NHS Lanarkshire

This paper presents narratives about the experience of parent work undertaken separately, but alongside child psychotherapy, with parents and carers in a specialist CAMHS service. This service is specifically for children 0-18 who have been impacted by severe and enduring parental mental health difficulties. This research generated direct accounts with one parent with severe anxiety and depression, another with complex post-traumatic stress disorder and a grandparental kinship carer. Narratives were generated using free association narrative interviewing, combined with a narrative inquiry approach, which allowed for further discussion of meanings of interview transcripts to be undertaken with each participant, facilitating co-composition with the researcher in the process of telling their stories. Psychoanalytic reflection and dialogue were incorporated in this approach through supervision, where unconscious aspects of meaning and communication were considered. Eight significant themes and key issues raised by all three narratives are outlined, and consideration is given to ways these findings resonate with or add to the existing knowledge base on parent work in child psychotherapy. A striking feature was the depth of engagement, with participants in touch with strong feelings and energised by the idea of their story contributing to learning in the field. Implications are discussed and the call is made for further direct participatory research with parents.

BACKGROUND:NHS Lanarkshire (NHSL) Physiotherapy Musculoskeletal (MSK) service receives approximately 30,000 referrals annually, facing long waiting times and workforce pressures. To address these challenges, NHSL piloted Community Appointment Days (CADs)-a patient-centred model offering same-day assessment, advice, and community support in non-medical settings. METHODS:A mixed-methods service evaluation was conducted using retrospective analysis of data from ten CADs delivered across three leisure centres in 2024-2025. Quantitative data from the Patient Management System included attendance, outcomes, and re-access rates. Qualitative data were collected via patient passports, surveys, and interviews. Objectives were to assess impact on waiting times, patient experience, cost avoidance, and sustainability. RESULTS:Of 2,287 patients booked, 1,866 attended. Outcomes included discharge (10%), patient-initiated review (PIR) (53%), and return appointment (37%). Average time per CAD was 69 minutes. PIR return rate was 8%, with 0% ED attendances for the same condition. CADs enabled a 3.7-fold increase in new patient capacity on the day, reducing waiting times in targeted waiting lists by 5 weeks in 2024 and 9 weeks in 2025. Initial setup costs were £16,388; subsequent CADs projected cost avoidance of £4,132 each. Patient feedback was highly positive, with strong Care CollaboRATE scores, though some reported environmental challenges. Staff reported CADs as less stressful or similar to routine work. CONCLUSION:CADs are a scalable, patient-centred model that improves access, reduces waiting times, and supports self-management while maintaining safety. Future work should refine triage, enhance booking systems, and evaluate long-term outcomes to ensure sustainability.

Years or highest level of formal education are typically used to quantify educational experience and stratify normative data. However, these approaches do not account for differences in education quality which may lead to misclassification of cognitive abilities. The present systematic review aimed to synthesize existing literature on the measurement of education quality and evaluate its effects on neuropsychological test performance in later life. Databases were searched to identify eligible studies that explored the effects of education quality on neuropsychological test scores in older adult populations (age ≥ 55 years). A narrative synthesis of the included studies was conducted, and the quality of evidence was assessed. The study was pre-registered on PROSPERO (Project ID: CRD42024373157). Of the 2,338 records identified, 16 studies were included in the review. Measurement of education quality was categorized in two ways: as performance-based proxies (typically assessment of literacy and numeracy), or as retrospective indicators of quality based on historical data or self-report. Proxies were most commonly tests of reading ability. Education quality measures correlated highly with years of education but emerged as stronger predictors of cognitive test performance. Findings suggest that education quality may be a more useful measure of educational experience than years of education, particularly for minoritized ethnic groups. This highlights the need to select tests that minimize the effects of education on cognitive test performance and to incorporate education quality measures. Future research should investigate the extent to which these measures represent education quality cross-culturally.

INTRODUCTION:Emergency general surgery (EGS) is an essential part of general surgery. However, the service configuration for EGS in the United Kingdom (UK) and Ireland varies significantly. This study aims to clarify current and desired future roles of EGS surgeons in the UK and Ireland, particularly regarding operative procedures. METHODS:An e-survey, designed by the Association of Surgeons of Great Britain and Ireland (ASGBI) Moynihan Academy, was distributed to ASGBI members at two national conferences in 2023. Data collection included the operative roles of EGS surgeons and factors influencing the appeal of a dedicated EGS career. The study was conducted and reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS:There were 132 of 347 (response rate 38.0%) complete responses analysed. Respondents identified a core set of procedures that could be safely performed by EGS surgeons, regardless of dedicated EGS service configuration. A minority of respondents stated that EGS surgeons - rather than a surgeon with a specialist interest - should operate on specific conditions: emergency colonic resection for cancer (65 of 132 [49.2%]) or for inflammatory bowel disease (49 of 132 [37.1%]), laparoscopic cholecystectomy plus intraoperative cholangiogram with or without common bile duct exploration (45 of 132 [34.1%]), operations for gastric volvulus (45 of 132 [34.1%), operations for Boerhaave's (37 of 132 [28.0%]) and operations for bariatric complications (34 of 132 [25.8%]). Factors that might improve future EGS careers included pragmatic job planning, minimally invasive elective surgical opportunities and dedicated continuing professional development. CONCLUSIONS:This study outlines the operative role of EGS surgeons within the broader general surgical profession and highlights controversies regarding whether EGS surgeons should perform specific complex operations.