ABSTRACT Introduction Pancreatic cancer has a high mortality rate due to late diagnosis and presentation with non‐specific symptoms like weight loss. Quantifying weight loss more precisely could enhance its utility as a diagnostic marker. Methods In March 2025, we systematically searched PubMed, Embase, Web of Science, The Cochrane Library, and Scopus for studies reporting quantitative pre‐diagnosis weight loss in pancreatic cancer, with no date restrictions. The protocol was registered with PROSPERO (CRD42022302985). Primary outcomes were weight loss (kg) and BMI change (kg/m2). Meta‐analyses provided pooled estimates with 95% confidence intervals, displayed in forest plots. We conducted stratified analyses at the study level by diabetes status, cancer type, self‐reported weight change, and timing of weight loss. Subgroup analyses considered publication year, country, study design, mean age, and percentage of male participants. Study quality and bias were assessed using the ROBINS‐I framework. Results The analysis included 25 studies (25,971 participants). In random‐effects meta‐analysis, we found that on average participants lost 5.9 kg [95% CI 4.7 to 7.1] of body weight. The average BMI change was −2.5 kg/m2 [95% CI −3.0 to −2.1]. There was significant heterogeneity between studies for both weight loss (I2 = 99.2%) and BMI change (I2 = 82.6%). For weight loss in kg, heterogeneity was partially explained (p < 0.001) by diabetes status (0.15%), weight loss timing (15.5%), whether weight loss was self‐reported (11.4%) and publication year (13.1%). For BMI change heterogeneity was partially explained (p < 0.001) by pancreatic cancer type (1.3%), whether BMI change was self‐reported (49.6%) and publication year (49.5%). Post hoc pairwise comparisons of moderators for stratified analysis were not significant (p < 0.0125). The certainty of evidence was moderate due to high heterogeneity between studies. Conclusions This meta‐analysis provides a reference for expected weight loss in pancreatic cancer, aiding clinical practice and improving early detection models.

Pancreatic cancer, characterised by high mortality and late diagnosis, urgently requires improved early detection methods. Unintentional weight loss, reported by 70-75% of patients prior to diagnosis, may serve as a key early marker. This systematic review and meta-analysis evaluated the extent of pre-diagnostic weight loss in pancreatic cancer patients compared with matched controls. Thirteen studies encompassing 12,081 cases and 367,678 controls were analysed, revealing a medium standardised mean difference (SMD = 0.51, [95% CI 0.31-0.71]) equivalent to a 2.26 kg/m2 BMI reduction in people with pancreatic cancer. Significant heterogeneity was observed, influenced by country, publication year, cancer type and diabetes status. Weight loss may serve as a useful non-invasive biomarker for early pancreatic cancer detection, especially in those with new-onset diabetes. Using quantified weight loss data could enhance the accuracy of predictive algorithms, allowing their inclusion in EMR based detection pipelines, ultimately aiding earlier detection and improving survival outcomes.

The use of digital technology has significantly increased since the Covid-19 pandemic. Many organisations have followed this trend and moved from face-to-face communication to online. Despite the increase in digital skills and online usage over the years amongst the general population, there are still specific groups of individuals who are more susceptible to experiencing digital inequalities, such as older adults. The study aimed to observe older adults' digital literacy development over time, as they engaged in a training programme provided by a community interest group. Additionally, the research aimed to understand the process by which older adult increase their digital skills, why they seek formal technology support services and what they use their digital devices for. Longitudinal participant observation and two semi-structured interviews were used to collect data from 11 older adults (65 years and older). Four overarching themes were identified during the analysis of the field notes and interview data: (1) the older adult as an individual (2) past experiences of using technology, (3) involvement of their Tech Angel and (4) overall experience. Older adults preferred learning to use their digital devices through a one-to-one approach due to its person-centred and tailored approach. They reported that the reason for seeking formal support was due to their family not providing comprehensive support initially, living far from family, or feeling guilty when asking for support. Older adults preferred learning to use their digital devices through a one-to-one approach due to its person-centred and tailored approach. They reported that the reason for seeking formal support was due to their family not providing comprehensive support initially, living far from family and/or feelings of guilt when asking for support. All participants used their digital devices to communicate with friends and family, most used e-health services and some used them for entertainment purposes and online shopping. Having access to in-person, one-to-one support was favoured by all participants, and all reported having positive experiences with their Tech Angel, suggesting similar services need to be available to increase older adults digital skills.

General practice, community healthcare and supported living staff have integrated virtual consultations (VCs) (video/telephone) into their daily practice. However, implementation has highlighted specific challenges, both for patient groups and for staff. Staff report organisational, professional, and personal challenges with virtual consultation use, especially when used with diverse and complex patient groups. However, the experiences of staff integrating VCs in general practice and community care settings for people with intellectual disabilities have not previously been explored. To explore the views and experiences of health and community care staffs' use of virtual consultations for people with intellectual disabilities. This paper reports on staffs’ experiences of virtual consultations, as part of a larger Experience-based Co-design (EBCD) study. The findings presented draw on semi-structured interviews with general practice and community and care teams (n=22). Data were analysed using Framework Analysis and supported using NVivo 14. The 30-month study was conducted between November 2021 and April 2024. Findings were synthesised into three overarching themes that illustrate how delivering care through virtual consultations with people with intellectual disabilities shapes the experiences, practices, and wellbeing of general practice and community care staff. These themes are structured in terms of 1. system-level factors (hybrid care delivery, impacted workload and supportive resources) 2. professional and team adaptations (accepting change and managing risk, collective confidence) and 3. personal wellbeing (increased cognitive demands and meeting individual needs). Our findings reveal staffs' views about the use of VCs and impact on their wellbeing and professional role identity. This contrasts with their views about the value of VCs in supporting good health for people with intellectual disabilities. Learning from our study extends knowledge about the factors that support and protect the wellbeing of staff who are integrating VCs into the care of people with intellectual disabilities. Conclusion: We show that while VC use for people with intellectual disabilities offers meaningful opportunities to enhance health service access, care continuity, and cross‑agency collaboration, they may also increase the cognitive load of staff and negatively affect their wellbeing if not managed well. As health services expand their provision of digital care, it is essential to design and resource systems that effectively support virtual working and to implement structured shared training, wellbeing initiatives, and organisational practices that safeguard staff health and resilience.

Chatbots are becoming ubiquitous for everyday tasks, such as getting customer support, banking or personal assistance. Health services are also increasingly using chatbot applications, for example to facilitate appointment booking. This paper investigates user perceptions of rapport with a generative AI chatbot which invites patients to and makes bookings for cervical cancer screening. Using seven interviews with patients at the trial site and a survey of patients eligible for cervical screening via the NHS (n = 300), analysed through content analysis based on the GAAFFE framework, we investigate how patients perceive the way this chatbot, named Asa, manages rapport and what positive or negative perceptions of rapport patients express. With a particular focus on patients' reactions to the language and interaction design in Asa's dialogue flow, we show that human-like features act as moderators across all dimensions of the rapport-management framework. We also show that rapport perceptions are influenced by other factors, e.g. themessaging channel. Based on these insights, we present a taxonomy of human-chatbot rapport for text-based conversational AI applications and show how this taxonomy and our findings can be used by conversation designers and researchers. The paper makes a theoretical contribution by applying the GAAFFE framework to human-AI interaction, paving the way for training and evaluating chatbots through the lens of rapport. It also provides theoretical underpinning for the 'Machines are Social Actors' framework through rapport theory. (c) 2026 Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BackgroundVirtual consultations (VCs) using video or telephone were embraced at speed in general practice (GP) and community care during the COVID-19 pandemic. People with intellectual disabilities, their families, and support workers (SWs), along with health care professionals (HCPs), had to adapt quickly to this change in provision, but little is known about how this new way of working was experienced. ObjectiveThis study aims to explore the views and experiences of people with intellectual disabilities, their families, SWs, GP, and community care professionals on the quality and safety of VCs. MethodsThis paper reports on users’ experiences of VCs, as part of a larger Experience-Based Co-design study. This paper relates to 2 stages of data collection. Observed video consultations in GP and community care (n=3), and semistructured interviews with people with intellectual disabilities, their family members or SWs, GP, and community care professionals (n=34). The 30-month study was conducted from November 2021 ending in April 2024. Data were analyzed using framework analysis. ResultsIntegrated results are presented through 5 themes, encompassed under an overarching theme of safety and quality. The five themes highlight critical factors in planning, delivery, and aftercare of VCs in GP and community services for people with intellectual disabilities in the United Kingdom: (1) context, space, and purpose—showing the importance of safe spaces to talk, and having clear consultation objectives and purpose; (2) choice—facilitating choice over time about modality of health care contact; (3) familiarity, online relationships, and trust—the building blocks for quality consultations; (4) prepare and personalize—to ensure that HCPs are aware of reasonable adjustments, and recognition of caregiver involvement; and (5) continued connection—where patients or families are offered continued contact with a named or same HCP enhancing access to regular or ongoing care. All participants were aware of the limitations of VC, which may impact safety, such as gaps in home monitoring due to the absence of appropriate equipment or recording, inability to identify vital risk indicators, and limited field of vision on screen. However, participants were also aware of the distinct benefits they offer in terms of quality provision, such as timeliness of care, building and sustaining comfortable relationships, support for more frequent attendance, and continuous connection to health teams. ConclusionsVCs offer an opportunity to improve digital inclusion in health care for people with intellectual disabilities. However, the quality and safety of VCs for this population are dependent on continuous review of patients’ needs over time and ensuring that their choices and preferences are considered when planning and providing ongoing care.

Pancreatic cancer has very low survival due to late diagnosis. Symptoms are often non-specific, complicating early detection in primary care. The Enriching New-Onset Diabetes for Pancreatic Cancer (ENDPAC) algorithm uses weight change, glycaemic control, and age at diabetes onset to identify new-onset diabetes (NOD) patients at increased pancreatic cancer risk. It was developed in the USA and has not been validated in the UK. Aim To validate ENDPAC in a UK primary care population and assess its predictive utility. Design and setting Retrospective cohort study using ORCHID, a national primary care sentinel network. Method Adults aged ≥50 with NOD and requisite glycated haemoglobin (HbA1c) and weight data were included. ENDPAC scores were calculated. Model performance was evaluated via discrimination, calibration, sensitivity, specificity, PPV and NPV. The Youden index identified optimal cutoffs. Sensitivity analyses assessed measurement timing, repeat HbA1c testing and multiple values. Results Among 70,050 individuals, 185 (0.26%) developed pancreatic cancer. Cases were older with higher HbA1c and greater weight loss at diagnosis. ENDPAC achieved an area under the curve (AUC) of 0.733. An optimal cutoff of ≥3 classified 27.6% of individuals as high-risk, with 62.6% sensitivity, 72.3% specificity, 0.6% PPV and 99.9% NPV. Sensitivity analyses showed similar performance across measurement windows and handling of multiple values. ENDPAC shows moderate discrimination in UK primary care. Although it has a relatively low PPV (0.6%), integration into routine systems could provide scalable, low-cost automated risk stratification, identifying people with NOD at higher pancreatic cancer risk as part of a sequential diagnostic pathway.

Pancreatic cancer is a devasting disease which is an increasing cause of cancer mortality. The aim of this study was to characterise, using descriptive statistics, the sociodemographic, risk and clinical characteristics of who develops pancreatic cancer. This retrospective cohort study examined data from one of the largest UK primary care databases, from January 1st 2006 to August 31st 2020. A total of 573 primary care practices contributed data. There were 9,267 people diagnosed with pancreatic cancer. The median age at diagnosis was 73 years (IQR 16) and 49.8% (4,616) of people were female. Nearly a third (30.2%, 2,798) of people had diabetes, and 85.8% (2,400) of the people with diabetes received the diabetes diagnosis before pancreatic cancer. For people for whom ethnicity was recorded 94.4% (5,979) were white. Under half of people with BMI recorded (41.9%, 571) were overweight or obese at pancreatic cancer diagnosis and 5.9% (80) were underweight. In addition, 12.6% (1,168) of participants were active smokers and 1.4% (130) exceeded recommended limits of alcohol. Improved characterisation of the sociodemographic, risk and clinical characteristics of who develops pancreatic cancer highlights the opportunity for machine learning and other technologies to flag people at high risk of this cancer.

Background Gradually, society has shifted more services online, with COVID-19 highlighting digital inequalities in access to services such as healthcare. Older adults can experience such digital inequalities, yet this group is also more likely to need medical appointments, compared to younger people. With the growing digitalisation of healthcare, it is increasingly important to understand how older people can best use communicative e-health services to interact with healthcare services. This is especially if older adults are to access, and actively interact with health professionals/clinicians due to their general health decline. This review aims to synthesise older adults’ experiences and perceptions of communicative e-health services and, in turn, identify barriers and facilitators to using communicative e-health services. Methods A meta-ethnography was conducted to qualitatively synthesise literature on older adults’ experiences of using communicative e-health services. A systematic search, with terms relating to ‘older adults’, ‘e-health’, ‘technology’, and ‘communication’, was conducted on six international databases between January 2014 and May 2022. The search yielded a total of 10 empirical studies for synthesis. Results The synthesis resulted in 10 themes that may impact older adults’ perceptions and/or experiences of using communicative e-health services. These were: 1) health barriers, 2) support networks, 3) application interface/design, 4) digital literacy, 5) lack of awareness, 6) online security, 7) access to digital devices and the internet, 8) relationship with healthcare provider(s), 9) in-person preference and 10) convenience. These themes interlink with each other. Conclusion The findings suggest older adults’ experiences and perceptions of communicative e-health services are generally negative, with many reporting various barriers to engaging with online services. However, many of these negative experiences are related to limited support networks and low digital literacy, along with complicated application interfaces. This supports previous literature identifying barriers and facilitators in which older adults experience general technology adoption and suggests a greater emphasis is needed on providing support networks to increase the adoption and usage of communicative e-health services.

Introduction Overall cancer survival has increased over recent decades, but the very low survival rates of pancreatic cancer have hardly changed in the last 50 years. This is attributed to late diagnosis. Pancreatic cancer symptoms are non-specific which makes early diagnosis challenging. Data-driven approaches, including algorithms using combinations of symptoms to predict cancer risk, can aid clinicians. A simple but effective algorithm called Enriching New-Onset Diabetes for Pancreatic Cancer (ENDPAC) has been developed in the United States (US). ENDPAC has not yet been used in the United Kingdom (UK), our aim is to translate ENDPAC into the UK setting. The objectives are to validate ENDPAC and report its predictive utility within primary care.Methods A retrospective cohort study of people with new-onset diabetes using the nationally representative Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) database. ORCHID holds over 10 million primary care electronic healthcare records. ENDPAC scores will be calculated for eligible people along with positive predictive value, negative predictive value, sensitivity and specificity of the algorithm. We will evaluate the optimal cut-off for defining people with high-risk of having pancreatic cancer.Discussion Once validated within the UK, ENDPAC could be implemented in practice to improve early pancreatic cancer diagnosis by using routine data. ENDPAC is currently being tested in the US in a clinical trial to evaluate its effectiveness. ENDPAC offers an automatable and inexpensive way to improve early diagnosis as part of a sequential approach to identify individuals at high-risk of having undiagnosed pancreatic cancer.How this fits in Pancreatic cancer is a devasting disease which is hard to diagnose. An algorithm called ENDPAC has been developed in the United States to help clinicians identify people at risk of having undiagnosed pancreatic cancer. These people can be referred for an imaging investigation to diagnose or rule out cancer. This protocol outlines a United Kingdom (UK) validation of ENDPAC so that it could be used in clinical practice in the UK.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementThis project was funded as part of an EPSRC iCase studentship undertaken by CP. The work of NPL co-authors was funded by the UK Governments Department for Science, Innovation & Technology through the UKs National Measurement System programmes.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:The Ethics Committee of University of Surrey gave ethical approval for this work (reference number: FHMS 21-22 269 EGA). Access to ORCHID data has been approved by Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) under data request RSC_0420.I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.YesData will remain under the control of the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID, orchid.phc.ox.ac.uk) and can be accessed following all necessary approvals.

ObjectivesThe objective was to map the experiences and needs of patients presenting with symptoms of suspected cancer in the primary care interval (from when they first present to primary care to their first appointment or referral to a secondary or tertiary level healthcare facility).DesignThis was a scoping review.Inclusion criteriaStudies or reports written in English which included primary data on the primary care interval experiences and/or needs of adult patients presenting with new symptoms of suspected cancer were eligible. Studies which only included patients with secondary or recurring cancer, conference abstracts and reviews were excluded. No date limits were applied.MethodsThe Joanna Briggs Institute method for Scoping Reviews guided screening, report selection and data extraction. At least two independent reviewers contributed to each stage. Medline, CINAHL, PsychInfo, Embase and Web of Science were searched and several grey literature resources. Relevant quantitative findings were qualitised and integrated with qualitative findings. A thematic analysis was carried out.ResultsOf the 4855 records identified in the database search, 18 were included in the review, along with 13 identified from other sources. The 31 included studies were published between 2002 and 2023 and most (n=17) were conducted in the UK. Twenty subthemes across four themes (patient experience, interpersonal, healthcare professional (HCP) skills, organisational) were identified. No studies included patient-reported outcome measures. Patients wanted (1) to feel heard and understood by HCPs, (2) a plan to establish what was causing their symptoms, and (3) information about the next stages of the diagnostic process.ConclusionsScoping review findings can contribute to service planning as the cancer diagnostic pathway for symptomatic presentation of cancer evolves. The effectiveness of this pathway should be evaluated not only in terms of clinical outcomes, but also patient-reported outcomes and experience, along with the perspectives of primary care HCPs.

In community nursing, the administration of insulin for people with type 2 diabetes can be delegated by registered nurses to healthcare support workers. Although a voluntary framework in England provides national guidance, little is known about its uptake. The project aim was to determine the roll-out, characteristics and support needs in relation to the delegation of insulin administration in community settings. An online survey was disseminated to community nursing services in England via social media and nursing networks. Of the 115 responding organisations, 81% (n=93) had an insulin delegation programme, with most initiated since 2018. From these services, 41% (n=3704) of insulin injections were delegated daily, with benefits for patients, staff and services reported, along with some challenges. Delegation of insulin administration is an established and valued initiative. Awareness of the national voluntary framework is increasing. National guidance is considered important to support governance arrangements and safety.

Background: Older people living with multimorbidity are projected to become the main recipients of palliative care in the coming decades, yet there is limited evidence regarding their expressed palliative care needs to inform person-centred care. Aim: To understand the palliative care needs of community-dwelling people aged ⩾60 living with multimorbidity in the last 2 years of life. Design: A scoping review following Arksey and O’Malley. Data sources: Three international electronic databases (CINAHL, Ovid Medline, PsycINFO) were searched from March 2018 to December 2021. Reference lists were hand searched. Eligible papers were those reporting empirical data on older people’s needs. Results: From 985 potential papers, 28 studies were included, published between 2002 and 2020; sixteen quantitative, nine qualitative and three mixed methods. Data were extracted and presented under the holistic palliative care domains of need: physical, psychological, social, spiritual, and additionally practical needs. Different measurement tools (n = 29) were used, of which 20 were multidimensional. Primacy in reporting was given to physical needs, most commonly pain and function. Social and practical needs were often prioritised by older people themselves, including maintaining social connections and accessing and receiving individualised care. Conclusion: Identifying the palliative care needs that matter most to older people with multimorbidity requires the recognition of their concerns, as well as their symptoms, across a continuum of living and dying. Available evidence is superficial. Supporting end of life provision for this growing and underserved population necessitates a shift to tailored multidimensional tools and community focussed integrated care services.

AIMS:To explore stakeholder perspectives on the benefits and/or disadvantages of the delegation of insulin injections to healthcare support workers in community nursing services.DESIGN:Qualitative case study.METHODS:Interviews with stakeholders purposively sampled from three case sites in England. Data collection took place between October 2020 and July 2021. A reflexive thematic approach to analysis was adopted.RESULTS:A total of 34 interviews were completed: patients and relatives (n = 7), healthcare support workers (n = 8), registered nurses (n = 10) and senior managers/clinicians (n = 9). Analysis resulted in three themes: (i) Acceptance and confidence, (ii) benefits and (iii) concerns and coping strategies. Delegation was accepted by stakeholders on condition that appropriate training, supervision and governance was in place. Continuing contact between patients and registered nurses, and regular contact between registered nurses and healthcare support workers was deemed essential for clinical safety. Services were reliant on the contribution of healthcare support workers providing insulin injections, particularly during the COVID-19 pandemic. Benefits for service and registered nurses included: flexible team working, increased service capacity and care continuity. Job satisfaction and career development was reported for healthcare support workers. Patients benefit from timely administration, and enhanced relationships with the nursing team. Concerns raised by all stakeholders included potential missed care, remuneration and task shifting.CONCLUSION:Delegation of insulin injections is acceptable to stakeholders and has many benefits when managed effectively.IMPACT:Demand for community nursing is increasing. Findings of this study suggest that delegation of insulin administration contributes to improving service capacity. Findings highlight the essential role played by key factors such as appropriate training, competency assessment and teamwork, in developing confidence in delegation among stakeholders. Understanding and supporting these factors can help ensure that practice develops in an acceptable, safe and beneficial way, and informs future development of delegation practice in community settings.PATIENT OR PUBLIC CONTRIBUTION:A service user group was consulted during the design phase prior to grant application and provided comments on draft findings. Two people with diabetes were members of the project advisory group and contributed to the study design, development of interview questions, monitoring study progress and provided feedback on study findings.

Background: Many specialist paramedics are moving from the ambulance service to primary care. There is a lack of empirical literature regarding this transition. Aims: This study aims to improve support for specialist paramedics undertaking the transition by ascertaining factors that may hinder or facilitate the process. Methods: The study used semi-structured interviews with eight specialist paramedics working in primary care in England. An interpretative phenomenological analysis approach was used to analyse data, and this was informed by a review of theoretical and empirical literature. Findings: Facilitators and barriers to transition were found, along with information regarding the transition. Five facilitators were identified: previous clinical experience; mentorship; support; clear role parameters; and opportunity to develop. Four barriers were identified: role misunderstanding; changing scope of clinical practice; time pressures; and gaps in education and knowledge. Conclusion: This study contributes to a limited field of research by highlighting barriers and facilitators to the transition of specialist paramedics to primary care. Practical steps can be taken to smooth this transition.

Abstract Background Infection is more frequent, and serious in people aged > 65 as they experience non-specific signs and symptoms delaying diagnosis and prompt treatment. Monitoring signs and symptoms using decision support tools (DST) is one approach that could help improve early detection ensuring timely treatment and effective care. Objective To identify and analyse decision support tools available to support detection of infection in older people (> 65 years). Methods A scoping review of the literature 2010–2021 following Arksey and O’Malley (2005) framework and PRISMA-ScR guidelines. A search of MEDLINE, Cochrane, EMBASE, PubMed, CINAHL, Scopus and PsycINFO using terms to identify decision support tools for detection of infection in people > 65 years was conducted, supplemented with manual searches. Results Seventeen papers, reporting varying stages of development of different DSTs were analysed. DSTs largely focussed on specific types of infection i.e. urine, respiratory, sepsis and were frequently hospital based (n = 9) for use by physicians. Four DSTs had been developed in nursing homes and one a care home, two of which explored detection of non- specific infection. Conclusions DSTs provide an opportunity to ensure a consistent approach to early detection of infection supporting prompt action and treatment, thus avoiding emergency hospital admissions. A lack of consideration regarding their implementation in practice means that any attempt to create an optimal validated and tested DST for infection detection will be impeded. This absence may ultimately affect the ability of the workforce to provide more effective and timely care, particularly during the current covid-19 pandemic.

Pain is one of the most common symptoms presented by patients of all ages to ambulance services. While children in pain make up a relatively small proportion of the patients attended by prehospital care services, medical intervention is needed in only 40% of cases. This might go some way to explaining why management of paediatric pain is perceived as poor. Aim: To establish and explore published barriers and facilitators to out-of-hospital pain management for children aged <18 years. Methods: Key search terms were used to search the three databases (CINAHL, MEDLINE and PSYCHInfo) individually and simultaneously. Inclusion and exclusion criteria were applied and 15 papers were identified as meeting the criteria and were subject to data extraction. Results: Three broad themes were identified; organisational factors, patient factors and clinician factors. Conclusion: From considering international systems and aspects of care, it can generally be accepted that the assessment and management of paediatric pain is below what would be expected, and compared with with that for adults, it is sub-optimal. Multiple demographic influences are evident and appear to influence clinician decisions.

Background: Pain is one of the commonest symptoms in patients of all ages presenting to ambulance services. Children in pain make up a relatively small proportion of the number of those attended by prehospital care and pain management is needed in only 40% of cases. This might go some way to explain why the management of paediatric pain is perceived to be poor. Aim: The primary aim of this study was to explore the experiences of UK paramedics in treating children in pain. Methods: A phenomenological study was undertaken using a purposeful sample of UK paramedics (n=12) to explore their experiences and decision-making during the treatment of children in pain. Results: Five themes became apparent through analysis—preparation and education; adaptation and change of approach; organisational and legal factors; support and guidance; familial and carer impact—with some crossover between themes noted. Conclusion: Clinicians are aware of multimodal techniques for managing pain in children but are often less confident in the use of pharmacological than non-pharmacological management methods. Advances in the use of technology in practice have enabled clinicians to use alternative measures to manage children in pain. However, while using these methods, practitioners lack confidence that they are meeting social expectations of their roles.

COVID-19 has resulted in an unprecedented expansion of virtual consultations in primary and community care services.[1][1] Although virtual consultations have been available for a long time, they were not widely adopted before COVID-19.[2][2] There has now been a rapid deployment of virtual

ObjectivesPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need.DesignFocus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach.SettingFocus groups and interviews were conducted in community settings in the UK.ParticipantsFifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else.ResultsParticipants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated.ConclusionsDiscussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.