IntroductionHealth Technology Wales (HTW) review guidance 3 years after publication to establish if reassessment is warranted because, for example, new evidence has become available. Since the publication of guidance on flash glucose monitoring (FGM) in 2018, HTW introduced a patient and public involvement (PPI) process with novel approaches to flexible engagement. This enabled HTW to include three streams of patient evidence into the review of FGM devices.MethodsHTW’s Patient and Public Involvement Standing Group (PPISG) considered appropriate methods of engagement using the HTW Patient and Public Involvement Mechanism Tool. This tool considers the nature of the health technology, the presence of appropriate patient organizations and questions that can be put to patients, as well as other approaches for obtaining patient evidence.ResultsHTW contacted Diabetes Cymru and met with them to discuss contributing to the appraisal of FGM devices. Diabetes Cymru produced a patient submission summarizing the experiences of their patient network, with particular focus on the expansion of the technology to closed-loop insulin systems. Diabetes Cymru later attended HTW’s Appraisal Panel committee and gave a presentation. Additionally, HTW conducted a patient evidence literature review. This review summarized published qualitative studies on a range of perspectives, including carer perspectives, family perspectives, children and adolescences perspectives as well as considerations from specific environments, such as schools, workplaces, homes, care homes and communities. In addition to new clinical and cost effectiveness evidence, this PPI input was used to formulate new guidance recommending more widespread adoption of FGM.ConclusionsThe introduction of flexible approaches to PPI enabled HTW to gain patient evidence from multiple sources. This ensured greater patient representation and a more detailed understanding of the role of FGM devices across different patient communities. This added considerable richness to the patient evidence, which is vital to understand the everyday impacts of FGM and its use amongst patients. Combining flexible PPI with the new clinical and cost effectiveness evidence resulted in a change in the original guidance recommendation.

The use of personal protective equipment (PPE) is a cornerstone of infection prevention and control guidelines and was of increased importance during the COVID-19 pandemic. Adherence with prescribed guidelines for the use of PPE and their applicability to the working practices of staff in general practitioner (GP) and ambulance settings have been a growing concern. The aim of this rapid review was to assess the barriers, facilitators, and potential adverse outcomes of the use of PPE in these specific settings. Included studies were published from 2020 to November 2022. We identified four systematic reviews, a rapid review, a retrospective chart review, and a prospective quantitative survey study. Outcome measures were broadly focused on physical adverse outcomes from the use of PPE, but also included barriers and facilitators to the use of PPE in varied healthcare settings. The five reviews covered a broad range of health and care settings, which included GP and ambulance settings, but not as a specific focus. Both the retrospective chart review and the prospective survey study took place in an ambulance or emergency response setting. Overall confidence in the body of evidence is low. Extended use of PPE is associated with an increased occurrence of adverse physiological events, such as pressure ulcers and de novo headaches. Evidence indicates that adherence with PPE guidance is primarily influenced by organisational communication and workplace cultures. In ambulance settings, adherence may also be affected by dispatch codes and indicative symptoms reported during the initial call. Policy implications: As there is evidence to suggest that usage of PPE increases risk of adverse effects in healthcare workers, this should be at the forefront of considerations when developing or reviewing new and existing infection prevention and control measures. If new policy regarding the use and implementation of PPE is to be developed, effective communication and dissemination should be a priority, as this was identified as a barrier to adherence. This review has identified a significant paucity of evidence in the settings of interest and is reliant on examining evidence that represents a large variety of health and care settings. It is important to acknowledge there may be some issues specific to Ambulance and GP settings that are not covered by this review. This does impact the validity of this reviews conclusions.

IntroductionThe COVID-19 pandemic has had a dramatic impact on the health and social care landscape, both in terms of service provision and citizen need. Responsive, evidence-based research is essential to develop and implement appropriate policies and practices that manage both the pandemic itself, and the impact COVID-19 has on other health and social care issues.To address this, the Wales COVID-19 Evidence Centre (WCEC) was launched in 2021 with the aim of providing the best available, up-to-date, and relevant evidence to inform health and care decision making across Wales.MethodsFunded by the Welsh Government, the WCEC comprises of a core team and several collaborating partner organizations, including Health Technology Wales, Wales Centre for Evidence-Based Care, Specialist Unit for Review Evidence Centre, SAIL Databank, Public Health Wales, Bangor Institute for Health & Medical Research in conjunction with Health and Care Economics Cymru, and the Public Health Wales Observatory. Over the last year, WCEC has developed its rapid review processes and methodology informed by best international practice and aims to provide around 50 reviews each year. WCEC works alongside various stakeholder groups from health and social care across Wales, and they form an integral part of the review process, from scoping to knowledge mobilization.ResultsTo date, the WCEC has produced reviews on a diverse range of COVID-19 topics, including transmission, vaccination uptake (barriers, facilitators and interventions), mental health and wellbeing, as well as face coverings and other preventative interventions. The topics have also covered a wide range of populations, from general public, to healthcare workers, to children. These reviews have been used to inform policy and decision-making, including the Welsh Government’s Chief Medical Officer 21-day COVID-19 reviews.ConclusionsThe WCEC has brought together multiple specialist centers with a diverse range of skills to produce timely reviews of the most up-to-date research to support decision makers across health and social care. These reviews have informed policy and decision-making across Wales.

Testing for COVID-19 has been deployed globally as a tool to interrupt transmission through isolating positive contacts from the broader population. Financial support systems have been deployed to increase the isolation compliance, there is uncertainty as to the effectiveness of these measures. Three reviews were identified, as well as four primary studies that were published after the review search dates. Six studies showed that financial support for isolation was associated with a higher compliance to isolate. Two epidemiological modelling studies found that increased levels of social isolation were associated with a reduction in COVID-19 transmission. The findings from a DCE demonstrated a positive relationship with longer isolation duration and higher financial requirements. An economic model showed that support programmes have the potential to be a cost-effective intervention. A retrospective observational study offered evidence supporting the viability of delivering medically assisted isolation hotels for people unable to isolate at home. Further to the COVID-19 literature, two household surveys found that financial support and improved social restriction information was associated with compliance with H1N1 isolation Policy and practice implications: There is limited evidence to suggest that financial support for isolation can increase compliance, lower social engagement, and reduce infection levels. There is insufficient evidence to inform the optimal scale of financial support required There was no evidence related to effectiveness of financial support for disadvantaged populations who are required to isolate or any insight to the impact of financial support on equality The overall certainty in the evidence is relatively low. Most studies relied on participant reported data on preference or behaviour, and where observational data were used there were issues with data quality and unobserved cofounders.

Since 2021 the UK has experienced a sharp rise in inflation. For many, wages and welfare payments have not kept up with rising costs, leading to a cost of living crisis. There is evidence indicating that economic crises are damaging to population mental health and that some groups are particularly vulnerable. The review aims to 1. Identify and appraise available population level measures and methods for assessing the impact on mental health of any public health response to the cost of living crisis, and 2. review the appropriateness of the measures for specific, vulnerable populations. Study designs and mental health measurement tools: These included secondary analyses of existing data, household panel surveys, repeated cross-sectional surveys; or used routine clinical data including medical records, prescribing data, or were ecological time-series studies using national or regional suicide death rates. 12 validated mental health measurement tools were identified. Four validated mental health measurement tools are embedded into UK population-level surveys. Vulnerable groups: 11 mental health measurement tools were used to identify population sub-groups whose mental health was most likely to be affected by an economic crisis. There is evidence that the mental health measurement tools and methods are suitable for measuring mental health in people with different socio-economic and financial situations. It was not possible to determine whether the methods and tools effectively captured data from people from minority ethnic groups. Policy and practice implications: Many UK population-level surveys, include validated mental health tools and questions about financial security, providing data that can be used to explore population mental health. A quasi-experimental study design, using data from a household panel could be suitable for measuring the mental health impact of a specific public health initiative to tackle cost of living pressures. Reports and studies using population-level surveys or medical records should present data on ethnicity and, where possible, plan to stratify analyses by ethnicity. Economic considerations: Poorer households are more exposed to inflationary pressures. In the lead up to the cost of living crisis, Wales had the highest proportion of working age adults and pensioners in relative income poverty out of the UK nations. 28% of children in Wales were living in relative poverty. Given that over half of all mental health problems start by age 14 (and 75% by age 18) and poverty being a risk factor for psychological illnesses, there is likely to be a long shadow of mental health continuing into future generations stemming from the cost-of-living crisis. Mental Health problems cost the Welsh economy 4.8 billion (UK pounds) per annum. In a recent survey of Welsh participants, 60% of respondents agreed that rising costs of living negatively affected their quality of life.