Takawira C. Marufu

Globally, the number of Children and Young People (CYP) that experience mental health crisis and access paediatric acute hospital settings continues to increase. Many of these CYP present with thoughts and behaviours of self-harm and/or suicide and often experience severe and fluctuating emotional states. It is therefore important that the risk of self-harm/suicide is assessed during an inpatient admission and strategies implemented to mitigate risk. This study aimed to identify self-harm and suicidality risk management pathways that have been developed and evaluated for use with CYP admitted to acute hospital settings with mental health crisis. A systematic review was conducted. Eight online academic database were searched up to February 2022. The critical appraisal skills programme tool was used to assess the methodological rigour of included studies. Online searches identified 120 potential studies. Five studies met the predefined inclusion criteria. Six risk mitigation strategies were identified; safety huddles, urgent full mental psychiatric review within 2-h of assessment, feedback on screening responses, motivational and barrier-reducing intervention, 1:1 constant observations and environmental safety. All included strategies targeted environmental, family, and individual CYP involving modifications to equipment, surveillance, and communication to enhance safety.

Background Delayed recognition of clinical deterioration can result in harm to patients. Parents/carers can often recognise changes in the child’s condition before healthcare professionals (HCPs). To mitigate the risk of failure to rescue and promote early intervention, family-activated rapid response (FARR) systems are part of family-integrated care. Mechanisms for parents/carers to escalate concerns regarding their child’s clinical status remain limited to direct verbal communication, which may impede those with communication/linguistic challenges. Aim To develop a digital multilingual intervention by which families/carers can escalate their concerns directly to the rapid response team while in acute paediatric care. Methods A single-centre qualitative, co-design app development study was conducted. Evidence synthesis from a systematic review of the international literature informed interviews on intervention prototype development using co-design focus groups. Participant recruitment targeted underserved communities for multilingual functionality validity. Data were analysed using qualitative content analysis. Results Thirty parents/carers (n=16) and HCPs (n=14) participated in the study. Three themes were generated from the data analysis: (1) relational considerations; communication, professional and parental attributes, and collaborative working; (2) technology considerations; app content, usage and outcomes; and (3) individual and environmental considerations; parental and professional elements, and workload. A FARR app prototype was developed based on the data. Conclusion The prototype app provides a platform to develop a coordinated and consistent technological approach to paediatric FARR that acknowledges cultural nuances and preferences, ensuring that parents can communicate in a manner that aligns with their cultural background and communication abilities, thereby enhancing the quality of care delivered.

Introduction: At least 85% of unplanned admissions to critical care wards for children and young people (CYP) are associated with clinical deterioration. CYP and their families play an integral role in the recognition of deterioration. The Paediatric Critical Care Outreach Team (PCCOT) supports the reduction of avoidable harm through earlier recognition and treatment of the deteriorating child, acting as a welcome conduit between the multiprofessional teams, helping ensure that CYP gets the right care, at the right time and in the right place. This positions PCCOT well to respond to families who call for help as part of family activation. Aim: This protocol details the methods and process of developing a family activation rapid response online application. Methods: This is a single-centre, sequential, multiple methods study design. Firstly, a systematic review of the international literature on rapid response interventions in paediatric family activation was conducted. Findings from the review aimed to inform the content for next stages; interviews/ focus groups and experience-based co-design (EBCD) workshops. Participants: parents / caregivers whose children have been discharged or admitted to an acute care hospital and healthcare professionals who care for paediatric patients (CYP). During interviews and workshops participants’ opinion, views and input will be sort on designing a family activation rapid response online-app, detailing content, aesthetics, broad functionality and multi-lingual aspects. Further areas of discussions include; who will use the app, access, appropriate language and terminology for use. A suitable app development company will be identified and will be part of the stakeholders present at workshops. Data obtained will be used to develop a multi-lingual paediatric family activation rapid response web based application prototype. Ethics and dissemination: Full ethical approval was received from the Wales Research Ethics Committee 2. Cardiff; REC reference: 22/WA/0174. The findings will be made available to all stakeholders.

Background: Neonatal inter‐hospital transport is associated with heightened stress for parents whose needs may remain unmet around this time.Aim: To identify interventions which are used to support parents whose infants require neonatal inter‐hospital transport.Study Design: A systematic literature review approach was used. Six online databases (CINAHL, EMBASE, EMCARE, Medline, PsycINFO, Web of Science) were searched up to February 2022. The eligibility criteria included interventional studies published in the English language. Methodological quality was assessed by the Critical Appraisal Skills Programme checklists. Data were extracted using a predefined framework and synthesized narratively because of heterogeneity of reported outcomes.Results: A total of 671 articles were screened, with five meeting the eligibility criteria. Three interventions were reported within the five studies: a communication‐based intervention before transport represented by 223 parents in one study, Kangaroo Care during transport, which was carried out with 136 infants in three studies, and video calls after transport evaluated by one study in seven parents versus a control group. The effectiveness of the interventions could not be reliably determined. Neonatal nurses were the main providers of all the interventions pre‐, peri‐, and post‐transport.Conclusions: Limited evidence of mixed quality and inconsistent outcome measurements is available. Future research should focus on developing a contemporary intervention, determining the optimum timing for its implementation, and evaluating it using a robust study design.Relevance to Clinical Practice: Neonatal nurses need to be aware of the importance of their role in supporting parents through the distressing time of neonatal transport.

Background Postoperative patient outcomes after hip fracture are significant to patients and their relatives, clinicians and policy makers. However, little is known about the collective views of these stakeholders on postoperative factors perceived to cause prolonged hospitalisation in this patient population. We aimed to explore individual stakeholders’ opinions on factors influencing timing of discharge.Methods Using a mixed methods approach, healthcare professionals, patients and relatives completed a questionnaire and interviews. The questionnaire consisted of 13 morbidity and non-medical domains on a five-point Likert scale. Participants were asked to rank each item identifying its importance in influencing length of hospital stay; 1 = strongly disagree, 2 = disagree, 3 = neither disagree nor agree, 4 = agree, 5 = strongly agree. Interviews were semi-structured exploring participant perceptions.Findings Twenty-six participants completed both interviews and questionnaires; three completed questionnaires only. Five themes affecting LOS emerged from interview data analysis; medical conditions, age and frailty, psychological aspects, the recovery process and social issues. There were some differences between the importance attributed by the semi-quantitative rating scales and the qualitative themes generated. Quantitative data suggested medical factors (pulmonary, infectious, gastrointestinal, cardiovascular, neurological, haematological, wound and pain). The interviews however highlighted functional and social aspects of recovery as key for patients and relative participants.Conclusion Recovery and discharge from hospital following hip fracture is understood by patients, carers or staff to be a complex interplay between medical conditions, psychosocial factors and the practicalities of living with increased dependency. Approaches to improving outcome will need to address each of these domains if they are to be effective.

Background: anaemia following hip fracture is common and associated with worse outcomes. Intravenous iron is a potential non-transfusion treatment for this anaemia and has been found to reduce transfusion rates in previous observational studies. There is good evidence for its use in elective surgical populations.Objective: to examine the impact of intravenous iron on erythropoiesis following hip fracture.Design: two-centre, assessor-blinded, randomised, controlled trial of patients with primary hip fracture and no contra-indications to intravenous iron.Method: the intervention group received three doses of 200 mg iron sucrose over 30 min (Venofer, Vifor Pharma, Bagshot Park, UK) on three separate days. Primary outcome was reticulocyte count at day 7 after randomisation. Secondary outcomes included haemoglobin concentration, complications and discharge destination. Eighty participants were randomised.Results: there was a statistically significantly greater absolute final reticulocyte count in the iron group (89.4 (78.9–101.3) × 109 cells l−1 (n = 39) vs. the control (72.2 (63.9–86.4)) × 109 cells l−1 (n = 41); P = 0.019; (mean (95% confidence intervals) of log-transformed data). There were no differences in final haemoglobin concentration (99.9 (95.7–104.2) vs. 102.0 (98.7–105.3) P = 0.454) or transfusion requirements in the first week (11 (28%) vs. 12 (29%); P = 0.899). Functional and safety outcomes were not different between the groups.Conclusions: although intravenous iron does stimulate erythropoiesis following hip fracture in older people, the effect is too small and too late to affect transfusion rates. Trial Registry Numbers: ISRCTN:76424792; EuDRACT: 2011-003233-34.