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Scream all you want, no one can hear... Inspector Logan McRae is looking forward to a nice simple case. But the Powers That Be have other ideas... The high-profile anti-independence campaigner, Professor Wilson, has gone missing, leaving nothing but bloodstains behind. There's a war brewing between the factions for and against Scottish Nationalsim. And it's all playing out in the merciless glare of the media. Someone out there is trying to make a point, and they're making it in blood. If Logan can't stop them, it won't just be his career that dies.

In Italy, hospital statistics show a substantial decrease in paediatric emergency visits compared with the same time in 2018 and 2019 of between 73% and 78%.1 In April 2020, both the Clinical Commissioning Groups and the Royal College of Paediatrics and Child Health provided guidance for general practitioners and paediatricians in England that the threshold for face-to-face assessment hospital referrals in children should not change because of the COVID-19 pandemic.2 This intervention is welcome; however, we remain concerned about wider, perhaps less immediately visible collateral damage of strategies used against COVID-19 on vulnerable children. Box 1 Definitions of vulnerable children Definitions of vulnerability, taken from the children’s commissioner technical paper 2 which defines seven groups of children as vulnerable.19 Formal categories of children in care of the state whether in care, or living in other forms of state provision such as offender institutions, residential special schools, mental health establishments or other forms of hospital. Social isolation, the withdrawal of peer support, the lack of structure and support from school and the increased anxiety over COVID-19 infection and risk to parents are all likely to have a negative impact on mental health in children and young people.7 Social isolation and loneliness in children, job loss, furlough and increased parental distress may lead to subsequent mental health problems, resulting in a substantial increase in need for Child and Adolescent Mental Health Services (CAMHS). Increased risk to the mental health of children from social isolation will also result from their exposure to domestic violence and abuse (DVA) during the pandemic.

This study presents two simulation modelling tools to support the organisation of networks of dialysis services during the COVID-19 pandemic. These tools were developed to support renal services in the South of England (the Wessex region caring for 650 dialysis patients), but are applicable elsewhere. A discrete-event simulation was used to model a worst case spread of COVID-19, to stress-test plans for dialysis provision throughout the COVID-19 outbreak. We investigated the ability of the system to manage the mix of COVID-19 positive and negative patients, the likely effects on patients, outpatient workloads across all units, and inpatient workload at the centralised COVID-positive inpatient unit. A second Monte-Carlo vehicle routing model estimated the feasibility of patient transport plans. If current outpatient capacity is maintained there is sufficient capacity in the South of England to keep COVID-19 negative/recovered and positive patients in separate sessions, but rapid reallocation of patients may be needed. Outpatient COVID-19 cases will spillover to a secondary site while other sites will experience a reduction in workload. The primary site chosen to manage infected patients will experience a significant increase in outpatients and inpatients. At the peak of infection, it is predicted there will be up to 140 COVID-19 positive patients with 40 to 90 of these as inpatients, likely breaching current inpatient capacity. Patient transport services will also come under considerable pressure. If patient transport operates on a policy of one positive patient at a time, and two-way transport is needed, a likely scenario estimates 80 ambulance drive time hours per day (not including fixed drop-off and ambulance cleaning times). Relaxing policies on individual patient transport to 2-4 patients per trip can save 40-60% of drive time. In mixed urban/rural geographies steps may need to be taken to temporarily accommodate renal COVID-19 positive patients closer to treatment facilities.

Background Patient‐reported outcome measures (PROMs) are used to evaluate the effectiveness of interventions, particularly for subjective health states such as well‐being. A parent carer is an adult primary caregiver for a child with a disability. Parent carers are at risk of poorer mental and physical health; targeted health promotion interventions are being developed, requiring evaluation. This study aimed to identify the important health and well‐being outcomes for parent carers for evaluating parent carer‐focused interventions. Methods We recruited parents of children with special educational needs and disabilities living in England. Participants took part in individual, semi‐structured interviews via video in two parts. First, participants were asked open‐ended questions about health and well‐being; second, there was an elicitation exercise, in which the interviewees were asked to consider the aspects of health assessed by the Warwick‐Edinburgh Mental Wellbeing Scale (WEMWBS). Verbatim transcripts were analysed in two stages. Initially, data were analysed inductively, taking a thematic analysis approach. Subsequently, the data were analysed deductively with reference to a comprehensive framework of well‐being composed of 6 domains and 196 dimensions of well‐being. Results Thirty parent carers participated. We found support for diverse dimensions across all six well‐being domains. Eighteen dimensions were perceived to be of greater importance for parent carers: ‘stress reaction’, ‘anxiety/depression’, ‘acceptance’, ‘autonomy’, ‘self‐esteem’, ‘cognition’, ‘achievement’, ‘interests/hobbies’, ‘learning’, ‘need for relatedness’, ‘rest’, ‘sleep’, ‘physical exercise’, ‘life purpose and satisfaction’, ‘community wellbeing’, ‘status’, ‘financial situation’ and ‘future security’. WEMWBS items focus on positive aspects of mental health. Not measuring reduction in ‘negative’ well‐being dimensions risks missing important changes. Conclusions All six domains of health and well‐being were relevant to parent carers. However, some dimensions were more significant for the well‐being of parent carers, and these dimensions should be captured when evaluating their health and well‐being outcomes. Patient or Public Contribution Parent carers were involved in all aspects of the research, including research aims, recruitment and sampling, data collection and analysis, and dissemination.

Introduction Parent carers of children with special educational needs or disabilities are at risk of poorer health and wellbeing outcomes because of the distinct and challenging circumstances they face. Evaluations of interventions promoting the health of parent carers should focus on measuring the aspects of health and wellbeing which are most relevant to this group. As part of a programme of research on parent carer‐focused interventions, this study aimed to understand which aspects of health and wellbeing are perceived by parent carers as most meaningful and important. Methods A qualitative study using semistructured online interviews was conducted. A purposive sample of parent carers was interviewed about relevant health and wellbeing outcomes. Transcripts were analysed thematically. Results Thirty parent carers were interviewed, 19 of whom had experienced a health‐promoting intervention, either as participants (n = 14) or facilitators (n = 5). Three main themes were identified: ‘self, identity and beliefs’; ‘social connections and support’ and ‘health‐promoting practices and outcomes.’ Each theme encompassed the challenges participants faced, and the changes that helped them overcome these challenges. ‘Self‐identity’ challenges focused on the overwhelming nature of the parental care role and the emotional impact of this. Changes were brought about by developing a positive mindset, increasing confidence, and reconnecting with aspects of their identity which were important to them before they became parent carers. Challenges related to ‘social connections’ reflected parent carers' isolation. Change was brought about through increased peer support and peer interactions. Parent carers experienced challenges in terms of ‘health‐promoting activities’ because they lacked free time and experienced poor physical health. Changes were brought about by engagement in health‐promoting activities of various kinds. Conclusion Parent carers view health and wellbeing in terms of overcoming the common challenges they face as a group. These challenges reflect the ways in which their physiological and psychological needs are often unmet. Researchers interested in measuring parent carer health and wellbeing should consider the specific challenges this group face, as well as theoretical frameworks which can make sense of these challenges, such as self‐determination theory. Patient or Public Contribution Our team carries out patient and public involvement (PPI) through a Family Faculty group facilitated by a Family Involvement Co‐ordinator (A. McD.) who is herself a parent carer. A study‐specific PPI working group was established which included members of the Family Faculty. The PPI group advised on various aspects of the research as reported in the paper. The manuscript was co‐authored by the team's Family Involvement Co‐ordinator (A. McD.).

IntroductionChildren and young people with neurodisability (conditions affecting the brain or nervous system, creating functional impairment, eg, autism, learning disabilities, epilepsy, cerebral palsy or attention-deficit/hyperactivity disorder) have more complex health and educational needs than their peers, contributing to higher healthcare use and special educational needs (SEN) provision. To guide policy and improve services, evidence is needed on how health and education support and outcomes change with age for adolescents with and without neurodisability.Methods and analysisUsing the Education and Child Health Insights from Linked Data (ECHILD) database, which links health and education data across England, we will follow adolescents from the start of secondary school (Year 7) into early adulthood. We will classify children with and without neurodisability recorded in hospital and education records before Year 7, compare their sociodemographic characteristics and describe trends in health and educational outcomes throughout secondary school. We will estimate rates of planned and unplanned healthcare contacts by year of age (11–22 years old), and we will examine changes in trends before, during and after transition to adult healthcare. We will also estimate the proportion of adolescents with school-recorded SEN provision and rates of school absences and exclusions by year of age (11–15 years old) for the two groups. We will explore variation in outcomes by neurodisability subgroup and sociodemographic characteristics and contextualise the findings using existing interview and survey data from children, young people and parents/carers generated in the Health Outcomes of young People throughout Education (HOPE) research programme.Ethics and disseminationEthics approval for analyses of the ECHILD database has been granted previously (20/EE/0180). Findings will be shared with academics, policymakers and stakeholders, and published in open-access journals. Code and metadata will be shared in the ECHILD GitHub repository.

Background Parents of disabled children report poorer inpatient experiences when they stay in hospital, and some staff report finding communicating with disabled children challenging. This study tested the feasibility of implementing a training package for staff on paediatric wards to improve communication with disabled children, especially those with communication difficulties, and their families. The package was developed with parent carers and clinicians, and comprises a manual, a video of parent carers talking about real experiences, discussion points and local resources. The 50‐minutes training is intended for in‐house delivery by local facilitators. Methods Thirteen training sessions were delivered in paediatric wards across four hospitals in England, totalling 123 staff who took part. Participants completed questionnaires before (n = 109) and after (n = 36) training, and a sample of champions (senior clinicians) and facilitators were interviewed at the end of the study. Results Facilitators found the training easy to deliver, and participants felt they took away important messages to improve their practice. After the training, further changes were reported at an organizational level, including offering further training and reviewing practices. Conclusions This study provides supporting evidence for the implementation of a low‐cost, minimal‐resource training package to support staff communication with children and their families in hospitals. It provides promising indication of impact on behavioural change at the individual and organizational level. Patient and public contribution Parent carers identified the need and helped to develop the training, including featuring in the training video. They were also consulted throughout the study on research design, delivery and reporting.

Background Parent carers of disabled children report poor physical health and mental wellbeing. They experience high levels of stress and barriers to engagement in health-related behaviours and with ‘standard’ preventive programmes (e.g. weight loss programmes). Interventions promoting strategies to improve health and wellbeing of parent carers are needed, tailored to their specific needs and circumstances. Methods We developed a group-based health promotion intervention for parent carers by following six steps of the established Intervention Mapping approach. Parent carers co-created the intervention programme and were involved in all stages of the development and testing. We conducted a study of the intervention with a group of parent carers to examine the feasibility and acceptability. Standardised questionnaires were used to assess health and wellbeing pre and post-intervention and at 2 month follow up. Participants provided feedback after each session and took part in a focus group after the end of the programme. Results The group-based Healthy Parent Carers programme was developed to improve health and wellbeing through engagement with eight achievable behaviours (CLANGERS – Connect, Learn, be Active, take Notice, Give, Eat well, Relax, Sleep), and by promoting empowerment and resilience. The manualised intervention was delivered by two peer facilitators to a group of seven parent carers. Feedback from participants and facilitators was strongly positive. The study was not powered or designed to test effectiveness but changes in measures of participants’ wellbeing and depression were in a positive direction both at the end of the intervention and 2 months later which suggest that there may be a potential to achieve benefit. Conclusions The Healthy Parent Carers programme appears feasible and acceptable. It was valued by, and was perceived to have benefited participants. The results will underpin future refinement of the intervention and plans for evaluation.

Parent carers of disabled children are at increased risk of physical and mental health problems. The Healthy Parent Carers (HPC) programme is a manualised peer-led group-based programme that aims to promote parent carer health and wellbeing. Previously, the programme had been delivered in person, with recruitment and delivery managed in a research context. This study explored implementation by two delivery partner organisations in the United Kingdom. Facilitator Training and Delivery Manuals were modified for online delivery using Zoom due to COVID-19. The study methodology utilised the Replicating Effective Programs framework. A series of stakeholder workshops informed the development of the Implementation Logic Model and an Implementation Package. After delivering the programme, delivery partner organisations and facilitators participated in a workshop to discuss experiences of implementing the programme. A wider group of stakeholders, including commissioners, Parent Carer Forums and charity organisations representatives and researchers subsequently met to consider the sustainability and potential barriers to delivering the programme outside the research context. This study explored implementation by two delivery partner organisations in the United Kingdom that were able to recruit facilitators, who we trained, and they recruited participants and delivered the programme to parent carers in different localities using Zoom. The co-created Implementation Logic Model and Implementation Package were subsequently refined to enable the further roll-out of the programme with other delivery partner organisations. This study provides insight and understanding of how the HPC programme can be implemented sustainably outside of the research context. Further research will evaluate the effectiveness of the programme and refine the implementation processes. Parent carers, delivery partner organisation staff and service commissioners were consulted on the design, delivery and reporting of the research.