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This paper forms part of a series of methodological guidance from the Cochrane Rapid Reviews Methods Group and addresses rapid qualitative evidence syntheses (QESs), which use modified systematic, transparent and reproducible methodsu to accelerate the synthesis of qualitative evidence when faced with resource constraints. This guidance covers the review process as it relates to synthesis of qualitative research. ‘Rapid’ or ‘resource-constrained’ QES require use of templates and targeted knowledge user involvement. Clear definition of perspectives and decisions on indirect evidence, sampling and use of existing QES help in targeting eligibility criteria. Involvement of an information specialist, especially in prioritising databases, targeting grey literature and planning supplemental searches, can prove invaluable. Use of templates and frameworks in study selection and data extraction can be accompanied by quality assurance procedures targeting areas of likely weakness. Current Cochrane guidance informs selection of tools for quality assessment and of synthesis method. Thematic and framework synthesis facilitate efficient synthesis of large numbers of studies or plentiful data. Finally, judicious use of Grading of Recommendations Assessment, Development and Evaluation approach for assessing the Confidence of Evidence from Reviews of Qualitative research assessments and of software as appropriate help to achieve a timely and useful review product.

ObjectivesTo systematically gather information on the professional team members, services provided, funding sources and population served for all consultant-led specialised paediatric palliative care (SPPC) teams in the UK.MethodsTwo-part online survey.ResultsSurvey 1: All 17 medical leads from hospital-based or hospice-based SPPC teams responded to the survey (100% response rate).Only six services met the NICE guidance for minimum SPPC team.All services reported providing symptom management, specialist nursing care, end-of-life planning and care, and supporting discharges and transfers to home or hospice for the child’s final days-hours. Most services also provided care coordination (n=14), bereavement support (n=13), clinical psychology (n=10) and social work-welfare support (n=9). Thirteen had one or more posts partially or fully funded by a charity.Survey 2: Nine finance leads provided detailed resource/funding information, finding a range of statutory and charity funding sources. Only one of the National Health Service (NHS)-based services fully funded by the NHS.ConclusionsOne-third of services met the minimum criteria of professional team as defined by NICE. Most services relied on charity funding to fund part or all of one professional post and only one NHS-based service received all its funding directly from the NHS.

Background: Previous evidence suggests home-based dialysis to be more cost-effective than unit-based or hospital-based dialysis. However, previous analyses to quantify the costs of different dialysis modalities have used varied perspectives, different methods, and required assumptions due to lack of available data. The National Institute for Health and Care Excellence reports uncertainty about the differences in costs between home-based and unit-based dialysis. This uncertainty limits the ability of policy makers to make recommendations based on cost effectiveness, which also impacts on the ability of budget holders to model the impact of any service redesign and to understand which therapies deliver better value. The aim of our study was to use a combination of top-down and bottom-up costing methods to determine the direct medical costs of different dialysis modalities in one UK nation (Wales) from the perspective of the National Health Service (NHS).Methods: Detailed hybrid top-down and bottom-up micro-costing methods were applied to estimate the direct medical costs of dialysis modalities across Wales. Micro-costing data was obtained from commissioners of the service and from interviews with renal consultants, nurses, accountants, managers and allied health professionals. Top-down costing information was obtained from the Welsh Renal Clinical Network (who commission renal services across Wales) and the Welsh Ambulance Service Trust.Results: The annual direct cost per patient for home-based modalities was £16,395 for continuous ambulatory peritoneal dialysis (CAPD), £20,295 for automated peritoneal dialysis (APD) and £23,403 for home-based haemodialysis (HHD). The annual cost per patient for unit-based modalities depended on whether or not patients required ambulance transport. Excluding transport, the cost of dialysis was £19,990 for satellite units run in partnership with independent sector providers and £23,737 for hospital units managed and staffed by the NHS. When ambulance transport was included, the respective costs were £28,931 and £32,678, respectively.Conclusion: Our study is the most comprehensive analysis of the costs of dialysis undertaken thus far in the United Kingdom and clearly demonstrate that CAPD is less costly than other dialysis modalities. When ambulance transport costs are included, other home therapies (APD and HHD) are also less costly than unit-based dialysis. This detailed analysis of the components that contribute to dialysis costs will help inform future cost-effectiveness studies, inform healthcare policy and drive service redesign.

Background:Palliative care improves the health of children with a life-limiting condition and appears to draw implicitly on concepts shared with a model of health promotion. However, to date there has been no scrutiny about how this relationship may shape understanding about children's palliative care.Aim:To explore the influence of health promoting concepts on children's palliative care models, policies and guidelines.Data sources:Health and social care databases were searched for policies, models and guidelines published between 2000–2018. Additional searches of professional national and international healthcare websites, children's palliative care charities and UK and Ireland government websites were conducted.Methods:A best fit framework synthesis was used.Findings:A total of 55 policies and guidelines were reviewed for the framework synthesis. Eight themes were generated: (1) health promoting children's palliative care policy and guidelines; (2) planning ahead; (3) creating a supportive environment; (4) enabling coping and independence; (5) reorienting children's palliative care sectors; (6) the lengthening trajectory of need for support; (7) strengthening community engagement in children's palliative care; and (8) quality of life and value-based ideologies.Conclusion:The best fit framework synthesis confirmed a conceptual relationship between children's palliative care and health promotion. This is captured in a new model that will extend professionals' understanding.

Aim: Emergent infectious diseases often lack medical treatment or preventive vaccines, thus requiring non-pharmaceutical interventions such as quarantine to reduce disease transmission. Quarantine, defined as the separation and restriction of movement of healthy people who have potentially been exposed to the disease, remains contentious especially when the risks and benefits are not fully discussed and not effectively communicated to the people by the organizations who impose this public health measure. Subject and methods: A qualitative evidence synthesis was conducted to examine the phenomenon of adherence to quarantine focused on the following questions: What strategies affect adherence to quarantine? What are the barriers and facilitators to quarantine acceptance? What benefits and harms of quarantine have been described or measured? Results: The evidence synthesis produced 18 findings assessed with high confidence. The findings were used to construct a conceptual framework for inter- and within-organization coordination and public communication that includes the following topics for consideration: desired orientation for implementation; population demographics; perceptions of messages; prior acceptance of quarantine; likelihood of impacts of quarantine; perceptions of health infrastructure; and perceptions of policy importance. Conclusion: The findings and conceptual framework can guide development of effective non-pharmaceutical interventions and as such have direct relevance to public health policy and decision-making for intervening in emergent infectious diseases outbreak such as the ongoing COVID-19 pandemic.

Patellofemoral pain syndrome (PFPS) is a very common knee condition with various aetiologies. Because of the nebulous factors of the syndrome, physiotherapists often find it difficult to assess and treat these patients. The aim of this study was to identify the clinical assessment tool that can differentiate PFPS patients from patients with other lower limb conditions. Fifty-two patients from the National Health System (26 with PFPS and 26 with other lower limb conditions) took part in this study. They underwent a series of strength, flexibility, and stress tests. Their pain levels were also recorded. The results showed that among the various clinical tests, only the hip flexion component of the Thomas test was able to differentiate between the two groups. In addition, the stress test showed that the PFPS group could not recover their gluteal muscle strength in the same way the group with the other lower limb conditions did. The Lower Extremity Functional Scale was found to be more able to differentiate between the two groups than the Anterior Knee Pain Scale. This study has shown that it is difficult to find specific clinical tests to diagnose PFPS. More research is needed in this important area.

This paper reports on a small exploratory phenomenological study to describe the lived experiences of paediatric intensive care nurses, who extended their roles to care for critically ill children requiring continuous veno-venous haemofiltration. In describing and understanding this learning experience, an insight into the educational and support needs of these nurses is offered. From the insight shared, five main themes were identified. These included the overwhelming need to be a competent practitioner, which was perceived within the context of knowledge for effective practice and technical dexterity.

BackgroundWithin the UK, over a quarter of a million people currently receive care from hospices either within hospice care facilities or within their own homes. In a difficult financial climate and uncertain funding support, independent Hospices need to reaffirm their impact and contribution to society. However, there is limited information on what outcomes patients, carers and families view as important. Here, we present findings from a systematic literature review collating the evidence.AimsA systematic literature review was conducted to explore patients’, carers’ and family members’ experiences and perceptions of hospice servicesMethodsLiterature searchingKey terms and Medical Subject Headings were implemented in a range of databases to identify studies and grey literature.Study selectionTitles and abstracts were screened against a criteria list and papers were chosen based on relevance to the research question.Quality assessmentPapers were assessed for quality using appropriate toolsData extraction and collationData from each included paper was fully screened, recorded and summarisedResultsPending as review still being undertaken at time of abstract submissionWider studyThis review is part of a study funded by Knowledge Economy Skills Scholarship, a major European Convergence programme which offers collaborative research projects linked with a local company partner. The aim of the research is to explore the social value of hospices in North Wales. The Social Return on Investment framework will be utilised to quantify social and environmental values allowing for an understanding which extends beyond financial values from key stakeholder perspectives. A combination of qualitative narratives and quantitative measurements will be utilised including:Semi-structured interviews with staffReview of patient feedbackAnalysis of current hospice dataSearching unit cost and social cost databases to source proxy values for outcomes.

Infants with a history of an apparent life-threatening event that received mouth-to-mouth resuscitation (ALE-R) are high risk for sudden death (SID). Investigation of 114 infants (median age 2.8 months; 15 with SID in siblings; 20 born preterm) who had single (n=64) or recurrent (50) ALE-R revealed, compared to controls 12, 38 with abnormal hypoxaemia on a 12 hour physiological recording (with accompanying clinical events in 21). Home event recording of TcpO2, breathing movements, ECG ± SaO2 was performed in 46 infants for a median duration 1.4 months: this produced further physiological data in 22 infants.In 49 infants, mechanisms for ALE-R were found, including: respiratory events suggestive of intrapulmonary shunting (n=29), seizure induced hypoxaemia (7), imposed upper airway obstruction (7), fabricated history/data (4) and pallor without hypoxaemia/arrhythmia (3). 104 infants underwent home TcpO2 monitoring (median duration 6 months): 2 patients died suddenly - non-compliance (1) & discontinued pO2 monitor (1).Multi-channel physiological recordings ± event capture can provide information relevant to the diagnosis and management of these infants.1Slebbens VA, Poets CF. Alexander JR et at. Arch Dis Child 1991:66:569-5732Poets CF, Stebbens VA, Alexander JR et at. Arch Dis Child 1991:66:574-578