Explore the vast range of titles available.

Correspondence to Professor Rachel Isba; rachel.isba@nhs.net Background Lack of access to primary care services, by not being registered with a general practitioner (GP), is a source of health inequality.1 Unregistered children are at risk of missing healthcare activity, including routine vaccination.2 NHS England has emphasised the importance of ensuring no child misses out on vaccination invitations and has sought to explore solutions for those not registered with a GP. Results Within 2 months of the initial mailout, 77 children (9.5%) were newly registered with a GP in the area and 52 (6.4%) became up to date with their age-appropriate vaccinations.2 The cost of postage (the most expensive item at £0.86 per letter) for both mailouts (896 letters in total) was £770.56, which equates to just over £10 per new registration or just under £15 per child catching up with their vaccinations. CHIS providers are well positioned to identify non-registered cohorts and send simple and low-cost mailouts, resulting in increased registrations and an associated increase in uptake of routine childhood vaccination.

Why did you do this work?In May 2024, the local NHS England screening and immunisation team provided financial support for a ten-month pilot catch-up MMR (measles, mumps, and rubella) vaccination programme for eligible1 children and young people (CYP) at a specialist children’s hospital. This was in response to the ongoing measles outbreak in the UK,2 and low local uptake of MMR1 and MMR2.3 Activity so far is reported here.What did you do?The team includes Consultants in Paediatric Infectious Diseases and Public Health Medicine (4h/week each), an Advanced Nurse Practitioner, and a project officer (8h/week each). There are weekly virtual Vaccination Multi-Disciplinary Team meetings (VMDT) and fortnightly Vaccination Ward Rounds (VWR).Eligible CYP are identified from weekly inpatient lists, initially with a stay > 30 days, expanding to those with a stay > 7 days in mid-July 2024.Vaccination data are obtained from sources including Child Health Information Services (CHIS). CYP missing at least one MMR are discussed at the VMDT and seen on the VWR. Any other missed vaccines (routine or condition-specific) are incorporated into management plans.What did you find?In the first four months of the pilot, the team ‘screened’ the notes of 395 CYP for eligibility, checked the vaccination status of 340, contributed to the management of 42, and administered 10 vaccines to nine CYP. Vaccines were administered by the vaccination team or the clinical team caring for the CYP. If the CYP had left the hospital, the vaccine team liaised with community colleagues. It was often initially difficult to confirm vaccination status, but this was improved via direct access to CHIS for the local region.A small number (five) of absolute contraindications to administration of MMR were encountered (e.g. immune suppression). Relative contraindications were more common but usually time-bound (e.g. undergoing cardiac surgery), so incorporated into management plans.Four parents/carers refused the offer of vaccination, and two children died after screening and before being offered an intervention.What does it mean?It is possible to offer an in-patient MMR vaccination catch-up programme to often complex CYP. Easy access to accurate vaccination data remains an issue. A small number of parents/carers refused vaccination.Activity will now expand to include low-volume but high-risk (e.g. with immune modulation) and high-volume but low-risk (e.g. attending for constipation) outpatients. Learning from the pilot is being shared with other specialist settings looking to develop similar services.

IntroductionVaping among children and young people (CYP) has increased globally over the past decade, with rates stabilising in the UK in recent years. Factors such as curiosity, social influence, stress management and attractive flavours contribute to its popularity. Although the long-term health impacts are uncertain, vaping poses risks including nicotine dependence, cardiovascular and respiratory issues, and cognitive impairment, though evidence on long-term effects is still emerging. Despite established smoking cessation programmes for adults, tailored resources for vaping cessation among CYP remain scarce, particularly within healthcare settings, which offer unique opportunities for professional intervention and ongoing support. The objective of this review is to assess the extent and nature of available literature on interventions delivered in healthcare settings to support vaping cessation among CYP under the age of 18 years.Methods and analysisThis scoping review will include studies targeting CYP under the age of 18 years, specifically focusing on interventions delivered within healthcare settings. Studies outside healthcare contexts or those without healthcare provider involvement will be excluded. Additionally, interventions delivered solely to parents or carers will not be considered.A comprehensive search will be conducted in MEDLINE, Embase, Web of Science, Cochrane Library and CINAHL from January 2004 to present, with additional grey literature from sources including grey literature repositories and Google Scholar. Results will be imported into Rayyan for screening, with two independent reviewers assessing studies for inclusion. Data extraction will include study design, population characteristics (including explicit age ranges, specifically CYP under 18 years), intervention details and outcomes. A descriptive synthesis will map study characteristics, while thematic analysis will identify intervention themes and healthcare contexts.Ethics and disseminationEthics approval is not required for this secondary analysis. Findings will be disseminated through publication, conference presentations and shared with public health stakeholders.

ObjectiveThe objective was to see if it was feasible and acceptable to deliver a brief public health intervention as part of an attendance at the paediatric emergency department (PED).DesignA feasibility and acceptability pilot design was used as there is no previous work done in this clinical area, population or using this approach in children and young people (CYP). Quantitative and qualitative data were collected. Follow-up was at 1 week and 1, 3 and 6 months.SettingThis pilot took place in a single PED in Greater Manchester, England.ParticipantsParticipants were CYP (under 16 years old) and their parents/carers, attending the PED during a 2-week recruitment period in September 2019.InterventionsThe intervention was a brief conversation with a Consultant in Paediatric Public Health Medicine, using Screening, Brief Intervention and Referral to Treatment. The intervention focused on vaccination, dental health, household smoking and frequent attendance.Primary and secondary outcome measuresThe primary outcome measure was information to support the effective development of a larger-scale study. Secondary outcomes were measures of health, again intended to provide additional information prior to a larger study.ResultsThirty CYP were recruited from 29 households. Sixty per cent of CYP triggered at least one screening question, most commonly household smoking and dental health. It was not possible to accurately assess frequent attendance and 97% of parents/carers stated that they thought their child or young person was fully vaccinated for their age, which is likely to be an over-estimate.ConclusionsIt is feasible to deliver a brief public health intervention in the PED and such an approach is acceptable to a variety of stakeholders including CYP, parents/carers and nursing staff. The pilot revealed issues around data quality and access. Future work will focus on vaccination and dental health.

ObjectivesTo identify burnout constructs from descriptions of staff experiences of health inequalities operating across paediatric specialist hospitals and to categorise the constructs according to Leiter and Maslach’s six Areas of Worklife (AWL) model of burnout.DesignA secondary data analysis of a qualitative study using semi-structured interviews and focus groups.SettingThe interviews and focus groups were conducted within nine children’s hospitals in England.ParticipantsThe dataset included responses from 217 individual staff members occupying various roles: leadership, clinical, professional and support. All staff who volunteered to participate were included in the study.ResultsThe results of this exploratory analysis showed that psychological burnout constructs were frequently embedded in hospital staff’s descriptions of their experiences of health inequalities in hospitals, and relevant excerpts were found for all six domains of the AWL model. Staff described a work environment where socioeconomic disparities increased workload pressures, but efforts to improve services were frustrated by a perceived lack of control in decision making or professional recognition. There was ambiguity of role-based responsibilities for tackling health inequalities and an imbalance between organisational practices and personal and professional values of social justice.ConclusionsThere is a reciprocal relationship between health inequalities and burnout experienced by healthcare professionals operating within specialist children’s hospital settings. The extant knowledge and approaches to health inequalities and occupational burnout should be considered in tandem, integrated into quality improvement and operationalised within paediatric healthcare organisations to improve safety and quality of care.

Clerkship education has been called a ‘black box’ because so little is known about what, how, and under which conditions students learn. Our aim was to develop a blueprint for education in ambulatory and inpatient settings, and in single encounters, traditional rotations, or longitudinal experiences. We identified 548 causal links between conditions, processes, and outcomes of clerkship education in 168 empirical papers published over 7 years and synthesised a theory of how students learn. They do so when they are given affective, pedagogic, and organisational support. Affective support comes from doctors’ and many other health workers’ interactions with students. Pedagogic support comes from informal interactions and modelling as well as doctors’ teaching, supervision, and precepting. Organisational support comes from every tier of a curriculum. Core learning processes of observing, rehearsing, and contributing to authentic clinical activities take place within triadic relationships between students, patients, and practitioners. The phrase ‘supported participation in practice’ best describes the educational process. Much of the learning that results is too tacit, complex, contextualised, and individual to be defined as a set of competencies. We conclude that clerkship education takes place within relationships between students, patients, and doctors, supported by informal, individual, contextualised, and affective elements of the learned curriculum, alongside formal, standardised elements of the taught and assessed curriculum. This research provides a blueprint for designing and evaluating clerkship curricula as well as helping patients, students, and practitioners collaborate in educating tomorrow’s doctors.

ObjectivesTo gain a deep understanding of factors driving retention in emergency medicine. To understand in detail the day-to-day lived experience of emergency medicine doctors, to identify and explore factors influencing retention, to situate these descriptions within the current educational and health policy contexts and to advance the debate and make policy and practice recommendations.DesignEthnography and semistructured interviews.SettingTwo purposively sampled emergency departments in England, with additional interview participants recruited via social media and relevant stakeholder organisations.Participants41 interview participants comprising 21 emergency physicians across 2 sites, 10 former emergency physicians and 10 stakeholders, with 132 hours of observation over 11 weeks in one emergency department in England.ResultsThree key themes were developed as relevant to the day-to-day lived experience of work in the emergency department, presenting challenges to retention and opportunities for change. First, emergency physicians needed to develop workarounds to mitigate the sensory and material challenges of working in a difficult environment.Second, education influences retention through valuing, fostering competence and entrustment and supporting interdependence. These were primarily observable in the workplace through senior staff prioritising the education of more junior staff.Third, community was important for retention. Linked to education through communities of practice, it was built by brief interpersonal interactions between emergency department workers.Situating these descriptions in current policy contexts identified less than full-time working, portfolio careers and mentorship as retention strategies. Self-rostering and annualisation facilitated these retention strategies.ConclusionsThe emergency department represents a difficult environment with many challenges, yet by focusing on how doctors navigate these difficulties, we can see the way in which retention occurs in everyday practices, and that valuing staff is critical for retention.

ObjectivesThis study aimed to understand how staff in children’s hospitals view their responsibility to reduce health inequalities for the children and young people who access their services.DesignWe conducted an exploratory qualitative study.SettingThe study took place at nine children’s hospitals in England.Participants217 members of staff contributed via interviews and focus groups conducted January–June 2023. Staff were represented at all levels of the organisations, and all staff who volunteered to contribute were included in the study.AnalysisData were analysed using Rapid Research Evaluation and Appraisal (RREAL) methodology for rapid assessment procedures (RAP).ResultsAll of the children’s hospitals were taking some action to reduce health inequalities. Two key themes were identified. First, it was clear that reducing health inequalities was seen as something that was of vital import and should be part of staff’s day-to-day activity, framed as ‘everyone’s business.’ Many staff felt that there was an obligation to intervene to ensure that children and young people receiving hospital treatment were not further disadvantaged by, for example, food poverty. Second, however, the deeply entrenched and intersectional nature of health inequalities sometimes meant that these inequalities were complex to tackle, with no clear impetus to specific actions, and could be framed as ‘no-one’s responsibility’. Within a complex health and social care system, there were many potential actors who could take responsibility for reducing health inequalities, and staff often questioned whether it was the role of a children’s hospital to lead these initiatives.ConclusionsBroadly speaking, senior leaders were clear about their organisational role in reducing health inequalities where they impacted on access and quality of care, but there was some uncertainty about the perceived boundaries of responsibility. This led to fragility in the sustainability of activity, and a lack of joined-up intervention. Most hospitals were forging ahead with activity, considering that it was more important to work to overcome health inequalities rather than debate whose job it was.

IntroductionHealth needs are issues that face a population or specific groups, which can benefit from healthcare and wider social and environmental changes. They are inextricably linked to health inequalities, which are largely determined by non-health-related factors such as socioeconomic deprivation or belonging to ethnic minority groups. The hospital-accessing paediatric population, with higher rates of morbidity and mortality, are likely to have higher levels of met and unmet health needs related to social determinants, compared with their peers. As the gap in health inequalities widens globally, paediatric health services may now have an increasingly important role to play in identifying and acting on inequalities affecting their patient population. This scoping review aims to collate information on how children’s hospitals assess the health and wider health-related social needs of patients using a health inequalities lens. On a broader level, the review may also reveal themes about healthcare and other health needs of children accessing hospitals globally.Methods and analysisThis scoping review will follow Joanna Briggs Institute guidance. A search strategy will be described to identify published articles from healthcare databases worldwide as well as healthcare-related grey literature. Literature will be examined to identify methods that aim to assess the health and related social needs of hospital-accessing paediatric patients and will exclude literature published before 2010. Two or more reviewers will independently review the results of the searches using the inclusion and exclusion criteria. Study findings will be presented in tabular form detailing the assessments identified.Ethics and disseminationThe review will synthesise information on hospital approaches to understand and assess the health and health-related social needs of children and young people worldwide. The findings will be used to inform guidelines for children’s hospitals in the UK and will be disseminated through national and international professional bodies, conferences and research papers.

Research in 2007 showed that World Health Organization (WHO) recommendations were largely based on expert opinion, rarely used systematic evidence-based methods, and did not follow the organization's own \"Guidelines for Guidelines\". In response, the WHO established a \"Guidelines Review Committee\" (GRC) to implement and oversee internationally recognized standards. We examined the impact of these changes on WHO guideline documents and explored senior staff's perceptions of the new procedures. We used the AGREE II guideline appraisal tool to appraise ten GRC-approved guidelines from nine WHO departments, and ten pre-GRC guidelines matched by department and topic. We interviewed 20 senior staff across 16 departments and analyzed the transcripts using the framework approach. Average AGREE II scores for GRC-approved guidelines were higher across all six AGREE domains compared with pre-GRC guidelines. The biggest changes were noted for \"Rigour of Development\" (up 37.6%, from 30.7% to 68.3%) and \"Editorial Independence\" (up 52.7%, from 20.9% to 73.6%). Four main themes emerged from the interviews: (1) high standards were widely recognized as essential for WHO credibility, particularly with regard to conflicts of interest; (2) views were mixed on whether WHO needed a single quality assurance mechanism, with some departments purposefully bypassing the procedures; (3) staff expressed some uncertainties in applying the GRADE approach, with departmental staff concentrating on technicalities while the GRC remained concerned the underlying principles were not fully institutionalized; (4) the capacity to implement the new standards varied widely, with many departments looking to an overstretched GRC for technical support. Since 2007, WHO guideline development methods have become more systematic and transparent. However, some departments are bypassing the procedures, and as yet neither the GRC, nor the quality assurance standards they have set, are fully embedded within the organization.