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Background: Patients who are critically ill are at increased risk of hospital acquired pneumonia and ventilator associated pneumonia. Effective evidence based oral care may reduce the incidence of such iatrogenic infection. Aim: To provide an evidence‐based British Association of Critical Care Nurses endorsed consensus paper for best practice relating to implementing oral care, with the intention of promoting patient comfort and reducing hospital acquired pneumonia and ventilator associated pneumonia in critically ill patients. Design: A nominal group technique was adopted. A consensus committee of adult critical care nursing experts from the United Kingdom met in 2018 to evaluate and review the literature relating to oral care, its application in reducing pneumonia in critically ill adults and to make recommendations for practice. An elected national board member for the British Association of Critical Care Nurses chaired the round table discussion. Methods: The committee focused on 5 aspects of oral care practice relating to critically ill adult patients. The evidence was evaluated for each practice within the context of reducing pneumonia in the mechanically ventilated patient or pneumonia in the non‐ventilated patient. The five practices included the frequency for oral care; tools for oral care; oral care technique; solutions used and oral care in the non‐ventilated patient who is critically ill and is at risk of aspiration. The group searched the best available evidence and evaluated this using the Grading of Recommendations Assessment, Development, and Evaluation system to assess the quality of evidence from high to very low, and to formulate recommendations as strong, moderate, weak, or best practice consensus statement when applicable. Results: The consensus group generated recommendations, delineating an approach to best practice for oral care in critically ill adult patients. Recommendations included guidance for frequency and procedure for oral assessment, toothbrushing, and moisturising the mouth. Evidence on the use of chlorhexidine is not consistent and caution is advised with its routine use. Conclusion: Oral care is an important part of the care of critically ill patients, both ventilated and non‐ventilated. An effective oral care programme reduces the incidence of pneumonia and promotes patient comfort. Relevance to Clinical practice: Effective oral care is integral to safe patient care in critical care. [ABSTRACT FROM AUTHOR]

Background: In 2016/17, the CATALISE Consortium published the results of a multinational and multidisciplinary Delphi consensus study, representing agreement among professionals about the definition and process of identification of children with Developmental Language Disorder (DLD) (Bishop et al., 2016, 2017). The extent to which the current clinical practice of UK speech and language therapists (SLTs) reflects the CATALISE consensus statements is unknown. Aims: To investigate how UK SLTs' expressive language assessment practices reflect the CATALISE documents' emphasis on the functional impairment and impact caused by DLD, by examining: whether multiple sources of assessment information are gathered; how standardised and non‐standardised sources are combined in clinical decision‐making, and how clinical observation and language sample analysis are utilised. Methods and Procedures: An anonymous, online survey was carried out between August 2019 and January 2020. It was open to UK‐based paediatric SLTs who assess children up to age 12 with unexplained difficulties using language. Questions probed different aspects of expressive language assessment which are referred to in the CATALISE consensus statements and supplementary comments, and asked about participants' familiarity with the CATALISE statements. Responses were analysed using simple descriptive statistics and content analysis. Outcomes and Results: The questionnaire was completed by 104 participants, from all four regions of the United Kingdom, working in a range of clinical settings with different levels of professional experience of DLD. The findings indicate that clinical assessment practices broadly align with the CATALISE statements. Although clinicians carry out standardised assessments more frequently than other types of assessment, they also gather information from other sources and use this alongside standardised test scores to inform clinical decisions. Clinical observation and language sample analysis are commonly utilised to evaluate functional impairment and impact, along with parent/carer/teacher and child report. However, asking about the child's own perspective could be more widely utilised. The findings also highlight a lack of familiarity with the details of the CATALISE documents among two thirds of the participants. Conclusions and Implications: Assessment practices broadly align with the CATALISE statements, but there is a need for greater clarity regarding terminology and the assessment of functional language impairment and impact. This research should prompt discussion in the profession about how to further develop and adopt expressive language assessment practices which reflect the CATALISE consensus and support effective assessment. What This Paper Adds: What is already known on the subject: The CATALISE consortium documents on Developmental Language Disorder (DLD) were published in 2016/17. The extent to which expressive language assessment practice in the United Kingdom reflects the new definition and statements on assessment has not previously been investigated. What this paper adds to existing knowledge: This survey indicates that speech and language therapists in the United Kingdom assessing children for DLD mostly balance standardised language test scores with other sources of information in clinical decision‐making, and utilise clinical observation and language sample analysis to consider functional impairment and the impact of the language disorder. However, important questions are raised regarding the robustness and objectivity with which these key parameters are currently defined and evaluated. What are the potential or actual clinical implications of this work?: Clinicians, individually and at service level, are encouraged to reflect on their assessment of functional impairment and the impact of language disorder and to take steps to incorporate this where necessary. Professional guidance and clinical tools to facilitate robust, objective assessment would support clinical practice that aligns with expert consensus. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to report on the dynamics of "identity leadership" with a quality improvement project undertaken by an International Medical Graduate (IMG) from Sri Lanka, on a two year Medical Training Initiative (MTI) placement in the National Health Service (NHS) [Academy of Medical Royal Colleges (AoMRC), 2017]. A combined MTI rotation with an integrated Fellowship in Quality Improvement (Subedi et al., 2019) provided the driver to implement the HEART score (HS) in an NHS Emergency Department (ED) in the UK. The project was undertaken across ED, Acute Medicine and Cardiology at the hospital, with stakeholders emphasizing different and conflicting priorities to improve the pathway for chest pain patients. Design/methodology/approach: A social identity approach to leadership provided a framework to understand the insider/outsider approach to leadership which helped RH to negotiate and navigate the conflicting priorities from each departments' perspective. A staff survey tool was undertaken to identify reasons for the lack of implementation of a clinical protocol for chest pain patients, specifically with reference to the use of the HS. A consensus was reached to develop and implement the pathway for multi-disciplinary use of the HS and a quality improvement methodology (with the use of plan do study act (PDSA) cycles) was used over a period of nine months. Findings: The results demonstrated significant improvements in the reduction (60%) of waiting time by chronic chest pain patients in the ED. The use of the HS as a stratified risk assessment tool resulted in a more efficient and safe way to manage patients. There are specific leadership challenges faced by an MTI doctor when they arrive in the NHS, as the MTI doctor is considered an outsider to the NHS, with reduced influence. Drawing upon the Social Identity Theory of Leadership, NHS Trusts can introduce inclusion strategies to enable greater alignment in social identity with doctors from overseas. Research limitations/implications: More than one third of doctors (40%) in the English NHS are IMGs and identify as black and minority ethnic (GMC, 2019a) a trend that sees no sign of abating as the NHS continues its international medical workforce recruitment strategy for its survival (NHS England, 2019; Beech et al., 2019). IMGs can provide significant value to improving the NHS using skills developed from their own health-care system. This paper recommends a need for reciprocal learning from low to medium income countries by UK doctors to encourage the development of an inclusive global medical social identity. Originality/value: This quality improvement research combined with identity leadership provides new insights into how overseas doctors can successfully lead sustainable improvement across different departments within one hospital in the NHS. [ABSTRACT FROM AUTHOR]

Introduction: The role of the clinical nurse specialist is complex but is defined differently across the world. The role of clinical nurse specialist stoma care is undefined and it is uncertain what aspects of the role are included in the general day‐to‐day working role. Aims: The aim was to gain consensus opinion to answer the research question: 'What is the role of the clinical nurse specialist in stoma care?' Design: Delphi consensus. Methods: Previous data gained from a scoping review and expert consultation was utilized to form role statements. At a UK conference the 13 statements and 173 sub‐categories were voted upon. Consensus was agreed if 75% of voters voted agree or strongly agree. Two stages of voting occurred with results from the first vote being shared in the second voting session. Results: All 13 statement and most (150/193) statement sub‐categories reached consensus, with 20 sub‐categories added during voting session one. Conclusions: The four pillars of advanced practice were met by the 13 statements with clinical and education reaching higher consensus and agreement than leadership/management and research. The results of the consensus study provide a clearer articulation of the clinical nurse specialist stoma care role, which is complex and multifaceted which has not been described previously. Implications for Practice: Consideration of role evolution is made possible, to gain a greater expertise in the scope of practice it is necessary to include prescribing, management and research which could improve service delivery and optimize patient outcomes. There was no patient or public contribution, which in hindsight would have potentially improved the process but it was considered that patients might not recognize the full role of the nurse, understanding only aspects of the role that were patient‐centred. Patient or Public Contribution: No patients or public were involved in any aspect of this paper—in hindsight this might have been useful. [ABSTRACT FROM AUTHOR]

Introduction: Major trauma centre (MTC) care has been associated with improved outcomes for injured patients. English ambulance services and trauma networks currently use a range of triage tools to select patients for bypass to MTCs. A standardised national triage tool may improve triage accuracy, cost-effectiveness and the reproducibility of decision-making. Methods: We conducted an expert consensus process to derive and develop a major trauma triage tool for use in English trauma networks. A web-based Delphi survey was conducted to identify and confirm candidate triage tool predictors of major trauma. Facilitated roundtable consensus meetings were convened to confirm the proposed triage tool’s purpose, target diagnostic threshold, scope, intended population and structure, as well as the individual triage tool predictors and cut points. Public and patient involvement (PPI) focus groups were held to ensure triage tool acceptability to service users. Results: The Delphi survey reached consensus on nine triage variables in two domains, from 109 candidate variables after three rounds. Following a review of the relevant evidence during the consensus meetings, iterative rounds of discussion achieved consensus on the following aspects of the triage tool: reference standard, scope, target diagnostic accuracy and intended population. A three-step tool comprising physiology, anatomical injury and clinical judgement domains, with triage variables assessed in parallel, was recommended. The triage tool was received favourably by PPI focus groups. Conclusions: This paper presents a new expert consensus derived major trauma triage tool with defined purpose, scope, intended population, structure, constituent variables, variable definitions and thresholds. Prospective evaluation is required to determine clinical and cost-effectiveness, acceptability and usability. [ABSTRACT FROM AUTHOR]

Background: Despite global efforts to improve paediatric clinical trials, significant delays continue in paediatric drug approvals. Collaboration between research networks is needed to address these delays. This paper is a first step to promote interoperability between paediatric networks from different jurisdictions by comparing drivers for, and content of, metrics about clinical trial conduct. Methods: Three paediatric networks, Institute for Advanced Clinical Trials for Children, the Maternal Infant Child and Youth Research Network and conect4children, have each developed metrics to address delays and create efficiencies. We identified the methodology by which each network identified metrics, described the metrics of each network, and mapped consistency to come to consensus about core metrics that networks could share. Results: Metric selection was driven by site quality improvement in one network (11 metrics), by network performance in one network (13 metrics), and by both in one network (five metrics). The domains of metrics were research capacity/capability, site identification/feasibility, trial start-up, and recruitment/enrolment. The network driven by site quality improvement did not have indicators for capacity/capability or identification/feasibility. Fifteen metrics for trial start up and conduct were identified. Metrics related to site approvals were found in all three networks. The themes for metrics can inform the development of 'shared' metrics. Conclusion: We found disparity in drivers, methodology and metrics. Tackling this disparity will result in a unified approach to addressing delays in paediatric drug approvals. Collaborative work to define inter-operable metrics globally is outlined. [ABSTRACT FROM AUTHOR]

Purpose: Recently, there have been renewed calls to place social workers in schools. Although these are not unchartered waters, contextual understandings of safeguarding have reaffirmed the centrality of schools in the lives of young people and keeping them safe. Yet, schools can only do so much to support young people. Safeguarding practice reviews continue to highlight the shortcomings of contextless assessment. This paper aims to make the case for a broader approach to safeguarding practice by placing social workers in schools. Design/methodology/approach: A scoping review was undertaken to elicit social workers in schools (SWIS) literature from the UK, as well as international examples. Keyword searches revealed a lack of consensus on shared/agreement terminology for SWIS. The literature was organised thematically, as a mechanism to open up the extent, range and nature of research activity in relation to SWIS. Findings: Findings are presented in three themes: misunderstandings of SWIS – what do they actually do?; micro versus macro interventions; and the concept of reach. Research limitations/implications: The main implications of this study are to sharpen the focus on the centrality of schools in the lives of children and young people; to expand school-based initiatives as a way to reach young people at risk; to re-centre practice to local, community orientation with an emphasis on early help; and to bring together pockets of good practice and learn from successful partnership models. Originality/value: Little attempt has been made to contemplate the past and present and rethread school-based initiatives. There is an absence of attention afforded to the theoretical foundations of SWIS. This paper identifies a gap in interest from the early iterations of SWIS, with a recent upsurgence in attention. [ABSTRACT FROM AUTHOR]

Currently in the UK and Ireland, after a hip fracture most patients do not receive bone protection medication to reduce the risk of refracture. Yet randomised controlled trial data specifically examining patients with hip fracture have shown that intravenous zoledronate reduces refracture risk by a third. Despite this evidence, use of intravenous zoledronate is highly variable following a hip fracture; many hospitals are providing this treatment, whilst most are currently not. A range of clinical uncertainties, doubts over the evidence base and practical concerns are cited as reasons. This paper discusses these concerns and provides guidance from expert consensus, aiming to assist orthogeriatricians, pharmacists and health services managers establish local protocols to deliver this highly clinically and cost-effective treatment to patients before they leave hospital, in order to reduce costly re-fractures in this frail population. [ABSTRACT FROM AUTHOR]

'Levelling up' is a new term to add to the economic and political lexicon for the well-known but intractable problem of the uneven performance of the UK economy over the past century. The component parts of the national economy — the regions — mostly have not performed well enough to ensure the UK performs better than its close economic rivals. To convert laggards into leaders can be done, but it requires time, political consensus and a lot of radical thinking: the past tells us very little about the future. A UK economy firing on all cylinders can be a world-beater. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present an examination of the development of adult safeguarding policy from the perspectives of both policymakers and those who have sought to influence policy, to empower individuals with a learning disability to have a say in how policies, that influence their life and impact their right to independence, are developed. Design/methodology/approach: This paper is based on a project which was led by a UK-wide interdisciplinary and multi-agency team, which included the central involvement of peer researchers who had lived experience of learning disability. It was based on a participatory disability research design. Findings: Factors which enabled or restrained individuals with a learning disability, and their supporting organisations, from getting their voice heard in policy development, are identified. Originality/value: This paper builds on policy theory and research, making recommendations for policy makers, disabled people and their supporting organisations as to how adult safeguarding policy, could be more effectively informed and influenced. [ABSTRACT FROM AUTHOR]

Purpose The landscape of adult social care, and in particular of adult safeguarding, has shifted considerably over the last decade. Alongside policy changes in the responses to adult abuse, there have been shifts in professional and public understanding of what falls within the remit of this area of work. This results, arguably, in differing understandings of how adult safeguarding is constructed and understood. Given the increasing emphasis on multi-agency inter-professional collaboration, service user involvement and lay advocacy, it is important to consider and reflect on how both professionals and lay people understand this area of work. The paper aims to discuss these issues.Design/methodology/approach This study employed Augusto Boal’s model of Forum Theatre to explore how a variety of professional and lay groups understood, related to and engaged with how the Care Act 2014 defines and describes “adult safeguarding”.Findings Lay participants responded to the scenario in a variety of ways, upholding the construct validity of “adult safeguarding” and the authority of the social worker. Social care and health practitioners sought orderly, professionalised and sometimes ritualistic solutions to the “adult safeguarding” scenario presented, seeking carefully to structure and to manage lay involvement. Inter-professional collaboration was often problematic. The role of lay advocates was regarded ambiguously and ambivalently.Originality/value This paper offers a number of practice and research recommendations. Safeguarding practitioners could benefit from more effective and reflexive inter-professional collaboration. Both practitioners and service users could benefit from the more thoughtful deployment of the lay advocates encouraged within the Care Act 2014 and associated guidance. [ABSTRACT FROM AUTHOR]

The focus on patient autonomy in American and increasingly British medicine highlights the importance of choice. However, to truly honour patient autonomy, there must be both understanding and non‐control. Fifty‐eight semi‐structured in‐depth interviews were conducted with internal medicine physicians at three hospitals in the US and one in the UK. At hospitals where autonomy was prioritised, trainees equated autonomy with giving a menu of choices and felt uncomfortable giving a recommendation based on clinical knowledge as they worried that that would infringe upon patient autonomy. Employing Habermas's Theory of Communicative Action, this paper explores how physician trainees' communication practices of using purposefully graphic descriptions of resuscitation to discourage that choice prevent greater understanding and compromise non‐control. Central to this problem are also issues of colonisation of the life‐world by the system. Physicians are fully inculcated in their respect for autonomy but unintentionally resort to strategic forms of communication that prevent patients from adequately understanding their situation because trainees feel constrained against making recommendations. However, if the ideal of autonomy is to be realised, physicians might have to move towards practices that embrace a more authentic autonomy that fosters open communication that allows for co‐creation of consensus between doctors and patients. [ABSTRACT FROM AUTHOR]

This paper explores concerns over apparent failures to translate the rhetoric of British policy on sustainable development into recognisable and widespread success. After looking at examples of reported problems of policy and implementation, the paper asks whether we are seeing policy failure, institutional failure or a failure of political will. The paper looks at the changing responsibilities of town planners at a time when the delivery of sustainable development is identified as central to their role. But a major point of the paper is that any analysis of policy performance must understand planning as an enduring discipline distinct from any current institutional structure, so that critiques of the current system can be disentangled from critiques of the nature of urban planning. [ABSTRACT FROM AUTHOR]

Oral potentially malignant disorders (OPMDs) are associated with an increased risk of occurrence of cancers of the lip or oral cavity. This paper presents an updated report on the nomenclature and the classification of OPMDs, based predominantly on their clinical features, following discussions by an expert group at a workshop held by the World Health Organization (WHO) Collaborating Centre for Oral Cancer in the UK. The first workshop held in London in 2005 considered a wide spectrum of disorders under the term "potentially malignant disorders of the oral mucosa" (PMD) (now referred to as oral potentially malignant disorders: OPMD) including leukoplakia, erythroplakia, proliferative verrucous leukoplakia, oral lichen planus, oral submucous fibrosis, palatal lesions in reverse smokers, lupus erythematosus, epidermolysis bullosa, and dyskeratosis congenita. Any new evidence published in the intervening period was considered to make essential changes to the 2007 classification. In the current update, most entities were retained with minor changes to their definition. There is sufficient evidence for an increased risk of oral cancer among patients diagnosed with "oral lichenoid lesions" and among those diagnosed with oral manifestations of 'chronic graft‐versus‐host disease'. These have now been added to the list of OPMDs. There is, to date, insufficient evidence concerning the malignant potential of chronic hyperplastic candidosis and of oral exophytic verrucous hyperplasia to consider these conditions as OPMDs. Furthermore, due to lack of clear evidence of an OPMD in epidermolysis bullosa this was moved to the category with limited evidence. We recommend the establishment of a global research consortium to further study the natural history of OPMDs based on the classification and nomenclature proposed here. This will require multi‐center longitudinal studies with uniform diagnostic criteria to improve the identification and cancer risk stratification of patients with OPMDs, link them to evidence‐based interventions, with a goal to facilitate the prevention and management of lip and oral cavity cancer. [ABSTRACT FROM AUTHOR]

This paper reports on a multi-phased, mixed-method consensus-based study conducted with young carers in the UK aged 11–18, and health, social care and education professionals from the UK, USA and Canada, to identify priority items for inclusion in a short screening tool for use with young carers of a family member with a progressive or long-term illness or disability. Following ethical approval from University and local Research Ethics Committees, qualitative and quantitative data were collected between 2017 and 2019 from 267 people (107 young carers; 160 professionals), through interviews, a focus group, a Delphi survey, consensus group meetings and consultations. Qualitative data were analysed thematically, and quantitative data were analysed using measures of central tendency, frequency and levels of dispersion. The resulting Carers' Alert Thermometer (CAT-YC) contains an identification question followed by ten areas of need across two themes of 'current caring situation' and 'carer's health and wellbeing,' along with guidance for possible next steps and space for an action plan to be jointly agreed between the screener and young carer. Preliminary piloting of the CAT-YC provides evidence of identifying and monitoring needs, and is expected to be useful for young carers, a wide range of professionals, and organisations that support young carers. [ABSTRACT FROM AUTHOR]

Objective The aim of this paper is to present a UK-based consensus of principles and recommendations to guide rheumatology US training and practice. Method A Delphi process was conducted involving 19 US experts representing each of the 14 regions of the UK. A working group of experienced British Society for Rheumatology Ultrasound Special Interest Group (BSRUSSIG) members made seven proposals that were presented to the whole group for further discussion. This resulted in minor modifications and seven preliminary recommendations. Members were then asked to anonymously agree or disagree with each recommendation using an electronic ballot. A threshold of 75% was used to determine consensus agreement. Results were collated by an independent chairperson and presented to the BSRUSSIG in a face to face meeting where agreement for each recommendation was ratified and an action plan agreed for dissemination of the results and future development work. Results Using a validated process, experts in rheumatology US have worked through an iterative process and have unanimously agreed seven recommendations for rheumatology training and practice. These cover a hierarchy of practice indications, education and training, including the need for practitioners to demonstrate lifelong learning, as well as a commitment to support mentors and trainers through the BSRUSSIG. Conclusion These are the first specific education and practice recommendations for rheumatology US in the UK and have been developed and endorsed by the BSRUSSIG. We intend that these proposals will help to support and validate rheumatology US practice and inform the development of future rheumatology training curricula and education programmes. [ABSTRACT FROM AUTHOR]

Aim and Objective: To generate content for a new questionnaire, based on the 10 Principles of Dignity in Care. Background: Older people in hospital are vulnerable and at risk of harm, including indignity. The 10 Principles of Dignity in Care, which undergird the United Kingdom's Dignity in Care Campaign, have been used to promote dignified care for older people in hospital. A 2006 recommendation of the campaign was to survey people on their experiences of dignity in care. To undertake such a survey, a questionnaire based on the 10 Principles of Dignity is required. Design: Qualitative methods based on a modified Delphi technique, assessed against the CREDES checklist. Methods: A Delphi panel of experts was convened that included: consumers, carers, clinicians, academics, policy experts and representatives from the National Dignity Council in the UK, Aboriginal people and people from culturally and linguistically diverse backgrounds. Results: Fifty‐seven experts consented to participate, over the three rounds of Delphi panel deliberations (response rate: R1 n = 49, R2 n = 47 and R3 n = 44). The Delphi panellists were asked to rank, rewrite, relocate or remove items and suggest additional items, under each of the 10 Principles of Dignity in Care. The initial list of 93 items, generated from a review of the literature, existing questionnaires and drafted by the authors, was reduced to 87 items in Round 2 and 69 items in Round 3. Conclusions: A panel of experts were able to determine, based on their own judgement, and through consensus, the 69‐items and response categories to be included in the patient and carer versions of the Dignity in Care questionnaire, to progress to a pilot study. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to provide a professional consensus position with regard to the provision of specialist inpatient rehabilitation services for people with intellectual disability (ID), autism and mental health, behavioural or forensic needs in the UK. Design/methodology/approach: The concept of rehabilitation is discussed, as well as the functions and goals of specialist inpatient rehabilitation services with regard to the aforementioned contexts. Current use of rehabilitation beds is considered, both on a regional and national scale, as well as various outcome measures, including effectiveness, patient safety and patient experience. Findings: There is a clear need for specialist inpatient rehabilitation services, though historically there have been instances of inappropriate admissions, as well as lengthy inpatient stays that could have been significantly reduced with the right type of community support package. Such services should be subjected to rigorous measurement of outcome measures, to determine that patients within such services are receiving a consistently high standard of care. Additionally, amendments to current legal frameworks should be considered, with a view to accommodating for individuals with capacity who require continuous community-based supervision. Originality/value: To the best of the author's knowledge, this is the first article detailing a professional consensus position for specialist inpatient rehabilitation services for people with ID, autism and mental health, behavioural or forensic needs. [ABSTRACT FROM AUTHOR]

This paper reviews the use of psychotherapeutic approaches to treat individuals who have committed sex crimes and/or have problematic sexual interests (PSI); including types of psychotherapy used, descriptions of preventive and reintegration programmes, and highlighting specific theoretical controversies. In the second part, experts from Canada, the Czech Republic, Russia, the United Kingdom, and the United States, who participated in an International Consensus Meeting held in Prague (2017), summarize treatment programmes in their countries. The comparison revealed some general findings: each country has variability between its own programmes; most countries have different programmes for people who are in custody and who are in the community; the state-directed treatment programmes are primarily focused on criminal individuals, while non-criminal individuals are treated in preventive programmes and/or in special clinics or are untreated; the presence of PSI in patients is acknowledged in most programmes, although specific programmes exclusively for individuals with PSI rarely exist. Studies on effectiveness are difficult to compare due to methodologic, political, and cultural differences. Further communication between more countries to share knowledge about successful treatments and preventive approaches is needed, especially enhanced international collaboration between researchers and clinicians to verify the effectiveness of current clinical and experimental program, rs. [ABSTRACT FROM AUTHOR]

The importance of quantitative research in the social sciences generally and social work specifically has been highlighted in recent years, in both an international and a British context. Consensus opinion in the UK is that quantitative work is the 'poor relation' in social work research, leading to a number of initiatives. However, Sharland's UK work involves interviews with academics, representing consensus opinion. We have little independent measures of their accuracy. This paper is the first to focus on the academic impact of quantitative research in social work developing measurable outcomes. It focuses on three leading British-based generic journals over a 10-year period, encapsulating 1490 original articles. Impact is measured through three indices: Google Scholar and Web of Science Citations, and downloads. These provide measures of 'revealed preference' in relation to individual scholars' impact (though to use them for a particular methodology is novel), whose particular qualities, strengths and limitations are noted. Contrary to received opinion of quantitative work as the 'poor relation' of social work research, findings show that it is not significantly disadvantaged relative to qualitative work in its 'reach' as measured by citations and downloads. The implications of this, including caveats and nuances, are discussed. [ABSTRACT FROM AUTHOR]

Aim This paper reviews three research methods for developing consensus. Background Consensus statements and guidelines are increasingly used to clarify and standardise practice, and inform health policy, when relevant and rigorous evidence is lacking. Clinicians need to evaluate the quality of practice guidelines to determine whether to incorporate them into clinical practice or reject them. Formal methods of developing consensus provide a scientific method that uses expert panel members to evaluate current evidence and expert opinions to produce consensus statements for clinical problems. Data sources Online search for relevant literature was conducted in Medline and CINAHL. Review methods A literature review of consensus, consensus development and research methods papers published in English in peer-reviewed journals. Discussion The three methods of developing consensus discussed are the Delphi technique, nominal group technique and the consensus development conference. The techniques and their respective advantages are described, and examples from the literature are provided. The three methods are compared and a flowchart to assist researchers selecting an appropriate method is included. Online resources with information on the development and evaluation of clinical guidelines are reviewed. Conclusion This paper will help researchers to select an appropriate research method for developing consensus statements and guidelines. Implications for research/practice When developing consensus guidelines for clinical practice, researchers should use a formal research method to ensure rigour and credibility. [ABSTRACT FROM AUTHOR]

Objective: Epistaxis is a common ENT emergency in the UK; however, despite the high incidence, there are currently no nationally accepted guidelines for its management. This paper seeks to recommend evidence-based best practice for the hospital management of epistaxis in adults. Methods: Recommendations were developed using an Appraisal of Guidelines for Research and Evaluation ('AGREE II') framework. A multifaceted systematic review of the relevant literature was performed and a multidisciplinary consensus event held. Management recommendations were generated that linked the level of supporting evidence and a Grading of Recommendations Assessment, Development and Evaluation ('GRADE') score explaining the strength of recommendation. Recommendations: Despite a paucity of high-level evidence, management recommendations were formed across five management domains (initial assessment, cautery, intranasal agents, haematological factors, and surgery and radiological intervention). Conclusion: These consensus recommendations combine a wide-ranging review of the relevant literature with established and rigorous methods of guideline generation. Given the lack of high-level evidence supporting the recommendations, an element of caution should be used when implementing these findings. [ABSTRACT FROM AUTHOR]

We present an overview of the research evidence on nurse staffing levels in acute hospitals, and how it has been applied to policy and practice, focussing primarily on the UK. Drawing on research reviews and examples of specific studies, we outline the current state of knowledge. Much of the evidence comes from cross‐sectional studies. More recently, longitudinal studies allow a causal link between staffing and outcomes to be inferred. Lack of specificity on staffing levels has hindered application of research findings to practice; research rarely specifies how many nurses are needed for safe and effective care. The most significant impediment to achieving safe staffing has been an underestimation of the number of RNs needed and overestimation of the potential for substitution, resulting in low baseline staffing and a national shortage of RNs. Repeatedly, new staffing solutions are sought rather than tackle the problem of too few RNs head‐on. [ABSTRACT FROM AUTHOR]

Introduction: The mental health of young people (aged 16–25 years) is a growing public health concern in the United Kingdom due to the increasing numbers of young people experiencing mental health difficulties, with many not in contact with mental health services. To design services that meet the needs of all young people, a diversity of young people must be involved in mental health research, beyond being participants. This Delphi study aimed to identify different types of 'involvement' and to define and describe 'under‐representation' in young people's involvement in mental health research. Methods: Twenty‐seven experts in young people's mental health research completed a series of online questionnaires. The experts were academic researchers, patient and public involvement (PPI) professionals and young 'experts by experience'. Round 1 generated panellists' views on 'involvement' and 'under‐representation'. Round 2 summarised panellists' responses from Round 1 and sought consensus (minimum 70% agreement) in nine question areas. Round 3 validated the findings of the previous rounds. Results: Consensus was achieved in eight out of nine areas, resulting in a matrix (with definitions) of the different types of young people's involvement in mental health research, from being advisors to involvement ambassadors. The findings generated an agreed‐upon definition of under‐representation, an identification of when in the research process there is under‐representation and the characteristics of the young people who are under‐represented. Experts further agreed on demographic data that should be collected to improve reporting on involvement. Conclusions: This study adds to our understanding of involvement and under‐representation in the context of young people's mental health research through expert consensus. It provides a practical resource for researchers considering involving young people in the research process and suggests the data that should be collected to improve reporting on the diversity of the young people involved. Patient and Public Contribution: A research oversight group of five young people advised on this study. They contributed throughout the project—from endorsing the research question to commenting on the findings and dissemination. Two of the group reviewed all participant materials and piloted the initial questionnaire. [ABSTRACT FROM AUTHOR]

Background: Current evidence in cariology teaching is not consistently reflected in paediatric dentistry in the United Kingdom (UK). Many dental schools are not consistently teaching biological approaches to caries management, with outdated or complex methods being taught outwith the purview of general dental practitioners. This scoping review aimed to map current guidelines on the management of caries in children and young people. This is part of a work package to inform the consensus and development of a UK-wide caries management curriculum for paediatric dentistry. Methods: A search of electronic databases for peer reviewed literature was performed using Cochrane Library, MEDLINE via PubMed, TRIP Medical Database and Web of Science. Hand searching was undertaken for grey literature (citations of sources of evidence, websites of global organisations and Google Web Search™ (Google LLC, California, USA). Results from databases were screened independently, concurrently by two reviewers. Full texts were obtained, and reviewers met to discuss any disagreement for both database and hand searching. Results: This review identified 16 guidelines suitable for inclusion. After quality appraisal, eight were selected for synthesis and interpretation. Key themes included the shift towards selective caries removal and avoidance of complete caries removal unless in specific circumstances in anterior teeth. For "early lesions" in primary and permanent teeth with and without cavitation, several guidelines recommend biological management including site specific prevention and fissure sealants. Conclusions: This review mapping current cariology guidelines for children and young people found gaps in the literature including classification of early carious lesions and management of early cavitated lesions. Areas identified for further exploration include integration of biological caries management into treatment planning, selective caries removal and whether pulpotomy is specialist-level treatment, requiring referral. These results will inform consensus recommendations in the UK, using Delphi methods. [ABSTRACT FROM AUTHOR]

The article explores the challenges facing informal carers in Great Britain. Topics discussed include the lack of recognition for informal carers, results of the 2021 Census on the number of unpaid carers in England and Wales, an increase in dependence upon informal carers, and the need for statutory services to respect the perspective of informal carers.

Poverty means more than having a low income and includes exclusion from a minimally accepted way of life. It is now common practice in Europe to measure progress against poverty in terms of low income, material deprivation rates and some combination of both. This makes material deprivation indicators, and their selection, highly significant in its own right. The 'consensual poverty' approach is to identify deprivation items which a majority of the population agree constitute life's basic necessities, accepting that these items will need revised over time to reflect social change. Traditionally, this has been carried out in the UK through specialised poverty surveys using a Sort Card (SC) technique. Based on analysis of a 2012 omnibus survey, and discussions with three interviewers, this article examines how perception of necessities is affected by mode of administration-SC and Computer Assisted Personal Interviewing (CAPI). More CAPI respondents scored deprivation items necessary. Greatest disparities are in material items where 25 out of 32 items were significantly higher via CAPI. Closer agreement is found in social participation with 3 out of 14 activities significantly different. Consensus is higher on children's material deprivation. We consider influencing variables which could account for the disparities and believe that the SC method produces a more considered response. However, in light of technological advances, we question how long the SC method will remain socially acceptable. This paper concludes that the CAPI method can be easily modified without compromising the benefits of the SC method in capturing thoughtful responses. [ABSTRACT FROM AUTHOR]

There is appetite in the UK to better measure the impact of domestic violence and abuse (DVA) interventions on children. The spread of outcomes-based commissioning means outcome measurement is no longer just the territory of academic researchers but is now firmly within the purview of practitioners and policy makers. However, outcomes measured in trials only partially represent the views of those delivering and using services with respect to how success should be defined and captured. Even within trials there is huge inconsistency in the definition and measurement of important endpoints. This yields a body of evidence that is difficult to make sense of, defeating the ends for which it was produced - to improve the response to children and families who have experienced abuse. Development of Core Outcome Sets (COS) is seen as a solution to this problem, by establishing consensus across key stakeholder groups regarding a minimum standard for outcome measurement in trials, and increasingly in service delivery contexts. To date COS development has addressed outcomes relating to health conditions or interventions, with limited application to public health challenges. We reflect on our efforts to develop a COS to evaluate psychosocial interventions for children and families experiencing DVA. We highlight the value of COS development as a mechanism for improving evidence quality and the response to families experiencing abuse. Finally, we make recommendations to researchers and COS guideline developers to support this broader application of COS methodology. [ABSTRACT FROM AUTHOR]

Evidence-based and person-centred care requires the measurement of treatment outcomes that matter to youth and mental health practitioners. Priorities, however, may vary not just between but also within stakeholder groups. This study used Q-methodology to explore differences in outcome priorities among mental health practitioners from two countries in relation to youth depression. Practitioners from the United Kingdom (UK) (n = 27) and Chile (n = 15) sorted 35 outcome descriptions by importance and completed brief semi-structured interviews about their sorting rationale. By-person principal component analysis (PCA) served to identify distinct priority profiles within each country sample; second-order PCA examined whether these profiles could be further reduced into cross-cultural "super profiles". We identified three UK outcome priority profiles (Reduced symptoms and enhanced well-being; improved individual coping and self-management; improved family coping and support), and two Chilean profiles (Strengthened identity and enhanced insight; symptom reduction and self-management). These could be further reduced into two cross-cultural super profiles: one prioritized outcomes related to reduced depressive symptoms and enhanced well-being; the other prioritized outcomes related to improved resilience resources within youth and families. A practitioner focus on symptom reduction aligns with a long-standing focus on symptomatic change in youth depression treatment studies, and with recent measurement recommendations. Less data and guidance are available to those practitioners who prioritize resilience outcomes. To raise the chances that such practitioners will engage in evidence-based practice and measurement-based care, measurement guidance for a broader set of outcomes may be needed. [ABSTRACT FROM AUTHOR]

This paper analyzes the empirical utility of consensual and conflictual theories in explaining the social cohesion of the liberal democracies of Britain and the United States. After clarifying conceptual problems of value consensus theory and Marxist theory, it examines the forms and extent of value-commitment in these countries. The conclusion is that both theories grossly overstate the amount of both value consensus between individuals and value consistency within individuals that actually exists. Cohesion in liberal democracy depends rather on the lack of consistent commitment to general values of any sort and on the "pragmatic acceptance" by subordinate classes of their limited roles in society. Suggestive evidence is also found for the existence of some "false consciousness" among subordinate classes. [ABSTRACT FROM AUTHOR]

Objective: Local wound infections are a major challenge for patients and health professionals. Various diagnostic and therapeutic options are available. However, a generally accepted standard is still lacking in Europe. The aim was to develop an easy-to-use clinical score for the early detection of local wound infections, as a basis for decisionmaking on antiseptic therapy or decolonisation. Method: An interdisciplinary and interprofessional panel of experts from seven European countries was brought together to discuss the various aspects of diagnosing local wound infections. Results: The result was the adoption of the Therapeutic Index for Local Infections (TILI) score, developed in Germany by Initiative Chronische Wunden e.V., specifically for health professionals not specialised in wound care. Available in six European languages, the TILI score could also be adapted for different European countries, depending on their specific national healthcare requirements. The six clinical criteria for local wound infection are erythema to surrounding skin; heat; oedema, induration or swelling; spontaneous pain or pressure pain; stalled wound healing; and increase and/or change in colour or smell of exudate. Meeting all criteria indicates that antiseptic wound therapy could be started. Regardless of these unspecific clinical signs, there are also health conditions for the clinical situation which are a direct indication for antimicrobial wound therapy. These include the presence of wound pathogens, such as meticillin-resistant Staphylococcus aureus, septic surgical wound or the presence of free pus. Conclusion: The development of the new internationally adapted TILI score, which could also be used by any caregiver in daily practice to diagnose local infections in acute and hard-to-heal wounds, is the result of expert consensus. However, the score system has to be validated through a clinical evaluation. This is to be performed in expert centres throughout Europe. Declaration of interest: JD has received research support, lecture fees and travel-cost reimbursements from 4M, Coloplast, Convatec, Draco, Engelhardt, Paul Hartmann, KCI, Lohmann&Rauscher, Mölnlycke, SastoMed and Urgo. RL has received research support, lecture fees and travel-cost reimbursements from Mölnlycke and Urgo. AK has received research support, lecture fees and travel-cost reimbursements from 3M, B. Braun Melsungen, Bode/Paul Hartmann, Ethicon, Lohmann&Rauscher, Mundipharma, Oculus, SastoMed Schülke&Mayr, SERAG-WIESSNER and Urgo. JVS has received research support, lecture fees and travel-cost reimbursements from Mundipharma, Histocell, Quesper and Urgo. This work was supported by an unlimited grant from Urgo Medical. The views expressed are those of the authors and do not necessarily reflect those of Urgo Medical. The company had no direct influence on the content of this paper. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to gain consensus regarding the clinical priorities and tasks required in supporting communication needs in those living with semantic dementia and their families, by specialist speech and language therapists (SLTs), working in clinical practice within dementia care settings in the UK. Design/methodology/approach – A nominal group technique was used, followed by further exploration and refinement of issues using a modified Delphi technique with a group of six SLTs who specialised in dementia care and who had experience of working with individuals with semantic dementia and their families. Findings – The findings in the study demonstrate a broader scope of practice than is evident within the research literature with this client group. Therapists identified a range of psychosocial issues for both the person with semantic dementia and their family, in particular finding ways to support activity and participation in conversation and explore barriers and facilitators within the communication environment. Originality/value – This represents the first study to explore everyday practice in this rarer dementia and the information gathered here will be of use to a variety of health and social care professions interested in supporting those with semantic dementia and their families. [ABSTRACT FROM AUTHOR]

Introduction: It is increasingly recognised by UK researchers and population health advocates that an important impetus to effective policy action to address health inequalities is activation of public dialogue about the social determinants of health and how inequalities might be addressed. The limited body of existing scholarship reaches varying conclusions on public preferences for responding to health inequalities but with consensus around the importance of tackling poverty. Young people's perspectives remain underexplored despite their increasingly visible role in activism across a range of policy issues and the potential impact of widening inequalities on their generation's health and wellbeing. Methods: Six groups of young people (39 in total) from two UK cities (Glasgow and Leeds) were engaged in online workshops to explore views on health inequalities and potential solutions. Inspired by calls to employ notions of utopia, artist–facilitators and researchers supported participants to explore the evidence, debating solutions and imagining a more desirable society, using visual and performance art. Drawing together data from discussions and creative outputs, we analysed participants' perspectives on addressing health inequalities across four domains: governance, environment, society/culture and economy. Findings: Proposals ranged from radical, whole‐systems change to support for policies currently being considered by governments across the United Kingdom. The consensus was built around embracing more participatory, collaborative governance; prioritising sustainability and access to greenspace; promoting inclusivity and eliminating discrimination and improving the circumstances of those on the lowest incomes. Levels of acceptable income inequality, and how best to address income inequality were more contested. Individual‐level interventions were rarely presented as viable options for addressing the social inequalities from which health differences emanate. Conclusion: Young people contributed wide‐ranging and visionary solutions to debates around addressing the enduring existence of health inequalities in the United Kingdom. Their reflections signal support for 'upstream' systemic change to achieve reductions in social inequalities and the health differences that flow from these. Public Contribution: An advisory group of young people informed the development of project plans. Participants shaped the direction of the project in terms of substantive focus and were responsible for the generation of creative project outputs aimed at influencing policymakers. [ABSTRACT FROM AUTHOR]

The Care Act 2014 gave English local authorities a duty to 'shape' social care markets and encouraged them to work co-productively with stakeholders. Grid-group cultural theory is used here to explain how local authorities have undertaken market shaping, based on a four-part typology of rules and relationships. The four types are: procurement (strong rules, weak relationships); managed market (strong rules, strong relationships); open market (weak rules, weak relationships); and partnership (weak rules, strong relationships). Qualitative data from English local authorities show that they are using different types of market shaping in different parts of the care market (e.g. residential vs home care), and shifting types over time. Challenges to the sustainability of the care system (rising demand, funding cuts, workforce shortages) are pulling local authorities towards the two 'strong rules' approaches which run against the co-productive thrust of the Care Act. Some local authorities are experimenting with hybrids of the two 'weak rules' approaches but the rival cultural biases of different types mean that hybrid approaches risk antagonising providers and further unsettling an unstable market. [ABSTRACT FROM AUTHOR]

Objectives: Clinical communication is a core component of undergraduate medical training. A consensus statement on the essential elements of the communication curriculum was co-produced in 2008 by the communication leads of UK medical schools. This paper discusses the relational, contextual and technological changes which have affected clinical communication since then and presents an updated curriculum for communication in undergraduate medicine.Method: The consensus was developed through an iterative consultation process with the communication leads who represent their medical schools on the UK Council of Clinical Communication in Undergraduate Medical Education.Results: The updated curriculum defines the underpinning values, core components and skills required within the context of contemporary medical care. It incorporates the evolving relational issues associated with the more prominent role of the patient in the consultation, reflected through legal precedent and changing societal expectations. The impact on clinical communication of the increased focus on patient safety, the professional duty of candour and digital medicine are discussed.Conclusion: Changes in the way medicine is practised should lead rapidly to adjustments to the content of curricula.Practice Implications: The updated curriculum provides a model of best practice to help medical schools develop their teaching and argue for resources. [ABSTRACT FROM AUTHOR]

This paper critically examines claims of a new consensus on welfare and the end of the welfare state. We first review the concept of welfare consensus, concentrating on the idea of welfare pluralism, in particular the relatively neglected distinction between national minimum (base) and extension ladder (superstructure). We then examine these concepts in the 1990s under Conservative and New Labour governments. Important changes to welfare pluralism are noted. There have been changes in the character of means-tests, with the national minimum replaced by a series of residual minima, which represent fundamental changes to structural incentives governing the social division of welfare and work. The line between state and non-state provision has been blurred and there have been moves to achieve universalism in the private sector. It is possible to tentatively classify Labour's principles and fledgling policies into three categories: essential continuity with the Conservatives, reversing Conservative policies and extending Conservative policies. However, it is difficult to detect the degree of consensus because a new flexible language is beginning to pervade social policy, with the result that the welfare state is being redefined, notably in areas of full employment, citizenship and conditionality. It is possible to detect, in our terms, moves towards turning Beveridge inside out and from the "Marshall" towards the "Beveridge" welfare state. It is clear that the welfare state is being redefined, but reports of its death have been much exaggerated. [ABSTRACT FROM AUTHOR]

The term ‘consensus politics’ has frequently been used to describe post-war British politics. More recently it appears to have been overtaken by ‘the end of consensus polities’. The first part of this paper examines the different meanings of consensus in British politics, and analyses the concept with reference to the mixed economy and welfare. The second part examines the salient features of the consensus and how they emerged. The third section analyses the forces that have undermined the consensus and the concluson considers evidence about the nature of the political agenda in the 1980s, [ABSTRACT FROM AUTHOR]

Opportunities for adults to access support following a clinical diagnosis of autism are limited. This study investigated perspectives of autistic adults, relatives and clinicians regarding characteristics of optimal adult autism post-diagnosis support and services. In Stage 1, key stakeholders were surveyed about recent experiences of UK adult autism post-diagnostic services immediately following assessment/up to 12 months afterwards. Information gathered from Stage 1 was used to devise a set of statements describing optimal post-autism diagnostic support/service characteristics. In Stage 2 statements were presented to clinicians in a modified Delphi process. Data analyses were non-parametric and descriptive. Three hundred forty-three autistic adults and 45 relatives completed the Stage 1 surveys. Thirty-five clinicians completed a parallel survey. Just over half of adults and relatives reported receiving a follow-up appointment. Fewer than 40% of autistic people received support/services 12 months after diagnosis. Eleven statements describing optimal post-autism diagnostic support/service provision were developed and consensus among clinicians was reached on all. Autistic adults, relatives and clinicians described some aspects of post-autism diagnosis support and services positively; however, there were significant opportunities for improvement. The study findings can be used to develop current UK post-diagnosis support and services and may be relevant internationally. Research has identified types of support helpful to autistic people, for example, physical and mental health interventions, psycho-education, peer support, developing positive identities and affiliation with social groups. However, accessing suitable post-autism diagnosis support and services is extremely difficult. We asked autistic adults, relatives and clinicians about their experiences of receiving and delivering post-autism diagnosis support/services. In Stage 1, 343 autistic adults and 45 relatives completed a survey. They answered questions about their experiences of UK autism post-diagnosis support/services for adults within 12 months after receiving a diagnosis. Thirty-five clinicians completed a similar survey. Just over half of adults and relatives said there was a follow-up appointment or discussion about support after diagnosis. Fewer than 40% received any support/services in 12 months after diagnosis. We used information from the surveys to create 11 statements describing characteristics of appropriate adult post-autism diagnosis support/services. In Stage 2, we asked clinicians for their views on the statements – they agreed with all of them. For example, those adults are offered an additional follow-up meeting after diagnosis and have access to mental and physical health services. We shared results with autistic adults, relatives and clinicians at two events. Some autistic adults, relatives and clinicians were positive about post-autism diagnosis support/services. However, they described many areas for improvement. The study findings can be used to define, develop and improve the types of adult post-diagnosis support services. [ABSTRACT FROM AUTHOR]

Background: Psychological therapy assessments are a key point at which a person is accepted into a service or referred on. There is evidence of service users experiencing harm, dropping out of services and potentially experiencing poor outcomes because of inadequate assessment practices. Approaches to assessment tend to be developed by individual services, with a lack of research identifying what makes a good assessment. Methods: This survivor‐led study, based in England, aimed to generate guidelines for conducting trauma‐informed psychological therapy assessments. The study was guided by a Service User Advisory Group and a Clinician Advisory Group. The study was conducted in three key stages: (i) identifying, modelling and drafting guideline content (ii) modified Delphi study and (iii) guideline finalization. Stage 1 was informed by literature reviews, qualitative research, data workshops with Advisory Groups and an expert consultation. Fifty‐nine people with relevant experiences then participated in a single‐stage modified Delphi (Stage 2). The guidelines were finalized through an analysis of Delphi open comments and a final expert consultation (Stage 3). Results: The guidelines evolved through each stage of the process, and all items were deemed important by >90% of Delphi participants. The final trauma‐informed guidelines contain eight principles, including 'focus on relationships', 'from systems to people' and 'healing environments'. Conclusions: Experiential knowledge was key in generating the guidelines and conceptualizing content, with a consequent focus on areas, such as recognizing power differentials, understanding oppression as trauma and the relational aspects of assessments. Future research should focus on guideline implementation and investigate whether this impacts service user dropout, engagement with therapy, and outcomes. Patient or Public Contribution: This study is an example of survivor research, with several authors, including the study lead, identifying as survivors. We consider the ways in which our identities as survivor researchers impacted the study findings. [ABSTRACT FROM AUTHOR]

To examine current UK practice in diagnosis of patients under 65 with young onset dementia, within 5 years of date of diagnosis, identified from electronic health records of 8 NHS mental health trusts. Patients diagnosed with young onset dementia were assembled from the UK-Clinical Record Interactive System, (UK-CRIS) using diagnosis of dementia as the index date. A pre-designed proforma, derived by international Delphi consensus from experts in the field in previous work, was used to assess components of the diagnostic assessment in 402 electronic health records across 8 NHS sites. Information was extracted on key aspects of clinical and physical examination according to both a minimum and gold standard. Percentage compliance rates analysed by NHS site and statement, including compliance for site for minimum standard (11 statements), the additional 20 statements required for Gold standard, and the complete Gold standard set (31 statements) show that the additional 20 statements in the Gold standard had consistently higher compliance rates for every site compared to the minimum set. Findings confirmed variation in clinical practice and identified commonly missed items in examination and enquiry compared to expert consensus. This suggests that a template proforma, which contains the key indicators for comprehensive assessment of dementia in young adults according to a quality standard could help support clinicians to improve record keeping and reduce gaps in knowledge. [ABSTRACT FROM AUTHOR]

This guideline is written as a reference document for clinicians presented with the challenge of managing paediatric patients with differentiated thyroid carcinoma up to the age of 19 years. Care of paediatric patients with differentiated thyroid carcinoma differs in key aspects from that of adults, and there have been several re cent developments in the care pathways for this condition; this guideline has sought to identify and attend to these areas. It addresses the presentation, clinical assessment, diagnosis, management (both surgical and medical), genetic counselling, follow-up and prognosis of affected patients. The guideline development group formed of a multi-disciplinary panel of sub-speciality experts carried out a systematic primary literature review and Delphi Consensus exercise. The guideline was developed in accordance with The Appraisal of Guidelines Research and Evaluation Instrument II criteria, with input from stakeholders including charities and patient groups. Based on scientific evidence and expert opinion, 58 recommendations have been collected to produce a clear, pragmatic set of manage ment guidelines. It is intended as an evidence base for future optimal management and to improve the quality of clinical care of paediatric patients with differentiated thyroid carcinoma. [ABSTRACT FROM AUTHOR]

Visual perceptual deficits are frequently underdiagnosed in stroke survivors compared to sensory vision deficits or visual neglect. To better understand this imparity, we evaluated current practice for screening post-stroke visual perceptual deficits. We conducted a survey targeted at professionals working with stroke survivors involved in screening visual perceptual deficits across the United Kingdom and the Republic of Ireland. Forty orthoptists and 174 occupational therapists responded to the survey. Visual perceptual deficit screening was primarily conducted by occupational therapists (94%), with 75∼100% of stroke survivors screened per month. Respondents lacked consensus on whether several common post-stroke visual deficits were perceptual or not. During the screening, respondents primarily relied on self-reports and observation (94%), while assessment batteries (58%) and screening tools were underutilised (56%) and selected inappropriately (66%). Respondents reported lack of training in visual perception screening (20%) and physical/cognitive condition of stroke survivors (19%) as extremely challenging during screening. Visual perceptual deficits are screened post-stroke at a similar rate to sensory vision or visual neglect. Underdiagnosis of visual perceptual deficits may stem from both reliance on subjective and non-standardised screening approaches, and conflicting definitions of visual perception held among clinicians. We recommend increased training provision and use of brief performance-based screening tools. Lack of agreement among clinicians on what constitutes as visual perceptual or sensory vision deficits may prove problematic, as precise and exact language is often required for clinical decision-making (e.g., referrals). Biases for more familiar visual (perceptual) deficits held among clinicians during the screening process may lead to other visual deficits being missed. To avoid problems being missed, clinicians should aim to use standardised assessments rather than stroke survivor self-report and observations of function when screening for visual perceptual difficulties. [ABSTRACT FROM AUTHOR]

Accessing adult autism diagnostic pathways can be difficult. This study explored perspectives of UK autistic adults, relatives and clinicians regarding the characteristics of optimal adult autism assessment and diagnostic services. In stage 1, three key stakeholder groups were surveyed about experiences of adult autism diagnostic services (pre-assessment/assessment): 343 autistic adults, 45 relatives and 35 clinicians completed parallel surveys. Information from stage 1 surveys was used to devise statements for a modified Delphi process in stage 2 seeking consensus among clinicians on optimal diagnostic service characteristics. Data analyses were non-parametric and descriptive. Over half of adults were in contact with mental health services prior to autism diagnosis. Clinicians reported that multidisciplinary diagnostic teams lacked key professionals. Thirteen statements describing optimal autism diagnostic service provision were developed. There was consensus from clinicians on 11 statements relating to clear assessment pathways, updates for people while waiting, pre-assessment information gathering/provision, co-occurring condition identification and training/networking. Some autistic adults, relatives and clinicians were positive about services, all stakeholders identified improvements were needed. The findings describing optimal service provision are relevant for UK clinicians, managers and commissioners to improve diagnostic assessments for autistic adults, and have international relevance for similar health systems. Living with undiagnosed autism can be distressing and may affect mental health. A diagnosis of autism can help self-awareness and self-understanding. However, it can be difficult for adults to access an autism assessment. Clinicians also sometimes find it hard to identify autism in adults. This may mean an autism diagnosis is delayed or missed. In this study, we asked autistic adults, relatives and clinicians how to improve this. The study was in two stages. In the first stage (stage 1), 343 autistic adults and 45 relatives completed a survey. In the survey, we asked questions about people's experiences of UK autism assessment services for adults. Thirty-five clinicians completed a similar survey. Clinicians reported that some autism assessment teams lacked key professionals, for example, psychologists and occupational therapists. We used the information from the three separate surveys to create 13 statements describing best autism assessment services for adults. In stage 2, we asked clinicians for their views on the 13 statements. Clinicians agreed with 11 of the statements. Some autistic adults, relatives and clinicians were positive about autism assessment services, and many also described areas that could be improved. The study findings can be used to improve UK adult autism assessment services and may be helpful for service developments worldwide. [ABSTRACT FROM AUTHOR]

Sarcopenia is a skeletal muscle disorder that commonly occurs with advancing age as well as with a number of long-term conditions. Recognition in clinical practice is relatively recent but important because of the association between sarcopenia and a range of adverse effects on health including impaired mobility, increased morbidity and mortality. Originally characterised as loss of muscle mass, the definition has evolved to focus on loss of skeletal muscle function, particularly strength, through a number of international definitions such as that of the European Working Group on Sarcopenia in Older People most recently revised in 2019. Progress in the decades ahead is likely to be seen with regard to use of routine health data, prescription of resistance exercise, translation of biology and epidemiology into first in man studies for new treatments, and focus on sarcopenia in low and middle-income countries. Immediate next steps include the newly formed Global Leadership Initiative on Sarcopenia to develop international consensus on definition and diagnosis. [ABSTRACT FROM AUTHOR]

Background: Ambulant children with cerebral palsy (CP) undertake physiotherapy to improve balance and walking. However, there are no relevant clinical guidelines to standardize usual physiotherapy care in the United Kingdom. A consensus process can be used to define usual physiotherapy care for children with CP. The resulting usual care checklist can support the development of clinical guidelines and be used to measure fidelity to usual care in the control groups of trials for children with CP. Methods: Twelve expert physiotherapists were recruited. In Phase 1, statements on usual care were developed using a survey and two nominal groups. Phase 2 included a literature review to support usual physiotherapy interventions. Phase 3 used a confirmatory survey, which also captured changes to provision during the COVID‐19 pandemic. Consensus was calculated by deriving the mean of the deviations from the median score (MDM). High consensus was deemed to be where MDM < 0.42. Results: Physiotherapists reached high consensus on five outcome measures (MDM range 0–0.375) and nine areas of assessment (MDM range 0–0.25). Physiotherapists reached moderate consensus on task‐specific training (MDM = 0.75), delivered at weekly intensity for 4–6 weeks (MDM = 0.43). There was high consensus (MDM = 0) that children should participate in modified sport and fitness activities and that children with Gross Motor Function Classification System Level III should be monitored on long‐term pathways (MDM = 0.29). Conclusions: Physiotherapists reached consensus on two usual care interventions, and a checklist was developed to inform the control groups of future randomized controlled trials. Further consensus work is required to establish clinical guidelines to standardize usual physiotherapy care in the United Kingdom. [ABSTRACT FROM AUTHOR]

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, considers recent discussions and recommendations to review the current compensation scheme [ABSTRACT FROM AUTHOR]

Aim: This article describes the development and implementation of a virtual Consensus development project to address current challenges in adult nursing care in the UK. Design: This is a Consensus Development Project (CDP). Methods: The five stages of this CDP were: develop questions (informed by PPI representatives and a documentary review), generate evidence reviews, recruit and orient the lay panel, host Consensus seminars, and consult with panel members and stakeholders. Results: To the best of our knowledge, a CDP has not previously been conducted in a UK nursing context, and this is the first of its kind to be hosted virtually. This article contributes a detailed outline of the Consensus development methodology and constructive commentary to support future Consensus development projects. Learning points include reflections on the impact of hosting this event virtually, the relationship between the project coordinator and chair, and the composition of the lay panel. [ABSTRACT FROM AUTHOR]

Critical Race Theory (CRT) suggests psychology's contribution to racism takes various forms. Abstractly, racism is promoted through psychology's flawed theoretical conceptualization as an individualized, inevitable occurrence. Concretely, it occurs because psychology is one of the most popular reasons students come to university and Black Asian and Minoritized Ethnic (BAME) students report racist harassment and less access to formal support whilst there. This racism and student‐proposed anti‐racist recommendations are often ignored. Concretely assessing what racism students face, assessing how students understand racism, and demonstrating student support for anti‐racist recommendations, are CRT‐informed methods of challenging university racism. White (n = 213) and BAME (n = 182) UK students were asked about their estimation of racism, any positive action and discrimination experienced, and their access to university support. Participants were also randomized into multiple conditions where five anti‐racist recommendations were proposed (by Professors N. Patel, R. Smith, or no one). Participant consensus was found in high racism estimations, in benefiting from similar positive actions and in accessing four types of university support. However, White students underestimated racism more so, received less discrimination, and reported more access to three university support types. Almost all participants supported the recommendations regardless of proposer. These results suggest the implementation of anti‐racist recommendations converges with university's interests as student stakeholder support them. Psychologists in universities can advocate for these recommendations and take other anti‐racist actions. [ABSTRACT FROM AUTHOR]

This paper examines evidence of contemporary British evangelical diversity, in terms of theological and socio-political convictions. Survey responses are analyzed from the leadership teams of prominent evangelical organisations, delegates at the most recent National Evangelical Assembly and theological college students. The contours of a modified theological consensus become apparent. Although evangelicals have embraced social justice -- anti-racist, anti-sexist and favouring debt cancellation for the developing world -- they remain conservative in terms of sexual ethics, supporting restrictive policies concerning abortion, censorship and divorce, with most rejecting the legalisation of marijuana. However, senior evangelical leaders are more inclined to restrictive social policies than evangelicals who are younger or female: socio-political concern among moderate evangelicals may therefore have begun to evolve towards the societal consensus. Given this emergent socio-political heterogeneity, traditional evangelical ethical givens are likely to become as contested as the previous conservative theological consensus. [ABSTRACT FROM AUTHOR]