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Background: Patients hospitalised with COVID-19 have increased morbidity and mortality, which requires extensive involvement of specialist Hospital Palliative Care Teams. Evaluating the response to the surge in demand for effective symptom management can enhance provision of Palliative Care in this patient population., Aim: To characterise the symptom profile, symptom management requirements and outcomes of hospitalised COVID-19 positive patients referred for Palliative Care, and to contextualise Palliative Care demands from COVID-19 against a 'typical' caseload from 2019., Design: Service evaluation based on a retrospective cohort review of patient records., Setting/participants: One large health board in Scotland. Demographic data, patient symptoms, drugs/doses for symptom control, and patient outcomes were captured for all COVID-19 positive patients referred to Hospital Palliative Care Teams between 30th March and 26th April 2020., Results: Our COVID-19 cohort included 186 patients (46% of all referrals). Dyspnoea and agitation were the most prevalent symptoms (median 2 symptoms per patient). 75% of patients were prescribed continuous subcutaneous infusion for symptom control, which was effective in 78.6% of patients. Compared to a 'typical' caseload, the COVID-19 cohort were on caseload for less time (median 2 vs 5 days; p  < 0.001) and had a higher death rate (80.6% vs 30.3%; p  < 0.001). The COVID-19 cohort replaced 'typical' caseload; overall numbers of referrals were not increased., Conclusions: Hospitalised COVID-19 positive patients referred for Palliative Care may have a short prognosis, differ from 'typical' caseload, and predominantly suffer from dyspnoea and agitation. Such symptoms can be effectively controlled with standard doses of opioids and benzodiazepines.

Aims: We investigated which patients with heart failure (HF) should receive specialist palliative care (SPC) by first creating a definition of need for SPC in patients hospitalised with HF using patient-reported outcome measures (PROMs) and then testing this definition using the outcome of days alive and out of hospital (DAOH). We also evaluated which baseline variables predicted need for SPC and whether those with this need received SPC., Methods and Results: PROMs assessing quality of life (QoL), symptoms, and mood were administered at baseline and every 4 months. SPC need was defined as persistently severe impairment of any PROM without improvement (or severe impairment immediately preceding death). We then tested whether need for SPC, so defined, was reflected in DAOH, a measure which combines length of stay, days of hospital re-admission, and days lost due to death. Of 272 patients recruited, 74 (27%) met the definition of SPC needs. These patients lived one third fewer DAOH than those without SPC need (and less than a quarter of QoL-adjusted DAOH). A Kansas City Cardiomyopathy Questionnaire (KCCQ) summary score of <29 identified patients who subsequently had SPC needs (area under receiver operating characteristic curve 0.78). Twenty-four per cent of patients with SPC needs actually received SPC (n = 18)., Conclusions: A quarter of patients hospitalised with HF had a need for SPC and were identified by a low KCCQ score on admission. Those with SPC need spent many fewer DAOH and their DAOH were of significantly worse quality. Very few patients with SPC needs accessed SPC services., (© 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology.)

Aims: To investigate medical students' experiences and perception of support following a patient's death, contrasting their experiences in the UK, and while overseas during their elective period., Methods: An anonymous online questionnaire was distributed to all final year medical students at one UK medical school in November 2009., Results: 220 students were contacted, 60% responded. 72% (94) of medical students had been involved in end-of-life care at some point during their course; students on elective experiencing patient death across all ages. Some students saw many patients dying during their elective period. Students had mixed emotions following a patient's death. In the UK, students reported feeling shocked, upset and sad. When overseas, many students were angry or frustrated, and many reported feelings of injustice. Following a death, students found talking to people beneficial, but when overseas they turned to friends and family using email and Facebook, rather than talking to local doctors and nurses. Only 13% (16) of medical students thought their medical training had prepared them sufficiently to deal with death. Of those who did feel prepared some said they had gained this knowledge through working as a healthcare assistant., Conclusions: Students feel ill prepared for experiencing the death of a patient. Even though they may have 'medical knowledge' they are still lacking in emotional support and are often inadequately supported around the time of a patient's death. Medical schools should consider their curricula so that students are aware of the possible experiences and emotions which they may face when involved with the death of a patient, and students should be given advice on whom to turn to for support.

Aim: To quantify use of complementary and alternative medicine (CAM) in children with non-malignant, life-limiting illness., Method: A self-administered questionnaire was sent to families who received care from a community children's nursing and psychology team for children with non-malignant, life-limiting conditions., Results: A total of 32 per cent of respondents had used up to seven types of CAM for their child and 43.4 per cent had used CAM for themselves or other family members. Most parents used CAM to enhance general wellbeing rather than treat specific diagnoses. A total of 58.3 per cent felt the therapy was helpful, 50 per cent had tried conventional medicine first, and 63.9 per cent of users discussed their use of CAM with a doctor or community nurse., Conclusion: The rate of CAM use is significantly higher in this population than found in many previous cross-sectional studies. This may reflect the different needs and expectations of families with children with non-malignant, life-limiting illnesses.

This article presents the findings of parents' views on the human papillomavirus vaccine from one area of England. The authors outline that many parents have strong views about the vaccine particularly in relation to safety and effectiveness, age, and medical and moral concerns. This article presents an analysis of some of the issues. The authors conclude that nurses should provide up-to-date advice to help allay concerns.

Aim: To discover whether community children's nurses and other members of the multi-disciplinary team had changed their practice in the light of the 'copying letters' initiative recommended by the Department of Health and to seek their views on the process., Method: A documentary analysis of the notes was undertaken on 30 sets of notes chosen at random from the community children's nursing team's caseload and the total number of letters in each child's notes was retrospectively recorded for periods before and after the implementation of the 'copying letter initiative'. In addition, 14 community children's nurses were interviewed about their communication practice., Results: Letters accounted for 70 per cent of the total correspondence in the children's notes. Most of the 466 letters were from doctors (65 per cent) with nine per cent having been sent by community children's nurses. Before the initiative 70 per cent of letters from medical staff were copied compared to 74 per cent afterwards, with community children's nurses copying 19% of letters before and 47% afterwards. Only 13 were sent to the child. Nurses commented on changes to their practice since the copying initiative began and reported varying use of other forms of communication such as text messaging and email. CONCLUSION Professionals should be encouraged to copy letters to parents and children. A number of technologies are available to facilitate communication between patients, parents and other health care professionals. Careful consideration must be given to their introduction to ensure their use conforms to legal and professional codes and good practice principles.

Objective: To audit doctors' knowledge of informed consent., Design: 10 consent scenarios with "true", "false", or "don't know" answers were completed by doctors who care for children at a large district general hospital. These questions tested clinicians' knowledge of who could give consent in different clinical situations., Setting: Royal United Hospital, Bath, UK., Results: 51 doctors participated (25 paediatricians and 26 other clinicians). Paediatricians scored higher than other clinicians (average correct response 69% v 49%). Only 36% (9/25) of paediatricians and 8% (2/26) of other clinicians realised that the biological father of a child born before 1 December 2003 needed a court order or a parental responsibility agreement to acquire parental responsibility, and thus be able to consent on behalf of his child, if he was not married to the child's mother. Non-paediatric clinicians were unsure or incorrect when tested on situations where people with parental responsibility do not agree, or where young people (<16 years), who are Fraser competent do not want to consult their parents. Most clinicians did not know that the parents of a 20-year-old man with severe learning difficulties are unable to consent to surgery on his behalf, and many non-paediatricians were unclear on who could give consent when a child lived with foster parents., Conclusion: Clinicians who obtain consent for the treatment of children need to increase their knowledge on who is able to give informed consent to ensure best (legal and safe) practice.

Over recent years piercing of parts of the body other than the earlobes has become more common among school children. This article seeks to explore the issues raised by the practice, particularly for the school nurse, who may be involved in the management of children with body piercing in school. An overview of the different types of body piercing is provided, as well as a discussion of the legal aspects of body piercing in children under the age of 18. The infectious and non-infectious complications that may arise are examined. The article also addresses some of the psychological issues around body piercing, in particular exploring what motivates children to have a piercing done, and looks at the evidence that associates body piercing with high risk behaviours in this age group. Finally, the article provides practical guidance to healthcare professionals about managing children with body piercings, looking in particular at steps that can be taken to promote safe healing and the avoidance of complications.

Announcement of the introduction of the five-in-one vaccine (DTaP/IPV/Hib) into the primary immunisation schedule was made on 9 August 2004. In this study all calls to the immunisation hotline were recorded between 9 August 2004 and 19 November 2004, noting who called and the nature of their enquiry. A total of 208 calls were received during the study period, and of these 23 (11.1%) related to the new vaccine. Calls were from parents (10/23, 43%), health visitors (9/23, 39%) and practice nurses (3/23, 13%). A variety of themes were covered in calls including local availability of the five-in-one vaccine, vaccine safety, mercury content and efficacy. Calls not connected with the new vaccine concerned mostly adolescent MMR (17.3%) as there was a local mumps epidemic. Others related to clarification of a child's immunisation status (13.5%), primary MMR immunisation (13.5%), vaccination scheduling or administration difficulties (12%), other schedule (12.5%) and non-schedule vaccines (2.4%), vaccine reactions (2.4%), travel vaccines (6%), BCG (6%), and a few miscellaneous queries (3%). Overall questions about the new five-in-one vaccine accounted for an extra 23 calls to the immunisation hotline during the study period (11.1% of calls).

Objective: To review paediatric admissions with a primary diagnosis of constipation to see whether some could have been managed in the community instead., Method: A review of the medical notes of all patients admitted with a primary diagnosis of constipation to the children's ward of a district general hospital over a 12-month period., Results: Of 41 admissions (19 girls and 22 boys, age range 6 weeks to 12 years), the average length of stay was less than two nights., Conclusion: The short duration of hospital stay implies rapid improvement. It is likely that many of these children could have been managed in the community if suitable resources, such as a community nurse specialising in constipation, were available.