Seilin Uhm

Purpose: The purpose of this study is to synthesise empirical evidence on the factors that enable or hinder diversion of prescribed medicines in prison populations. Design/methodology/approach: A systematic review of primary studies published in English between January 2018 and 31 July 2025 was undertaken in MEDLINE, CINAHL and PubMed. Methodological quality was appraised with the Long-French & Brooks adaptation of CASP. Findings were integrated through narrative synthesis and mapped against Smith’s Model of Addiction. Findings: Seven studies met the criteria (six qualitative, one mixed-methods; n = 239 participants were involved in six papers; one paper stated they interviewed 11 jails rather than participants). Study samples were drawn from the UK and the USA except May et al. (2020), which was conducted in Wales. In all, 12 recurring determinants were clustered within three domains: institutional (e.g. dispensing procedures and staffing levels), social (e.g. peer hierarchies and informal economies) and individual (e.g. pain management needs and substance-use history). Some determinants acted as both barriers and facilitators depending on local configuration. The interplay of environment, behaviour and personal agency suggests that single-level interventions are unlikely to curb diversion sustainably. Research limitations/implications: Evidence is predominantly from US jail/prison contexts with limited demographic diversity; more UK/EU prison research is needed. Practical implications: This study co-designed dispensing protocols, person-centred communication training and expanded access to MOUD (including diversion-resistant formulations) warrant testing. Social implications: Medication diversion in prisons has wider social consequences beyond clinical risk. It can fuel informal trading economies, debt, intimidation and violence and can undermine trust between people in prison and health-care staff. Fear of diversion may lead to restrictive dispensing practices that reduce timely access to legitimate therapies, potentially widening health inequalities and increasing relapse and self-harm risk. Addressing diversion, therefore, supports safer prison communities, improves equitable access to care and strengthens continuity of treatment on release. Originality/value: This study co-designed dispensing protocols, person-centred communication training and expanded access to Medication for Opioid Use Disorder (MOUD) (including diversion-resistant formulations) warrant development and testing.

Background: Pediatric end‐of‐life care profoundly impacts families, yet existing reviews on bereaved parents' experiences lack methodological rigor and comprehensive synthesis. Identifying key quality indicators from parents' perspectives is essential for improving care. Objectives: This scoping review synthesizes evidence on bereaved parents' views of high‐quality pediatric end‐of‐life care, identifying critical domains and developing a thematic framework. Methods: We conducted a scoping review adhering to PRISMA‐ScR guidelines. Searches in MEDLINE, CINAHL, PsycINFO, PsycArticles, and AMED included studies without date restrictions. Two reviewers independently screened studies, extracted data, and conducted inductive thematic analysis. Results: From 4962 records, 20 studies (1997–2015) met inclusion criteria, comprising 16 qualitative and 4 quantitative studies. Three themes emerged: (1) Interpersonal Interaction (compassionate communication, shared decision‐making); (2) Interdisciplinary Care (symptom management, emotional, spiritual, and sibling support); and (3) Practical Support (care accessibility, skilled staff, financial/logistical assistance). Conclusions: Bereaved parents advocate for a holistic, family‐centred approach integrating empathetic communication, clinical expertise, and systemic support. These findings inform quality improvement initiatives and policy development in pediatric palliative care.

Objective: The prevalence of children needing palliative or end-of-life care is increasing. However, no comprehensive tool exists to assess the experiences of such care. We describe the development and testing of VOICES-Children (VOICES-C): the first questionnaire to assess care experiences of palliative and end-of-life services for children aged 0 to 18 years in the last 3 months of life. Methods: VOICES-Children was developed in 3 phases: (1) a literature review of care quality domains, parent interviews, healthcare professional (HCP) focus-groups/interviews, data integration, and prototype development; (2) prototype testing through HCP and parent interviews; and (3) completion of VOICES-C. In phase 1, 24 parents were interviewed, 38 HCPs (critical care nurses, physicians, palliative care staff, and specialist palliative care service staff) participated in focus groups, and 3 took part in an interview. Participants were recruited from 2 neonatal intensive care units, 2 pediatric intensive care units, 1 cardiac intensive care unit, and a children's specialist palliative care service. In phase 2, 10 HCPs and 14 parents were interviewed. Results: Data integration identified 19 meta-themes, including the importance of space, and the timing and amount of information. Testing demonstrated that VOICES-C captured parent experiences effectively. The final questionnaire comprised 83 questions about home care, the pediatric setting, and experiences of the last 2 days of life. Conclusions: VOICES-Children uses literature, experience data, and parental insights to produce a robust questionnaire of pediatric end-of-life care experience, administered postbereavement, that can be applied across healthcare settings. By assessing quality, services can be improved and inequities in delivery reduced.

With the increasing number of research priority setting (RPS) exercises, systematic reviews synthesising their findings have also grown in prevalence. While these reviews offer a structured way to compare methodologies, identify underrepresented stakeholder groups, and guide funding decisions, conventional systematic review methodologies, designed primarily for clinical and health research, often fail to capture the complexity, contextual nuance, and participatory nature of RPS. In this commentary, we critically examine these limitations and propose methodological adaptations to enhance the relevance and utility of systematic reviews of RPS. Beyond knowledge generation, we highlight the broader implications of RPS, including its role in stakeholder engagement, research funding allocation, and policy translation, as well as its impact on how these exercises are synthesised. By re‐evaluating how systematic reviews of RPS are conducted, we advocate for context‐sensitive methodologies that better reflect the dynamic and iterative nature of research priority setting.

Background: We report a process to identify and prioritise research questions in preterm birth that are most important to people affected by preterm birth and healthcare practitioners in the United Kingdom and Republic of Ireland. Methods: Using consensus development methods established by the James Lind Alliance, unanswered research questions were identified using an online survey, a paper survey distributed in NHS preterm birth clinics and neonatal units, and through searching published systematic reviews and guidelines. Prioritisation of these questions was by online voting, with paper copies at the same NHS clinics and units, followed by a decision-making workshop of people affected by preterm birth and healthcare professionals. Results: Overall 26 organisations participated. Three hundred and eighty six people responded to the survey, and 636 systematic reviews and 12 clinical guidelines were inspected for research recommendations. From this, a list of 122 uncertainties about the effects of treatment was collated: 70 from the survey, 28 from systematic reviews, and 24 from guidelines. After removing 18 duplicates, the 104 remaining questions went to a public online vote on the top 10. Five hundred and seven people voted; 231 (45%) people affected by preterm birth, 216 (43%) health professionals, and 55 (11%) affected by preterm birth who were also a health professional. Although the top priority was the same for all types of voter, there was variation in how other questions were ranked. Following review by the Steering Group, the top 30 questions were then taken to the prioritisation workshop. A list of top 15 questions was agreed, but with some clear differences in priorities between people affected by preterm birth and healthcare professionals. Conclusions: These research questions prioritised by a partnership process between service users and healthcare professionals should inform the decisions of those who plan to fund research. Priorities of people affected by preterm birth were sometimes different from those of healthcare professionals, and future priority setting partnerships should consider reporting these separately, as well as in total.