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402a4c2a-6e60-4ba0-ab22-b08ca49f80a9 Deprescribing and Optimisation of Medicines IN Older people with Heart Failure and Frailty (DOMINO-HFF) Chief Investigator: Dr Eloise Radcliffe, Senior Research Fellow School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton Team: Dr Kinda Ibrahim, Associate Professor, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton Dr Sara Mckelvie, Clinical lecturer, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton. Dr Stephen Lim, Principal Clinical Research Fellow, Consultant Geriatrician, Medicine for Older People, University Hospital Southampton, Southampton General Hospital. Dr Chris Young, Consultant Geriatrician, Medicine for Older People, University Hospital Southampton, Southampton General Hospital. Dr Nina Fudge, Lecturer, Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary University of London. Dr James Sheppard, Associate Professor, Nuffield Dept of Primary Care Health Sciences, Medical Sciences Division, University of Oxford. Mrs Clare Howard, Clinical Lead for Medicines Optimisation, Health Innovation Wessex. Prof Simon Fraser, Professor of Public Health, School of Primary Care, Population Sciences and Medical Education,Faculty of Medicine, University of Southampton. Dr Peter Cowburn, Consultant Cardiologist, University Hospital Southampton, Southampton, General Hospital. Ms Rajneesh Kaur, Patient and carer representative . Partners: University Hospital Southampton NHS Foundation Trust, University of Southampton, Health Innovation Wessex, Queen Mary University of London, University of Oxford. Start: 1 October 2024 End: 31 March 2026 Background Heart failure (HF) is a long-term disease with symptoms including breathlessness, tiredness and leg swelling. HF is more likely to affect older people and is the leading cause for hospital admission in the UK for those aged over 65 years. Most people with HF have other health conditions therefore taking multiple medication is common. Guidelines for doctors to treat HF recommending multiple medications to help improve symptoms and help people live longer, have led to concerns about further increases in numbers of medication for patients. The application of these guidelines in older adults has had the unintended problem of more complex medication regimes, and possible impacts on physical ability and quality of life. More generally, taking multiple medication can increase risk of side-effects, hospital admission and death for older people. The research studies used to decide guidelines for doctors to treat HF, may underestimate the risks of taking multiple medicines as they do not include populations most vulnerable to potential harms such as older adults and those with frailty. This leads to uncertainty about the long-term benefits and risks of HF medications in the very old and frail populations who are, nonetheless, still treated based on the guidelines. Prescribing should ideally be tailored to each patient’s health condition and their preferences. These factors will change over time, supporting the need for regular medication reviews, and where appropriate, the need for reducing, stopping, or switching drugs in order to improve outcomes. However, this may be challenging due to the lack of research studies, as patients and multiple health care professionals involved in caring for older patients with HF, may experience uncertainty and have differing approaches to the application of the guidelines. Aim To examine research studies on prescribing and deprescribing of HF medication in older people, including those living with frailty. This will inform current guidelines for doctors to treat HF. It will also identify gaps in the research on this vulnerable group commonly prescribed HF medication, but at the greatest risk of experiencing harms linked with taking multiple medications. Design and methods Two literature searches will be carried out, guided by an information specialist librarian, following the established guidelines. Patient, public and community involvement This study has patient and public involvement (PPI) throughout. We will have PPI group of older people and carers living with HF, chaired by our PPI lead who is also a research team member and has contributed to study development. The group will contribute to the interpretation andcommunication of findings on a wider scale. What did we find out? •We found that there is very little research on prescribing for older people with heart failure, especially those aged over 75. No studies looked at frailty, which is important for understanding how well treatments work in this group. Very few studies reported on ethnicity, and none considered people’s socio-economic background. Only a small number included information about quality of life, and none were carried out in primary care settings. •Overall, this means there is not enough good evidence to clearly understand the benefits of heart failure treatments for older people. •Some medications may help, particularly a group called SGLT-2 inhibitors (also known as “gliflozins,” such as dapagliflozin), but it is difficult to say how much benefit they provide. In addition, side effects may make these treatments harder to tolerate and could increase the risk of harm for some patients. •We found that for research on stopping or reducing (deprescribing) heart failure medications for older people is also limited. Stopping medicines during a sudden worsening of symptoms may be harmful. However, the available evidence is limited and varies in quality, and it does not properly consider people living with frailty. This highlights an important gap in research and a need for better evidence to guide safe treatment decisions. What have we done with this new knowledge? We have presented findings at the South West Society for Academic Primary Care conference in Oxford, and later in the year at the European Geriatric Medicine Society in France, and are publishing the results of the two systematic reviews in two peer-review widely read journals. We also plan to share the findings with We will share findings with the National Clinical Director for Prescribing in England, Prof. Tony Avery, and the British Geriatric Society (BGS) and present the findings to the South West BGS group. This will ensure the findings reach decision-makers who design and fund future clinical trials. The impact of this research is in contributing to the evidence base and identifying critical gaps in knowledge about how heart failure medications are used in frail older populations. It highlights the underrepresentation of these groups in clinical trials and the limited evidence available to guide deprescribing. This will inform priorities for future research, while also supporting greater awareness among clinicians of the need for personalised, context-specific prescribing and shared decision-making. In the long-term this will contribute to safer prescribing, reduced medication-related harm, improved quality of life, and fewer avoidable hospital admissions. What will we do next? •This is a complex and challenging area of research. Our work has highlighted variation in approaches to prescribing, as well as differences in the challenges faced by healthcare professionals across disciplines and care settings. •It is clear that further high-quality clinical trials are needed to address the important gaps we have identified—particularly the lack of robust evidence on prescribing and deprescribing for older people with heart failure who are living with frailty and multiple long-term conditions. •We will share findings with the National Clinical Director for Prescribing in England, Prof. Tony Avery, and the British Geriatric Society (BGS) and present the findings to the South West BGS group. •We hope our findings will contribute to the recent ongoing public debate on medicines optimisation in frail older people, and will shape and inform future research, supporting the development of clearer, more relevant evidence to guide care for this population.

62657f5f-1a8d-4fc4-8b32-bd364cb93d3a ADOPTED PROJECT - PREMAC 2 STUDY Development and application of Patient Report Experience Measure for patients accessing ACute oncology services: Aim This study will test a newly designed patient report experience measure (PREM) questionnaire for acute oncology (AO) across three NHS Trusts. Objectives The study will test: i) the acceptability of the PREM instrument to patients; ii) how well the PREM questionnaire performs, its validity and reliability, when completed by patients who have received care from different clinical teams; iii) the capability of the PREM instrument to identify variations of patient experience between participating trusts, and; iv) how easily the PREM questionnaire can be used to collect information across several trusts that might deliver services in different ways. Background People with cancer often need to access AO services for serious problems caused by their disease or treatment. Although trusts are required to obtain feedback from patients who receive AO services, there is currently accepted way of collecting this information. A preceding study, the PREMAC study, designed the new PREM questionnaire that we will test in this subsequent study. Design and Methods The study will include three NHS Trusts, and a sample of at least 100 completed responses will be required for statistical analysis from each site. Patients who have accessed AO services will be sent an electronic link to the questionnaire by text message or email, between one and two weeks following their care. Participants will be eligible if they: have a confirmed diagnosis of cancer; are 18 years old and above; have sought urgent care/advice for problems for cancer or its treatment; have accessed AO service via a triage helpline, a bespoke AO unit or via ED. Only anonymised information will be collected from respondents. Study outputs The main study output will be a validated PREM, which can be used to explore and benchmark the quality of AO services at trusts across England with different service delivery models.

6dc4c269-ddb7-41c3-afd8-8173c69a4651 ADOPTED ActMed-VW - Healthcare professional's experiences of Access to Medication for people on Virtual Wards who are in their last year of life Virtual wards provide acute, hospital-level care in an individual’s own home, rather than in a hospital or hospice. They are also known as Hospital at Home services. We know that virtual wards can care for people who are in their last year of life. For individuals approaching the end of life, control of symptoms requires prompt access to medication. We know access to palliative care medication can be challenging in the community. There have also been reports of difficulty accessing medication on virtual wards; however, it is not known if there are specific issues accessing palliative care medications on virtual wards. This study aims to investigate access to medication for adults on virtual wards who are in their last year of life. We aim to understand the experiences of healthcare professionals so that we can make recommendations on how to improve access to medication in the future. We will ask healthcare professionals working in virtual wards to answer questions in an online survey. We will ask doctors, nurses, pharmacists, and allied health professionals such as physiotherapists to complete the survey. We will ask them about what works well and what does not. We will ask them about the challenges they have faced, and what would help them to minimise or eradicate these. We will also interview 20 healthcare staff. This will include both professionals who completed the survey and individuals who oversee the management of virtual ward services. We will explore in more detail examples of good practice and the processes that need to be in place to ensure straightforward, fast access to medication. We will consult with clinical and policy experts on potential solutions to the challenges identified in the study findings. We will also work with these experts to develop recommendations for policy and practice. Project team includes: Co-PI - Dr Nicola Andrews Co-PI - Prof Sue Latter Co-I Dr Natasha Campling Co-I Dr Sara McKelvie Research Fellow Dr Dan Aze

b369496b-453f-489e-9d44-7a954ac3f6d7 Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways (STIMULATE) This project is part of a national consortium Contact: Professor Nisreen Alwan MBE , University of Southampton There is evidence that access to Long Covid (Post Covid-19 Syndrome) NHS Care and related care pathways, the nature of those pathways, and patient experience, varies. Research is required to inform diagnosis, care, public health strategies, policy planning, resource allocation and budgeting. It is likewise essential to define the usual care pathway in Post Covid services, and to understand patient presentation, and the effectiveness and cost of care. The STIMULATE-ICP consortium includes: University College London Hospitals NHS Trust, University College London, University of Central Lancashire, LongCovidSOS, UK Doctors #Longcovid , Royal College of General Practitioners, University of Liverpool, Liverpool University Hospitals Foundation Trust, Perspectum, Living With, University of Hull, Hull University Teaching Hospitals Trust, University of York, University of Leicester, University of Exeter, University of Southampton, University of Sussex, Alliance Medical, GE Healthcare, Olink, Francis Crick Institute, NIHR Applied Research Collaboration South West Peninsula, NIHR Applied Research Collaboration East Midlands, NIHR Applied Research Collaboration North Thames, NIHR Applied Research Collaboration Yorkshire and Humber, NIHR Applied Research Collaboration North West Coast, British Heart Foundation Data Science Centre, BHF Data Science Centre, Health Data Research UK, Office of National Statistics, Royal Devon and Exeter NHS Trust, as well as NIHR Clinical Research Network support. Plain English Summary of the health inequalities work within STIMUALTE-ICP: 23 interviews were completed with people with probable Long Covid We found… There was a lack of awareness of Long Covid, its symptoms and the support available for people with Long Covid An assumed lack of awareness of Long Covid within healthcare People with Long Covid symptoms experienced doubt and uncertainty about the cause of their symptoms Experiences of stigma and discrimination were commonly experienced by people with probable Long Covid. This included experiences of age and gender discrimination, experiences of being dismissed, unsympathetic attitudes and social exclusion. People with probable Long Covid reported feeling embarrassment, feeling tainted and/or different to others because of their Long Covid symptoms. In addition, they expected disbelief and/or judgement from others because of Long Covid People with Long Covid were sometimes reluctant to seek care due to worries surrounding possible investigations and medications, or worries about symptoms being wholly attributed to mental health conditions. There were also concerns about burdening the NHS. The nature of Long Covid symptoms made accessing care difficult. Long Covid symptoms can often come and go or fluctuate, and sometimes one symptom may be more prominent than others. This can mean some symptoms can be overlooked by patients and healthcare professionals. Experiences of people with Long Covid are also constitute epistemic injustice, or inequality surrounding creating, interpreting and conveying knowledge. This is due to the lack of awareness and knowledge of Long Covid both in the community and within healthcare. The findings are published here https://onlinelibrary.wiley.com/doi/abs/10.1111/hex.14037 Our recommendations: What we did Research findings from this study and the NIHR funded HICOVE study have been translated into an easily-usable webtool. This tool aims to encourage people with probable Long Covid who have not yet sought help and support from the NHS or other services to do so. It covers topics of self-doubt, stigma and effects on mental health as well as offering resources, tips, and advice on next steps. This tool is primarily aimed at people who may have Long Covid but are not currently accessing care but may also be helpful to those who are. It is also aimed at healthcare professionals, social prescribers, as well as community organisations to raise awareness about the difficulties and stigma people, particularly those from disadvantaged backgrounds, may face when considering reaching out for a consultation or community support. The webtool is available here: Supporting Long Covid Care ( long-covid-care.org.uk ) Where next? We are working on disseminating the Supporting Long Covid Care webtool as widely as possible and evaluating so that we improve it further. See our news article

Healthier Southampton Many of the things that affect our health also affect the environment. For example, the foods that we eat and whether we walk or drive. Some of these things also affect whether we can access good quality, nutritional food- for example, what lunches are provided by schools or colleges, and whether people can get a local allotment. It can be useful to see weight, food, and the environment as part of a complex system, a web of things that all influence each other. We are running a research exercise with local community members in Southampton on the 26th November, and we’ll share the results of that meeting here. We will run some more community gatherings on 3rd December 2025 where we will talk through the results of our research exercise and take part in a series of activities in small groups designed to explore the Southampton system in more detail. If you have any questions or comments about this research, please email j.l.barker@soton.ac.uk .

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

Talia Emmanuel is a PhD candidate in the Health Workforce & Systems research group at the University of Southampton. < Back What do nurses want? Improving nurses’ shift patterns - where do we start? Talia Emmanuel is a PhD candidate in the Health Workforce & Systems research group at the University of Southampton. Talia Emmanuel is a PhD candidate in the Health Workforce & Systems research group at the University of Southampton. In this blog, she summarises some key results from her recent research paper that explored nurses’ views and values around their shift patterns and working time. Talia Emmanuel -University of Southampton. As a PhD student, one must be well-prepared to answer the question…“What is your research about?”. I typically answer with “I’m trying to find ways of improving shift patterns for nurses when they’re working in hospital”. Enthusiastic nods usually follow, along with a quippy reply: “Wow, that sounds important and complicated ”. Although simply put, “important and complicated” neatly summarises the nuances of this topic. We recognise the significance of improving nurses’ working conditions in the context of persistent health workforce shortages, both nationally and internationally. However, we also realise that singular cure-all solutions are non-existent – there are too many factors at play. So, where do we start? Some of those complicating factors centre around how nurses’ working hours are organised. In hospitals, nurses often have to work in shifts that cover different periods of the 24-hour day. Previous research has identified various repercussions of working shifts (and in particular, working long shifts of 12-hours or more and night shifts): increased burnout , poor work-life balance , and risk of chronic illness and cancer on the long-term. Impacts to nurses’ performance and safety while at work have also been flagged, which pose knock-on effects on the quality of care patients ultimately receive. Despite these risks, shift work is a necessary reality for many nurses working in hospitals. Therefore, administrators and managers are tasked with organising nurses’ shifts into rotas that balance staff wellbeing with service demands and operational costs - and this is no easy feat. Further complications come from recent increased pressure on NHS employers to offer staff more say over their working patterns as a way of improving job satisfaction and their experiences of work. But this raises the question: What do nurses want? More specifically, what shift patterns do they prefer, and why? While there is some existing literature on this (an excellent summary can be found here ), our understanding of the factors that lead nurses to prefer certain shift patterns needs more work. As part of my doctoral research, I was eager to do a deep-dive into this area: I know that in order to find ways to improve nurses’ shift patterns, it is crucial to ask nurses themselves about their views and values around the organisation of their working hours. Fortunately, I had access to a rich data source around this topic: a recent survey study funded by the NIHR ARC Wessex that collected responses from nurses working across the UK and Ireland. My supervisors and I were particularly interested in nurses’ responses when asked: “ If you could choose your shift patterns, what would be the most important factor in that choice?” While we expected nurses to describe many diverse factors/preferences, we were hopeful of commonalities too. Nearly 800 nurses provided their open-ended responses to this question. We analysed all of them and developed 3 overarching themes: Theme 1, “When I want to work ”: Nurses shared many preferences for when they wanted to work, and equally, how they wanted their rest days to be arranged. Even though individual preferences differed, three general scheduling practices were also repeatedly mentioned as helpful: working less ‘harmful’ shift patterns from the start, working more consistent/predictable patterns, and having more flexibility and control over when to work. “Not working consecutive shifts so that I am exhausted by the time I get a day off.” “Know what I am doing each week, either set days or set nights, so I can predict what I am working…” “Having the freedom to give myself more days to recover between weekly shifts.” Theme 2, “Impacts to my life outside work” : Many factors emerged from nurses wanting shift patterns that enable a good work-life balance and minimise disruption to their lives outside work. Their preferences and priorities related to wanting quality recreational time with family and friends, to be able to arrange childcare easily and inexpensively, and having enough rest/recovery time to protect their own wellbeing. “Quality time with my children and family without being permanently drained, exhausted, and sad” “That the pattern could stay the same each week so it would be easier for childcare needs. Many nurseries like set days and when our rota is changing from week to week this can be difficult.” “…Not mixing days and nights in a week […] this does not observe HSE best practice guidelines and messes with the body clock and sleep patterns. It should not be allowed to happen.” Theme 3, “Improving my work environment” : Some nurses mentioned job-specific factors that influenced their choices, like wanting to work the shift patterns they believed to be best for patient care, or, working the best configuration of shifts for optimal take-home pay. But other concepts, like having sufficient staffing numbers and being able to take breaks, were also stressed. “A shift where I feel I have accomplished the care I have wanted to give for my patients” “To not have so much pressure on the shift, with the right amount of staff on and to take my break when needed”. When thinking back to the question “What shift patterns do nurses prefer, and why?”, these themes provide several helpful clues. They also highlight that while there is variation in nurses’ specific shift preferences, there are also more general scheduling practices that also support their priorities. For my research, this finding is particularly striking, as it moves away from the oft-assumption that there are “countless individual preferences that are difficult to accommodate” and toward the idea that there are more universal preferences too. Moreover, when these universal preferences are used during the scheduling process, nurses’ shift patterns can be improved overall. That sounds like a good starting point! Read our full analysis of nurses’ survey responses in the open-access research paper here Follow Talia: Twitter/X | ResearchGate Follow the UoS Health Workforce & Systems team: Twitter/X | UoS website Previous Next

c7fa8be0-4046-4345-a82a-ce4a38e05e07 Social network facilitated engagement in people who are Homeless to address InEqualities in alcohol related Liver Disease - The SHIELD feasibility study Principle Investigator: Dr Ryan Buchanan, University of Southampton Team: Professor Salim Khakoo, University of Southampton, Dr Mark Wright, University of Southampton, Dr Yun J Kim, University Hospital Southampton NHS Foundation Trust. Starts: 1/4/22 Ends: 1/4/23 Aim: To develop and assess the feasibility of a social network-based intervention to engage people who are homeless and at risk of alcohol-related liver disease with Hepatology services Background: Mortality in people who are homeless (PWAH) is eight times higher than the general population and liver cirrhosis is the third commonest cause of death. PWAH infrequently access hospital based Hepatology services for assessment. Alcohol consumption is a socially perpetuated behaviour that is known to cluster within human social networks. What we did Recruitment continued from February to July 2022 of people who are homeless with high risk of alcohol dependence (AUDIT score) were identified in hostels and at a homeless day centre in Southampton. Those people were then asked to take part in tests and to refer thier drinking partners to the programme. They were given supermarket vouchers as an incentive. Those homeless people who took part, filled in a survey and took part in an interview. They also had a test on their liver and were referred to liver health services. What did we find out? Fifty six peoople took part, all were from homeless hostels. Almost 20% of the group had a new diagnosis of cirrhosis, and there was a link between people who had type 2 diabetes or lived house where alcohol was present. Homeless people with hazardous alcohol consumption are socially connected to others that drink dangerously. This programme of referral can identify undiagnosed disease, however, engagement via trusted staff may be just as effective. The study highlights the importance of working with community organisations supporting underserved populations to overcome inequalities in liver disease and manage multi-morbidity. What's next? Identifying liver disease in people experiencing homelessness is progress but… Sustaining underserved populations with liver health care services after a diagnosis is made is crucial – we have since been awarded a further NIHR research grant in investigate how to approach this problem: To find out more: Follow @liverchampions https://www.southampton.ac.uk/research/projects/nihr-liver-disease-research-partnerships-liver-champions

Senior Research Assistant < Back Gabrielle Palermo Senior Research Assistant Ageing and Dementia Gabrielle Palermo is a Senior Research Assistant at the NIHR ARC Wessex Mental Health Hub, University of Southampton. She supports quantitative research on alcohol use disorder in older adults and contributes to other Hub projects involving complex routine datasets, including the OLA study. With over 20 years of experience in applied statistics, Gabrielle specialises in quantitative methods for epidemiological, socioeconomic, and public health research, particularly in the analysis of survey and administrative data. Her expertise includes multilevel modelling, complex survey design for cross-sectional and longitudinal data, data cleaning and linkage, and the treatment of missing data. She holds an MSc in Population Studies and a BSc in Statistics from ENCE–IBGE (Brazil). Her doctoral research focuses on statistical methodologies for unbalanced longitudinal data in sample-based educational panel studies, with emphasis on school effectiveness and pupil mobility. Since 2022, she has worked across multiple departments within the Faculty of Medicine at the University of Southampton, contributing to research in epidemiology and clinical trials. Previous Next

a95fe10a-8d2a-464a-8d99-2e3067bb89e8 ADOPTED PROJECT: ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis – A randomised pilot trial ADOPTED PROJECT: ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis – A randomised pilot trial Principal Investigators: Dr Don Urquhart , Dr Zoe Saynor Co Applicants : Mrs Lorna Allen (Cystic Fibrosis Trust), Professor Steve Cunningham, Professor Ioannis Vogiatzis , Professor Steff Lewis, Ms Aileen Neilson Partners: University of Portsmouth, University Hospital Southampton NHS Foundation Trust, University of Edinburgh, University of Northumbria at Newcastle, Cystic Fibrosis Trust, CF Warriors (Charity) Starts: May 2022 Ends: 31 October 2023 Background: Cystic fibrosis (CF) is the UK’s most common inherited genetic condition and affects more than 10,500 people. The disease causes problems with the movement of salt and water in the body, resulting in sticky mucus building up, mostly in the lungs and gut. Thick mucus in the airways leads to repeated infections which, over time, damage the lungs. Chest physiotherapy is prescribed to loosen and clear sticky thick mucus from the airways and so to help to reduce lung infection. Chest physiotherapy is a routine treatment to keep people with CF healthy. However, many say it is time consuming and a burden. People with CF have asked if doing exercise could have the same effect as chest physiotherapy sessions for helping clear mucus. Exercise could be more enjoyable and less burdensome. Through a recognised priority setting partnership, the CF community recently ranked research to ‘reduce the burden of their care’ and answer ‘whether exercise can replace chest physiotherapy’, as their number 1 and 7 priorities. Surveys show that many people with CF have occasionally chosen to replace chest physiotherapy with exercise for airway clearance, and we recently confirmed this through a UK-wide survey. We now need to know if they would be willing to take part in research that asks some to stop chest physiotherapy and to exercise (with coughs and huffs) instead. New medicine (modulators) have recently become available for many people with CF, bringing dramatic improvements in their health. Some people who have started modulators are considering whether they can reduce or stop treatments – including chest physiotherapy. So, we need to know the effects of stopping chest physiotherapy and determine if exercise can be used instead - our study aims to understand this. Our recent survey in people with CF, their families, physiotherapists and doctors, showed us that many consider hard exercise with coughs and huffs to be able to clear mucus from the airways. We will study 50 people with CF (>12 years old) for 28-days. We will ask half of them to continue their usual care, and half to stop chest physiotherapy and do exercise that gets them breathing deeply (with coughs and huffs) instead. We will see if people are willing to start and continue with such a study and what they think of the study processes. We will also see how stopping chest physiotherapy and replacing it with exercise affects measurements of their lung function. Within the study we will talk with people with CF and members of their CF team to understand their experiences. This information will tell us whether a larger study can answer Publications Safety, feasibility and efficacy of exercise as an airway clearance technique in cystic fibrosis: a randomised pilot feasibility trial | Thorax

d4e68544-5bd2-44f6-bac8-dd9848c01967 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. Findings from the study were used to support further funding and commissioning of WaDE, while also contributing to the expansion of academic research into health and justice interventions through continued involvement of the research team This includes an evaluation of JUNO which has evolved from WaDE

42074b03-6b8a-4374-ab92-19ec23c313f3 ADOPTED PROJECT: Happier Feet ADOPTED PROJECT: Happier Feet Disrupting the vicious cycle of healthcare decline in Diabetic Foot Ulceration through active prevention: The future of self-managed care Chief Investigator: Dr Andrew Weightman – University of Manchester Project Team Members: Dr Katherine Bradbury – University of Southampton, Professor Helen Dawes – University of Exeter, Mr Andrew Eccles – University of Strathclyde, Dr Safak Dogan – Loughborough University, Dr Glen Cooper – University of Manchester, Professor Frank Bowling – University of Manchester, Dr Xiyu Shi, Loughborough University, Professor Ahmeet Kondoz– Loughborough University Organisations Involved: Diabetes UK Background: There is a significant unmet clinical need for an adaptable, acceptable and adoptable technology to identify and prevent diabetic foot ulcer (DFU) formation, to enable self-management and timely clinical intervention to improve outcomes and reduce the economic burden of healthcare provision. Our primary purpose is to develop and implement an adaptable, acceptable, and cost- effective smart sensing insole technology which can detect when a DFU is likely to occur and can adapt plantar tissue loading to prevent formation, thus enabling self-management. This project proposes to build and expand on current smart insole technologies for the detection of DFUs, utilising a sensor fusion approach for their identification. A smart insole with integrated pressure (normal, shear), temperature, gait (IMU) and mechanomyography (acoustic) sensors will identify early indicators of ulceration and when movement is appropriate/inappropriate. The smart insole will respond to these inputs and adjust the foot (and gait), through an array of artificial muscles, to support better (safe/ comfortable) movement. This project aims to co-develop this new smart sensing insole with people living with diabetic foot ulcers. We hope to establish: What patients think of the idea of a smart sensing insole for early detection of DFUs which includes the provision to adjust the foot to reduce pressure on areas of likely ulceration. A prototype insole and optimised this with patient feedback. Early safety testing of this device. Security protocols to enable secure storage and sharing of data from this insole (e.g., between patient and clinicians). Publications Journal of Participatory Medicine - Developing a Smart Sensing Sock to Prevent Diabetic Foot Ulcers: Qualitative Focus Group and Interview Study In-shoe plantar temperature, normal and shear stress relationships during gait and rest periods for people living with and without diabetes | Scientific Reports