Adult community intellectual disability services in the United Kingdom (UK) are required to deliver specialist, evidence-based care for a variety of conditions while minimising restrictive practices and reliance on inpatient provision. Care pathway models have emerged as a potential mechanism to reconcile these aims yet remain under-used in care philosophies in intellectual disabilities. We propose a generalisable pathways model for community intellectual disability services and examine its implications for policy, clinical practice, and research. The model integrates care navigation, proportionate specialist input, and defined clinical condition care including behaviours that challenge, mental and physical health, forensics, neurodevelopmental conditions, epilepsy, and dementia within a community-based service architecture. It considers recent focus on digitalsation, prevention, workforce and practice innovation. The model aligns with contemporary policy priorities. We argue that pathway-based care delivery provides a pragmatic and ethically grounded framework for organising services. It supports consistency, integration, and preventative care while reducing reliance on reactive risk-based responses. By synthesising service design principles, core pathway functions, and system interfaces, this paper offers a coherent model for contemporary community intellectual disability services. Further empirical evaluation is required to assess the impact of care pathways on outcomes, patient experience, and cost-effectiveness.

Introduction Global ageing is increasing. Most older people live independently but at times require nursing care as they age. This care is provided in a variety of settings including acute, primary, community and residential care services. In such instances, it is important that older people feel comfortable and listened to, and it is imperative that student nurses are educated to competently care for and nurse older people in collaborative partnerships. Intergenerational initiatives promote shared learning and help break down barriers among different age cohorts. An online intergenerational caf & eacute; was developed to provide a learning opportunity for older people and student nurses to meet as equals and connect socially in a protected place and time. This paper reports on older people's views of their participation in an online intergenerational caf & eacute;. Methods Ethical approval was granted for this survey design research. Older people living in the community (n = 49) participated in online intergenerational caf & eacute;s with student nurses. Following the online caf & eacute;, participants were invited to voluntarily participate in the study through completion of an anonymous online survey. Consent was indicated through the return of the survey questionnaire. All agreed to complete the survey. Likert scale quantitative data was analysed using descriptive statistical analysis (SPSS, version 21). Responses to the open-ended questions were thematically analysed. Findings The cafes supported intergenerational learning, and participants felt comfortable participating. Participants discovered some but not all key points of interest about students. In many ways, they were quite similar to students. Participants felt students would be respectful, empathetic and advocate for them in a care situation. Many agreed that the caf & eacute;s were well organised, but some would have liked more clarity on the discussion topics. Conclusions This caf & eacute; initiative has merit as it helped reduce barriers and facilitated intergenerational learning. Implications for Practice Participation in Intergenerational caf & eacute;s can help reduce barriers by faciliating understanding and mutual respect . They can provide a forum for discussion on nursing care expectations.

Abstract Background Patients over the age of 50 years and those who are on immunosuppressive therapy are at increased risk of contracting Herpes Zoster (Shingles). Most recent international (ECCO) guidelines have recommended that all patients commencing on JAK inhibitors be vaccinated to ensure optimum protection against the Shingles Virus. Shingrix (non-live) vaccine is available in Ireland but is not reimbursed by the HSE, therefore patients are required to pay privately. Unfortunately, due to the significant cost of receiving this vaccine in the community the uptake among IBD patients is minimal. The aim of this clinic was: •To provide optimum protection against the Shingles virus to all IBD patients commencing on a JAK inhibitor •To eliminate the burden of shingles for immunocompromised patients with IBD •To ensure evidence-based practice is adhered to in line with national and international guidelines •To provide a nurse led vaccination clinic for patients with IBD •To ensure that all patients with IBD have equal access to Shingrix Methods We negotiated with the pharmacy department to ensure all patients on JAK inhibitors have access to Shingrix vaccination at no cost to the patient. A business case was submitted to the Mercy University Hospital Drugs and therapeutics board. Vaccination protocol was designed with key stakeholders, which was then communicated to all team members. A weekly nurse led vaccination clinic was established in October 2023. Vaccination administration given in two consecutive doses as per guidelines. Results Since the launch of the weekly nurse led vaccination clinic, 196 vaccinations have been administered to date, with 98 patients fully vaccinated with Shingrix (non-live vaccination). JAK inhibitor treatment can now be commenced without delay, resulting in increased patient satisfaction with the IBD service. Of the vaccinated patients, to date, none have developed Shingles. Conclusion This nurse led project has ensured that patients with IBD who require treatment with a JAK inhibitor can now avail of vaccination in line with national and international guidelines resulting in increased patient service satisfaction and reassurance following vaccination with nil adverse effects experienced from patients. References T Kucharzik, P Ellul, T Greuter, J F Rahier, B Verstockt, C Abreu, A Albuquerque, M Allocca, M Esteve, F A Farraye, H Gordon, K Karmiris, U Kopylov, J Kirchgesner, E MacMahon, F Magro, C Maaser, L de Ridder, C Taxonera, M Toruner, L Tremblay, M Scharl, N Viget, Y Zabana, S Vavricka, on behalf of the European Crohn’s and Colitis Organisation [ECCO], ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease, Journal of Crohn's and Colitis, Volume 15, Issue 6, June 2021, Pages 879–913, https://doi.org/10.1093/ecco-jcc/jjab052

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Abstract Background The National Bowel Screening Program (Bowelscreen), a nationwide initiative program, aims to provide direct access to those aged 55-74 (currently 59-69) for colonoscopy assessment deemed high risk for colorectal cancer via positive faecal immunochemical test (FIT). Inflammatory Bowel Disease (IBD) follows a bimodal distribution of onset with European studies reporting 10-15% diagnosis after age 60. Limited published research exists on IBD incidence in Ireland via FIT-based population screening and associated outcomes. We aim to dtermine incidence rates/severity of incident IBD cases found via FIT-based colorectal screening programme and hRetrospective review was conducted of all index colonoscopes conducted in FIT positive screening participants (aged 59-69) in multiple Irish centres between 2015-2024. Inclusion criteria: histological diagnosis of colitis. Parameters measured: distribution of colitis, histology, clinical sequalae/IBD history, faecal calprotectin (FCP) and treatment escalation based on screening colonoscopyow often screening colonoscopy is performed for patients with known IBD and positive FIT. Methods Retrospective review was conducted of all index colonoscopes conducted in FIT positive screening participants (aged 59-69) in multiple Irish centres between 2015-2024. Inclusion criteria: histological diagnosis of colitis. Parameters measured: distribution of colitis, histology, clinical sequalae/IBD history, faecal calprotectin (FCP) and treatment escalation based on screening colonoscopy. Results 203/8070 (2.52%) of index screening colonoscopies analysed reported endoscopic diagnosis of colitis. 105/8070 (1.3%) satisfied diagnostic criteria for classic IBD (65.7% UC; 34.2% Crohn’s), of which the majority were new diagnosis (73.3%). 32% cases of segmental colitis associated with diverticulosis (SCAD) were identified. 21% cases of NSAID induced colitis were identified. UC Colitis distribution: 18.8% pancolitis, 38.4% proctitis and 42.8% left-sided. Crohn’s distribution: 8.3% small bowel solely; 89% colonic and 2.7% mixed. 48% reported symptoms at endoscopy. Median FCP following diagnostic colonoscopy was 216.5μg/g. 10% of newly diagnosed IBD patients required biologic escalation. Conclusion Incidental diagnosis of colitis occurs in 3% of FIT-positive screening participants in a population based screening programme with new diagnoses of IBD including UC, Crohn’s and SCAD requiring treatment. This is a novel, unintended benefit to FIT-based population screening.

Abstract Background Point of care ultrasound is a real-time, non-invasive imaging modality used across many disciplines for several years, including in Inflammatory Bowel Disease (IBD) patients in central Europe. However, it is only recently beginning to be introduced in an Irish context. This study aims to explore the perspectives of key stakeholders in IBD in Ireland, towards the introduction of point of care ultrasound (PoCUS) amongst IBD patients. The secondary aim is to clarify if key stakeholders are supportive of nurse performed PoCUS in IBD if a referral pathway was to become available in an Irish context. Methods A quantitative cross sectional, descriptive online survey was developed to collect anonymous responses from key stakeholders in the IBD clinical care context in Ireland. The email inviting potential respondents to consider participation in the survey was distributed by two professional bodies – The Irish Society of Gastroenterology and Inflammatory Bowel Disease Nurses Association of Ireland. Analysis included a descriptive modelling of the data using logistic regression. Results In completing the survey, 25% of respondents confirmed that they had an ultrasound service for IBD patients while 44% (n=42) have future plans to develop one. Among the surveyed doctors, only 9% (n=9) have undergone training in PoCUS, while 79% of all respondents express intentions to pursue training or are open to considering it in the future. On average, respondents disagreed that PoCUS will replace Colonoscopy and MRI in the future, with a mean score of 2.47 (SD 1.24). Doctors and nurses perceive having access to PoCUS as important for patient outcome and quality of care, mean 4.06 (SD 1.02). Overall, 51% (n=48) of respondents reported having no fears or reservations associated with using PoCUS in clinical practice. Both doctors and nurses exhibited positive attitudes towards nurse-led PoCUS in IBD, highlighting its perceived cost effectiveness, as evidenced by a mean score of 4.38 (SD 1.01). Conclusion Key findings highlight a majority of respondents have plans to develop a PoCUS service and undertake training to improve quality of care for patients with IBD. The vast majority of respondents support the introduction of nurse performed PoCUS in the Irish setting. References Dolinger, M. Kayal, M. Intestinal Ultrasound Is the Ideal Patient-Centric, Point-of-Care Tool for Clinical Decision Making in the Inflammatory Bowel Disease Practice, Crohn's & Colitis 360, Volume 5, Issue 3, July 2023, otad029, available at: https://doi.org/10.1093/crocol/otad029.

In November 2023, the Department of Health and Social Care published guidance, entitled 'Baroness Hollins' Final Report: My Heart Breaks - Solitary Confinement in Hospital Has no Therapeutic Benefit for People with a Learning Disability and Autistic People'. The report's commendable analysis of the problems and identification of the areas where practice should be improved is unfortunately not matched by many of its recommendations, which appear to be contrary to evidence-based approaches. The concerns are wide-ranging, from the use of the term 'solitary confinement' for current long-term segregation (LTS) and seclusion, to presumption that all LTS and seclusion is bad, to holding clinicians (mainly psychiatrists) responsible for events beyond their locus of control. Importantly, there is a no guidance on how to practically deliver the recommendations in an evidence-based manner. This Feature critically appraises the report, to provide a comprehensive summary outlining potential positive impacts, identifying specific concerns and reflecting on best practice going forward.

The Mental Health Bill, 2025, proposes to remove autism and learning disability from the scope of Section 3 of the Mental Health Act, 1983 (MHA). The present article represents a professional and carer consensus statement that raises concerns and identifies probable unintended consequences if this proposal becomes law. Our concerns relate to the lack of clear mandate for such proposals, conceptual inconsistency when considering other conditions that might give rise to a need for detention and the inconsistency in applying such changes to Part II of the MHA but not Part III. If the proposed changes become law, we anticipate that detentions would instead occur under the less safeguarded Deprivation of Liberty Safeguards framework, and that unmanaged risks will eventuate in behavioural consequences that will lead to more autistic people or those with a learning disability being sent to prison. Additionally, there is a concern that the proposed definitional breadth of autism and learning disability gives rise to a risk that people with other conditions may unintentionally be unable to be detained. We strongly urge the UK Parliament to amend this portion of the Bill prior to it becoming law.

The NHS 2025 Health Plan aims for radical reform but overlooks people with intellectual disability. This editorial highlights critical omissions in policy, services, research and rights protections. Without intentional inclusion, digital and community shifts risk deepening inequality. True progress demands co-produced strategies to ensure equitable care for this vulnerable population.

Abstract Background 8-weekly dosing regimen of ustekinumab in the treatment of moderate-to-severe Inflammatory Bowel Disease (IBD) is the current standard of care. Accelerated 4-weekly dosing has been suggested to be efficacious, however not licensed, in ‘non-responders’. The aim of this study is to determine how 4-weekly accelerated dosing regimen in ustekinumab drug levels correlate with response to treatment in patients with IBD. Methods Patients for inclusion were identified retrospectively utilising online prescription records at Mercy University Hospital, Cork. Inclusion criteria consisted of IBD patients commenced on ustekinumab with a treatment duration of at least 6 months. Participants were separated into 4-weekly and 8-weekly treatment groups. Faecal calprotectin (FCP) levels/ustekinumab drug levels were recorded from the 12-week check in post initiation and at the 2nd assessment. Symptoms were scored at these visits and further quantified using the Harvey Bradshaw index for Crohn’s Disease and the partial mayo score for Ulcerative Colitis. Results 101 patients at the Mercy University Hospital Cork were identified utilising a database of prescriptions and physical charts (4-weekly: 27; 8-weekly: 74). A statistically significant decrease in FCP levels at 2nd assessment was noted in patients with 4-weekly dosing (p=0.028). There was no statistically significant relationship between dosing interval and symptoms (p=0.735). Individual patient factors including age, gender, type of IBD, and concurrent IBD medications did not have a statistically significant effect on faecal calprotectin levels or symptoms. Conclusion The greater percentage decrease in faecal calprotectin provides objective evidence supporting the escalated dosing interval at the Mercy University Hospital IBD centre. However, further study is necessary to justify increasing the dosing interval for all patients treated with ustekinumab for IBD.

Background: Within the context of global ageing, older people will require health care during times in their later lives. As most nurses will care for older people across a variety of care settings, it is crucial that older people and nurses can work together in partnership. In preparation for this, it is important to develop intergenerational learning innovations for student nurses and older people. An online intergenerational discussion cafe' was developed to provide an opportunity for older people and student nurses to meet and get to know each other. Objectives: 1) Evaluate the effectiveness of an intergenerational discussion cafe' as a way of facilitating intergenerational learning, 2) Elicit participants' views on whether intergenerational learning had occurred. Design: Ethically approved survey research.Settings: Tertiary education institution. Participants: Third year student nurses (n = 50) across three BSc Nursing pre-registration degree programmes enrolled on a shared community care module. Methods: Post-cafe', student nurses were invited via email to voluntarily participate in the research and to complete an anonymous online survey. Questionnaire return implied consent. Fifty student nurses (n = 50) participated in the post cafe' survey. Descriptive statistical analysis of Likert scale quantitative data and thematic analysis of open-ended questions was undertaken.Results: Participants reported that the intergenerational cafe's were well organised, worked well and strongly agreed that the cafe's were helpful in facilitating student nurses and older people to connect socially and share views.Results also showed that participants felt they got to know a lot about older people and that they were in many ways quite similar to older people.Conclusions: This study provides valuable information on the use of intergenerational cafe's as a means of facilitating intergenerational learning. Findings indicate that it was a positive learning experience for participants.

Background Specialist forensic community teams for people with intellectual disability and/or autism have been developed, but little is known about their extent and delivery. Aims To describe specialist forensic community teams for people with intellectual disability and/or autism across the UK. Method An online survey was sent to representatives of each UK Trust/Health Board providing adult mental health and/or intellectual disability services. Questions covered the availability, structure and activities of specialist community forensic services. Quantitative data were summarised and associations between access to specialist forensic teams and care were tested with Chi-squared tests. Thematic analysis of free-text survey responses was used to understand the challenges of providing community forensic mental health services for this group. Results A total of 49 out of 78 (63%) eligible Trusts/Health Boards responded, of which 25 (51%) had access to a specialist forensic community team. Teams operated either as part of a single Trust/Board (n = 13) or over a larger regional footprint (n = 12). The availability of specialist forensic community teams was associated with better access to offence-related interventions (χ2 = 15.1002, P < 0.005) and co-production of patient care plans (χ2 = 7.8726, P = 0.005). Respondents reported a wide variation in availability, expertise and perceived quality of community services. The availability of secure and generic in-patient beds, commissioning and legal barriers were also significant challenges in providing appropriate care. Conclusions Coverage of specialist community forensic teams is not universal. There are indications that such teams are associated with improved care processes, but further work is needed to establish longer-term outcomes and the optimal model of care.

BACKGROUND:Autism spectrum disorder (hereafter referred to as autism) is characterised by difficulties with (i) social communication, social interaction, and (ii) restricted and repetitive interests and behaviours. Estimates of autism prevalence within the criminal justice system (CJS) vary considerably, but there is evidence to suggest that the condition can be missed or misidentified within this population. Autism has implications for an individual's journey through the CJS, from police questioning and engagement in court proceedings through to risk assessment, formulation, therapeutic approaches, engagement with support services, and long-term social and legal outcomes. METHODS:This consensus based on professional opinion with input from lived experience aims to provide general principles for consideration by United Kingdom (UK) CJS personnel when working with autistic individuals, focusing on autistic offenders and those suspected of offences. Principles may be transferable to countries beyond the UK. Multidisciplinary professionals and two service users were approached for their input to address the effective identification and support strategies for autistic individuals within the CJS. RESULTS:The authors provide a consensus statement including recommendations on the general principles of effective identification, and support strategies for autistic individuals across different levels of the CJS. CONCLUSION:Greater attention needs to be given to this population as they navigate the CJS.

Abstract Background Ulcerative Colitis (UC) is a chronic inflammatory bowel disease (IBD) often leading to impaired quality of life in affected patients. Current treatment modalities include anti-tumour necrosis factor (anti-TNF) monoclonal antibodies including infliximab, adalimumab and golimumab (GLM). RCT show higher trough drug levels (DL) following induction are associated with enhanced rates of remission in maintenance. GOAL-ARC is a pragmatic RCT to examine if dose optimisation of GLM following induction in response to suboptimal DL or persistently raised faecal calprotectin (FCP) improves rates of patient continuous clinical response (pCCR) and reduces maintenance disease activity in UC Methods A pragmatic randomised, multi-centre two-arm investigator initiated trial (NCT0268772) . Population – Patients with moderate to severe UC requiring TNF inhibitor therapy. Intervention - one arm receiving GLM treatment as per SMPC and one arm with dose optimisation of GLM based on FCP and DL from week 6 according to a dedicated algorithm. Eligible patients were randomised in a 1:1 ratio to 1 of 2 treatment groups. Study Duration - 46 weeks. Primary end-point pCCR = absence of flare defined as no increase in modified partial Mayo (MPM) score of 2 points from week 14-46 (requiring treatment intervention). Secondary endpoints included rate of clinical response to induction (week 14), defined as a drop of MPM of 2 points or decrease of ≥30% from baseline and level of FCP and rate of mucosal healing (Mayo endoscopic subscore of 0/1) at Wk 46 Results 107 patients were enrolled (target enrolment n=135, study enrolment terminated early due to recruitment problems during and following C19 pandemic). 97 patients (median age 42) were randomised, with one patient subsequently excluded due to ineligibility. Of 96 evaluable patients, 46 were randomised to SMPC treatment and 50 were randomised to the intervention. Baseline characteristic were comparable. 28/46 (61%) achieved wk 14 clinical response with SMPC and 19/46 (41%) met the primary endpoint (pCCR wk 14-46). In the intervention arm 28/50 (56%) achieved wk 14 clinical response and 24/50 (48%) met the primary endpoint (pCCR wk 14-46). The difference between groups in the rates of pCCR was 6.7% (95% CI:-0.15,0.29) in favour of the intervention and was not statistically significant. No safety signal associated with the intervention was observed. Conclusion In a pragmatic RCT no significant increase in the rate of pCCR was observed with personalised dosing of GLM for treatment of moderate to severe UC. A numerical trend towards reduced loss of response during maintenance (20% with SMPC versus 8% with intervention) is observed with personalised dosing of GLM suggesting this strategy may be beneficial in some patients

Abstract Background Studies in different countries of defendants with mild to borderline intellectual disability found they have distinct characteristics from other defendants. The aim of this study was to examine several characteristics among defendants with intellectual disability comparing to those defendants without intellectual disability presenting to court services in London, England. Method This was a retrospective data analysis of routine administrative data collected by the Liaison and Diversion services across five Magistrates courts in London, England. Data were analysed on defendants identified through screening to have an intellectual disability and compared to defendants without an intellectual disability. Results 9088 defendants were identified and of these 349 (4%) had an intellectual disability. Defendants with intellectual disability were over four times more likely to have comorbid attention deficit hyperactive disorder and over 14 times more likely to have autism spectrum disorder. There was an increased odds ratio of self-reported suicidal/self-harming behaviour for those defendants with intellectual disability compared to those without intellectual disability. Conclusion This study has highlighted the increased vulnerability of defendants with intellectual disability for other neurodevelopmental disorders. Disclosure of Interest J. McCarthy Grant / Research support from: Guy’s & St. Thomas’ Charity for £674,000, E. Chaplin Grant / Research support from: Guy’s & St. Thomas’ Charity for £674,000

Abstract Background Patients with Ulcerative Colitis (UC) in clinical and endoscopic remission (ER) may still experience disease relapse, emphasizing the need to identify reliable predictors of outcome in clinical practice. Recently, neutrophil-based histological scores have highlighted the pivotal role of neutrophils in predicting disease outcome. Furthermore, the impairment of the intestinal barrier has been proposed as a crucial element in forecasting disease outcomes. Hence, this study aims to assess the predictive role of epithelial versus lamina propria neutrophil localization and barrier proteins expression in UC patients in ER. Methods UC patients in clinical remission who underwent colonoscopy between January 2020 and June 2022 at two tertiary referral centres were retrospectively enrolled. Patients in ER, defined by Mayo Endoscopic Score (MES) ≤1 and UC Endoscopic Index of Severity (UCEIS) ≤1 were included. Histological activity was assessed with Robarts Histopathology Index (RHI), Nancy Histological Index (NHI) and PICaSSO Histological Remission Index (PHRI). Neutrophil localization in the epithelium and lamina propria was accurately evaluated. Additionally, immunohistochemical expression of epithelial barrier proteins, namely Claudin-2 and JAM-A, was assessed to evaluate the integrity of intestinal barrier. Two pathologists experienced in IBD independently analysed all histological slides to ensure reliability. Kaplan-Meier were plotted to analyse survival free from adverse events such as flare-up, change/optimization of medication or hospitalization over a 12-month follow-up period. Results Out of 60 UC patients in ER (58.3% males, mean age 44.2±13.6 years), 36.7%, 38.3% and 36.7% were in histological remission according to RHI, NHI and PHRI, respectively. 25% of patients developed an adverse outcome within 12 months. Neutrophils in the epithelium significantly correlated with adverse outcomes compared with lamina propria localization (p=0.03) or their absence altogether (p<0.01). Claudin-2 showed significantly higher expression according to endoscopic and histological activity (Table 1), while no significant difference was found for JAM-A. Notably, strong and diffuse claudin-2 expression was associated with a higher rate of adverse outcomes (p<0.01), as well as the simultaneous presence of epithelial neutrophils and Claudin-2 (p=0.04). Substantial agreement between pathologists was found (K=0.67). Conclusion This multicentre retrospective study highlights the potential role of epithelial neutrophils localization and claudin-2 ‘leaky gut’ protein expression as practical clinical tools to predict outcomes in UC patients. These findings hold promise in guiding patient-tailored therapy in IBD.

Abstract The very brief presentation will describe the initial approach to the psychiatric assessment of the case presented including the issue of fitness to participate in court proceedings. The use of screening tools at court to identify people with intellectual disabilities will be highlighted along with what support can be provided for vulnerable offenders in attending court. The potential disposal options for the court such as prison or hospital or community will be outlined. Variation in practice across Eurpean countries needs further discussion to ensure the rights of defendants with intellectual disabilities are safeguarded during their participation in court proceedings Disclosure of Interest None Declared