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a8af900b-b089-4b7b-8da9-b042b753eab0 The feasibility of community pharmacies testing for Hepatitis C in people who inject image and performance enhancing drugs Principal Investigators: Dr Ryan Buchanan Team members: Dr Ryan Buchanan (Academic Clinical Lecturer Hepatology, Faculty of Medicine, University of Southampton), Professor Salim Khakoo (Professor of Hepatology, Faculty of Medicine, University of Southampton), Dr Charlotte Cook (Hepatology Research Fellow, University Hospital Southampton), Dr Mark Wright (University Hospital Southampton NHS Foundation Trust), Charlotte Matthews (Southampton City Council), Dr Gemma Ward (Public Health England) , Colin McAllister (Southampton City CCG), Stuart Smith ( Hepatitis C Trust ), Mark Wright (NHS England, Wessex Operational Delivery Network for Hepatitis C ), Pamela Campbell (Solent NHS Trust, Homeless Healthcare Team) Start: 1 December 2019 Ends: 1 January 2024 Project Partners : University of Southampton, University Hospital Southampton NHS Foundation Trust, Solent NHS Trust, NHS England, Public Health England, Southampton City CCG, Southampton City Council, Hepatitis C Trust. Lay summary: The people at highest risk of Hepatitis C (HCV) in the United Kingdom (UK) are those who are sharing needles, syringes or injecting equipment. This includes people who inject performance and image enhancing drugs (PIEDs) such as steroids.This population are high users of needle and syringe programmes, however, the risks taken by this population and their access to testing for HCV are poorly understood. The information that is available is not consistent, with the proportion of people with HCV varying widely but may be as high as one in seven PIED users. The study has been discussed in detail with bodybuilders, a gym owner, pharmacists and people who work at needle and syringe programmes (NSPs). The bodybuilders were very keen to be involved in the study as they want to have accurate, scientifically performed studies. They feel strongly that the information that is out there currently is not representative of their community that use PIEDs. They also felt that it was important that to have a focus on HCV but they were keen to be involved in a study that also addresses at other elements of liver health. The methodology for the study were discussed and adapted after patient and public involvement (PPI) meetings.The aim of this study is to see if widening access to testing of HCV based in community pharmacies with a pathway into specialist care is able to provide improved and acceptable access to testing and treatment compared with standard care. We also want to gain a better understanding of the burden of HCV in this group of people who are using PIEDs, and an understanding of risk behaviours. We will also investigate knowledge of liver disease caused by other factors (e.g. alcohol and obesity). This will be done via interviews with bodybuilders to understand more about their behaviour and the risks they take. This will be followed by a survey with an associated HCV test and measurement of liver scarring. The information gained from the interviews, surveys and tests will give a far greater understanding of this population and their risk of HCV. This information can then be used to target at-risk groups and to adapt current approaches with the aim of elimination. The results will be disseminated in medical journals and presented at medical conferences. Publications doi.org/10.1111/jvh.13207 https://doi.org/10.1111/jvh.13554 https://doi.org/10.1093/ijpp/riac064 http://dx.doi.org/10.1136/gutjnl-2022-BASL.130 http://dx.doi.org/10.1136/gutjnl-2021-BASL.40 https://doi.org/10.1111/jvh.13786 https://doi.org/10.1016/S0168-8278(20)32040-7

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0962122f-1175-4112-bec9-7327da6e0e5a COMPLETED: Work lives and Wellbeing of Mental Health Nursing Workforce Lead applicant: Prof Jane Ball Co-applicants: Dr Gemma Simons, Prof David Baldwin, Prof Peter Griffiths, Dr Catherine Smith, Dr Emma Wadey Project Summary: Read a long project summary Read a short project summary We have a growing demand for mental health care and nurses are key to meting this demand. Each year roughly 10,000 NHS staff in England leave mental health services. 22% of nursing posts in mental health are vacant. Across the NHS it is recognised that work pressures impact on staff wellbeing, their ability to deliver care well, and likelihood of staff staying in the NHS. Despite being a priority area, most research related to nurses’ work engagement, retention and positive staff outcomes focuses on staff in general acute hospitals. Very little attention has been paid to mental health nurses’ work lives and wellbeing. Where will the research take place and who will it in involve This study focusses on mental health nurses. It will take place in Wessex but also includes desk research to collate workforce data, and a national survey of nurses in a range of mental health settings (community, hospitals, specialist units). The project will be led by the mental health workforce team at Southampton, in collaboration with the Hampshire & Isle of Wight Staff Support Hub, and the national lead for mental health nursing. An advisory group and patient public group will support the research. Aim & Design The aim is to examine the work lives and wellbeing of mental health nurses, in order to improve wellbeing and retention of these staff. This study will map what is known about the mental health nursing workforce, identify modifiable workplace factors that impact on staff experience, wellbeing and outcomes, and work collaboratively to identify solutions. The companion project will identify metrics that we can use to assess the wellbeing of the mental health workforce. Methods Labour market and workforce review - analyse data on the mental health nursing workforce, to create an overview. Survey nurses working in mental health (in Wessex NHS Trusts and a national sample). The questionnaire includes measures of: burnout, job satisfaction, intention to leave, workloads and practice environment. We will include open-ended questions so staff can give their views of work-life challenges, how they impact on their health, and what helps. The RCN Mental Health Forum will be main gateway for the national survey. Interview and focus groups with mental health nurses in Wessex NHS Trusts to explore experiences and views of working in mental health and issues related to wellbeing. These will be both before and after the survey (to help with survey design, and afterwards, to enrich interpretation). Coproduction workshop . Preliminary findings will be shared with a wide range of people with vested interest in, or responsibility for, the mental health workforce (e.g. nurses, managers, workforce leads) at a Wessex based co-production workshop, to identify actions and next steps. How will the findings inform improvements in population health and patient care? Services will run better and care quality will be improved if the workforce is healthy, happy and there are enough staff to provide care to the expected standards. Publications doi:10.12968/bjmh.2023.0037

32e7d264-0fc5-4abd-9de2-3d80f41ddbb6 PROCED: PROactive, Collaborative and Efficient complex Discharge Joint Lead: Dr Carlos Lamas Fernandez and Professor Michael Boniface . Co Applicants : Antonio Martinez-Sykora (CORMSIS), Professor Peter Griffiths, Abigail Barkham (Southern Health NHS FT), Eleanor Corbett Partners: University of Southampton, Southern Health NHS Foundation Trust & University Hospital Southampton NHS Foundation Trust. Lay Summary Aims: PROCED aims to improve complex hospital discharge by using computer algorithms to support the way community and social care services are planned for patients fit to leave hospital. The goal is to avoid patients staying in in hospital longer than needed when they are well enough to be discharged. Leaving hospital at the right time is better for patients for many reasons. It reduces physical and mental deconditioning and chance of hospital infections. It also allows patients to recover with families, friends, and carers. By planning care earlier during hospital stays, PROCED aims to provide more time for patients and families to discuss care needs with care workers. Also, integrated care services are expected to be more efficient as resources can be planned using better predictions of patient needs. Background : In 2018/2019 patient discharges from hospital in the UK were delayed by over 1.5 million days. Almost 75% of delays were due to arrangements for community care not being in place. Plans require many services including further non-acute care, residential homes, nursing homes, care packages, community equipment and public funding. Avoiding delays to discharge from hospital is desirable as it leads to better outcomes. The University Hospital Southampton has recently developed a digital system supporting complex discharge. The system allows patients, families, and care providers to share information about a care needs and resources during discharge decisions. PROCED will now extend this system with advanced computer algorithms to support better decisions making. Approach: PROCED will develop computer algorithms that can predict care needs and schedule care services. Predictions will be developed using machine learning. Machine learning is a way to train a computer by using data about patients and services they use. Scheduling will use optimisation algorithms to find the best use of resources from available options. The prediction and scheduling algorithms will be integrated within a discharge decision process. The process will be part of a patient journey co-designed with patients and healthcare workers. The algorithms will be tested to ensure they are accurate and useful.The approach will be assessed by patients and the workforce for acceptance and overall satisfaction. Patient and Public Involvemen t: Patients and public have helped develop the research concept and will be involved in co-design, testing and evaluation. PPI will influence data usage, patient journey, algorithms, and visualisation. The public will participant in a Steering Committee. A PPI Committee will organise eight workshops to involve patients and public in the research. Dissemination: Communication materials will engage the public and decision makers.Evidence of effectiveness, safety and acceptance will be published. A complex discharge system with computer-based decision support will be demonstrated. The outcomes will be championed with institutional, regional, and national implementation teams.

c011903f-4a36-460d-bf9c-db9cb8525bc0 Implementation and Evaluation of the Advanced Practice Research Toolkit Chief Investigator : Professor Kerry Gaskin, Birmingham City University Start Date: 1st October 2024 End Date: 31st March 2026 Summary Research is important for clinicians to improve treatments and care in the NHS. It is fundamental to what is called advanced practice. In 2023 the Advanced Practitioner Research Toolkit was developed for one NHS trust to help plan research activity. This novel toolkit, developed to meet the needs of advanced practitioners in one organisation, has gained interest nationally and internationally, with many positive comments received about how simple it is to use. We are currently designing a national evaluation to ascertain how the toolkit has been implemented and the impact it has had for advanced practitioners. It has the potential to improve research and engage more clinicians in research, leading to evidence based service improvement in the NHS. Anecdotally this pillar is perceived as being more difficult to achieve within the AP role due to a variety of barriers, including operational priorities, lack of time and lack of support. A common theme arising from communication with APs at GHNHSFT was ‘ not knowing how or where to get started’ , which informed development of the toolkit. The objectives of the APRT were to support APs to 'get started' with the research pillar; to encourage AP teams to consider their research priorities; to enable individual and team research objective setting and to aid appraisal discussions. The aim of this project is to improve Advanced Practitioners’ (AP) research capabilities, thereby enabling APs to achieve the research pillar of their role Objectives: · to develop a tailored strategy to implement the APRT · to test this implementation strategy in the context of healthcare organisations · to evaluate the acceptability, appropriateness and feasibility of the APRT · to evaluate the impact of using the APRT for APs, AP Teams, Supervisors and Line-Managers · to report the findings and recommendations to inform future roll out across the NHS Development and Implementation of An Advanced Practice Research Toolkit - Birmingham City University

f6a3bc9c-cb06-4577-8723-be7beaceddc2 COMPLETED: Development, evaluation and provision of an intervention for primary and community NHS staff to help carers and homecare workers supporting people living at home with dementia with their continence. Principal Investigator: Dr Catherine Murphy, Senior Research Fellow, School of Health Sciences, University of Southampton. c.murphy@soton.ac.uk Team: Jane Ward: former carer, Alzheimer’s Society Research Network Member, co-founder of Dementia Friendly Hampshire, Patient Research Ambassador: Prof Miriam Santer: Professor of Primary Care Research, Faculty of Medicine, University of Southampton: Prof Jill Manthorpe: Professor of Social Work, Director of NIHR Policy Research Unit in Health & Social Care Workforce, King’s College London – Associate Director of NIHR School for Social Care Research: Prof Mandy Fader: Professor of Continence Technology, School of Health Sciences, University of Southampton: Dr Leanne Morrison: Lecturer in Health Psychology, School of Psychology & Primary Care Research Centre, University of Southampton. Partners: Health Innovation Wessex, Alzheimer’s Society, Homecare Association, Carers UK, Queen’s Nursing Institute, Dementia UK, King's College London. Start: 1/06/2022 End: 1/4/2024 Plain English Summary of Findings We found that Healthcare professionals wanted an easy and quick to use intervention to sign-post carers to continence care guidance. Homecare workers would welcome resources aimed at having difficult continence conversations The findings led us to develop the first evidence-based website to support healthcare professionals to provide continence advice to the carers of people living with dementia. The intervention also provides carers with detailed, practical self-management guidance. The website is www.demcon.org.uk A summary of the work can be found in this article: C Murphy, B Bradbury, M Fader, L Morrison, M Santer, J Ward, H Chester. Supporting continence care for people living at home with dementia. 22 APRIL, 2024. Nursing Times What Next? The project has provided foundational findings for the next phase of work which includes developing a new intervention to support homecare workers to initiate continence conversations with people living at home with dementia. This work (DemCon2) is being funded by NIHR Three School’s Dementia Research Programme and will start Autumn 2024. Initial Summary (2022) Most of the 850,000 people living with dementia in the UK live in their own homes with support from family or friend carers. Dementia puts people at much greater risk of developing continence problems (with urine/wee or faeces/poo) than people without dementia of the same age. Continence and toilet-use difficulties cause many problems for both people living with dementia and carers, for example, sore skin, infections, embarrassment, anxiety, fear of going out, relationship breakdown, and expenses such as cleaning carpets or laundry. Dementia can mean that using pads or reminders do not work well for people as time goes by. Many carers find dealing with incontinence hugely distressing. They describe feeling poorly prepared and alone. Many find it difficult to talk about and want better support from health and care professionals. Recently we asked people living with dementia, carers and nurses to tell us what information and support they would find useful. From that, we developed a detailed, practical handbook specifically for carers, covering: · understanding why someone with dementia might become incontinent · helping people keep ‘dry’ · managing incontinence · talking about incontinence · continuing with daily activities and socialising. The handbook contains many ‘real-world’ quotes from carers and will be made freely available on www.continenceproductadvisor.org (an NHS endorsed website). This is a good start but requires carers to find and use the handbook by themselves. Most carers want proactive support from the professionals they see (either healthcare or homecare workers), but healthcare professionals often feel ill-equipped to help carers or advise homecare workers. Therefore, in this study, we will develop a new resource that will build on the handbook and equip healthcare professionals to: · start conversations with carers and homecare workers · discuss continence problems and help people choose goals · deliver practical advice to carers and homecare workers. To do this, first we will review research on similar resources and speak to up to 45 primary and community healthcare professionals and homecare workers to fully understand their needs and how a new resource could be used and useful. We know that many people living with dementia and carers have regular contact with homecare workers who often help with washing and going to the toilet. Then, we will work with carers, people living with dementia, healthcare professionals, homecare workers, care commissioners or funders, voluntary groups and professional bodies to develop the resource. We will ask up to 60 people living with dementia, carers, homecare workers and healthcare professionals to use the resource and tell us what they think. We will then make changes to improve the resource. We want this resource to be used by as many primary and community healthcare professionals as possible so that they can support homecare workers and family carers. So, throughout this project, we will ask people about the best way to make it both useful and accessible. It will be freely available via www.continenceproductadvisor.org and we expect adopted and recommended by a range of organisations such as the Alzheimer’s Society, Skills for Care, Homecare Association and professional groups.

Clinical Doctoral Research Fellow and Specialist Research Nurse, Portsmouth < Back How I overcame my fears to win recognition for nurse research Rosalynn Austin Clinical Doctoral Research Fellow and Specialist Research Nurse, Portsmouth For the past 3 years, every year in October, I have a tradition. The call for Early Investigator Awards (EIA) comes out and with the support of my supervisors I submit an abstract. Every year the abstract gets rejected. When I saw the email this year, from the British Society for Heart Failure (BSH), I steeled myself for the traditional annual rejection. The words, “I am delighted to tell you that you have been selected to present at the meeting” jumped off my screen and I double checked to see if it was actually addressed to me. To then learn that my research was the first nurse led research to be shortlisted for this award carried with it a mixture of honour and responsibility. Having attended this conference before I knew my biggest challenge was not the 5-minute presentation, but in explaining burden of treatment to a clinical audience, unfamiliar with this theory. I knew that this was key to them understanding the relevance of my results and increasing the possibility of impacting on their clinical care of heart failure patients. Channelling my inner Florence Nightingale, I wrote and re-wrote my presentation, practicing it multiple times to the cardiology team at Portsmouth Hospitals University NHS Trust. “Never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself.”― Florence Nightingale Nerves before a presentation are normal for me, but on Thursday Dec 2, 2021 my pre-presentation nerves were on a new level. The knowledge that I was the first nurse to be invited to present for this award category in the BSH, had raised the stakes considerably. I wanted honour and represent so many nurse researchers who inspired and supported my journey as a Nurse Researcher. At the coffee break following my presentation, nurses and doctors come up to me and not just comment on my presentation going well, but on how they found it interesting. Better than that they had more questions about burden of treatment and my research. This continued on social media and even now looking back on Thursday evening I can’t help but smile. I felt then that regardless of the announcement of winner announcement on Friday morning, that I had won. I had represented nurse researchers honourably, becoming a trailblazer, inspiring others and creating clinical curiosity around burden of treatment. The announcement ( https://twitter.com/BSHeartFailure/status/1466720998468820994 ), the next day, that I together with Simon Beggs (Cardiology registrar & Honorary clinical lecturer) and Amrit Lota (Cardiology Specialist Registrar, specialising in heart failure and imaging) were to be joint winners cemented those thoughts. I am grateful to my supervisors who supported me in this journey and especially the participants who gave of their time to inform my research. This win is theirs too. To find out more about the winners follow on twitter: @RosalynnAustin @amritlota *Link to the report of the event including the announcement of the winners of the EIA: https://bjcardio.co.uk/2022/01/freedom-from-failure-the-british-society-of-heart-failure-annual-meeting-highlights/ Previous Next

b4eba41c-3299-4935-88f1-36d55163f934 MODIFY: The development and iMplementation Of a multidisciplinary medication review and Deprescribing Intervention among Frail older people in primarY care COMPLETED: MODIFY: The development and iMplementation Of a multidisciplinary medication review and Deprescribing Intervention among Frail older people in primarY care Principal Investigator: Dr Kinda Ibrahim Project team : Eloise Radcliffe, Dr Simon Fraser , Clare Howard , Professor Paul Rutter , Professor Susan Latter , Claire Sheikh , Dr Lawrence Brad , Dr Mark Lown , Dr Alejandra Recio-Saucedo , Dr Kat Bradbury , Dr David Culliford , Dr Maria Chorozoglou , Cynthia Russell (PPI lead). Further PPI involvement from:Pam Holloway, Neil Wilson, Rajneesh Kaur Additional support from Renee Servin and Lucy Murphy (Medical students) Partners: University of Portsmouth, Westbourne Medical Centre, Wessex Health Innovation Network, PresQiPP, NIHR CRN Wessex Summary of findings - download plain text summary 1 in 3 people aged 65 and older take 5 or more medicines every day (polypharmacy). Some of these drugs may no longer be appropriate. They could increase the risk of falls, hospital admission, or even death, especially among people who are frail (and less able to recover from injury and illness). Deprescribing (reducing, stopping or switching drugs) is safe for some conditions, medications and in settings such as primary care. But Health Care Professionals (HCPs) may face problems with carrying this out. Problems may include a lack of time for HCPs, and HCPs and patients may be concerned about stopping medication which was first prescribed by a specialist. Previous research highlights that this problem could be addressed by teams of HCPs from different disciplines, including practice pharmacists, working together on the medication review and deprescribing process. The research team reviewed 28 studies on older people in primary care to explore what makes medication review and deprescribing work best in a team of HCPs. Alongside this, the research team carried out in-depth interviews with ten older patients and three of their family carers, and focus groups with 26 health care professionals working in eight different GP practices. This helped the team to understand different experiences of medication reviews and deprescribing, and how this process can work best. Based on the results the team suggested ways to improve deprescribing in primary care. They include: clear roles and responsibilities for HCPs, with good communication between team members, and pharmacists integrated within teams training and education on deprescribing for HCPs routine discussions about deprescribing when prescribing, with medication reviews tailored to patients’ needs and preferences, and addressing any questions or concerns involvement of patients and informal carers, and trusted relationships with professionals allowing continuity of care. Based on the results the research team developed an intervention to improve medication review and deprescribing for older people with frailty and taking 10 or more medicines, to target those who would benefit most. The intervention has five phases: 1) Identification on practice databases of older patients aged 75 and over living with frailty, prescribed 10 or more medications, to be invited for a medication review 2) Preparation for HCPs, through using deprescribing tip sheets and a digital tool to help prioritise medication for deprescribing (with training provided) 3) Written information leaflet sent to patients and carers about the purpose of medication review and the reasons for potentially stopping or changing medications 4) The HCP (mainly a practice pharmacist) will conduct a person-centred medication review taking into account patient and carer needs and preferences. They will involve other HCPs members based on their expertise, and document and share any agreed changes with patients and other staff members if needed; 5) Tailored written follow-up plans to be given to patients and carer, and further contact arranged if needed. See NIHR Alert - How to deprescribe in Primary Care which features this research Downloads: MODIFY poster ICP MODIFY poster 20.10.25 .pptx Download PPTX • 2.32MB MODIFY POSTER Plain English ICP poster Plain English version 17.9.25 .odt Download ODT • 10KB How we shared these findings Conferences and dissemination to Health Care Professionals •European Clinical Pharmacy Society conference, October 2022, Prague, Czech Republic 2022 (oral and poster) •Faculty of Medicine Conference, University of Southampton, June 2023 (oral and poster) •Health Services Research and Pharmacy Practice conference, Cork, Ireland 2023 (oral and poster) •ARC Wessex collaborating for impact showcase event, June 2023 •Society for Academic Primary Care conference, Brighton, July 2023 •South West Society for Academic Primary Care conference, Cardiff Wales, March 2024 •International Conference on Deprescribing, Nantes, France September 2024 Other presentations and talks •Invited to present MODIFY at the Society for Academic other presentations Primary Care Medicines Optimisation Special Interest Group, 12th March 2024 •Invited to present on deprescribing at the CRN national event on Multimorbidity in May 2023. •Invited to present MODIFY at the CRN coordination Wessex Pharmacy Research Network meeting, 28th February 2024 •Presented MODIFY during a meeting with Prof. Tony Avery, the National Clinical Director for Prescribing, 1st March 2024 •Shared learning on MODIFY with Prof David Alldred and his team at Leeds, Jan 2022 •Introduced MODIFY at the Health Innovation Network Polypharmacy Community of Practice meeting, July 2022 Publications: We published our findings from our realist review in BMC Geriatrics: What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis Plos One publication (April 2025): Development of a complex multidisciplinary medication review and deprescribing intervention in primary care for older people living with frailty and polypharmacy Our publication was selected as an NIHR evidence alert, and promoted more widely on social media to health care professionals and policymakers: How to deprescribe inprimary care - NIHR Evidence Education of undergraduate an postgraduate students •Plenary talk on polypharmacy and deprescribing to year 1 medical students in May 2024 •Invited talk by University Hospital Southampton at a General Internal Medicine Training day 16th September 2024, MODIFY presented to over 100 trainees Public and patient engagement Presentation and discussion of MODIFY at a Community medical science engagement session with 12 older people (via Communicare, a local social service organisation on 4th September 2024) The project has prompted Bob Heath to write a song about deprescribing - which was played at the ARC Event 2025 Bob and Peter Heath wrote this song about deprescribing Lay Summary or research protocol Background: A third of older people take five or more regular medications (polypharmacy) potentially increasing the risk of side-effects, hospital admission and death. These effects are higher among people living with frailty who lose their in-built reserves and become vulnerable to changes triggered by small events such as a change in medication. National recommendations suggest that medications taken by frail older people should be reviewed annually by their GPs to identify and reduce/stop inappropriate medications (deprescribing).Yet this does not happen routinely due to GPs’ lack of time, increased workloads and worries about stopping medicines. Recent recommendations suggest involving other non-medical prescribers such as practice pharmacists and advanced nurse practitioners (ANPs) in reviewing medications. However, it is unknown how staff could work together most effectively and whether they have any training needs. Aim: This research will investigate how practice-pharmacists, ANPs and GPs could best work together with patients living with frailty to perform regular medication review. Methods The study involves four work packages (WPs). We will review previous literature to identify what makes a successful medication review and how to safely reduce/ stop inappropriate medications (WP1). Interviews with GPs, practice-pharmacists, ANPs, frail older patients and carers will be conducted (WP2). These will discover views about where medication review should take place, the role of each of the involved parties in the process, type of medications that could be deprescribed, staff development and training needs, barriers and facilitators for implementation, and strategies to address these barriers. Information gathered from WP1&2 will be used to develop the intervention: a structured medication review process using pharmacists, ANPs and GPs most effectively and involving frail patients and their families in decisions about medications (WP3). The intervention will be refined further through a series of workshops with service users, clinicians and commissioners. A training programme to implement the intervention and increase staff confidence in reducing/ stopping medications safely will be developed and delivered to GPs, practice-pharmacists and ANPs based on the Polypharmacy Action Learning Sets approach adopted by the Wessex Academic Health Science Network (AHSN) . Finally, we will assess whether itis feasible and acceptable for staff in four GP practices to be trained and to implement the intervention with their patients (WP4). Public Patient Involvement: Three PPI members have been involved in protocol development and refinement and will continue to contribute to the research study by for example being involved in developing research instruments and monitoring recruitment. Dissemination and Impact: Working with colleagues in the Wessex AHSN and local clinical commissioners, we will be able to share our findings and training programme to the wider research and clinical community in Wessex and potentially influence practices and policies both locally and nationally. Ibrahim, K., Cox, N.J., Stevenson, J.M. et al. A systematic review of the evidence for deprescribing interventions among older people living with frailty. BMC Geriatr 21, 258 (2021). https://doi.org/10.1186/s12877-021-02208-8 Pazan, F., Petrovic, M., Cherubini, A. et al. Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials. Eur J Clin Pharmacol 77, 1–12 (2021). https://doi.org/10.1007/s00228-020-02951-8 Radcliffe E, Servin R, Cox N, Lim S, Tan QY, Howard C, Sheikh C, Rutter P, Latter S, Lown M, Brad L, Fraser SDS, Bradbury K, Roberts HC, Saucedo AR, Ibrahim K. What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis. BMC Geriatr. 2023 Sep 25;23(1):591 (2023). https://doi.org/10.1186/s12877-023-04256-8

74e67d37-7f00-423e-b571-0f47e11e3dca ADOPTED: Investigating the impact of food vouchers on diet composition and the prevention of childhood obesity Principal Investigator: Grace Grove Start Date: 10 May 2021 End Date: 9 May 2023 Background: Childhood obesity is increasing in the UK, and children from disadvantaged backgrounds are more likely to live with obesity. Obesity in childhood is linked to obesity in adulthood and poor health outcomes. It is therefore vital that we work to prevent and reduce inequalities in childhood obesity. We know that children from disadvantaged backgrounds are more likely to have poor diets, and children who have poor diets are more likely to be obese. Therefore, improving diet quality of young families may contribute to preventing the development of childhood obesity. Healthy Start is a scheme in England that aims to improve diet quality by providing vouchers to spend on milk, fruit and vegetables to disadvantaged families. However, the voucher value is modest and has not changed for a decade, despite increasing food prices. The scheme needs assessing to consider how it can best support families, as uptake among eligible families is very low, at 54% nationally. Health visitors support young families, and give extra support to those with increased needs, including those from deprived groups. This provides a unique opportunity to support young families who are at risk of childhood obesity and eligible for Healthy Start. The aim of this research is to understand if voucher schemes can have a positive effect on diet quality of disadvantaged families. This research will contain several elements, including reviewing the literature for evidence on the effectiveness of voucher schemes, speaking to families and health visitors, collecting diet and shopping information from families, and modelling the best approach to a modified Healthy Start scheme. Publications Systematic review of fruit and vegetable voucher interventions for pregnant women and families with young children | Public Health Nutrition | Cambridge Core

d4e68544-5bd2-44f6-bac8-dd9848c01967 COMPLETED: WADE. Women and Desistence Engagement : An evaluation of a community-based, conditional caution pilot programme for women in the criminal justice system Principle Investigator: Sara Morgan, Fiona Maxwell Start Date: 20th November 2019 End Date: 30th March 2022 Background and study aims Compared to the previous year, in 2018 there was an overall 8% increase in theft in England and Wales and a 6% increase in crimes involving sharp instruments or knives. In order to tackle this increase in crime, many believe that more needs to be done to address the reasons why people commit crime in the first place, as well as the damage it causes to peoples’ lives. This means working together in the community to offer solutions to those affected by crime, including victims and offenders. When we discussed possible solutions with local service providers, it was felt that a tailored approach is needed for women, as their needs are unique. Women in prison are very likely to be both victims and offenders whilst, in the general population, one in four women are also victims of abuse within the home and more than half the women in prison have experienced domestic abuse themselves. In response, three projects are being piloted in Hampshire and Dorset to address the needs of women affected by crime. What does the study involve? To understand how these projects are working, we carried out group interviews with those delivering the pilot intervention projects in the community. These were primarily to understand how the projects are working. We also used information gathered from the project staff about the women using the service to understand whether women go on to seek further assistance in the community, what sort of women engage with the project, and what changes for them as a result of using the service. This study proposal was developed in collaboration with public representatives; including offenders, victims, social care workers, domestic abuse service manager, and police officers. They have all shaped the design of the study; by informing us what types of research questions we should be asking. We continued to involve similar representatives throughout the research study; for example, to co-produce the materials used in the study, such as information sheets, and to gain feedback on the write up of the study. What will we do with the study findings? It is important that the information gained from the study reaches the widest number of people. We therefore considered who to engage, and how to reach them, from the very start of the study. The main findings will be developed into a short summary report, which will be accessible to the general public through our public representatives and collaborators. They might include charitable organisations in the community (e.g. Stop Domestic Abuse, Hampton Trust) or services that work directly with women affected by crime (e.g. NHS, probation services). Impact of the COVID-19 Pandemic The first WaDE cautions were offered from March 2019 and workshops began shortly after. Numbers were initially fewer than expected, and although some variance throughout the year would not have been unusual, there were fewer than the anticipated 10 per month for the first months of the pilot. Unfortunately, from March 2020 the COVID pandemic and stay-at-home regulations had a very significant impact on the operation of the pilot. The pilot was suspended from March as Hampshire Constabulary temporarily ceased offering conditional cautions. From March it was also not possible to deliver the WaDE programme in its intended group format, and a small number of participants who had completed the first workshop as a group completed their second part by telephone on a 1:1 basis with a HT facilitator. As an alternative, a non-mandatory, individual telephone intervention was briefly offered from March 2020 during the first period of restrictions. Overall this had an impact on the planned evaluation, resulting in a reduction in the available quantitative data for analysis (due to fewer numbers coming through the programme). Additionally, there was a planned qualitative element to the evaluation (focus groups) which were cancelled due to the restrictions. Due to the impact of COVID-19 on both the programme operation, and the staff involved in researching, the findings of the final report cover the period of September 2021 – March 2020. Reoffending Due to the suspension of the WaDE programme and the extended period between cohort A completing their workshops and the compilation of this report, reoffending data up to 12m post-intervention is now available. From the initial 27 referrals, 4 women went on to commit further offences. These were: 1 at 35 days (common assault) 1 at 157 days (shoplifting) 1 at 229 days (bladed implement) 1 at 310 days (cannabis) Two of those who reoffended had breached (not attended) any WaDE workshops, and two had completed. A chi-square comparison of the reoffending rate between those who breached and those who attended gives a χ2 value of 2.1, indicating that this difference does not meet the threshold for statistical significance. Exit Questionnaires Hampton Trust routinely ask participants in their programmes to complete an exit questionnaire, which allows for some feedback on the perceived benefits of having attended. It also provides the opportunity for some free text comments. Ten participants answered the following questions: Q1 Since being on the workshops have you identified areas of your life in which you need support? Q2 Since being on the workshop do you have a better understanding of what led you to offend? Q3 Have the workshops helped give you tools/support to make safer more positive life choices? Q4 Since being on the workshops have you accessed other services (e.g. counselling, drugs and alcohol support) or plan to do so in the near future? Q5 Do you intend to attend all or any of the follow-on 12 week programme workshops? Q6 How much have you enjoyed the WaDE workshop? Q7 In your opinion, how well presented were the workshops? Q8 To what extent have the workshops helped you with your problems? Q9 Where 10 is ‘very confident’, how confident are you of not offending in future? On the basis of these responses, the WaDE programme is evidently acceptable to, and valued, by the participants. One respondent was generally negative in her responses and indicated in the free text feedback that she felt she shouldn’t have been having to attend WaDE at all; however even she felt that the course was well presented and enjoyable. Due to the small number of responses and the limited amount of free text feedback, full thematic analysis of the responses is not likely to offer reliable identification of consistent key themes. However, for the majority of respondents the comments reflected overall high levels of satisfaction with the programme, its delivery and its usefulness in terms of helping the participants to understand and address the factors and circumstances leading to their caution. Limitations Overall The WaDE programme delivery, and consequently the size and scope of this evaluation, has been significantly impacted by the COVID-19 pandemic. Greater numbers would have added validity to our findings and allowed for meaningful associations to be explored, while qualitative research would have added a depth of understanding of the true impact of the WaDE programme on its participants. At the time of writing it is hoped that WaDE can now revert to its original model and that a steady throughput in line with original expectations on numbers will be observed. Further research is recommended, including a comparative statistical analysis with a larger cohort. Qualitative research would also be valuable to explore in-depth attitudes, towards reoffending for example, in order to provide better evidence for future decision-making. Conclusions Despite some very challenging times, the team delivering WaDE remains committed to its ongoing operation. Continuing support from the OPCC and a strong working partnership between Hampton Trust and Hampshire Constabulary has enabled the programme to ‘weather the storm’ of the pandemic and emerge ready to re-start. The flexibility and hard work of each individual throughout this time speaks to their belief in WaDE as a worthwhile and much-valued means of supporting female offenders towards a better future.

6bbcedc2-84c3-4fab-84e5-93672150e077 ADOPTED: Social Prescribers In Deprescribing Role (SPiDeR) Team: Dr Kinda Ibrahim, Pharmacist and Lecturer, Faculty of Medicine, Deputy Lead Ageing and Dementia, ARC Wessex Dr Sara McKelvie, NIHR Clinical Lecturer in General Practice Dr Eloise Radcliff, Research Fellow, Faculty of Medicine Emma Ward, 3rd Year Medical Student Lizzie Wimbourne, PhD candidate and Policy Intern (supported by Gareth Giles) Dr Laura Bryant, GP and School of Primary Care Apprentice Pam Douglas and Neil Wilson, Public Contributors and Co-applicants Senior Support Prof Hazel Everitt, Dr Stephanie Tierney, Prof Peter Griffiths and Prof Joanne Reeve Starts: April 2023 Ends: September 30, 2024 In the UK, a third of all people aged 65 years and above regularly take five or more medications, known as polypharmacy. Polypharmacy can increase the risks of side effects and hospital admissions. One of national priorities for NHS England set by the Chief Pharmacist, is to reduce prescribing unnecessary medication (overprescribing) by 10% for patients being treated by their GPs. One important way to identify and stop harmful medication is called a Structured Medication Review (SMR) but only half of older patients attended their GP practice for this in 2018-19. Instead of medicines, some people might benefit from other activities such as changes in diet, ways to reduce stress, increasing exercise or participating in group activities. Social prescribers are starting to work within GP teams to direct people to some of these activities. The Chief Pharmacists report on overprescribing suggested that NHS England should expand the use of SMRs in GP practices to benefit patients most at risk of overprescribing. They also recommended the involvement of trained social prescribing link workers as part of GP teams to support patients during and after a SMR. We currently don’t know how social prescribers can be integrated in the SMR process or whether this will have an impact on overprescribing for older people. The aim of this study is to explore the role of social prescribers in the SMR process and identify any training needs or resources required to enable their active involvement in the process. We will hold focus groups with healthcare professionals (GPs, pharmacists and social prescribing link workers) and interview older people who have experience of taking several medicines and/or their caregivers to: 1- Understand whether there is a role for social prescribers in SMR in Primary Care teams 2- Identify training needs for social prescribers to be actively involved in Primary Care teams who are doing SMR reviews 3- Identify factors that might prevent or improve social prescribers’ involvement in SMR 4- Consider what older people and healthcare professionals felt about alternatives to medications and map relevant activities and guidance that could be used as a substitute to medications such as dietary advice, exercise groups or cognitive behaviour therapy 5- Develop a model to describe how social prescribers can be best involved in SMR Understanding the role of social prescribing link workers in the SMR process might increase the use of non-medical solutions for health-related problems and reduce overprescribing. This study could help develop the role of social prescribers and understanding how they could work in primary care to support SMR. We hope this research will help us design and test different models of how social prescribers can work within GP teams to support deprescribing. This project is linked to STOP-DEM and MODIFY SPiDeR project for ARC Wessex 18.9.23 .pptx Download PPTX • 6.89MB

8dc1e114-6eb5-464b-a8c0-3feeadb70748 ADOPTED: Understanding how and why live-in care packages are arranged and sustained, when dementia is the primary support need: A mixed methods study. Lead: Professor Ruth Bartlett, Health Sciences, University of Southampton. Team: Dr Laura Cole, University of West London. Mr Terry Clark, Southampton City Council. Professor Joanna Thompson-Coon and Mrs Morwenna Rogers from NIHR Applied Research Collaboration South West Peninsula (PenARC). Dr Catherine Henderson, on School of Economics & Political Science. Dr Karen Harrison Dening, Dementia UK. Dr Stefan Brown, Royal Holloway, University of London. Mr George Rook, Public and Patient Contributor, Alzheimer's Society. Ms Aimee Day, Public and Patient Contributor. Ms Linda Hammond, Professor Anne Sophie Darlington and Ms Kathleen Curry, Health Sciences, University of Southampton Start: 01/01/2025 End: 30/06/2027 Summary Our research aims to understand how and why live-in care packages are arranged and sustained in England, when dementia is the primary support need, and to describe the nature of this market (e.g., size and cost). Dementia is a disability affecting hundreds of thousands of people in England. A person with dementia has difficulty with thinking and remembering and this will affect their ability to do everyday tasks such as getting dressed, eating, and going out. A person with dementia will eventually need round-the-clock care. Many people move to a care home when they require help all the time. However, other options are available. One alternative for people with enough living space is to organise a live-in carer; this is when a paid carer moves into (rather than visits) a person’s home to provide support. Searching the internet will bring up lots of home-care providers in England that offer this service. However, it is a relatively ‘hidden market’–there is no information or guidance about this form of homecare on government websites, and all the research about live-in care has been done overseas. Research is needed so people in England know more about this option and can make informed choices about their long-term care. DESIGN & METHODS First we will review previous research to check what is already known and identify the main gaps and issues. Then we will survey all the 42 integrated care boards in England about the live-in care packages they arrange and/or fund for people with dementia. We will also survey all the homecare agencies that provide live-in care listed on the CQC /care regulator website (142) to find out about funding arrangements and other issues like staff training. To learn about the arrangement in detail, we will recruit ten households where a live in carer is employed. In each we will ask the person with dementia and live-in carer to keep a photo diary of their everyday activities for two blocks of seven days. Asking people to keep a photo diary at two separate intervals will provide information about any changes in the arrangement, and we will be able to actually see how it works. We will interview the person with dementia and live-in carer together, before and after each block of diary-keeping. We will conduct separate interviews with a family member and the person’s dementia care coordinator (e.g., a social worker or nurse). These interviews will take place in person, online or by phone. We will create a timeline to show when, how, and why the package was arranged based on these interviews. PATIENT & PUBLIC INVOLVEMENT The research team includes a person with lived experience of dementia (Rook) who will lead the PPI work with support from an independent dementia advocate (Day). It also includes the research lead for a national charity (Harrison Dening/Dementia UK) and a purchaser of care services (Clarke). DISSEMINATION Our findings will be published in an information resource and accompanying video that we will co-create with individuals and families with dementia and make available on the Dementia UK website. We will launch the resource at a Community Conference about live-in care that we will