Nasogastric tube feeding under physical restraint: understanding the effects on parents and how to support them.

Background: Nasogastric tube (NGT) feeding under physical restraint is a clinical intervention that may be required when a child or young person is medically unstable secondary to restrictive eating.

Aim: To explore the experiences of parents when their child receives NGT feeding under physical restraint and understand the effects of this on them.

Method: This is a secondary analysis of data from two previous studies on NGT feeding under physical restraint - one in mental health wards and one in children's wards - in which semi-structured interviews had been conducted with patients, staff and parents.

'We are not trained to do clinical work': security staff providing physical restraint for NGT feeding in English paediatric wards-a qualitative multi-informant study.

Objective: To gain insights into the experience, and impact, of using security staff to facilitate physical restraints for nasogastric tube feeding.

Design: A cross-sectional design using 39 individual interviews, three online focus groups and three written submissions involving young people with lived experience (PWLE), parents/carers, paediatric staff and security staff involved in nasogastric feeding under restraint in paediatric settings in England. Qualitative semistructured interviews were transcribed and thematically analysed.

Navigating the ethical complexities of severe and enduring (longstanding) eating disorders: tools for critically reflective practice and collaborative decision-making.

Decisions about the treatment of eating disorders do not occur in a socio-political vacuum. They are shaped by power relations that produce categories of risk and determine who is worthy of care. This impacts who gets access to care and recognition of rights in mental health services.

The importance of individualised care, good communication and trust for reducing nasogastric tube feeding under physical restraint: qualitative multi-informant study.

Background: Nasogastric tube (NGT) feeding against a patient's consent is an intervention that clinicians working in specialist mental health in-patient units may need to implement from time to time. Little research has explored clinician, patient and carer perspectives on good practice.

Aims: To use qualitative data from people with lived experience (PWLE), parents/carers and clinicians, to identify components of best practice when this intervention is required.

Nasogastric tube feeding under restraint: understanding the impact and improving care.

Background: Nasogastric tube feeding under physical restraint is an intervention that clinicians working in specialist mental health in-patient units may need to implement.

Aims: To examine the impact of this intervention on people with lived experience, carers and staff.

Method: People with lived experience and parents and/or carers were recruited via UK eating disorder charity Beat.

Effects of the COVID-19 pandemic on the mental health of clinically extremely vulnerable children and children living with clinically extremely vulnerable people in Wales: a data linkage study.

Objectives: To determine whether clinically extremely vulnerable (CEV) children or children living with a CEV person in Wales were at greater risk of presenting with anxiety or depression in primary or secondary care during the COVID-19 pandemic compared with children in the general population and to compare patterns of anxiety and depression during the pandemic (23 March 2020-31 January 2021, referred to as 2020/2021) and before the pandemic (23 March 2019-31 January 2020, referred to as 2019/2020), between CEV children and the general population.

Design: Population-based cross-sectional cohort study using anonymised, linked, routinely collected health and administrative data held in the Secure Anonymised Information Linkage Databank. CEV individuals were identified using the COVID-19 shielded patient list.

Recognising and managing eating disorders in the emergency department.

Compared with other mental health conditions or psychiatric presentations, such as self-harm, which may be seen in emergency departments, eating disorders can seem relatively rare. However, they have the highest mortality across the spectrum of mental health, with high rates of medical complications and risk, ranging from hypoglycaemia and electrolyte disturbances to cardiac abnormalities. People with eating disorders may not disclose their diagnosis when they see healthcare professionals.

Nasogastric tube feeding under physical restraint: comprehensive audit and case series across in-patient mental health units in England.

Aims And Method: To identify the clinical characteristics of patients receiving nasogastric tube (NGT) feeding under physical restraint. Clinicians participated via professional networks and subsequent telephone contact. In addition to completing a survey, participants were invited to submit up to ten case studies.

Recognising and managing eating disorders in the emergency department.

Compared with other mental health conditions or psychiatric presentations, such as self-harm, which may be seen in emergency departments, eating disorders can seem relatively rare. However, they have the highest mortality across the spectrum of mental health, with high rates of medical complications and risk, ranging from hypoglycaemia and electrolyte disturbances to cardiac abnormalities. People with eating disorders may not disclose their diagnosis when they see healthcare professionals.

Decision-making and best practice when nasogastric tube feeding under restraint: multi-informant qualitative study.

Background: Clinicians working in mental health in-patient settings may have to use nasogastric tube feeding under physical restraint to reverse the life-threatening consequences of malnutrition when this is driven by a psychiatric condition such as a restrictive eating disorder.

Aims: To understand the decision-making process when nasogastric tube feeding under restraint is initiated in mental health in-patient settings.

Method: People with lived experience of nasogastric tube feeding under restraint and parents/carers were recruited via the website of the UK's eating disorder charity BEAT.

Nasogastric tube feeding under restraint: practical guidance for children's nurses.

The number of children and young people admitted to children's wards with an eating disorder has increased significantly since the start of the coronavirus disease 2019 (COVID-19) pandemic. In the most extreme cases, those with severe malnutrition may need to be fed via a nasogastric tube without their consent. Children's nurses working on hospital wards may therefore care for children and young people who need to receive nasogastric tube feeding under physical restraint.

Nasogastric tube feeding under physical restraint on paediatric wards: ethical, legal and practical considerations regarding this lifesaving intervention.

Eating disorders have the highest mortality rate of any psychiatric condition. Since the COVID-19 pandemic, the number of patients who have required medical stabilisation on paediatric wards has increased significantly. Likewise, the number of patients who have required medical stabilisation against their will as a lifesaving intervention has increased.

Remote mental health services: a mixed-methods survey and interview study on the use, value, benefits and challenges of a national video consulting service in NHS Wales, UK.

Unlabelled: Social distancing laws during the first year of the pandemic, and its unprecedented changes to the National Health Service (NHS) forced a large majority of services, especially mental health teams to deliver patient care remotely. For many, this approach was adopted out of necessity, rather than choice, thus presenting a true 'testing ground' for remote healthcare and a robust evaluation on a national and representative level.

Objective: To extract and analyse mental health specific data from a national dataset for 1 year (March 2020-March 2021).

Identifying and managing eating disorders in type 1 diabetes mellitus: An all-Wales study.

Background: Co-morbid diabetes and eating disorders have a particularly high mortality, significant in numbers and highly dangerous in terms of impact on health and wellbeing. However, not much is known about the level of awareness, knowledge and confidence amongst healthcare professionals regarding co-morbid Type 1 Diabetes Mellitus (T1DM) and eating disorders.

Aim: To understand the level of knowledge and confidence amongst healthcare professionals in Wales regarding co-morbid T1DM and eating disorder presentations, identification and treatment.

The Welsh Eating Disorder Service Review 2018, Scottish Eating Disorder Service Review 2021 and recommendations of best practice in comorbid eating disorders and diabetes.

Background: Diabetes and eating disorders are frequently comorbid. This particular comorbidity is not only often poorly recognised, but is difficult to treat and has a high mortality.

Method: In this article, we will briefly review the relationship between diabetes and eating disorders.

Clinical management and mortality risk in those with eating disorders and self-harm: e-cohort study using the SAIL databank.

Background: Individuals with eating disorders who self-harm are a vulnerable group characterised by greater pathology and poorer outcomes.

Aims: To explore healthcare utilisation and mortality in those with a record of: self-harm only; eating disorders only; and both co-occurring.

Method: We conducted a retrospective whole population e-cohort study of individuals aged 10-64 years from 2003 to 2016.

A visual step-by-step guide for clinicians to use video consultations in mental health services: NHS examples of real-time practice in times of normal and pandemic healthcare delivery.

Despite the increasingly widespread use of video consultations, there are very few documented descriptions of how to set up and implement video consultations in real-time practice. This step-by-step guide will describe the set-up process based on the authors' experience of two real-time National Health Service (NHS) examples: a single health board use (delivered in normal time), and an All-Wales National Video Consultation Service roll-out (delivered during an emergency pandemic as part of the COVID-19 response). This paper provides a simple visual step-by-step guide for using telepsychiatry via the remote use of video consultations in mental health services, and outlines the mandatory steps to achieving a safe, successful and sustainable use of video consultations in the NHS by ensuring that video consultations fit into existing and new NHS workflow systems and adhere to legal and ethical guidelines.

Debate: COVID crisis, natural capital and clinical care - 'building back better' for a new values-based CAMHS.

The COVID-19 pandemic has meant upheaval for child and adolescent mental health services and for children, young people and their families. We look at this disruption through the lens of values-based practice. We also briefly examine the concept of natural capital and the opportunity for 'Building Back Better' post-COVID.

Current eating disorder healthcare services - the perspectives and experiences of individuals with eating disorders, their families and health professionals: systematic review and thematic synthesis.

Background: Eating disorders have the highest mortality rate of mental disorders and a high incidence of morbidity, but if diagnosed and treated promptly individuals can benefit from full recovery. However, there are numerous problems at the healthcare interface (i.e.

Shining the light on eating disorders, incidence, prognosis and profiling of patients in primary and secondary care: national data linkage study.

Background: Diagnosing eating disorders can be difficult and few people with the disorder receive specialist services despite the associated high morbidity and mortality.

Aims: To examine the burden of eating disorders in the population in terms of incidence, comorbidities and survival.

Method: We used linked electronic health records from general practitioner and hospital admissions in Wales, UK within the Secure Anonymised Information Linkage (SAIL) databank to investigate the incidence of new eating disorder diagnoses.

The Moral Obligation to Prioritize Research Into Deep Brain Stimulation Over Brain Lesioning Procedures for Severe Enduring Anorexia Nervosa.

Deep Brain Stimulation is currently being investigated as an experimental treatment for patients suffering from treatment-refractory AN, with an increasing number of case reports and small-scale trials published. Although still at an exploratory and experimental stage, initial results have been promising. Despite the risks associated with an invasive neurosurgical procedure and the long-term implantation of a foreign body, DBS has a number of advantageous features for patients with SE-AN.

School achievement as a predictor of depression and self-harm in adolescence: linked education and health record study.

Background: Mental disorders in children and adolescents have an impact on educational attainment. Aims To examine the temporal association between attainment in education and subsequent diagnosis of depression or self-harm in the teenage years.

Method: General practitioner, hospital and education records of young people in Wales between 1999 and 2014 were linked and analysed using Cox regression.

Deep Brain Stimulation in Anorexia Nervosa: Hope for the Hopeless or Exploitation of the Vulnerable? The Oxford Neuroethics Gold Standard Framework.

Neurosurgical interventions for psychiatric disorders have a long and troubled history (1, 2) but have become much more refined in the last few decades due to the rapid development of neuroimaging and robotic technologies (2). These advances have enabled the design of less invasive techniques, which are more focused, such as deep brain stimulation (DBS) (3). DBS involves electrode insertion into specific neural targets implicated in pathological behavior, which are then repeatedly stimulated at adjustable frequencies.