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Reflective practice (RP) is a core component of infant mental health (IMH); however, there is limited published empirical research on IMH practitioner experiences of RP. This two-stage, qualitative, multimodal study explored Irish IMH practitioners' experiences of RP spaces. Visual and verbal data from seven individual interviews and a participatory arts-based focus group with seven participants (eight participants in total, all white Irish females) were analyzed using Interpretative Phenomenological Analysis. Five group experiential themes (Just get on with it; What should I be bringing to this space?; Who are my "hands"?; Taking a step back; and You go in heavy and you come out light) were generated by the analysis. These were used to construct a developmental and experiential model of learning in an RP space. The themes portray how a practitioner's RP experience can change over time: influenced by prior experiences and practice development stage, practitioners move from initial uncertainty, anxiety, and perceived pressure in a busy workload to developing the trust and ability to be vulnerable in an RP space. Through relationships (supervisor/facilitator or group members), a shared safe space can be created, which addresses practitioners' needs for containment, allowing for experiential learning through a process of transformational moments., (© 2024 The Author(s). Infant Mental Health Journal published by Wiley Periodicals LLC on behalf of Michigan Association for Infant Mental Health.)

Objective: To report the performance of clinical practice guidelines (CPG) in the diagnosis of serious/invasive bacterial infections (SBI/IBI) in infants presenting with a fever to emergency care in the UK and Ireland. Two CPGs were from the National Institutes for Health and Care Excellence (NICE guidelines NG51 and NG143) and one was from the British Society for Antimicrobial Chemotherapy (BSAC)., Design: Retrospective multicentre cohort study., Patients: Febrile infants aged 90 days or less attending between the 31 August 2018 to 1 September 2019., Main Outcome Measures: The sensitivity, specificity and predictive values of CPGs in identifying SBI and IBI., Setting: Six paediatric Emergency Departments in the UK/Ireland., Results: 555 participants were included in the analysis. The median age was 53 days (IQR 32 to 70), 447 (81%) underwent blood testing and 421 (76%) received parenteral antibiotics. There were five participants with bacterial meningitis (1%), seven with bacteraemia (1%) and 66 (12%) with urinary tract infections. The NICE NG51 CPG was the most sensitive: 1.00 (95% CI 0.95 to 1.00). This was significantly more sensitive than NICE NG143: 0.91 (95% CI 0.82 to 0.96, p=0.0233) and BSAC: 0.82 (95% 0.72 to 0.90, p=0.0005). NICE NG51 was the least specific 0.0 (95% CI 0.0 to 0.01), and this was significantly lower than the NICE NG143: 0.09 (95% CI 0.07 to 0.12, p<0.0001) and BSAC: 0.14 (95% CI 0.1 to 0.17, p<0.0001)., Conclusion: None of the studied CPGs demonstrated ideal performance characteristics. CPGs should be improved to guide initial clinical decision making., Trial Registration Number: NCT04196192., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The traditional outpatient paradigm of seeing patients prior to diagnostic tests and treatment is unsustainable without additional funding. New models of service delivery such as "one-stop clinics", direct access to diagnostics and advanced nurse practitioner (ANP)-led clinics have the potential to improve the efficiency of existing services., Methods: To determine the most effective changes to improve service provision, the reasons for encounter (RFE) to a urology clinic were assessed using the International Classification Primary Care. To test these changes, a clinical validation process was performed on existing waiting patients waiting ≥ 15 months. Direct access to diagnostics and an ANP-led clinic were introduced. The impact of this validation process was measured prospectively using independently-collated National Treatment Purchase Fund waiting list data., Results: From January to December 2017, 1114 new patients were referred. The 3 most frequent RFEs were haematuria, urinary frequency/urgency and cystitis and accounted for 48% of referrals overall. A new outpatient pathway, combining direct access to diagnostics and an ANP-led clinic, was implemented on 508 existing patients waiting ≥ 15 months. The validation process resulted in referral directly to a consultant-led clinic in 36%, to an ANP-led clinic in 12%, direct access to diagnostics in 38% and removal in 13%. This change was implemented in July 2017 and there was a 76% reduction in the number of patients waiting ≥ 12 months by December 2017., Conclusion: New models of outpatient service delivery have the potential to reduce existing waiting lists and could be implemented in other Irish hospital groups.

Background: A new legal capacity act was introduced in Ireland in 2015. This study aimed to identify and critically examine key issues in the area of decision-making capacity from the perspective of psychologists working with adults with an intellectual disability., Methods: A qualitative exploratory approach was employed, and the study was positioned in a social constructionist framework. Purposive and snowballing sampling methods were used to recruit 15 clinical psychologists working with adults with an intellectual disability. Data were collected with the use of individual semistructured interviews. Interview transcripts were analysed using a model of thematic analysis., Results: Six themes were identified: (1) a presumption of capacity but a culture of incapacity, (2) supporting decision making as a process, (3) authenticity of decision making, (4) need for support and training, (5) contributions of psychology and (6) the way forward., Conclusions: Participants described that people with intellectual disabilities were often excluded from decision-making processes. They welcomed the functional approach to decision making, considered substituted decision making to be necessary within a support framework and described supporting decision making as a process. Systemic, resource and attitudinal challenges were identified., (© 2020 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.)

Objective: To compare the prostate cancer prevention trial risk calculator (PCPT-RC) and European randomized study of screening for prostate cancer risk calculator (ERSPC-RC) in a unique unscreened population from the West of Ireland., Patients and Methods: Data was prospectively recorded for all 556 consecutive men who underwent prostate biopsy at our institution as part of the Rapid Access Prostate Assessment Clinic program in Ireland. The estimated probabilities of detecting prostate cancer and high-grade disease were calculated using the PCPT and ERSPC risk calculators. For each calculator the discriminative ability, calibration and clinical utility was assessed., Results: Prostate cancer was detected in 49% and high-grade prostate cancer in 34% of men. Receiver operating characteristic curve analysis demonstrated that the PCPT-RCs outperformed the ERSPC-RCs for the prediction of prostate cancer areas underneath the ROC curve (AUC 0.628 vs. 0.588, p = 0.0034) and for the prediction of high-grade prostate cancer (AUC 0.792 vs. 0.690, p = 0.0029). Both risk calculators generally over-predicted the risk of prostate cancer and high-grade disease across a wide range of predicted probabilities. Decision curve analysis suggested greater net benefit using the PCPT-RCs in this population., Conclusions: Multivariable nomograms can further aid patient counselling for early prostate cancer detection. In unscreened men from Western Ireland, the PCPT-RCs provided better discrimination for overall prostate cancer and high-grade disease compared to the ERSPC-RC. However, both tools overpredicted the risk of cancer detection on biopsy, and it is possible that a different set of predictive variables may be more useful in this population.

We herein present a regional review of the management of renal trauma in the west of Ireland. The majority of renal injuries occur as a result of blunt trauma and are amenable to conservative management. We sought to streamline the management of renal trauma in the west of Ireland. With the current restructuring of the Irish Health Service, it is important to acknowledge the role of the urologist in the management of trauma patients.