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NHS ward accreditation programmes and their effects on driving improvements in patient care standards and safety: a literature review
No full textWard accreditation programmes provide ward-to-board assurances of quality and safety, and have been implemented in NHS settings for a number of years. Locally implemented ward accreditation programmes aim to standardise care delivery, support clinical governance and foster continuous quality improvement, but the evidence on whether such programmes lead to improvements in patient care and safety is yet to be established. This article reports the findings of a literature review that explored whether ward accreditation programmes drive improvements in standards of patient care and safety in NHS settings. The findings suggest that ward accreditation programmes are drivers for identifying and communicating measurable improvements in patient care and safety outcomes, and can support identification of areas requiring improvement and highlight areas of excellence. However, it is vital that care standards and evaluation methods are continually reviewed, improved and updated to reflect current policy, recommendations and evidence. Further research is required to assess the clinical effectiveness and cost-effectiveness of NHS ward accreditation programmes and to inform future quality and safety initiatives.https://journals.rcni.com/nursing-management/evidence-and-practice/nhs-ward-accreditation-programmes-and-their-effects-on-driving-improvements-in-patient-care-standards-and-safety-a-literature-review-nm.2025.e2166/ab
Quantitative and qualitative outcomes of Non-Violent Resistance interventions for children and adolescents with emotional and behavioural difficulties and their caregivers – a systematic review
No full textBackground Non-Violent Resistance (NVR) is an approach of parent training developed to respond to child behavioural difficulties including aggression and risk-taking behaviours. NVR is offered in child and adolescent mental health services across Europe. There has been no published systematic review exploring the effectiveness of this intervention to date. We therefore aimed to examine the outcomes of NVR training for children, adolescents and their caregivers.Methods A systematic literature search was conducted using multiple databases. Critical appraisal skills programme checklists were used to appraise the quality of studies.Results We identified five randomised controlled trials, two simple ‘before and after’ studies, two qualitative studies, one study reporting mixed outcomes and nine articles including case reports. A range of different outcome measures were reported. Overall, the review suggests that NVR shows promise in improving parent-reported child behavioural difficulties, such as externalising symptoms. There is also evidence of improvement in areas of parents’ helplessness, stress and behaviours. However, it is unclear if these outcomes are maintained in the longer term.Conclusions Overall, the evidence base for NVR is relatively limited, especially for informing service provision and commissioning decisions. Further research with RCTs, larger sample sizes and longer follow-up is required to enhance the evidence base.Plain language summaryNon-Violent Resistance (NVR) is a parent training programme that was developed to enable parents and carers to respond constructively towards their child’s challenging behaviours. NVR is offered by some child and adolescent mental health services across Europe. There have been no published reviews of literature exploring the benefits of this intervention so far. In our research, we have analysed the outcomes of NVR training for parents and other carers, such as foster carers. A systematic literature search was completed, and 19 published articles were included in the review. The outcomes from the review were variable. Overall, the review suggests that NVR shows promise in improving parent-reported child behavioural difficulties, such as aggression and self-harm. There is also evidence of improvement in areas of parents’ feelings of helplessness and levels of stress. However, it is unclear if these improvements are maintained over the years. Overall, the existing research for NVR is relatively limited, especially in regard to designing service delivery and interventions. Further research with robust methodology, larger sample sizes and longer follow-up is required to enhance the evidence base.https://journals.sagepub.com/doi/abs/10.1177/0308575925134041
The Implications of Type 1 Diabetes Mellitus Associated with Coeliac Disease.
No full textT1D and CD commonly occur together. This association has received increasing attention from researchers and is considered in detail in this review. Since CD is over-represented in T1D, it may cause ill health with attendant complications, but because there is an effective dietary treatment, screening has been recommended in children and adults. However, there are many unknowns regarding this association, and understanding the why, when, and how with regard to screening and managing those with dual diagnoses requires thorough consideration when introducing the concept of screening to patients. It is important that patients and, where appropriate, carers are put at the heart of the decision-making process with careful discussion of the issues involved before undertaking screening that might uncover a second life-changing diagnosis, for which, without preparatory preparation and support, individuals may be ill-prepared, causing mental health issues. For some patients, an initial policy of monitoring rather than moving to immediate small bowel biopsy and exposure to a gluten-free diet (GFD) will be appropriate. The correct management of patients will ultimately improve their quality of life medically and socially
Toward Standardized Performance Metrics in the Cardiovascular ICU: A Systematic Review of Quality Indicators.
Get PDFThe cardiovascular intensive care unit (CVICU) requires robust quality indicators (QIs) to standardize performance measurement and improve patient outcomes. However, heterogeneity in QI definitions, measurement tools, and implementation practices persists. This systematic review synthesizes evidence on CVICU QIs, evaluates their methodological rigor, and proposes a framework for standardization. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched PubMed, Embase, Scopus, Web of Science, and CINAHL for relevant studies. Eight studies met the inclusion criteria, encompassing retrospective cohorts, predictive models, and mixed-methods designs. Quality assessment employed the Newcastle-Ottawa Scale (NOS) for cohort studies and the Mixed Methods Appraisal Tool (MMAT) for non-randomized studies. Narrative synthesis categorized QIs by Donabedian domains (structure, process, outcome). Included studies (n=8) predominantly focused on outcome QIs (5/8 studies), particularly mortality prediction using machine learning. Risk of bias was moderate to high, with most studies lacking prospective validation or objective measurements. Structural QIs were especially underrepresented, and although Delphi methods were employed, they lacked external validation and reproducibility, limiting generalizability. Process QIs relied on subjective surveys, while structural QIs lacked robust measurement frameworks. Alignment with Donabedian and Institute of Medicine (IOM) frameworks was reported in 6/8 studies, yet consistency in application was limited. CVICU QIs prioritize outcome measurement through artificial intelligence (AI)-driven tools but lack standardization in the development, validation, and operationalization of process and structural indicators. Future work should (1) validate predictive models in multicenter, prospective settings, (2) develop objective and reproducible process metrics, and (3) expand structural QIs for global applicability, accounting for resource constraints, variability in infrastructure, and cultural differences in care delivery. Given the limited number of studies, findings should be interpreted cautiously and considered hypothesis-generating rather than definitive. This review informs efforts to harmonize CVICU performance measurement
Key outcomes for a vocational rehabilitation intervention for people with multiple sclerosis : a nominal group technique study
Get PDFThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly
cited.
© 2025 The Author(s). Health Expectations published by John Wiley & Sons LtdBACKGROUND: Job retention vocational rehabilitation (VR) interventions for people with multiple sclerosis (MS) can positively impact a person's independence and directly influence health and employment outcomes. However, evaluating the effectiveness of VR interventions can be challenging due to their highly individualised nature and the diverse range of potential health and employment outcomes that may be impacted. AIM: To identify the most important outcomes of a job retention VR intervention from the perspective of people with MS. DESIGN: A nominal group technique (NGT) was conducted with people with MS using Microsoft Teams and Microsoft Forms. The study involved completing a demographic questionnaire, being introduced to VR, silently generating ideas, round-robin discussions, ranking outcomes and reaching a consensus. NGT data were analysed using thematic analysis. RESULTS: We conducted two NGTs involving 10 participants with MS. Nine outcomes were identified and ranked based on priority, relating to four themes: (1) Employer support and collaboration; (2) Empowerment; (3) Symptom management and progression and (4) Professional well-being and performance. CONCLUSION: Improvements in employer support and symptom management were seen as key outcomes for VR interventions that could eventually lead to enhanced work performance and job retention for people with MS. Future research should explore how feasible it is to collect these outcomes to ascertain the impact of VR on employment over time. Due to the complexity of the outcomes identified, there may be a need to develop new outcome measures with improved validity and sensitivity to these interventions. PATIENT OR PUBLIC CONTRIBUTION: This study is part of a larger project co-developed with three people MS. A lead patient and public involvement representative and lay co-author reviewed the study topic guide to improve clarity and study focus and supported the group discussions and data analysis with input from the lead researcher.https://onlinelibrary.wiley.com/doi/full/10.1111/hex.7026
Mental health and resilience in young people on Saint Helena Island
Get PDF© The Author(s) 2024 CC BY 4.0This study explored the mental health needs and strengths of young people (aged 11-18 years) living on the remote island of Saint Helena (SH). 24 young people and their carers completed standardised inventories assessing mental health and resilience, of whom 15 of the young people and their carers participated in semi-structured interviews enquiring into mental health awareness, contributing factors to young people's mental health and resilience, as well as experience with local mental health services. Descriptive data were reported based on the quantitative measures and thematic analysis was applied to the interview transcripts. A number of young people were found to meet criteria for mental health problems while they showed high levels of resilience. The themes derived from young people's interviews were broadly centred around mental health boosters, including personal successes, social interactions, engagement in pleasurable activities and use of anxiety management strategies; and around limitations of living in SH in terms of limited resources and difficulty in maintaining trust in the community. From the carers, the themes revolved around awareness of mental health needs and strengths in young people, perceived barriers to access support mainly due to apprehensions around stigma and anonymity. Recommendations for improvement of mental health provision are made.https://journals.sagepub.com/doi/full/10.1177/13591045241284326?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.or
Safety, feasibility, and tolerability of ten days of at-home, remotely supervised tDCS during gamified attention training in children with acquired brain injury : an open-label, dose-controlled pilot trial
Get PDF2025 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license
(https://creativecommons.org/
licenses/by/4.0/).Background/Objectives: Chronic attention problems occur in approximately 25% of children after acquired brain injury (ABI). When delivered daily, transcranial direct current stimulation (tDCS) may improve attention; however, access to daily in-clinic tDCS treatment can be limited by other commitments, including concurrent therapy, school commitments, and caregiver schedules. Treatment access can be improved through home-based interventions, though these require several practical and safety considerations in a pediatric ABI population. This study evaluated the safety, feasibility, and tolerability of remotely monitored at-home tDCS during online gamified attention training in pediatric ABI. Methods: We conducted a randomized, single-blind, dose-controlled clinical trial of at home tDCS in Brisbane, Australia (10 tDCS sessions; 20 min; 1 mA or 2 mA; bilateral dorsolateral prefrontal cortex). Participants attended our clinic at baseline for clinical assessments, fitting of the personalized tDCS headband, and training in how to use tDCS at home. All sessions were remotely supervised using live videoconferencing. We assessed the feasibility and tolerability of at-home tDCS and our customized, personalized at-home tDCS headband as primary outcomes. As secondary outcomes, we evaluated changes in functional connectivity (fc) and reaction time (RT). Results: Seventy-three participants were contacted over six months (January-June 2023) and ten were enrolled (5 males; mean age: 12.10 y [SD: 2.9]), satisfying a priori recruitment timelines (CONSORT reporting). All families successfully set up tDCS and completed attention training with excellent protocol adherence. There were no serious adverse events over the 100 total sessions. Nine participants completed all stimulation sessions (1 mA: n = 5, 2 mA: n = 4). Participants in the 2 mA group reported greater tingling, itching, and discomfort (all p < 0.05). One participant in the 1 mA group was unable to complete all sessions due to tolerability challenges; however, these challenges were resolved in the second half of the intervention by gradually increasing the stimulation duration across the 10 days alongside additional coaching and support. Conclusions: Overall, daily remotely supervised at-home tDCS in patients with pediatric ABI is safe, feasible, and tolerable. Our results support larger, sham-controlled efficacy trials and provide a foundation for the development of safe and effective at-home stimulation therapeutics that may offer targeted improvement of neurocognitive symptoms in children.https://www.mdpi.com/2076-3425/15/6/56
The weight of existence : suicide, self-harm and health inequalities in transgender populations - Article 2
No full textThis series explores the experiences of the transgender community with regards to mental health conditions, suicide, self-harm and systemic and socio-political barriers that impact their access to care. The second article in the series will explore health inequalities within the trans population in the UK, looking at how policy, politics and clinical practice shape people's wellbeing.https://www.magonlinelibrary.com/doi/full/10.12968/bjha.2025.003
Co-prescribing of antidepressants and opioids for non-cancer pain in England, 2010-2019 : a descriptive study using CPRD primary care electronic health records
Get PDF© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use,
sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and
the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this
article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included
in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder.BACKGROUND: There is a complex relationship between pain and mood disorders, and interactions between opioids and antidepressants can affect the effectiveness and adverse effects of these medicines when taken together. However, little is known about the scale of co-prescription for these medicines. METHODS: We used routinely collected primary care data from the Clinical Practice Research Datalink to describe the extent of opioid and antidepressant co-prescribing in over 4.3 million adults in England. Linked data included deprivation information and hospital episode statistics admitted patient care data to improve completeness of ethnicity information. We identified all primary care prescriptions of opioids and antidepressants between 2010 and 2019 and counted if an opioid and antidepressant prescription overlapped, and if so, for how long. People were censored at the first date of a record of cancer, terminal illness, heart failure or opioid misuse. RESULTS: There were 4,355,694 people included in the study population. Of these, 304,029 (7.0%) had an opioid and antidepressant co-prescribed at least once during the study period. The prevalence of co-prescribing increased from 35.8 per 1000 person-years in 2010 to 44.1 in 2015 and then decreased to 39.2 in 2019. Co-prescribing rates were higher in females, older age groups, people living in more deprived areas and the White ethnic group. The overall median length of the opioid and antidepressant co-prescriptions was 29 days (interquartile range: 17 to 51 days). The most commonly co-prescribed medicines were codeine and amitriptyline, co-prescribed 235,017 times to 87,274 people. The second most commonly co-prescribed combination was codeine and citalopram, co-prescribed 55,792 times to 158,812 people. Combinations of opioids and antidepressants both metabolised by CYP2D6 were also common. CONCLUSIONS: There is a substantial group of people co-prescribed opioids and antidepressants in England, including combinations that may be less effective. This information will be useful to help GPs, dispensing professionals, policymakers and others understand how many people in the UK may be at risk of harm from using both types of medicines at the same time, and which groups are particularly affected. Future research should determine whether there are higher risks of adverse events in these co-prescribed groups.https://bmcprimcare.biomedcentral.com/articles/10.1186/s12875-025-02956-
Digital transformation of robotic surgery train the trainer 'TTT' courses: training the trainer in technique and technology (the 4Ts course).
Get PDFAs the role of robot-assisted surgery continues to expand there has been as an associated proliferation of novel technologies to aid training. Necessitating the development of standardised and validated training programmes that incorporate guidance on curriculum development with training techniques, and where and when to utilise novel training technologies. To provide guidance on an optimised "Train-the-Trainer in Technique and Technology" (4Ts) structured educational programme for surgical trainers, in which delegates learn a standardised approach to training candidates in knowledge and skills acquisition both for surgery and the utilisation of novel training technologies. We aim to describe a 4Ts course for robotic surgery based on the current published literature and to define the key elements within a 4Ts course by seeking consensus from an expert committee formed of key opinion leaders in training and MedTech industry. The project was carried out in phases: a systematic review of the current evidence was conducted, a hybrid meeting was held, and an initial survey was created based on the current literature and expert opinion and sent to the committee. Twenty experts in robotic training, contributed to the Delphi process that included clinicians, academics, and industry representing nine different surgical specialties and seven different robotic companies. An accelerated Delphi process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. Consensus opinion was defined as 80% agreement. There was 100% consensus that there was a need for a standardized platform agnostic 4Ts course in robotic surgery. A consensus was reached in multiple areas, including the following: (1) definitions and terminologies, (2) qualifications to attend, (3) course objectives, (4) pre-course considerations, (5) requirements of e-learning, (6) theory and course content, and (7) measurement of outcomes and (8) performance certification and regulation. The resulting formulated curriculum showed good internal consistency among experts, with a Cronbach alpha of 0.90. An evidence-based consensus has been achieved to reach content validation for guidance on a 4Ts curriculum for robotic surgery training. This recommended content lays the foundation for developing platform agnostic metric-based progression curricula for trainers in robotic surgery. Future 4Ts curricula related to procedural training will require further validation. As the role of robot-assisted surgery continues to expand, development of standardised and validated training programmes is becoming increasingly important. There is currently a lack of agreement on how best to train trainers in both training and awareness of novel training technologies. We report a consensus view on a standardised "4Ts" curriculum focused on robotic surgery. It was formulated by polling the opinions of experts and industry, combining current evidence for training technologies with experts' knowledge of surgical training