Optimizing clinical care for infants, children and young people with bacterial meningitis and meningococcal septicaemia: ‘NICE’ guidance plus an insight into its development

AimsTo establish whether physical health monitoring for CYP on ADHD medication is according to NICE guidance (2018).To determine the impact of COVID-19 pandemic restrictions on physical health monitoring for CYP on ADHD medication.Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, characterised by a persistent pattern of inattention and/or hyperactivity-impulsivity, directly impacting on academic, occupational, or social functioning. It affects between 1-5% of children and young people (CYP) most often presenting in early-mid childhood.Pharmacological treatment can be considered in CYP if certain criteria are met, where licensed medications include methylphenidate, dexamfetamine, lisdexamfetamine, atomoxetine and guanfacine. Stimulant and non-stimulant medications require frequent physical health monitoring due to their side effects including an increase in blood pressure and/or heart rate, loss of appetite, growth restriction and tics.MethodStandards and criteria were derived from the NICE guidance (2018), whilst local trust policies were reviewed, demonstrating discrepancies. Standards were expected to be met for 100% of patients.Electronic patient records were reviewed retrospectively from a representative cohort of CYP reviewed by clinicians in a community CAMHS service during March-November 2020. Data were entered manually into a spreadsheet for evaluation.ResultA total of 27 CYP records were reviewed, average age 13yo, on a range of stimulant/non-stimulant preparations.5 (19%) had height checked every 6 months, with 4 delayed to 7-8 months.For those >10yo, only 5 (19%) had weight checked every 6 months.Only 2 (7%) had their height and weight plotted on a growth chart and reviewed by the healthcare professional responsible for treatment.Just 4 (15%) had heart rate and blood pressure recorded before and after each dose change, whilst similarly only 4 (not the same) had these parameters recorded every 6 months.17 patients were reviewed by telephone/video call, where 5 patients provided physical health parameters (measured at home).ConclusionAcross all parameters, standards are not being met for the required physical health monitoring for CYP on ADHD medication.The COVID-19 pandemic has significantly changed the working conditions for community teams, impacting face to face reviews, creating challenges for physical health monitoring.Our ongoing implementations for change include the use of a proforma for physical health measurements, improving psychoeducation for families, exploring potential barriers with senior colleagues and collaborating with pharmacy colleagues to update local guidelines in accordance with the latest NICE recommendations. We aim to re-audit in June 2021.

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Spasticity in children and young people with non-progressive brain disorders: summary of NICE guidance

BMJ ◽

10.1136/bmj.e4845 ◽

2012 ◽

Vol 345 (jul26 2) ◽

pp. e4845-e4845 ◽

Cited By ~ 12

Author(s):

M. A. Mugglestone ◽

P. Eunson ◽

M. S. Murphy ◽

Keyword(s):

Young People ◽

Brain Disorders ◽

Children And Young People ◽

Nice Guidance

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Standard 5/6 – clinical care of children and young people

Primary Health Care ◽

10.7748/phc2004.07.14.6.35.c515 ◽

2004 ◽

Vol 14 (6) ◽

pp. 35-38

Author(s):

Harmony Richardson

Keyword(s):

Young People ◽

Clinical Care ◽

Children And Young People

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Recognition and management of psychosis and schizophrenia in children and young people: summary of NICE guidance

BMJ ◽

10.1136/bmj.f150 ◽

2013 ◽

Vol 346 (jan23 1) ◽

pp. f150-f150 ◽

Cited By ~ 27

Author(s):

T. Kendall ◽

C. Hollis ◽

M. Stafford ◽

C. Taylor ◽

Keyword(s):

Young People ◽

Children And Young People ◽

Nice Guidance

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Protocol for the Process Evaluation of the Online Remote Behavioural Intervention for Tics (ORBIT) Randomised Controlled Trial for children and young people

10.21203/rs.2.10297/v2 ◽

2019 ◽

Author(s):

Kareem Khan ◽

Chris Hollis ◽

Charlotte L Hall ◽

E Bethan Davies ◽

David Mataix-Cols ◽

...

Keyword(s):

Young People ◽

Process Evaluation ◽

Qualitative Data ◽

Controlled Trial ◽

Clinical Care ◽

Complex Interventions ◽

Behavioural Intervention ◽

Main Trial ◽

Children And Young People ◽

Standard Clinical Practice

Abstract Background Process evaluations are an important component in the interpretation and understanding of outcomes in trials. The ‘Online Remote Behavioural Intervention for Tics’ (ORBIT) study is a randomized controlled trial evaluating the effectiveness of an internet delivered behavioural intervention (called BIP TIC) compared to an internet delivered education program aimed at children and young people with tics. A process evaluation will be undertaken alongside the main trial to determine precisely how the behavioural intervention works and ascertain whether, and if so, how, the intervention could be successfully implemented in standard clinical practice. This protocol paper describes the rationale, aims, and methodology of the ORBIT trial process evaluation. Methods The process evaluation will use a mixed-methods design following the UK Medical Research Council’s 2015 guidelines, comprising of both quantitative and qualitative data collection. This will include: analyzing data usage of participants in the intervention arm; purposively sampled, semi-structured interviews of parents and children, therapists and supervisors, and referring clinicians of the ORBIT trial, as well as analysis of qualitative comments input into the online therapy platform by participants at the end of treatment. Qualitative data will be analyzed thematically. Quantitative and qualitative data will be integrated in a triangulation approach, to provide an understanding of how the intervention works, and what resources are needed for effective implementation, uptake and use in routine clinical care. Discussion This process evaluation will explore the experiences of participants, therapists and supervisors, and referring clinicians of a complex online intervention. By contextualising trial efficacy results, this will help understand how and if the intervention worked and what may be required to sustain the implementation of the treatment long-term. The findings will also aid in our understanding of factors that can affect the success of complex interventions. This will enable future researchers developing online behavioural interventions for children and young people with mental health and neurological disorders to gain invaluable information from this process evaluation.

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Advance Care Planning: practicalities, legalities, complexities and controversies

Archives of Disease in Childhood ◽

10.1136/archdischild-2014-305945 ◽

2014 ◽

Vol 100 (4) ◽

pp. 380-385 ◽

Cited By ~ 22

Author(s):

Karen A Horridge

Keyword(s):

Decision Making ◽

Young People ◽

Advance Care Planning ◽

Clinical Care ◽

Active Management ◽

Ethical Framework ◽

Multidisciplinary Teams ◽

Care Planning ◽

Children And Young People ◽

Advance Care

Increasing numbers, complexities and technology dependencies of children and young people with life-limiting conditions require paediatricians to be well prepared to meet their changing needs. Paediatric Advance Care Planning provides a framework for paediatricians, families and their multidisciplinary teams to consider, reflect and record the outcome of their conversations about what might happen in the future in order to optimise quality of clinical care and inform decision-making. For some children and young people this will include discussions about the possibility of death in childhood. This may be unexpected and sudden, in the context of an otherwise active management plan or may be expected and necessitate discussions about the process of dying and attention to symptoms. Decision-making about appropriate levels of intervention must take place within a legal and ethical framework, recognising that the UK Equality Act (2010) protects the rights of disabled children and young people and infants and children of all ages to the same high quality healthcare as anyone else.

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‘Becoming more confident in being themselves’: The value of cultural and creative engagement for young people in foster care – Dawn Mannay, Phil Smith, Catt Turney, Stephen Jennings and Peter Davies

Qualitative Social Work ◽

10.1177/14733250211009965 ◽

2021 ◽

pp. 147332502110099

Author(s):

Dawn Mannay ◽

Phil Smith ◽

Catherine Turney ◽

Stephen Jennings ◽

Peter Henry Davies

Keyword(s):

Foster Care ◽

Young People ◽

Interpersonal Relationships ◽

Social Connectedness ◽

Field Observations ◽

Children And Young People ◽

Cultural Engagement ◽

The Arts ◽

Insight Into

There is evidence that engagement with the arts can engender transformative effects on young people’s views of themselves and their futures, this can be particularly useful for children and young people in care. This paper draws on a case study of an arts-based programme delivered in Wales, UK. Field observations of the arts-based sessions were conducted, and the participant sample included young people in foster care (n = 8), foster carers (n = 7) and project facilitators (n = 3). The study employed interviews, observations, reflexive diaries, and metaphor work to explore the subjective accounts of these different stakeholders. This provided an insight into their experience of being involved with the arts-based programme, the impacts of this involvement, and what steps they felt could be taken to improve the model. The paper argues that arts and cultural engagement can be transformative in improving the confidence and social connectedness of young people in foster care, but that attention needs to be given to how programmes are delivered. The paper documents the often overlooked mundane, yet important, aspects of planning arts-based programmes, exploring the involvement of foster carers, interpersonal relationships, and the provision of refreshments. It calls for investment in developing carefully designed extracurricular opportunities for young people in care, where they can experience ‘becoming more confident in being themselves’.

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