such terms had in Irish society has been discussed only briefly by historians of this period.5 Oftentimes comments on physical degeneracy or deterioration are made in passing when examining much broader medical or public-health interventions.6 Likewise, popular debates and discussions about physical degeneracy were removed from the small and elite eugenics societies studied by Greta Jones.7 One exception to studies of degeneracy among the public at large is the excellent work conducted by Catherine Cox, Alice Mauger, and others when discussing lunacy in late nineteenth-century Ireland.8 As Cox made clear in 2012, theories of physical and mental degeneration were often used as an explanatory mechanism for the high rates of lunacy in Ireland as compared with those of Britain.9 Building on such work, this article examines the popular expression of physical degeneracy not in regard to lunacy but rather in relation to the physical bodies of Irish men, women, and children. Physical degeneracy, understood here as the idea that the present generation was physically inferior to previous ones, was both a popular and a professional concern in [End Page 226] Ireland during this period.10 It could be used to critique, praise, or simply begin conversations about Irish "racial fitness." The idea that the Irish race was physically weaker than previous generations elsewhere was not particularly novel in a global context in the late nineteenth and early twentieth centuries. This was a period when racial-fitness concerns began to rise in intensity in both Europe and the United States.11 Fears about modernity's ever-quickening pace, urbanization, new forms of commerce, and military warfare helped to legitimize ideas about degeneracy. This was certainly the case in Britain, from which imperial concerns about population health often trickled into Ireland. Much work has already been conducted into degeneracy in the British context. Michael Anton Budd has explored the role of degeneracy fears in shaping British physical education and military training.12 Vanessa Heggie has studied the moral panic that arose following the Second South African War (1899–1902), while Thomas Edward Jordan has examined the intersection between eugenics, degeneracy, and childhood.13 Put simply, the British use of physical degeneracy was situated within an imperial framework that included people who worried about the long-term viability of the empire. This practice partly explains why sporting contests between British and colonial teams assumed such importance during this period. Such events quite literally pitted British and colonial men against one another in a test...

Ireland, Literature, and the Coast: Seatangled by Nicholas Allen

<i>Ireland, Literature, and the Coast: Seatangled</i> by Nicholas Allen

Craft, Politics, Collaboration: The Irish National Banner, 1890

Craft, Politics, Collaboration: The Irish National Banner, 1890

저항하는 헤테로토피아 공간으로서의 이란 위성미디어와 경합하는 정체성들

Since the beginning of satellite broadcasting in 1991, there are around 100 foreign satellite channel programs currently being broadcasted in Iran. Satellite channels in Persian from outside of Iran are create alternative discourses. Moreover Satellite Media became ‘Heterotopic Space’ of resistance and competing identites. In this process, a rupture is formed between the top-down national identity fed through the Islam republic and the identity built through the discourses formed through alternative media. The Iranian nationals come in contact with global issues and discourses through global channels, therefore the Iranian government emphasizes the ‘soft war’ and warned the negative effects. This study will examine the processes in which the satellite media become the eyes and ears of the citizens who long for change in Iran when anti-governmental social movement is under way, and in which the Iranian people become aware of the ‘power of solidarity’ through the satellite programs.

The meaning in grandiose delusions: measure development and cohort studies in clinical psychosis and non-clinical general population groups in the UK and Ireland

The content of grandiose delusions-inaccurate beliefs that one has special powers, wealth, mission, or identity-is likely to be highly meaningful. The meaning, for example providing a sense of purpose, could prove to be a key factor in the delusion taking hold. We aimed to empirically define and develop measures of the experience of meaning in grandiose delusions and the sources of this meaning, and to test whether severity of grandiosity in clinical and non-clinical populations is associated with level of meaning. We did a cross-sectional self-report questionnaire study in two cohorts: non-clinical participants aged 18 years and older, with UK or Irish nationality or residence; and patients with affective or non-affective psychosis diagnoses, aged 16 years and older, and accessing secondary care mental health services in 39 National Health Service providers in England and Wales. Participants with high grandiosity completed two large item pools: one assessing the experience of meaning in grandiose delusions (Grandiosity Meaning Measure [termed gram]) and one assessing the sources of meaning (Grandiosity Meaning Measure-Sources [termed grams]). The Grandiosity Meaning Measure and Grandiosity Meaning Measure-Sources were developed using exploratory factor analysis and confirmatory factor analysis. Structural equation modelling was used to test the associations of meaning with the severity of grandiosity. The primary outcome measure for grandiosity was the Specific Psychotic Experiences Questionnaire (grandiosity subscale) and associations were tested with the Grandiosity Meaning Measure and the Grandiosity Meaning Measure-Sources. From Aug 30, 2019, to Nov 21, 2020, 13 323 non-clinical participants were enrolled. 2821 (21%) were men and 10 134 (76%) were women, 11 974 (90%) were White, and the mean age was 39·5 years (SD 18·6 [range 18-93]). From March 22, 2021, to March 3, 2022, 798 patients with psychosis were enrolled. 475 (60%) were men and 313 (39%) were women, 614 (77%) were White, and the mean age was 43·4 years (SD 13·8 [range 16-81]). The experience of meaning in relation to grandiose delusions had three components: coherence, purpose, and significance. The sources of meaning had seven components: positive social perceptions, spirituality, overcoming adversity, confidence in self among others, greater good, supporting loved ones, and happiness. The measurement of meaning was invariant across clinical and non-clinical populations. In the clinical population, each person typically endorsed multiple meanings and sources of meaning for the grandiose delusion. Meaning in grandiose delusions was strongly associated with severity of grandiosity, explaining 53·5% of variance, and with grandiose delusion conviction explaining 27·4% of variance. Grandiosity was especially associated with sense of purpose, and grandiose delusion conviction with coherence. Similar findings were found for the non-clinical population. Meaning is inherently tied to grandiose delusions. This study provides a framework for research and clinical practice to understand the different types of meaning of grandiosity. The framework is likely to have clinical use in psychological therapy to help guide patients to find sources of equivalent meaning from other areas of their lives and thereby reduce the extent to which the grandiose delusion is needed. Health Education England and National Institute for Health and Care Research.

CORR Insights®: Can Bar Code Scanning Improve Data Capture in a National Register? Findings From the Irish National Orthopaedic Register.

CORR Insights®: Can Bar Code Scanning Improve Data Capture in a National Register? Findings From the Irish National Orthopaedic Register.

Iranian National Survey on Tinea Capitis: Antifungal Susceptibility Profile, Epidemiological Characteristics, and Report of Two Strains with a Novel Mutation in SQLE Gene with Homology Modeling.

The data on the epidemiological and antifungal susceptibility profile of tinea capitis (TC) in Iran has not been updated in recent decades. This report presents the Iranian epidemiological and drug susceptibility data regarding the distribution of dermatophytes species isolated by six national mycology centers for a period of one year (2020-2021). A total of 2100 clinical samples from individuals suspeted to TC were subjected to mycological analysis of direct microscopy and culture. For definite species identification, the culture isolates were additionally subjected to PCR-RFLP and PCR-sequencing of the ITS ribosomal DNA (ITS-rDNA) region. Antifungal susceptibility profiles for eight common antifungal drugs were determined by CLSI M38-A3 guidelines. The SQLE gene was partially amplified and sequenced in two terbinafine-resistant and two susceptible T. mentagrophytes isolates to elucidate probable substitutions involved in resistance. TC (n = 94) was diagnosed in 75 children (79.8%) and 19 adults (20.2%) by direct microscopy and culture. Frequency of TC was significantly more among males (66 males = 70.2% vs 28 females = 29.8%). The prevalent age group affected was 5-9years (39.36%). Thirty-two (34.04%) T. mentagrophytes, 27 (28.7%) T. tonsurans, 14 (14.9%) M. canis, 13 (13.8%) T. violaceum, 5 (5.32%) T. indotineae, 2 (2.1%) T. benhamiae, and 1 (1.1%) T. schoenleinii were identified as the causative agents. MIC values of isolates showed susceptibility to all antifungal agents, except for fluconazole and griseofulvin with GM MIC of 11.91μg/ml and 2.01μg/ml, respectively. Terbinafine exhibited more activity against isolates, with GM MIC 0.084μg/ml followed by ketoconazole (0.100μg/ml), econazole (0.107μg/ml), itraconazole (0.133μg/ml), butenafine (0.142μg/ml), and miconazole (0.325μg/ml). Two resistant T. mentagrophytes isolates harbored missense mutations in SQLE gene, corresponding to amino acid substitution F397L. Remarkably, one unique mutation, C1255T, in the SQLE sequence of two terbinafine-susceptible T. mentagrophytes strains leading to a change of leucine at the 419th position to phenylalanine (L419F) was detected. T. mentagrophytes, T. tonsurans, and M. canis remained the main agents of TC in Iran, however less known species such as T. indotinea and T. benhamiae are emerging as new ones. Terbinafine could still be the appropriate choice for the treatment of diverse forms of TC.

Feasibility study of CETO wave energy converter in Iranian coastal areas to meet electrical demands (a case study)

Using wave energy to supply the electrical demand of the coastal population is an exciting idea. In recent years, many wave energy converters (WEC) have been invented, researched, and used in different parts of the world. These WECs can be used alone or in a hybrid system with other renewable resources. Also, they can be used stand-alone or grid-connected to generate electricity. Iran has access to the sea from the north and south. Using wave energy to provide power can be a good solution for energy production. This study investigates the application of a point absorber WEC named CETO to supply electricity for a 300 population on the Coasts of the Caspian Sea, Persian Gulf, and Oman sea. Waves scatter diagram for three locations calculated based on the data collected by the Iranian National Center of Ocean Data. According to these diagrams, the average wave height and period on the Konarak coast in the Oman Sea were 69 cm and 5.4 s, respectively, and Konarak had the best wave condition between the desired location in terms of wave energy potential. Also, the Cost of Energy (COE) and Net Present Cost (NPC) for three areas calculated, and the lowest amount of COE and NPC occurred in Konarak. The COE range at Konarak was between 0.523 and 0.991 $/kWh for different WEC numbers. The best performance in terms of power generation and emissions reduction also occurred in Konarak; and the output power of each CETO unit was 23.01 kW, and emissions and related penalties reduced by about 24 %. Also, the effect of load change and grid extension cost on financial results sensitively analyzed, and the results presented. The obtained financial results compared with the results of some similar WECs and it was found that the obtained results differed very little from the results of other research, and were within their range.

Can Bar Code Scanning Improve Data Capture in a National Register? Findings from the Irish National Orthopaedic Register.

The Irish National Orthopaedic Register (INOR) provides a national mechanism for managing data on THA and TKA in Ireland, including a detailed implant record populated by intraoperative implant bar code scanning. It is critically important that implant details are recorded accurately for longitudinal outcome studies, implant recalls, and revision surgery planning. Before INOR's 2014 launch, Irish hospitals maintained separate, local institutional arthroplasty databases. These individual databases typically took the form of hardcopy operating room (OR) logbooks with handwritten patient details alongside the descriptive stickers from the implant packaging and/or individual institution electronic records using manual electronic implant data input. With the introduction of the INOR, a single, unifying national database was established with the ability to instead collect implant data using bar code scanning at time of implant unpackaging in the OR. We observed that bar code data entry represented a novel and potentially substantial change to implant recording methods at our institution and so sought to examine the potential effect on implant data quality. We compared the new bar code scanning method of implant data collection used by the INOR to the previously employed recording methods at our institution (in our case, the previous methods included both an electronic operation note database [Bluespier software] and a duplicate hardcopy OR logbook) and asked (1) Does bar code scanning improve the completeness of implant records? (2) Does bar code scanning improve the accuracy of implant records? Although the INOR was launched in 2014, our institution went live with it in 2019. To avoid any potential recording issues that may have occurred during the 2019 introduction of the novel system, a clear period before the introduction of INOR was selected at our institution to represent an era of manual data input to Bluespier software: July 2018. Although we initially aimed for 2 months of data from July 1, 2018, to August 31, 2018 (n = 247), we decided to proceed to 250 consecutive, primary THAs or TKAs for clarity of results. No procedure meeting these criteria was excluded. A second recent period, January 2021, was identified to represent an era of bar code data input; 250 consecutive, primary THAs or TKAs were also included from this date (to February 15, 2021). No case meeting these criteria was excluded. A total of 4244 implant parameters from these 500 primary THAs or TKAs were manually cross-referenced for missing or incorrect data. Eleven THA and six TKA parameters were chosen for comparison, including implant names and component sizes. For each case, either the 2018 Bluespier electronic record or the 2021 INOR electronic record was manually interrogated, and implant details were recorded by two authors before they were compared against the duplicate record for every case (the reference-standard OR logbook containing the corresponding implant product stickers) for both completeness and accuracy. Completeness was defined binarily as the implant parameter being either present or absent; we did likewise for accuracy, either that parameter was correct or incorrect. The OR logbooks were chosen as the reference standard because we felt the risk of product stickers containing errors (inaccuracies) was negligible, and in our collective experience, missing stickers (incompleteness) has not been encountered. Logbook case completeness was also confirmed by comparison to our inpatient management system. With the introduction of the automated bar code data entry in the INOR, the proportion of missing data declined from 7% (135 of 2051) to 0% (0 of 2193), and the proportion of incorrectly recorded implant parameters declined from 2% (45 of 2051) to 0% (0 of 2193). The proportion of procedures with entirely accurate implant records rose from 53% (133 of 250) to 100% (250 of 250). The completeness and accuracy of implant data capture was improved after the introduction of a contemporary electronic national arthroplasty registry that utilizes bar code data entry. Based on the results of this study, other local and national registers may consider bar code data entry in the OR to achieve excellent implant data quality. Future studies may examine implant data quality at a national level to validate the bar code-populated data of the INOR.