Editorial group: Cochrane Methodology Review Group. Publication status and date: New search for studies and content updated (conclusions changed), published in Issue 3, 2021.

Context: Globally, governments have introduced a variety of public health measures including restrictions and reducing face-to-face contact, to control the spread of COVID-19. This has implications for mental health services in terms of support and treatment for vulnerable groups such as people with pre-existent mental health conditions. However, there is limited evidence of the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions. Objectives: To identify the impact of COVID-19 and its related restrictions on people with pre-existent mental health conditions. Methods: A scoping review of the literature was employed. Eight electronic databases (PsycINFO, Cochrane, Web of Science, MEDLINE, EMBASE, CINAHL, Scopus, Academic Search Complete) were searched and 2566 papers identified. 30 papers met the criteria for this review and findings were summarised under three key review questions. Results: COVID-19 and its related restrictions have had a notable effect on people with pre-existent mental health conditions. Public health restrictions have contributed to increased levels of social isolation, loneliness, and reduced opportunities for people to connect with others. Reduced access to health services and treatments has compounded matters for those seeking support. Exacerbation and deterioration of symptoms are commonly reported and can lead to greater susceptibility to COVID-19 infection. Implications: The importance of proactive planning, alternative accessible healthcare services and supports for vulnerable and at-risk groups is illuminated. Increased monitoring, early intervention and individually tailored care strategies are advocated. Recommendations revolve around the need for enhanced provision of remote support strategies facilitated using technology enhanced resources.

BackgroundA holistic profile that includes demographic, medical history and wound characteristics of individuals with venous leg ulceration is lacking. Lack of such a profile negatively impacts the ability to develop interventions to improve patient outcomes.Objectives: To describe the profile of the patient population with venous leg ulceration from published observational (non-interventional) studies and to identify gaps in the knowledge base for future research in this area.Methods: A systematic review of observational studies that included more than 50 patients, from any world region, of any age and in any care setting.Results: twenty studies, involving 3,395 patients, from all world regions met our criteria. Demographic characteristics were well reported and showed a female to male ratio of 1.2:1, average age of 47-65 years, high levels of co-morbidities including hypertension (53 -71%) and diabetes (16 -20%), and only one study reporting ethnicity. When reported, approximately 4-30% had high levels of depression. The average wound size was 18.6 -43.39cm 2 ; mean wound duration was 13.8 -65.5 months, mean number of recurrences was four. No study reported on demographic factors plus medical history plus wound characteristics together.Conclusion: a comprehensive, holistic profile of the population with VLU is lacking. There is a critical need for more comprehensive profiling to enable the development of targeted interventions to improve outcomes.

Mounting reports of missed nursing care emphasizes the negative implications on patient outcomes, illuminating the stark realities currently facing the profession (Recio-Saucedo et al., 2018; White, Aiken,

Background Recruitment of pregnant or postnatal women and young families into health research is a challenge. Community midwives and health visitors are well placed to invite service users to participate, but evidence suggests that they do not always invite all potentially eligible service users. Our aim was to use the Theoretical Domains Framework to explore health visitors' and community midwives' perceived barriers and enablers to approaching service users about participation in research and to use the Behaviour Change Wheel to suggest theory-based strategies to improve future recruitment. Methods Health visitors and community midwives working in four NHS Trusts and one community partnership in England were invited to complete an anonymous, online survey. The sample comprised health visitors (n=39) and community midwives (n=22). Qualitative data from open-ended questions about recruitment behaviour informed by the Theoretical Domains Framework were analysed using directed content analysis and inductive coding to identify salient Theoretical Domains Framework domains and speci c barriers and enablers. Strategies to address these barriers and enablers were identi ed using the Behaviour Change Wheel. Results Six key Theoretical Domains Framework domains were identi ed as salient to service user approach: (a) environmental context and resources; (b) social/professional role and identity; (c) social in uences; (d) goals; (e) beliefs about capabilities; (f) knowledge. Intervention strategies were identi ed to address speci c barriers (insu cient time and staff capacity, inadequate study materials, rejection of the study's relevance to practitioners' role, negative in uence of researchers and managers, and competing priorities) and to leverage speci c enablers (additional staff resource, the relevance of service user approach to professional role, positive in uence of team members, managers and researchers, and a belief in the link between service user approach and improvements in healthcare). Conclusions This study provides new insights into why community midwives and health visitors do, and do not, invite service users to participate in research. Using the Theoretical Domains Framework and the Behaviour Change Wheel we identi ed that resourcing and social support for staff together with education and communication about the health bene ts of approaching service users about research participation are key to improving research recruitment involving these health professionals.

Background Addressing recruitment and retention challenges in trials is a key priority for methods research, but navigating the literature is difficult and time-consuming. In 2016, ORRCA ( www.orrca.org.uk ) launched a free, searchable database of recruitment research that has been widely accessed and used to support the update of systematic reviews and the selection of recruitment strategies for clinical trials. ORRCA2 aims to create a similar database to map the growing volume and importance of retention research. Methods Searches of Medline (Ovid), CINAHL, PsycINFO, Scopus, Web of Science Core Collection and the Cochrane Library, restricted to English language and publications up to the end of 2017. Hand searches of key systematic reviews were undertaken and randomised evaluations of recruitment interventions within the ORRCA database on 1 October 2020 were also reviewed for any secondary retention outcomes. Records were screened by title and abstract before obtaining the full text of potentially relevant articles. Studies reporting or evaluating strategies, methods and study designs to improve retention within healthcare research were eligible. Case reports describing retention challenges or successes and studies evaluating participant reported reasons for withdrawal or losses were also included. Studies assessing adherence to treatments, attendance at appointments outside of research and statistical analysis methods for missing data were excluded. Eligible articles were categorised into one of the following evidence types: randomised evaluations, non-randomised evaluations, application of retention strategies without evaluation and observations of factors affecting retention. Articles were also mapped against a retention domain framework. Additional data were extracted on research outcomes, methods and host study context. Results Of the 72,904 abstracts screened, 4,364 full texts were obtained, and 1,167 articles were eligible. Of these, 165 (14%) were randomised evaluations, 99 (8%) non-randomised evaluations, 319 (27%) strategies without evaluation and 584 (50%) observations of factors affecting retention. Eighty-four percent (n = 979) of studies assessed the numbers of participants retained, 27% (n = 317) assessed demographic differences between retained and lost participants, while only 4% (n = 44) assessed the cost of retention strategies. The most frequently reported domains within the 165 studies categorised as ‘randomised evaluations of retention strategies’ were participant monetary incentives (32%), participant reminders and prompts (30%), questionnaire design (30%) and data collection location and method (26%). Conclusion ORRCA2 builds on the success of ORRCA extending the database to organise the growing volume of retention research. Less than 15% of articles were randomised evaluations of retention strategies. Mapping of the literature highlights several areas for future research such as the role of research sites, clinical staff and study design in enhancing retention. Future studies should also include cost–benefit analysis of retention strategies.

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