Publications

Howard C, Sheikh C, Rutter P, Latter S, Lown M, Brad L, Fraser SDS, Bradbury K, Roberts HC, Saucedo AR, Ibrahim K

A third of older people take five or more regular medications (polypharmacy). Conducting medication reviews in primary care is key to identify and reduce/ stop inappropriate medications (deprescribing). Recent recommendations for effective deprescribing include shared-decision making and a multidisciplinary approach. Our aim was to understand when, why, and how interventions for medication review and deprescribing in primary care involving multidisciplinary teams (MDTs) work (or do not work) for older people.

https://doi.org/10.1186/s12877-023-04256-8

September 2023

Johnson L, Kirk H, Clark B, Heath S, Royse C, Adams C, Portillo MC

Systematically implementing personalised care has far reaching benefits to individuals, communities and health and social care systems. If done well, personalised care can result in better health outcomes and experiences, more efficient use of health services and reduced health inequalities. Despite these known benefits, implementation of personalised care has been slow. 

Evaluation is an important step towards achieving the ambition of universally delivered personalised care. There are currently few comprehensive assessments or tools that are designed to understand the implementation of personalised care at a service or system level, or the cultural, practical and behavioural factors influencing this. The aim of this paper is to describe the development and testing of a system-wide evaluation tool.

https://doi.org/10.1136/bmjoq-2023-002324

September 2023

Griffiths P, Saville C, Ball J, Dall'Ora C, Meredith P, Turner L, Jones J

Extensive research shows associations between increased nurse staffing levels, skill mix and patient outcomes. However, showing that improved staffing levels are linked to improved outcomes is not sufficient to provide a case for increasing them. This review of economic studies in acute hospitals aims to identify costs and consequences associated with different nurse staffing configurations in hospitals.

https://doi.org/10.1016/j.ijnurstu.2023.104601

September 2023

Stannard S, Berrington A, Paranjothy S, Owen R, Fraser S, Hoyle R, Boniface M, Wilkinson B, Akbari A, Batchelor S, Jones W, Ashworth M, Welch J, Mair FS, Alwan NA

Social, biological and environmental factors in early-life, defined as the period from preconception until age 18, play a role in shaping the risk of multiple long-term condition multimorbidity. However, there is a need to conceptualise these early-life factors, how they relate to each other, and provide conceptual framing for future research on aetiology and modelling prevention scenarios of multimorbidity. We develop a conceptual framework to characterise the population-level domains of early-life determinants of future multimorbidity.

https://doi.org/10.1177/26335565231193951

September 2023

Almuhairi ES, Badejo M, Peer A, Pitkanen M, McKenzie CA

Delirium is a neuropsychiatric syndrome common in critical illness. Worsening delirium severity is associated with poorer clinical outcomes, yet its assessment remains under-reported with most severity assessment tools not validated for critical care. The DRS-R98 is a widely applied and validated tool. The aim of this project is to report the validation and utility of the DRS-R98 in critical illness.

https://doi.org/10.1177/08850666231199986

September 2023

Grove G, Ziauddeen N, Roderick P, Vassilev I, Appleton JV, Smith D, Alwan NA

A Childhood Obesity Risk Estimation tool (SLOPE CORE) has been developed based on prediction models using routinely available maternity and early childhood data to estimate risk of childhood obesity at 4-5 years. This study aims to test the feasibility, acceptability and usability of SLOPE CORE within an enhanced health visiting (EHV) service in the UK, as one context in which this tool could be utilised.

https://doi.org/10.1186/s12889-023-16500-2

September 2023

Shaw S, Muir S, Strömmer S, Crozier S, Cooper C, Smith D, Barker M, Vogel C

Factors from social and food environments can influence the food choices of adolescents in ways not experienced during childhood. Evidence suggests these two environments influence adolescents' food choices independently, but there is limited knowledge of how the interplay between these environments influence adolescents' diets. An enhanced understanding of this interplay surrounding adolescent food choice could aid the development of more nuanced interventions and policies. 

This qualitative study involved 13 online focus groups with adolescents (n = 45) aged 11-18 years, attending secondary school or college in England, UK. Data were analysed using thematic analysis. Social experiences which accompanied eating were perceived as more important than the food itself, and fast-food outlets were described as uniquely suited to facilitating these interactions. Young people wanted to spend their money on foods they considered worthwhile, but this did not always relate to the most affordable foods. Adolescents wanted to put little effort into making food decisions and appreciated factors that helped them make quick decisions such as prominent placement and eye-catching promotions on foods they wanted to buy. Chain food outlets were valued as they offered familiar and frequently advertised foods, which minimized the effort needed for food decisions. Adolescents' sense of autonomy underpinned all themes. 

Participants described having limited opportunities to make their own food choices and they did not want to waste these buying unappealing 'healthy' foods. Interventions and government policies should align with adolescents' experiences and values relating to food choice to ensure that they are effective with this important age group.

https://doi.org/10.1093/heapro/daad097

August 2023

Vester LB, Haahr A, Nielsen TL, Bartolomeu S, Portillo MC

Objective: To identify multi-sectoral integrated care initiatives for people with Parkinson's disease and caregivers.

Method: Following the Matrix Method we created a synthesis of literature across methodological approaches. The search was conducted in four databases until June 2022, and included studies focusing on multi-sectoral integrated care initiatives, and how they helped people with Parkinson's disease and caregivers in everyday living.

https://doi.org/10.1016/j.pec.2023.107931

August 2023

Meredith SJ, Cox NJ, Ibrahim K, Higson J, McNiff J, Mitchell S, Rutherford M, Wijayendran A, Shenkin SD, Kilgour AHM, Lim SER

Despite the advantages of physical activity (PA), older adults are often insufficiently active to maximise health. Understanding factors that influence PA engagement will support well-designed interventions for older people. Our aim was to review the qualitative evidence exploring the factors affecting older adults' engagement in PA.

https://doi.org/10.1093/ageing/afad145

August 2023

Collins P, Bridges J, Bartlett R

This is a methodological paper that aims to advance the conceptualisation of participatory research by focusing on the value of capturing and understanding movement as a vital means of communication for older people with dementia in a general hospital ward. Qualitative research involving people with dementia tends to be word-based and reliant upon verbal fluency. This article considers a method for capturing and understanding movement as a vital means of communication.

https://doi.org/10.1002/gps.5987

August 2023

Hesketh KR, Baird J, Crozier SR, Godfrey KM, Harvey NC, Cooper C, van Sluijs EMF

Purpose: To explore how activity behaviors before/during pregnancy relate to those in later parenthood, we assessed associations between sitting and moderate-/strenuous exercise before/during pregnancy, and sedentary time (SED) and moderate to vigorous physical activity (MVPA) 4-7 years postpartum ("later parenthood").

https://doi.org/10.1123/jpah.2022-0630

August 2023

Saynor ZL, Gruet M, McNarry MA, Button B, Morrison L, Wagner M, Sawyer A, Hebestreit H, Radtke T, Urquhart DS; European Cystic Fibrosis Society Exercise Working Group

Regular exercise testing is recommended for all people with cystic fibrosis (PwCF). A range of validated tests, which integrate both strength and aerobic function, are available and increasingly being used. Together, these tests offer the ability for comprehensive exercise evaluation. Extensive research and expert consensus over recent years has enabled the adaptation and standardisation of a range of exercise tests to aid the understanding of the pathophysiology related to exercise limitation in PwCF and has led to the development of novel exercise tests which may be applied to PwCF. 

This article provides expert, opinion-based clinical practice guidance, along with test instructions, for a selection of commonly used valid tests which have documented clinimetric properties for PwCF. Importantly, this document also highlights previously used tests that are no longer suggested for PwCF and areas where research is mandated. This collaboration, on behalf of the European Cystic Fibrosis Society Exercise Working Group, represents expert consensus by a multidisciplinary panel of physiotherapists, exercise scientists and clinicians and aims to improve global standardisation of functional exercise testing of PwCF. In short, the standardised use of a small selection of tests performed to a high standard is advocated.

https://doi.org/10.1183/16000617.0029-2023

August 2023

Ziauddeen N, Roderick PJ, Santorelli G, Alwan NA

In England, 41% of children aged 10-11 years live with overweight or obesity. Identifying children at risk of developing overweight or obesity may help target early prevention interventions. We aimed to develop and externally validate prediction models of childhood overweight and obesity at age 10-11 years using routinely collected weight and height measurements at age 4-5 years and maternal and early-life health data.

https://doi.org/10.1038/s41366-023-01356-8

August 2023

Lim SER, Meredith SJ, Agnew S, Clift E, Ibrahim K, Roberts HC

Despite the clear benefits of physical activity in healthy ageing, engagement in regular physical activity among community-dwelling older adults remains low, with common barriers including exertional discomfort, concerns with falling, and access difficulties. The recent rise of the use of technology and the internet among older adults presents an opportunity to engage with older people online to promote increased physical activity. This study aims to determine the feasibility and acceptability of training volunteers to deliver online group exercises for older adults attending community social clubs.

https://doi.org/10.1186/s12877-023-04184-7

July 2023

Alwan NA, Clutterbuck D, Pantelic M, Hayer J, Fisher L, Hishmeh L, Heightman M, Allsopp G, Wootton D, Khan A, Hastie C, Jackson M, Rayner C, Brown D, Parrett E, Jones G, Smith K, Clarke R, Mcfarland S, Gabbay M, Banerjee A

Background and aim: Long Covid is a significant public health concern with potentially negative implications for health inequalities. We know that those who are already socially disadvantaged in society are more exposed to COVID-19, experience the worst health outcomes and are more likely to suffer economically. We also know that these groups are more likely to experience stigma and have negative healthcare experiences even before the pandemic. However, little is known about disadvantaged groups' experiences of Long Covid, and preliminary evidence suggests they may be under-represented in those who access formal care. We will conduct a pilot study in a defined geographical area in London, United Kingdom to test the feasibility of a community-based approach of identifying Long Covid cases that have not been clinically diagnosed and have not been referred to Long Covid specialist services. We will explore the barriers to accessing recognition, care, and support, as well as experiences of stigma and perceived discrimination.

https://doi.org/10.1371/journal.pone.0284297

July 2023

Eadie R, McKenzie CA, Hadfield D, Kalk NJ, Bolesta S, Dempster M, McAuley DF, Blackwood B; UK ALERT-ICU study investigators

Background: Iatrogenic withdrawal syndrome, after exposure medication known to cause withdrawal is recognised, yet under described in adult intensive care.

Aim: To investigate, opioid, sedation, and preadmission medication practice in critically ill adults with focus on aspects associated with iatrogenic withdrawal syndrome.

https://doi.org/10.1007/s11096-023-01614-9

July 2023

Ambrosio L, Hislop-Lennie K, Serrano-Fuentes N, Driessens C, Portillo MC

Introduction: Parkinson's disease is the second most prevalent neurodegenerative disease, affecting 10 million people worldwide. Health and social care professionals need to have personalised tools to evaluate the process of living with Parkinson's disease and consequently, plan individualised and targeted interventions. Recently, the English version of the Living with Long term conditions (LwLTCs) scale has been developed filling an important gap related to person-centred tools to evaluate the process of living with long term conditions among English-speaking population. However, no validation studies for testing its psychometric properties have been conducted.

Aim: To analyse the psychometric properties of the LwLTCs scale in a wide English-speaking population living with Parkinson's disease.

https://doi.org/10.1186/s12955-023-02154-6

July 2023

Ambrosio L, Morris J, Compton E, Portillo MC

Introduction: Regular physical activity is a strategy that is effective in the physical management of long term conditions. The COVID-19 pandemic, led to disruption of physical activity routines for many people with long term conditions. It is important, to understand the experiences of people with long term conditions regarding physical activity during COVID-19 to enable future identification of strategies to mitigate the impact of restrictions on health.

Objective: To explore perceptions and experiences of people with long term conditions of the impact of the UK Government physical distancing restrictions on their physical activity participation during the COVID-19 pandemic.

https://doi.org/10.1371/journal.pone.0285785

July 2023

Woodrow M, Carey C, Ziauddeen N, Thomas R, Akrami A, Lutje V, Greenwood DC, Alwan NA

Long COVID occurs in those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) whose symptoms persist or develop beyond the acute phase. We conducted a systematic review to determine the prevalence of persistent symptoms, functional disability, or pathological changes in adults or children at least 12 weeks postinfection.

https://doi.org/10.1093/ofid/ofad233

July 2023

Montague C, D'Angelo S, Harvey N, Vogel C, Baird J

Background: Previous studies of the UK Biobank have examined intake of single food items and their association with health outcomes. Our aim was to develop a dietary quality score and examine the relationship between this score and markers of cardiometabolic health.

Methods: Principal component analysis was performed on dietary data from UK Biobank participants. Linear regression was used to analyse the relationship between diet and cardiometabolic health.

https://doi.org/10.1093/pubmed/fdad103

July 2023

Belfrage SL, Husted M, Fraser S, Patel S, Faulkner JA

Aim: The aim of this systematic review was to examine the effectiveness of community-based health literacy interventions in improving the health literacy of parents.

Methods: A systematic review of six databases - MEDLINE, PsycINFO, CINAHL, Cochrane Library, Embase, and Education Source - was conducted to identify relevant articles. Risk of bias was assessed using version two of the Cochrane risk of bias tool for randomised controlled trials or the Cochrane collaboration risk of bias in non-randomised studies of interventions. The study findings were grouped and synthesised following the synthesis without meta-analysis framework.

https://doi.org/10.1177/17579139231180746

June 2023

Moult A, McGrath C, Lippiett K, Coope C, Chilcott S, Mann C, Evans N, Turner A, Dziedzic K, Portillo MC, Johnson R

Patient and public involvement (PPI) is increasingly seen as essential to health service research. There are strong moral and ethical arguments for good quality PPI. Despite the development of guidance aimed at addressing the inconsistent reporting of PPI activities within research, little progress has been made in documenting the steps taken to undertake PPI and how it influences the direction of a study. Without this information, there are minimal opportunities to share learnings across projects and strengthen future PPI practices. The aim of this paper is to present details on the processes and activities planned to integrate PPI into the qualitative research component of a mixed-methods, multi-site study evaluating the implementation of a smart template to promote personalised primary care for patients with multiple long-term conditions.

https://doi.org/10.1186/s40900-023-00440-7

June 2023

Walker S, Goodfellow H, Pookarnjanamorakot P, Murray E, Bindman J, Blandford A, Bradbury K, Cooper B, Hamilton FL, Hurst JR, Hylton H, Linke S, Pfeffer P, Ricketts W, Robson C, Stevenson FA, Sunkersing D, Wang J, Gomes M, Henley W, Collaboration LWCR

Objectives: To describe self-reported characteristics and symptoms of treatment-seeking patients with post-COVID-19 syndrome (PCS). To assess the impact of symptoms on health-related quality of life (HRQoL) and patients' ability to work and undertake activities of daily living. 

https://doi.org/10.1136/bmjopen-2022-069217

June 2023

El-Heis S, Crozier SR, Harvey NC, Healy E, Godfrey KM

The risk of developing atopic eczema is influenced by various events pre-conception, during pregnancy, and throughout the neonatal period. Recent reports have suggested that early life exposure to microbiome altering medications, such as antibiotics and laxatives, could impact the risk of atopic eczema in infancy and childhood. For example, Lin et al., 2022, reported an increased risk of allergic disease in offspring whose mother used laxatives in pregnancy independent of laxative exposure in the offspring but no associations were found for maternal antibiotic use.

As the evidence on this topic is sparse, we aimed to examine whether maternal gestational exposure to antibiotics or laxatives were associated with the risk of atopic eczema in infancy as well as the link between offspring antibiotic exposure in the first 12 months of life and risk of infantile atopic eczema.

https://doi.org/10.1111/pai.13964

May 2023

Rubbo B,   Saville C, Dall'Ora C, Turner L, Jones J, Ball J, Culliford D, Griffiths P

Objectives: Examine the association between multiple clinical staff levels and case-mix adjusted patient mortality in English hospitals. Most studies investigating the association between hospital staffing levels and mortality have focused on single professional groups, in particular nursing. However, single staff group studies might overestimate effects or neglect important contributions to patient safety from other staff groups.

https://doi.org/10.1136/bmjopen-2022-066702

May 2023

Pearce S, McKenzie C

In this issue of Intensive & Critical Care Nursing, David Jarrett and colleagues have published a notable study (Jarret et al., 2023). This prospective observational study elegantly describes one of the lesser appreciated challenges in administering the correct dose into our patients in the intensive care unit (ICU)

https://doi.org/10.1016/j.iccn.2023.103445

May 2023

Hjelle   EG, Rønn-Smidt H, Haahr A, Haavaag SB, Sørensen D, Navarta-Sánchez MV,   Portillo MC, Bragstad LK

Objectives: The purpose of this study was to explore the expectations of and experiences with the public healthcare system of domestic partners of people with Parkinson`s disease (PD) in Denmark and Norway.

http://10.1177/17423953231174470

May 2023

Dall'Ora   C, Ejebu OZ, Ball J, Griffiths P

Background: Nurses working long shifts (≥12 h) experience higher levels of burnout. Yet other shift characteristics, including fixed versus rotating night work, weekly hours and breaks have not been considered. Choice over shift length may moderate the relationship; however, this has not been tested.

Aims: To examine the association between shift work characteristics and burnout and exhaustion, and whether choice over shift length influences burnout and exhaustion.

https://doi.org/10.1093/occmed/kqad046

May 2023

Ankravs  MJ, McKenzie CA, Kenes MT

Delirium occurs in critical illness and is associated with poor clinical outcomes, having a longstanding impact on survivors. Understanding the complexity of delirium in critical illness and its deleterious outcome has expanded since early reports. Delirium is a culmination of predisposing and precipitating risk factors that result in a transition to delirium. Known risks range from advanced age, frailty, medication exposure or withdrawal, sedation depth, and sepsis. Because of its multifactorial nature, different clinical phenotypes, and potential neurobiological causes, a precise approach to reducing delirium in critical illness requires a broad understanding of its complexity. Refinement in the categorization of delirium subtypes or phenotypes (i.e., psychomotor classifications) requires attention. Recent advances in the association of clinical phenotypes with clinical outcomes expand our understanding and highlight potentially modifiable targets. Several delirium biomarkers in critical care have been examined, with disrupted functional connectivity being precise in detecting delirium. Recent advances reinforce delirium as an acute, and partially modifiable, brain dysfunction, and place emphasis on the importance of mechanistic pathways including cholinergic activity and glucose metabolism. Pharmacologic agents have been assessed in randomized controlled prevention and treatment trials, with a disappointing lack of efficacy. Antipsychotics remain widely used after "negative" trials, yet may have a role in specific subtypes. However, antipsychotics do not appear to improve clinical outcomes. Alpha-2 agonists perhaps hold greater potential for current use and future investigation. The role of thiamine appears promising, yet requires evidence. Looking forward, clinical pharmacists should prioritize the mitigation of predisposing and precipitating risk factors as able. Future research is needed within individual delirium psychomotor subtypes and clinical phenotypes to identify modifiable targets that hold the potential to improve not only delirium duration and severity, but long-term outcomes including cognitive impairment.

https://doi.org/10.1002/phar.2807

May 2023

Shaw S,   Barrett M, Shand C, Cooper C, Crozier S, Smith D, Barker M, Vogel C

Adolescence is a period of increased autonomy over decision-making, including food choices, and increased exposure to influences outside the home, including the food environment. This review aims to synthesize the evidence for the influence of community nutrition environments, spatial access to food outlets, and consumer nutrition environments, environments inside food outlets, on adolescent food purchasing and dietary behaviors in high-income countries. Six databases were searched for articles published before January 2023. Results were synthesized using a vote-counting technique and effect direction plots that record the direction of the effect in relation to the anticipated relationship with health. Thirty-four observational and two intervention studies met the inclusion criteria. In the 13 studies assessing adolescent exposure to healthy community nutrition environments, results did not show clear associations with dietary and purchasing outcomes. Thirty studies assessed adolescents' exposure to unhealthy community nutrition environments with the majority (n = 17/30, 57%) reporting results showing that greater exposure to food outlets classified as unhealthy was associated with less healthy food purchases and dietary intakes. Inconsistent results were observed across the seven studies investigating associations with the consumer environment. Further research in these areas, including more high-quality intervention studies, may help to develop policy strategies to improve adolescents' dietary behaviors.

https://doi.org/10.1111/obr.13569

Cameron   LK, Lumlertgul N, Bear DE, Cooney E, McKenzie C, Ostermann M

Micronutrients, principally vitamins and minerals, play an important role both in health and in disease. Parenteral micronutrient products are commonly prescribed for critically ill patients both in line with the terms of the product's license, and for other indications where there is an underpinning physiological rationale, or precedent, for their use but little evidence. This survey sought to understand United Kingdom (UK) prescribing practice in this area.

https://doi.org/10.1016/j.clnesp.2023.03.023

Dall’Ora, C., Rubbo, B., Saville, C. et al. The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review. Hum Resour Health 21, 30 (2023). https://doi.org/10.1186/s12960-023-00817-5

Published: 20 April 2023

DOI https://doi.org/10.1186/s12960-023-00817-5

Objectives

Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital. We aimed to synthesise the evidence on the relationship between multi-disciplinary staffing levels in hospital including nursing, medical and allied health professionals and the risk of death.

Article Source: Exploring the associations between number of children, multi-partner fertility and risk of obesity at midlife: Findings from the 1970 British Cohort Study (BCS70)
Stannard S, Berrington A, Alwan NA (2023) Exploring the associations between number of children, multi-partner fertility

Background

Early parenthood, high parity, and partnership separation are associated with obesity. However, the emergence of non-marital partnerships, serial partnering and childbearing across unions, means that it is important to consider their association to obesity. This paper examined the associations between number of biological children and multi-partner fertility (MPF)—defined as having biological children with more than one partner, with obesity at midlife

Article Source: The role of social networks in the self-management support for young women recently diagnosed with breast cancer
Vassilev I, Lin SX, Calman L, Turner J, Frankland J, et al. (2023) The role of social networks in the self-management support for young women recently diagnosed with breast cancer. PLOS ONE 18(4): e0282183. https://doi.org/10.1371/journal.pone.0282183

It is widely acknowledged that social network support plays an important role in the quality of life and illness management of breast cancer survivors. However, the factors and processes that enable and sustain such support are less well understood. 

This paper reports baseline findings from a prospective UK national cohort of 1,202 women with breast cancer (aged <50 years at diagnosis), recruited before starting treatment, conducted in 2016–2019. Descriptive, univariate and multivariate regression analyses explored associations between the individual, and network member characteristics, and the type of support provided. 

Social network members provided a substantial level of illness-related, practical and emotional support. Highest contribution was provided by friends, followed by close family members. The social network members of women who did not have a partner provided a higher level of support than those in networks with a partner. Women without higher education were more reliant on close family members than those with higher education, and this was more so for women without a partner. 

Women with higher education without a partner were more reliant on friends and were overall best supported. Women without higher education who did not have a partner were overall least well supported. They had much smaller networks, were highly reliant on close family members, and on high level contributions from all network members. 

There is a need to develop network-based interventions to support people with a cancer diagnosis, prioritising support for the groups identified as most at risk. Interventions that support engagement with existing network members during treatment, and those that help extend such networks after treatment, are likely to be of benefit. A network perspective can help to develop tailored support and interventions by recognising the interactions between network and individual level processes

Dall’Ora, C., Rubbo, B., Saville, C. et al. The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review. Hum Resour Health21, 30 (2023). https://doi.org/10.1186/s12960-023-00817-5

Abstract

Objectives

Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital. We aimed to synthesise the evidence on the relationship between multi-disciplinary staffing levels in hospital including nursing, medical and allied health professionals and the risk of death.

Methods

Systematic review. We searched Embase, Medline, CINAHL, and the Cochrane Library for quantitative or mixed methods studies with a quantitative component exploring the association between multi-disciplinary hospital staffing levels and mortality.

Results

We included 12 studies. Hospitals with more physicians and registered nurses had lower mortality rates. Higher levels of nursing assistants were associated with higher patient mortality. Only two studies included other health professionals, providing scant evidence about their effect.

Conclusions

Pathways for allied health professionals such as physiotherapists, occupational therapists, dietitians, pharmacists, to impact safety and other patient outcomes are plausible and should be explored in future studies.

https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-023-00817-5

Farrington, N.,  Richardson, A., &  Bridges, J. (March 2023).

Aims
Studies of health services reveal a focus on provision of scheduled care at the expense of patient need, placing the health service in a position of power and the patient as passive recipient. This secondary qualitative analysis of a focused ethnography draws on the Foucauldian concept of power as pervasive and relational, to examine how an imbalance of power is manifested in situations where people with both cancer and dementia are being treated for cancer.

Design
Secondary qualitative analysis of a focused ethnographic study.

Data Sources
In the original study, qualitative data were gathered from observation and interviews with people with cancer and dementia (n = 2), caregivers (n = 7) and staff (n = 20). The study was conducted in the outpatient departments of two teaching hospitals in England between January 2019 and July 2021. Data from all sources were analysed for this secondary analysis using constant comparison.

Results
The principal theme was balance, encapsulating the competing priorities involved in delivering cancer treatment. There was tension between maintaining safety and ensuring an individual's right to treatment, and difficulty reconciling the needs of the system with the needs of individuals.

Conclusion
The pervasive nature of power can be harnessed to enhance the agency of people with cancer and dementia by incorporating principles of shared decision making.

https://doi.org/10.1111/jan.15629

Fearn S, Bartolomeu Pires S, Agarwal V, Roberts HC, Spreadbury J, Kipps C.

21 June 2021

Background: The reasons for acute hospital admissions among people with Parkinson's disease are well documented. However, understanding of crises that are managed in the community is comparatively lacking. Most existing literature on the causes of crisis for people with Parkinson's disease (PwP) uses hospital data and excludes the individual's own perspective on the crisis trigger and the impact of the crisis on their care needs.

Objective: To identify the causes and impact of crises in both community and hospital settings, from a patient and carer perspective.

Methods: A total of 550 UK-based PwP and carers completed a survey on (a) their own personal experiences of crisis, and (b) their general awareness of potential crisis triggers for PwP.

Results: In addition to well-recognised causes of crisis such as falls, events less widely associated with crisis were identified, including difficulties with activities of daily living and carer absence. The less-recognised crisis triggers tended to be managed more frequently in the community. Many of these community-based crises had a greater impact on care needs than the better-known causes of crisis that more frequently required hospital care. PwP and carer responses indicated a good general knowledge of potential crisis triggers. PwP were more aware of mental health issues and carers were more aware of cognitive impairment and issues with medications.

Conclusion: These findings could improve care of Parkinson's by increasing understanding of crisis events from the patient and carer perspective, identifying under-recognised crisis triggers, and informing strategies for best recording symptoms from PwP and carers.

https://pubmed.ncbi.nlm.nih.gov/34250952/

Qian Yue Tan , Helen C. Roberts, Simon D. S. Fraser, Khaled Amar, Kinda Ibrahim

March 30, 2023

Background

People with long-term conditions must complete many healthcare tasks such as take medications, attend appointments, and change their lifestyle. This treatment burden and ability to manage it (capacity) is not well-researched in Parkinson’s disease.

Objective

To explore and identify potentially modifiable factors contributing to treatment burden and capacity in people with Parkinson’s disease and caregivers.

Methods

Semi-structured interviews with nine people with Parkinson’s disease and eight caregivers recruited from Parkinson’s disease clinics in England (ages 59–84 years, duration of Parkinson’s disease diagnosis 1–17 years, Hoehn and Yahr (severity of Parkinson’s disease) stages 1–4) were conducted. Interviews were recorded and analyzed thematically.

Results

Four themes of treatment burden with modifiable factors were identified: 1) Challenges with appointments and healthcare access: organizing appointments, seeking help and advice, interactions with healthcare professionals, and caregiver role during appointments; 2) Issues obtaining satisfactory information: sourcing and understanding information, and satisfaction with information provision; 3) Managing medications: getting prescriptions right, organizing polypharmacy, and autonomy to adjust treatments; and 4) Lifestyle changes: exercise, dietary changes, and financial expenses. Aspects of capacity included access to car and technology, health literacy, financial capacity, physical and mental ability, personal attributes and life circumstances, and support from social networks.

Conclusions

There are potentially modifiable factors of treatment burden including addressing the frequency of appointments, improving healthcare interactions and continuity of care, improving health literacy and information provision, and reducing polypharmacy. Some changes could be implemented at individual and system levels to reduce treatment burden for people with Parkinson’s and their caregivers. Recognition of these by healthcare professionals and adopting a patient-centered approach may improve health outcomes in Parkinson’s disease.

Nida Ziauddeen,, Paul J. Roderick, Gillian Santorelli, John Wright, Nisreen A. Alwan

June 2022

Abstract

Tackling the childhood obesity epidemic can potentially be facilitated by risk-stratifying families at an early-stage to receive prevention interventions and extra support. Using data from the Born in Bradford (BiB) cohort, this analysis aimed to externally validate prediction models for childhood overweight and obesity developed as part of the Studying Lifecourse Obesity PrEdictors (SLOPE) study in Hampshire. BiB is a longitudinal multi-ethnic birth cohort study which recruited women at around 28 weeks gestation between 2007 and 2010 in Bradford. The outcome was body mass index (BMI) ≥91st centile for overweight/obesity at 4–5 years. Discrimination was assessed using the area under the receiver operating curve (AUC). Calibration was assessed for each tenth of predicted risk by calculating the ratio of predicted to observed risk and plotting observed proportions versus predicted probabilities. Data were available for 8003 children. The AUC on external validation was comparable to that on development at all stages (early pregnancy, birth, ~1 year and ~2 years). The AUC on external validation ranged between 0.64 (95% confidence interval (CI) 0.62 to 0.66) at early pregnancy and 0.82 (95% CI 0.81 to 0.84) at ~2 years compared to 0.66 (95% CI 0.65 to 0.67) and 0.83 (95% CI 0.82 to 0.84) on model development in SLOPE. Calibration was better in the later model stages (early life ~1 year and ~2 years). The SLOPE models developed for predicting childhood overweight and obesity risk performed well on external validation in a UK birth cohort with a different geographical location and ethnic composition.

https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000258

Moon RJ, D'Angelo S, Holroyd CR, Crozier SR, Godfrey KM, Davies JH, Cooper C, Harvey NC.

Context: Children born to parents who are overweight or obese have a high risk of adult obesity, but it is unclear if transgenerational associations relating to unfavorable body composition differ by parent.

Objective: To examine differential mother-offspring and father-offspring associations in body composition in early childhood.

Methods: A total of 240 mother-father-offspring trios from a prospective UK population-based pre-birth cohort (Southampton Women's Survey) were included for anthropometry and dual-energy x-ray absorptiometry assessment of whole-body-less-head body composition in the offspring at 3 different ages (4, 6-7, and 8-9 years) and in the mother and father at the 8- to 9-year offspring visit. Associations were assessed using linear regression adjusting for the other parent.

Results: Positive associations between mother-daughter body mass index (BMI) and fat mass were observed at ages 6 to 7 (BMI: β = .29 SD/SD, 95% CI = .10, .48; fat mass β = .27 SD/SD, 95% CI = .05, .48) and 8 to 9 years (BMI: β = .33 SD/SD, 95% CI = .13, .54; fat mass β = .31 SD/SD, 95% CI = .12, .49), with similar associations at age 4 years but bounding the 95% CI. The mother-son, father-son, and father-daughter associations for BMI and fat mass were weaker at each of the ages studied.

Conclusion: A strong association between the fat mass of mothers and their daughters but not their sons was observed. In contrast, father-offspring body composition associations were not evident. The dimorphic parent-offspring effects suggest particular attention should be given to early prevention of unfavorable body composition in girls born to mothers with excess adiposity.

Corine Driessens, Lynne Mills, Ravin Patel, David Culliford, Diane Gbesemete, Emma Lee, Meera Shaunak, Harry Chappell, Saul N. Faust, Hans de Graaf,

Abstract: The COVID-19 pandemic has proved unique in both its unpredictability and the extent to which it has continued to impact on daily life since March 2020. Among the immunosuppressed population the challenges of the COVID-19 pandemic are cumulative to the ever-present challenges of living with a long-term condition. This prospective longitudinal study explored patterns of concern experienced by 467 British parents caring for an immunosuppressed child during the first 2 years of the COVID-19 pandemic and related this to parental mental wellbeing. Most parents slowly adapted or were resilient to the ever-changing stressors of the COVID-19 pandemic. However, 12% experienced high levels of concern throughout the first 2 years of the pandemic. This group was also more likely to report emotional mental health problems towards the end of this period. The experience of emotional mental health problems among parents caring for an immunosuppressed child was related to low household income, single parenting, difficult access to greenspace, and higher level of exposure to COVID positive cases and COVID restrictions (North of England). Parents reported that optimism, reduction of isolation, and support promoted coping and management of the challenges of the COVID-19 pandemic. More reliable COVID information and periodic medical-condition-specific guidance would have been appreciated. These findings can increase clinical awareness of high-risk parental groups and make an important contribution to the planning of appropriate targeted psychological family interventions.

Miriam Avery BN (Hons), PhD, Greta Westwood CBE, RN, PhD, MSc, Alison Richardson BN (Hons), MSc, PhD, PGDip, ED, RN

Published: 28 January 2021

Abstract

Aims and Objectives

This study aimed to understand the routes by which nurses, midwives and allied health professionals (NMAHPs) pursue and sustain a research career and the enablers and barriers to career progression.

Background
Robust evidence is central to practice and professional decision making of NMAHPs, with generation and translation of research arguably best led by those clinically active. Whilst countries like the UK and USA have fellowship schemes to support research career development, anecdotal reports suggest barriers exist in translating these opportunities into sustainable clinical academic careers.

External web link - https://onlinelibrary.wiley.com/doi/10.1111/jocn.15673

Article published in The Guardian newspaper  on 14th January 2021(Kellyn Lee) 

External web link - https://www.theguardian.com/society/2021/jan/14/everyday-objects-people-with-dementia-quality-of-life-care-homes

CRN Vision Magazine (July 2020)

External web link - https://mcusercontent.com/1100bd355403b33d410f8067a/files/138916b8-e47e-4f82-ab0e-0f804c034ff4/CRN_Wessex_VISION_magazine_Summer_2020_Final.pdf

Tan QY, Lim SER, Cox NJ, Roberts HC.(December 2019)

Pulse Magazine

External web link - https://www.pulsetoday.co.uk/clinical-feature/clinical-areas/elderly-care/ten-top-tips-on-frailty-in-general-practice/?cmpredirect

Michelle Myall, Carl May, Alison Richardson, Sarah Bogle, Natasha Campling, Sally Dace and Susi Lund – August 2020

Abstract

Purpose – The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings.

External web link - https://www.emerald.com/insight/content/doi/10.1108/JHOM-06-2020-0240/full/pdf?title=creating-pre-conditions-for-change-in-clinical-practice-the-influence-of-interactions-between-multiple-contexts-and-human-agency

Matt Johnson, Lucy Rigge, David Culliford, Lynn Josephs, Mike Thomas, Tom Wilkinson - december 4 2019

ABSTRACT

Most clinical contacts with chronic obstructive pulmonary disease (COPD) patients take place in primary care, presenting opportunity for proactive clinical management. Electronic health records could be used to risk stratify diagnosed patients in this setting, but may be limited by poor data quality or completeness. We developed a risk stratification database algorithm using the DOSE index (Dyspnoea, Obstruction, Smoking and Exacerbation) with routinely collected primary care data, aiming to calculate up to three repeated risk scores per patient over five years, each separated by at least one year.

External web link - https://www.nature.com/articles/s41533-019-0154-6

Yincent Tse, Anne-Sophie E. Darlington, Kay Tyerman, Dean Wallace, Tanya Pankhurst, Sofia Chantziara, David Culliford, Alejandra Recio-Saucedo & Arvind Nagra 

Background

During the initial COVID-19 pandemic, young United Kingdom (UK) kidney patients underwent lockdown and those with increased vulnerabilities socially isolated or ‘shielded’ at home. The experiences, information needs, decision-making and support needs of children and young adult (CYA) patients or their parents during this period is not well known.

External web link - https://link.springer.com/article/10.1007/s00467-021-05041-8

Cindy Faith Brooks, Anastasios Argyropoulos, Catherine Brigitte Matheson‑Monnet and David Kryl

June 2022

Background

Issues of medication adherence, multimorbidity, increased hospitalisation risk and negative impact upon quality of life have led to the management of polypharmacy becoming a national priority. Clinical guidelines advise a patient-centred approach, involving shared decision-making and multidisciplinary team working. However, there have been limited educational initiatives to improve healthcare practitioners’ management of polypharmacy and stopping inappropriate medicines. This study aimed to evaluate the impact of a polypharmacy Action Learning Sets (ALS) tool across five areas: i. healthcare practitioners’ confidence and perceptions of stopping medicines; ii. knowledge and information sources around stopping medicines; iii. perception of patients and stopping medicines; iv. perception of colleagues and stopping medicines and v. perception of the role of institutional factors in stopping medicines.

External web link - https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-022-03556-8

Christina Saville PhD, Peter Griffiths PhD, RN (Published 8 May 2021)

Aims

To assess how well the Safer Nursing Care Tool (SNCT) predicts staffing requirements on hospital wards, and to use professional judgement to generate hypotheses about factors associated with a “poor fit”.

External web link - https://onlinelibrary.wiley.com/doi/10.1111/jonm.13341

Chiara Dall'ora, Peter Griffiths, Joanna Hope, Jim Briggs, Jeremy Jones, Stephen Gerry & Oliver C Redfern (June 2021)

Introduction

Monitoring vital signs in hospital is an important part of safe patient care. However, there are no robust estimates of the workload it generates for nursing staff. This makes it difficult to plan adequate staffing to ensure current monitoring protocols can be delivered.

External web link - https://doi.org/10.1016/j.ijnurstu.2021.103921

Maben, J. Taylor, C. and Bridges, J. (April 2020)

This guidance is designed to be used by all nursing team members across health and social care settings and may need tailoring for different contexts.

External web link - https://www.surrey.ac.uk/sites/default/files/2020-05/guidance-to-support-nurses-psychological-well-being-during-covid-19-crisis-final.pdf

Sue Latter, Natasha Campling, Jacqueline Birtwistle, Alison Richardson, Michael I. Bennett, Sean Ewings, David Meads & Miriam Santer – September 2020

Background

Patient access to medicines at home during the last year of life is critical for symptom control, but is thought to be problematic. Little is known about healthcare professionals’ practices in supporting timely medicines access and what influences their effectiveness. The purpose of the study was to evaluate health professionals’ medicines access practices, perceived effectiveness and influencing factors.

External web link - https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-020-00649-3

Carole Fogg, Jackie Bridges, Paul Meredith, Claire Spice, Linda Field, David Culliford, Peter Griffiths – September 2020

Background

Lower nurse staffing levels are associated with increased hospital mortality. Older patients with cognitive impairments (CI) have higher mortality rates than similar patients without CI and may be additionally vulnerable to low staffing.

External web link - https://academic.oup.com/ageing/advance-article-abstract/doi/10.1093/ageing/afaa133/5909776?redirectedFrom=fulltext

The influence of personal communities in understanding avoidable emergency department attendance: qualitative study

Gemma McKenna, Anne Rogers, Sandra Walker & Catherine Pope – September 2020

Background

Use of emergency department (ED) care globally seems to be increasing at a faster rate than population growth. In the UK there has been a reported 16% rise in emergency admissions over the past 5 years. Estimates that between 11 and 40% of ED attendances are non-urgent, with 11% of patients being discharged from the ED without treatment (NHS Digital 2017), and a further 44% require no follow-up treatment …….

External web link - https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05705-5

Jackie Bridges, Joanna Hope - November 8 2019

Background

Older people's care experiences in hospital may be negative in the absence of relational work by nurses to maintain people's identity, establish caring connections and ensure that individual patient needs, preferences and values are honoured in the care that is delivered. Relational care by nurses can mediate powerful institutional drivers that may otherwise result in negative experiences and poor care.

External web link - https://www.sciencedirect.com/science/article/pii/S0020748919302767#!

There is limited research that focuses on the patient view of factors affecting adherence to prevention measures, particularly in community settings. Individual and daily lifestyle considerations and involvement in decision-making around pressure ulcer care are important aspects from the patient perspective. Further research is necessary to explore which factors affect patient adherence in order to improve clinical practice and support patient involvement in preventative strategies.

Jo Hope, Lisette Schoonhoven - October 23 2019

External web link - https://www.sciencedirect.com/science/article/pii/S0020748919302561

Authors: Carole Fogg, Paul Meredith, David Culliford, Jackie Bridges, Peter Griffiths - August 2019

Background

Older adults admitted to hospital are often cognitively impaired. It is not clear whether the presence of cognitive impairment conveys an additional risk for poor hospital outcomes in this patient population.

External web link - https://www.sciencedirect.com/science/article/pii/S0020748919300367

Griffiths, Savile, Ball, Jones, Monks, et al

(May 2021)

Background

In the face of pressure to contain costs and make best use of scarce nurses, flexible staff deployment (floating staff between units and temporary hires) guided by a patient classification system may appear an efficient approach to meeting variable demand for care in hospitals.

External web link - https://www.sciencedirect.com/science/article/pii/S002074892100033X#

(August 2021)

Ourega-Zoé Ejebu, Chiara Dall’Ora , Peter Griffiths

Abstract

Objective

To explore the evidence on nurses’ experiences and preferences around shift patterns in the international literature.

External web link - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256300

Yuan-Sheng Ryan Poon, Yongxing Patrick Lin, Peter Griffiths, Keng Kwang Yong, Betsy Seah & Sok Ying Liaw

September 24, 2022

Background

Globally, the health workforce has long suffered from labour shortages. This has been exacerbated by the workload increase caused by the COVID-19 pandemic. Major collapses in healthcare systems across the world during the peak of the pandemic led to calls for strategies to alleviate the increasing job attrition problem within the healthcare sector. This turnover may worsen given the overwhelming pressures experienced by the health workforce during the pandemic, and proactive measures should be taken to retain healthcare workers. This review aims to examine the factors affecting turnover intention among healthcare workers during the COVID-19 pandemic.

External web link - https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-022-00764-7

(February 17, 2022)

L.Turner, D.Culliford, J.Ball, E.Kitson-Reynolds, P.Griffiths

Background

Women have consistently reported lower satisfaction with postnatal care compared with antenatal and labour care. The aim of this research was to examine whether women’s experience of inpatient postnatal care in England is associated with variation in midwifery staffing levels.

External web link - https://www.sciencedirect.com/science/article/pii/S1871519222000312#!

Jane Ball, Sydney Anstee, Keith Couper, Jill Maben, Holly Blake, Janet E. Anderson, Daniel Kelly, Ruth Harris, Anna Conolly, the full ICON Study Team

First published: 29 September 2022

Aims

To use nurses' descriptions of what would have improved their working lives during the first peak of the COVID-19 pandemic in the UK.

External web link - https://onlinelibrary.wiley.com/doi/10.1111/jan.15442

A social network approach determined what resources and support people with diabetes require when incorporating a new health technology. Visualisation of support networks using concentric circles enabled people to consider and mobilise support and engage in new activities as their needs changed. The novelty of pump therapy creates new illness‐related work, but mobilisation of personally valued flexible, tailored support can improve the process of adaptation.

C. Reidy, C. Foster, A. Rogers - October 16 2019

External web link - https://onlinelibrary.wiley.com/doi/full/10.1111/dme.14155

Mal North, Simon Bourne, Ben Green, Anoop J. Chauhan, Tom Brown, Jonathan Winter, Tom Jones, Dan Neville, Alison Blythin, Alastair Watson, Matthew Johnson, David Culliford, Jack Elkes, Victoria Cornelius & Professor Tom M. A. Wilkinson – October 2020

Abstract

Exacerbations of COPD are one of the commonest causes of admission and readmission to hospital. The role of digital interventions to support self-management in improving outcomes is uncertain. We conducted an open, randomised controlled trial of a digital health platform application (app) in 41 COPD patients recruited following hospital admission with an acute exacerbation. Subjects were randomised to either receive usual care, including a written self-management plan (n = 21), or the myCOPD app (n = 20) for 90 days.

External web link - https://www.nature.com/articles/s41746-020-00347-7

Corbett, T., Cummings, A., Lee, K., Calman, L., Fenerty, V., Farrington, N., Lewis, L., Young, A., Boddington, H., Wiseman, T., Richardson, A., Foster, C., Bridges, J. - October 16, 2020

Background

Older people are more likely to be living with cancer and multiple long-term conditions, but their needs, preferences for treatments, health priorities and lifestyle are often not identified or well-understood. There is a need to move towards a more comprehensive person-centred approach to care that focuses on the cumulative impact of a number of conditions on daily activities and quality of life. This paper describes the intervention planning process for CHAT& PLANTM, a structured conversation intervention to promote personalised care and support self-management in older adults with complex conditions.

External web link - https://doi.org/10.1371/journal.pone.0240516

Teresa Corbett, Amanda Cummings, Lynn Calman, Naomi Farrington, Vicky Fenerty, Claire Foster, Alison Richardson, Theresa Wiseman, Jackie Bridges - June 2020

Abstract

Objective: Many older people with cancer live with multimorbidity. Little is understood about the cumulative impact of old age, cancer and multi-morbidity on self-management. This qualitative systematic review and synthesis aimed to identify what influences self-management from the perspective of older adults living with cancer and multi-morbidity.

External web link - https://onlinelibrary.wiley.com/doi/epdf/10.1002/pon.5453

James E, Kennedy A, Vassilev I, Ellis J, Rogers A - March 2020

Abstract

Successful facilitation of patient-centred interventions for self-management support has traditionally focussed on individual behaviour change. A social network approach to self-management support implicates the need for facilitation that includes an orientation to connecting to and mobilizing support and resources from other people and the local environment.

External web link - https://www.ncbi.nlm.nih.gov/pubmed/32162435

Kinda Ibrahim, Natalie J. Cox, Jennifer M. Stevenson, Stephen Lim, Simon D. S. Fraser & Helen C. Roberts

(April 2021)

Background

Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty.

External web link - https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-021-02208-8

Farhad Pazan, Mirko Petrovic, Antonio Cherubini, Graziano Onder, Alfonso J. Cruz-Jentoft, Michael Denkinger, Tischa J. M. van der Cammen, Jennifer M. Stevenson, Kinda Ibrahim, Chakravarthi Rajkumar, Marit Stordal Bakken, Jean-Pierre Baeyens, Peter Crome, Thomas Frühwald, Paul Gallaghar, Adalsteinn Guðmundsson, Wilma Knol, Denis O’Mahony, Alberto Pilotto, Elina Rönnemaa, José Antonio Serra-Rexach, George Soulis, Rob J. van Marum, Gijsbertus Ziere, Alpana Mair, Heinrich Burkhardt, Agnieszka Neumann-Podczaska, Katarzyna Wieczorowska-Tobis, Marilia Andreia Fernandes, Heidi Gruner, Dhayana Dallmeier, Jean-Baptiste Beuscart, Nathalie van der Velde & Martin Wehling

(August 2021)

Background

Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty.

External web link - https://link.springer.com/article/10.1007/s00228-020-02951-8

(January 2022)

Sharon X Lin, Thomas Phillips, David Culliford, Christopher Edwards, Christopher Holroyd, Kinda Ibrahim, Ravina Barrett, Clare Howard, Ruth Johnson, Jo Adams, Mathew Stammers, Adam Rischin, Paul Rutter, Nicola Barnes, Paul J Roderick and Simon DS Fraser

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for pain and inflammation. NSAID complications include acute kidney injury (AKI), causing burden to patients and health services through increased morbidity, mortality, and hospital admissions.

External web link - https://bjgpopen.org/content/early/2022/01/10/BJGPO.2021.0208

Paul Clarkson, Aoife Stephenson, Chloe Grimmett, Katherine Cook, Carol Clark, Paul E Muckelt, Philip O’Gorman, Zoe Saynor, Jo Adams, Maria Stokes and Suzanne McDonough.

(April 2022)

Abstract

Objective

This scoping review aimed to bring together and identify digital tools that support people with one or more long-term conditions to maintain physical activity and describe their components and theoretical underpinnings

External web link - https://doi.org/10.1177%2F20552076221089778

L Ambrosioa , D Lambrickb , J Faulknerc , and MC Portilloa

a NIHR ARC Wessex. Health and Life Sciences, University of Southampton, Southampton, UK

b School of Health Sciences, University of Southampton, Southampton, UK

c Department of Sport, Exercise and Health, University of Winchester, Winchester, UK

(April 2022)

ABSTRACT

To review the applicability and accessibility of physical activity guidelines for adults living with long-term conditions whilst shielding during the COVID-19. A narrative review with systematic methodology was conducted between 2015 and 2021, with two stages: 1) Search of electronic databases PubMed/Medline, Web of Science, PsycInfo, and Cinahl; 2) search of long-term condition organisations. Sixty-five articles were identified, where nine included specific guidelines during the COVID-19, 28 specific guidelines to individuals living with long-term conditions and 7 identified the utilization of online resources. Twenty-one long-term condition organizations websites were reviewed where all of them included a section regarding physical activity guidelines and seven referred to online and offline accessible resources during COVID-19. Accessibility and applicability were variable across academic databases and long-term conditions organisation websites. Findings could inform long-term condition policy and guidelines development to better and more relevant support people living with long-term conditions to be physically active.

External web link - https://doi.org/10.1080/09603123.2022.2066071

Rosalynn C. Austin, Professor Lisette Schoonhoven, Dr Vasiliki Koutra, Professor Alison Richardson, Professor Paul R. Kalra, Professor Carl R. May

Aims

This study aimed to describe patient-reported symptoms and burden of treatment (BoT) experienced by patients with chronic heart failure (CHF). BoT describes the illness workload, individual capacity to perform that work, and resultant impact on the individual. Overwhelming BoT is related to poor quality of life and worse clinical outcomes. This research is the first to explore symptoms and BoT in people with CHF, in the UK.

(April 2022)

External web link - https://onlinelibrary.wiley.com/doi/10.1002/ehf2.13904

Hilda Hounkpatin, Paul Roderick, Scott Harris, James E Morris, Dianna Smith, Bronagh Walsh, Helen Roberts, Hajira Dambha-Miller, Qian Tan, Forbes Watson and Simon D Fraser

(May 2022)

Background: Treatment burden is the workload of being a patient and its impact on wellbeing. Little is known about change in treatment burden over time for people with multimorbidity.

Aim: To quantify change in treatment burden, determine factors associated with this change, and evaluate a revised single-item measure for high treatment burden in older adults with multimorbidity.

External web link - https://bjgp.org/content/early/2022/05/04/BJGP.2022.0103

Nestor Serrano-Fuentes MSc, Anne Rogers PhD, Mari Carmen Portillo PhD

24 June 2022

Background

Obesity in adults is a leading health challenge that causes millions of deaths worldwide and represents a risk factor for developing long-term conditions. Social relationships are one of the multiple drivers shaping obesity and obesity-related practices. However, there is still little evidence as to the processes by which relationships influence the adoption of positive and negative obesity health-related practices—eating, physical activity and alcohol intake. This study aims first to identify the types of relationships relevant to the adoption of practices in adults with obesity and, second, to explore the type of activities these relationships engage with or promote to produce those practices and their potential health consequences.

External web link - https://onlinelibrary.wiley.com/doi/10.1111/hex.13540

Sebastian Stannard, Emilia Holland, Sarah R Crozier, Rebecca Hoyle, Michael Boniface, Mazen Ahmed, James McMahon, William Ware, Zlatko Zlatev, Nisreen A Alwan, DS Fraser 

Correspondence to Dr Sebastian Stannard; S.J.Stannard@soton.ac.uk

October 10, 2022

Abstract

Objectives The prevalence of multiple long-term condition (LTC) multimorbidity is increasing with younger onset among socioeconomically deprived populations. Research on life course trajectories towards multimorbidity is limited and early-onset multimorbidity poorly characterised. Understanding sentinel conditions (the first LTC occurring in the life course), the sequence of LTC accrual and the permanency of the reporting of LTCs may help identify time points for prevention efforts. We used a longitudinal birth cohort to estimate the prevalence of a common three-condition early-onset multimorbidity (multiple long-term condition multimorbidity (MLTC-M)) group at midlife, describe the frequency of sentinel conditions, the sequence of LTC accrual and explore the permanency of one of these conditions: psychological distress.

External web link - https://bmjopen.bmj.com/content/12/10/e059587.full

Soilemezi D, Palmar-Santos A, Navarta-Sánchez MV, Roberts HC, Pedraz-Marcos A, Haahr A, Sørensen D, Bragstad LK, Hjelle EG, Haavaag SB, Portillo MC. Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study.

2022 Dec 27.

Background: Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long-term conditions such as Parkinson's disease.

External web link - https://pubmed.ncbi.nlm.nih.gov/36573594/

Dianna M. Smith , Christina Vogel, Monique Campbell, Nisreen Alwan, Graham Moon (June 23, 2021)

Background

Small-area estimation models are regularly commissioned by public health bodies to identify areas of greater inequality and target areas for intervention in a range of behaviours and outcomes. Such local modelling has not been completed for diet consumption in England despite diet being an important predictor of health status. The study sets out whether aspects of adult diet can be modelled from previously collected data to define and evaluate area-level interventions to address obesity and ill-health.

External web link - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252877

J. Ellis , I. Vassilev, E. James and A. Rogers - October 27, 2020

Background

Policy makers and researchers recognise the challenges of implementing evidence-based interventions into routine practice. The process of implementation is particularly complex in local community environments. In such settings, the dynamic nature of the wider contextual factors needs to be considered in addition to capturing interactions between the type of intervention and the site of implementation throughout the process. This study sought to examine how networks and network formation influence the implementation of a self-management support intervention in a community setting.

External web link - https://implementationsciencecomms.biomedcentral.com/articles/10.1186/s43058-020-00087-5

(10 February 2022)

Caroline Barker, Katharine Collet, Diane Gbesemete, Maria Piggin, Daniella Watson, Philippa Pristerà, Wendy Lawerence, Emma Smith, Michael Bahrami-Hessari, Halle Johnson, Katherine Baker, Ambar Qavi, Carmel McGrath, Christopher Chiu, Robert C. Read, Helen Ward

Background: Human challenge studies involve the deliberate exposure of healthy volunteers to an infectious micro-organism in a highly controlled and monitored way. They are used to understand infectious diseases and have contributed to the development of vaccines. In early 2020, the UK started exploring the feasibility of establishing a human challenge study with SARS-CoV-2. Given the significant public interest and the complexity of the potential risks and benefits, it is vital that public views are considered in the design and approval of any such study and that investigators and ethics boards remain accountable to the public.

External web link - https://wellcomeopenresearch.org/articles/7-49/v1

Sebastian Stannard, Ann Berrington, Nisreen A. Alwan.

June 2022

Abstract: Whilst research has demonstrated an intergenerational transmission of partnership dissolution, there is limited evidence as to the early life course pathways through which these associations operate, and whether these differ by gender. Many studies have not considered prospective data from early childhood, thus potentially neglecting the importance of the early childhood period in explaining this intergenerational transmission. Given that serial partnering has become increasingly commonplace it is important research considers those who experience multiple partnership dissolution. This paper examines, using data from the 1970 British Birth Cohort Study, the early life mediators underpinning the association between parental separation and the number of offspring partnership dissolutions. Among both men and women there is a significant unadjusted relationship between parental separation and the experience of multiple partnership dissolutions in adulthood. These associations were reduced once parental confounders and childhood mediators are included. Formal mediation analyses demonstrated that early life mediators accounted for more of the association in men than women. Mediators included childhood living standards, and for men child cognition and child behaviour, and for women maternal mental wellbeing. Parental separation and many early life mediators were related to the likelihood of multiple partnership dissolutions through age at first partnership.

External web link - https://www.sciencedirect.com/science/article/pii/S1040260822000089?via%3Dihub#sec0045

Authors: Vogel C, Shaw S, Strömmer S, Crozier S, Jenner S, Cooper C, Baird J, Inskip H, Barker M.

6 December 2022

Abstract

Objective: To examine energy drink consumption among adolescents in the United Kingdom (UK) and associations with deprivation and dietary inequalities.

Design: Quantitative dietary and demographic data from the National Diet and Nutrition Survey (NDNS) repeated cross-sectional survey were analysed using logistic regression models. Qualitative data from semi-structured interviews were analysed using inductive thematic analysis.

Setting: UK.

Participants: Quantitative data: nationally representative sample of 2587 adolescents aged 11-18 years. Qualitative data: 20 parents, 9 teachers, and 28 adolescents from Hampshire, UK.

Results: NDNS data showed adolescents' consumption of energy drinks was associated with poorer dietary quality (OR 0.46 per SD; 95% CI 0.37, 0.58; p<0.001). Adolescents from more deprived areas and lower income households were more likely to consume energy drinks than those in more affluent areas and households (OR 1.40; 95%CI 1.16, 1.69; p<0.001; OR 0.98 per £1000; 95%CI, 0.96, 0.99; p<0.001 respectively). Between 2008 and 2016, energy drink consumption among adolescents living in the most deprived areas increased, but decreased among those living in the most affluent neighbourhoods (p=0.04). Qualitative data identified three themes. First, many adolescents drink energy drinks because of their friends and because the unbranded drinks are cheap. Second, energy drink consumption clusters with other unhealthy eating behaviours and adolescents don't know why energy drinks are unhealthy. Third, adolescents believe voluntary bans in retail outlets and schools do not work.

Conclusions: This study supports the introduction of age-dependent legal restrictions on the sale of energy drinks which may help curb existing socio-economic disparities in adolescents' energy drink intake.

External web link - https://pubmed.ncbi.nlm.nih.gov/36472075/#affiliation-1

Authors: Dianna M. Smith  , Lauren Rixson , Grace Grove, Nida Ziauddeen, Ivaylo Vassilev, Ravita Taheem, Paul Roderick, Nisreen A. Alwan

Published: 9 December 2022

Background

In England, the responsibility to address food insecurity lies with local government, yet the prevalence of this social inequality is unknown in small subnational areas. In 2018 an index of small-area household food insecurity risk was developed and utilised by public and third sector organisations to target interventions; this measure needed updating to better support decisions in different settings, such as urban and rural areas where pressures on food security differ.

External web link - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0267260

Sarah Muir, Preeti Dhuria, Emma Roe, Wendy Lawrence, Janis Baird & Christina Vogel

January 26.2023

Background

The current food system in England promotes a population diet that is high in fat, sugar and salt (HFSS). To address this, the UK government has implemented legislation to restrict the promotion of HFSS products in prominent locations (e.g. store entrances, checkouts) in qualifying retailers since October 2022. This study investigated the perceived impact of the legislation for affected stakeholders.

Methods

A pre-implementation rapid qualitative evaluation of stakeholder interviews. One hundred eight UK stakeholders participated in the study including 34 consumers, 24 manufacturers and retailers, 22 local authority enforcement officers and 28 academic and charitable health representatives. A participatory conference was used to enable policy recommendations to be confirmed by stakeholders.

Results

Stakeholders perceived the legislation to be a ‘good first step’ towards improving population diet but recognised this needed to be considered amongst a range of long-term obesity policies. Areas of further support were identified and these are presented as six recommendations for government to support the successful implementation of the legislation: (1) provide a free central HFSS calculator, (2) refine legislation to enhance intent and clarity, (3) conduct a robust evaluation to assess intended and unintended outcomes, (4) provide greater support for smaller businesses, (5) provide ring-fenced resources to local authorities and (6) create and communicate a long-term roadmap for food and health.

Conclusions

This legislation has the potential to reduce impulse HFSS purchases and makes a solid start towards creating healthier retail outlets for consumers. Immediate government actions to create a freely accessible HFSS calculator, support smaller businesses and provide additional resources to local authorities would support successful implementation and enforcement. Independent evaluation of the implementation of the legislation will enable monitoring of potential unintended consequences identified in this study and support refinement of the legislation. A long-term roadmap is necessary to outline strategies to support equal access to healthier and sustainable food across the whole food system within the next 20–30 years.

External web link - https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-02726-9

Doherty W J, Stubbs T A, Chaplin A, Langford S, Sinclair N, Ibrahim K, Reed M R, Sayer A A, Witham M D, Sorial A K. (February 2021)

Objectives
Risk stratification scores are used in hip fracture surgery, but none incorporate objective tests for low muscle strength. Grip strength testing is simple and cheap but not routinely assessed for patients with hip fracture. This project aimed to assess the feasibility of implementing grip strength testing into admission assessment of patients with hip fracture. 

External web link - https://eprints.soton.ac.uk/446434/

Cox N, Bowyer R, Lochlainn M, Wells P, Roberts H, Steves C. (February 2021)

Background
Anorexia of ageing is common and important in the development of sarcopenia in older individuals. Links have been proposed between the gut microbiota and sarcopenia. Disordered gut function is also recognized in anorexia of ageing, but how this may relate to resident gut microbiota is unexplored. Understanding this relationship may provide a basis for novel interventions for anorexia of ageing and sarcopenia. This study explores compositional differences of the gut microbiota between community dwelling healthy older adults with good or poor appetite, and associated differences in sarcopenia.

External web link - https://doi.org/10.1002/jcsm.12683

Pazan F, Ibrahim K & et al. (January 2021). 

Background
Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty.

External web link - https://eprints.soton.ac.uk/445965/

Gosch M, Heppner H, Lim S. et al. (January 2021)

Abstract
Long-term care facilities (LTCF) and their vulnerable residents are particularly affected by the coronavirus disease 2019 (COVID-19) pandemic. Estimates from various countries suggest that 3–66% of all COVID-19 deaths were residents of LTCF, of which 80% died in their facilities. Despite these significant numbers, recommendations for LTCF for the prevention and medical care of residents during the COVID-19 pandemic are still lacking. These recommendations are based on the existing literature and the expertise of the authors who are specialists in geriatric medicine. The recommendations are addressed to LTCF management, their operators, physicians working in LTCFs and also politicians, to provide the necessary framework conditions. We are confident that our recommendations will offer important help and guidance for LTCFs as well as their physicians. Adherence to these recommendations is likely to improve the outcomes and care of residents in long-term facilities during the COVID-19 pandemic.

External web link - https://doi.org/10.1007/s00391-021-01847-1

Spreadbury J, Kipps C. (December 2020)

Abstract
Post-diagnostic care in young-onset dementia (YoD) varies, from something that is occasionally structured, to improvised, to frequently non-existent depending on geographic region. In a few regions in England, a nurse designated to helping families may exist. This study aimed to describe this seldom-observed nursing role and its content. It used an investigative qualitative case study design based on the analysis of two YoD clinical nurse specialists (CNSs) describing the work they did in providing post-diagnostic care to YoD service users.

External web link - https://doi.org/10.12968/bjcn.2020.25.12.604

Lee K, Frankland J, Griffiths P, Hewer,  Richards L, Young A, Bridges J. (November 2020)

Introduction
Establishing methods to evaluate interactions between hospital staff and patients with a dementia is vital to inform care delivery. This study aimed to assess the validity of Quality of Interactions Schedule (QuIS) ratings in relation to the care experiences of people with a dementia in a general hospital setting.

External web link - https://doi.org/10.1002/gps.5464

Corbett T, Cummings A, Lee K, Calman L, Fenerty V, Farrington N, Lewis L, Young A, Boddington H, Wiseman T, Richardson A, Foster C, Bridges J. (October 2020)

Background
Older people are more likely to be living with cancer and multiple long-term conditions, but their needs, preferences for treatments, health priorities and lifestyle are often not identified or well-understood. There is a need to move towards a more comprehensive person-centred approach to care that focuses on the cumulative impact of a number of conditions on daily activities and quality of life. This paper describes the intervention planning process for CHAT& PLANTM, a structured conversation intervention to promote personalised care and support self-management in older adults with complex conditions.

External web link - https://doi.org/10.1371/journal.pone.0240516

Coutts L, Ibrahim K, Tan QY, Lim SER, Cox NJ and Roberts HC (September 2020)

Abstract
Research evaluating the effect of probiotics, prebiotics and synbiotics (PPS) on laboratory markers of health (such as immunomodulatory and microbiota changes) is growing but it is unclear whether these markers translate to improved functional outcomes in the older population. This systematic review evaluates the effect of PPS on functional outcomes in older people.

External web link - https://doi.org/10.1007/s41999-020-00396-x

Evenden D, Brailsford S, Walsh B, Roderick P. (September 2020)

Objectives
The aim of the study was to model dementia prevalence and outcomes within an ageing population using a novel hybrid simulation model that simultaneously takes population-level and patient-level perspectives to better inform dementia care service planning, taking into account severity progression variability.

External web link - https://doi.org/10.1016/j.puhe.2020.07.018

Prosser A, Tossici-Bolt L, Kipps C. (September 2020)

AIM
To assess the clinical impact of regional cerebral blood flow (rCBF) single-photon-emission computed tomography (SPECT) imaging on diagnosis and clinician diagnostic confidence in a cohort of individuals with cognitive impairment.

External web link - https://doi.org/10.1016/j.crad.2020.04.016

Dixit D, Spreadbury J, Orlando R, Hayward E, Kipps C. (July 2020)

Background
Quality of life (QoL) has seldom been investigated or explicitly measured in young-onset dementia (YoD). The aims of this study were (1) to investigate and compare QoL self- and proxy reports in a sample of YoD patients and caregivers using different conceptual assessments of QoL and (2) to examine the relationship between caregiver QoL and both burden and mental health.

External web link - https://journals.sagepub.com/doi/10.1177/0891988720933348

Cox NJ, Morrison L, Ibrahim K, Robinson SM, Sayer AA, & Roberts HC. (July 2020)

Abstract
Appetite drives essential oral nutritional intake. Its regulation is complex, influenced by physiology, hedonism (the reward of eating) and learning from external cues within a person’s society and culture. Appetite loss is common in the older population and not always attributable to medical conditions or treatment. Although the physiological basis of the anorexia of ageing (loss of appetite due to the ageing process) has been established, the effect of ageing on hedonism and external cues, which may be equally important, is less well understood. The anorexia of ageing is associated with reductions in dietary diversity and oral intake, and increased risk of malnutrition, sarcopenia and frailty.

External web link - https://academic.oup.com/ageing/article/49/4/526/5733078?login=true

Prosser AMJ, Evenden D, Holmes R, Kipps CM. (July 2020)

Background
Prognosis for Alzheimer’s disease is difficult, with rates of disease progression varying widely. Despite the extensive use of clinical dementia severity assessment scales to determine dementia diagnosis and to monitor progression, there is no consensus on which imaging factors may accurately predict future decline trajectories on these measures. Determination of baseline imaging patterns that are related to slower, or faster, decline rates could be used to identify those at highest risk of worse outcomes and inform care planning.

External web link - https://doi.org/10.1002/alz.045900

Cox N J, Lim SE, Howson FFA, Moyses HE, Ibrahim K, Sayer AA, Roberts HC, Robinson SM (July 2020). 

Abstract

Appetite loss is common in hospitalised older individuals but not routinely assessed. Poor appetite in hospital has previously been identified as predictive of greater mortality in the six months following discharge in a single study of female patients. The present study aimed to assess this association in a larger sample including both hospitalised men and women.

External web link - https://link.springer.com/article/10.1007/s12603-020-1442-0

Evenden D, Brailsford S, Walsh B, Kipps C, Roderick P. (June 2020)

Abstract
Dementia is an increasing problem in today’s ageing society, and meeting future demand for care is a major concern for policy-makers and planners. This paper presents a novel hybrid simulation model that simultaneously takes population-level and patient-level perspectives to calculate the numbers of patients at different stages of disease severity over time, and their associated care costs.

External web link - https://doi.org/10.1080/01605682.2020.1772020

Corbett T, Cummings A, Calman L, Farrington N, Fenerty V, Foster C, Richardson A, Wiseman T, Bridges J (June 2020)

Objective
Many older people with cancer live with multimorbidity. Little is understood about the cumulative impact of old age, cancer and multimorbidity on self‐management. This qualitative systematic review and synthesis aimed to identify what influences self‐management from the perspective of older adults living with cancer and multimorbidity.

External web link - https://doi.org/10.1002/pon.5453

Lim SER, Cox NJ, Tan QY, Ibrahim K, Roberts HC. (April 2020)

Background
Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. There is strong evidence to support the benefits of physical activity interventions on the health outcomes of older adults. Nonetheless, innovative approaches are needed to ensure that these interventions are practical and sustainable.

External web link - https://link.springer.com/article/10.1007/s40520-020-01556-6

Maben J, Bridges J (April 2020)

Background
As the coronavirus disease 2019 (COVID‐19) pandemic takes hold, nurses are on the front line of health and social care in the most extreme of circumstances. We reflect during a moment in time (week three of lockdown in the UK and week 5/6 across Europe) to highlight the issues facing nurses at this unprecedented time.

External web link - https://doi.org/10.1111/jocn.15307

Bridges J, Collins P, Flatley M, Hope J, Young A, (February 2020)

Background
There is no recent synthesis of primary research studies into older people's experiences of hospital care.

External web link - http://https://doi.org/10.1016/j.ijnurstu.2019.103469

Lim S, Ibrahim K, Dodds R, Purkis A, Baxter M, Rogers A, Aihie Sayer A, Roberts H. (September 2019)

Objectives: to determine the feasibility and acceptability of a volunteer-led mobility intervention to improve activity levels of older inpatients.

Design: pre-post mixed methods study.

Setting: acute medical wards for older people.

External web link - https://doi.org/10.1093/ageing/afz114

Garrad J, Cox N, Dodds R, Roberts H, Sayer AA. (April 2019)

Background
Comprehensive geriatric assessment (CGA) involves the multidimensional assessment and management of an older person. It is well described in hospital and home-based settings. A novel approach could be to perform CGA within primary healthcare, the initial community located healthcare setting for patients, improving accessibility to a co-located multidisciplinary team.

External web link - https://link.springer.com/article/10.1007%2Fs40520-019-01183-w

Roberts H, Lim S, Cox N & Ibrahim K. (April 2019). 

Abstract

Many older people with frailty are at risk of malnutrition and poor health, yet there is evidence that improving nutrition and weight loss can reduce frailty. This will become more important as the number of older people with frailty increases worldwide in future. Identifying those at risk is challenging due to the difficulty of reaching and screening those older people most at risk, the large number of nutritional assessment tools used, and the lack of consensus on the criteria to make a diagnosis of malnutrition. The management of older people with or at risk of malnutrition should be multi-modal and multi-disciplinary, and all care staff have an important role in delivering appropriate nutritional advice and support. This paper will highlight a number of practical approaches that clinicians can take to manage malnutrition in older people with frailty in community and acute settings, including environmental changes to enhance mealtime experience, food fortification and supplementation

External web link - https://www.mdpi.com/2072-6643/11/4/808

Cox N, Ibrahim K, Aihie Sayer A, Robinson S, & Roberts H. (January 2019)

Background

Appetite loss in older people, the 'Anorexia of Aging' (AA), is common, associated with under-nutrition, sarcopenia, and frailty and yet receives little attention. This review had two aims: describe interventions for AA and their effectiveness, and identify the methods of appetite assessment.

External web link - https://pubmed.ncbi.nlm.nih.gov/30641897/

Qian Yue Tan, Natalie J Cox, Stephen E R Lim, Laura Coutts , Simon D S Fraser, Helen C Roberts, Kinda Ibrahim

(July 2021)

Abstract

BackgroundHigh treatment burden is associated with poor adherence, wasted resources, poor quality of life and poor health outcomes. Identifying factors that impact treatment burden in Parkinson's disease can offer insights into strategies to mitigate them.ObjectiveTo explore the experiences of treatment burden among people with Parkinson's disease (PwP) and their caregivers.MethodsA systematic review of studies published from year 2006 was conducted. Qualitative and mixed-method studies with a qualitative component that relate to usual care in Parkinson's disease were included. Quantitative studies and grey literature were excluded. Data synthesis was conducted using framework synthesis.Results1757 articles were screened, and 39 articles included. Understanding treatment burden in PwP and caregivers was not the primary aim in any of the included studies. The main issues of treatment burden in Parkinson's disease are: 1) work and challenges of taking medication; 2) healthcare provider obstacles including lack of patient-centered care, poor patient-provider relationships, lack of care coordination, inflexible organizational structures, lack of access to services and issues in care home or hospital settings; and 3) learning about health and challenges with information provision. The treatment burden led to physical and mental exhaustion of self-care and limitations on the role and social activities of PwP and caregivers.Conclusion:There are potential strategies to improve the treatment burden in Parkinson's disease at an individual level such as patient-centered approach to care, and at system level by improving access and care coordination between services. Future research is needed to determine the modifiable factors of treatment burden in Parkinson's disease.

External web link - https://pubmed.ncbi.nlm.nih.gov/34334419/

Kinda Ibrahim, Natalie J. Cox, Jennifer M. Stevenson, Stephen Lim, Simon D. S. Fraser & Helen C. Roberts (April 2021)

Background

Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty.

External web link - https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-021-02208-8

Natalie J Cox, Leanne Morrison , Sian M Robinson , Helen C Roberts , Kinda Ibrahim

(December 2021)

Abstract

Appetite loss in later life is common and associated with malnutrition; however, there is limited knowledge on older individuals' perspectives of appetite. This study aimed to explore what 'appetite' means to older adults, how they experience its change and perceived influences on this experience. Semi-structured interviews were conducted with thirteen participants, aged ≥65 years, in their own home, following a recent arm fracture. Transcripts were analysed using reflexive thematic analysis with inductive coding resulting in three themes. 1. 'Appetite as an emotional experience' encompassed positive or negative thoughts and feelings driving or undermining desire to eat. Mood, the appeal of food, cooking and effects of interaction and experiences with other people were factors in this narrative. 2. 'Appetite reflects a physical need' comprised physical bodily sensations or requirements as a driver for appetite with poor appetite resulting from early or over fullness. Declines with age, illness and less activity, were factors in this narrative. 3. 'Adaption to poor appetite aligns with perception of appetite and wider physical health' accounts for how experiential strategies, or practical strategies were used to mitigate poor appetite depending on the narrative of appetite loss, alongside perceptions of physical health and unplanned weight loss. Most individuals used one narrative in their discussions and reflections but for some, perceptions of appetite and its change were more complex. Understanding relationships between these perceptions of appetite and influential factors could facilitate development of multi-component, person-centred, strategies that are optimally meaningful and relevant to address appetite loss in later life.

External web link - https://pubmed.ncbi.nlm.nih.gov/34311002/

Kinda Ibrahim, Mark A Mullee, Natalie Cox, Cynthia Russell, Mark Baxter, Simon Tilley, Guiqing Lily Yao, Shihua Zhu, Helen C Roberts

December 30, 2021

Background:

Sarcopenia and frailty are associated with increased risk of falls and fractures. This study evaluated the feasibility of assessing sarcopenia and frailty among older people attending fracture clinics.

External web link - https://pubmed.ncbi.nlm.nih.gov/34977920/

Author John Henry Spreadbury, BSc, MSc, PhD, Alex Young, MSc, PhD and Christopher Myles Kipps, MBBS, PhD

Published: July 2022

Background
The use of digital health technology to promote and deliver postdiagnostic care in neurological conditions is becoming increasingly common. However, the range of digital tools available across different neurological conditions and how they facilitate self-management are unclear.

External web link - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9377435/

Natalie Cox,  Isra Ilyas,  Helen C Roberts,  Kinda Ibrahim

Published: 10 November 2022

Background
Medications and specifically fall-risk-increasing drugs (FRIDs) are associated with increased risk of falls: reducing their prescription may improve this risk. This study explored patient characteristics associated with FRID use, prevalence and type of FRIDs and changes in their prescriptions among older people with arm fractures over 6 months

External web link - https://academic.oup.com/ijpp/advance-article/doi/10.1093/ijpp/riac084/6821269

Stefanny Guerra, Kate Lambe, Gergana Manolova, Euan Sadler, Katie J. Sheehan

7 November 2022

Objective

To understand multidisciplinary team healthcare professionals’ perceptions of current and optimal provision of acute rehabilitation, perceived facilitators and barriers to implementation, and their implications for patient recovery, using hip fracture as an example.

External web link - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277986

Cox NJ, Howson F, Ibrahim K, Morrison L, Sayer AA, Roberts HC, Robinson SM. Mood and physical activity are associated with appetite in hospitalised older men and women. Age Ageing. 2022 Dec 5

Background: The anorexia of ageing is important in the development of malnutrition, frailty and sarcopenia amongst the older population and is a particular problem for hospital inpatients. This study assessed appetite-related factors in a group of hospitalised older adults, to identify potential preventive strategies.

External web link - https://pubmed.ncbi.nlm.nih.gov/36580556/

Kinda Ibrahim PhD,  Sophie Baron BMedSci, BMBS,  Judith Lathlean PhD,  Jackie Bridges PhD,  Nuala McGrath PhD,  Helen C. Roberts PhD

April 2022

Introduction

Involuntary relocation when care homes close can be detrimental to residents’ health and well-being and is associated with increased mortality. There is little formal evidence to support whether planning can mitigate the impact of such moves. This study aimed to understand the experiences of a whole care home relocation where staff and residents relocated together using existing published guidance.

External web link - https://onlinelibrary.wiley.com/doi/10.1111/opn.12466

Konstantinos Prokopidis,  Panagiotis Giannos,  Jean Yves Reginster,  Olivier Bruyere, Mirko Petrovic,  Antonio Cherubini,  Konstantinos K. Triantafyllidis,  Konstantinos S. Kechagias,  Yannis Dionyssiotis,  Matteo Cesari,  Kinda Ibrahim,  David Scott,  Mario Barbagallo,  Nicola Veronese,  Special interest group in Systematic Reviews and Meta-analyses and the Task Force on Pharmaceutical Strategy of the European Geriatric Medicine Society (EuGMS) February 13 2023

Soilemezi D, Palmar-Santos A, Navarta-Sánchez MV, Roberts HC, Pedraz-Marcos A, Haahr A, Sørensen D, Bragstad LK, Hjelle EG, Haavaag SB, Portillo MC. Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study.

2022 Dec 27.

Background: Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long-term conditions such as Parkinson's disease.

Sarah Muir, Preeti Dhuria, Emma Roe, Wendy Lawrence, Janis Baird & Christina Vogel January 26.2023

Background

The current food system in England promotes a population diet that is high in fat, sugar and salt (HFSS). To address this, the UK government has implemented legislation to restrict the promotion of HFSS products in prominent locations (e.g. store entrances, checkouts) in qualifying retailers since October 2022. This study investigated the perceived impact of the legislation for affected stakeholders.

Crabtree, D.R., Cox, N.J., Lim, S.E.R. et al. Enhancing the management of anorexia of ageing to counteract malnutrition: are physical activity guidelines optimal?. Aging Clin Exp Res (2023). https://doi.org/10.1007/s40520-022-02317-3

January 20, 2023

Introduction

Poor appetite in later life—termed “anorexia of ageing”—is acknowledged as a key determinant of age-related malnutrition. While physical activity (PA) is often recommended for increasing drive to eat, these recommendations are not well-evidenced in the older population. In this opinion piece we outline limitations to physical activity recommendations in anorexic older adults. We then discuss current evidence for the relationship between physical activity and appetite amongst younger adults and postulate how this relationship may change in later life, with implications regarding future recommendations and research.