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Borkett-Jones C, Thakur N, Roy P, Clayton-Payne A, Erdunast A, Wilkinson S, Mehta H, Jones AJ. A retrospective case review of young people referred for paediatric critical care transport following self-harm or a suicide attempt, 2015-2022. Arch Dis Child 2024; 109:262-263. [PMID: 38182267 DOI: 10.1136/archdischild-2023-326419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Caroline Borkett-Jones
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital for Children, London, UK
| | - Nitin Thakur
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital for Children, London, UK
| | - Prithwish Roy
- Paediatric and Neonatal Decision Support and Retrieval Service (PaNDR), Addenbrooke's Hospital, Cambridge, UK
| | - Ali Clayton-Payne
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital for Children, London, UK
| | - Anna Erdunast
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital for Children, London, UK
| | - Simon Wilkinson
- Psychological and Mental Health Services (PAMHS), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Hiren Mehta
- Paediatric and Neonatal Decision Support and Retrieval Service (PaNDR), Addenbrooke's Hospital, Cambridge, UK
| | - Andrew J Jones
- Children's Acute Transport Service (CATS), Great Ormond Street Hospital for Children, London, UK
- Infection, Immunity and Inflammation Research and Teaching Department, University College London Institute of Child Health, London, UK
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Vázquez-Vázquez A, Smith A, Gibson F, Roberts H, Mathews G, Ward JL, Viner RM, Nicholls D, Cornaglia F, Roland D, Phillips K, Hudson LD. Admissions to paediatric medical wards with a primary mental health diagnosis: a systematic review of the literature. Arch Dis Child 2024:archdischild-2023-326593. [PMID: 38373777 DOI: 10.1136/archdischild-2023-326593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To systematically review the literature describing children and young people (CYP) admissions to paediatric general wards because of primary mental health (MH) reasons, particularly in MH crisis. DESIGN PubMed, Embase, PsycINFO, Web of Science and Google Scholar were searched, with no restriction on country or language. We addressed five search questions to inform: trends and/or the number of admissions, the risk factors for adverse care, the experiences of CYP, families/carers and healthcare professionals (HCPs) and the evidence of interventions aimed at improving the care during admissions.Two reviewers independently assessed the relevance of abstracts identified, extracted data and undertook quality assessment. This review was registered with PROSPERO (CRD42022350655). RESULTS Thirty-two studies met the inclusion criteria. Eighteen addressed trends and/or numbers/proportions of admissions, 12 provided data about the views/experiences of HCPs, two provided data about CYP's experiences and four explored improving care. We were unable to identify studies examining risk factors for harm during admissions, but studies did report the length of stay in general paediatric/adult settings while waiting for specialised care, which could be considered a risk factor while caring for this group. CONCLUSIONS MH admissions to children's wards are a long-standing issue and are increasing. CYP will continue to need to be admitted in crisis, with paediatric wards a common location while waiting for assessment. For services to be delivered effectively and for CYP and their families/carers to feel supported and HCPs to feel confident, we need to facilitate more integrated physical and MH pathways of care. PROSPERO REGISTRATION NUMBER CRD42022350655.
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Affiliation(s)
- Adriana Vázquez-Vázquez
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Abigail Smith
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Faith Gibson
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- University of Surrey, Guildford, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Helen Roberts
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Gabrielle Mathews
- CYP Transformation Team, NHS England and NHS Improvement London, London, UK
| | - Joseph Lloyd Ward
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
| | | | - Damian Roland
- SAPPHIRE Group, Population Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Kirsty Phillips
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lee D Hudson
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
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Hudson LD, Ward J, Vázquez-Vázquez A, Settle K, Cornaglia F, Gibson F, Phillips K, Mathews G, Roberts H, Roland D, Nicholls DE, Elphinstone H, Viner R. Mental Health Admissions to Paediatric Wards Study (MAPS): a protocol for the analysis of Hospital Episode Statistics (HES) data. BMJ Paediatr Open 2024; 8:e002352. [PMID: 38286521 DOI: 10.1136/bmjpo-2023-002352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/25/2023] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that CYP occupied 6% of general paediatric inpatient beds due to an MH crisis, and there have been longstanding concerns about the quality of care to support these patients in this setting. Mental Health Admissions to Paediatric Wards Study aims to generate a theory of change (ToC) model to improve the quality of care for CYP admitted to acute paediatric services after presenting in a MH crisis. METHODS AND ANALYSIS We will undertake a national (England), sequential, mixed methods study to inform a ToC framework alongside a stakeholder group consisting of patients, families/carers and healthcare professionals (HCPs). Our study consists of four work packages (WP) undertaken over 30 months. WP1 is limited to using national routine administrative data to identify and characterise trends in MH admissions in acute paediatric wards in England between 2015- 2022. ETHICS AND DISSEMINATION WP1 received ethical approval (Ref 23/NW/0192). We will publish the overall synthesis of data and the final ToC to improve care of CYP with MH crisis admitted to general acute paediatric settings. As coproducers of the ToC, we will work with our stakeholder group to ensure wide dissemination of findings. Potential impacts will be on service development, new models of care, training and workforce planning.
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Affiliation(s)
- Lee Duncan Hudson
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Joseph Ward
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Adriana Vázquez-Vázquez
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Kate Settle
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Faith Gibson
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
- University of Surrey, Guildford, UK
| | - Kirsty Phillips
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Gabrielle Mathews
- CYP Transformation Team, NHS England and NHS Improvement London, London, UK
| | - Helen Roberts
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Damian Roland
- SAPPHIRE Group, Population Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | | | - Holly Elphinstone
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Russell Viner
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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4
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Hudson LD, Vázquez-Vázquez A, Gibson F, Phillips K, Mathews G, Roberts H, Cornaglia F, Roland D, Ward J, Nicholls DE, Elphinstone H, Viner R. Mental Health Admissions to Paediatric Wards Study (MAPS): protocol of a prospective study of mental health admissions to paediatric wards in England using surveillance and qualitative methods. BMJ Paediatr Open 2024; 8:e002186. [PMID: 38272539 PMCID: PMC10824001 DOI: 10.1136/bmjpo-2023-002186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/09/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that CYP occupied 6% of general paediatric inpatient beds due to an MH crisis, and there have been longstanding concerns about the quality of care to support these patients in this setting. MAPS aims to generate a Theory of Change (ToC) model to improve the quality of care for CYP admitted to acute paediatric services after presenting with an MH crisis. Here, we describe work packages (WPs) 2 and 3 of the study, which have been granted ethics approval. METHODS AND ANALYSIS We will undertake a national (England), sequential, mixed-methods study to inform a ToC framework alongside a stakeholder group consisting of patients, families/carers and healthcare professionals (HCPs). Our study consists of four WPs undertaken over 30 months. WP2 is limited to working with stakeholders to develop a data collection instrument and then use this in a prospective study of MH admissions over 6 months in 15 purposively recruited acute paediatric wards across England. WP3 consists of gathering the views of CYP, their families/carers and HCPs during admissions using semistructured interviews. ETHICS AND DISSEMINATION WP2 and WP3 received ethical approval (ref: 23/LO/0349). We will publish the overall synthesis of data and the final ToC to improve care of CYP with MH crisis admitted to general acute paediatric settings. As co-producers of the ToC, we will work with our stakeholder group to ensure wide dissemination of findings. Potential impacts will be upon service development, new models of care, training and workforce planning. PROSPERO REGISTRATION NUMBER CRD42022350655.
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Affiliation(s)
- Lee Duncan Hudson
- University College London Great Ormond Street Institute of Child Health, London, UK
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Adriana Vázquez-Vázquez
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Faith Gibson
- University College London Great Ormond Street Institute of Child Health, London, UK
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Kirsty Phillips
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Gabrielle Mathews
- CYP Transformation Team, NHS England and NHS Improvement London, London, UK
| | - Helen Roberts
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Damian Roland
- SAPPHIRE Group, Population Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Joseph Ward
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Holly Elphinstone
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Russell Viner
- University College London Great Ormond Street Institute of Child Health, London, UK
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5
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Holland J, Roe J, Guo B, Dasilva-Ellimah M, Burn AM, Dubicka B, Ford T, Wagner AP, Nazir S, James A, Morriss R, Sayal K. 'Far Away from Home': adolescent inpatient admissions far from home, out of area or to adult wards: a national surveillance study. BMJ MENTAL HEALTH 2023; 26:e300843. [PMID: 38097391 PMCID: PMC10728958 DOI: 10.1136/bmjment-2023-300843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND The increasing prevalence and acuity of mental disorders among children and adolescents have placed pressure on services, including inpatient care, and resulted in young people being admitted at-distance or to adult wards. Little empirical research has investigated such admissions. OBJECTIVE To determine the incidence, clinical characteristics and 6-month outcomes of patients aged 13-17 years old admitted at-distance (>50 miles from home or out of region) to general adolescent psychiatric wards or to adult psychiatric wards. METHODS Surveillance over 13 months (February 2021-February 2022) using the Child and Adolescent Psychiatry Surveillance System including baseline and 6-month follow-up questionnaires. FINDINGS Data were collected about 290 admissions (follow-up rate 99% (288 of 290); sample were 73% female, mean age 15.8 years). The estimated adjusted yearly incidence of at-distance admission was 13.7-16.9 per 100 000 young people 13-17 years old. 38% were admitted >100 miles from home and 8% >200 miles. The most common diagnoses at referral were depression (34%) and autism spectrum disorder (20%); other common referral concerns included suicide risk (80%), emotional dysregulation (53%) and psychotic symptoms (22%). Over two-fifths (41%) waited ≥1 week for a bed, with 55% waiting in general hospital settings. At 6-month follow-up, 20% were still in hospital, the majority in at-distance placements. CONCLUSIONS At-distance and adult ward admissions for patients aged <18 remain an ongoing challenge for healthcare provision and have an impact on acute hospital resource use. CLINICAL IMPLICATIONS Long waits in non-specialist settings increase pressure across the healthcare system, highlighting the need to improve local service provision and commissioning to reflect identified clinical needs.
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Affiliation(s)
- Josephine Holland
- Mental Health and Clinical Neurosciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - James Roe
- National Institute for Health and Care Research Applied Research Collaboration (ARC) East Midlands, University of Nottingham, Nottingham, UK
| | - Boliang Guo
- National Institute for Health and Care Research Applied Research Collaboration (ARC) East Midlands, University of Nottingham, Nottingham, UK
| | - Morenike Dasilva-Ellimah
- Mental Health and Clinical Neurosciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Anne-Marie Burn
- National Institute for Health and Care Research Applied Research Collaboration (ARC) East of England, University of Cambridge, Cambridge, UK
| | - Bernadka Dubicka
- Department of Child and Adolescent Psychiatry, University of York, York, UK
| | - Tamsin Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Adam P Wagner
- National Institute for Health and Care Research Applied Research Collaboration (ARC) East of England, University of East Anglia, Norwich, UK
| | - Saeed Nazir
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - Richard Morriss
- Mental Health and Clinical Neurosciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Kapil Sayal
- Mental Health and Clinical Neurosciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
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6
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Rothwell L, Vivek K, Nicholls D, Maconochie I, Dyer EM. Fifteen-minute consultation: Recognition and management of eating disorders presenting to the emergency department. Arch Dis Child Educ Pract Ed 2023; 108:330-334. [PMID: 35790339 DOI: 10.1136/archdischild-2021-323348] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022]
Abstract
Eating disorder presentations in children and young people during the COVID-19 pandemic have increased, and this has become a common presentation to paediatric emergency departments (EDs). We cover a structured approach on identifying and managing these presentations within the ED including history taking, what to look for on examination, what investigations are needed and how to decide who requires admission to hospital.
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Affiliation(s)
- Luke Rothwell
- Paediatric Emergency Department, Imperial College Healthcare NHS Trust, London, UK
| | - Kavyesh Vivek
- Faculty of Medicine, Imperial College London, London, UK
| | - Dasha Nicholls
- Department of Brain Sciences, Imperial College London, London, UK
| | - Ian Maconochie
- Paediatric Emergency Department, Imperial College Healthcare NHS Trust, London, UK
| | - Emma M Dyer
- Paediatric Emergency Department, Imperial College Healthcare NHS Trust, London, UK
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7
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Castellini G, Cassioli E, Rossi E, Marchesoni G, Cerini G, Pastore E, De Bonfioli Cavalcabo' N, Rotella F, Mezzani B, Alterini B, Lucarelli S, Magazzini S, Corazzesi P, Caini S, Ricca V. Use and misuse of the emergency room by patients with eating disorders in a matched-cohort analysis: What can we learn from it? Psychiatry Res 2023; 328:115427. [PMID: 37647700 DOI: 10.1016/j.psychres.2023.115427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/01/2023]
Abstract
We examined the pattern of access to hospital emergency room (hER) in 2018-2021 among patients with eating disorders (ED) from Florence, Italy, diagnosed during 1994-2018, using a matched cohort design. We included 902 ED patients and an equal number of sex-, age-, and residence-matched individuals. We fitted conditional Poisson regression models with robust variance estimator to estimate incidence rate ratios (IRR) and 95% confidence intervals. ED patients accessed hER more than twice as often as matched individuals: the IRR was 2.11 (1.21-3.70), 2.02 (1.36-3.00), and 2.49 (1.71-3.61) among AN, BN, and BED patients. Factors associated with increased hER use were older age (≥40 years; for AN patients, also younger age, <20 years), BMI ≤ 16 kg/m2 (for AN), and psychopathological severity. The rise in access to hER was particularly marked during the early phases of the COVID-19 pandemic and declined only partially thereafter. Acute psychiatric symptoms and non-specific medical conditions represented the main causes of increased access to hER. Use of hER was more often inappropriate among ED patients than matched individuals. Integration of primary and mental health care may be necessary to counteract the high and often inappropriate use of hER by patients with ED.
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Affiliation(s)
- Giovanni Castellini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Emanuele Cassioli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | - Giorgia Marchesoni
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Cerini
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence 50134, Italy
| | - Elisa Pastore
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Nora De Bonfioli Cavalcabo'
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Francesco Rotella
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
| | | | - Brunetto Alterini
- Division of Cardiovascular and Perioperative Medicine, Careggi University Hospital, Florence, Italy
| | - Stefano Lucarelli
- Eating Disorders Unit, Central Tuscany Local Health Authority, Florence, Italy
| | - Simone Magazzini
- Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department ASL Toscana Centro, Prato, Italy
| | - Patrizia Corazzesi
- Emergency Medicine Unit, Ospedale Santo Stefano, Emergency Department ASL Toscana Centro, Prato, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy; Psychiatry Unit, Careggi University Hospital, Florence, Italy
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Chapman S, Hudson LD, Street KN. Restrictive eating disorders in children and young people: the role of the paediatrician and paediatric ward. Arch Dis Child 2023; 108:e4. [PMID: 35131839 DOI: 10.1136/archdischild-2021-322745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/25/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Simon Chapman
- Child Health, King's College Hospital NHS Foundation Trust, London, UK
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK
| | - Lee D Hudson
- Population, Policy & Practice Research Programme, University College London, London, UK
- General Paediatrics, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Fuller SJ, Thomson S, Tan J. Nasogastric tube feeding under restraint: practical guidance for children's nurses. Nurs Child Young People 2023; 35:18-23. [PMID: 36408588 DOI: 10.7748/ncyp.2022.e1457] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 11/22/2022]
Abstract
The number of children and young people admitted to children's wards with an eating disorder has increased significantly since the start of the coronavirus disease 2019 (COVID-19) pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint. This article offers an overview of eating disorders and their detrimental effects as well as practical advice for children's nurses, supporting them to provide safe, compassionate and person-centred care to their patients.
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Affiliation(s)
- Sarah J Fuller
- child and adolescent mental health, East London NHS Foundation Trust, Bedford, England
| | - Sharon Thomson
- child and adolescent mental health, East London NHS Foundation Trust, Bedford, England
| | - Jacinta Tan
- child and adolescent mental health, Oxford Health NHS Foundation Trust, Bedford, England
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10
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Nicholls D. Editorial Perspective: A perfect storm - how and why eating disorders in young people have thrived in lockdown and what is happening to address it. J Child Psychol Psychiatry 2023; 64:335-338. [PMID: 35902107 PMCID: PMC10087223 DOI: 10.1111/jcpp.13676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2022] [Indexed: 01/17/2023]
Abstract
The number of children and young people referred to community eating disorders services escalated dramatically shortly after onset of the Covid-19 pandemic. Many presented with medical instability following restrictive eating and needed acute hospitalisation to correct malnutrition. In addition to the many risk factors for mental health problems that young people have been subjected to since onset of the pandemic, the question for eating disorders researchers, practitioners and policy makers is how, for so many, did it become about eating. In this editorial, some of the factors that may explain how eating, weight, shape and body image may have taken centre stage in young people's lives are explored. Finally, some clinical service adaptations and gaps, policy considerations, and research priorities are outlined.
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Affiliation(s)
- Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
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Otis M, Barber S, Green Hofer S, Straus J, Kay M, Hargreaves DS, Hayhoe B, Anokye N, Lennox L, Nicholls D. Evaluating the implementation and impact of a new model of care for integrating children and young people's acute mental healthcare in a paediatric setting: a protocol for a realist, mixed-methods approach. BMJ Open 2023; 13:e067074. [PMID: 36669846 PMCID: PMC9872460 DOI: 10.1136/bmjopen-2022-067074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/23/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The mental health of children and young people in the UK has been declining and has continued to worsen throughout the pandemic, leading to an increase in mental health-related emergencies. In response, the Best for You programme was developed as a new service designed to integrate mental healthcare for children and young people between acute hospital and community services. The programme is comprised of four new services: a rapid assessment young people's centre with dual-trained staff, a co-located day service offering family-based care,a digital hub, designed to integrate with the fourth element of the model, namely community support and mental health services. This evaluation protocol aims to assess the development, implementation and outcomes of the Best for You programme and develops a scalable model that could be implemented in other parts of the National Health Service (NHS). METHODS AND ANALYSIS This mixed-methods realist evaluation aims to delineate the components of the system to assess their interdependent relationships within a wider context. Data collection will include interviews, participant observations, focus groups and the collection of local quantitative healthcare data. The research will be conducted across four phases. Phase 1-captures the development of the underlying programme theory. Phase 2-a process evaluation testing the programme theory. Phase 3- an outcome and economic evaluation. Phase 4-consolidation of learning from phases 1-3 to identify barriers, facilitators and wider contextual factors that have shaped implementation drawing on the Consolidated Framework for Implementation Research. ETHICS AND DISSEMINATION Ethical approval for the evaluation was received from the NHS local ethics committee. Embedded within the evaluation is a formative review to feedback and share learning with stakeholders to scale-up the programme. Findings from this study will be disseminated in peer-reviewed journals as well as presentations to be useful to service user organisations and networks.
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Affiliation(s)
- Michaela Otis
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | - Susan Barber
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | - Stuart Green Hofer
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | | | | | - Dougal S Hargreaves
- NIHR ARC Northwest London, London, UK
- Mohn Centre for Children's Health and Wellbeing, Imperial College London, London, UK
| | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | - Nana Anokye
- NIHR ARC Northwest London, London, UK
- College of Health and Life Sciences, Brunel University London, Uxbridge, UK
| | - Laura Lennox
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
- NIHR ARC Northwest London, London, UK
| | - Dasha Nicholls
- NIHR ARC Northwest London, London, UK
- Department of Brain Sciences, Imperial College London, London, UK
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McDonnell T, Conlon C, McNicholas F, Barrett E, Barrett M, Cummins F, Hensey C, McAuliffe E, Nicholson E. Paediatric hospital admissions for psychiatric and psychosocial reasons during the first year of the COVID-19 pandemic. Int Rev Psychiatry 2022; 34:128-139. [PMID: 35699100 DOI: 10.1080/09540261.2022.2061840] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Increases in youth psychiatric presentations to out-patient and emergency department settings during COVID-19 have been reported. This study, using data from five hospitals in Ireland, examines changes in the number and type of paediatric admissions during COVID-19 (March 2020 - February 2021) compared to the previous two years. ICD-10 classification was used to establish admissions with mental, behavioural, neuro-developmental disorders and psychosocial reasons (MBN-PS). Overall hospital admissions fell by 25.3%, while MBN-PS fell by only 2.6%, mostly during an initial lockdown. Admissions for MBN-PS increased in July-August (9.2%), increased further in September-December (28.3%), returning to pre-COVID-19 levels in January-February 2021. Significant increases were observed among youths with anorexia nervosa (47.8%), other eating disorders (42.9%), and admissions for anxiety (29.6%), with these effects relating to females only. Although admissions for self-harm increased (3%) and rates of ASD admissions reduced (17%), these were not statistically significant. The disproportionate increase in admissions for MBN-PS compared to medical admissions suggests an adverse effect of COVID-19 on youth mental health, for females in particular, and supports previous reports of a pandemic specific increase in eating psychopathology. Combined community and acute service delivery and capacity planning are urgently needed given the prior underfunding of services pre-pandemic.
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Affiliation(s)
- T McDonnell
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - C Conlon
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - F McNicholas
- Children's Health Ireland at Crumlin, Dublin, Ireland.,UCD Child and Adolescent Psychiatry, University College Dublin, Belfield, Ireland.,Lucena Clinic, Rathgar, Ireland
| | - E Barrett
- UCD Child and Adolescent Psychiatry, University College Dublin, Belfield, Ireland.,Children's Health Ireland at Temple Street, Dublin, Ireland
| | - M Barrett
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Women's and Children's Health, School of Medicine, University College Dublin, Dublin, Ireland.,National Children's Research Centre, Dublin, Ireland
| | - F Cummins
- ALERT, REDSPOT, Emergency Department, Limerick University Hospital, Limerick, Ireland
| | - C Hensey
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - E McAuliffe
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - E Nicholson
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland.,School of Psychology, Dublin City University, Dublin, Ireland
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Affiliation(s)
- Lee D Hudson
- Clinical Associate Professor, GOS UCL Institute of Child Health, UK
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