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Childhood cancer survivors (CCSs) experience educational disruptions during and following treatment, yet robust, longitudinal evidence on educational performance remains limited. We will investigate differences in educational outcomes between CCSs and non-cancer peers during primary and secondary school. We will also explore how sociodemographic factors and age at diagnosis contribute to potential differences in General Certificate of Secondary Education (GCSE) examinations, a critical indicator of future academic and employment prospects.
We will use the Education and Child Health Insights from Linked Data (ECHILD) to capture linked health and education data for children born in National Health Service (NHS)-funded hospitals in England. We will generate birth cohorts spanning September 1997 to August 2015 (estimated sample size: ~10 million), formed of pupils expected to have undertaken national curriculum assessments between academic years 2004/2005 and 2021/2022 including Key Stage (KS) 1, 2 and 4, corresponding to ages 7, 11 and 16 respectively. Cancer diagnosis will be identified from inpatient hospital records, using International Classification of Diseases, 10th Revision codes (ICD-10). We will investigate differences between CCS and their non-cancer peers in terms of their sociodemographic characteristics and describe trends in educational performances at all KSs, recorded Special Educational Needs and Disabilities (SEND) and school absences. Differences in KS4 (GCSE) performances between CCS and non-cancer peers will be quantified, according to and accounting for geographic region, sex, deprivation, ethnicity and birth characteristics. To assess whether cancer diagnosis disrupts academic trajectories, we will restrict analysis to those with KS2 attainment data and investigate KS4 performance. We will finally explore the influence of age at diagnosis on educational performance at KS4.
Ethics approval was granted by NHS Health Research Authority Research Ethics Committee (20/EE/0180). Findings will be shared with academics, policymakers, children and families affected by childhood cancer, and published in journals. Code/metadata will be shared on ECHILD GitHub repository.
Over 100 000 service users are admitted to acute mental health wards annually, many involuntarily. Wards are under incredible pressure due to high bed occupancy rates and staff shortages. In a recent survey, over 80% of mental health nurses reported experiencing aggression and violence within their role. National and international policy dictates that mental health ward staff manage incidents of aggression and violence using communication, known as de-escalation. However, de-escalation practice is variable, and there is little empirical evidence to underpin training. As such, there is still a reliance on more restrictive practices, including seclusion and physical restraint.
The aim of this study is to identify the communication and organisational factors that characterise effective management of service users’ behaviour and distress in acute adult inpatient mental health wards, reducing the reliance on more restrictive practices (eg, seclusion and restraint).
This observational study will be conducted on mental health wards in England. It will be comprised of three work packages (WPs).
A microanalysis of communication during de-escalation incidents from Body Worn Camera footage on wards (n=64), to identify staff communication practices that lead to effective management of service users’ distress. Ethnographic observations of ward routine practice, alongside interviews and questionnaires with staff and service users, to examine how challenging behaviour is anticipated, planned for and responded to on wards, and staff experiences and perceptions of this process. Triangulation of the findings from WPs 1 and 2 to examine the relationship between approaches to aggression management and staff communication, exploring the similarities and differences within and between wards.
Ethical approval for sites in England has been granted by the Wales Research Ethics Committee 3, REF 22/WA/0066. Findings will be disseminated through peer-reviewed journals, scientific conferences and service user and clinical networks.
by Megan Wiggins, Marie Varughese, Ellen Rafferty, Sasha van Katwyk, Christopher McCabe, Jeff Round, Erin Kirwin
BackgroundDuring public health crises such as the COVID-19 pandemic, decision-makers relied on infectious disease models to evaluate policy options. Often, there is a high degree of uncertainty in the evidence base underpinning these models. When there is increased uncertainty, the risk of selecting a policy option that does not align with the intended policy objective also increases; we term this decision risk. Even when models adequately capture uncertainty, the tools used to communicate their outcomes, underlying uncertainty, and associated decision risk have often been insufficient. Our aim is to support infectious disease modellers and decision-makers in interpreting and communicating decision risk when evaluating multiple policy options.
MethodsWe developed the Decision Uncertainty Toolkit by adapting methods from health economics and infectious disease modelling to improve the interpretation and communication of uncertainty. Specifically, we developed a quantitative measure of decision risk as well as a suite of risk visualizations. We refined the toolkit contents based on feedback from early dissemination through conferences and workshops.
ResultsThe Decision Uncertainty Toolkit: (i) adapts and extends existing health economics methods for characterization, estimation, and communication of uncertainty to infectious disease modelling, (ii) introduces a novel risk measure that quantitatively captures the downside risk of policy alternatives, (iii) provides visual outputs for dissemination and communication of uncertainty and decision risk, and (iv) includes instructions on how to use the toolkit, standard text descriptions and examples for each component. The use of the toolkit is demonstrated through a hypothetical example.
ConclusionThe Decision Uncertainty Toolkit improves existing methods for communicating infectious disease model results by providing additional information regarding uncertainty and decision risk associated with policy alternatives. This empowers decision-makers to consider and evaluate decision risk more effectively when making policy decisions. Improved understanding of decision risk can improve outcomes in future public health crises.
Self-harm is the strongest predictor of suicide in young people. Self-harm presentations to the emergency department (ED) are associated with repeat self-harm and suicide. Rapid follow-up contact after ED offers an opportunity to intervene before self-harm becomes an established coping strategy. Despite recent progress in self-harm treatment, currently, there are no evidence-based interventions to prevent future self-harm and suicide offered to young people after visits to the ED. Preliminary evidence suggests therapeutic assessment and rapid follow-up contacts may reduce self-harm and improve engagement in follow-up care. In this study, we assess the clinical and cost-effectiveness of a brief psychological intervention, supporting adolescents with self-harm (SASH), in addition to standard care in a randomised controlled trial, compared with standard care only. As per National Institute for Health and Care Excellence guidelines, standard care involves at least one follow-up by a mental health professional within 7 days of ED discharge.
The SASH intervention comprises up to six follow-up contacts with a mental health professional delivered over approximately 2 months for young people and their carers using a solution-focused approach, shortly after presenting to the ED. Participants are aged 12–18, presenting to the ED with self-harm or suicidal ideation (with self-harm in the past month), with capacity to consent. We aim to recruit 144 young people into the trial who will be randomised on a 1:1 basis to the SASH intervention or treatment as usual. Participants are assessed postintervention/standard care and at 6-month follow-up after randomisation. Self-reported self-harm is assessed via text message survey every 2 weeks during the 6-month follow-up period. The primary outcome is self-reported episodes of self-harm in the past month assessed at 6 months by summing three behavioural domains of the self-injurious thoughts and behaviours interview. We hypothesise that the therapeutic relationship with the mental health practitioner will mediate this relationship. Secondary outcomes include symptoms of depression and anxiety, frequency of reattendance at ED, death by suicide, school attendance, well-being and additional domains of self-harm-related behaviour and thoughts in the past month. The trial will also consider service use, costs to carer and carer health-related quality of life to evaluate the costs and cost-effectiveness of the intervention.
London-Riverside Nation Health Service REC (22/LO/0400) provided a favourable ethical opinion. Findings will be disseminated through social media, a website, scientific papers, conferences and reports, in collaboration with our Young Person’s Lived Experience Advisory Group.
13.0, 30.06.2025.
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