The University Maternity Hospital, Limerick (Irish: Ospidéal Máithreachais na hOllscoile, Luimneach) is a hospital in County Limerick, Ireland. It is managed by UL Hospitals Group.
Background The international development of specialist perinatal mental health care pathways aims to align practice with evidence-based guidelines and strengthen the effectiveness and equity of support. Clinicians working directly with women and families are ideally placed to assess care pathways and provide valuable insights to enhance clinical processes, coordination, and optimisation of care. Aim To synthesise the current evidence on clinicians’ perspectives on specialist perinatal mental health service care pathways. Method This systematic integrative review was guided by Whittemore and Knafl’s integrative review framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of six international databases, including MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science, was conducted with no date, language, or geographical limits. The initial search yielded 5081 studies. Data were extracted from the final 35 included papers and synthesised using narrative synthesis. Findings This review identified three primary themes and subthemes: (1) pathways defined by criteria, (2) engaging and inclusive pathways, and (3) perspectives on service integration. Across the included studies, care pathways were described as highly criteria-driven, with complex referral processes and gaps in provision that risked women being lost between services. Structural and relational factors that shape service accessibility, engagement, and inclusion were consistently reported. Conclusion Specialist perinatal mental health care pathways require timely, equitable access and seamless continuity, particularly for women with complex needs and minority groups. Clinicians highlight the importance of flexible, culturally sensitive, trauma‑informed care within collaborative integrated systems, where open communication and clear pathways ensure a consistent, coordinated care experience.
BACKGROUND:Coronary microvascular dysfunction (CMD) is common among patients with angina with non-obstructive coronary artery disease (ANOCA) and leads to poorer clinical outcomes. Exercise stress testing (EST) was shown to have a high specificity for detecting CMD. However, the relationship between diagnosing CMD using different invasive physiological parameters and thresholds and the association between EST findings and the endotype of CMD remains unknown. METHODS:This multicentre, prospective cohort study enrolled 117 patients with ANOCA who underwent EST prior to invasive coronary angiography with functional assessment to measure coronary flow reserve (CFR), the index of microvascular resistance (IMR) and microvascular resistance reserve (MRR)=(CFR/FFR)×(Pa rest/Pa hyper). CMD was classified using multiple criteria, including MRR <3.0, CFR <2.5 and CFR <2.0 or IMR ≥25. Diagnostic sensitivity and specificity and the accuracy of EST findings (exercise-induced chest discomfort, ischaemic ECG changes and exercise intolerance) for diagnosing CMD were assessed. RESULTS:The prevalence of CMD was similar under all three definitions. However, structural CMD was more common using MRR <3.0. Ischaemic ECG changes during EST showed an excellent diagnostic accuracy of 86.3% (78.7-92.0%) for detecting CMD, with a sensitivity and specificity of 86.2% (68.3-96.1%) and 86.4% (77.4-92.8%), respectively. Exercise-induced chest discomfort also had a good diagnostic accuracy of 76.1% (95% CI 67.3% to 83.5%); however, it offered no additional value when added to ischaemic ECG changes. EST preferentially identified structural CMD, while functional CMD was more frequently missed. CONCLUSIONS:Ischaemic ECG changes during EST performed immediately before invasive functional assessment demonstrated excellent diagnostic accuracy for identifying patients with CMD, particularly the structural endotype. TRIAL REGISTRATION NUMBER:NCT05841485.
In Ireland, while most women express milk for their preterm very low birthweight (VLBW) infants, only a few are discharged home exclusively receiving mothers' own milk, and even fewer are engaged in direct feeding at breast (DFAB). This is in the context of Ireland having one of the lowest breastfeeding initiation and sustenance rates in the world. This qualitative descriptive study aimed to explore parents' experiences and perspectives on sustaining breastmilk expression and DFAB for VLBW infants. Semi-structured interviews were conducted with nine mothers and three partners, and the data were analysed using Braun and Clarkes' (2022) framework for reflexive thematic analysis. The themes developed were: (1) Sustaining breastmilk expression for preterm infants; (2) Navigating the transition to DFAB; and (3) The emotional Journey of feeding a VLBW infant. Supportive conditions for sustained milk expression included access to equipment, skin-to-skin contact, and both practical and emotional support from partners and healthcare professionals. Key influences on the transition to DFAB encompassed infant-related challenges, health system factors and the role of partner involvement. Scheduled support from lactation consultants, midwives and nurses in both hospital and community settings, who have undertaken specialised training on supporting women to breastfeed a VLBW infant is recommended to facilitate the transition to DFAB. Participants identified strategies that could be integrated into a 'DFAB care pathway' to provide a structured and consistent evidence-based approach to support women, their premature infants and families.
