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When the WHO announced a global pandemic in response to COVID-19, individual countries reacted in a similar way with care homes closing their doors to visits, including visits from family members. The UK was no different, initially they closed to protect care home residents during a period of uncertainty, particularly as many were frail, with complex health needs and classed as vulnerable to the virus. This did however, create a sustained period of uncertainty for family members as well as the wider UK care home community. During 2020, 13 family carers in the UK shared their experiences through this period of COVID related enforced lockdowns, in total 27 interviews were conducted. Our findings and three themes narrate to time points when we were conducting interviews and were often linked to key changes in policy, often in the wider society but not conveyed into care home practices or visiting policies. Three overarching themes are described: Understanding and Acceptance, Disappointment and Resentment, Grief and Sense of Loss

Around 20% of 1- to 4-month-old infants cry for long periods without an apparent reason. Traditionally, this was attributed to gastrointestinal disorder ('colic'), but evidence shows that just 5% of infants cry a lot because of organic disturbances; in most cases, the crying is attributable to normal developmental processes. This has led to a focus on the impact of the crying on parents. Parental vulnerabilities influence how parents evaluate and respond to the crying and predict adverse outcomes. By developing evidence-based services that support parents, this study was designed to take the first steps towards national health services that enhance the coping and well-being of parents whose babies excessively cry. Related aims were to improve these infants' outcomes and how NHS money is spent.To develop a novel intervention package to support parents of excessively crying infants and to examine the feasibility of delivering and evaluating it in the NHS.Stage 1 of this study aimed to (1) complete a literature review to identify example support materials, (2) obtain parents' guidance on the support needed when a baby cries excessively, together with their evaluation of the example materials, and (3) develop a support package based on the results. Stage 2 aimed to (1) recruit 60 parents whose babies were currently excessively crying, (2) assess parents' and NHS professionals' willingness to complete a study of the support package, (3) measure the use and evaluation of the package components, (4) estimate the package component costs and (5) provide evidence on the feasibility and methods for a large-scale trial.Primary health care.Stage 1: 20 parents of previously excessively crying infants and 55 health visitors (HVs) or specialist community public health nurses (SCPHNs). Stage 2: 57 parents of currently excessively crying infants and 124 HVs/SCPHNs.The support package included a website, a printed booklet and a programme of cognitive-behavioural therapy-based sessions delivered to parents by a qualified practitioner.(1) Demographic data, (2) figures for parents' use of the package components and continuation in the study, (3) parents' and HVs'/SCPHNs' ratings of the package components and suitability for NHS use, (4) questionnaire measures of parental well-being and infant health and (5) costs.Most parents (95%) accessed the website or printed materials and half (51%) attended the practitioner sessions. All 52 parents and 85% of HVs/SCPHNs providing data would support the inclusion of the package in the NHS. It was associated with reduced parental frustration, anxiety, depression, reported infant crying and contacts with health professionals and increased knowledge about crying. Methods for a full trial and figures for the cost of excessive infant crying for the NHS and each package element were identified.No control group was included. Most of the recruited parents were white, well educated and in stable relationships.Parents and HVs/SCPHNs recognise the need for NHS provisions that support parents of excessively crying babies and consider the materials developed to meet that need. A full-scale randomised controlled trial is feasible and desirable.Current Controlled Trials ISRCTN84975637.This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inThis study is a first step in developing evidence-based NHS services to support parents whose babies cry excessively.Around one-fifth of babies cry a lot without an apparent reason. This ‘excessive’ infant crying used to be known as ‘colic’ and was blamed on indigestion pain. Recent evidence suggests that only 5% of infants taken to the doctor because of excessive crying are actually unwell. The crying peak and ‘unsoothable’ crying bouts that alarm parents in early infancy usually stop by themselves once the baby is 5 months old and are probably attributable to normal developmental processes. Although most babies who cry a lot are well, the crying can distress parents and lead to poor consequences; these include overfeeding, stopping breastfeeding, maternal depression, poor parent–child relationships, problems with child development and, in extreme cases, infant abuse. By developing NHS services that support parents to manage excessive infant crying, this project aimed to improve parents’ well-being, long-term outcomes and how NHS money is spent.In stage 1 of the study (development of an intervention package), the research evidence was reviewed and parents whose babies previously cried excessively and NHS health visitors (HVs) and specialist community public health nurses (SCPHNs) were involved to develop evidence-based support materials. These included a website, a printed booklet and support sessions with a qualified practitioner. In stage 2 (a feasibility study of package implementation in the NHS), HVs/SCPHNs helped to recruit 57 parents whose babies were currently excessively crying. On average, these babies cried for 6.9 hours per day. Most parents accessed the website or booklet and half attended the practitioner sessions. The package was associated with reduced parental anxiety and depression, and all 52 parents and 85% of HVs/SCPHNs who gave an opinion considered that it should be included in the NHS. Findings for the cost of each package element and suggestions for future services were provided.

Prognosis with malignant mesothelioma (MM) is poor, yet evidence indicates a better chance of survival at earlier diagnosis. There is a shortage of research to produce evidence based guidance related to patients’ journey to mesothelioma diagnosis, which could be vital in improving earlier diagnosis and ultimately the survival rate. This is particularly important for the UK as the survival rate in the UK is lower than Europe’s average. Although, there has been an attempt to examine MM patients’ referral pathway once they present to a healthcare professional, there has been no study that has examined their entire pathway to diagnosis (i.e. from patient’ symptom awareness to diagnosis). This is particularly relevant at this period as evidence has shown the impact COVID19 has on waiting times to diagnosis for other cancers. There has been little attention to MM patients’ experiences prior to diagnosis (i.e. early symptom awareness, help-seeking decisions and subsequent treatment pathways) as available studies have focused on their lived experiences after diagnosis. It is important to understand how MM patients appraise their symptoms, present to health services with MM symptoms and the speed of the pathway from presentation and referral to diagnosis and treatment.

The suggested first, second, and third-year social studies program described in this outline provides opportunities for teachers to involve public school students in Lincoln, Nebraska, in exploring the plurality of our society, and specifically the positive aspects, contributions, uniqueness and dignity of ethnic minority groups in the the United States. The outline and materials involve students in value clarification, explanation of feelings, conflict resolution, group experience, decision making, generalizing, hypothesizing, concept formation and application. Goal statements for the entire K-12 social studies program are listed and terms used in the program outline are clarified. The outline presents the rationale, goals, and materials for the first three years of the social studies program on their respective topics of Self, Family, and Neighborhood. The knowledge, attitudinal, and skills aspects of the rationale, goals, and materials at each level are delineated. The materials sections contain simple, basic bibliographies requiring supplementation by teachers in the areas of media, field trips, and community resources. An appendix of skills applied in social studies relates a skill development sequence by naming skills and the levels at which they are introduced, developed, or extended. (Author/KSM)

Executive Summary According to the Office for National Statics (2018) the UK population has been steadily getting older and this trend is projected to continue. In 2016, there were 11.8 million UK residents aged 65 years and over, representing 18% of the total population – 25 years before, there were 9.1 million, accounting for 15.8% of the population. Linked to these statistics over 9 million people in the UK – almost a fifth of the population – say they are always or often lonely, but almost two thirds feel uncomfortable admitting to it (British Red Cross and Co-Op, 2016) and over half (51%) of all people aged 75 and over live alone (ONS, 2010). The Leicester Ageing Together partnership, known as LAT, has been working since October 2015 to reduce isolation and loneliness in older people in Leicester. So far, they have reached almost 6,000 older people, nearly half of whom were aged 80 years plus. This large and extensive programme recruited over 1,300 volunteers, as well as funding local jobs worth £1.5 million. LAT is part of Ageing Better, a programme set up by The National Lottery Community Fund, the largest funder to date of community activity in the UK. Ageing Better aimed to develop creative ways for older people to be actively involved in their local communities, helping to combat social isolation and loneliness. It was one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aimed to make people’s lives healthier and happier. This report commissioned by the LAT board in December 2018 was conducted by De Montfort University and reports the findings of a qualitative evaluation conducted at the end of the funding stream for the programme. The evaluation aimed to gauge the views and experiences of beneficiaries, stakeholders and provider organisations who were involved in the delivery of the programme. This evaluation was conducted over a four month period in early 2019 and where possible aimed to gain insights from across a range of ethnic groups, contexts and viewpoints. In total 50 participants shared their experiences of the programme, for which the evaluation team at De Montfort and LAT are extremely grateful. This report should be read with the understanding that the views shared in this report are not necessarily the views of everyone involved in the programme. They are time specific based on hindsight offering a snap shot of views at the end of the programme rather than throughout. The findings relate to data collected over a months in 2019 involving 50 participants who were at the time of data collection actively engaged in an activity as a beneficiary or were delivering programmes as a provider. The majority of the views shared in this report are generated from the 35 older people classed as the LAT programme beneficiaries with a further 15 interviews undertaken with provider and stakeholder organisations. This evaluation did not seek the views of the LAT board members. Ageing Better, the Big Lottery funders or organisations that were no longer offering LAT funded activities. The findings and therefore the recommendations are solely based on the evidence gathered during this evaluation exercise and it would be useful for these to be considered in light of the other extensive evaluations that have been commissioned not just for the Leicester programme but others commissioned across the sector. For example at the time of submitting this final report we understand there is an ongoing national evaluation by the Big Lottery which is anticipated to have cross cutting themes to other local evaluations. It would be wise, therefore, to review these in the context of Leicester and other UK Cities and similar programmes aimed to support loneliness and social isolation amongst older people (those aged over 50) and the communities to which they live. The report findings aim to capture the essence of the LAT programme including highlights, strengths and opportunities for future learning for similar programmes of activity.

Aims of the Presentation Provide an overview of the qualitative evaluation, how conducted, when and where Our preliminary findings from 3 groups: beneficiaries, providers and stakeholders Implications and next direction for the draft report

Table S1. Promoting good outcomes in Lesbian, Gay and Bisexual (LGB) cancer care: a qualitative study of patientsâ experiences and interactions with health professionals in clinical oncology (DOCX 105 kb)

Supplementary Information relating to the Hospital Sites (DOCX 12 kb)

Including PPI in study design of LGB cancer care (DOCX 23 kb)

Background: Survey data suggest that LGBT people report lower levels of satisfaction with healthcare for cancer than heterosexuals. This presentation summarises findings from recent qualitative research to understand the experiences of British LGBT people with cancer and their long-term partners. Methods: Participants were recruited through 5 oncology units at British hospitals, 2 cancer support charities and through media campaigns. In-depth interviews typically lasting between 45 and 75 minutes were carried out with 31 cancer patients who identified as lesbian (N=13), gay (N=14), bisexual (N= 3) and queer (N=1) and 9 long-term partners of cancer patients who identified as lesbian (N= 5), gay (N= 2) and trans* (N=2). Data were analysed through thematic analysis. Findings: Three themes are presented: Understanding the Motives, Meanings and ‘Mechanics’ of Disclosure explores how decisions around whether to ‘come out’ as LGBTQ are influenced by several factors including anticipated stigma, perceived moral or political ‘obligation’ and the manner of healthcare professionals. Creating and Communicating LGBTQ-Affirmative Spaces outlines anxieties faced by LGBTQ patients in interactions with staff and patients in clinical spaces such as waiting-rooms and hospital wards and the desire for more explicit evidencing of an anti-discriminatory culture. Finally Seeking LGBTQ-tailored Information and Support shows how current cancer support typically fails to meet psychosocial and psychosexual needs of LGBTQ patients. Discussion: The findings can be used to influence policy and practice by statutory and voluntary agencies to ensure that effective oncology treatment is accompanied by an holistic understanding of the needs and concerns of LGBTQ patients

The Publisher's final version can be found by following the URI link. Incontinence is a common problem in people with dementia and can be due to a complex combination of physical and functional issues. This article reports on a product evaluation of pant-style continence pads, which found they could help promote dignity and independence in care home residents who had mild to moderate dementia.

EXECUTIVE SUMMARY Cancer inequalities, including differences in cancer outcomes and patient satisfaction, affect a range of groups including lesbian, gay and bisexual (LGB) people. In its strategy to reduce these inequalities, the Department of Health commissioned the Cancer Patient Experience Survey (CPES) providing baseline data in which LGB patients were more likely to say their experiences were less positive than those of heterosexual patients. These differences included accessible information, psychosocial support and the human rights concerns of dignity and respect. The CPES, which was carried out in four successive years (2010-2014), suggesting that these are intractable problems, found that LGB patients were more likely to disagree with statements such as they ‘never felt treated as a set of cancer symptoms rather than as a whole person’ or the ‘doctor never talked about me as if I wasn’t there’. The CPES did not collect qualitative data and consequently the reasons for these differences were not known. This De Montfort University study, funded by Macmillan, illuminates some of the reasons for these survey findings as we were able to gather people’s accounts of their treatment and care. This report identifies key moments in the cancer journey where care provided for LGB cancer patients can contribute to their recovery and well-being. Alongside this evidence of unmet need, NHS England (2017) has recently issued guidance to support the introduction of mechanisms for recording sexual orientation across all health services in England for patients over 16. It recommends that sexual orientation monitoring occurs at every face to face contact with the patient. The collection of this monitoring data has implications; not only for cancer professionals, but also that patients themselves understand why this information is being requested. The report draws on LGB cancer patients’ motivations and methods for disclosing their sexual orientation and the perceived benefits of doing so for their quality of life. The findings will contribute to understanding the health benefits of coming out and how disclosure might be facilitated in hospital settings. This study provides compelling data about some of the factors underpinning inequalities in the experiences and, potentially, cancer outcomes for LGB patients. Managing the worry about whether it is safe to disclose their sexual orientation to professionals and the uncertainty about how this will be received presents an additional burden for LGB people with cancer. Participants in this study were sometimes hesitant to disclose because the opportunity did not arise or they were uncertain about its relevance. The report identifies some moments that matter in the care relationship where professionals could seek to facilitate disclosure thus contributing to Achieving World Class Cancer Outcomes (Department of Health, 2015) for LGB patients. In addition, the findings point to the importance of creating an inclusive care environment; participants noted that even in the Cancer Centres of Excellence, there were few visible signs of inclusion for LGB cancer patients. Steps to promote inclusion may entail a diversity policy statement, imagery on walls or the display of a LGB staff network on a hospital notice-board. participants also shared experiences where they were accepted in an everyday manner by hospital staff. They often talked about a whole hospital approach where they were acknowledged by staff from porters, health care assistants, nurses and consultants. These cancer narratives also highlight the need for LGB cancer support groups and tailored resources. The lack of LGB support groups in the UK mean that some participants were coping with their cancer with few forms of social and emotional support and they found few sources of information which addressed their needs. There was a clear demand for a greater range of LGB support resources that were relevant to the challenges and concerns of specific cancer types and reports of rather patchy provision in this regard, with differences influenced primarily by geographic location and cancer type. Finally, our findings suggest that participants had heterogeneous expectations of cancer care requiring complex .skills from professionals. Yet there is little or no curricula content in university programmes of Medicine or Nursing. This might suggest a lack of recognition of distinctive cancer care needs and may explain why participants reported different patient experiences even within the same hospital. The inclusion of research with LGB patients alongside heterosexual populations and relevant case studies to underpin Learning and Development and Continuous Professional Development to inform understanding of patient experience, psychosocial concerns and cancer risk is urgently needed.

Incontinence is a common symptom experienced by many older people with dementia, with an increased prevalence noted in care home settings when compared to community dwellings. Incontinence may often be a reason for care home admission. Absorbent continence pads are a common form of intervention with this client group. However, disposable continence pants are becoming more common and TENA Pants are one such example. Research Aim: To understand what are the key product satisfaction indicators for absorbent continence pads; and in light of this review the experience of using the TENA Pants product compared to currently used continence products with people with dementia in care homes. Methods: A review of the literature was undertaken to identify factors reported to affect user experience of absorbent continence pads. These results led to the development of a pre and post carer intervention questionnaire that focused on user satisfaction, which together with a semi-structured interview, reviewed a 4 week user trial of the TENA pull-up pants. Findings: Overall, high satisfaction levels with the product were recorded suggesting this to be a suitable continence product for people with dementia residing in care homes. However, the qualitative data showed that satisfaction with the pads was greatest when used with people in the early and mid-stages of disease progression. Three key factors were found to account for the highest percentage of satisfaction and as such are likely to become key predictor variables for good quality and satisfaction when developing absorbent continence pads for this client group, as well as key points for product development and marketing. These were: • Absorbent pads are comfortable to wear when they are dry • Absorbent pads need to be designed so they can be easily fitted and removed • Absorbent pads need to control odour well • Considerations for further research in this area are also discussed.