The COVID-19 pandemic presented policymakers with time-sensitive decision problems and a rapidly increasing volume of research, not all of which was robust, or relevant to local contexts. A bespoke evidence review process supporting stakeholder engagement was developed as part of the Wales COVID-19 Evidence Centre (WCEC), which could flexibly react to the needs of decision-makers, to address urgent requests within days or months as required. To describe and appraise the WCEC review process and methods and identify key learning points. Three types of rapid review products were used, which could accommodate the breadth of decision problems and topics covered. Stakeholder (including public) engagement was integrated from the onset and supported throughout. The methods used were tailored depending on the needs of the decision-maker, type of research question, timeframe, and volume and type of evidence. We appraised the overall process and compared the methods used with the most recent and relevant best practice guidance. The remote collaboration between research teams, establishing a clear pathway to impact upfront, and the strong stakeholder involvement embedded in the review process were considered particular strengths. Several key learning points were identified, which focused on: enhancing stakeholders’ abilities to identify focused policy-relevant research questions; the collection and storage of review protocols at a central location; tightening quality assurance process regarding study selection, data extraction and quality assessment; adequate reporting of methodological shortcuts and understanding by stakeholders; piloting of an algorithm for assigning study design descriptors, and a single quality assessment tool covering multiple study designs; and incorporate, where appropriate an assessment of the confidence in the overall body of evidence using GRADE or similar framework. The review process enabled a high volume of questions that were directly relevant to policy and clinical decision making to be addressed in a timely manner using a transparent and tailored approach.

Risk prediction tools play a critical role in preoperative care by estimating the likelihood of adverse outcomes, including mortality, morbidity, and postoperative complications. In low-risk surgical settings such as surgical hubs, accurate risk prediction is particularly valuable. The aim of this review was to identify and map the evidence for 14 validated pre-operative surgical risk prediction tools currently used in Wales within any elective, or non-emergency surgical setting, and to provide a more in-depth look at the findings for a selection of tools deemed to be the most applicable on a population level to the context of surgical hubs. Included studies were published between 1999 and 2024. No evidence was found for two of the risk prediction tools however, a total of 118 studies were identified across 12 risk prediction tools. None of the evidence found was looking at the predictive ability of risk prediction tools for selecting patients suitable for surgical hubs. The tools were used across a range of surgical specialties and measured composite complications, individual complications, and healthcare utilisation and recovery measures. No risk prediction tool adequately predicted complications across all surgical specialties. Among the included studies, there was considerable heterogeneity in which surgical specialties the risk prediction tools were used for, how complications were defined, and which measures were used to determine a tool’s predictive ability. This makes direct comparisons very challenging. Four tools were selected as being potentially the most impactful at a population level for a more in-depth look at the findings: ACS NSQIP, P-POSSUM, RCRI, ASA classification system. A total of 76 studies were identified across these 4 tools. Key findings for the four risk prediction tools of interest are described. Overall, no one tool was identified that adequately predicted complications across all surgical specialties. The predictive ability of the tools varied across different surgical specialties. Further research using consistent methods is needed to better understand the predictive ability of risk prediction tools and allow a robust evaluation. Given no single risk prediction tool adequately predicted complications across all surgical specialties, it may be likely that some tools are better suited for specific surgery types or that a combination of risk prediction tools may be needed to adequately assess an individual’s level of risk. Funding statement The authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes 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. Yes I 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). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Mental health problems among young people have continued to rise over the last decade. Support services are available in higher education and in many workplace environments. However, while approaches to maintain or enhance mental health and wellbeing within these settings are valuable, it is important to understand what alternative community-based supportive measures or interventions are effective for young people who may not be able to access these services. It is estimated that 13.4% of all young people (aged 16-24) are considered not in education, employment or training (NEET) across the UK. Young people who are NEET have also been found to have a higher incidence of mental health problems than young people who are not NEET. The aim of this rapid review is to identify the effectiveness of interventions to support mental and health and wellbeing in young people who are NEET. Included studies were published between 2013 and 2025. Nine primary studies, conducted in a range of countries, were included. Studies investigated psychological interventions (n=3), nature-based interventions (n=2), animal assisted interventions (n=2), social prescribing interventions (n=1), and holistic coaching interventions (n=1). Overall, there is evidence to suggest that interventions delivered in a nonclinical, community- based, or home setting could potentially improve a range of mental health and wellbeing outcomes in young people who are NEET. Participants were generally accepting of the interventions. The psychological interventions were found to improve psychological, social and occupational functioning, reduce difficulties in emotion regulation, reduce psychological distress and led to positive behaviour changes. The nature-based interventions were found to improve social, emotional and behavioural functioning, as well as social connection and mental wellbeing and may be more effective for those who meet the criteria for anxiety or depression. The animal assisted interventions were found to improve social behaviour, and participant abilities however some mixed findings were reported for the impact on self-esteem. The social prescribing intervention improved mental wellbeing and psychological distress. Lastly, the holistic coaching intervention improved participants sense of wellbeing; anxiety; access to peer support resources; knowledge of and access to services; and connection to learning and earning opportunities. Our confidence in the evidence is limited as the majority of outcomes were only evaluated by a single study. However, while the evidence base identified was limited in number and quality, the findings may help to inform the development and delivery of interventions in young people who are NEET. Given the limited evidence base, robust evaluations should be considered when developing and implementing an intervention for young people who are NEET. Further robust studies assessing long term effects are needed to determine how best to support this population.

Background: The mental health and well-being of care-experienced children and young people remains a concern. Despite a range of interventions, the existing evidence base is limited in scope, with a reliance on standalone outcome evaluations which limits understanding of how contextual factors influence implementation and acceptability. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise evidence of intervention theory, outcome, process and economic effectiveness. This paper reports the process evaluation synthesis, exploring how system factors facilitate and inhibit implementation and acceptability of mental health and wellbeing interventions for care-experienced children and young people. Methods: Sixteen databases and 22 websites were searched between 2020 and 2022 for studies published from 1990 and May 2022. This was supplemented with contacting experts in the field, citation tracking, screening of relevant systematic reviews and stakeholder consultations. We drew on framework synthesis of qualitative data and incorporated a systems lens, taking account of contextual influences across socio-ecological domains. Quality appraisal assessed reliability and usefulness. Confidence in synthesised findings was assessed with the GRADECERQual tool. We report the review in accordance with relevant elements of both the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) checklist. Results: Searches retrieved 15,068 unique study reports, and 23 of these were eligible for process evaluation synthesis, reporting on sixteen interventions. Studies were published between 2003 and 2021. Nine interventions were from the UK and Ireland, six interventions were from the USA, and one was from Australia. They were largely classified as interpersonal, where the aim was to modify carer-child relationships. Five key context factors were identified that supported and prohibited intervention delivery: (1) lack of system resources; (2) intervention burden, which encompasses the time, cognitive, and emotional burden associated with implementation and participation; (3) interprofessional relationships between health and social care professionals; (4) careexperienced young people's identity; and (5) carer identity. Conclusion: We identified several supportive and restrictive factors across social and health care systems that may impact intervention implementation and acceptability. Key implications include: the importance of involving diverse stakeholders in intervention development and delivery; the need to better resource and support those involved in interventions, particularly training and support for carers; and ensuring future evaluations integrate process evaluations in order to optimise interventions.

Older adults constitute the largest proportion of non-users of the internet. With the increasing digitalisation of services, in particular those provided by Social Care Wales, it is important to understand how best to support older adults to overcome the challenges they face with accessing or engaging with the digital world (for personal use). This rapid review aimed to assess the effectiveness of interventions to address digital exclusion in older adults (aged 60 years and above). Digital exclusion can occur due to issues with motivation (if people do not see why the internet might be beneficial), accessibility (unable to physically access to the internet), ability (lack of skills to use the internet) or affordability (unable to afford access to the internet) of digital technology. Research Implications and Evidence Gaps The majority of studies included in this review were of low quality. It is unclear whether study findings would be generalisable to the UK. Outcome measures were heterogeneous across studies making it difficult to compare findings directly. Only one study assessed the cost-effectiveness of a digital education intervention. No study reported on interventions to address language barriers, for example, that may be experienced by people whose first language is not English. No study focused specifically on interventions to improve access to, or affordability of the internet and digital technologies to overcome digital exclusion. Further high-quality UK-based research is needed to better understand the effectiveness and cost-effectiveness of interventions for addressing digital exclusion in older adults. Policy and Practice Implications This rapid review highlighted the potential benefits of a range of complex multi-component educational interventions, particularly with regards to improving digital literacy, and suggests that older adults are accepting of these interventions. To reduce digital exclusion in older adults, evidence suggests it may be important to ensure structural barriers, such as access to the internet and affordability of devices are removed. However, the cost of provision should be considered and assessed. Educational interventions may help to reduce perceptual barriers regarding digital technologies that contribute to digital exclusion including lack of confidence, fear and anxiety, or perceived lack of abilities. It is important to consider that older adults should be equipped with the skills to make an informed choice to interact with essential services physically (offline) or digitally. With the increasing digitalisation of services, it is important that older members of the community who do not wish to use digital technologies, are not left behind or disadvantaged.### Competing Interest StatementThe authors have declared no competing interest.### Funding StatementPublic Health Wales were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesI 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.YesAll data produced in the present study are available upon reasonable request to the authors

Abstract Background The COVID-19 pandemic presented policymakers with time-sensitive decision problems and a rapidly increasing volume of research, not all of which was robust, or relevant to local contexts. A bespoke evidence review process supporting stakeholder engagement was developed as part of the Wales COVID-19 Evidence Centre (WCEC), which could flexibly react to the needs of decision-makers, to address urgent requests within days or months as required.Aims To describe and appraise the WCEC review process and methods and identify key learning points.Methods Three types of rapid review products were used, which could accommodate the breadth of decision problems and topics covered. Stakeholder (including public) engagement was integrated from the onset and supported throughout. The methods used were tailored depending on the needs of the decision-maker, type of research question, timeframe, and volume and type of evidence. We appraised the overall process and compared the methods used with the most recent and relevant best practice guidance.Results The remote collaboration between research teams, establishing a clear pathway to impact upfront, and the strong stakeholder involvement embedded in the review process were considered particular strengths. Several key learning points were identified, which focused on: enhancing stakeholders’ abilities to identify focused policy-relevant research questions; the collection and storage of review protocols at a central location; tightening quality assurance process regarding study selection, data extraction and quality assessment; adequate reporting of methodological shortcuts and understanding by stakeholders; piloting of an algorithm for assigning study design descriptors, and a single quality assessment tool covering multiple study designs; and incorporate, where appropriate an assessment of the confidence in the overall body of evidence using GRADE or similar framework.Conclusions The review process enabled a high volume of questions that were directly relevant to policy and clinical decision making to be addressed in a timely manner using a transparent and tailored approach.

Currently, there is a significant demand for tier 3 weight management services, with individuals waiting between three and five years to access these services in parts of Wales. This rapid review aimed to identify and synthesise the evidence for the effectiveness of strategies for supporting the health and well-being of individuals with obesity on such waiting lists, with a focus on practical and resource-efficient interventions that can be implemented within current healthcare constraints. Seven studies were included, and these were published between 2017 and 2024. Studies were conducted in a range of countries, and no relevant UK based study was identified. Studies investigated exercise, physical activity counselling, education and text message-based prehabilitation interventions in people awaiting surgery. This review did not identify any studies assessing the effectiveness of interventions that could be feasibly implemented or scaled up within the resource limitations of typical tier 3 weight management services in Wales. Most studies required significant resource and input from healthcare professionals, and were delivered in-person at healthcare settings or remotely via teleconferencing. All studies assessed patients with obesity on a waiting list for surgery, but none included a patient population that matched those on waiting lists for tier 3 weight management services in Wales. None of the studies evaluated the cost-effectiveness of interventions. Overall, we are not confident in the evidence. Most studies were of low quality, with significant methodological and reporting limitations affecting the reliability of their findings. Although we have little confidence in the evidence, there is some evidence from four studies, that suggest exercise interventions may support the quality of life and anthropometric measures of people with obesity waiting for surgery. This evidence could be cautiously considered to inform interventions in practice, but those designing interventions should be mindful of the population and setting in which they are applied. Other interventions, including text message-based prehabilitation interventions, preoperative educational interventions and physical activity counselling interventions were reliant on findings from single low-quality studies. Some of these interventions showed improvements for participants quality of life, mental well-being and anthropometric measures. In relation to obesity weight management services, allocation of resources should allow for conducting and evaluating robust studies and economic evaluations investigating interventions for those awaiting obesity weight management services. Given the current healthcare resource constraints, it may be beneficial to consider the feasibility and scalability of interventions during their design. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The authors and their Institutions were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes 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. Yes I 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). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Abstract The Welsh Government aims to reduce smoking prevalence from the current rate of 13% to below 5% of the population by 2030. People with mental health conditions have a higher rate of smoking prevalence and are less likely to access smoking cessation services. Evidence shows that smoking cessation in this population decreases symptoms, improves positive mood and quality of life. This rapid review aimed to identify and synthesise the evidence for the effectiveness of smoking cessation interventions in people with anxiety and/or depression living in the community. Results The literature searches were conducted in March 2024, the included study reports were published between 2008 and 2023, nine were published since 2019. Eleven primary studies from 15 reports were included in the rapid review: 10 RCTs, two of which were pilot RCTs, and one quasi-experimental pilot study. Studies were conducted in the USA (n=6), Spain (n=1), France (n=1), Netherlands (n=1), and two studies were conducted across the EU and USA. Research Implications and Evidence Gaps No UK studies were identified therefore it is unclear whether findings are generalisable to the UK. No studies applying interventions at critical touchpoints within smoking cessation or mental health services were identified. Only one study assessed the cost-effectiveness of a smoking cessation intervention. Only one study assessed a smoking cessation intervention in participants with anxiety. Most studies included in this review were judged to be of low quality. Most studies recruited participants from the general population, therefore it is unclear whether participants were engaged with mental health services. Further high-quality UK-based research is needed to better understand the effectiveness of smoking cessation interventions for people with anxiety and depression. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Public Health Wales were funded for this work by the Health and Care Research Wales Evidence Centre, itself funded by Health and Care Research Wales on behalf of Welsh Government. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes 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. Yes I 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). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

The COVID-19 pandemic further exacerbated disruptions to elective care services in the UK, leading to longer waits for treatment and a growing elective surgery backlog. There have been growing calls for the creation of surgical hubs to help reduce this backlog. Surgical hubs aim to increase surgical capacity by providing quicker access to procedures, as well as facilitate infection control by segregating patients and staff from emergency care. This rapid review aimed to assess the effectiveness, efficiency, and acceptability of surgical hubs in supporting planned care activity, to inform the implementation of these hubs in Wales. The review identified evidence available up until January 2023. Twelve primary studies were included, eight of which used comparative methods. Most of the studies were conducted during the COVID-19 pandemic and described surgical hubs designed mainly to mitigate the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Outcome measures reported included clinical, performance, economic, and patient reported outcomes across a variety of different surgical disciplines. Most of the studies did not describe surgical hubs based on their structure, i.e., standalone, integrated, or ring-fenced hubs. The evidence relating to the impact of surgical hubs on clinical outcomes appeared to be heterogenous and limited. Included studies did not appear to control for the impact of the COVID-19 pandemic on outcomes. Evidence of the impact of surgical hubs on performance outcomes such as efficiency, utilisation/usage, volume of surgeries/treatments, performance, cancellations, and time from diagnosis to treatment is limited. Evidence relating to the economic impact of surgical hubs is also limited, however there is evidence to suggest that total average costs are lower in surgical hubs when compared to general hospitals. Evidence relating to the impact of surgical hubs on patient reported outcomes is limited but indicates there may be a positive effect on patient satisfaction and compliance. Considerable variation in the types of surgical hubs reviewed, surgical disciplines, along with the small number of comparative studies, as well as methodological limitations across included studies, could limit the applicability of these findings.

The COVID-19 pandemic, and measures put in place to try to control it, impacted the psychosocial wellbeing of children and adolescents. Teachers reported an increasing trend of challenging and disruptive behaviours among school children. This rapid review evaluates the effectiveness of interventions to address challenging and disruptive behaviours within schools and further education colleges. Early searches conducted in May 2022 identified no relevant studies during the pandemic. This rapid review therefore sought research publications in the five years before the pandemic and during the pandemic, i.e., from 2015 to 2022. Three primary outcomes were the focus of detailed consideration: sexual harassment, attendance/truancy, and school exclusion/suspension.14 studies were identified of school-based interventions: 10 randomised controlled trials and 4 non-randomised controlled trials. Based on the findings of recent controlled studies there is no strong evidence to suggest that multi-component school-wide interventions or training/support for students will lead to improvements in sexual harassment (in the longer term at least), attendance or exclusion/suspension outcomes in schools.Training and educational interventions to reduce sexual harassment may be effective in the short term in some settings, but it is unclear as to ‘what might work for whom’ in the short term, and whether benefits can persist in the longer term.There is moderate evidence to suggest that neither school-wide nor training/educational interventions affect school attendance, but 5/7 studies were conducted in primary schools. Evidence for older age groups is lacking.More evidence is needed in relation to school exclusion/suspensions, but limited evidence suggests that high fidelity to a school-wide approach may have positive effects on frequency and duration of school suspensions. Further analysis is needed.Confidence in the findings on attendance/truancy is moderate, whilst confidence in the findings on sexual harassment and school exclusions/suspensions is low.

Abstract: Older adults who have undergone treatment as hospital inpatients and are now medically fit for discharge back into the community may require additional care to support that transition. Prolonged hospital admissions can also have risks including functional decline, dependency and the risk of hospital acquired infections. The aim of this rapid review was to review the research evidence for the effectiveness of workforce models in the community that may be able to rapidly grow capacity for community care and help older adults leave hospital. 19 studies were included: 11 systematic reviews and 8 UK primary studies not included in the reviews (4 quantitative study designs, 1 case study,1 mixed method study and 2 qualitative studies). The 19 studies evaluated 5 different intervention areas and a range of outcomes including: hospital length of stay; bed day rates, days to early supported discharge, delayed transfers of care (DTOCs); episode length of care; mortality; readmission; and carer, patient or staff perceptions. Intervention areas that were studied the most were: Early Supported Discharge and Transitional care/Continuity of Care. Nine recent UK studies from the systematic reviews describing these interventions were analysed separately for data on outcomes and workforce components. It is difficult to draw firm conclusions due to the limited evidence from a UK setting, and low quality of included studies. There is insufficient information to propose an optimum service design, but the evidence does suggest that interventions that are more comprehensive (covering a range of different components) and more intensive are more likely to be effective. Further research is needed to evaluate the effectiveness of workforce models introduced to rapidly grow capacity for community care to help older adults leave hospital in the UK setting. The Early Supported Discharge and Transitional Care models hold some promise.

Obstetric anal sphincter injury (OASI) occurs in 2.9% of all vaginal births in the UK and can result in faecal incontinence. Where there is a clinical need for episiotomy, OASI can be minimised by accurate selection of the optimum angle of mediolateral episiotomy. Episcissors-60 are adapted surgical scissors incorporating a guide-limb to help achieve an accurate angle of mediolateral episiotomy. The ability of Episcissors-60 to reduce OASI by preventing inaccurate visual estimates of episiotomy angles was considered by the National Institute of Health and Care Excellence (NICE) as part of the Medical Technologies Evaluation Programme (MTEP). NICE concluded that Episcissors-60 shows promise for mediolateral episiotomy both in terms of clinical effectiveness and potential cost savings, but that there was not enough evidence to support routine adoption into the NHS at this time. NICE MTG47 recommends that key gaps in the evidence including patient-reported outcomes and the addition of Episcissors-60 to care bundles be addressed through research with specific focus on potential equality considerations.

Introduction The mental health and well-being of children and young people who have been in care (ie, care-experienced) are a priority. There are a range of interventions aimed at addressing these outcomes, but the international evidence-base remains ambiguous. There is a paucity of methodologically robust systematic reviews of intervention effectiveness, with few considering the contextual conditions under which evaluations were conducted. This is important in understanding the potential transferability of the evidence-base across contexts. The present systematic review will adopt a complex systems perspective to synthesise evidence reporting evaluations of mental health and well-being interventions for care-experienced children and young people. It will address impact, equity, cost-effectiveness, context, implementation and acceptability. Stakeholder consultation will prioritise a programme theory, and associated intervention, that may progress to further development and evaluation in the UK. Methods and analysis We will search 16 bibliographic databases from 1990 to June 2020. Supplementary searching will include citation tracking, author recommendation, and identification of evidence clusters relevant to included evaluations. The eligible population is children and young people (aged ≤25 years) with experience of being in care. Outcomes are (1) mental, behavioural or neurodevelopmental disorders; (2) subjective well-being; (3) self-harm; suicidal ideation; suicide. Study quality will be appraised with methodologically appropriate tools. We will construct a taxonomy of programme theories and intervention types. Thematic synthesis will be used for qualitative data reporting context, implementation and acceptability. If appropriate, meta-analysis will be conducted with outcome and economic data. Convergent synthesis will be used to integrate syntheses of qualitative and quantitative data. Ethics and dissemination We have a comprehensive strategy for engagement with care-experienced children and young people, carers and social care professionals. Dissemination will include academic and non-academic publications and conference presentations. Ethical approval from Cardiff University’s School of Social Sciences REC will be obtained if necessary. PROSPERO registration number CRD42020177478.

Central line-associated bloodstream infections (CLABSIs) are primary, laboratory confirmed bloodstream infections in patients with a central line within 48 h of symptom onset. Catheter-related bloodstream infection (CRBSI) is a more specific term used when the cause of infection has been confirmed by catheter tip cultures. CLABSIs and CRBSIs occur as a result of bacteraemia originating from intravenous catheters. Bloodstream infections are associated with increased length of stay, mortality and increased cost in treatment. The ability of Curos™, a disinfecting cap for needleless connectors of vascular access lines, to prevent bloodstream infections was considered by the National Institute of Health and Care Excellence (NICE) as part of the Medical Technologies Evaluation Programme (MTEP). Curos is a single-use device that contains a foam that is impregnated with 70% isopropyl alcohol; use of Curos is claimed to avoid the need to manually disinfect needleless connectors. Curos disinfection caps may contribute to the prevention of CLABSIs and CRBSIs as part of a bundle of infection prevention processes; however, the evidence for Curos is limited in both quantity and quality and may not be generalisable to National Health Service (NHS) practice. Therefore, the guidance published by NICE in May 2019 recommended further research to address uncertainties regarding the clinical benefits of using Curos.

Obstetric anal sphincter injury (OASI) occurs in 2.9% of all vaginal births in the UK and can result in faecal incontinence. Where there is a clinical need for episiotomy, OASI can be minimised by accurate selection of the optimum angle of mediolateral episiotomy. Episcissors-60 are adapted surgical scissors incorporating a guide-limb to help achieve an accurate angle of mediolateral episiotomy. The ability of Episcissors-60 to reduce OASI by preventing inaccurate visual estimates of episiotomy angles was considered by the National Institute of Health and Care Excellence (NICE) as part of the Medical Technologies Evaluation Programme (MTEP). NICE concluded that Episcissors-60 shows promise for mediolateral episiotomy both in terms of clinical effectiveness and potential cost savings, but that there was not enough evidence to support routine adoption into the NHS at this time. NICE MTG47 recommends that key gaps in the evidence including patient-reported outcomes and the addition of Episcissors-60 to care bundles be addressed through research with specific focus on potential equality considerations.

The Axonics sacral neuromodulation (SNM) system can be used by people with refractory overactive bladder (OAB) to reduce symptoms of urge urinary incontinence and urinary frequency, where conservative treatments have failed or are not suitable. It is the first system for this indication that makes use of a rechargeable battery to prolong the lifespan of the implanted device, with the potential advantage of reducing the frequency of surgical replacement procedures and associated complications. We describe the evidence considered by the UK National Institute of Health and Care Excellence (NICE) in their evaluation of this evidence, supported by Cedar Healthcare Technology Research Centre. Two observational studies provided descriptive data that suggested improvement in control of symptoms after implantation of the Axonics SNM system; however, there was no peer-reviewed evidence that directly compared rechargeable and non-rechargeable SNM systems. In the absence of long-term data, economic modelling relies on the accuracy of battery life estimates. The evidence supports the case for adopting the Axonics SNM system for treating refractory OAB, when conservative treatment or treatment with medicines has not worked. This conclusion is consistent with other relevant NICE guidelines. Use of Axonics SNM technology in the UK National Health Service (NHS) is associated with a potential cost saving of £6025 per person over a 15-year period when compared with an equivalent non-rechargeable SNM system, assuming the claimed battery life estimate (a minimum of 15 years) is accurate. The cost savings are estimated to start around 6 years after implantation.

Cluster headaches are excruciating attacks of pain that can last between 15 min and 3 h. Cluster headaches can be episodic, where patients have long pain-free intervals between attacks, or chronic, where they do not. As part of the Medical Technologies Evaluation Programme, the UK National Institute for Health and Care Excellence (NICE) considered the clinical effectiveness and cost impact of gammaCore (electroCore), a handheld, patient-controlled device used to treat and prevent cluster headache. gammaCore is a non-invasive vagus nerve stimulator, the aim of which is to modify pain signals by stimulating the vagus nerve through the skin of the neck. Evidence suggests that gammaCore reduces the intensity and frequency of cluster headaches and that the addition of gammaCore to standard care is cost saving. Therefore, the guidance published by NICE in December 2019 recommends routine adoption of gammaCore into the UK national health service. However, the guidance noted that gammaCore does not work for everyone and recommended that treatment with gammaCore should stop after 3 months in patients whose symptoms do not improve.

Purpose: What Works for Children’s Social Care has developed an ‘Evidence Store’ to improve awareness of evidence from systematic reviews in children’s social care. During review selection, some reviews were excluded due to methodological flaws, which this paper considers. Methods: Reviews were identified using a systematic search and screening process. Where reviews were identified as systematic reviews or meta-analyses, exclusion reasons were recorded and analysed. Results: The main methodological issue related to quality assessment, which was not conducted in the majority of cases. Several different types of quality assessment tools were used: scales, checklists, and domain-based approaches. Conclusions: This is the first study to examine the use of systematic review terminology in combination with the use of quality assessment tools in reviews in children’s social care. Consideration of appropriate systematic review methods will enable researchers to generate high quality evidence and support delivery of evidence-based care.

The Peristeen transanal irrigation system is intended to allow people with bowel dysfunction to flush out the lower part of the bowel as part of their bowel management strategy. Peristeen was the subject of an evaluation by the National Institute for Health and Care Excellence, through its Medical Technologies Evaluation Programme, for the management of bowel dysfunction. The company, Coloplast, submitted a case for adoption of the technology, claiming that the technology improves the severity of chronic constipation or faecal incontinence and improves quality of life for people with bowel dysfunction. Other claimed benefits included reduced frequency of UTIs, stoma surgery and hospitalisation rates, as well as reduced costs. The submission was critiqued by Cedar. The clinical evidence assessed included one randomised controlled trial, and 12 observational studies for adults and 11 studies for children. Although there are limitations in the evidence, the assessed studies show some improvement in outcomes for patients who choose to continue using Peristeen. The committee heard from patient experts that Peristeen had improved their lives and allowed them increased independence. The submitted economic evidence had numerous flaws, however following Cedar's changes to the model, and additional sensitivity analysis, the use of Peristeen was judged unlikely to be cost incurring compared with standard bowel care. The Peristeen transanal irrigation system received a positive recommendation in Medical Technologies Guidance 36.