Gloucestershire Evidence & Research Repository

Background: Social eating is a key aspect of recovery for many individuals with an Eating Disorder (ED). To develop effective interventions to support recovery of social eating we need to understand the challenges that people with ED face when eating in public spaces. This study was conducted in the context of the development of a virtual reality graded-exposure café intervention for people with ED. The current analysis explores stakeholder perspectives on the challenges that people with ED face in café environments. Methods: People with lived experience of ED (n = 15), parents/carers (n = 4) and clinicians (n = 6) took part in semi-structured focus groups and 1:1 interviews. Transcripts were analysed thematically. Results: We identified six major themes: (1) Facing the unexpected and unknown; (2) Cafés elicit difficult emotions; (3) Challenges are highly individual; (4) Challenges relating to the physical café environment; (5) Challenges of social interactions in cafés; (6) Challenges of the process of choosing and consuming food and drink. Conclusions: This study highlights the challenges cafés present for people with ED, many of which also apply to other social eating scenarios. These findings will enable more targeted support and development of novel interventions to help people with ED return to social eating. Keywords: Adolescents; Eating disorders; Lived experience; Qualitative research; Social eating; Thematic analysis; Young adults.

In Gloucestershire we are rightly proud of our strong track record in collaborative working across organisations in the wider health, care and wellbeing system. We are committed to the delivery of Integrated Neighbourhood Teams building on integrated care. Across our partnerships we strive to continuously improve the care and outcomes for our people. However we are not without our challenges. While life expectancy continues to improve for the most affluent 10%, it has either stalled or fallen for the most deprived 10%. An ageing population means there’s a growing demand and pressure on the system to remain sustainable. The Working as One transformation Programme endeavours “to deliver quality, integrated care for the people of Gloucestershire to support the best possible physical and mental health outcomes, enabling them to lead the most happy and healthy lifestyles”. One improvement cycle of the Prevention workstream of Working as One is the development of Integrated Proactive Neighbourhoods; Integrated Neighbourhood Teams focussed on proactive frailty. We know there are over 73,000 people in Gloucestershire over the age of 65 coded as frail within our GP clinical systems. If and when people in this age group attend our acute hospital emergency department, they are more likely to spend longer there than those aged under 65, and more likely than the younger age group for that attendance to lead to an admission. We are keen to prevent attendances where reasonably avoidable and where people can be proactively supported to remain in their own homes and communities. We know a patchwork of interventions has developed for different cohorts of people living with frailty. This programme enables us; a system comprising teams of teams around specific populations; to collectively work better together to improve the health and care outcomes for our populations. It is an opportunity to systematise adoption of the most impactful evidence based interventions for people across our county by cohort and individual need and positively impact the wider system. We acknowledge that, whilst transformative in many respects, this is also an evolutionary change that builds on examples of already successful integrated working practices. We’re phasing our approach across fifteen neighbourhoods in Gloucestershire to collectively run improvement and change cycles. Importantly whilst system and senior strategic colleagues can provide the structure, conditions for change and permissions for this new way of working, it is the local health and care professionals, our vibrant voluntary and community sector and people in communities who hold the key to delivering locally appropriate adaptations of the model to meet local people’s needs in a meaningful and sustainable way. Our work links most to pillars 1,2,3 and 6 of integrated care. Our key next step is convening a series of workshops to enable local teams the time and space to co-develop the integrated working in their neighbourhoods. With the support of our systemwide Improvement Community and strategic leaders, local teams will be enabled and empowered to work with people to continuously develop and iterate integrated care for, and with the people we serve.

Aims: This audit aimed to assess compliance with British Orthopaedic Association Standards for Trauma (BOAST) for paediatric forearm and wrist fractures across UK NHS hospitals and identify targets for improvement locally and nationally. Methods: This was a prospective, multicentre observational audit of BOAST standards for the Early Management of the Paediatric Forearm Fracture guideline. Consecutive patients aged under 16 years presenting with a forearm or distal radius fracture over a two-month period were included with follow-up to eight weeks post injury. Data were collected to assess each of the BOAST standards for practice. Percentage compliance with all standards was calculated for each hospital. Results: Data from 1,699 patients across 53 hospitals were included. The mean age was 9.7 years (SD 3.6), and 37% (n = 636) were female. Overall, 60% of fractures (n = 1,023) were metaphyseal distal radius fractures. A total of 577 patients (34%) underwent manipulation with the majority initially reduced in the Emergency Department (ED) (n = 423, 73%); 89 (21%) required subsequent theatre manipulation. The median time to first manipulation in the ED was two hours 43 minutes (IQR 1 hr 43 mins to 4 hrs 4 mins) and 18 hours 47 minutes (IQR 13 hrs 48 mins to 24 hrs 2 mins) when first manipulation was performed in theatre. Overall compliance with BOAST standards was 63%, with 20% of patients (n = 85) having pain scores documented, 51% (n = 217) having a complete neurovascular assessment, and 23% (n = 95) receiving analgesia and a patient information leaflet on discharge. Conclusion: This study highlights variability in managing paediatric fractures despite established standards. In line with recommendations, a high proportion of reductions are now being performed in EDs. Particular areas requiring improvement are the management of paediatric pain, documented assessment of neurovascular status, and the provision of patient information. We recommend that hospitals review their current practice and ensure that local protocols are in place to promote the provision of optimal care for this patient group, and to minimize the impact on operating theatre capacity.