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Currently in the UK and Ireland, after a hip fracture most patients do not receive bone protection medication to reduce the risk of refracture. Yet randomised controlled trial data specifically examining patients with hip fracture have shown that intravenous zoledronate reduces refracture risk by a third. Despite this evidence, use of intravenous zoledronate is highly variable following a hip fracture; many hospitals are providing this treatment, whilst most are currently not. A range of clinical uncertainties, doubts over the evidence base and practical concerns are cited as reasons. This paper discusses these concerns and provides guidance from expert consensus, aiming to assist orthogeriatricians, pharmacists and health services managers establish local protocols to deliver this highly clinically and cost-effective treatment to patients before they leave hospital, in order to reduce costly re-fractures in this frail population. [ABSTRACT FROM AUTHOR]

Ireland and neighbouring Britain share much of their tectonic history and are both far from active plate boundaries at present. Their seismicity shows surprising lateral variations, with very few earthquakes in Ireland but many low-to-moderate ones in the adjacent western Britain. Understanding the cause of these variations is important for our understanding of the basic mechanisms of the intraplate seismicity distributions and for regional hazard assessment. The distribution of microseismicity within Ireland and its underlying causes have been uncertain due to the sparsity of the data sampling of the island, until recently. Here, we use the data from numerous recently deployed seismic stations in Ireland and map its seismicity in greater detail than previously. The majority of detectable seismic events are quarry and mine blasts. These can be discriminated from tectonic events using a combination of the waveform data, event origin times, and the epicentres' proximity to quarries and mines, catalogued or identified from the satellite imagery. Our new map of natural seismicity shows many more events than known previously but confirms that the earthquakes are concentrated primarily in the northernmost part of the island, with fewer events along its southern coast and very few deeper inland. Comparing the seismicity with the recently published surface wave tomography of Ireland and Britain, we observe a strong correspondence between seismicity and the phase velocities at periods sampling the lithospheric thickness. Ireland has relatively thick, cold and, by inference, mechanically strong lithosphere and has very few earthquakes. Most Irish earthquakes are in the north of the island, the one place where its lithosphere is thinner, warmer and, thus, weaker. Western Britain also has relatively thin lithosphere and numerous earthquakes. By contrast, southeastern England and, probably, eastern Scotland have thicker lithosphere and, also, few earthquakes. The distribution of earthquakes in Ireland and Britain is, thus, controlled primarily by the thickness and mechanical strength of the lithosphere. The thicker, colder, stronger lithosphere undergoes less deformation and features fewer earthquakes than thinner, weaker lithosphere that deforms more easily. Ireland and Britain are tectonically stable and the variations in the lithospheric thickness variations across them are estimated to be in a 75–110 km range. Our results thus indicate that moderate variations in the lithospheric thickness within stable continental interiors can exert substantial control on the distributions of seismicity and seismic hazard—in Ireland, Britain and elsewhere around the world. [ABSTRACT FROM AUTHOR]

Background In Europe, more than 15 million people live with heart failure (HF). It imposes an enormous social, organizational and economic burden. As a reaction to impending impact on healthcare provision, different country-specific structures for HF-care have been established. The aim of this report is to provide an overview and compare the HF-care approaches of Germany, Ireland, the Netherlands and the UK, and to open the possibility of learning from each other's experience. Methods A mixed methods approach was implemented that included a literature analysis, interviews and questionnaires with HF-patients and caregivers, and expert interviews with representatives from healthcare, health service research and medical informatics. Results The models of HF-care in all countries analyzed are based on the European Society of Cardiology guidelines for diagnosis and treatment of HF. Even though the HF-models differed in design and implementation in practice, key challenges were similar: (i) unequal distribution of care between urban and rural areas, (ii) long waiting times, (iii) unequal access to and provision of healthcare services, (iv) information and communication gaps and (v) inadequate implementation and financing of digital applications. Conclusion Although promising approaches exist to structure and improve HF-care, across the four countries, implementation was reluctant to embrace novel methods. A lack of financial resources and insufficient digitalization making it difficult to adopt new concepts. Integration of HF-nurses seems to be an effective way of improving current models of HF-care. Digital solutions offer further opportunities to overcome communication and coordination gaps and to strengthen self-management skills. [ABSTRACT FROM AUTHOR]

Background the mySupport advance care planning intervention was originally developed and evaluated in Northern Ireland (UK). Family caregivers of nursing home residents with dementia received an educational booklet and a family care conference with a trained facilitator to discuss their relative's future care. Objectives to investigate whether upscaling the intervention adapted to local context and complemented by a question prompt list impacts family caregivers' uncertainty in decision-making and their satisfaction with care across six countries. Second, to investigate whether mySupport affects residents' hospitalisations and documented advance decisions. Design a pretest–posttest design. Setting in Canada, the Czech Republic, Ireland, Italy, the Netherlands and the UK, two nursing homes participated. Participants in total, 88 family caregivers completed baseline, intervention and follow-up assessments. Methods family caregivers' scores on the Decisional Conflict Scale and Family Perceptions of Care Scale before and after the intervention were compared with linear mixed models. The number of documented advance decisions and residents' hospitalisations was obtained via chart review or reported by nursing home staff and compared between baseline and follow-up with McNemar tests. Results family caregivers reported less decision-making uncertainty (−9.6, 95% confidence interval: −13.3, −6.0, P  < 0.001) and more positive perceptions of care (+11.4, 95% confidence interval: 7.8, 15.0; P  < 0.001) after the intervention. The number of advance decisions to refuse treatment was significantly higher after the intervention (21 vs 16); the number of other advance decisions or hospitalisations was unchanged. Conclusions the mySupport intervention may be impactful in countries beyond the original setting. [ABSTRACT FROM AUTHOR]

This article considers the implications of Brexit for UK–Irish relations. It examines how Brexit has altered the terms of the British–Irish relationship by considering the impact on bilateral and cross-border economic and trade patterns. The article focuses on two primary economic effects. First, the short-term impact of Brexit and the Ireland/Northern Ireland Protocol on the Northern Ireland economy, and on trade relations between Great Britain and Ireland and across the Irish border; and second, how Brexit has spurred a discussion about the (economic) appropriateness of partition on the island of Ireland in the post-Brexit period, the extent to which it has led to increased calls for a border poll, and how any future unification process might be economically managed. This includes some provisional evaluation of the economic costs and challenges in relation to future constitutional change for the island of Ireland and the UK. The discussion here connects with wider British constitutional issues including calls for Scottish independence and the possible break-up of the UK. [ABSTRACT FROM AUTHOR]