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Objectives: A national electronic health record is being procured for Health Service Executive hospitals in Ireland. A number of hospitals have implemented an electronic document management system. This study aimed to investigate the efficiency and safety of the electronic document management system in our centre., Methods: A retrospective audit was performed of patients operated on at Galway University Hospital. The availability and location of patients' admission data on the electronic document management system were recorded. These data were analysed using Microsoft Excel software, version 16.45., Results: The records of 100 patients were analysed. The main findings were: 5 per cent of operation notes were missing, 80 per cent were in the incorrect section, while 15 per cent were in the correct 'procedure' section on the electronic document management system., Conclusion: This study shows there is potential for error with 'paper-light' solutions, whereby delayed scanning, misfiling of scanned records and missing records may lead to significant delays in treatment and potential patient safety issues.

Objective: The association between higher registered nurses (RN) staffing (educational level and number) and better patient and nurse outcomes is well-documented. This discussion paper aims to provide an overview of safe staffing policies in various high-income countries to identify reform trends in response to recurring nurse workforce challenges., Methods: Based on a scan of the literature five cases were selected: England (UK), Ireland, California (USA), Victoria and Queensland (Australia). Information was gathered via a review of the grey and peer-reviewed literature. Country experts were consulted for additional information and to review country reports., Results: The focus of safe staffing policies varies: increasing transparency about staffing decisions (England), matching actual and required staffing levels based on patient acuity measurement (Ireland), mandated patient-to-nurse ratios at the level of the nurse (California) or the ward (Victoria, Queensland). Calibration of the number of patients by the number of nurses varies across cases. Nevertheless, positive effects on the nursing workforce (increased bedside staffing) and staff well-being (increased job satisfaction) have been consistently documented. The impact on patient outcomes is promising but less well evidenced., Conclusion: Countries will have to set safe staffing policies to tackle challenges such as the ageing population and workforce shortages. Various approaches may prove effective, but need to be accompanied by a comprehensive policy that enhances bedside nurse staffing in an evidence-based, objective and transparent way., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues - missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care left undone - suggesting that nurses, in certain contexts, are actively engaged in rationing care - in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care - despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource.

Aims: To review, discuss and compare nursing and midwifery regulatory and professional bodies' scope of practice and associated decision-making frameworks., Background: Scope of practice in professional nursing and midwifery is an evolving process which needs to be responsive to clinical, service, societal, demographic and fiscal changes. Codes and frameworks offer a system of rules and principles by which the nursing and midwifery professions are expected to regulate members and demonstrate responsibility to society., Design: Discussion paper., Data Sources: Twelve scope of practice and associated decision-making frameworks (January 2000-March 2014)., Implications for Nursing: Two main approaches to the regulation of the scope of practice and associated decision-making frameworks exist internationally. The first approach is policy and regulation driven and behaviour oriented. The second approach is based on notions of autonomous decision-making, professionalism and accountability. The two approaches are not mutually exclusive, but have similar elements with a different emphasis. Both approaches lack explicit recognition of the aesthetic aspects of care and patient choice, which is a fundamental principle of evidence-based practice., Conclusion: Nursing organizations, regulatory authorities and nurses should recognize that scope of practice and the associated responsibility for decision-making provides a very public statement about the status of nursing in a given jurisdiction., (© 2015 John Wiley & Sons Ltd.)

Introduction: Hypospadias, the most common congenital malformation of the penis, is characterized by an abnormal ventral opening of the urethral meatus, abnormal ventral curvature of the penis, and an abnormal distribution of the foreskin around the glans, with a ventrally-deficient hooded foreskin, and has been described in modern peer-reviewed literature since Noble's description in 1853. A dramatic increase in the literature on hypospadiology has focused on two main topics: The aetiology of the condition including molecular mechanisms and environmental influences, as well as surgical techniques to repair the defect, however there have been a number of facets of research stemming from this poorly understood condition in a developing subspecialty (Figure). The majority of these publications focus on the evolution of surgical technique and management. Urethral reconstruction should offer the ability to stand to urinate and combine a satisfactory cosmetic result. The tubularized incised plate repair, popularized by Snodgrass et al., and the Mathieu repair, have been the mainstay for distal hypospadias, however, there have still been a large number of well-described techniques, with no consensus as to the ideal method of repair, some of which is attributed to non-uniform standards of reporting outcomes. There is also no standard objective means to qualitatively assess the importance of each of these contributions., Objective: The objective of this study was to determine the top 150 peer-reviewed articles in the field of hypospadiology by way of citation analysis as a means to determine the importance/relevance of each contribution throughout 8 decades of research., Study Design: A cited reference search was carried out for indexed citations within Web of Science™ Core Collection. The top 150 indexed cited articles containing the topic "hypospadias" in specific subject categories were compiled using a component of Science Citation Index command. References were then evaluated, and analysed across a number of indices, and over time., Results: The mean number of citations was 76 for each article. The top 150 articles were published across 21 countries, with the majority originating from the USA. The lead research institution was the University of Texas (Southwestern) Medical Center. In total, the top 3 centers represented 33 publications within the top 150 citations. The most commonly utilized journal was the Journal of Urology. The most cited author was W.T. Snodgrass. 39% papers in the top 150 cited articles were published prior to 1990. Three out of the five papers cited in the 1940s dealt with operative technique to repair hypospadias. The period 2000-2010 in contrast, demonstrated a significant inverse correlation between molecular biology citations, and those for operative techniques, with the incidence of the latter dropping to 6% of all cited papers., Discussion: This is the first study of its kind to analyse the most influential articles in hypospadiology, and their characteristics assessed for authorship, content and impact factor. Furthermore it allows data analysis by topic and between time points. This not only de-clutters the wealth of accumulated data on this subject, but also provides an important adjunct to education and training. As with this study, other citation analytical studies in urology found a significant preponderance in cited studies originating from the USA. The prevalence of the US in cited papers doesn't reflect any inherent bias, just a greater number of publications., Conclusion: Although there are inherent potential elements of bias in citation analysis, this study demonstrates that citation analysis in a complicated topic can provide a high-throughput, uncomplicated method of quickly deciphering important contributions of authors and institutions to the field of hypospadias research., (Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: Medical education policy in Ireland has enabled an increase in undergraduate and postgraduate education activity in general practice. Internationally, 'vertical integration in general practice education' is suggested as a key strategy to support the implementation of this policy development., Aims: To review the emerging literature on vertical integration in GP education, specifically to define the concept of 'vertical integration' with regard to education in general practice and to describe its benefits and challenges., Methods: We searched 'Pubmed', 'Academic Search Complete', 'Google', and 'MEDLINE' databases using multiple terms related to 'vertical integration' and 'general practice education' for relevant articles published since 2001. Discussion papers, reports, policy documents and position statements were identified from reference lists and retrieved through internet searches., Results: The key components of 'vertical integration' in GP education include continuous educational pathway, all stages in GP education, supporting the continuing educational/professional development needs of learners at each stage and effective curriculum planning and delivery. Many benefits (for GPs, learners and the community) and many challenges (for GPs/practices, learners and GPs in training) have been described. Characteristics of successful implementation include role sharing and collaborative organisational structures., Conclusions: Recent developments in medical education in Ireland, such as the increase in medical school clinical placements in general practice and postgraduate GP training and the introduction of new competence assurance requirements offer an important opportunity to further inform how vertical integration can support increased educational activity in general practice. Describing this model, recognising its benefits and challenges and supporting its implementation in practice are priorities for medical education in Ireland.

Background: Mental and substance use disorders are a leading cause of morbidity among young people. Policy and clinical services in Ireland are endeavouring to address these twin issues., Aims: To review the emerging literature on the role of general practice in addressing youth mental health and to discuss the implications of this literature for further research, education and service delivery., Methods: We conducted a review of 'PubMed' and a web search of relevant national/international primary/mental healthcare agencies and professional bodies., Results: Although general practice has an important role in addressing youth mental health, there are challenges in how young people seek help. Specifically, young people do not engage with healthcare agencies and many factors which act as barriers and enablers in this regard have been identified. The detection and treatment of mental and substance use disorders by GPs can be improved and implementing interventions to improve screening and early intervention are likely to be valuable., Conclusions: General practice is a central agency in addressing youth mental health and complex multifaceted interventions (education, clinical guidelines, and promoting awareness) are likely to support its role. Further research exploring this issue is a priority.

Background: Medical complications of substance use are a considerable cause of morbidity and the role of the physician in the care of such problems has consistently been demonstrated. Appropriate knowledge and skills are necessary to carry out this role., Aims: To review the literature on training undergraduate medical students in identifying and managing substance misuse and to discuss the implications of this literature for Irish medical education., Methods: A search of the literature was performed using keywords; "substance-related disorders", "undergraduate" and "curriculum". All abstracts were reviewed and the full text of relevant abstracts was studied and references reviewed for further articles., Results: Despite an increase in prevalence of the problem of drug and alcohol use in Ireland and the UK, this has not been reflected in undergraduate medical curricula. In the UK, minimal time is devoted to formal teaching of medical undergraduates in the area of substance misuse and many doctors do not have the appropriate knowledge, skills, attitudes and confidence to treat patients with such problems. In Ireland, no data has reported formal undergraduate teaching hours in the area of drug and alcohol misuse. Internationally, substance abuse curricula have been developed and implemented in medical schools in the United States and Australia., Conclusion: While substance misuse is increasing in prevalence, this is not reflected in the composition of medical curricula, especially in Ireland. International best practice whereby undergraduate curricula that adequately address substance misuse and related issues are systematically developed and implemented, is recommended for adoption by Irish medical schools.

Background: In a study to establish the interrater reliability of the Irish Nursing Minimum Data Set (I-NMDS) for mental health difficulties relating to the choice of reliability test statistic were encountered., Objectives: The objective of this paper is to highlight the difficulties associated with testing interrater reliability for an ordinal scale using a relatively homogenous sample and the recommended kw statistic., Method: One pair of mental health nurses completed the I-NMDS for mental health for a total of 30 clients attending a mental health day centre over a two-week period. Data was analysed using the kw and percentage agreement statistics., Results: A total of 34 of the 38 I-NMDS for mental health variables with lower than acceptable levels of kw reliability scores achieved acceptable levels of reliability according to their percentage agreement scores., Conclusion: The study findings implied that, due to the homogeneity of the sample, low variability within the data resulted in the 'base rate problem' associated with the use of kw statistic. Conclusions point to the interpretation of kw in tandem with percentage agreement scores. Suggestions that kw scores were low due to chance agreement and that one should strive to use a study sample with known variability are queried.

Aim: In light of debates arising from recent developments in Irish nursing education, this paper analyses tensions in the positioning of nursing in academia in terms of notions of the sacred and profane, and the symbolic boundaries between them, and discusses the implications of this analysis for nurse academics' identities., Background: The entry of nursing education to the higher education sector has occurred against a discursive backcloth of opposition which constructs nursing work as either sacred, and under threat from the academy, or profane, and unworthy of a place in it., Method: Conceptual resources derived from the work of Basil Bernstein are deployed to analyse the forces driving the loom weaving this discursive backcloth. These forces are conceptualised as deriving from deep-seated fears and anxieties sparked by changes in the strength of symbolically important boundaries between constructions of the sacred and profane in the fields of nursing and higher education. These constructions are explicated., Findings: Bernstein regards secure academic identities as inhering in strong boundaries between disciplines and between the fields of education and work. The transfer of nursing education from health to the higher education sector and nurse academics' attempts to articulate a nursing-discipline specific knowledge base can be understood in these terms. This analysis challenges nurse academics who promote disciplinary eclecticism and those who legitimate academic nursing principally in terms of the acquisition of generic and transferable lifelong learning skills., Conclusions: To counter a discourse that constructs them as a profane presence in higher education, some nurse academics have articulated a discourse of legitimation that constructs (academic) nursing as a sacred endeavour. Whether this can provide the grounds of their legitimacy and the basis of their careers as distinctively nursing academics is unclear at this stage of nursing's development as an academic discipline.

The production of newspaper corresponds to 37 kg per person per annum in Ireland. Newspaper becomes a waste product in a short period of time; only 13% of domestic waste paper is recycled (data on newspaper is not available). Four scenarios, which generate energy from newspaper, are analysed. These scenarios may be summarised as follows: lignocellulosic biomass conversion to ethanol (transport fuel); co-digestion with the organic fraction of municipal solid waste and production of CH4-enriched biogas (transport fuel); co-firing with the residue of municipal solid waste in an incinerator; and gasification of newspaper as a sole fuel. Two of the scenarios involve transport fuel production; two involve the production of electricity and heat. Two of the scenarios involve newspaper as the sole ingredient; two involve co- utilisation of newspaper with another waste stream. Assuming no economic market for heat, then only the transport scenarios have the potential to be economic; indeed the biogas scenario is shown to be extremely competitive generating a potential profit of euro 227/t newspaper. A greenhouse-gas analysis indicates that the biogas scenario generated the best net greenhouse-gas savings. However when a market for heat is available, gasification was shown to be most advantageous.

Critical care education is an important part of the professional development of a competent critical care nurse. Interdependence between physiological and psychosocial theories and concepts is a key consideration in the development of critical care educational programs. This multidisciplinary educational framework fosters a deeper understanding of factors contributing to ill health. Establishing a strategic framework where research, education, clinical excellence, and quality assurance are interlinked is central to enhancing the efficacy of patient care outcomes.

Open research practices seek to enhance the transparency and reproducibility of research. While there is evidence of increased uptake in these practices, such as study preregistration and open data, facilitated by new infrastructure and policies, little research has assessed general uptake of such practices across psychology university researchers. The current study estimates psychologists' level of engagement in open research practices across universities in the United Kingdom and Ireland, while also assessing possible explanatory factors that may impact their engagement. Data were collected from 602 psychology researchers in the United Kingdom and Ireland on the extent to which they have implemented various practices (e.g., use of preprints, preregistration, open data, open materials). Here we present the summarized descriptive results, as well as considering differences between various categories of researcher (e.g., career stage, subdiscipline, methodology), and examining the relationship between researcher's practices and their self-reported capability, opportunity, and motivation (COM-B) to engage in open research practices. Results show that while there is considerable variability in engagement of open research practices, differences across career stage and subdiscipline of psychology are small by comparison. We observed consistent differences according to respondent's research methodology and based on the presence of institutional support for open research. COM-B dimensions were collectively significant predictors of engagement in open research, with automatic motivation emerging as a consistently strong predictor. We discuss these findings, outline some of the challenges experienced in this study, and offer suggestions and recommendations for future research. Estimating the prevalence of responsible research practices is important to assess sustained behaviour change in research reform, tailor educational training initiatives, and to understand potential factors that might impact engagement., (© 2024 The Authors. British Journal of Psychology published by John Wiley & Sons Ltd on behalf of The British Psychological Society.)

Introduction: Advancements in evaluating the impact of participatory health research (PHR) have been made through comprehensive models like the community-based participatory research (CBPR) conceptual model, which provides a useful framework for exploring how context and partnership processes can influence health research design and interventions. However, challenges in operationalising aspects of the model limit our understanding and evaluation of the PHR process. Trust is frequently identified as an important component of the CBPR model, which supports the development of key partnership outcomes, such as partnership synergy. However, trust continues to be limited to a binary view (as present or absent), which is problematic given its inherently dynamic and temporal nature., Study Aim: The aim of this qualitative study is to understand the evolution of trust in the national public and patient involvement (PPI) network in Ireland., Setting and Participants: Participants from the PPI network (n = 15/21) completed a semistructured interview discussing the evolution of trust by reviewing four social network maps derived from a previous longitudinal study., Analysis: Following Braun and Clarke, we used reflexive thematic analysis, to iteratively develop, analyse and interpret our mediated reflection of the data., Results: Participants described the evolution of trust as a function of three contextual factors: (1) the set-up and organisation of the network, (2) how people work together and (3) reflection on the process and outcomes. Their descriptions across these themes seemed to vary depending on partnership type with National Partners and Site Leads having more opportunities to demonstrate trust (e.g., via leadership roles or more resources), compared to Local. Thus, visibility and the opportunity to be visible, depending on the set-up and organisation of the network and how people work together, seemingly play an important role in the evolution of trust over time. Based on these findings, we provide important questions for reflection across themes that could be considered for future PHR partnerships., Discussion: Given that the opportunity and visibility to build and maintain trust over time may not be equally available to all partners, it is important to find ways to invest in and commit to equitable relationships as the key to the success (i.e., longevity) of partnerships. We reflect on/offer important implications for those engaging in PHR partnerships and those who fund such research., Patient or Public Contribution: A Research Advisory Group comprising four research partners (representing academic, service and community organisations) from the PPI Ignite Network provided input and approval for the research objectives of this study as well as previously published work informing this study. Informal consultation occurred with members of this group to discuss findings from this study, assisting with the way findings are presented and described, to be accessible for diverse audiences. Two Research Advisory Group members were involved in the interpretation of the results, and one is a co-author of this manuscript (Zoe Hughes)., (© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

A study comparing recently available 100 x 3 mm id, 200 x 3 mm id monolithic reversed-phase columns with a 50 x 2.1 mm id, 1.8 microm particle packed reversed-phase columns was carried out to determine the most efficient approach (using traditional van Deemter analysis and a modern kinetic plot approach) for the rapid screening of samples for 16 illicit drugs and associated metabolites. A plot of column backpressure versus plate number (N) showed a significant advantage of using the monolithic phases, with the 20 cm monolithic column exhibiting a maximum 15,000 plates at a column backpressure of approximately 70 bar, compared to approximately 7000 plates at 150 bar for the 5 cm 1.8 microm particle packed column. Optimum linear velocities were found to be 0.40 mm s(-1), 0.52 mm s(-1) and 0.98 mm s(-1) for the three above columns, respectively. The 20 cm monolithic column was subsequently applied to the separation and determination of illicit drug contamination on Irish euro banknotes, using methanol extraction followed by LC-MS/MS. Method performance data showed that the new LC-MS/MS method was significantly more sensitive than previous GC-MS/MS based methods for this application, with detection limits in the pg note(-1) region, based upon a 20 microL standard injection. All of the notes examined tested positive for trace quantities of cocaine, with benzoylecgonine detected on 12 of the 45 notes sampled. Traces of heroin were also detected on three of the 45 notes.

In the European Union (EU), many assumptions are employed to calculate the intake of migrating chemicals from food packaging. However, very little is known about the actual intake of packaged food, the type of this food and the type of packaging used for this food. The objective of the current study was to examine intakes of packaged food in children aged 5-12 years to provide information on the types of food that are packaged and the type of packaging used. To do this, a food-consumption database, which also recorded information on packaging, was merged with a packaging database, which provided information on the contact layers of packaging. Foods were classified into EU Food categories according to European Council Directive EC 85/575/EEC (European Council 1985), which determined their food type (i.e. aqueous, acidic, alcoholic and fatty). The mean daily intake of all packaged food was 1195 g day-1 with an upper intake of 1959 g day-1 (97.5th percentile); the intake of food packaged in plastic was 993 g day-1 with an upper percentile of 1692 g day-1 (97.5th percentile). The mean daily intake of fat from all packaged food was 62 g day-1, with an upper intake of 100 g day-1 (97.5th percentile). When this was investigated further, it was found that the mean fat intake from packaged 'fatty' foods only was 32 g day-1, with an upper intake of 61 g day-1 (97.5th percentile). The food that contributed most to fat intake was milk. As many food chemical intake assessments are moving towards probabilistic methods, probabilities of a food being packaged and the probability of the type of packaging used were determined. The probability of food being packaged was 0.88. Some foods not 100% packaged included fruit, vegetables, liquid beverages non-alcoholic (includes water) and bread. Probabilities were also derived for the packaging types used for food. It can be concluded that not all the individual assumptions used in the EU exposure assessment are conservative, but in combination they are conservative.

Scholars have extensively used the job demands-resources model to explain the dynamics underlying work engagement and proposed several versions of the model. However, in theoretical terms, nonwork elements have not been incorporated into the model. This study investigated the roles of home demands and resources in the model by testing the boost/buffer hypotheses for work engagement from the perspective of the work-home interface. We demonstrated that (1) the demands of a domain boost the positive impact of resources drawn from another domain on work engagement, (2) the resources of a domain buffer the negative impact of demands derived from another domain on work engagement; and (3) the buffering and boosting effects of home demands and resources impact work engagement. We conducted a diary study on a group of coffee shop employees in Ireland. The results partially supported the proposed hypotheses but nevertheless indicated support for the cross-domain boost/buffer hypotheses with regard to work engagement. The proposed model may serve as a theoretical foundation for research on issues related to the impact of work and nonwork domains on work engagement., (© 2024 The Authors. Stress and Health published by John Wiley & Sons Ltd.)

National and international hypertension guidelines recommend that adults with young-onset hypertension (aged <40 years at diagnosis) are reviewed by a hypertension specialist to exclude secondary causes of hypertension and optimise therapeutic regimens. A recent survey among UK secondary care hypertension specialist physicians highlighted variations in the investigation of such patients. In this position statement, the British and Irish Hypertension Society seek to provide clinicians with a practical approach to the investigation and management of adults with young-onset hypertension. We aim to ensure that individuals receive consistent and high-quality care across the UK and Ireland, to highlight gaps in the current evidence, and to identify important future research questions., (© 2024. The Author(s).)

Background: There are few prospective studies of factors that mediate the association between exposure to adverse childhood experiences (ACEs) and obesity in adolescence. Our aim was to address this limitation., Methods: We used prospective data from the Growing up in Ireland cohort study, with measurements at 9, 13, and 18 years old. The exposures were 14 adverse experiences before age 9. The main outcome was body mass index (BMI) at 18 years. Mediators were daily activity, diet quality, self-image and behavioural difficulties at 13 years., Results: Among the 4561 adolescents in the final cohort, 77.2% experienced any adversity, 50.5% were female and 26.7% were overweight/obese at 18 years. BMI Z was higher at ages 9 (0.54 vs 0.43, p < 0.05, 95% CI of difference: -0.22, -0.01) and 13 years (0.50 vs 0.35, p < 0.05, 95% CI of difference: -0.25, -0.06), in those exposed to an ACE, compared to those unexposed. Structural equation models revealed that behavioural difficulties (β = 0.01; 95% CI: 0.007-0.018, p < 0.001) and self-concept (β = 0.0027; 95% CI: 0.0004-0.0050, p = 0.026) indirectly mediate the association between exposure to ACEs and BMI at 18 years., Conclusions: The association between ACEs and BMI in adolescence is mediated by behavioural difficulties and self-concept., Impact: In a previous study, we found modest associations between exposure to a range of adverse childhood experiences and weight gain at 13 years of age. The strength of the association between adverse childhood experiences and weight gain was lower at 18 years of age compared to the association observed at 13 years and was no longer significant after controlling for confounding and including possible mediators. The association between adverse childhood experiences and BMI in adolescence is indirectly mediated by behavioural difficulties and self-concept., (© 2024. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Aim: To explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland., Background: Clinical decision-making in an emergency department environment is a complex process often occurring in times of crisis. It is an important aspect contributing to the quality of care. However, empirical research is limited regarding the decision-making process in different nursing roles., Methods: In accordance with the consolidated criteria for reporting qualitative research, a qualitative and observational study was conducted to explore clinical decision-making by comparing the processes used by three groups of nurses in the emergency departments of three hospitals: in Norway, Finland and Ireland. Six Registered Nurses, six Nurse Specialists and six Nurse Practitioners were observed. A total of 40 hours of observation was made at each setting according to a structured observation guideline, followed by clarifying questions. The data material was analysed by means of a qualitative manifest and latent content analysis., Results: Three themes arose: acting in accordance with routines, previous experience and intuition; considering patient experience; and facilitating new alternatives based on critical thinking. The Registered Nurses mainly used the first approach, the Nurse Specialists used the first and the second approaches, and the Nurse Practitioners used all three approaches., Conclusions: The results highlight the differences in decision-making processes between these groups. Nurse Practitioners were the only group that facilitated and evaluated new alternatives using their clinical autonomy, such as stepping up and making independent and collaborative decision-making., Implication: The results can be used in countries developing advanced practice nursing education and defining their scope of practice to inform stakeholders., (© 2024 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

Empirical research into the relationship between economic well-being and child outcomes has been limited by its cross-sectional nature, or its narrow focus on predominantly financial aspects of economic well-being. This article attempts to overcome these shortcomings by using data from the Growing Up in Ireland Cohort98 (age: 9-17; N = 5,748; female: 51.4%) and Cohort08 studies (age: 3-9 years; N = 7,208; female: 49.8%), which cover a period of large macroeconomic fluctuation (2007-2017). This fluctuation makes a robust fixed effects analysis feasible, allowing for economic well-being effects to be isolated by controlling for all time-invariant confounders. The article uses three different measures of economic well-being (subjective financial strain, material deprivation, income) to explore how distinct forms of economic well-being affect child behavior. The results suggest that household income is not related to behavioral difficulties, whereas subjective financial strain is predictive of externalized behavioral difficulties in adolescent boys. Material deprivation is predictive of externalized behavioral difficulties in adolescent boys and internalized behavioral difficulties in younger boys, but has no effect on girls' behavioral outcomes. The findings indicate that the relationship between economic well-being and child behavioral outcomes is complex, and requires multi-dimensional measures of economic well-being to accurately ascertain the different effects., (© 2023. The Author(s).)

Primary care mental health services need to expand to assist the increased number of people reporting mild to moderate mental health difficulties. In Ireland, the primary care mental health service has been recently enhanced through the employment of Assistant Psychologists (AP) in primary care psychology. This paper provides an early and brief evaluation of the impact of the AP-enhanced model through a tripartite approach to evaluation which utilises measures of throughput, output and stakeholder satisfaction. We use data from two sources; Health service key performance indicators, and a routinely gathered minimal dataset of client measures. Results indicate that the numbers of clients seen in the period rose by 16%, that AP-delivered treatments are beneficial for clients with mild to moderate mental health difficulties, and more than 80% of clients reported being 'totally satisfied' with the care received. The data provide early evidence that the AP model is beneficial in meeting clients' needs across a range of presentations within the service admission criteria, and that the AP-enhanced model may offer a satisfactory solution to primary care needs. However, further data collection is required, and additional stakeholder input is necessary for a complete evaluation of the assistant psychologist model in primary care., (© 2021 John Wiley & Sons Ltd.)

Background: During the COVID-19 pandemic, Ireland implemented a series of stringent public health measures, including lockdowns and suspension of non-urgent clinical services., Aims: To investigate the impact of the COVID-19 pandemic on the demand for and delivery of speech and language therapy (SLT) services in Ireland in 2020., Methods & Procedures: Two iterations of a cross-sectional, mixed-methods online survey were distributed to speech and language therapists (SLTs) and SLT students in Ireland in the spring and autumn of 2020 using a combination of purposive and snowball sampling. The spring survey yielded 407 responses (including 14 from SLT students), while 197 respondents took part in the autumn (13 students). Survey analysis focused on questions related to the impact of the COVID-19 pandemic on delivery and demand for SLT services (student responses were excluded from analysis owing to low response rate). The largest group in respect of experience were senior SLTs (58% in both surveys). The work settings most strongly represented were HSE primary care (34.4%) and disability services (26.5%) in the spring, and HSE primary care (39.1%), acute hospitals (22.8%) and disability services (20.8%) in the autumn. We used descriptive statistics, including distribution analysis, to analyse the quantitative data. Free text data were interrogated through a variant of a conventional qualitative content analysis., Outcomes & Results: In the spring, cessation of face-to-face services featured prominently (reported by 65.6% versus 14.2% in the autumn), across SLTs' work settings, except acute hospitals. Lower demand was reported by 42.5% in the spring, while in the autumn, 48.7% indicated that demand was higher. SLTs experienced large-scale redeployment (spring: 45.9%, autumn: 38.4%), with HSE primary care SLTs redeployed most (spring: 71.7%; autumn: 62.3%). The need to suddenly pivot to telehealth was a significant challenge in terms of training, technology and logistics. New ways of working emerged and gradually, telehealth became more embedded. SLTs also had to adapt to working with evolving public health measures, such as space restrictions and personal protective equipment (PPE) requirements. Across the two survey iterations, SLTs reported tensions between demands and capacity: while referrals and demand initially decreased in the spring, this led to increased backlog and longer waiting lists, ongoing and increasing pressure on clinicians and services, and negatively impacted clients and families., Conclusions & Implications: The COVID-19 pandemic had a significant negative impact on SLT services in Ireland. Going forward, the SLT profession and its services will require sustained support to mitigate long-term negative consequences, such as increased waiting lists., What This Paper Adds: What is already known on this subject The negative impact of the COVID-19 pandemic on SLT services has been examined in several countries. Ireland imposed more stringent pandemic-management measures than many other countries, and it was therefore warranted to investigate how SLT services in the country were affected. What this study adds to the existing knowledge Face-to-face SLT services effectively ceased in most non-urgent contexts in spring 2020. This coincided with large-scale redeployment of SLTs to non-SLT contexts. By autumn 2020, demand had increased again, but not all services had recommenced, and redeployment was still a factor. Although SLTs adapted to the ongoing changes imposed by the pandemic, they voiced concern about increasing backlogs and longer waiting lists, ongoing and increasing pressure on both SLTs and services, and negative impacts on clients and families. What are the actual and clinical implications of this work? The COVID-19 pandemic had a significant negative impact on SLT services in Ireland. Going forward, the SLT profession and its services will require sustained support to mitigate long-term negative consequences, such as increased waiting lists., (© 2023 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: Acute abdominal pain in paediatric patients is a common presentation to the Emergency Department (ED). The COVID-19 pandemic had a significant impact on the health care sector leading to a decline in hospital attendance., Aims: We compare the burden of paediatric abdominal pain 1 year before and after the start of the COVID-19 pandemic in an Irish ED., Methods: A retrospective cohort study was conducted in a tertiary hospital. Ethical approval was obtained. Data was collected from January 1 to June 30, 2019, and 2021. Patients' charts were accessed using Therefore ® software. Key variables were extracted and summarised in Microsoft Excel tables. Univariate and multivariate data analysis were conducted in SPSS ® software., Results: Six hundred sixty-one (2019) and 479 (2021) patient records were evaluated. There was a 28% reduction in case presentations during pandemic months. Age group, sex and attending discipline were similar for both years. Rates of imaging were significantly higher in 2021 (22.5% vs. 10.6%). Overall admission rate was higher in 2021 (37% vs. 25%, p < 0.001). Viral gastroenteritis decreased (13%) and non-specific diagnosis increased (46%) in 2021. Fewer children re-presented in 2021 (13%)., Conclusions: The COVID-19 pandemic had an impact on the presentation, investigations and admission rates of abdominal pain in the ED. Our study highlights the need for increased awareness of severe abdominal pain signs and symptoms in paediatric patients and importance for diagnostic accuracy. Improving patient flow through the ED and having clear guidelines for staff and parents can optimise clinical practice and improve patient outcomes., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Child chronic illness/ disability can present significant challenges for children, families and society that require appropriate policy responses; yet little is known about the demands placed on families resources from an economics perspective in terms of its impact on household income and the extra income required to achieve the same standard of living as families who do not have a child with a chronic illness/disability. The paper uses data from the Growing Up in Ireland National survey dataset for nine year olds. It is the first study to empirically investigate the impact of child chronic illness/disability on earnings, standard of living and the extra cost of disability together. It is also the first study to explicitly address endogeneity in the standard of living model by using a two-stage process where residuals were harvested to provide efficient estimates. The findings show that families experience significant disadvantage and economic hardship due to reduced household income and a lower standard of living due to the extra cost of disability that would require considerable income to compensate. Policy implications of these findings suggest that a tiered approach to disability support payments which encompass broader criteria for inclusion based on varying severity levels be introduced to alleviate the financial hardship and compromised economic wellbeing of families affected. In addition, more innovative policies are required to implement appropriate timely access to health and social care services and flexi parental employment, which in turn requires the provision of adequate access to high quality educational and care facilities., (© 2021. The Author(s).)

Despite private hospitals occupying an important role in the delivery of acute hospital care in Ireland, an understanding of future spending pressures on these services is limited. Particularly, a key dimension of Ireland's ambitious roadmap for healthcare reform (Sláintecare) seeks to remove private practice from public hospitals. However, to date, there has been no examination of how this reform could impact private hospital demand and expenditure, and ultimately, the capacity to treat public patients. Using previously unavailable administrative health insurer data and a healthcare macro-simulation projection model, we project real (volume-based) and nominal expenditure on private hospital services over the medium-term (2018-2035). We develop a number of projection scenarios that vary assumptions in relation to population growth and ageing, healthy ageing, and the future cost of care delivery. Additionally, by developing profiles of private activity in public hospitals, we examine how the removal of private practice from public hospitals could impact on demand and expenditure in private hospitals over time. Findings from this analysis have implications for capital investment and workforce planning in private hospitals, and failure to meet future demand could have implications for access to care in public hospitals. Moreover, should private practice be ended in public hospitals, most complex private in-patient and emergency care is likely to remain within the public hospitals with limited capacity benefits for the public system., (© 2021 John Wiley & Sons Ltd.)

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability. Its diagnosis, classification and management are complex. There is a paucity of data on the standard of COPD management in Irish general practice., Aims: We studied whether COPD diagnosis and management was in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. We investigated if patients who were smokers had received smoking cessation advice. We examined whether influenza and pneumococcal vaccination had been given., Methods: Ten general practices affiliated with the Irish Mid-West Specialist Training Programme in General Practice (GP) were searched, to determine which patients had a diagnosis of COPD. A data-collection audit tool was developed using GOLD 2019 guidelines. Results were tabulated in SPSS. Descriptive statistics were used., Results: Of 482 patients studied, 91.7% were eligible for free GP care. In 49.4%, the diagnosis of COPD had been made appropriately. In 56.2%, there was no evidence that the stage of COPD had been formally assessed. Of the patients studied, 33.2% were deemed to be receiving appropriate therapy. Smoking status was documented in 99.6% of cases studied and 59.9% were ex-smokers, while 25.9% were current smokers. Appropriate smoking cessation advice had been offered to 71% of eligible patients. Influenza vaccine had been given to 66.2% in the previous 12 months. A total of 53.9% had ever received pneumococcal vaccination., Conclusions: This study provides a comprehensive snapshot of care in Irish general practice for patients with COPD prior to introduction of the Chronic Disease Management programme (CDM)., (© 2020. Royal Academy of Medicine in Ireland.)

Aims: To identify the costs associated with nurse sensitive adverse events and the impact of these events on patients' length of stay., Design: Retrospective cohort study using administrative hospital data., Methods: Data were sourced from patient discharge information (N = 5544) from six acute wards within three hospitals (July 2016-October 2017). A retrospective patient record review was undertaken by extracting data from the hospitals' administrative systems on inpatient discharges, length of stay and diagnoses; eleven adverse events sensitive to nurse staffing were identified within the administrative system. A negative binomial regression is employed to assess the impact of nurse sensitive adverse events on length of stay., Results: Sixteen per cent of the sample (n = 897) had at least one nurse sensitive adverse event during their episode of care. The model revealed when age, gender, admission type and complexity are controlled for, each additional nurse sensitive adverse event experienced by a patient was associated with an increase in the length of stay beyond the national average by 0.48 days (p = .001). Applying this to the daily average cost of inpatient stay per patient (€1456), we estimate the average cost associated with each nurse sensitive adverse event to be €694. Extrapolating this nationally, the economic cost of nurse sensitive adverse events to the health service in Ireland is estimated to be €91.3 million annually., Conclusion: These potentially avoidable events are associated with a significant economic burden to health systems. The estimates provided here can be used to inform and prepare the way for future economic evaluations of nurse staffing initiatives that aim to improve care and safety., Impact: As many of these nurse sensitive adverse events are avoidable, in addition to patient benefits, there is a potential substantial financial return on investment from strategies such as improved nurse staffing that can reduce their occurrence., (© 2021 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Background: Despite the high prevalence of miscarriage, there are few studies which assess the concordance of a diagnosis of miscarriage in routinely collected health databases., Objectives: To determine agreement and accuracy for the diagnosis of miscarriage between electronic health records (EHR), the Hospital Inpatient-Enquiry (HIPE) system, and hospital register books in Ireland., Methods: This is a retrospective study comparing agreement of diagnosis of miscarriage between three hospital data sources from January to June 2017. All inpatient admissions for miscarriage were reviewed from a single, tertiary maternity hospital in Ireland. Kappa, sensitivity, specificity, positive and negative predictive value were calculated., Results: In this retrospective concordance study, EHR records confirmed 96.2% diagnosis of miscarriage of HIPE records, and 95.1% of register books records. A total of 95 records were not recorded in the register books but were recorded in HIPE and EHR. This study found a considerable variability when comparing definitions of type of miscarriage (i.e., missed miscarriage, incomplete, and complete) between the three data sources., Conclusion: Although this study found a high concordance in inpatient admissions for miscarriage between EHR, HIPE, and register books, a considerable discrepancy was found when classifying miscarriage between the three data sources., (© 2021 The Authors. Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.)

Background: Clinical genetics is an under-resourced service in the Republic of Ireland. There can be a number of avenues that lead to barriers in patient triage noted within the department., Aims: To evaluate the reasons for referral rejection in the triage pathway. To identify the time and cost implications., Methods: A retrospective analysis of rejected referrals consecutively triaged by one consultant was undertaken over an 18-month period. Calculation of costs used data from a previous study., Results: The consultant rejected 128/1581 (8.3%) of referrals. The rejection reasons included the following: 75% had not included the family/patient genetic report, 10% were conditions not accepted by our service, 8% redirected to other specialities, 3% given written advice in lieu of appointment and 4% for other reasons. Follow-up information was requested on 78% of rejected referrals. For 57% this was received; in 43% no response was received, and these cases remain closed. Median response time was 33 days. Of those who sent back appropriate information, 39% remain on waiting list, 50% attended OPD or were given appropriate advice, 5% did not attend and 4% had alternative follow-up pathways. The estimated time cost of rejected referrals equated to 88.5 h (59 h/year). Using this as our cost of rejection letter, it equated €11,878.4/year departmental cost., Conclusion: The majority of referrals are rejected for non-enclosure of patient genetic reports. Many referrals would have accepted to the waiting list if the appropriate report had been attached. This means patients at risk of genetic disorders are not accessing clinical services because the referrer is not providing the necessary information to allow triage. Active management of the waiting list via upfront letters is costly, with a 57% response rate. Should similar rejection rates exist in other specialities, we estimate this would equate to a cost of €2,714,214.40/year to the HSE., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Morphological similarities between skates of the genus Dipturus in the north-eastern Atlantic and Mediterranean have resulted in longstanding confusion, misidentification and misreporting. Current evidence indicates that the common skate is best explained as two species, the flapper skate (Dipturus intermedius) and the common blue skate (D. batis). However, some management and conservation initiatives developed prior to the separation continue to refer to common skate (as 'D. batis'). This taxonomic uncertainty can lead to errors in estimating population viability, distribution range, and impact on fisheries management and conservation status. Here, we demonstrate how a concerted taxonomic approach, using molecular data and a combination of survey, angler and fisheries data, in addition to expert witness statements, can be used to build a higher resolution picture of the current distribution of D. intermedius. Collated data indicate that flapper skate has a more constrained distribution compared to the perceived distribution of the 'common skate', with most observations recorded from Norway and the western and northern seaboards of Ireland and Scotland, with occasional specimens from Portugal and the Azores. Overall, the revised spatial distribution of D. intermedius has significantly reduced the extant range of the species, indicating a possibly fragmented distribution range., (© 2023 The Authors. Journal of Fish Biology published by John Wiley & Sons Ltd on behalf of Fisheries Society of the British Isles.)

Aims and Objectives: Surveillance of wound infection including signs of infection alongside antimicrobial usage (types, duration, frequency) can highlight knowledge gaps and inconsistencies. This manuscript aims to highlight these, identify and inform opportunities for practice improvement and to show impact of infection management practice may be having on the issue of antimicrobial resistance., Background: Infected wounds pose challenges to healthcare professionals. Balancing risk of wound deterioration and progression to systemic infection with appropriate use of antimicrobials is necessary to minimise development of resistance., Methods: Analysis consisted of a practice survey of 9661 wounds across 70 community sites over a period of one week. Data were collected from projects between 2017 and 2020. The form was available to providers within the UK, Ireland, Norway, Denmark, Sweden and Finland. EQUATOR research guidelines were followed; STROBE checklist for observational research reporting was completed., Results: Infection rates of 8.9% were reported from wounds assessed. These data indicate inconsistencies with diagnosis across practice with non-specialists more likely to be unsure of wound infection. Greater confidence in infection identification was observed as number of signs increased. Inconsistencies were also observed in appropriate treatment; antimicrobials were used in 35% of wounds considered not infected and not used in 41% of wounds that were identified as infected., Conclusions: This investigation of infection management practice of over 9000 wounds provides an insight into diagnosis and treatment of infection. Inconsistencies in diagnosis and treatment of wound infections reported highlight the need for increased education, awareness of diagnosis and treatment of infection., Relevance to Clinical Practice: Variability in management of infected wounds highlights opportunities to aid more effective diagnosis and treatment of infected wounds. Incorporation of support tools or evidence-based pathways into practice may enhance confidence in management of local infection, balanced with appropriate use, potentially minimising resistance and improving outcomes., (© 2022 John Wiley & Sons Ltd.)

Background: In Ireland, a 'COVID-19 death' is defined as any death in which the decedent was COVID-19 positive and had no clear alternative cause of death unrelated to COVID-19, a definition based on World Health Organization guidance., Aims: The objectives of this audit were to determine the proportion of COVID-19 deaths notified in the Cork/Kerry region of Ireland during winter 2021-2022 which adhered to this national definition, and to determine whether COVID-19 was deemed to be the primary cause of death, or a contributory or incidental factor., Methods: A review of all deaths in individuals who were COVID-19 positive at the time of death notified to the Department of Public Health for Cork and Kerry between 22 November 2021 and 31 January 2022 was conducted to determine whether each death adhered to the national COVID-19 death definition. The clinical opinion on cause of death was obtained by contacting decedents' clinicians., Results: Sixty deaths in individuals who were COVID-19 positive at the time of death were notified to the Department in the study period. Of deaths notified as being due to COVID-19, COVID-19 was deemed the primary cause of death, a contributory factor or an incidental factor in 72.7%, 21.8%, and 5.5% of cases, respectively. Most (93.3%) notified deaths adhered to the national COVID-19 death definition., Conclusions: The COVID-19 death definition in Ireland may require revision so it can distinguish between deaths caused by COVID-19 and those in which COVID-19 played a less direct role. The current COVID-19 mortality reporting system may also need updating to capture more clinical nuance., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: Transport is an important basis for social participation. Challenges to accessing and using transport for people with intellectual disabilities increase their risk of exclusion and loneliness., Method: Data from a nationally representative study of older people with intellectual disabilities (n = 708) were used to examine longitudinal changes in transport usage and factors associated with using public transport and other travel options., Results: Findings confirmed that this population depends on others for transportation. The most frequently used mode, staff-supported transport, showed no significant longitudinal change. Public transport was secondary, with only moderate continued use between data collection points. Level of intellectual disability most strongly predicted public transport use, while community residence most strongly predicted using public transport to attend work or day programmes., Conclusions: Transport usage is associated with demand and supply factors linked to the person's environment, including having somewhere to go that requires transport and availability of transport options., (© 2019 John Wiley & Sons Ltd.)

Aims: To explore Advanced Nurse Practitioners' (ANP) (Emergency) perceptions of their role, positionality and professional identity., Background: Advanced nursing practice was formally established in the Republic of Ireland in 2001 with 336 ANPs currently registered, projection increasing to a critical mass of 750 by 2021. Advanced practitioners (Emergency) give full emergency care for a specific cohort of clients with unscheduled, undifferentiated and undiagnosed conditions., Design: Qualitative narrative inquiry using Bourdieu's concepts of habitus, field and capital as the theoretical framework was undertaken., Methods: Data were collected in 10 in-depth interviews and thematic analysis applied., Results: Five key themes emerged: participants' career pathways, personal and professional transitions, role dimensions and core concepts, and position in the organization and emergent professional identity. Role transitioning and a change in habitus, field and capital revealed the uniqueness of their nursing role. Minimizing waiting times, timely patient care and patient satisfaction were key performance indicators. A heightened awareness regarding higher-level decision-making, autonomy and accountability is integral to advanced practice., Conclusion: This study presents unique insights into the ANP role covering recruitment, organizational culture changes required and support to ease transition emerged., Impact: Better understanding the motivation to undertake the role, the transition experience and use of advanced practice skills sets will inform the targets for the future recruitment and retention of ANPs are met nationally and internationally. Dissatisfaction with previous management roles and wanting to be clinically close to patients were motivations to follow an advanced practice clinical career trajectory. Positionality and emergent professional identity are key enablers ensuring that advanced practitioners' roles demonstrate the attributes of advanced practice. Educators could use the findings to develop recruitment, retention and progression strategies. Disseminating the role and scopes of practice could positively influence collaborative models of service delivery and policy development., (© 2020 John Wiley & Sons Ltd.)

Diabetes mellitus (DM) is associated with an elevated risk of post-operative complications. The impact it has on patients living with DM following hip fracture surgery (HFS) is not completely understood and may represent a predictor of increased mortality. This study investigates the impact of DM, gender, American Society of Anaesthesiologists (ASA) grade, and fracture location, on the outcome of HFS in Ireland. The Hospital Inpatient Enquiry (HIPE) database records all fragility hip fractures within Galway University Hospital. Retrospective data collection was performed over a 3-year period. Data collected included patient age, gender, date of HFS, anatomical fracture location, type of operation, ASA grade, DM status, and mortality. A database of 650 individuals was created including 461 females and 189 males, with an average group age of 80.2 ± 9.3 years. Results showed a significantly higher incidence of hip fractures in males with DM (19.57%) than females with DM (12.36%) (χ 2 test, p = 0.020). Cox regression survival analysis indicated that DM status and ASA grade were the two main independent predictors of patient survival following HFS. Nevertheless, when examining the combined impact of gender and DM status on survival after HFS, results showed that survival post HFS differed significantly with gender and presence of DM (log-rank test, p < 0.001), with males with DM performing worse than females with DM (p = 0.021) or males without DM (p = 0.001). This gender and disease-associated outcome should prompt an early multi-disciplinary team approach to the management of hip fractures in patients with DM. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:834-842, 2020., (© 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.)

The finding that drugs and metabolites can be detected from fingerprints is of potential relevance to forensic science and as well as toxicology and clinical testing. However, discriminating between dermal contact and ingestion of drugs has never been verified experimentally. The inability to interpret the result of finding a drug or metabolite in a fingerprint has prevented widespread adoption of fingerprints in drug testing and limits the probative value of detecting drugs in fingermarks. A commonly held belief is that the detection of metabolites of drugs of abuse in fingerprints can be used to confirm a drug has been ingested. However, we show here that cocaine and its primary metabolite, benzoylecgonine, can be detected in fingerprints of non-drug users after contact with cocaine. Additionally, cocaine was found to persist above environmental levels for up to 48 hours after contact. Therefore the detection of cocaine and benzoylecgonine (BZE) in fingermarks can be forensically significant, but do not demonstrate that a person has ingested the substance. In contrast, the data here shows that a drug test from a fingerprint (where hands can be washed prior to donating a sample) CAN distinguish between contact and ingestion of cocaine. If hands were washed prior to giving a fingerprint, BZE was detected only after the administration of cocaine. Therefore BZE can be used to distinguish cocaine contact from cocaine ingestion, provided donors wash their hands prior to sampling. A test based on the detection of BZE in at least one of two donated fingerprint samples has accuracy 95%, sensitivity 90% and specificity of 100% (n = 86).