Irish National Research Articles

Silencing a Nation: How the United States Restricts and Censors Iranians on the Internet

ABSTRACT Contrary to the initial expectations, censorship managed to survive through the Digital Age as far as Internet censorship is today a global issue. The present paper attempts to provide insight into some new forms of censorship through investigating the various restrictions imposed on the Iranian nation by the United States. This study has shown that the U.S. government (in collaboration with Meta, Twitter, and Google) suppresses the Iranian media, removing them from the platforms, limiting Iranians’ access to the Internet, and silencing their dissenting voices in order to preserve its monopoly on the narrative. The results of this investigation also reveal one of the most extensive cases of censorship in the history of social media, which has been practiced by Instagram against General Qasem Soleimani.

Rumbold,Valerie. Swift in Print: Published Texts in Dublin and London, 1691– 1765

Rumbold,Valerie. <i>Swift in Print: Published Texts in Dublin and London, 1691– 1765</i>

The Child Sex Scandal and Modern Irish Literature: Writing the Unspeakable, by Joseph Valente and Margot Gayle Backus

<i>The Child Sex Scandal and Modern Irish Literature: Writing the Unspeakable</i>, by Joseph Valente and Margot Gayle Backus

Vitamin B-6 and riboflavin, their metabolic interaction, and relationship with MTHFR genotype in adults aged 18–102 years

The generation of the active form of vitamin B-6, pyridoxal 5'-phosphate (PLP), in tissues is dependent upon riboflavin as flavin mononucleotide, but whether this interaction is important for maintaining vitamin B-6 status is unclear. To investigate vitamin B-6 and riboflavin status, their metabolic interaction, and relationship with methylenetetrahydrofolate reductase (MTHFR) genotype in adulthood. Data from 5612 adults aged 18-102 y were drawn from the Irish National Adult Nutrition Survey (NANS; population-based sample) and the Trinity-Ulster Department of Agriculture (TUDA) and Genovit cohorts (volunteer samples). Plasma PLP and erythrocyte glutathione reductase activation coefficient (EGRac), as a functional indicator of riboflavin, were determined. Older (≥65 y) compared with younger (<65 y) adults had significantly lower PLP concentrations (P<0.001). A stepwise decrease in plasma PLP was observed across riboflavin categories, from optimal (EGRac ≤1.26), to suboptimal (EGRac: 1.27-1.39), to deficient (EGRac ≥1.40) status, an effect most pronounced in older adults (mean±SEM: 76.4±0.9 vs 65.0±1.1 vs 55.4±1.2nmol/L; P<0.001). In individuals with the variant MTHFR 677TT genotype combined with riboflavin deficiency, compared with non-TT (CC/CT) genotype participants with sufficient riboflavin, we observed PLP concentrations of 52.1±2.9 compared with 76.8±0.7nmol/L (P<0.001). In participants with available dietary data (i.e., NANS cohort, n = 936), PLP was associated with vitamin B-6 intake (nonstandardized regression coefficient β: 2.49; 95% CI 1.75, 3.24; P<0.001), supplement use (β: 81.72; 95% CI: 66.01, 97.43; P<0.001), fortified food (β: 12.49; 95% CI: 2.08, 22.91; P=0.019), and EGRac (β: -65.81; 95% CI: -99.08, -32.54; P<0.001), along with BMI (β: -1.81; 95% CI: -3.31, -0.30; P=0.019). These results are consistent with the known metabolic dependency of PLP on flavin mononucleotide (FMN) and suggest that riboflavin may be the limiting nutrient for maintaining vitamin B-6 status, particularly in individuals with the MTHFR 677TT genotype. Randomized trials are necessary to investigate the PLP response to riboflavin intervention within the dietary range. The TUDA study and the NANS are registered at www.ClinicalTrials.gov as NCT02664584 (27 January 2016) and NCT03374748 (15 December 2017), respectively.Clinical Trial Registry details: Trinity-Ulster-Department of Agriculture (TUDA) study, ClinicalTrials.gov no. NCT02664584 (January 27th 2016); National Adult Nutrition Survey (NANS), ClinicalTrials.gov no. NCT03374748 (December 15th 2017).

ANCA-associated vasculitis in Ireland: a multi-centre national cohort study.

Background: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare multisystem autoimmune disease. There is a need for interoperable national registries to enable reporting of real-world long-term outcomes and their predictors in AAV. Methods: The Irish National Rare Kidney Disease (RKD) registry was founded in 2012. To date, 842 patients with various forms of vasculitis have been recruited across eight nephrology, rheumatology and immunology centres. We focus here on patient- and disease- characteristics, treatment and outcomes of the 397 prospectively recruited patients with AAV. Results: Median age was 64 years (IQR 55-73), 57.9% were male, 58.9% had microscopic polyangiitis and 85.9% had renal impairment. Cumulative one- and five-year patient survival was 94% and 77% respectively. Median follow-up was 33.5 months (IQR 10.7-52.7). After controlling for age, baseline renal dysfunction (p = 0.04) and the burden of adverse events (p <0.001) were independent predictors of death overall. End-stage-kidney-disease (ESKD) occurred in 73 (18.4%) patients; one- and five-year renal survival was 85% and 79% respectively. Baseline severity of renal insufficiency (p = 0.02), urine soluble CD163 (usCD163) (p = 0.002) and "sclerotic" Berden histological class (p = 0.001) were key determinants of ESKD risk. Conclusions: Long-term outcomes of Irish AAV patients are comparable to other reported series. Our results emphasise the need for personalisation of immunosuppression, to limit treatment toxicity, particularly in those with advanced age and renal insufficiency. Baseline usCD163 is a potential biomarker for ESKD prediction and should be validated in a large independent cohort.

Eliza Lynn Linton and the Irish Question

This essay extends current scholarship on Eliza Lynn Linton by focusing on an under-examined aspect of her work—her Irish writings, in particular About Ireland (1890) and About Ulster (1892). These writings reflect the shift from her early support of radical Irish nationalism to her late advocacy of Liberal Unionism. Linton's contributions to literary and social history have been primarily discussed in terms of her position as an independent, professional woman writer who was a vociferous anti-feminist. Her Irish writings are similarly contentious, written during the historical juncture defined by the Home Rule movement (independence) and Ulster Unionism (strengthening the Union). Less an objective journalist than a provocative opinion writer, Linton in her writing reflects the period's debates about Ireland's impending break from the British Empire.

Migration and partisan identification as British Unionists or Irish Nationalists in Northern Ireland

The notion that mobility weakens collective norms and increases tolerance has a long pedigree in sociology. In this article, we examine the association of migration with partisan identification as British Unionists or Irish Nationalists in Northern Ireland, a region where the overlap of opposing religious and national identities is reflected in the residential segregation of its population. In representative samples of the population, we find that Irish Nationalist identification among Catholics and British Unionist identification among Protestants was lower among people not born in Northern Ireland and return migrants from beyond the British Isles. Having lived in the Republic was associated with more Nationalist identification among Catholics but less Unionist identification among Protestants and others. Moreover, having lapsed from the family religion is associated with decreased partisan identification. While international migration has in many countries led to increased tensions, conflict and the ascendance of exclusionary national populist movements, our results thus suggest that mobility beyond the British Isles has contributed to less nation–state conflict in Northern Ireland.

John Singer's Comedic Drama and Western Culture

The writing of the West in Irish drama began in the Irish Renaissance in the late 19th and early 20th centuries and continues to this day. During the Irish Renaissance, in order to resist British colonial rule, writers endowed the western frontier region of Ireland with romantic imagery and mythic qualities, seeing it as a cultural symbol embodying nationhood, poetic idyll and Irishness. The West of Ireland fits perfectly with the writers' construction of Irish culture during this period in terms of its colonial history, economic environment, sense of national identity, language and culture, and religious beliefs. Thus, the Irish West became not only a symbol of Irish identity, but also a unique ideological field for the revitalisation of the Irish nation.

Distinction and Survival: Zoroastrians, Religious Nationalism, and Cultural Ownership in Shiʿi Iran

AbstractThis article argues that the notion of Iranian culture employed in the public discourse of Zoroastrians allows them to tackle the dilemma of Shiʿi-dominated Iranianness without provoking Shiʿi authorities. The piece offers an analysis of ethnographic data, including detailed speech acts documented in Zoroastrians’ ritual spaces and cultural exhibitions. It explores the Zoroastrian configuration of an Iranian culture that summons and encodes pre-Islamic tropes and modern nationalist sentiments by constantly maneuvering around national, religious, and ethnic categories. This configuration's underpinning assumptions, narratives, and texts have powerful platforms in Iranian nationalist imagination. I propose that this arrangement attempts to carve out a space for Zoroastrians’ distinct identity by connecting the history of the Muslim Arab invasion of Persia to the Shiʿi hegemonic norms of Iranian culture today. It further invokes Zoroaster's indigeneity and teachings as the foundation of authentic Iranianness to establish Zoroastrians’ survival as a cultural system.

TÜRKİYE-İRAN GÖÇ SİSTEMİ: SÜREKLİLİK VE DEĞİŞİMLER

Amaç: Son yıllarda Türkiye’ye dair göç çalışmalarında ciddi bir artış gözlense de Türkiye-İran göç koridoruna dair araştırmalar sınırlı sayıdadır. Bu makalede Türkiye-İran Göç sisteminde son dönemde yaşanan gelişmeler incelenecektir. Bu bağlamda tartışılacak üç kategori: yıllardır süregelen uluslararası korumaya tabi kişiler; sayıları gittikçe artan uluslararası öğrenciler ve yatırım yoluyla vatandaşlık hareketliliklerini kapsamaktadır.Yöntem: Türkiye-İran göç koridorunda son yıllarda artış gösteren öğrenci hareketliliği ve konut alımı ile aynı süreçte Türkiye’ye gelerek sığınma başvurusunda bulunan İranlı bireylerin sayısında ciddi azalma olmuştur. Tarihsel süreçte bu değişimi iz sürme yöntemiyle sunan çalışma bu noktada verilerin ne ifade ettiğini göstermek adına TÜİK, YÖK ve GİB’den yararlanmaktadır. Azalan ve artan trendi anlamak adına ise makro politikalardaki değişiklikleri analiz ederek, makro değişimlerin yeni olan etkisini ortaya çıkarmaktadır.Bulgular: 1980’lerin başından itibaren İranlı bireylerin sığınma temelli Türkiye’ye olan hareketliliğiyle sınırlı olan Türkiye-İran göç koridorunda 2011 sonrası süreçte önemli bir dönüşüm yaşanmıştır. Özellikle 2011 sonrası dönemde İranlı öğrenciler ile İranlı ailelerin Türkiye’de konut edinimi yoluyla göçü her yıl sürekli olarak artış göstermektedir. Bu iki kategorinin varlığı ilk olarak Türkiye ve İran arasındaki göçü bir göç sistemine dönüştüğünün göstergesidir. Daha da önemlisi çalışma, bu iki düzenli göç kategorisinin varlığı Türkiye’nin göç politikalarının neoliberalleşmesiyle ilgili olduğunu tartışmaktadır.Özgünlük: Türkiye’ye olan İranlı bireylerin hareketliliği temel olarak İranlı sığınmacı ve mülteciler ile onların üçüncü ülkelere yerleştirilmesi üzerinden tartışılmıştır. Son dönemlerde Türkiye’de artan sayıdaki İranlı yabancı lisans öğrencisi ve konut satın alan İranlı bireyler akademik olarak yazında irdelenmemiştir. Çalışmanın özgün tarafı bu iki kategorileri makro politikalardaki değişikler ile ilişkilendirmesi, Türkiye-İran arasındaki hareketliliğin bir göç sistemine dönüşmesini göstermesi ve Türkiye göç yönetiminin giderek piyasa mantığına uygun politika tercihleriyle neoliberalleşmesini göstermektir.

‘Unfailing Unity’: Jessie Louisa Moore Rickard, Great War Ireland and the Italian Risorgimento

This article offers a development of traditional approaches to Irish Great War literature which focus on issues of national identity towards a wider transnational field. It investigates two war narratives by Dublin-born Anglo-Irish writer Jessie Louisa Moore Rickard (1876–1963): her 1915 article for New Ireland ‘The Munsters at Rue du Bois’ and her 1918 home front novel The Fire of Green Boughs, both of which contain intertextual references to the Italian Risorgimento (1815–1871), or the unification of the Italian peninsula. By framing her works within the Italian context, Rickard establishes new paradigms of interpretation for both the representations of Ireland in First World War fiction and the Italian Risorgimento in English literature. In her works, Great War Ireland is no longer perceived as an essentially domestic conflict but rather as connected to other events across time and space, inscribing First World War Ireland within a more global context. Representations of the Risorgimento are also expanded in her work. So far, Irish scholarship has established strong links between the Italian struggle for independence and Irish nationalism. Rickard’s work, however, shows that the Risorgimento can also become a model for the Union between Ireland and England.

Impact of universal tuberculosis vaccination cessation on the epidemiology of paediatric tuberculosis cases in Ireland from 2011 to 2021

BackgroundUniversal Bacillus Calmette-Guérin vaccine (BCG) vaccination was discontinued in Ireland in April 2015 due to a lack of vaccine supply. We analysed notifications from the Irish National Tuberculosis Surveillance System from 2011 to 2021 to examine the direct impact of vaccination cessation on active tuberculosis cases among young children. MethodsWe did a cross-sectional study to compare tuberculosis age-specific incidence rates (ASIRs) among children aged 0–4 years born during a period of BCG vaccination (January 2007 to March 2015) with those born after BCG vaccination cessation (April 2015 to December 2021). We calculated ASIRs using census population denominators and did a temporal trend analysis of ASIRs using negative binomial regression. Data were anonymised before use in this study so no ethical approval or patient consent was required. FindingsNo significant temporal trend was detected in ASIR by notification year during 2011–21 (incidence rate ratio [IRR] 0·98; 95% CI 0·85–1·1). However, the temporal trend for cases born during universal vaccination was significantly declining (IRR 0·72 [95% CI 0·56–0·93]) whereas cases born after vaccination ceased had a non-significant increase (1·4 [0·99–1·96]). No meningitis cases were reported during universal vaccination compared with one (5%) of 19 cases reported after vaccination ceased. The proportion of cases reported as vaccinated decreased from 58% (11 of 19) during universal vaccination to 21% (four of 19) after vaccination ceased. Six (32%) of 19 cases born after vaccination ceased would have been eligible to receive BCG under a selective programme. No significant difference in the proportion of cases associated with outbreaks was detected across the two periods. Regional ASIRs increased in two eastern regions after vaccination ceased, whereas they declined in the remaining six regions. InterpretationUniversal BCG cessation has not directly impacted on new tuberculosis cases among children aged 0–4 years. However, timely surveillance is needed to monitor the impact of vaccination cessation. A selective BCG programme might have prevented cases diagnosed in certain risk groups. FundingHealth Service Executive, Ireland.

Pancreatic Cancer in Iran - Result of the Iranian National Cancer Registry Program.

In this article, we aimed to report the incidence rate of PC at the national and regional levels of Iran from 2014 to 2017 for the first time based on the IARC protocols. The data was recruited from the Iranian national program of cancer registry, a national cancer registry program reformed in 2014 after including cancer diagnosis based on clinical judgment and death certificates. This registry includes data from the pathology laboratories and clinical sectors included with death certificates from 60 medical universities in 31 provinces of Iran. Age-standardized incidence rates were calculated at the national and regional levels. From 2014 to 2017, 8851 new cases (males=60.46%) were diagnosed, with a mean age of 66.2 ± 19.6. Forty-one percent of the patients were diagnosed by microscopic verification, and 51% were diagnosed based on clinical judgment without microscopic verification and death certificates. The age-standardized incidence rate was measured as 3.45 per 100,000 in 2017, with the highest rates in individuals older than 85 (30.91 per 100,000), and the provinces of Qom, Tehran, and Isfahan recorded the highest incidence rates with 3.87, 3.85, and 3.66 per 100,000 respectively. PC incidence in Iran is still lower than in western countries. However, the incidence from 2014 to 2017 is higher than previous national and regional reports and should not be overlooked. Improvement in the national cancer registry program and documentation may be reasons for this difference.

The Iranian National Blood Pressure Measurement Campaign: What Do the Process and Output Evaluation say?

The Iranian National Blood Pressure Measurement Campaign (INBPMC) was conducted all over the country to raise awareness in different groups of people regarding the importance of blood pressure and persuading them to manage their blood pressure. The present research aimed at assessing the process and output of this campaign. For process evaluation, 31 universities/faculties were selected. Experts from the Ministry of Health and Medical Education assessed the documentation of the campaign implementation using the designed checklist. The output was assessed by including 8274 people and through a telephone survey using the designed instructions. The response rate of the telephone interviews was 82.74% (8274 people). It was found that 79% of the selected groups were aware of the INBPMC. Among them, 64% remembered the messages, 99% of the participants who remembered the messages agreed with those messages, and 89% of the participants who agree with the messages went for a measurement of their blood pressure. In the telephone interviews, 30% of the participants stated that they were diagnosed with hypertension, 97% of these participants received the required consultations for subsequent care, and 86% of them went to the health service centers to receive care. The process evaluation of the INBPMC indicated that the universities of medical sciences obtained 97% of the score of the checklist. The INBPMC was successful and accomplished its objectives.

Improving Acute Orthopaedic Admission Note Documentation Standards at a Tertiary Centre Through Proforma Introduction: A Quality Improvement Initiative.

Background Clear, accurate written documentation plays an important role in the handover of medical information, helping to improve care efficiency and avoid medical errors. Both HSE and the Irish National Orthopaedic Models of Care guidelines include key documentation standards for admission notes. Standardised medical admission proforma can help improve documentation standards, but their usage across Irish orthopaedic units is limited to three centres. We evaluated whether an admission proforma improved the documentation standards of acute orthopaedic trauma admission notes within our regional trauma unit. Methods Cycle 1 consisted of a retrospective review of 50 consecutive acute orthopaedic trauma admissions. Exclusion criteria included planned admissions, age <16 years, spinal or pelvic trauma, and 'hip' fractures for whom an existing proforma was in use. Cycle 2 consisted of a prospective review of 50 consecutive acute trauma admissions using the new proforma. Each cycle was scored against a pre-determined checklist incorporating Irish Health Service Executive and Orthopaedic Models of Care documentation standards, with results collated and statistical analysis then performed using Fisher's exact test. Findings Significant improvements in admission note compliance with national documentation were observed. This encompassed multiple domains including clinical identification, e.g., consultant identification (78% to 100% p=0.0005), clinical history, time of injury (72% to 100% p=0.0001), medical history, smoking status (86% to 100% p=0.0001), and patient assessment, vital signs (28% to 70% p=0.0001). Conclusion Improvements in admission note compliance with national documentation standards followed the introduction of a standardised proforma. These findings may encourage the introduction of similar proforma in other units, with potential benefits in patient care.

157 STAFF MEMBERS’ PERSPECTIVES OF HOW TO INCREASE DEMENTIA-FRIENDLINESS IN AN ACUTE IRISH HOSPITAL SETTING

Abstract Background Key principles from The Irish National Dementia Strategy promote accessibility and ease of understanding for those with dementia. Those who provide services and care to people with dementia have a key role to play in identifying gaps in existing service provision. Reduced compliance with National dementia guidelines and overall reduced dementia-friendliness were noted in a hospital-wide audit. It is imperative to seek opinions from those providing direct care to dementia patients on how we can improve dementia-friendliness at a service level. Methods Random selection was used to distribute staff questionnaires. An open-ended question was used to gather their perceptions on how this hospital can improve its dementia-friendliness at a service level. Results Forty-seven suggestions were collated across the hospital. Thematic analysis identified 11 different themes; increased staffing, environmental changes, the introduction of dedicated day rooms, increased signage, and introduction of activity boxes were the most common suggestions (68% of answers). Other suggestions included use of sensory items, increased staff education, orientation boxes and improved communication with patients. Conclusion Healthcare workers have an important role in driving and implementing changes in healthcare settings. Collating staff members’ perceptions of improving dementia-friendliness is invaluable given their role in providing services to people with dementia. Implementation of the above-mentioned changes must be explored in order to increase dementia-friendliness, to maintain high-quality service provision, and to ensure compliance with National standards.

119 ENHANCING THE QUALITY OF STROKE CARE IN IRELAND - DEVELOPMENT OF AN IRISH NATIONAL STROKE AUDIT

Abstract Background Population ageing, stroke treatment advances, changing models of care, and between-hospital heterogeneity in stroke outcomes demonstrate the necessity of continual audit of stroke care to support quality improvement at local and national levels, and to enhance patient recovery and wellbeing. This project aims to identify the core minimum datasets for acute and non-acute stroke care, and Patient-Reported Outcome Measures (PROMs), for integration in to the newly-developed Irish National Audit of Stroke (INAS), in addition to identifying resourcing needs and implementation procedures. Methods In Phase 1, a minimum dataset for acute stroke care was identified based on a scoping review of international practice and available guidelines. Phase 2 (ongoing) involves identifying datasets for non-acute rehabilitative and follow-up care based on a scoping review of international practice, iterative cycles of qualitative stakeholder engagement, and systematic review of PROMs. In Phase 3, a review of resourcing and data collection procedures used in stroke audits internationally will be used to produce an implementation strategy for data collection, contextualised to the Irish healthcare system. Results Twenty-one eligible international stroke registries were identified from the scoping review. Within Phase 1, core clinical and thrombectomy items in the Irish registry were benchmarked against internationally-collected items to identify common items and to generate an inventory of items that other registries collect that Ireland does not. Based on consensus agreement on the most frequently-occurring international items, as reviewed by key stakeholders, a core minimum dataset for audit of acute stroke care was delivered. Conclusion These minimum datasets shall act as the “gold standard” for evaluating stroke care in Ireland, by not only incorporating structure, process, and care quality outcome indicators, but also PROMs. The resultant datasets may inform policy and quality improvement initiatives, and shape health service delivery across the trajectory of stroke care, from hyper-acute care, to rehabilitation, and return to the community.

210 AUDIT OF AN AUDIT: UNDERSTANDING THE INTERPRETATION AND REPORTING OF KEY PERFORMANCE VARIABLES OF THE IRISH NATIONAL AUDIT OF STROKE

Abstract Background The Irish National Audit of Stroke (INAS) coordinates the collection and analysis of key performance variables which can be interpreted as proxies of care quality in stroke. Time metrics such as “Time-to-CT” and “Time-to-Thrombolysis” reflect the organisation of in-hospital stroke care pathways, with shorter times reflecting better care coordination and quality. While the INAS data dictionary defines each variable, differing interpretations of a definition can impact on the exact data point collected. We wished to understand the interpretation and reporting of key performance variables at all clinical sites reporting to INAS. Methods An online survey in three parts was designed and distributed to 34 INAS audit co-ordinators along with the INAS dictionary definition of each data variable. Audit co-ordinators were asked to select the exact data point they collect for that variable from a dropdown list, with space also allotted for free-text entry of any challenges they may encounter for that variable. Results Responses were received from 11/34 audit co-ordinators, representing 10/24 hospitals. Variability was seen in the specific times selected for data points including hospital arrival time, team time, and brain imaging time. This variability was seen across sites and regions. Data points with less scope for interpretation such as thrombolysis or thrombolysis time showed less variability. Conclusion By understanding the scope of responses given to any data point definition and the challenges that may exist for audit co-ordinators, it is hoped to achieve a consensus approach to defining variables for a robust core data set. Future data definitions may be refined to assist in the collection of exact data points that are accurate, consistent and reproducible across hospital sites. In so doing, all key elements of a patient’s pathway can be captured accurately and compared with best practice guidelines with a view to optimising future care provision and service organisation.

238 THE IMPACT OF COVID-19 ON ACUTE STROKE TREATMENT

Abstract Background Acute stroke management is time critical. Treatment options are dictated by time of symptom onset. 2019 Irish National Audit of Stroke (INAS) showed less than 50% stroke cases arrived in hospital within three hours of symptoms and national average rate of thrombolysis was 11%. The median time Door-To-Needle time (DTN) was 56 minutes, and to thrombectomy 93 and 240 minutes ‘direct to mothership’ / ‘drip and ship’ transfer to thrombectomy centre respectively. Methods Retrospective review of all stroke FAST calls on our acute stroke database in TUH from July 2019 -2021. Data was analysed pre (up until March 2020) and during COVID-19 pandemic. Results FAST protocol imaging was obtained in 78% of cases (464/594). Documented time of symptom onset to CT was 1:50:00 pre-Covid-19 and 2:26:00 during Covid (p&amp;lt;0.001). ED registration to CT was 28mins pre-Covid-19 and 30mins during Covid (p&amp;lt;0.001). The median DTN time was 41mins pre-Covid-19 (n=21), and 54mins during Covid-19 (n=37). Conclusion In contrast to INAS COVID-19 report, median DTN times and thrombolysis rates dis-improved at TUH. Trends observed probably reflect multiple factors; patient hesitation to attend ED; patient isolation from family; busier ambulance service; Infection control protocols. We observed small but significant change in door-to-CT time but a more significant increase in DTN. This may reflect time taken donning Personal Protective Equipment (PPE) or general increased ED activity. Understanding the impact of COVID-19 on acute stroke treatment metrics in addition to differences at sites may identify targets for national quality improvement in service delivery.

361 EXPLORING THE EXPERIENCES OF HEALTHCARE PROFESSIONALS (HCPS) WORKING IN ACUTE STROKE DURING THE COVID-19 PANDEMIC: A QUALITATIVE STUDY

Abstract Background The COVID-19 pandemic had a significant impact on the delivery of stroke care internationally. The INAS (Irish National Audit for Stroke) report 2020, found that there was no significant disruption to stroke services as a result of the COVID-19 pandemic. Little is known about the experiences of Health-Care Professionals (HCPs) who were working in stroke care during the COVID-19 pandemic. This study explored the experiences of HCPs working in acute stroke care in an Irish hospital group during the COVID-19 pandemic. Methods A qualitative descriptive study was conducted. Using a combination of purposive and snowball sampling, 16 semi-structured interviews of healthcare professionals from six specialities (Medicine, Nursing, Physiotherapy, Occupational therapy, Speech and Language Therapy and Medical Social Work) in two model three hospitals and one model four hospital were conducted. Interviews were virtual. Analysis was completed using the Braun and Clarke six-step method. This research was approved by the Royal College of Surgeons Research Ethics committee and permission was secured from the Stroke Clinical lead at each site to conduct interviews. Results Two main themes emerged: (i) Disruption of the end-to-end acute stroke pathway and (ii) Opportunities of the pandemic to develop a new model of care. Theme (i) suggests challenges were experienced in emergency care, access to Stroke Units (SU) beds and multidisciplinary teams (MDT). In theme (ii) participants described opportunities in telemedicine, the development of new rehabilitation and existing Early Supported Discharge (ESD) pathways. Conclusion This study highlights the lived experience of HCPs, the disruption to the stroke pathway and the opportunities as a result of the pandemic. It demonstrates the need for further exploration of, telemedicine, alternative rehabilitation pathways in stroke care and the need for a wider stroke education programme for HCPs working outside stroke. Finally, this study highlights the unwavering resilience and empathy of HCPs working in Stroke.