This is a repository copy of Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH) : a stepped-wedge cluster-randomised trial. The Lancet. ISSN 0140-6736 https://doi.org/10.1016/S0140-6736(18)32521-2 eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ ReuseThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) licence. This licence only allows you to download this work and share it with others as long as you credit the authors, but you can't change the article in any way or use it commercially. More information and the full terms of the licence here: https://creativecommons.org/licenses/ Implications of all the available evidenceDespite the success of some smaller projects, there was no survival benefit from a national quality improvement programme to implement a care pathway for patients undergoing emergency abdominal surgery. To succeed, large national quality improvement programmes need to allow for differences between hospitals and ensure teams have both the time and resources needed to improve patient care.

Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

This study aimed to examine whether changes in the illness perceptions of oesophageal cancer survivors explain changes in their levels of psychological distress relative to demographic and biomedical variables and coping strategies. Oesophageal cancer survivors completed the Illness Perception Questionnaire - Revised, the Cancer Coping Questionnaire and the Hospital Anxiety and Depression Scale at two points in time, 12 months apart. Cluster analysis was used to identify groups of respondents who reported a similar profile of change in their illness perception scores over time. Findings suggested that enhancing control cognitions and encouraging a positive focus coping strategy may be important in improving psychological health.

The increasing use of qualitative methodologies to explore experiences of child sexual abuse (CSA) disclosure has led to the need to synthesise these findings. Recent reviews have tended to focus on the barriers to disclosure more than the facilitators or to conflate findings from studies of adults and studies of children and adolescents. This paper focuses on a qualitative meta‐analysis of studies conducted in the past 20 years (1998–2018) that addresses the question of what helps children disclose experiences of CSA. An analysis of 20 studies that met the inclusion criteria suggests that six key themes are important facilitators of disclosure: access to someone you can trust; realising it's not normal; inability to cope with emotional distress; wanting something to be done about it; expecting to be believed; and being asked. These can be conceptualised as representing two key dynamics that help children tell: needing to tell (pressure cooker effect), and opportunity to tell. Professionals and carers can facilitate the process of disclosure through building trusting relationships with children, recognising their distress and initiating conversations with children about their wellbeing. Key Practitioner Messages There is a need for the focus to be on what helps children tell rather than what hinders children telling. Children need those around them to notice when they need to talk about themselves and what is happening in their lives – when they are unable to cope with their distress, when they want something done about it. Professionals and adults interacting with children need to ask children about their lives and wellbeing, in order to: help create opportunities for children to tell; help them access someone they can trust; let them know they will be taken seriously; and help them to understand that abusive behaviour is not normal.

Objective: The research aimed to determine the extent to which illness cognitions and coping explain psychological distress (fear of cancer recurrence, anxiety and depression symptoms) among family carers of survivors of oesophageal cancer.Methods: Carers of patients registered with the Oesophageal Patients' Association in the UK were mailed a questionnaire booklet containing questions about medical and demographic variables, the Illness Perception Questionnaire‐Revised, the Cancer Coping Questionnaire, the Concerns about Recurrence Scale and the Hospital Anxiety and Depression Scale.Results: Complete responses were received from 382 family carers (75% male; mean (SD) age=62 (10.91) years). Regression models indicated that the variables measured could explain between 35 and 49% of the variance in psychological distress among carers. Illness cognitions (particularly perceptions of the cause of, consequences of and personal control over oesophageal cancer and the carer's understanding of the condition) explained the majority of this variance. Positive focus coping strategies were also found to be important in explaining psychological distress.Conclusion: The results of this study are consistent with previous research demonstrating that illness cognitions are significant correlates of adaptive outcomes, thereby suggesting that cognition‐based interventions could potentially be effective in minimizing emotional distress among family carers of oesophageal cancer survivors. Copyright © 2010 John Wiley & Sons, Ltd.