Still room for improvement? The educational experiences of looked after children in Scotland

In this chapter Kirstie Maclean and Graham Connelly present an analysis of joined-up thinking in Scotland from both social services and education perspectives

Book review : Development of children's care services in Scotland: Report from the Scottish Child Abuse Inquiry by Kendrick, A., Lux, E., McGregor, S., and Withington, R.

The idea of reading an 800-page report is fairly daunting for researchers, let alone for over-stretched residential workers and social workers. Nevertheless, I would urge you to read this report as it simply and very comprehensively provides the history, development, successes, downsides, and crises of the children’s care services in which we are involved. Whilst mainly covering the years 1900 – 2014, it also delves further back into the past, providing a real understanding of how and why services developed, and exploring some of the distinctive aspects of Scottish services. Although it particularly describes children’s services in Scotland, comparisons are made with practice in England and Wales, and it is likely that some of the practice will also be recognised elsewhere

Two and a half cheers for the national care standards

Nineteen volumes of National Care Standards were issued by the Scottish Executive in the Spring of 2002. The two volumes which are most relevant and important for residential child care owners, staff, children and young people and their parents, are the Standards relating to 'Care Homes for Children and Young People' (Scottish Executive, 2002a) and 'School Care Accommodation Services' (Scottish Executive, 2002b). It is extremely important that units and schools familiarise themselves with the standards and audit their services against them; they are the tool that will be used by the Scottish Commission for the Regulation of Care (the Care Commission) when it registers and inspects services. It is therefore vital that we celebrate the major step forward which the Standards represent for looked after and accommodated children and other children living away from home

Revitalising residential and foster care : new horizons in the 21st Century: 7th EUSARF International Congess, Trondheim, Norway, 11 – 14 September 2002

The European Scientific Association for Residential and Foster Care for Children and Adolescents (EUSARF) held its 7th International Congress in the ancient Norwegian capital of Trondheim. SIRCC made a good showing at the congress, with papers presented by Ian Milligan, Andy Kendrick and myself. There was a wide and varied programme with presentations from practitioners and researchers from across Europe, as well as from the USA, South Africa and New Zealand. It was reassuring, although also disappointing, to discover that other countries still wrestle with many of the same problems as we do in Scotland

Guest editorial

After just over 3 years as Director of the Scottish Institute for Residential Child Care (SIRCC), I am returning to work in the Social Work Services Inspectorate. This has caused me to reflect on whether anything has changed in residential care over that period and, if so, what and why. It is my conviction that there has been change, although much of the change is quite small, gradual and, to some extent, fragile. Nevertheless, it leads me to believe that a corner has been turned. The old side of the corner often had residential care viewed as in decline and a last resort; the new side of the corner has residential child care increasingly seen as a positive choice for some children and young people and a valued part of the placement spectrum

Residential Child Care Qualifications Audit

This report outlines the level and range of the qualifications found and the very major challenges for achieving a fully qualified workforce posed by them; some of the implications of the findings; some of the wider considerations of which account needs to be taken if a strategy for achieving qualifications is to be successful; some of the unknown, and in some cases, unknowable, factors which will complicate planning and lead to a need for flexibility and adaptability; proposals for a qualifications framework which we consider is the minimum needed if the quality of care for looked after young people is to be improved; and some suggestions for how a fully qualified work force might be achieved

In Residence : A series of 12 papers

This re-issue of 12 papers written over a period of six years has been produced to celebrate SIRCC's 10th anniversary – the organisation launched in April 2000. I'd like to express my appreciation to all the authors, who are drawn from SIRCC staff and residential practitioners currently working in various settings. The papers are circulated free of charge to all Scotland's residential homes and schools, and are available for download on our website. A recent survey told us that the papers are valued by those who read them, although that survey also prompted us to look again at how we promote them, and try to make sure they don't get stuck in a manager's office! This re-issue has been substantially augmented with material for supervisors linked to each of the papers. We hope this will help workers look at how they can transfer the learning within the paper into practice, with the help of their supervisor. We have also asked subject experts to review the earliest papers and add their own foreword which provides a reflection on the original

Procalcitonin Is Not a Reliable Biomarker of Bacterial Coinfection in People With Coronavirus Disease 2019 Undergoing Microbiological Investigation at the Time of Hospital Admission

Abstract Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11–1.70] ng/mL vs 0.24 [0.10–0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51–.60]).</jats:p

Implementation of corticosteroids in treating COVID-19 in the ISARIC WHO Clinical Characterisation Protocol UK:prospective observational cohort study

BACKGROUND: Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. METHODS: We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. FINDINGS: Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70–0·89], p=0·0001, for 70–79 years; 0·52 [0·46–0·58], p80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75–80% in January, 2021. INTERPRETATION: Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. FUNDING: UK National Institute for Health Research and UK Medical Research Council

Genetic mechanisms of critical illness in COVID-19.

Host-mediated lung inflammation is present1, and drives mortality2, in the critical illness caused by coronavirus disease 2019 (COVID-19). Host genetic variants associated with critical illness may identify mechanistic targets for therapeutic development3. Here we report the results of the GenOMICC (Genetics Of Mortality In Critical Care) genome-wide association study in 2,244 critically ill patients with COVID-19 from 208 UK intensive care units. We have identified and replicated the following new genome-wide significant associations: on chromosome 12q24.13 (rs10735079, P = 1.65 × 10-8) in a gene cluster that encodes antiviral restriction enzyme activators (OAS1, OAS2 and OAS3); on chromosome 19p13.2 (rs74956615, P = 2.3 × 10-8) near the gene that encodes tyrosine kinase 2 (TYK2); on chromosome 19p13.3 (rs2109069, P = 3.98 ×  10-12) within the gene that encodes dipeptidyl peptidase 9 (DPP9); and on chromosome 21q22.1 (rs2236757, P = 4.99 × 10-8) in the interferon receptor gene IFNAR2. We identified potential targets for repurposing of licensed medications: using Mendelian randomization, we found evidence that low expression of IFNAR2, or high expression of TYK2, are associated with life-threatening disease; and transcriptome-wide association in lung tissue revealed that high expression of the monocyte-macrophage chemotactic receptor CCR2 is associated with severe COVID-19. Our results identify robust genetic signals relating to key host antiviral defence mechanisms and mediators of inflammatory organ damage in COVID-19. Both mechanisms may be amenable to targeted treatment with existing drugs. However, large-scale randomized clinical trials will be essential before any change to clinical practice