Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder occurring in approximately one in twenty young people in Ireland, and in one-third of those attending Irish Child and Adolescent Mental Health Services (CAMHS). It is important to treat ADHD, as un/poorly treated ADHD is associated with a raft of negative health and socio-economic outcomes. Effective interventions for ADHD are available, and the use of standardised, evidence-based pathways for assessment and management of ADHD optimises outcomes. Despite this, there is no national standardised clinical pathway for assessment and treatment of ADHD in Ireland. ADMiRE, the first public healthcare specialist service for children and adolescents in Ireland, has developed a strongly evidence-based, efficient, effective and safe clinical pathway for assessment and management of ADHD. This paper describes the ADMiRE Clinical Pathway and references ADMiRE resources that are available to other services.

Acute pyelonephritis (AP) epidemiology has been sparsely described. This study aimed to describe the evolution of AP patients hospitalised in France and identify the factors associated with urinary diversion and fatality, in a cross-sectional study over the 2014–2019 period. Adult patients hospitalised for AP were selected by algorithms of ICD-10 codes (PPV 90.1%) and urinary diversion procedure codes (PPV 100%). 527,671 AP patients were included (76.5% female: mean age 66.1, 48.0% Escherichia coli), with 5.9% of hospital deaths. In 2019, the AP incidence was 19.2/10,000, slightly increasing over the period (17.3/10,000 in 2014). 69,313 urinary diversions (13.1%) were performed (fatality rate 6.7%), mainly in males, increasing over the period (11.7% to 14.9%). Urolithiasis (OR [95% CI] =33.1 [32.3–34.0]), sepsis (1.73 [1.69–1.77]) and a Charlson index ≥3 (1.32 [1.29–1.35]) were significantly associated with urinary diversion, whereas E. coli (0.75 [0.74–0.77]) was less likely associated. The same factors were significantly associated with fatality, plus old age and cancer (2.38 [2.32–2.45]). This nationwide study showed an increase in urolithiasis and identified, for the first time, factors associated with urinary diversion in AP along with death risk factors, which may aid urologists in clinical decision-making.

Background: Western policy initiatives prioritize early diagnosis of dementia, but minority ethnic (ME) people currently present later to dementia specialist care than their indigenous counterparts. In order to allow the development of rational interventions, we completed this first study to explore the link between attitudes to help-seeking for dementia and the help-seeking pathway in the ME and indigenous population.

Methods: We purposively recruited a maximum variation sample comprising 18 family carers of people with dementia from the major UK ethnic groups. We used semi-structured interviews to determine the barriers to and facilitators of help-seeking, and the pathways to diagnosis. Two researchers independently coded interviews and recruitment continued until theoretical saturation was reached.

Results: ME carers, in contrast to the indigenous population, tended to delay help-seeking until they could no longer cope or until others commented on the problems. They often thought that families should look after their own elders and a diagnosis alone was purposeless. This appeared to relate to beliefs about the etiology of cognitive impairment, negative beliefs about psychiatry and their sense of familial responsibility.

Conclusions: ME carer beliefs were an important barrier to early diagnosis. Further work should explore whether an intervention can modify these attitudes, so that families understand that a diagnosis may allow planning and avoidance of crises; rather than signifying a failure in duty, disloyalty, or relinquishing of the caring role. Further research should focus on developing interventions to tackle barriers to help-seeking in ethnic minorities so that healthcare access can be equitable for all.

Hip fractures, fragility fractures, indicate an increased risk for further fragility fractures. Although the way to define osteoporosis, requiring antiresorptive therapy, is not clear, all patients who have had hip fractures should be prescribed calcium and vitamin D at a minimum. In a retrospective chart review, we have explored the effectiveness of incorporating a standing recommendation (but not a standing order) for calcium and vitamin D treatment in a hip fracture care pathway, comparing units where the pathway had been implemented with those where it had not yet been started. The pathway resulted in significantly more initiation of calcium and vitamin D compared to patients not on the pathway (72% vs. 13.5%, p < 0.01). However, a follow-up study after four years showed a marked decline in the frequency of the initiation of calcium and vitamin D, suggesting the need for ongoing encouragement for the intervention to continue to be successful.

Objectives: It was hypothesised that patients admitted to forensic mental health facilities are stratified along the pathway through care according to levels of need. Level of risk and psychopathology should vary with different levels of security.

Method: Seventy-five men in a forensic hospital were interviewed by three trained clinicians using the HCR-20 (Historical Clinical Risk Assessment) – clinical and risk items, The Health of the Nation Scales – Secure (HoNOS-SECURE), PANSS (Positive and Negative Syndrome Scale), GAF (Global Assessment of Functioning) and the CANFOR (Camberwell Assessment of need Forensic Version).

Results: The mean scores on a variety of clinical measures were higher in admission/high security areas and progressively lower in rehabilitation and pre-discharge areas. As patients moved through the pathways of care, they improved in a number of areas including psychiatric morbidity, risk, function, unmet needs. The following results stratified significantly; the HCR-20 summated clinical and risk (F = 9.2, df = 5, p < 0.001), the HoNOS secure (F = 18.2, df = 5, p < 0.001), PANSS (positive, general and total), GAF, staff and user unmet needs on the CANFOR.

Conclusions: The data indicate that the theoretical organisation of the units of the hospital into high, medium and low security units to form a coherent pathway through care is reflected in practice. This is a transparent route out of secure care in which restrictions are proportionate to risk and supports proportionate to need. It is unclear whether alternative models, consisting of a series of generic unstratified units for admission and discharge, all at the same level of therapeutic security, allow for the provision of treatment programmes and relational interventions appropriate to the patient's stage of recovery and rehabilitation.