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COMPLETED: The ImPACt study - Improving physical activity of older people in the community Club members at Brendoncare joining in group exercise Principal Investigator: Dr Stephen Lim Team members: Dr Stephen Lim (NIHR Clinical Lecturer in Geriatric Medicine, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Professor Helen Roberts (Professor of Medicine for Older People, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Dr Kinda Ibrahim (Senior Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Esther Clift (Consultant Practitioner in Frailty, Southern Health NHS Foundation Trust, Lymington New Forest Hospital), Samantha Agnew (Head of Clubs Services, The Brendoncare Foundation , Winchester), Pam Holloway (Patient representative) Start: 1 February 2020 Ended: 31 October 2021 Project Partners: University of Southampton, University Hospital Southampton NHS Foundation Trust, Southern Health NHS Foundation Trust, Brendoncare. Lay summary Physical activity is important for older people. It has many benefits including maintaining older people’s ability to perform activities of daily living, be independent, and improve their well-being. However, many older adults living in the community do not engage in regular physical activity. Findings We found that we could train volunteers to support older people during the COVID-19 pandemic to stay active by performing exercises that help strengthen their muscles. Trained volunteers from Brendoncare led the online group exercises for older people who attended online community clubs during the COVID-19 pandemic. This was a challenging time when social distancing and lockdown rules were in place, which limited opportunities for older people to stay active. We recruited 19 volunteers, and 15 volunteers completed the training. The volunteers were mainly female (78%), with an average age of 68 years. The exercises were seated exercises and older adults were given exercise bands to increase the exercise intensity. Halfway through the study, lockdown restrictions were lifted, and some groups continued the group exercise in a face-to-face setting. The volunteers led 184 group weekly exercise sessions (127 online and 57 in-person). 30 older adults participated in the group exercises. We interviewed volunteers, older adults and Brendoncare staff to find out more about what they thought of the online group exercise. The older adults enjoyed the intervention and understood the benefits of exercising. Additionally, they felt that they could exercise in a relaxed way with their peers without fear of being judged. The group exercises helped reduce social isolation and motivated older adults to engage with the exercises. Volunteers were enthusiastic to support the exercise groups. They appreciated the training and opportunity to lead the group exercises. One volunteer reported that the role gave her a sense of purpose by playing an active role the community club. Brendoncare staff members were a great help to the older adults and supported them with any issues, in particular those who were less familiar with the internet. At six months, we found that older adults who participated in the group exercise had an improved physical activity level. The time spent in light physical activity per week improved from an average of 1530 minutes per week to 1620 minutes per week. Only two minor incidents happened during the group exercises. Two participants experienced worsening of old injuries while performing the exercises. Overall, we found that volunteers can be trained to lead online group seated exercises. The exercises were safe and older adults enjoyed the exercises as well as the social interaction in the group setting. What we did with the new knowledge We supported Brendoncare in continuing the exercise groups after the study had ended. We presented our study findings to the board of trustees and demonstrated the exercises. Brendoncare has since employed an activity coordinator to continue to role of training volunteers and supporting volunteer-led exercise groups within Brendoncare. We trained the activity coordinator and shared our exercise sheets and other study materials to help Brendoncare develop their own training package. They are now actively recruiting more volunteers to lead group exercises in their community clubs. https://www.brendoncare.org.uk/get-involved/support-us/volunteering/#:~:text=Chair%20Based%20Exercise%20Volunteer,improving%20their%20health%20and%20wellbeing . Where next? Having explored how we can trained volunteers to engage with healthy community-dwelling older adults to stay active through online group exercises, we collaborated with researchers from the Southampton Biomedical Research Centre and Bournemouth University to further develop this volunteer-led online intervention. We have been successful in securing research funding (£51,000) from University Hospital Southampton NHS FT to conduct a study to explore a multimodal intervention consisting of exercise, nutrition and behaviour change support, to engage with older people living with frailty who have been discharged from hospital, to stay active and eat well. This research is now underway and due to be reported in the summer of 2024. What did people say about the work? Volunteer : “We do it because we want to help others…. we enjoy it. I'm gonna go back to belonging again, I feel that I'm benefiting from the group. Because again, I feel like I belong to that group….. I get so much out of it.” Club member: ‘We are not self-conscious when they (volunteers) are around. We have a laugh as well.’ Club member: ‘I’ve really enjoyed it because it keeps you in touch with people, especially during this COVID….. I still feel as if I’m part of a group.’ NEWS: ImPACT volunteers recognised for their wor k ImPACt exercise video IMPACT Exercise with Steve and Esther from NIHR ARC Wessex on Vimeo . Impact Exercise video using Resistance bands - Dr Sam Meredith watch the video on Vimeo

Domestic Abuse and Life-Limiting Illness: identifying and supporting adults at risk (DALLI Study) Principal Investigator: Dr Michelle Myall Team Members: Dr Michelle Myall (Principal Research Fellow ARC Wessex, School of Health Sciences, University of Southampton); Sophia Taylor (Senior Research Assistant , School of Health Sciences, University of Southampton); Dr Susi Lund (Visiting Research Fellow, School of Health Sciences, University of Southampton); Karen Drake (Matron in Specialist Palliative Care, Salisbury NHS Foundation Trust); Sally Dace (Patient and Public Representative) Start : 1 January 2021 Ends: 30 September 2024 Project Partners: University of Southampton; University Hospital Southampton NHS Foundation Trust (UHS); Weldmar Hospicecare, Dorset; Salisbury NHS Foundation Trust; Yellow Door Domestic and Sexual Abuse Charity; Southampton City Council; The Rowans Hospice, Portsmouth; Body Positive, Dorset ; Citizens Advice Southampton; Hampshire Macmillan Cancer Support Citizens Advice Service Summary of Findings Why the study is important In England and Wales an estimated 2.4 million adults experience domestic abuse (DA). People living with a life-limiting illness (LLI) are at increased risk of DA because they are vulnerable, frail, isolated and dependent on others. They may spend long periods of time in the home, in close proximity to the abuser, who is often their carer, and have difficulty accessing help and support. To date, little attention has been paid to the experiences of those living with a life-limiting-illness who are victims of DA, their specific needs and the extent to which these are being met by statutory and specialist and non-specialist services. Furthermore, we know little about the views and experiences of health and social care professionals who provide support to them. What we did Between 2021-2024 we conducted the mixed-method DALLI (Domestic Abuse and Life-Limiting Illness) study, which explored DA where it co-exists with LLI. Initially we carried out scoping work comprising a literature review; survey to map local service provision; and held informal discussions with those with lived experience, health and social care professionals working in hospice and palliative care services, and specialist domestic abuse organisations. This helped to identify research priorities and focus of the study. What we found Our scoping review highlighted the impact that DA has on mental health and wellbeing which can result in delays in screening, leading to late diagnosis and an illness advancing with only palliative rather than curable treatments being available. We know many people living with a LLI and at end-of-life are likely to access palliative and other health and care services frequently. Trusted relationships with healthcare professionals (HCP), enhanced by continuity of care can lead to the development of interpersonal trust between patient and HCP, increasing the likelihood of disclosures of abuse. However, interviews with health and social care professionals highlighted a lack confidence to ask about abuse, and challenges with recognising signs of abuse amongst the complexities of DA in the LLI context. This highlighted the need for increased training, education, and continued professional development in this area. Working with hospice and palliative care professionals, specialist and non-specialist third sector organisations, and people with lived experience, we established a Community of Practice and held a series of workshops with them over 15 months to co-develop the DALLI Toolkit. We also conducted interviews with health and care professionals and people from relevant third sector organisations to help inform Toolkit content. The Toolkit, which complements existing safeguarding policies, aims to increase practitioners’ confidence and understanding offering resources to support health and social care professionals working with people with a LLI identify and respond to DA encountered in practice. Outcomes Following piloting and evaluation the Toolkit has been adopted in a small number of hospice and palliative care settings in Wessex, and following discussions with Marie Curie’s Head of Safeguarding, is to be implemented in Marie Curie Hospices nationwide and included on their website as a resource for healthcare professionals. The Toolkit is also being used by domestic abuse services in local authorities and as an educational resource for social workers at a local university. Next steps It is now our aim to achieve greater impact and encourage adoption and spread to extend the Toolkit’s reach to other hospice and palliative care organisations and potentially other health and social care services. We have secured Impact Funding from Marie Curie to enable us to work with a professional production company to create a short promotional film about the DALLI Toolkit, and its use in practice, and hold a launch event in the Autumn 2024 to publicise the film and Toolkit and encourage wider adoption. Embedding and integration of the Toolkit will enable health and social care professionals to improve understanding of the complexities of DA in the LLI context and increase confidence to ask about and respond to DA. Please see below copies of the DALLI toolkit and quick reference guide DALLI Toolkit v5.0 040324 .pdf Download PDF • 1.40MB DALLI Toolkit Quick reference Guide v0.3 140623[9] .pdf Download PDF • 260KB

Wessex DIET: Determining the Impact of covid-19 on food sEcurity in young families and Testing interventions Joint Lead: Professor Nisreen Alwan and Dr Dianna Smith . Co Applicants : Nida Ziauddeen , Tim Lloyd, Dr Marta Disegna , Ravita Taheem, Sally Shillaker, Fran Richards, Duncan House, Sara Crawford. Partners: Southampton City Council, University of Southampton, Bournemouth University, Solent NHS Trust. starts: 1 November 2021 Ends: 31 March 2024 Publications: Household food insecurity risk indices for English neighbourhoods: Measures to support local policy decisions News: New map shows regions in the UK with a higher risk of food insecurity Lay Summary Aim of the research : We will explore the impact of system shocks on food security, diet quality and health in young families across Wessex, using the covid-19 pandemic and lockdowns as an example of such shocks. We will find out if Council-supported food aid initiatives to counter difficulties around adequate and healthy diet are acceptable, well taken-up and impactful in local populations. This will lead to a toolkit that can be used by Councils to decide which initiatives are best for their populations. Background: The covid-19 pandemic restrictions are likely to have negatively impacted UK families in many ways, including food insecurity (not having enough food because of cost or other barriers, or not having good quality food). Food insecurity has negative health impacts in the short-term including weight gain, malnutrition, poor mental health; these may lead to longer term health outcomes including obesity, diabetes, anxiety, and depression. Local Councils in Wessex have a range of initiatives to help this situation, including food pantries, where eligible families can purchase a range of items at a greatly reduced price, and recipe boxes. Design and methods During this 2-year project we will: Use statistical modelling to explore the effect of the covid-19 pandemic on important aspects of health and wellbeing in Wessex’s families with children under age 12, including their diet quality, food availability, weight status and mental health. Interview families to explore how they coped with the changing social and economic circumstances during the pandemic particularly in relation to their food quality and purchasing behaviours, Work with the local Councils in Southampton and Dorset to evaluate the initiatives to improve diet in disadvantaged families including food pantries. Public Patient Involvement: We involved public contributors in the design of this research through three meetings with 12 contributors overall. We have a public contributor as a co-applicant. Our PPI activities will ensure the interventions reflect the individual needs of young families in the target groups, and that the outreach activities to support the interventions are properly communicated. We already have ongoing public engagement activities involving Sure Start within our existing ARC project which we will continue to utilise. We have and willcontinue to actively involve people on the frontline of food aid systems in shaping this research. Dissemination: We will produce an implementation toolkit for Councils to aid decision-making on food-aid initiatives. Non-academic outputs will be specific to the audience and will include videos, presentations, social media posts and flyers. For public health/councils, short reports on the findings in the form of policy briefs will add to academic content and presentations. We will follow successful models like the oral health posters to Family Hubs delivered by Solent Health.

Developing training for person-centred care: adapting the Chat & Plan for use in domiciliary care Chief Investigator: Dr Teresa Corbett, Visiting Research Fellow, School of Health Sciences , University of Southampton and Senior Lecturer in Psychology, Solent University. Co-Investigators: Professor Jackie Bridges, Professor of Older People's Care, School of Health Sciences, University of Southampton Dr Nicola Andrews, Research Fellow - NIHR ARC Wessex , School of Health Sciences, University of Southampton Cindy Brooks, Research Fellow - NIHR ARC Wessex , School of Health Sciences, University of Southampton Dr Pippa Collins, Advanced Clinical Practitioner, Post Doc Research Fellow – NIHR ARC Wessex, School of Health Sciences, University of Southampton Collaborating organisations: Hampshire County Council – Maria Hayward, Learning & Development Service Manager and Implementation Champion Bournemouth, Christchurch and Poole Council – Alison Pearman, Service Improvement Manager Wessex AHSN – Cheryl Davies, Senior Programme Manager (Healthy Ageing) Skills for Care – Debbie Boys, Locality Manager – Hampshire, Southampton, Portsmouth and Isle of Wight Purple Lilac Healthcare - Violet Chatindo, Registered Manager Right at home – Andrew Davis, Registered Manager Partners in Care – Kate Blake, Manager Start date: 1/6/23 End date: 1/9/24 Aim of the research The aim of this research is to adapt a communication tool for use by social care workers and to find out what type of information we should include in a training package for social care workers providing domiciliary care (e.g., practical help and support in the community) to support its use. This study will help us to make a training course that we can try out with social care workers in future research. Background to the research We made a tool to help healthcare staff to talk to older adults about their needs. This tool has 8 steps that should be followed in a discussion with people about their needs and personal goals. However, the tool might need to be changed if we want to use it in domiciliary or other social care settings instead of healthcare (e.g., the NHS) settings. In this research, we want to see if we need to change the tool so that it can be used by social care workers. We also want to find out about how we might be able to train social care workers to improve how they talk to older adults about their needs. Design and methods used We will study existing courses, workshops and training so that we can find out more about how we should plan our training. We will also interview social care workers to find out more about what they do in their role. We will ask them to tell us what they think of the tool, and what changes we might need to make to it. Up to 15 social care workers will take part. We will make a draft of what will be included in the training. Experts will discuss the training and we will make changes based on what they say. We will interview some more social care workers to find out what they like or do not like about the training plan we have made. Patient, public and community involvement Members of the public have been part of the study so far in many ways. They have helped us to make the tool that we will ask social care workers about. We will also work with experts in social care who have agreed to help us to in a number of ways. These include: · Looking over content and letting us know what they think. · Coming to project meetings. · Helping to plan the study. · Looking over study information that we will send to participants. · Helping us to make sense of the research findings. Dissemination We will share our findings at conferences and at events with audiences who are interested in our study. We will also write about our findings for academic and public audiences via Communications channels (e.g. relevant websites, social media, newsletters). We will also share findings with those working in social care, e.g., via domiciliary care forums (each local authority has one) and with Learning and development teams in local authorities.

Publications Filter by theme or subject area Select theme or subject area Theme: Long Term Conditions Beyond individual responsibility: Exploring lay understandings of the contribution of environments on personal trajectories of obesity Serrano-Fuentes N, Rogers A, Portillo MC Reversing the upward trajectory of obesity requires responding by including the multiple influences on weight control. Research has focused on individual behaviours, overlooking the environments where individuals spend their lives and shape lifestyles. Thus, there is a need for lay understandings of the impact of environments as a cause and solution to obesity. This research aimed to understand the influence of environments on the adoption of health practices in adults with obesity and to identify lay strategies with which to address environmental barriers to behaviour change. https://doi.org/10.1371/journal.pone.0302927 May 2024 Theme: Long Term Conditions Interventions to Foster Resilience in Family Caregivers of People with Alzheimer's Disease: A Scoping Review. Santonja-Ayuso L, Corchón-Arreche S, Portillo MC The family caregiver of a person with Alzheimer's disease still experiences, in most cases, negative consequences in their biopsychosocial environment, which are related to the acquisition of this role. However, it has been observed that this fact is not universal in this type of population since benefits can be obtained in the act of caring through the development of resilience. Given this possibility and given that nurses are the health professionals who support people in this illness process, there is an urgent need to identify which non-pharmacological interventions could improve or promote resilience in family caregivers of people with Alzheimer's disease. https://doi.org/10.3390/ijerph21040485 April 2024 Theme: Long -Term Conditions Physical activity and mental health in individuals with multimorbidity during COVID-19: an explanatory sequential mixed-method study Ambrosio L, Faulkner J, Morris JH, Stuart B, Lambrick D, Compton E, Portillo MC The objective of this study is to understand the physical activity and mental health of individuals living with long-term conditions during the COVID-19 pandemic. It is a sequential explanatory mixed-methods study with two phases: phase 1: quantitative survey and phase 2: qualitative follow-up interviews. https://doi.org/10.1136/bmjopen-2023-079852 April 2024 Theme: Workforce & Health Systems Causes and solutions to workplace psychological ill-health for nurses, midwives and paramedics: the Care Under Pressure 2 realist review Maben J, Taylor C, Jagosh J, Carrieri D, Briscoe S, Klepacz N, Mattick K Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves. The aimof this study is to improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions. https://doi.org/10.3310/twdu4109 April 2024 Theme: Ageing & Dementia Barriers and motivators to undertaking physical activity in adults over 70-a systematic review of the quantitative literature Kilgour AHM, Rutherford M, Higson J, Meredith SJ, McNiff J, Mitchell S, Wijayendran A, Lim SER, Shenkin SD Physical activity (PA) has multiple benefits for older adults (≥70 years old). Despite this many older adults do not undertake the World Health Organisation guideline recommended amount of PA. This systematic review examines barriers and motivators to PA in adults aged ≥70 years. We analysed the quantitative literature, including observational studies and baseline data from randomised controlled trials. Studies examining specific diseases (e.g. cognitive impairment), or care home residents were excluded. Database searches of ASSIA, CINAHL, Embase, Medline, PsycINFO and Web of Science were undertaken on 7 March 2023. Quality assessment was performed using the ROBANS tool. We synthesised the results using the socioecological model. The protocol was registered on PROSPERO (CRD42021160503) https://doi.org/10.1093/ageing/afae080 April 2024 Theme: Healthy Communities Barriers to healthcare access: findings from a co-produced Long Covid case-finding study Clutterbuck D, Ramasawmy M, Pantelic M, Hayer J, Begum F, Faghy M et al Long Covid is often stigmatised, particularly in people who are disadvantaged within society. This may prevent them from seeking help and could lead to widening health inequalities. This coproduced study with a Community Advisory Board (CAB) of people with Long Covid aimed to understand healthcare and wider barriers and stigma experienced by people with probable Long Covid. An active case finding approach was employed to find adults with probable, but not yet clinically diagnosed, Long Covid in two localities in London (Camden and Merton) and Derbyshire, England. Interviews explored the barriers to care and the stigma faced by participants and were analysed thematically. This study forms part of the STIMULATE-ICP Collaboration. https://doi.org/10.1111/hex.14037 April 2024 Theme: Healthy Communities Domestic Abuse in the Context of Life-Limiting Illness: A Systematic Scoping Review Michelle Myall, Sophia Taylor, Sally Wheelwright, Susi Lund Domestic abuse is a global public health issue which impacts the health and wellbeing of victim-survivors and their families. While prevalence of domestic abuse is consistent amongst individuals and groups, some experience additional inequalities, vulnerabilities, and risk factors. This includes people living with life-limiting illnesses such as incurable cancer, neurological conditions and progressive heart, pulmonary, and renal conditions, who are at increased risk of domestic abuse because they are vulnerable, frail, isolated, and dependent on others. People with a life-limiting illness are more likely to spend long periods in the home, in close proximity to the perpetrator who may also be their caregiver, and experience multiple barriers to accessing and seeking support and may be less willing or able to escape the abusive situation. Lockdown and social isolation measures implemented to combat COVID-19 exacerbated the risk for those with a life-limiting illness experiencing domestic abuse. Existing patterns of abuse increased in terms of frequency and type. To date, little is known about domestic abuse in the context of life-limiting illness, including the experiences and support needs of those affected; awareness, knowledge, and understanding of domestic abuse and life-limiting illness amongst health and care professionals and third sector organisations or their views and experiences of enquiring about, responding to, and supporting adults living with a life-limiting illness impacted by domestic abuse. This review has been undertaken as part of a wider study (DALLI) to coproduce a toolkit to enable hospice and palliative care practitioners to identify and respond to domestic abuse. The review is needed to inform understanding about the coexistence of domestic abuse and life-limiting illness, address gaps in academics and practitioners’ knowledge, and identify areas for further research. https://doi.org/10.1155/2023/1841944 April 2023 Theme: Long -Term Conditions Exercise as an Airway Clearance Technique in people with Cystic Fibrosis (ExACT-CF): rationale and study protocol for a randomised pilot trial Urquhart DS, Cunningham S, Taylor E, Vogiatzis I, Allen L, Lewis S, Neilson AR et al Chest physiotherapy is an established cornerstone of care for people with cystic fibrosis (pwCF), but is often burdensome. Guidelines recommend at least one chest physiotherapy session daily, using various airway clearance techniques (ACTs). Exercise (with huffs and coughs) may offer an alternative ACT, however the willingness of pwCF to be randomised into a trial needs testing. The 'ExACT-CF: Exercise as an Airway Clearance Technique in people with Cystic Fibrosis' trial will test the feasibility of recruiting pwCF to be randomised to continue usual care (chest physiotherapy) or replace it with exercise ACT (ExACT) for 28-days. Secondary aims include determining the short-term clinical impact (and safety) of stopping routine chest physiotherapy and replacing it with ExACT, and effects on physical activity, sleep, mood, quality of life and treatment burden, alongside preliminary health economic measures and acceptability. https://doi.org/10.3310/nihropenres.13347.1 December 2022 Theme: Workforce & Health Systems A protocol for a cross-sectional survey exploring the work lives and wellbeing of the mental health nursing workforce in the UK Klepacz N, Wadey E, Griffiths P, Woodnutt S, Snowden J, Smith C et al Demand for mental health services is high, but so are vacancy levels for registered nurses in mental health. To effectively address the workforce disparity, we need to engage with nurses to understand better the rewards and challenges of being part of the UK's mental health nursing workforce. The aim of the study set out in this protocol will be to identify modifiable workplace factors impacting nurses' work lives and wellbeing. https://doi.org/10.12968/bjmh.2023.0037 February 2024 Theme: Workforce & Health Systems Inpatient midwifery staffing levels and postpartum readmissions: a retrospective multicentre longitudinal study Turner LY, Saville C, Ball J, Culliford D, Dall'Ora C, Jones J et al Preventing readmission to hospital after giving birth is a key priority, as rates have been rising along with associated costs. There are many contributing factors to readmission, and some are thought to be preventable. Nurse and midwife understaffing has been linked to deficits in care quality. This study explores the relationship between staffing levels and readmission rates in maternity settings. 10.1136/bmjopen-2023-077710 April 2024 Theme: Workforce & Health Systems Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey Remmington C, Cameron L, Hanks F, Liang YH, Barrow L, Coxhead R et al There is good evidence describing pharmacy workforce and service provision in general critical care units. However, no data exist from adult extracorporeal membrane oxygenation (ECMO) centres. The aim of this study is to describe workforce characteristics, pharmacy service provision, and pharmaceutical care activities in critical care units (CCUs) providing an adult ECMO service in the United Kingdom (UK) and compare to national staffing standards for CCUs. https://doi.org/10.1007/s11096-024-01719-9 April 2024 Theme: Workforce & Health Systems The association between midwifery staffing and reported harmful incidents: a cross-sectional analysis of routinely collected data Turner L, Ball J, Meredith P et al. Independent inquiries have identified that appropriate staffing in maternity units is key to enabling quality care and minimising harm, but optimal staffing levels can be difficult to achieve when there is a shortage of midwives. The services provided and how they are staffed (total staffing, skill-mix and deployment) have been changing, and the effects of workforce changes on care quality and outcomes have not been assessed. This study aims to explore the association between daily midwifery staffing levels and the rate of reported harmful incidents affecting mothers and babies. https://doi.org/10.1186/s12913-024-10812-8 March 2024 Theme: Long Term Conditions Methodological Proposal for the Adaptation of the Living with Long-Term Conditions Scale to the Family Caregiver Marín-Maicas P, Portillo MC, Corchón S, Ambrosio L Caring for people living with LTCs has a negative impact on the quality of life of caregivers, affecting their psychological, emotional, social, physical, and financial well-being. Evaluating how the family caregivers live with LTC can provide social health professionals with important information when planning interventions that favor better living . Therefore, it would be useful to have a tool available that allows for objectifying the degree to which people live with LTCs, for both the individuals affected by LTCs and the family caregiver. Presently, many scales exist that allow for measuring different concepts in family caregivers.However, although an instrument exists that measures the degree of living with LTC, according to the people with LTCs the “Living with Chronic Illness Scale” , no instrument was found that measures the degree of living with LTCs of family caregivers that includes all the dimensions that shape said process. This gap in the literature, in relation to measurement instruments that evaluate how the family caregiver experiences living with LTCs, is the common thread in this work. Based on an instrument created for people living with LTCs, an adaptation of this scale was planned to extend the reach of the instrument to family caregivers. Numerous recommendations exist on the process of adaptation of a scale to a context different from which it was created, but the available guides only refer to the methodological process for their transcultural adaptation, and especially to the guidelines established that allow the use of the scale in a language that is different from the one used for its creation. However, no specific system with the necessary methodological steps to be taken for the adaptation of the EC-PC to the family caregiver was found. Therefore, the aim of this study is to present a detailed description of the methodological process of adapting the EC-PC to the family caregiver (EC-PC-Family), providing transparency to the process followed to construct a robust instrument, to contribute towards filling the gap found in the scientific literature. https://doi.org/10.3390/nursrep14010041 March 2024 Theme: Ageing & Dementia Consequences of Anorexia of Aging in Hospital Settings: An Updated Review Cox NJ The anorexia of aging is a widespread problem amongst older people, particularly in the hospital setting with up to 60% affected. Despite its high prevalence anorexia often goes undiagnosed in hospital, due to a lack of standardized assessment and evidence-based management, but also lack of knowledge regarding consequences. This review summarizes current evidence for anorexia of aging specific to the hospital setting, giving an overview of correlates of appetite in hospital and consequences of anorexia. It highlights an overall scarcity of research on this important clinical problem for hospitalized cohorts. The few studies point to the importance of anorexia of aging in major health burdens for older people, namely malnutrition, sarcopenia and reduced physical performance, as well as higher mortality. Further research is needed to assess temporal sequence in pathways of causality and to develop effective interventions to combat anorexia. https://doi.org/10.2147/cia.s431547 March 2024 Theme: Healthy Communities Silymarin (Milk Thistle) Treatment of Adults With Gambling Disorder: A Double-Blind, Placebo-Controlled Trial Grant JE, Driessens C, Chamberlain SR Data on the pharmacological treatment of gambling disorder are limited. Silymarin (derived from milk thistle) has antioxidant properties. The goal of the current study was to determine the efficacy and tolerability of silymarin in adults with gambling disorder. 10.1097/WNF.0000000000000585 March 2024 Theme: Ageing & Dementia Healthcare professionals' experiences and views of providing continence support and advice to people living at home with dementia: "That's a carer's job" Bradbury B, Chester H, Santer M, Morrison L, Fader M, Ward J, Manthorpe J, Murphy C People living with dementia at home and their family carers often feel unsupported by healthcare professionals in managing continence problems. In turn, primary and community-based healthcare professionals have reported lacking specific knowledge on dementia-continence. This study aimed to understand more about healthcare professionals' experiences and views of supporting people living with dementia experiencing continence problems, as part of developing acceptable resources. Having a nuanced understanding of unmet need would facilitate the design of engaging resources that enable healthcare professionals to provide more effective continence support to people living with dementia at home. https://doi.org/10.1186/s12877-024-04830-8 March 2024 Theme: Healthy Communities Cognitive function and skeletal size and mineral density at age 6-7 years: Findings from the Southampton women's survey Moon RJ, D'Angelo S, Crozier SR, Fernandes M, Fall C, Gale CR et al Poor cognitive function and osteoporosis commonly co-exist in later life. In women, this is often attributed to post-menopausal estrogen loss. However, a common early life origin for these conditions and the associations between cognitive function and bone mineral density (BMD) in childhood have not previously been explored. We examined these relationships at age 6–7 years in the Southampton Women's Survey (SWS) mother-offspring cohort. https://doi.org/10.1016/j.bone.2024.117067 March 2024 Theme: COVID-19 Employment outcomes of people with Long Covid symptoms: community-based cohort study. Ayoubkhani D, Zaccardi F, Pouwels KB, Walker AS, Houston D, Alwan NA Evidence on the long-term employment consequences of SARS-CoV-2 infection is lacking. We used data from a large, community-based sample in the UK to estimate associations between Long Covid and employment outcomes. https://doi.org/10.1093/eurpub/ckae034 March 2024 Theme: Ageing & Dementia Towards an improved dementia care experience in clinical radiography practice: A state-of-the-art review Abowari-Sapeh ME, Ackah JA, Murphy JL, Akudjedu TN The increasing global incidence rate of dementia and associated co/multimorbidity has consequently led to a rise in the number of people with dementia (PwD) requiring clinical radiography care services. This review aims to explore and integrate findings from diverse settings with a focus on the experiences of PwD and stakeholders, towards the development of a holistic approach for dementia care and management within the context of radiography services. https://doi.org/10.1016/j.jmir.2024.01.008 February 2024 Theme: Ageing & Dementia The anorexia of ageing and risk of mortality: More than a story of malnutrition? Cox NJ, Lim SE Appetite loss or anorexia due to physiological, psychological and socioenvironmental effects of the aging process is termed the anorexia of aging. The link between anorexia of aging and mortality has subsequently been established by a number of longitudinal studies across multiple settings. Despite the association, clear interpretation of the mechanistic relationship between anorexia of aging and mortality, has been limited. https://doi.org/10.1016/j.jnha.2024.100173 February 2024 Theme: Workforce & Health Systems Photovoice: An active learning tool with community nursing students Andina-Díaz E, Welch L, Siles-González J, Serrano-Fuentes N, Gutiérrez-García AI, Solano-Ruiz M Objective: To assess nursing students' experiences of using photovoice as a pedagogical approach to active learning in the community. Methods: A descriptive design with a cross-sectional mixed-method questionnaire was used with 108 students following an educational activity, in which their communities were photographed and the impact of the pandemic on vulnerable populations was reflected. Descriptive statistics and thematic analysis were used to analyze the data. https://doi.org/10.1111/phn.13285 February 2024 Theme: Workforce & Health Systems What might make nurses stay? A protocol for discrete choice experiments to understand NHS nurses' preferences at early-career and late-career stages Ejebu OZ, Turnbull J, Atherton I, Rafferty AM, Palmer B, Philippou J, Prichard J, Jamieson M, Rolewicz L, Williams M, Ball J Like many countries, England has a national shortage of registered nurses. Employers strive to retain existing staff, to ease supply pressures. Disproportionate numbers of nurses leave the National Health Services (NHS) both early in their careers, and later, as they near retirement age. Research is needed to understand the job preferences of early-career and late-career nurses working in the NHS, so tailored policies can be developed to better retain these two groups. https://doi.org/10.1136/bmjopen-2023-075066 February 2024 Theme: Long Term Conditions Change in treatment burden among people with multimorbidity: a follow-up survey Hounkpatin HO, Roderick P, Harris S, Morris JE, Smith D, Walsh B, Roberts HC, Dambha-Miller H, Tan QY, Watson F, Fraser SD Background: Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. Little is known about change in treatment burden over time for people with multimorbidity. Aim: To quantify change in treatment burden, determine factors associated with this change, and evaluate a revised single-item measure for high treatment burden in older adults with multimorbidity. https://doi.org/10.3399/bjgp.2022.0103 October 2022 Theme: Workforce & Health Systems Position Paper on the Reporting of Norepinephrine Formulations in Critical Care from the Society of Critical Care Medicine and European Society of Intensive Care Medicine Joint Task Force Wieruszewski PM, Leone M, Kaas-Hansen BS, Dugar S, Legrand M, McKenzie CA, Bissell Turpin BD, Messina A, Nasa P, Schorr CA, De Waele JJ, Khanna AK Objectives: To provide guidance on the reporting of norepinephrine formulation labeling, reporting in publications, and use in clinical practice. Design: Review and task force position statements with necessary guidance. https://doi.org/10.1097/ccm.0000000000006176 January 2024 Theme: Long Term Conditions Person-centred integrated care for people living with Parkinson's, Huntington's and Multiple Sclerosis: A systematic review Bartolomeu Pires S, Kunke Dl, Kipps C, Goodwin N, Portillo MC People living with long-term neurological conditions (LTNCs) have complex needs that demand intensive care coordination between sectors. This review aimed to establish if integrated care improves outcomes for people, and what characterises successful interventions. https://doi.org/10.1111/hex.13948 January 2024 Theme: Workforce & Health Systems Nursing 12-Hour Shifts and Patient Incidents in Mental Health and Community Hospitals: A Longitudinal Study Using Routinely Collected Data Dall’Ora C, Ejebu OZ, Jones J, Griffiths P Shifts of 12 hours or longer are common in nursing services within general hospital wards. Concerns have been raised about their safety, but previous research has mostly used staff-reported measures of quality and safety and has occurred in general hospital settings only. This study aims to measure the association between the use of 12+ hour shifts in nursing staff (including registered nurses, healthcare support workers or nursing assistants, and nursing associates) and the rate of patient incidents in mental health and community hospitals https://doi.org/10.1155/2023/6626585 January 2024 Theme: Workforce & Health Systems Evidence on the use of Birthrate Plus® to guide safe staffing in maternity services - A systematic scoping review Griffiths P, Turner L, Lown J, Sanders J Birthrate Plus® is a widely used tool that informs decisions about the number of midwifery staff needed to provide safe and high quality care in maternity services. Evidence about the effectiveness, validity, reliability, and feasibility of tools such as this is needed. https://doi.org/10.1016/j.wombi.2023.11.003 January 2024 Theme: Ageing & Dementia Perfusion Imaging and Inflammation Biomarkers Provide Complementary Information in Alzheimer's Disease Michopoulou S, Prosser A, Dickson J, Guy M, Teeling JL, Kipps C Single photon emission tomography (SPECT) can detect early changes in brain perfusion to support the diagnosis of dementia. Inflammation is a driver for dementia progression and measures of inflammation may further support dementia diagnosis. In this study, we assessed whether combining imaging with markers of inflammation improves prediction of the likelihood of Alzheimer's disease (AD). https://doi.org/10.3233/jad-230726 January 2024 Theme: General publications Using collaborative autoethnography to explore the teaching of qualitative research methods in medicine Ibrahim K, Weller S, Elvidge E, Tavener M This article explores experiences of teaching qualitative research (QR) broadly, and qualitative methods (QM) more specifically in medicine, highlighting the challenges faced, and offering recommendations for overcoming them. https://doi.org/10.1007/s10459-023-10224-z May 2023 Theme: General publications Expanding Possibilities for Inclusive Research: Learning from People with Profound Intellectual and Multiple Disabilities and Decolonising Research Grace J, Nind M, de Haas C, Hope J. This paper pursues the argument that finding a way for people with profound intellectual and multiple disabilities to belong in inclusive research requires starting from a deep knowledge of the people in question. This paper illustrates this idea in action showing what can be possible from building research around ‘being with’ people with profound intellectual disabilities, creating intersubjective knowledge together https://doi.org/10.3390/socsci13010037 January 2024 Theme: Long Term Conditions Psychometric properties of the living with long term conditions scale in an English-speaking population living with long term conditions in the UK Ambrosio L, Hislop-Lennie K, Serrano-Fuentes N, Driessens C, Portillo MC Objective: To present the psychometric properties of the living with long-term condition (LwLTCs) scale in an English-speaking population of people with different LTCs. Design: An observational and cross-sectional study, with retest was conducted. Psychometric properties including feasibility, internal consistency, confirmatory factor analysis, reproducibility and content validity were tested. https://doi.org/10.1136/bmjopen-2023-077978 January 2024 Theme: Long -Term Conditions The Quality of Life of Pseudomyxoma Peritonei Patients: A Scoping Review Taher R, Gray D, Ramage J Pseudomyxoma peritonei (PMP) is a form of peritoneal malignancy. It originates from a perforated appendiceal epithelial tumour. Patients with PMP experience various stressful and traumatic events including diagnosis with a rare disease, treatment with extensive and complex surgery, and long hospital stays. Currently, there is a scarcity of studies that primarily aim to assess the quality of life of patients with PMP, and there is no reviews or comprehensive understanding of the quality of life (QoL) issues faced by these patients. Even fewer studies have consulted with patients themselves. https://doi.org/10.1155/2024/8137209 January 2024 Theme: Workforce & Health Systems Ten reasons for the presence of pharmacy professionals in the intensive care unit McKenzie C, Spriet I, Hunfeld N The intensive care unit (ICU) patient requires a plethora of disciplines to optimise care and clinical outcomes. Recently, the European Society of Intensive Care Medicine (ESICM) has given greater attention to ICU pharmacy professionals, i.e., the clinical pharmacist and pharmacy technician, and their integration into the ICU multidisciplinary (MDT) team. In this article, we describe ten reasons why ICU pharmacy professionals are vital for high-quality care in the ICU. 10.1007/s00134-023-07285-4 January 2024 Theme: Workforce & Health Systems Evaluation of the nurse-assisted eHealth intervention 'eHealth@Hospital-2-Home' on self-care by patients with heart failure and colorectal cancer post-hospital discharge: protocol for a randomised controlled trial. Storm M, Morken IM, Austin RC, Nordfonn O, Wathne HB, Urstad KH et al Patients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care. https://doi.org/10.1186/s12913-023-10508-5 January 2024 Theme: Long -Term Conditions Person-centred integrated care for people living with Parkinson's, Huntington's and Multiple Sclerosis: A systematic review Bartolomeu-Pires S, Kunkel D, Kipps C, Goodwin N, Portillo MC People living with long-term neurological conditions (LTNCs) have complex needs that demand intensive care coordination between sectors. This review aimed to establish if integrated care improves outcomes for people, and what characterises successful interventions. https://doi.org/10.1111/hex.13948 January 2024 Theme: Workforce & Health Systems Validation of oxygen saturations measured in the community by emergency medical services as a marker of clinical deterioration in patients with confirmed COVID-19: a retrospective cohort study Inada-Kim M, Chmiel FP, Boniface M, et al Objectives: To evaluate oxygen saturation and vital signs measured in the community by emergency medical services (EMS) as clinical markers of COVID-19-positive patient deterioration doi: 10.1136/bmjopen-2022-067378 January 2024 Theme: Workforce & Health Systems The important factors nurses consider when choosing shift patterns: A cross-sectional study. Emmanuel T, Griffiths P, Lamas-Fernandez C, Ejebu OZ, Dall'Ora C Aim: To gain a deeper understanding of what is important to nurses when thinking about shift patterns and the organisation of working time. Methods: We recruited from two National Health Service Trusts and through an open call via trade union membership, online/print nursing profession magazines and social media. Worked versus preferred shift length/pattern, satisfaction and choice over shift patterns and nurses' views on aspects related to work and life (when working short, long, rotating shifts) were analysed with comparisons of proportions of agreement and crosstabulation. Qualitative responses on important factors related to shift preferences were analysed with inductive thematic analysis. https://doi.org/10.1111/jocn.16974 December 2023 Theme: Healthy Communities Blood pressure measurement and adverse pregnancy outcomes: A cohort study testing blood pressure variability and alternatives to 140/90 mmHg Wilson MG, Bone JN, Slade LJ, Mistry HD, Singer J, Crozier SR To examine the association with adverse pregnancy outcomes of: (1) American College of Cardiology/American Heart Association blood pressure (BP) thresholds, and (2) visit-to-visit BP variability (BPV), adjusted for BP level. https://doi.org/10.1111/1471-0528.17724 December 2023 Theme: COVID-19 Immunosuppressed Children and Young People, Psychosocial Wellbeing, and the COVID-19 Pandemic: a Prospective Cohort Study Driessens C, Mills L, Patel R, Culliford D, Gbesemete D, Lee E et al Early on in the COVID-19 pandemic, research highlighted the impact of the pandemic on the psychosocial wellbeing of children and young people (CYP). The long-term consequences of the pandemic on clinically vulnerable CYP is however unclear. This study aims to describe the psychosocial experiences of immunosuppressed CYP while Britain moved from the COVID-19 pandemic to epidemic. http://dx.doi.org/10.21203/rs.3.rs-2322586/v1 December 2023 Theme: Long -Term Conditions, Mental Health Role of Social Prescribing Link Workers in Supporting Adults with Physical and Mental Health Long-Term Conditions: Integrative Review Linceviciute S, Ambrosio L, Baldwin DS, Portillo MC Social prescribing link workers interventions have been widely adopted within healthcare systems, particularly in the UK, to support a range of patients’ needs and to help improve condition management for those living with multiple long-term conditions. However, there is a lack of consistency in implementation and unclear guidance about how social prescribing link workers might address these needs, particularly in individuals living with physical and mental health long-term conditions who bear a greater burden of multifaceted everyday problems and health challenges. This review aimed to identify the existing ways in which link workers might support the needs of this group. https://doi.org/10.1155/2023/7191247 December 2023 Theme: Long Term Conditions Exploring Adherence to Pelvic Floor Muscle Training in Women Using Mobile Apps: Scoping Review Harper RC, Sheppard S, Stewart C, Clark CJ Pelvic floor dysfunction is a public health issue, with 1 in 3 women experiencing symptoms at some point in their lifetime. The gold standard of treatment for pelvic floor dysfunction is supervised pelvic floor muscle training (PFMT); however, adherence to PFMT in women is poor. Mobile apps are increasingly being used in the National Health Service to enable equity in the distribution of health care and increase accessibility to services. However, it is unclear how PFMT mobile apps influence PFMT adherence in women. We aimed to identify which behavior change techniques (BCTs) have been used in PFMT mobile apps, to distinguish the core "capability, opportunity, and motivation" (COM) behaviors targeted by the BCTs used in PFMT mobile apps, and to compare the levels of PFMT adherence in women between those using PFMT mobile apps and those receiving usual care. https://doi.org/10.2196/45947 December 2023 Theme: Healthy Communities Causal effects of later-eating rhythm on adiposity in children through the comparison of two cohorts in the UK and China: a cross-cohort study Zou M, Northstone K, Leary S. Later-eating rhythm (LER) refers to a later timing, greater energy intake, and higher meal frequency in the evening. The role of childhood LER in obesity development is emerging, but most evidence is cross-sectional. Cross-context comparison allows the improvement of causal inference in observational studies by comparing cohorts with different confounding structures. This method is applied to assess the causal effects of LER on adiposity, by exploring the likelihood of residual confounding due to socioeconomic status. https://doi.org/10.1016/s0140-6736(23)02142-6 November 2023 Theme: COVID-19 Impact of long COVID-19 on work: a co-produced survey Ziauddeen N, Pantelic M, O'Hara ME, Hastie C, Alwan NA A proportion of people infected with SARS-CoV-2 develop post-COVID-19 condition (also known as long COVID), a predominantly multisystem condition resulting in varying degrees of functional disability limiting day-to-day activities. We aimed to describe the impact of long COVID on work. https://doi.org/10.1016/s0140-6736(23)02157-8 November 2023 Theme: Healthy Communities Food insecurity and diet quality in households accessing food membership clubs in Wessex: a mixed-methods study Taylor E, Ziauddeen N, Alwan NA, Smith D Food membership clubs that charge a small fee for a set number of items are in place in Wessex to address food insecurity (inadequate reliable access to sufficient affordable, nutritious food). These clubs incorporate longer-term solutions such as budgeting support, benefit maximisation, and cooking skills. The Wessex DIET project was established to measure acceptability and impact of these clubs. Given the paucity of evidence on the prevalence of food insecurity in those accessing such clubs, we aimed to quantify food insecurity and assess diet quality and wellbeing at recruitment. https://doi.org/10.1016/s0140-6736(23)02131-1 November 2023 Theme: Workforce & Health Systems Reducing medication errors in adult intensive care: Current insights for nursing practice Nixon C, McKenzie C, Bourne RS Intensive care unit (ICU) nurses have a pivotal role in delivering quality care for some of the sickest and most vulnerable patients in our hospitals. The direct patient care provided by ICU nurses affords a unique opportunity to influence the quality of care delivered. Delivering care that is safe is critical in the complex and dynamic environment of the ICU. Medication is the most common intervention that ICU patients receive. Medication errors (MEs) are numerous and contribute to worse ICU patient outcomes. https://doi.org/10.1016/j.iccn.2023.103578 November 2023 Theme: Healthy Communities Barriers and facilitators experienced in delivering alcohol screening and brief interventions in community pharmacy: a qualitative evidence synthesis Smith A, Buchanan A, Parkes J, Stone H, Tan QY, Ibrahim K Following increases in deaths due to alcohol during the COVID-19 pandemic, there have been renewed calls to increase resources in alcohol screening and brief intervention (SBI). Research has shown that community pharmacy could be a promising setting for SBI. This review aimed to investigate the barriers and facilitators to SBI delivery in community pharmacy to inform its further development. https://doi.org/10.1093/ijpp/riad071 November 2023 Theme: Workforce & Health Systems Intravenous antimicrobial infusions: Getting it right every time, some of the time. Kemp I, McKenzie C “60% of the time, it works every time” stated the character Brian Fantana in the film Anchorman in (2004) . In the previous issue of Intensive and Critical Care Nursing , Joan Rout and colleagues critically observed nursing practice in the preparation, double checking and administration of antimicrobials (in this case carbapenems) in the intensive care unit (ICU) and essentially asked “How well are we doing? Are we getting it right all the time, or just some of the time? ” (Rout et al., 2023 ). The study outcomes report adherence to multiple steps that are intended to reduce the risk of errors associated with the preparation and administration of medication in the ICU. In the context of antimicrobials these processes, by design, endeavour to guarantee delivery of the correct drug at the correct dose, to the correct patient at the correct time i.e., antimicrobial stewardship. doi: 10.1016/j.iccn.2023.103569 November 2023 Theme: Workforce & Health Systems Scheduled intravenous opioids. McKenzie C, Skrobik Y, Devlin JW Maintaining comfort and analgesia is fundamental to providing adequate care in intensive care unit (ICU) patients. Pain assessment and its control remain the highest priorities and concerns among survivors of critical illness and their loved ones DOI: 10.1007/s00134-023-07254-x November 2023 Theme: Long Term Conditions English Validation of the Living with Long Term conditions scale Ambrosio L, Hislop-Lennie K, Serrano-Fuentes N, Driessens C, Portillo MC Background: The English version of the living with long term conditions (LwLTCs) scale is a comprehensive person-centred measure that evaluates the complex process of living with long term conditions. Objectives: To present the psychometric properties of the LwLTCs scale in an English-speaking population in people with different long term conditions. https://doi.org/10.1093/eurpub/ckad160.811 October 2023 Theme: Long Term Conditions Reducing the impact of COVID-19 on physical activity and mental health Ambrosio L, Faulkner J, Lambrick D, Morris J, Compton E, Portillo MC Background: During the COVID-19 pandemic the United Kingdom government released regular guidance on limiting the spread of COVID-19. People, including those with long term conditions, were told to use physical distancing, self-isolation and/or shielding during COVID-19 to protect themselves and others. A consequence of these interventions was to exacerbate poor lifestyle behaviours, namely less physical activity. Objectives: To propose recommendations to support and sustain their physical activity of people with long term conditions during and after COVID-19 or other pandemics. https://doi.org/10.1093/eurpub/ckad160.1570 October 2023 Theme: Healthy Communities The Palestinian primary ciliary dyskinesia population: first results of the diagnostic and genetic spectrum Rumman N, Fassad MR, Driessens C, Goggin P, Abdelrahman N, Adwan A, Albakri M, Chopra J, Doherty R, Fashho B, Freke GM, Hasaballah A, Jackson CL, Mohamed MA, Abu Nema R, Patel MP, Pengelly RJ, Qaaqour A, Rubbo B, Thomas NS, Thompson J, Walker WT, Wheway G, Mitchison HM, Lucas JS. Diagnostic testing for primary ciliary dyskinesia (PCD) started in 2013 in Palestine. We aimed to describe the diagnostic, genetic and clinical spectrum of the Palestinian PCD population. doi: 10.1183/23120541.00714-2022. April 2023 Theme: Healthy Communities The role of parity in the relationship between endometriosis and pregnancy outcomes: a systematic review and meta-analysis Sri Ranjan Y, Ziauddeen N, Stuart B, Alwan NA, Cheong Y Endometriosis is a chronic and debilitating condition which can affect the entire reproductive life course of women with a potentially detrimental effect on pregnancy. Pregnancy (and increasing parity) can affect endometriosis by modulating disease severity and suppressing symptoms. Multiparous women could be less likely to suffer from endometriosis-related pregnancy complications than primiparous women. We aimed to systematically review the evidence examining the role of parity in the relationship between pregnancy outcomes and endometriosis. doi: 10.1530/RAF-22-0070 March 2023 Theme: Healthy Communities Ethnic differences in kidney function in childhood: the Born in Bradford Cohort Renal Study Ziauddeen N, Jeffrey RF, Waiblinger D, Fraser SDS, Alwan NA, Yuen HM, Azad R, Mason D, Wright J, Coward RJM, Roderick PJ Endstage kidney failure rates are higher in South Asians than in White Europeans. Low birth weight is associated with adult chronic kidney disease and is more common in South Asians. Foetal kidney size was smaller in South Asians in the Born in Bradford (BiB) birth cohort. As part of BiB follow up, we aimed to investigate if there were ethnic differences in kidney function and blood pressure in early childhood and whether this was different by foetal kidney size. 10.12688/wellcomeopenres.17796.1 August 2023 Theme: Ageing & Dementia How can I improve cancer services for people with dementia? Farrington N, Richardson A, Bridges J Tips and guidance on making cancer services People with dementia have poorer cancer outcomes than those without, and are more likely to experience complications and poorer overall survival (McWilliams et al 2017). Few interventions are designed for older people with cancer and complex needs, such as those with dementia (Farrington et al 2022). doi: 10.7748/cnp.21.5.22.s10 October 2023 Theme: Healthy Communities EXPERTS II - How are patient and caregiver participation in health and social care shaped by experienced burden of treatment and social inequalities? Protocol for a qualitative synthesis. May CR, Chew-Graham CA, Gallacher KI, Gravenhorst KC, Mair FS, Nolte E, Richardson A Background: The workload health and social care service users and caregivers take on, and their capacity to do this work is important. It may play a key part in shaping the implementation of innovations in health service delivery and organisation; the utilisation and satisfaction with services; and the outcomes of care. Previous research has often focused on experiences of a narrow range of long-term conditions, and on factors that shape adherence to self-care regimes. Aims: With the aim of deriving policy and practice implications for service redesign, this evidence synthesis will extend our understanding of service user and caregiver workload and capacity by comparing how they are revealed in qualitative studies of lived experience of three kinds of illness trajectories: long-term conditions associated with significant disability (Parkinson's disease, schizophrenia); serious relapsing remitting disease (Inflammatory Bowel Disease, bipolar disorder); and rapidly progressing acute disease (brain cancer, early onset dementia). doi: 10.7748/cnp.21.5.22.s10 October 2023 Theme: COVID-19 COVID-19- Experiences and support needs of children and young people with Hydrocephalus and parents in the United Kingdom Collaço N, Campion A, McNicholas R, Darlington AS Purpose: Little is known about the impact of COVID-19 on children and young people (CYP) with hydrocephalus and their families. This study explored the experiences and support needs of CYP with hydrocephalus and parents who have a child with hydrocephalus during the COVID-19 pandemic. Methods: CYP with hydrocephalus and parents of CYP with hydrocephalus in the United Kingdom completed an online survey with open and closed questions exploring experiences, information, support needs and decision making processes. Qualitative thematic content analysis and descriptive quantitative analyses were undertaken. https://doi.org/10.1007/s00381-023-05980-7 May 2023 Theme: Ageing & Dementia Artificial intelligence for diagnostic and prognostic neuroimaging in dementia: A systematic review Borchert RJ, Azevedo T, Badhwar A, Bernal J, Betts M, Bruffaerts R, Burkhart MC, Dewachter I, Gellersen HM, Low A, Lourida I, Machado L, Madan CR, Malpetti M, Mejia J, Michopoulou S, Muñoz-Neira C, Pepys J, Peres M, Phillips V, Ramanan S, Tamburin S, Tantiangco HM, Thakur L, Tomassini A, Vipin A, Tang E, Newby D; Deep Dementia Phenotyping (DEMON) Network; Ranson JM, Llewellyn DJ, Veldsman M, Rittman T Introduction: Artificial intelligence (AI) and neuroimaging offer new opportunities for diagnosis and prognosis of dementia. Methods: We systematically reviewed studies reporting AI for neuroimaging in diagnosis and/or prognosis of cognitive neurodegenerative diseases. https://doi.org/10.1002/alz.13412 August 2023 Theme: Ageing & Dementia Case management for integrated care of older people with frailty in community settings Sadler E, Khadjesari Z, Ziemann A, Sheehan KJ, Whitney J, Wilson D, Bakolis I, Sevdalis N, Sandall J, Soukup T, Corbett T, Gonçalves-Bradley DC, Walker DM Ageing populations globally have contributed to increasing numbers of people living with frailty, which has significant implications for use of health and care services and costs. The British Geriatrics Society defines frailty as "a distinctive health state related to the ageing process in which multiple body systems gradually lose their inbuilt reserves". This leads to an increased susceptibility to adverse outcomes, such as reduced physical function, poorer quality of life, hospital admissions, and mortality. Case management interventions delivered in community settings are led by a health or social care professional, supported by a multidisciplinary team, and focus on the planning, provision, and co-ordination of care to meet the needs of the individual. Case management is one model of integrated care that has gained traction with policymakers to improve outcomes for populations at high risk of decline in health and well-being. These populations include older people living with frailty, who commonly have complex healthcare and social care needs but can experience poorly co-ordinated care due to fragmented care systems. Objectives: To assess the effects of case management for integrated care of older people living with frailty compared with usual care. https://doi.org/10.1002/14651858.cd013088.pub2 May 2023 Theme: Ageing & Dementia Frequency, duration, and type of physiotherapy in the week after hip fracture surgery - analysis of implications for discharge home, readmission, survival, and recovery of mobility Almilaji O, Ayis S, Goubar A, Beaupre L, Cameron ID, Milton-Cole R, Gregson CL, Johansen A, Kristensen MT, Magaziner J, Martin FC, Sackley C, Sadler E, Smith TO, Sobolev B, Sheehan KJ Purpose: To examine the association between physiotherapy access after hip fracture and discharge home, readmission, survival, and mobility recovery. Methods: A 2017 Physiotherapy Hip Fracture Sprint Audit was linked to hospital records for 5383 patients. Logistic regression was used to estimate the association between physiotherapy access in the first postoperative week and discharge home, 30-day readmission post-discharge, 30-day survival and 120-days mobility recovery post-admission adjusted for age, sex, American Society of Anesthesiology grade, Hospital Frailty Risk Score and prefracture mobility/residence. https://doi.org/10.1016/j.physio.2023.03.002 September 2023 Theme: Ageing & Dementia Physiotherapists' perspectives of barriers and facilitators to effective community provision after hip fracture: a qualitative study in England Adams J, Jones GD, Sadler E, Guerra S, Sobolev B, Sackley C, Sheehan KJ. Purpose: to investigate physiotherapists' perspectives of effective community provision following hip fracture. Methods: qualitative semi-structured interviews were conducted with 17 community physiotherapists across England. Thematic analysis drawing on the Theoretical Domains Framework identified barriers and facilitators to implementation of effective provision. Interviews were complemented by process mapping community provision in one London borough, to identify points of care where suggested interventions are in place and/or could be implemented. https://doi.org/10.1093/ageing/afad130 September 2023 Theme: Long Term Conditions A conceptual framework for characterising lifecourse determinants of multiple long-term condition multimorbidity Stannard S, Berrington A, Paranjothy S, Owen R, Fraser S, Hoyle R et al Social, biological and environmental factors in early-life, defined as the period from preconception until age 18, play a role in shaping the risk of multiple long-term condition multimorbidity. However, there is a need to conceptualise these early-life factors, how they relate to each other, and provide conceptual framing for future research on aetiology and modelling prevention scenarios of multimorbidity. We develop a conceptual framework to characterise the population-level domains of early-life determinants of future multimorbidity. https://doi.org/10.1177/26335565231193951 September 2023 Theme: Long Term Conditions Multidisciplinary ecosystem to study lifecourse determinants and prevention of early-onset burdensome multimorbidity (MELD-B) – protocol for a research collaboration Fraser SD, Stannard S, Holland S, Boniface M, Hoyle RB, Wilkinson R et al Most people living with multiple long-term condition multimorbidity (MLTC-M) are under 65 (defined as ‘early onset’). Earlier and greater accrual of long-term conditions (LTCs) may be influenced by the timing and nature of exposure to key risk factors, wider determinants or other LTCs at different life stages. We have established a research collaboration titled ‘MELD-B’ to understand how wider determinants, sentinel conditions (the first LTC in the lifecourse) and LTC accrual sequence affect risk of early-onset, burdensome MLTC-M, and to inform prevention interventions. https://doi.org/10.1177/26335565231204544 September 2023 Theme: Ageing & Dementia What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? Howard C, Sheikh C, Rutter P, Latter S, Lown M, Brad L, Fraser SDS, Bradbury K, Roberts HC, Saucedo AR, Ibrahim K A third of older people take five or more regular medications (polypharmacy). Conducting medication reviews in primary care is key to identify and reduce/ stop inappropriate medications (deprescribing). Recent recommendations for effective deprescribing include shared-decision making and a multidisciplinary approach. Our aim was to understand when, why, and how interventions for medication review and deprescribing in primary care involving multidisciplinary teams (MDTs) work (or do not work) for older people. https://doi.org/10.1186/s12877-023-04256-8 September 2023 Theme: Long Term Conditions Improving personalised care, through the development of a service evaluation tool to assess, understand and monitor delivery Johnson L, Kirk H, Clark B, Heath S, Royse C, Adams C, Portillo MC Systematically implementing personalised care has far reaching benefits to individuals, communities and health and social care systems. If done well, personalised care can result in better health outcomes and experiences, more efficient use of health services and reduced health inequalities. Despite these known benefits, implementation of personalised care has been slow. Evaluation is an important step towards achieving the ambition of universally delivered personalised care. There are currently few comprehensive assessments or tools that are designed to understand the implementation of personalised care at a service or system level, or the cultural, practical and behavioural factors influencing this. The aim of this paper is to describe the development and testing of a system-wide evaluation tool. https://doi.org/10.1136/bmjoq-2023-002324 September 2023 Theme: Workforce & Health Systems Costs and cost-effectiveness of improved nurse staffing levels and skill mix in acute hospitals: A systematic review Griffiths P, Saville C, Ball J, Dall'Ora C, Meredith P, Turner L, Jones J Extensive research shows associations between increased nurse staffing levels, skill mix and patient outcomes. However, showing that improved staffing levels are linked to improved outcomes is not sufficient to provide a case for increasing them. This review of economic studies in acute hospitals aims to identify costs and consequences associated with different nurse staffing configurations in hospitals. https://doi.org/10.1016/j.ijnurstu.2023.104601 September 2023 Theme: Long Term Conditions A conceptual framework for characterising lifecourse determinants of multiple long-term condition multimorbidity Stannard S, Berrington A, Paranjothy S, Owen R, Fraser S, Hoyle R, Boniface M, Wilkinson B, Akbari A, Batchelor S, Jones W, Ashworth M, Welch J, Mair FS, Alwan NA Social, biological and environmental factors in early-life, defined as the period from preconception until age 18, play a role in shaping the risk of multiple long-term condition multimorbidity. However, there is a need to conceptualise these early-life factors, how they relate to each other, and provide conceptual framing for future research on aetiology and modelling prevention scenarios of multimorbidity. We develop a conceptual framework to characterise the population-level domains of early-life determinants of future multimorbidity. https://doi.org/10.1177/26335565231193951 September 2023 Theme: Workforce & Health Systems The Validity and Applicability of the Revised Delirium Rating Scale (DRS-R98) for Delirium Severity Assessment in a Critical Care Setting Almuhairi ES, Badejo M, Peer A, Pitkanen M, McKenzie CA Delirium is a neuropsychiatric syndrome common in critical illness. Worsening delirium severity is associated with poorer clinical outcomes, yet its assessment remains under-reported with most severity assessment tools not validated for critical care. The DRS-R98 is a widely applied and validated tool. The aim of this project is to report the validation and utility of the DRS-R98 in critical illness. https://doi.org/10.1177/08850666231199986 September 2023 Theme: Healthy Communities Mixed methods feasibility and usability testing of a childhood obesity risk estimation tool Grove G, Ziauddeen N, Roderick P, Vassilev I, Appleton JV, Smith D, Alwan NA A Childhood Obesity Risk Estimation tool (SLOPE CORE) has been developed based on prediction models using routinely available maternity and early childhood data to estimate risk of childhood obesity at 4-5 years. This study aims to test the feasibility, acceptability and usability of SLOPE CORE within an enhanced health visiting (EHV) service in the UK, as one context in which this tool could be utilised. https://doi.org/10.1186/s12889-023-16500-2 September 2023 Theme: Healthy Communities The interplay between social and food environments on UK adolescents' food choices: implications for policy Shaw S, Muir S, Strömmer S, Crozier S, Cooper C, Smith D, Barker M, Vogel C Factors from social and food environments can influence the food choices of adolescents in ways not experienced during childhood. Evidence suggests these two environments influence adolescents' food choices independently, but there is limited knowledge of how the interplay between these environments influence adolescents' diets. An enhanced understanding of this interplay surrounding adolescent food choice could aid the development of more nuanced interventions and policies. This qualitative study involved 13 online focus groups with adolescents (n = 45) aged 11-18 years, attending secondary school or college in England, UK. Data were analysed using thematic analysis. Social experiences which accompanied eating were perceived as more important than the food itself, and fast-food outlets were described as uniquely suited to facilitating these interactions. Young people wanted to spend their money on foods they considered worthwhile, but this did not always relate to the most affordable foods. Adolescents wanted to put little effort into making food decisions and appreciated factors that helped them make quick decisions such as prominent placement and eye-catching promotions on foods they wanted to buy. Chain food outlets were valued as they offered familiar and frequently advertised foods, which minimized the effort needed for food decisions. Adolescents' sense of autonomy underpinned all themes. Participants described having limited opportunities to make their own food choices and they did not want to waste these buying unappealing 'healthy' foods. Interventions and government policies should align with adolescents' experiences and values relating to food choice to ensure that they are effective with this important age group. https://doi.org/10.1093/heapro/daad097 August 2023 Theme: Long Term Conditions A Parkinson care-coordinator may make a difference: A scoping review on multi-sectoral integrated care initiatives for people living with Parkinson's disease and their caregivers Vester LB, Haahr A, Nielsen TL, Bartolomeu S, Portillo MC Objective: To identify multi-sectoral integrated care initiatives for people with Parkinson's disease and caregivers. Method: Following the Matrix Method we created a synthesis of literature across methodological approaches. The search was conducted in four databases until June 2022, and included studies focusing on multi-sectoral integrated care initiatives, and how they helped people with Parkinson's disease and caregivers in everyday living. https://doi.org/10.1016/j.pec.2023.107931 August 2023 Theme: Ageing & Dementia Factors that influence older adults' participation in physical activity: a systematic review of qualitative studies Meredith SJ, Cox NJ, Ibrahim K, Higson J, McNiff J, Mitchell S, Rutherford M, Wijayendran A, Shenkin SD, Kilgour AHM, Lim SER Despite the advantages of physical activity (PA), older adults are often insufficiently active to maximise health. Understanding factors that influence PA engagement will support well-designed interventions for older people. Our aim was to review the qualitative evidence exploring the factors affecting older adults' engagement in PA. https://doi.org/10.1093/ageing/afad145 August 2023 Theme: Ageing & Dementia Gaining access to unspoken narratives of people living with dementia on a hospital ward-A new methodology Collins P, Bridges J, Bartlett R This is a methodological paper that aims to advance the conceptualisation of participatory research by focusing on the value of capturing and understanding movement as a vital means of communication for older people with dementia in a general hospital ward. Qualitative research involving people with dementia tends to be word-based and reliant upon verbal fluency. This article considers a method for capturing and understanding movement as a vital means of communication. https://doi.org/10.1002/gps.5987 August 2023 Theme: Healthy Communities Activity Behaviors Before and During Pregnancy Are Associated With Women's Device-Measured Physical Activity and Sedentary Time in Later Parenthood: A Longitudinal Cohort Analysis Hesketh KR, Baird J, Crozier SR, Godfrey KM, Harvey NC, Cooper C, van Sluijs EMF Purpose: To explore how activity behaviors before/during pregnancy relate to those in later parenthood, we assessed associations between sitting and moderate-/strenuous exercise before/during pregnancy, and sedentary time (SED) and moderate to vigorous physical activity (MVPA) 4-7 years postpartum ("later parenthood"). https://doi.org/10.1123/jpah.2022-0630 August 2023 Theme: Long Term Conditions Guidance and standard operating procedures for functional exercise testing in cystic fibrosis Saynor ZL, Gruet M, McNarry MA, Button B, Morrison L, Wagner M, Sawyer A, Hebestreit H, Radtke T, Urquhart DS; European Cystic Fibrosis Society Exercise Working Group Regular exercise testing is recommended for all people with cystic fibrosis (PwCF). A range of validated tests, which integrate both strength and aerobic function, are available and increasingly being used. Together, these tests offer the ability for comprehensive exercise evaluation. Extensive research and expert consensus over recent years has enabled the adaptation and standardisation of a range of exercise tests to aid the understanding of the pathophysiology related to exercise limitation in PwCF and has led to the development of novel exercise tests which may be applied to PwCF. This article provides expert, opinion-based clinical practice guidance, along with test instructions, for a selection of commonly used valid tests which have documented clinimetric properties for PwCF. Importantly, this document also highlights previously used tests that are no longer suggested for PwCF and areas where research is mandated. This collaboration, on behalf of the European Cystic Fibrosis Society Exercise Working Group, represents expert consensus by a multidisciplinary panel of physiotherapists, exercise scientists and clinicians and aims to improve global standardisation of functional exercise testing of PwCF. In short, the standardised use of a small selection of tests performed to a high standard is advocated. https://doi.org/10.1183/16000617.0029-2023 August 2023 Theme: Healthy Communities Prediction of childhood overweight and obesity at age 10-11: findings from the Studying Lifecourse Obesity PrEdictors and the Born in Bradford cohorts Ziauddeen N, Roderick PJ, Santorelli G, Alwan NA In England, 41% of children aged 10-11 years live with overweight or obesity. Identifying children at risk of developing overweight or obesity may help target early prevention interventions. We aimed to develop and externally validate prediction models of childhood overweight and obesity at age 10-11 years using routinely collected weight and height measurements at age 4-5 years and maternal and early-life health data. https://doi.org/10.1038/s41366-023-01356-8 August 2023 Theme: Ageing & Dementia Volunteer-led online group exercise for community-dwelling older people: a feasibility and acceptability study Lim SER, Meredith SJ, Agnew S, Clift E, Ibrahim K, Roberts HC Despite the clear benefits of physical activity in healthy ageing, engagement in regular physical activity among community-dwelling older adults remains low, with common barriers including exertional discomfort, concerns with falling, and access difficulties. The recent rise of the use of technology and the internet among older adults presents an opportunity to engage with older people online to promote increased physical activity. This study aims to determine the feasibility and acceptability of training volunteers to deliver online group exercises for older adults attending community social clubs. https://doi.org/10.1186/s12877-023-04184-7 July 2023 Theme: COVID-19, Healthy Communities Long Covid active case finding study protocol: A co-produced community-based pilot within the STIMULATE-ICP study (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways) Alwan NA, Clutterbuck D, Pantelic M, Hayer J, Fisher L, Hishmeh L, Heightman M, Allsopp G, Wootton D, Khan A, Hastie C, Jackson M, Rayner C, Brown D, Parrett E, Jones G, Smith K, Clarke R, Mcfarland S, Gabbay M, Banerjee A Background and aim: Long Covid is a significant public health concern with potentially negative implications for health inequalities. We know that those who are already socially disadvantaged in society are more exposed to COVID-19, experience the worst health outcomes and are more likely to suffer economically. We also know that these groups are more likely to experience stigma and have negative healthcare experiences even before the pandemic. However, little is known about disadvantaged groups' experiences of Long Covid, and preliminary evidence suggests they may be under-represented in those who access formal care. We will conduct a pilot study in a defined geographical area in London, United Kingdom to test the feasibility of a community-based approach of identifying Long Covid cases that have not been clinically diagnosed and have not been referred to Long Covid specialist services. We will explore the barriers to accessing recognition, care, and support, as well as experiences of stigma and perceived discrimination. https://doi.org/10.1371/journal.pone.0284297 July 2023 Theme: Workforce & Health Systems Opioid, sedative, preadmission medication and iatrogenic withdrawal risk in UK adult critically ill patients: a point prevalence study Eadie R, McKenzie CA, Hadfield D, Kalk NJ, Bolesta S, Dempster M, McAuley DF, Blackwood B; UK ALERT-ICU study investigators Background: Iatrogenic withdrawal syndrome, after exposure medication known to cause withdrawal is recognised, yet under described in adult intensive care. Aim: To investigate, opioid, sedation, and preadmission medication practice in critically ill adults with focus on aspects associated with iatrogenic withdrawal syndrome. https://doi.org/10.1007/s11096-023-01614-9 July 2023 Theme: Long Term Conditions First validation study of the living with long term conditions scale (LwLTCs) among English-speaking population living with Parkinson's disease Ambrosio L, Hislop-Lennie K, Serrano-Fuentes N, Driessens C, Portillo MC Introduction: Parkinson's disease is the second most prevalent neurodegenerative disease, affecting 10 million people worldwide. Health and social care professionals need to have personalised tools to evaluate the process of living with Parkinson's disease and consequently, plan individualised and targeted interventions. Recently, the English version of the Living with Long term conditions (LwLTCs) scale has been developed filling an important gap related to person-centred tools to evaluate the process of living with long term conditions among English-speaking population. However, no validation studies for testing its psychometric properties have been conducted. Aim: To analyse the psychometric properties of the LwLTCs scale in a wide English-speaking population living with Parkinson's disease. https://doi.org/10.1186/s12955-023-02154-6 July 2023 Theme: Long Term Conditions Physical activity and mental health experiences of people living with long term conditions during COVID-19 pandemic: A qualitative study Ambrosio L, Morris J, Compton E, Portillo MC Introduction: Regular physical activity is a strategy that is effective in the physical management of long term conditions. The COVID-19 pandemic, led to disruption of physical activity routines for many people with long term conditions. It is important, to understand the experiences of people with long term conditions regarding physical activity during COVID-19 to enable future identification of strategies to mitigate the impact of restrictions on health. Objective: To explore perceptions and experiences of people with long term conditions of the impact of the UK Government physical distancing restrictions on their physical activity participation during the COVID-19 pandemic. https://doi.org/10.1371/journal.pone.0285785 July 2023 Theme: COVID-19 Systematic Review of the Prevalence of Long COVID Woodrow M, Carey C, Ziauddeen N, Thomas R, Akrami A, Lutje V, Greenwood DC, Alwan NA Long COVID occurs in those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) whose symptoms persist or develop beyond the acute phase. We conducted a systematic review to determine the prevalence of persistent symptoms, functional disability, or pathological changes in adults or children at least 12 weeks postinfection. https://doi.org/10.1093/ofid/ofad233 July 2023 Theme: Healthy Communities Development of a measure of dietary quality for the UK Biobank Montague C, D'Angelo S, Harvey N, Vogel C, Baird J Background: Previous studies of the UK Biobank have examined intake of single food items and their association with health outcomes. Our aim was to develop a dietary quality score and examine the relationship between this score and markers of cardiometabolic health. Methods: Principal component analysis was performed on dietary data from UK Biobank participants. Linear regression was used to analyse the relationship between diet and cardiometabolic health. https://doi.org/10.1093/pubmed/fdad103 July 2023 Theme: Healthy Communities A systematic review of the effectiveness of community-based interventions aimed at improving health literacy of parents/carers of children Belfrage SL, Husted M, Fraser S, Patel S, Faulkner JA Aim: The aim of this systematic review was to examine the effectiveness of community-based health literacy interventions in improving the health literacy of parents. Methods: A systematic review of six databases - MEDLINE, PsycINFO, CINAHL, Cochrane Library, Embase, and Education Source - was conducted to identify relevant articles. Risk of bias was assessed using version two of the Cochrane risk of bias tool for randomised controlled trials or the Cochrane collaboration risk of bias in non-randomised studies of interventions. The study findings were grouped and synthesised following the synthesis without meta-analysis framework. https://doi.org/10.1177/17579139231180746 June 2023 Theme: Long Term Conditions A proposal to embed patient and public involvement within qualitative data collection and analysis phases of a primary care based implementation study Moult A, McGrath C, Lippiett K, Coope C, Chilcott S, Mann C, Evans N, Turner A, Dziedzic K, Portillo MC, Johnson R Patient and public involvement (PPI) is increasingly seen as essential to health service research. There are strong moral and ethical arguments for good quality PPI. Despite the development of guidance aimed at addressing the inconsistent reporting of PPI activities within research, little progress has been made in documenting the steps taken to undertake PPI and how it influences the direction of a study. Without this information, there are minimal opportunities to share learnings across projects and strengthen future PPI practices. The aim of this paper is to present details on the processes and activities planned to integrate PPI into the qualitative research component of a mixed-methods, multi-site study evaluating the implementation of a smart template to promote personalised primary care for patients with multiple long-term conditions. https://doi.org/10.1186/s40900-023-00440-7 June 2023 Theme: COVID-19 Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome: a cross-sectional observational study Walker S, Goodfellow H, Pookarnjanamorakot P, Murray E, Bindman J, Blandford A, Bradbury K, Cooper B, Hamilton FL, Hurst JR, Hylton H, Linke S, Pfeffer P, Ricketts W, Robson C, Stevenson FA, Sunkersing D, Wang J, Gomes M, Henley W, Collaboration LWCR Objectives: To describe self-reported characteristics and symptoms of treatment-seeking patients with post-COVID-19 syndrome (PCS). To assess the impact of symptoms on health-related quality of life (HRQoL) and patients' ability to work and undertake activities of daily living. https://doi.org/10.1136/bmjopen-2022-069217 June 2023 Theme: Healthy Communities Early life exposure to antibiotics and laxatives in relation to infantile atopic eczema El-Heis S, Crozier SR, Harvey NC, Healy E, Godfrey KM The risk of developing atopic eczema is influenced by various events pre-conception, during pregnancy, and throughout the neonatal period. Recent reports have suggested that early life exposure to microbiome altering medications, such as antibiotics and laxatives, could impact the risk of atopic eczema in infancy and childhood. For example, Lin et al., 2022, reported an increased risk of allergic disease in offspring whose mother used laxatives in pregnancy independent of laxative exposure in the offspring but no associations were found for maternal antibiotic use. As the evidence on this topic is sparse, we aimed to examine whether maternal gestational exposure to antibiotics or laxatives were associated with the risk of atopic eczema in infancy as well as the link between offspring antibiotic exposure in the first 12 months of life and risk of infantile atopic eczema. https://doi.org/10.1111/pai.13964 May 2023 Theme: Workforce & Health Systems Staffing levels and hospital mortality in England: a national panel study using routinely collected data Rubbo B, Saville C, Dall'Ora C, Turner L, Jones J, Ball J, Culliford D, Griffiths P Objectives: Examine the association between multiple clinical staff levels and case-mix adjusted patient mortality in English hospitals. Most studies investigating the association between hospital staffing levels and mortality have focused on single professional groups, in particular nursing. However, single staff group studies might overestimate effects or neglect important contributions to patient safety from other staff groups. https://doi.org/10.1136/bmjopen-2022-066702 May 2023 Theme: Workforce & Health Systems Antimicrobial preparation in the intensive care unit. Oh, what a waste Pearce S, McKenzie C In this issue of Intensive & Critical Care Nursing, David Jarrett and colleagues have published a notable study (Jarret et al., 2023). This prospective observational study elegantly describes one of the lesser appreciated challenges in administering the correct dose into our patients in the intensive care unit (ICU) https://doi.org/10.1016/j.iccn.2023.103445 May 2023 Theme: Long Term Conditions Filling the gap in service provision. Partners as family carers to people with Parkinson's disease: A Scandinavian perspective Hjelle EG, Rønn-Smidt H, Haahr A, Haavaag SB, Sørensen D, Navarta-Sánchez MV, Portillo MC, Bragstad LK Objectives: The purpose of this study was to explore the expectations of and experiences with the public healthcare system of domestic partners of people with Parkinson`s disease (PD) in Denmark and Norway. http://10.1177/17423953231174470 May 2023 Theme: Workforce & Health Systems Shift work characteristics and burnout among nurses: cross-sectional survey Dall'Ora C, Ejebu OZ, Ball J, Griffiths P Background: Nurses working long shifts (≥12 h) experience higher levels of burnout. Yet other shift characteristics, including fixed versus rotating night work, weekly hours and breaks have not been considered. Choice over shift length may moderate the relationship; however, this has not been tested. Aims: To examine the association between shift work characteristics and burnout and exhaustion, and whether choice over shift length influences burnout and exhaustion. https://doi.org/10.1093/occmed/kqad046 May 2023 Theme: Workforce & Health Systems Precision-Based Approaches to Delirium in Critical Illness: A Narrative Review Ankravs MJ, McKenzie CA, Kenes MT Delirium occurs in critical illness and is associated with poor clinical outcomes, having a longstanding impact on survivors. Understanding the complexity of delirium in critical illness and its deleterious outcome has expanded since early reports. Delirium is a culmination of predisposing and precipitating risk factors that result in a transition to delirium. Known risks range from advanced age, frailty, medication exposure or withdrawal, sedation depth, and sepsis. Because of its multifactorial nature, different clinical phenotypes, and potential neurobiological causes, a precise approach to reducing delirium in critical illness requires a broad understanding of its complexity. Refinement in the categorization of delirium subtypes or phenotypes (i.e., psychomotor classifications) requires attention. Recent advances in the association of clinical phenotypes with clinical outcomes expand our understanding and highlight potentially modifiable targets. Several delirium biomarkers in critical care have been examined, with disrupted functional connectivity being precise in detecting delirium. Recent advances reinforce delirium as an acute, and partially modifiable, brain dysfunction, and place emphasis on the importance of mechanistic pathways including cholinergic activity and glucose metabolism. Pharmacologic agents have been assessed in randomized controlled prevention and treatment trials, with a disappointing lack of efficacy. Antipsychotics remain widely used after "negative" trials, yet may have a role in specific subtypes. However, antipsychotics do not appear to improve clinical outcomes. Alpha-2 agonists perhaps hold greater potential for current use and future investigation. The role of thiamine appears promising, yet requires evidence. Looking forward, clinical pharmacists should prioritize the mitigation of predisposing and precipitating risk factors as able. Future research is needed within individual delirium psychomotor subtypes and clinical phenotypes to identify modifiable targets that hold the potential to improve not only delirium duration and severity, but long-term outcomes including cognitive impairment. https://doi.org/10.1002/phar.2807 May 2023 Theme: Healthy Communities Influences of the community and consumer nutrition environment on the food purchases and dietary behaviors of adolescents: A systematic review Shaw S, Barrett M, Shand C, Cooper C, Crozier S, Smith D, Barker M, Vogel C Adolescence is a period of increased autonomy over decision-making, including food choices, and increased exposure to influences outside the home, including the food environment. This review aims to synthesize the evidence for the influence of community nutrition environments, spatial access to food outlets, and consumer nutrition environments, environments inside food outlets, on adolescent food purchasing and dietary behaviors in high-income countries. Six databases were searched for articles published before January 2023. Results were synthesized using a vote-counting technique and effect direction plots that record the direction of the effect in relation to the anticipated relationship with health. Thirty-four observational and two intervention studies met the inclusion criteria. In the 13 studies assessing adolescent exposure to healthy community nutrition environments, results did not show clear associations with dietary and purchasing outcomes. Thirty studies assessed adolescents' exposure to unhealthy community nutrition environments with the majority (n = 17/30, 57%) reporting results showing that greater exposure to food outlets classified as unhealthy was associated with less healthy food purchases and dietary intakes. Inconsistent results were observed across the seven studies investigating associations with the consumer environment. Further research in these areas, including more high-quality intervention studies, may help to develop policy strategies to improve adolescents' dietary behaviors. https://doi.org/10.1111/obr.13569 Theme: Workforce & Health Systems Micronutrient use in critical care Cameron LK, Lumlertgul N, Bear DE, Cooney E, McKenzie C, Ostermann M Micronutrients, principally vitamins and minerals, play an important role both in health and in disease. Parenteral micronutrient products are commonly prescribed for critically ill patients both in line with the terms of the product's license, and for other indications where there is an underpinning physiological rationale, or precedent, for their use but little evidence. This survey sought to understand United Kingdom (UK) prescribing practice in this area. https://doi.org/10.1016/j.clnesp.2023.03.023 Theme: Workforce & Health Systems The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review Dall’Ora, C., Rubbo, B., Saville, C. et al. The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review. Hum Resour Health 21 , 30 (2023). https://doi.org/10.1186/s12960-023-00817-5 Published: 20 April 2023 DOI https://doi.org/10.1186/s12960-023-00817-5 Objectives Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital. We aimed to synthesise the evidence on the relationship between multi-disciplinary staffing levels in hospital including nursing, medical and allied health professionals and the risk of death. Theme: Healthy Communities Exploring the associations between number of children, multi-partner fertility and risk of obesity at midlife: Findings from the 1970 British Cohort Study (BCS70) Article Source: Exploring the associations between number of children, multi-partner fertility and risk of obesity at midlife: Findings from the 1970 British Cohort Study (BCS70) Stannard S, Berrington A, Alwan NA (2023) Exploring the associations between number of children, multi-partner fertility Background Early parenthood, high parity, and partnership separation are associated with obesity. However, the emergence of non-marital partnerships, serial partnering and childbearing across unions, means that it is important to consider their association to obesity. This paper examined the associations between number of biological children and multi-partner fertility (MPF)—defined as having biological children with more than one partner, with obesity at midlife Theme: Healthy Communities The role of social networks in the self-management support for young women recently diagnosed with breast cancer Article Source: The role of social networks in the self-management support for young women recently diagnosed with breast cancer Vassilev I, Lin SX, Calman L, Turner J, Frankland J, et al. (2023) The role of social networks in the self-management support for young women recently diagnosed with breast cancer. PLOS ONE 18(4): e0282183. https://doi.org/10.1371/journal.pone.0282183 It is widely acknowledged that social network support plays an important role in the quality of life and illness management of breast cancer survivors. However, the factors and processes that enable and sustain such support are less well understood. This paper reports baseline findings from a prospective UK national cohort of 1,202 women with breast cancer (aged <50 years at diagnosis), recruited before starting treatment, conducted in 2016–2019. Descriptive, univariate and multivariate regression analyses explored associations between the individual, and network member characteristics, and the type of support provided. Social network members provided a substantial level of illness-related, practical and emotional support. Highest contribution was provided by friends, followed by close family members. The social network members of women who did not have a partner provided a higher level of support than those in networks with a partner. Women without higher education were more reliant on close family members than those with higher education, and this was more so for women without a partner. Women with higher education without a partner were more reliant on friends and were overall best supported. Women without higher education who did not have a partner were overall least well supported. They had much smaller networks, were highly reliant on close family members, and on high level contributions from all network members. There is a need to develop network-based interventions to support people with a cancer diagnosis, prioritising support for the groups identified as most at risk. Interventions that support engagement with existing network members during treatment, and those that help extend such networks after treatment, are likely to be of benefit. A network perspective can help to develop tailored support and interventions by recognising the interactions between network and individual level processes Theme: Workforce & Health Systems The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review Dall’Ora, C., Rubbo, B., Saville, C. et al. The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review. Hum Resour Health 21 , 30 (2023). https://doi.org/10.1186/s12960-023-00817-5 Abstract Objectives Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital. We aimed to synthesise the evidence on the relationship between multi-disciplinary staffing levels in hospital including nursing, medical and allied health professionals and the risk of death. Methods Systematic review. We searched Embase, Medline, CINAHL, and the Cochrane Library for quantitative or mixed methods studies with a quantitative component exploring the association between multi-disciplinary hospital staffing levels and mortality. Results We included 12 studies. Hospitals with more physicians and registered nurses had lower mortality rates. Higher levels of nursing assistants were associated with higher patient mortality. Only two studies included other health professionals, providing scant evidence about their effect. Conclusions Pathways for allied health professionals such as physiotherapists, occupational therapists, dietitians, pharmacists, to impact safety and other patient outcomes are plausible and should be explored in future studies. https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-023-00817-5 Theme: Ageing & Dementia ‘A real fine balancing act’: A secondary qualitative analysis of power imbalance in comorbid cancer and dementia in an outpatient treatment setting Farrington, N., Richardson, A., & Bridges, J. (March 2023). Aims Studies of health services reveal a focus on provision of scheduled care at the expense of patient need, placing the health service in a position of power and the patient as passive recipient. This secondary qualitative analysis of a focused ethnography draws on the Foucauldian concept of power as pervasive and relational, to examine how an imbalance of power is manifested in situations where people with both cancer and dementia are being treated for cancer. Design Secondary qualitative analysis of a focused ethnographic study. Data Sources In the original study, qualitative data were gathered from observation and interviews with people with cancer and dementia (n = 2), caregivers (n = 7) and staff (n = 20). The study was conducted in the outpatient departments of two teaching hospitals in England between January 2019 and July 2021. Data from all sources were analysed for this secondary analysis using constant comparison. Results The principal theme was balance , encapsulating the competing priorities involved in delivering cancer treatment. There was tension between maintaining safety and ensuring an individual's right to treatment, and difficulty reconciling the needs of the system with the needs of individuals. Conclusion The pervasive nature of power can be harnessed to enhance the agency of people with cancer and dementia by incorporating principles of shared decision making. https://doi.org/10.1111/jan.15629 Theme: Long Term Conditions, Ageing & Dementia The Causes and Impact of Crisis for People with Parkinson's Disease: A Patient and Carer Perspective Fearn S, Bartolomeu Pires S, Agarwal V, Roberts HC, Spreadbury J, Kipps C. 21 June 2021 Background: The reasons for acute hospital admissions among people with Parkinson's disease are well documented. However, understanding of crises that are managed in the community is comparatively lacking. Most existing literature on the causes of crisis for people with Parkinson's disease (PwP) uses hospital data and excludes the individual's own perspective on the crisis trigger and the impact of the crisis on their care needs. Objective: To identify the causes and impact of crises in both community and hospital settings, from a patient and carer perspective. Methods: A total of 550 UK-based PwP and carers completed a survey on (a) their own personal experiences of crisis, and (b) their general awareness of potential crisis triggers for PwP. Results: In addition to well-recognised causes of crisis such as falls, events less widely associated with crisis were identified, including difficulties with activities of daily living and carer absence. The less-recognised crisis triggers tended to be managed more frequently in the community. Many of these community-based crises had a greater impact on care needs than the better-known causes of crisis that more frequently required hospital care. PwP and carer responses indicated a good general knowledge of potential crisis triggers. PwP were more aware of mental health issues and carers were more aware of cognitive impairment and issues with medications. Conclusion: These findings could improve care of Parkinson's by increasing understanding of crisis events from the patient and carer perspective, identifying under-recognised crisis triggers, and informing strategies for best recording symptoms from PwP and carers. https://pubmed.ncbi.nlm.nih.gov/34250952/ Theme: Long Term Conditions What are the modifiable factors of treatment burden and capacity among people with Parkinson’s disease and their caregivers: A qualitative study Qian Yue Tan , Helen C. Roberts, Simon D. S. Fraser, Khaled Amar, Kinda Ibrahim March 30, 2023 Background People with long-term conditions must complete many healthcare tasks such as take medications, attend appointments, and change their lifestyle. This treatment burden and ability to manage it (capacity) is not well-researched in Parkinson’s disease. Objective To explore and identify potentially modifiable factors contributing to treatment burden and capacity in people with Parkinson’s disease and caregivers. Methods Semi-structured interviews with nine people with Parkinson’s disease and eight caregivers recruited from Parkinson’s disease clinics in England (ages 59–84 years, duration of Parkinson’s disease diagnosis 1–17 years, Hoehn and Yahr (severity of Parkinson’s disease) stages 1–4) were conducted. Interviews were recorded and analyzed thematically. Results Four themes of treatment burden with modifiable factors were identified: 1) Challenges with appointments and healthcare access: organizing appointments, seeking help and advice, interactions with healthcare professionals, and caregiver role during appointments; 2) Issues obtaining satisfactory information: sourcing and understanding information, and satisfaction with information provision; 3) Managing medications: getting prescriptions right, organizing polypharmacy, and autonomy to adjust treatments; and 4) Lifestyle changes: exercise, dietary changes, and financial expenses. Aspects of capacity included access to car and technology, health literacy, financial capacity, physical and mental ability, personal attributes and life circumstances, and support from social networks. Conclusions There are potentially modifiable factors of treatment burden including addressing the frequency of appointments, improving healthcare interactions and continuity of care, improving health literacy and information provision, and reducing polypharmacy. Some changes could be implemented at individual and system levels to reduce treatment burden for people with Parkinson’s and their caregivers. Recognition of these by healthcare professionals and adopting a patient-centered approach may improve health outcomes in Parkinson’s disease. Theme: Healthy Communities Childhood overweight and obesity at the start of primary school: External validation of pregnancy and early-life prediction models Nida Ziauddeen,, Paul J. Roderick, Gillian Santorelli, John Wright, Nisreen A. Alwan June 2022 Abstract Tackling the childhood obesity epidemic can potentially be facilitated by risk-stratifying families at an early-stage to receive prevention interventions and extra support. Using data from the Born in Bradford (BiB) cohort, this analysis aimed to externally validate prediction models for childhood overweight and obesity developed as part of the Studying Lifecourse Obesity PrEdictors (SLOPE) study in Hampshire. BiB is a longitudinal multi-ethnic birth cohort study which recruited women at around 28 weeks gestation between 2007 and 2010 in Bradford. The outcome was body mass index (BMI) ≥91st centile for overweight/obesity at 4–5 years. Discrimination was assessed using the area under the receiver operating curve (AUC). Calibration was assessed for each tenth of predicted risk by calculating the ratio of predicted to observed risk and plotting observed proportions versus predicted probabilities. Data were available for 8003 children. The AUC on external validation was comparable to that on development at all stages (early pregnancy, birth, ~1 year and ~2 years). The AUC on external validation ranged between 0.64 (95% confidence interval (CI) 0.62 to 0.66) at early pregnancy and 0.82 (95% CI 0.81 to 0.84) at ~2 years compared to 0.66 (95% CI 0.65 to 0.67) and 0.83 (95% CI 0.82 to 0.84) on model development in SLOPE. Calibration was better in the later model stages (early life ~1 year and ~2 years). The SLOPE models developed for predicting childhood overweight and obesity risk performed well on external validation in a UK birth cohort with a different geographical location and ethnic composition. https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0000258 Theme: Healthy Communities Parent-Offspring Associations in Body Composition: Findings From the Southampton Women's Survey Prospective Cohort Study Moon RJ, D'Angelo S, Holroyd CR, Crozier SR, Godfrey KM, Davies JH, Cooper C, Harvey NC. Context: Children born to parents who are overweight or obese have a high risk of adult obesity, but it is unclear if transgenerational associations relating to unfavorable body composition differ by parent. Objective: To examine differential mother-offspring and father-offspring associations in body composition in early childhood. Methods: A total of 240 mother-father-offspring trios from a prospective UK population-based pre-birth cohort (Southampton Women's Survey) were included for anthropometry and dual-energy x-ray absorptiometry assessment of whole-body-less-head body composition in the offspring at 3 different ages (4, 6-7, and 8-9 years) and in the mother and father at the 8- to 9-year offspring visit. Associations were assessed using linear regression adjusting for the other parent. Results: Positive associations between mother-daughter body mass index (BMI) and fat mass were observed at ages 6 to 7 (BMI: β = .29 SD/SD, 95% CI = .10, .48; fat mass β = .27 SD/SD, 95% CI = .05, .48) and 8 to 9 years (BMI: β = .33 SD/SD, 95% CI = .13, .54; fat mass β = .31 SD/SD, 95% CI = .12, .49), with similar associations at age 4 years but bounding the 95% CI. The mother-son, father-son, and father-daughter associations for BMI and fat mass were weaker at each of the ages studied. Conclusion: A strong association between the fat mass of mothers and their daughters but not their sons was observed. In contrast, father-offspring body composition associations were not evident. The dimorphic parent-offspring effects suggest particular attention should be given to early prevention of unfavorable body composition in girls born to mothers with excess adiposity. Theme: Healthy Communities, COVID-19, Mental Health Psychological distress experienced by parents caring for an immunosuppressed child during the COVID-19 pandemic Corine Driessens, Lynne Mills, Ravin Patel, David Culliford, Diane Gbesemete, Emma Lee, Meera Shaunak, Harry Chappell, Saul N. Faust, Hans de Graaf, Abstract: The COVID-19 pandemic has proved unique in both its unpredictability and the extent to which it has continued to impact on daily life since March 2020. Among the immunosuppressed population the challenges of the COVID-19 pandemic are cumulative to the ever-present challenges of living with a long-term condition. This prospective longitudinal study explored patterns of concern experienced by 467 British parents caring for an immunosuppressed child during the first 2 years of the COVID-19 pandemic and related this to parental mental wellbeing. Most parents slowly adapted or were resilient to the ever-changing stressors of the COVID-19 pandemic. However, 12% experienced high levels of concern throughout the first 2 years of the pandemic. This group was also more likely to report emotional mental health problems towards the end of this period. The experience of emotional mental health problems among parents caring for an immunosuppressed child was related to low household income, single parenting, difficult access to greenspace, and higher level of exposure to COVID positive cases and COVID restrictions (North of England). Parents reported that optimism, reduction of isolation, and support promoted coping and management of the challenges of the COVID-19 pandemic. More reliable COVID information and periodic medical-condition-specific guidance would have been appreciated. These findings can increase clinical awareness of high-risk parental groups and make an important contribution to the planning of appropriate targeted psychological family interventions. Theme: General publications Enablers and barriers to progressing a clinical academic career in nursing, midwifery and allied health professions: A cross‐sectional survey Miriam Avery BN (Hons), PhD, Greta Westwood CBE, RN, PhD, MSc, Alison Richardson BN (Hons), MSc, PhD, PGDip, ED, RN Published: 28 January 2021 Abstract Aims and Objectives This study aimed to understand the routes by which nurses, midwives and allied health professionals (NMAHPs) pursue and sustain a research career and the enablers and barriers to career progression. Background Robust evidence is central to practice and professional decision making of NMAHPs, with generation and translation of research arguably best led by those clinically active. Whilst countries like the UK and USA have fellowship schemes to support research career development, anecdotal reports suggest barriers exist in translating these opportunities into sustainable clinical academic careers. External web link - https://onlinelibrary.wiley.com/doi/10.1111/jocn.15673 Theme: General publications How everyday objects can improve quality of life for people with dementia Article published in The Guardian newspaper on 14th January 2021(Kellyn Lee) External web link - https://www.theguardian.com/society/2021/jan/14/everyday-objects-people-with-dementia-quality-of-life-care-homes Theme: General publications Making digital health accessible to all: An interview with Dr Sarah Fearn and Dr Alexandra Young CRN Vision Magazine (July 2020) External web link - https://mcusercontent.com/1100bd355403b33d410f8067a/files/138916b8-e47e-4f82-ab0e-0f804c034ff4/CRN_Wessex_VISION_magazine_Summer_2020_Final.pdf Theme: General publications Ten top tips for Frailty for General Practice Tan QY, Lim SER, Cox NJ, Roberts HC.(December 2019) Pulse Magazine External web link - https://www.pulsetoday.co.uk/clinical-feature/clinical-areas/elderly-care/ten-top-tips-on-frailty-in-general-practice/?cmpredirect Theme: General publications Creating pre-conditions for change in clinical practice: the influence of interactions between multiple contexts and human agency Michelle Myall, Carl May, Alison Richardson, Sarah Bogle, Natasha Campling, Sally Dace and Susi Lund – August 2020 Abstract Purpose – The purpose of this paper is to explore what happens when changes to clinical practice are proposed and introduced in healthcare organisations. The authors use the implementation of Treatment Escalation Plans to explore the dynamics shaping the translational journey of a complex intervention from research into the everyday context of real-world healthcare settings. External web link - https://www.emerald.com/insight/content/doi/10.1108/JHOM-06-2020-0240/full/pdf?title=creating-pre-conditions-for-change-in-clinical-practice-the-influence-of-interactions-between-multiple-contexts-and-human-agency Theme: General publications Primary care risk stratification in COPD using routinely collected data: a secondary data analysis Matt Johnson, Lucy Rigge, David Culliford, Lynn Josephs, Mike Thomas, Tom Wilkinson - december 4 2019 ABSTRACT Most clinical contacts with chronic obstructive pulmonary disease (COPD) patients take place in primary care, presenting opportunity for proactive clinical management. Electronic health records could be used to risk stratify diagnosed patients in this setting, but may be limited by poor data quality or completeness. We developed a risk stratification database algorithm using the DOSE index (Dyspnoea, Obstruction, Smoking and Exacerbation) with routinely collected primary care data, aiming to calculate up to three repeated risk scores per patient over five years, each separated by at least one year. External web link - https://www.nature.com/articles/s41533-019-0154-6 Theme: General publications COVID-19: experiences of lockdown and support needs in children and young adults with kidney conditions Yincent Tse, Anne-Sophie E. Darlington, Kay Tyerman, Dean Wallace, Tanya Pankhurst, Sofia Chantziara, David Culliford, Alejandra Recio-Saucedo & Arvind Nagra Background During the initial COVID-19 pandemic, young United Kingdom (UK) kidney patients underwent lockdown and those with increased vulnerabilities socially isolated or ‘shielded’ at home. The experiences, information needs, decision-making and support needs of children and young adult (CYA) patients or their parents during this period is not well known. External web link - https://link.springer.com/article/10.1007/s00467-021-05041-8 Theme: General publications Evaluating the impact of a polypharmacy Action Learning Sets tool on healthcare practitioners’ confidence, perceptions and experiences of stopping inappropriate medicines Cindy Faith Brooks, Anastasios Argyropoulos, Catherine Brigitte Matheson‑Monnet and David Kryl June 2022 Background Issues of medication adherence, multimorbidity, increased hospitalisation risk and negative impact upon quality of life have led to the management of polypharmacy becoming a national priority. Clinical guidelines advise a patient-centred approach, involving shared decision-making and multidisciplinary team working. However, there have been limited educational initiatives to improve healthcare practitioners’ management of polypharmacy and stopping inappropriate medicines. This study aimed to evaluate the impact of a polypharmacy Action Learning Sets (ALS) tool across five areas: i. healthcare practitioners’ confidence and perceptions of stopping medicines; ii. knowledge and information sources around stopping medicines; iii. perception of patients and stopping medicines; iv. perception of colleagues and stopping medicines and v. perception of the role of institutional factors in stopping medicines. External web link - https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-022-03556-8 Theme: Workforce & Health Systems Ward staffing guided by a patient classification system: A multi-criteria analysis of “fit” in three acute hospitals Christina Saville PhD, Peter Griffiths PhD, RN (Published 8 May 2021) Aims To assess how well the Safer Nursing Care Tool (SNCT) predicts staffing requirements on hospital wards, and to use professional judgement to generate hypotheses about factors associated with a “poor fit”. External web link - https://onlinelibrary.wiley.com/doi/10.1111/jonm.13341 Theme: Workforce & Health Systems How long do nursing staff take to measure and record patients’ vital signs observations in hospital? A time-and-motion study Chiara Dall'ora, Peter Griffiths, Joanna Hope, Jim Briggs, Jeremy Jones, Stephen Gerry & Oliver C Redfern (June 2021) Introduction Monitoring vital signs in hospital is an important part of safe patient care. However, there are no robust estimates of the workload it generates for nursing staff. This makes it difficult to plan adequate staffing to ensure current monitoring protocols can be delivered. External web link - https://doi.org/10.1016/j.ijnurstu.2021.103921 Theme: Workforce & Health Systems Guidance to support nurses’ psychological well-being during Covid-19 crisis. Maben, J. Taylor, C. and Bridges, J. (April 2020) This guidance is designed to be used by all nursing team members across health and social care settings and may need tailoring for different contexts. External web link - https://www.surrey.ac.uk/sites/default/files/2020-05/guidance-to-support-nurses-psychological-well-being-during-covid-19-crisis-final.pdf Theme: Workforce & Health Systems Supporting patient access to medicines in community palliative care: on-line survey of health professionals’ practice, perceived effectiveness and influencing factors Sue Latter, Natasha Campling, Jacqueline Birtwistle, Alison Richardson, Michael I. Bennett, Sean Ewings, David Meads & Miriam Santer – September 2020 Background Patient access to medicines at home during the last year of life is critical for symptom control, but is thought to be problematic. Little is known about healthcare professionals’ practices in supporting timely medicines access and what influences their effectiveness. The purpose of the study was to evaluate health professionals’ medicines access practices, perceived effectiveness and influencing factors. External web link - https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-020-00649-3 Theme: Workforce & Health Systems The association between ward staffing levels, mortality and hospital readmission in older hospitalised adults, according to presence of cognitive impairment: a retrospective cohort study Carole Fogg, Jackie Bridges, Paul Meredith, Claire Spice, Linda Field, David Culliford, Peter Griffiths – September 2020 Background Lower nurse staffing levels are associated with increased hospital mortality. Older patients with cognitive impairments (CI) have higher mortality rates than similar patients without CI and may be additionally vulnerable to low staffing. External web link - https://academic.oup.com/ageing/advance-article-abstract/doi/10.1093/ageing/afaa133/5909776?redirectedFrom=fulltext Theme: Workforce & Health Systems The influence of personal communities in understanding avoidable emergency department attendance: qualitative study The influence of personal communities in understanding avoidable emergency department attendance: qualitative study Gemma McKenna, Anne Rogers, Sandra Walker & Catherine Pope – September 2020 Background Use of emergency department (ED) care globally seems to be increasing at a faster rate than population growth. In the UK there has been a reported 16% rise in emergency admissions over the past 5 years. Estimates that between 11 and 40% of ED attendances are non-urgent, with 11% of patients being discharged from the ED without treatment (NHS Digital 2017), and a further 44% require no follow-up treatment ……. External web link - https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05705-5 Theme: Workforce & Health Systems Older people's experiences in acute care settings: systematic review and synthesis of qualitative studies Jackie Bridges, Joanna Hope - November 8 2019 Background Older people's care experiences in hospital may be negative in the absence of relational work by nurses to maintain people's identity, establish caring connections and ensure that individual patient needs, preferences and values are honoured in the care that is delivered. Relational care by nurses can mediate powerful institutional drivers that may otherwise result in negative experiences and poor care. External web link - https://www.sciencedirect.com/science/article/pii/S0020748919302767#! Theme: Workforce & Health Systems Patient involvement in pressure ulcer prevention and adherence to prevention strategies: An integrative review There is limited research that focuses on the patient view of factors affecting adherence to prevention measures, particularly in community settings. Individual and daily lifestyle considerations and involvement in decision-making around pressure ulcer care are important aspects from the patient perspective. Further research is necessary to explore which factors affect patient adherence in order to improve clinical practice and support patient involvement in preventative strategies. Jo Hope, Lisette Schoonhoven - October 23 2019 External web link - https://www.sciencedirect.com/science/article/pii/S0020748919302561 Theme: Workforce & Health Systems Cognitive impairment is associated with an increased risk of adverse outcomes in hospitalised older people with an unscheduled admission, by increasing hospital mortality, extending hospital stays and increasing frequency of readmissions. Authors: Carole Fogg, Paul Meredith, David Culliford, Jackie Bridges, Peter Griffiths - August 2019 Background Older adults admitted to hospital are often cognitively impaired. It is not clear whether the presence of cognitive impairment conveys an additional risk for poor hospital outcomes in this patient population. External web link - https://www.sciencedirect.com/science/article/pii/S0020748919300367 Theme: Workforce & Health Systems Beyond ratios - flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: A simulation and economic modelling study Griffiths, Savile, Ball, Jones, Monks, et al (May 2021) Background In the face of pressure to contain costs and make best use of scarce nurses, flexible staff deployment (floating staff between units and temporary hires) guided by a patient classification system may appear an efficient approach to meeting variable demand for care in hospitals. External web link - https://www.sciencedirect.com/science/article/pii/S002074892100033X# Theme: Workforce & Health Systems Nurses’ experiences and preferences around shift patterns: A scoping review (August 2021) Ourega-Zoé Ejebu, Chiara Dall’Ora , Peter Griffiths Abstract Objective To explore the evidence on nurses’ experiences and preferences around shift patterns in the international literature. External web link - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256300 Theme: Workforce & Health Systems A global overview of healthcare workers’ turnover intention amid COVID-19 pandemic: a systematic review with future directions Yuan-Sheng Ryan Poon, Yongxing Patrick Lin, Peter Griffiths, Keng Kwang Yong, Betsy Seah & Sok Ying Liaw September 24, 2022 Background Globally, the health workforce has long suffered from labour shortages. This has been exacerbated by the workload increase caused by the COVID-19 pandemic. Major collapses in healthcare systems across the world during the peak of the pandemic led to calls for strategies to alleviate the increasing job attrition problem within the healthcare sector. This turnover may worsen given the overwhelming pressures experienced by the health workforce during the pandemic, and proactive measures should be taken to retain healthcare workers. This review aims to examine the factors affecting turnover intention among healthcare workers during the COVID-19 pandemic. External web link - https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-022-00764-7 Theme: Workforce & Health Systems The association between midwifery staffing levels and the experiences of mothers on postnatal wards: Cross sectional analysis of routine data (February 17, 2022) L.Turner, D.Culliford, J.Ball, E.Kitson-Reynolds, P.Griffiths Background Women have consistently reported lower satisfaction with postnatal care compared with antenatal and labour care. The aim of this research was to examine whether women’s experience of inpatient postnatal care in England is associated with variation in midwifery staffing levels. External web link - https://www.sciencedirect.com/science/article/pii/S1871519222000312#! Theme: Workforce & Health Systems The impact of COVID-19 on nurses (ICON) survey: Nurses' accounts of what would have helped to improve their working lives Jane Ball, Sydney Anstee, Keith Couper, Jill Maben, Holly Blake, Janet E. Anderson, Daniel Kelly, Ruth Harris, Anna Conolly, the full ICON Study Team First published: 29 September 2022 Aims To use nurses' descriptions of what would have improved their working lives during the first peak of the COVID-19 pandemic in the UK. External web link - https://onlinelibrary.wiley.com/doi/10.1111/jan.15442 Theme: Long Term Conditions A novel exploration of the support needs of people initiating insulin pump therapy using a social network approach: a longitudinal mixed‐methods study A social network approach determined what resources and support people with diabetes require when incorporating a new health technology. Visualisation of support networks using concentric circles enabled people to consider and mobilise support and engage in new activities as their needs changed. The novelty of pump therapy creates new illness‐related work, but mobilisation of personally valued flexible, tailored support can improve the process of adaptation. C. Reidy, C. Foster, A. Rogers - October 16 2019 External web link - https://onlinelibrary.wiley.com/doi/full/10.1111/dme.14155 Theme: Long Term Conditions A randomised controlled feasibility trial of E-health application supported care vs usual care after exacerbation of COPD: the RESCUE trial Mal North, Simon Bourne, Ben Green, Anoop J. Chauhan, Tom Brown, Jonathan Winter, Tom Jones, Dan Neville, Alison Blythin, Alastair Watson, Matthew Johnson, David Culliford, Jack Elkes, Victoria Cornelius & Professor Tom M. A. Wilkinson – October 2020 Abstract Exacerbations of COPD are one of the commonest causes of admission and readmission to hospital. The role of digital interventions to support self-management in improving outcomes is uncertain. We conducted an open, randomised controlled trial of a digital health platform application (app) in 41 COPD patients recruited following hospital admission with an acute exacerbation. Subjects were randomised to either receive usual care, including a written self-management plan (n = 21), or the myCOPD app (n = 20) for 90 days. External web link - https://www.nature.com/articles/s41746-020-00347-7 Theme: Long Term Conditions Planning and optimising CHAT&PLAN: A conversation-based intervention to promote person-centred care for older people living with multimorbidity Corbett, T., Cummings, A., Lee, K., Calman, L., Fenerty, V., Farrington, N., Lewis, L., Young, A., Boddington, H., Wiseman, T., Richardson, A., Foster, C., Bridges, J. - October 16, 2020 Background Older people are more likely to be living with cancer and multiple long-term conditions, but their needs, preferences for treatments, health priorities and lifestyle are often not identified or well-understood. There is a need to move towards a more comprehensive person-centred approach to care that focuses on the cumulative impact of a number of conditions on daily activities and quality of life. This paper describes the intervention planning process for CHAT& PLANTM, a structured conversation intervention to promote personalised care and support self-management in older adults with complex conditions. External web link - https://doi.org/10.1371/journal.pone.0240516 Theme: Long Term Conditions Self-management in older people living with cancer and multi-morbidity: A systematic review and synthesis of qualitative studies Teresa Corbett, Amanda Cummings, Lynn Calman, Naomi Farrington, Vicky Fenerty, Claire Foster, Alison Richardson, Theresa Wiseman, Jackie Bridges - June 2020 Abstract Objective: Many older people with cancer live with multimorbidity. Little is understood about the cumulative impact of old age, cancer and multi-morbidity on self-management. This qualitative systematic review and synthesis aimed to identify what influences self-management from the perspective of older adults living with cancer and multi-morbidity. External web link - https://onlinelibrary.wiley.com/doi/epdf/10.1002/pon.5453 Theme: Long Term Conditions Mediating engagement in a social network intervention for people living with a long-term condition: A qualitative study of the role of facilitation. James E, Kennedy A, Vassilev I, Ellis J, Rogers A - March 2020 Abstract Successful facilitation of patient-centred interventions for self-management support has traditionally focussed on individual behaviour change. A social network approach to self-management support implicates the need for facilitation that includes an orientation to connecting to and mobilizing support and resources from other people and the local environment. External web link - https://www.ncbi.nlm.nih.gov/pubmed/32162435 Theme: Long Term Conditions A systematic review of the evidence for deprescribing interventions among older people living with frailty Kinda Ibrahim, Natalie J. Cox, Jennifer M. Stevenson, Stephen Lim, Simon D. S. Fraser & Helen C. Roberts (April 2021) Background Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty. External web link - https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-021-02208-8 Theme: Long Term Conditions Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials Farhad Pazan, Mirko Petrovic, Antonio Cherubini, Graziano Onder, Alfonso J. Cruz-Jentoft, Michael Denkinger, Tischa J. M. van der Cammen, Jennifer M. Stevenson, Kinda Ibrahim, Chakravarthi Rajkumar, Marit Stordal Bakken, Jean-Pierre Baeyens, Peter Crome, Thomas Frühwald, Paul Gallaghar, Adalsteinn Guðmundsson, Wilma Knol, Denis O’Mahony, Alberto Pilotto, Elina Rönnemaa, José Antonio Serra-Rexach, George Soulis, Rob J. van Marum, Gijsbertus Ziere, Alpana Mair, Heinrich Burkhardt, Agnieszka Neumann-Podczaska, Katarzyna Wieczorowska-Tobis, Marilia Andreia Fernandes, Heidi Gruner, Dhayana Dallmeier, Jean-Baptiste Beuscart, Nathalie van der Velde & Martin Wehling (August 2021) Background Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty. External web link - https://link.springer.com/article/10.1007/s00228-020-02951-8 Theme: Long Term Conditions Characterising risk of non-steroidal anti-inflammatory drug-related acute kidney injury: a retrospective cohort study (January 2022) Sharon X Lin, Thomas Phillips, David Culliford, Christopher Edwards, Christopher Holroyd, Kinda Ibrahim, Ravina Barrett, Clare Howard, Ruth Johnson, Jo Adams, Mathew Stammers, Adam Rischin, Paul Rutter, Nicola Barnes, Paul J Roderick and Simon DS Fraser Background Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for pain and inflammation. NSAID complications include acute kidney injury (AKI), causing burden to patients and health services through increased morbidity, mortality, and hospital admissions. External web link - https://bjgpopen.org/content/early/2022/01/10/BJGPO.2021.0208 Theme: Long Term Conditions Digital tools to support the maintenance of physical activity in people with long-term conditions: A scoping review Paul Clarkson, Aoife Stephenson, Chloe Grimmett, Katherine Cook, Carol Clark, Paul E Muckelt, Philip O’Gorman, Zoe Saynor, Jo Adams, Maria Stokes and Suzanne McDonough. (April 2022) Abstract Objective This scoping review aimed to bring together and identify digital tools that support people with one or more long-term conditions to maintain physical activity and describe their components and theoretical underpinnings External web link - https://doi.org/10.1177%2F20552076221089778 Theme: Long Term Conditions Accessibility and applicability of physical activity guidelines and recommendations for adults living with long term conditions during COVID-19 L Ambrosioa , D Lambrickb , J Faulknerc , and MC Portilloa a NIHR ARC Wessex. Health and Life Sciences, University of Southampton, Southampton, UK b School of Health Sciences, University of Southampton, Southampton, UK c Department of Sport, Exercise and Health, University of Winchester, Winchester, UK (April 2022) ABSTRACT To review the applicability and accessibility of physical activity guidelines for adults living with long-term conditions whilst shielding during the COVID-19. A narrative review with systematic methodology was conducted between 2015 and 2021, with two stages: 1) Search of electronic databases PubMed/Medline, Web of Science, PsycInfo, and Cinahl; 2) search of long-term condition organisations. Sixty-five articles were identified, where nine included specific guidelines during the COVID-19, 28 specific guidelines to individuals living with long-term conditions and 7 identified the utilization of online resources. Twenty-one long-term condition organizations websites were reviewed where all of them included a section regarding physical activity guidelines and seven referred to online and offline accessible resources during COVID-19. Accessibility and applicability were variable across academic databases and long-term conditions organisation websites. Findings could inform long-term condition policy and guidelines development to better and more relevant support people living with long-term conditions to be physically active. External web link - https://doi.org/10.1080/09603123.2022.2066071 Theme: Long Term Conditions SYMptoms in chronic heart failure imPACT on burden of treatment (SYMPACT): a cross-sectional survey Rosalynn C. Austin, Professor Lisette Schoonhoven, Dr Vasiliki Koutra, Professor Alison Richardson, Professor Paul R. Kalra, Professor Carl R. May Aims This study aimed to describe patient-reported symptoms and burden of treatment (BoT) experienced by patients with chronic heart failure (CHF). BoT describes the illness workload, individual capacity to perform that work, and resultant impact on the individual. Overwhelming BoT is related to poor quality of life and worse clinical outcomes. This research is the first to explore symptoms and BoT in people with CHF, in the UK. (April 2022) External web link - https://onlinelibrary.wiley.com/doi/10.1002/ehf2.13904 Theme: Long Term Conditions Change in treatment burden among people with multimorbidity: a follow-up survey Hilda Hounkpatin, Paul Roderick, Scott Harris, James E Morris, Dianna Smith, Bronagh Walsh, Helen Roberts, Hajira Dambha-Miller, Qian Tan, Forbes Watson and Simon D Fraser (May 2022) Background: Treatment burden is the workload of being a patient and its impact on wellbeing. Little is known about change in treatment burden over time for people with multimorbidity. Aim: To quantify change in treatment burden, determine factors associated with this change, and evaluate a revised single-item measure for high treatment burden in older adults with multimorbidity. External web link - https://bjgp.org/content/early/2022/05/04/BJGP.2022.0103 Theme: Long Term Conditions The influence of social relationships and activities on the health of adults with obesity: A qualitative study Nestor Serrano-Fuentes MSc, Anne Rogers PhD, Mari Carmen Portillo PhD 24 June 2022 Background Obesity in adults is a leading health challenge that causes millions of deaths worldwide and represents a risk factor for developing long-term conditions. Social relationships are one of the multiple drivers shaping obesity and obesity-related practices. However, there is still little evidence as to the processes by which relationships influence the adoption of positive and negative obesity health-related practices—eating, physical activity and alcohol intake. This study aims first to identify the types of relationships relevant to the adoption of practices in adults with obesity and, second, to explore the type of activities these relationships engage with or promote to produce those practices and their potential health consequences. External web link - https://onlinelibrary.wiley.com/doi/10.1111/hex.13540 Theme: Long Term Conditions Early-onset burdensome multimorbidity: an exploratory analysis of sentinel conditions, condition accrual sequence and duration of three long-term conditions using the 1970 British Cohort Study Sebastian Stannard, Emilia Holland, Sarah R Crozier, Rebecca Hoyle, Michael Boniface, Mazen Ahmed, James McMahon, William Ware, Zlatko Zlatev, Nisreen A Alwan, DS Fraser Correspondence to Dr Sebastian Stannard; S.J.Stannard@soton.ac.uk October 10, 2022 Abstract Objectives The prevalence of multiple long-term condition (LTC) multimorbidity is increasing with younger onset among socioeconomically deprived populations. Research on life course trajectories towards multimorbidity is limited and early-onset multimorbidity poorly characterised. Understanding sentinel conditions (the first LTC occurring in the life course), the sequence of LTC accrual and the permanency of the reporting of LTCs may help identify time points for prevention efforts. We used a longitudinal birth cohort to estimate the prevalence of a common three-condition early-onset multimorbidity (multiple long-term condition multimorbidity (MLTC-M)) group at midlife, describe the frequency of sentinel conditions, the sequence of LTC accrual and explore the permanency of one of these conditions: psychological distress. External web link - https://bmjopen.bmj.com/content/12/10/e059587.full Theme: Long Term Conditions Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study Soilemezi D, Palmar-Santos A, Navarta-Sánchez MV, Roberts HC, Pedraz-Marcos A, Haahr A, Sørensen D, Bragstad LK, Hjelle EG, Haavaag SB, Portillo MC. Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study. 2022 Dec 27. Background: Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long-term conditions such as Parkinson's disease. External web link - https://pubmed.ncbi.nlm.nih.gov/36573594/ Theme: Healthy Communities Adult diet in England: Where is more support needed to achieve dietary recommendations? Dianna M. Smith , Christina Vogel, Monique Campbell, Nisreen Alwan, Graham Moon (June 23, 2021) Background Small-area estimation models are regularly commissioned by public health bodies to identify areas of greater inequality and target areas for intervention in a range of behaviours and outcomes. Such local modelling has not been completed for diet consumption in England despite diet being an important predictor of health status. The study sets out whether aspects of adult diet can be modelled from previously collected data to define and evaluate area-level interventions to address obesity and ill-health. External web link - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252877 Theme: Healthy Communities Implementing a social network intervention: can the context for its workability be created? A quasiethnographic study J. Ellis , I. Vassilev, E. James and A. Rogers - October 27, 2020 Background Policy makers and researchers recognise the challenges of implementing evidence-based interventions into routine practice. The process of implementation is particularly complex in local community environments. In such settings, the dynamic nature of the wider contextual factors needs to be considered in addition to capturing interactions between the type of intervention and the site of implementation throughout the process. This study sought to examine how networks and network formation influence the implementation of a self-management support intervention in a community setting. External web link - https://implementationsciencecomms.biomedcentral.com/articles/10.1186/s43058-020-00087-5 Theme: Healthy Communities Public attitudes to a human challenge study with SARS-CoV-2: a mixed-methods study (10 February 2022) Caroline Barker, Katharine Collet, Diane Gbesemete, Maria Piggin, Daniella Watson, Philippa Pristerà, Wendy Lawerence, Emma Smith, Michael Bahrami-Hessari, Halle Johnson, Katherine Baker, Ambar Qavi, Carmel McGrath, Christopher Chiu, Robert C. Read, Helen Ward Background: Human challenge studies involve the deliberate exposure of healthy volunteers to an infectious micro-organism in a highly controlled and monitored way. They are used to understand infectious diseases and have contributed to the development of vaccines. In early 2020, the UK started exploring the feasibility of establishing a human challenge study with SARS-CoV-2. Given the significant public interest and the complexity of the potential risks and benefits, it is vital that public views are considered in the design and approval of any such study and that investigators and ethics boards remain accountable to the public. External web link - https://wellcomeopenresearch.org/articles/7-49/v1 Theme: Healthy Communities Understanding the early life mediators behind the intergenerational transmission of partnership dissolution Sebastian Stannard, Ann Berrington, Nisreen A. Alwan. June 2022 Abstract: Whilst research has demonstrated an intergenerational transmission of partnership dissolution, there is limited evidence as to the early life course pathways through which these associations operate, and whether these differ by gender. Many studies have not considered prospective data from early childhood, thus potentially neglecting the importance of the early childhood period in explaining this intergenerational transmission. Given that serial partnering has become increasingly commonplace it is important research considers those who experience multiple partnership dissolution. This paper examines, using data from the 1970 British Birth Cohort Study, the early life mediators underpinning the association between parental separation and the number of offspring partnership dissolutions. Among both men and women there is a significant unadjusted relationship between parental separation and the experience of multiple partnership dissolutions in adulthood. These associations were reduced once parental confounders and childhood mediators are included. Formal mediation analyses demonstrated that early life mediators accounted for more of the association in men than women. Mediators included childhood living standards, and for men child cognition and child behaviour, and for women maternal mental wellbeing. Parental separation and many early life mediators were related to the likelihood of multiple partnership dissolutions through age at first partnership. External web link - https://www.sciencedirect.com/science/article/pii/S1040260822000089?via%3Dihub#sec0045 Theme: Healthy Communities Inequalities in energy drink consumption among UK adolescents: a mixed-methods study Authors: Vogel C, Shaw S, Strömmer S, Crozier S, Jenner S, Cooper C, Baird J, Inskip H, Barker M. 6 December 2022 Abstract Objective: To examine energy drink consumption among adolescents in the United Kingdom (UK) and associations with deprivation and dietary inequalities. Design: Quantitative dietary and demographic data from the National Diet and Nutrition Survey (NDNS) repeated cross-sectional survey were analysed using logistic regression models. Qualitative data from semi-structured interviews were analysed using inductive thematic analysis. Setting: UK. Participants: Quantitative data: nationally representative sample of 2587 adolescents aged 11-18 years. Qualitative data: 20 parents, 9 teachers, and 28 adolescents from Hampshire, UK. Results: NDNS data showed adolescents' consumption of energy drinks was associated with poorer dietary quality (OR 0.46 per SD; 95% CI 0.37, 0.58; p<0.001). Adolescents from more deprived areas and lower income households were more likely to consume energy drinks than those in more affluent areas and households (OR 1.40; 95%CI 1.16, 1.69; p<0.001; OR 0.98 per £1000; 95%CI, 0.96, 0.99; p<0.001 respectively). Between 2008 and 2016, energy drink consumption among adolescents living in the most deprived areas increased, but decreased among those living in the most affluent neighbourhoods (p=0.04). Qualitative data identified three themes. First, many adolescents drink energy drinks because of their friends and because the unbranded drinks are cheap. Second, energy drink consumption clusters with other unhealthy eating behaviours and adolescents don't know why energy drinks are unhealthy. Third, adolescents believe voluntary bans in retail outlets and schools do not work. Conclusions: This study supports the introduction of age-dependent legal restrictions on the sale of energy drinks which may help curb existing socio-economic disparities in adolescents' energy drink intake. External web link - https://pubmed.ncbi.nlm.nih.gov/36472075/#affiliation-1 Theme: Healthy Communities Household food insecurity risk indices for English neighbourhoods: Measures to support local policy decisions Authors: Dianna M. Smith , Lauren Rixson , Grace Grove, Nida Ziauddeen, Ivaylo Vassilev, Ravita Taheem, Paul Roderick, Nisreen A. Alwan Published: 9 December 2022 Background In England, the responsibility to address food insecurity lies with local government, yet the prevalence of this social inequality is unknown in small subnational areas. In 2018 an index of small-area household food insecurity risk was developed and utilised by public and third sector organisations to target interventions; this measure needed updating to better support decisions in different settings, such as urban and rural areas where pressures on food security differ. External web link - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0267260 Theme: Healthy Communities UK government’s new placement legislation is a ‘good first step’: a rapid qualitative analysis of consumer, business, enforcement and health stakeholder perspectives Sarah Muir, Preeti Dhuria, Emma Roe, Wendy Lawrence, Janis Baird & Christina Vogel January 26.2023 Background The current food system in England promotes a population diet that is high in fat, sugar and salt (HFSS). To address this, the UK government has implemented legislation to restrict the promotion of HFSS products in prominent locations (e.g. store entrances, checkouts) in qualifying retailers since October 2022. This study investigated the perceived impact of the legislation for affected stakeholders. Methods A pre-implementation rapid qualitative evaluation of stakeholder interviews. One hundred eight UK stakeholders participated in the study including 34 consumers, 24 manufacturers and retailers, 22 local authority enforcement officers and 28 academic and charitable health representatives. A participatory conference was used to enable policy recommendations to be confirmed by stakeholders. Results Stakeholders perceived the legislation to be a ‘good first step’ towards improving population diet but recognised this needed to be considered amongst a range of long-term obesity policies. Areas of further support were identified and these are presented as six recommendations for government to support the successful implementation of the legislation: (1) provide a free central HFSS calculator, (2) refine legislation to enhance intent and clarity, (3) conduct a robust evaluation to assess intended and unintended outcomes, (4) provide greater support for smaller businesses, (5) provide ring-fenced resources to local authorities and (6) create and communicate a long-term roadmap for food and health. Conclusions This legislation has the potential to reduce impulse HFSS purchases and makes a solid start towards creating healthier retail outlets for consumers. Immediate government actions to create a freely accessible HFSS calculator, support smaller businesses and provide additional resources to local authorities would support successful implementation and enforcement. Independent evaluation of the implementation of the legislation will enable monitoring of potential unintended consequences identified in this study and support refinement of the legislation. A long-term roadmap is necessary to outline strategies to support equal access to healthier and sustainable food across the whole food system within the next 20–30 years. External web link - https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-02726-9 Theme: Ageing & Dementia Implementing grip strength assessment in hip fracture patients: a feasibility project. Doherty W J, Stubbs T A, Chaplin A, Langford S, Sinclair N, Ibrahim K, Reed M R, Sayer A A, Witham M D, Sorial A K. (February 2021) Objectives Risk stratification scores are used in hip fracture surgery, but none incorporate objective tests for low muscle strength. Grip strength testing is simple and cheap but not routinely assessed for patients with hip fracture. This project aimed to assess the feasibility of implementing grip strength testing into admission assessment of patients with hip fracture. External web link - https://eprints.soton.ac.uk/446434/ Theme: Ageing & Dementia The composition of the gut microbiome differs among community dwelling older people with good and poor appetite. Cox N, Bowyer R, Lochlainn M, Wells P, Roberts H, Steves C. (February 2021) Background Anorexia of ageing is common and important in the development of sarcopenia in older individuals. Links have been proposed between the gut microbiota and sarcopenia. Disordered gut function is also recognized in anorexia of ageing, but how this may relate to resident gut microbiota is unexplored. Understanding this relationship may provide a basis for novel interventions for anorexia of ageing and sarcopenia. This study explores compositional differences of the gut microbiota between community dwelling healthy older adults with good or poor appetite, and associated differences in sarcopenia. External web link - https://doi.org/10.1002/jcsm.12683 Theme: Ageing & Dementia Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials Pazan F, Ibrahim K & et al. (January 2021). Background Frailty and adverse drug effects are linked in the fact that polypharmacy is correlated with the severity of frailty; however, a causal relation has not been proven in older people with clinically manifest frailty. External web link - https://eprints.soton.ac.uk/445965/ Theme: Ageing & Dementia Recommendations for the management of COVID-19 pandemic in long-term care facilities. Gosch M, Heppner H, Lim S. et al. (January 2021) Abstract Long-term care facilities (LTCF) and their vulnerable residents are particularly affected by the coronavirus disease 2019 (COVID-19) pandemic. Estimates from various countries suggest that 3–66% of all COVID-19 deaths were residents of LTCF, of which 80% died in their facilities. Despite these significant numbers, recommendations for LTCF for the prevention and medical care of residents during the COVID-19 pandemic are still lacking. These recommendations are based on the existing literature and the expertise of the authors who are specialists in geriatric medicine. The recommendations are addressed to LTCF management, their operators, physicians working in LTCFs and also politicians, to provide the necessary framework conditions. We are confident that our recommendations will offer important help and guidance for LTCFs as well as their physicians. Adherence to these recommendations is likely to improve the outcomes and care of residents in long-term facilities during the COVID-19 pandemic. External web link - https://doi.org/10.1007/s00391-021-01847-1 Theme: Ageing & Dementia Clinical Nurse Specialist Role in Young Onset Dementia Care. Spreadbury J, Kipps C. (December 2020) Abstract Post-diagnostic care in young-onset dementia (YoD) varies, from something that is occasionally structured, to improvised, to frequently non-existent depending on geographic region. In a few regions in England, a nurse designated to helping families may exist. This study aimed to describe this seldom-observed nursing role and its content. It used an investigative qualitative case study design based on the analysis of two YoD clinical nurse specialists (CNSs) describing the work they did in providing post-diagnostic care to YoD service users. External web link - https://doi.org/10.12968/bjcn.2020.25.12.604 Theme: Ageing & Dementia Association between Quality of Interactions Schedule ratings and care experiences of people with a dementia in general hospital settings: a validation study. Lee K, Frankland J, Griffiths P, Hewer, Richards L, Young A, Bridges J. (November 2020) Introduction Establishing methods to evaluate interactions between hospital staff and patients with a dementia is vital to inform care delivery. This study aimed to assess the validity of Quality of Interactions Schedule (QuIS) ratings in relation to the care experiences of people with a dementia in a general hospital setting. External web link - https://doi.org/10.1002/gps.5464 Theme: Ageing & Dementia Planning and optimising CHAT&PLAN: a conversation-based intervention to promote person-centred care for older people living with multimorbidity. Corbett T, Cummings A, Lee K, Calman L, Fenerty V, Farrington N, Lewis L, Young A, Boddington H, Wiseman T, Richardson A, Foster C, Bridges J. (October 2020) Background Older people are more likely to be living with cancer and multiple long-term conditions, but their needs, preferences for treatments, health priorities and lifestyle are often not identified or well-understood. There is a need to move towards a more comprehensive person-centred approach to care that focuses on the cumulative impact of a number of conditions on daily activities and quality of life. This paper describes the intervention planning process for CHAT& PLANTM, a structured conversation intervention to promote personalised care and support self-management in older adults with complex conditions. External web link - https://doi.org/10.1371/journal.pone.0240516 Theme: Ageing & Dementia Can probiotics, prebiotics and synbiotics improve functional outcomes for older people: a systematic review. Coutts L, Ibrahim K, Tan QY, Lim SER, Cox NJ and Roberts HC (September 2020) Abstract Research evaluating the effect of probiotics, prebiotics and synbiotics (PPS) on laboratory markers of health (such as immunomodulatory and microbiota changes) is growing but it is unclear whether these markers translate to improved functional outcomes in the older population. This systematic review evaluates the effect of PPS on functional outcomes in older people. External web link - https://doi.org/10.1007/s41999-020-00396-x Theme: Ageing & Dementia Future Impact of dementia within an ageing population; simulation modelling of prevalence, outcomes and costs of dementia within the Wessex region. Evenden D, Brailsford S, Walsh B, Roderick P. (September 2020) Objectives The aim of the study was to model dementia prevalence and outcomes within an ageing population using a novel hybrid simulation model that simultaneously takes population-level and patient-level perspectives to better inform dementia care service planning, taking into account severity progression variability. External web link - https://doi.org/10.1016/j.puhe.2020.07.018 Theme: Ageing & Dementia The impact of regional 99mTc-HMPAO singlephoton-emission computed tomography (SPECT) imaging on clinician diagnostic confidence in a mixed cognitive impairment sample. Prosser A, Tossici-Bolt L, Kipps C. (September 2020) AIM To assess the clinical impact of regional cerebral blood flow (rCBF) single-photon-emission computed tomography (SPECT) imaging on diagnosis and clinician diagnostic confidence in a cohort of individuals with cognitive impairment. External web link - https://doi.org/10.1016/j.crad.2020.04.016 Theme: Ageing & Dementia Quality of Life Assessments in Individuals with Young-Onset Dementia and Their Caregivers. Dixit D, Spreadbury J, Orlando R, Hayward E, Kipps C. (July 2020) Background Quality of life (QoL) has seldom been investigated or explicitly measured in young-onset dementia (YoD). The aims of this study were (1) to investigate and compare QoL self- and proxy reports in a sample of YoD patients and caregivers using different conceptual assessments of QoL and (2) to examine the relationship between caregiver QoL and both burden and mental health. External web link - https://journals.sagepub.com/doi/10.1177/0891988720933348 Theme: Ageing & Dementia New horizons in appetite and the anorexia of ageing. Cox NJ, Morrison L, Ibrahim K, Robinson SM, Sayer AA, & Roberts HC. (July 2020) Abstract Appetite drives essential oral nutritional intake. Its regulation is complex, influenced by physiology, hedonism (the reward of eating) and learning from external cues within a person’s society and culture. Appetite loss is common in the older population and not always attributable to medical conditions or treatment. Although the physiological basis of the anorexia of ageing (loss of appetite due to the ageing process) has been established, the effect of ageing on hedonism and external cues, which may be equally important, is less well understood. The anorexia of ageing is associated with reductions in dietary diversity and oral intake, and increased risk of malnutrition, sarcopenia and frailty. External web link - https://academic.oup.com/ageing/article/49/4/526/5733078?login=true Theme: Ageing & Dementia Progression modelling of cognitive decline and associated FDG-PET imaging features in Alzheimer’s disease. Prosser AMJ, Evenden D, Holmes R, Kipps CM. (July 2020) Background Prognosis for Alzheimer’s disease is difficult, with rates of disease progression varying widely. Despite the extensive use of clinical dementia severity assessment scales to determine dementia diagnosis and to monitor progression, there is no consensus on which imaging factors may accurately predict future decline trajectories on these measures. Determination of baseline imaging patterns that are related to slower, or faster, decline rates could be used to identify those at highest risk of worse outcomes and inform care planning. External web link - https://doi.org/10.1002/alz.045900 Theme: Ageing & Dementia Poor appetite is associated with six month mortality in hospitalised older men and women. Cox N J, Lim SE, Howson FFA, Moyses HE, Ibrahim K, Sayer AA, Roberts HC, Robinson SM (July 2020). Abstract Appetite loss is common in hospitalised older individuals but not routinely assessed. Poor appetite in hospital has previously been identified as predictive of greater mortality in the six months following discharge in a single study of female patients. The present study aimed to assess this association in a larger sample including both hospitalised men and women. External web link - https://link.springer.com/article/10.1007/s12603-020-1442-0 Theme: Ageing & Dementia Hybrid simulation modelling for dementia care services planning Evenden D, Brailsford S, Walsh B, Kipps C, Roderick P. (June 2020) Abstract Dementia is an increasing problem in today’s ageing society, and meeting future demand for care is a major concern for policy-makers and planners. This paper presents a novel hybrid simulation model that simultaneously takes population-level and patient-level perspectives to calculate the numbers of patients at different stages of disease severity over time, and their associated care costs. External web link - https://doi.org/10.1080/01605682.2020.1772020 Theme: Ageing & Dementia Self-management in older people living with cancer and multi-morbidity: A theory-led systematic review and synthesis of qualitative studies. Corbett T, Cummings A, Calman L, Farrington N, Fenerty V, Foster C, Richardson A, Wiseman T, Bridges J (June 2020) Objective Many older people with cancer live with multimorbidity. Little is understood about the cumulative impact of old age, cancer and multimorbidity on self‐management. This qualitative systematic review and synthesis aimed to identify what influences self‐management from the perspective of older adults living with cancer and multimorbidity. External web link - https://doi.org/10.1002/pon.5453 Theme: Ageing & Dementia Volunteer-led physical activity interventions to improve health outcomes for community-dwelling older people: A systematic review. Lim SER, Cox NJ, Tan QY, Ibrahim K, Roberts HC. (April 2020) Background Physical activity (PA) is important for older people to maintain functional independence and healthy ageing. There is strong evidence to support the benefits of physical activity interventions on the health outcomes of older adults. Nonetheless, innovative approaches are needed to ensure that these interventions are practical and sustainable. External web link - https://link.springer.com/article/10.1007/s40520-020-01556-6 Theme: Ageing & Dementia Covid-19: supporting nurses’ psychological and mental health. Maben J, Bridges J (April 2020) Background As the coronavirus disease 2019 (COVID‐19) pandemic takes hold, nurses are on the front line of health and social care in the most extreme of circumstances. We reflect during a moment in time (week three of lockdown in the UK and week 5/6 across Europe) to highlight the issues facing nurses at this unprecedented time. External web link - https://doi.org/10.1111/jocn.15307 Theme: Ageing & Dementia Older people's experiences in acute care settings: systematic review and synthesis of qualitative studies. Bridges J, Collins P, Flatley M, Hope J, Young A, (February 2020) Background There is no recent synthesis of primary research studies into older people's experiences of hospital care. External web link - http://https://doi.org/10.1016/j.ijnurstu.2019.103469 Theme: Ageing & Dementia Physical activity among hospitalised older people: the feasibility and acceptability of a volunteer-led mobility intervention in the SoMoVe study. Lim S, Ibrahim K, Dodds R, Purkis A, Baxter M, Rogers A, Aihie Sayer A, Roberts H. (September 2019) Objectives: to determine the feasibility and acceptability of a volunteer-led mobility intervention to improve activity levels of older inpatients. Design: pre-post mixed methods study. Setting: acute medical wards for older people. External web link - https://doi.org/10.1093/ageing/afz114 Theme: Ageing & Dementia Comprehensive geriatric assessment in primary care: a systematic review. Garrad J, Cox N, Dodds R, Roberts H, Sayer AA. (April 2019) Background Comprehensive geriatric assessment (CGA) involves the multidimensional assessment and management of an older person. It is well described in hospital and home-based settings. A novel approach could be to perform CGA within primary healthcare, the initial community located healthcare setting for patients, improving accessibility to a co-located multidisciplinary team. External web link - https://link.springer.com/article/10.1007%2Fs40520-019-01183-w Theme: Ageing & Dementia The challenge of managing undernutrition in older people with frailty. Roberts H, Lim S, Cox N & Ibrahim K. (April 2019). Abstract Many older people with frailty are at risk of malnutrition and poor health, yet there is evidence that improving nutrition and weight loss can reduce frailty. This will become more important as the number of older people with frailty increases worldwide in future. Identifying those at risk is challenging due to the difficulty of reaching and screening those older people most at risk, the large number of nutritional assessment tools used, and the lack of consensus on the criteria to make a diagnosis of malnutrition. The management of older people with or at risk of malnutrition should be multi-modal and multi-disciplinary, and all care staff have an important role in delivering appropriate nutritional advice and support. This paper will highlight a number of practical approaches that clinicians can take to manage malnutrition in older people with frailty in community and acute settings, including environmental changes to enhance mealtime experience, food fortification and supplementation External web link - https://www.mdpi.com/2072-6643/11/4/808 Theme: Ageing & Dementia The challenge of managing undernutrition in older people with frailty. Cox N, Ibrahim K, Aihie Sayer A, Robinson S, & Roberts H. (January 2019) Background Appetite loss in older people, the 'Anorexia of Aging' (AA), is common, associated with under-nutrition, sarcopenia, and frailty and yet receives little attention. This review had two aims: describe interventions for AA and their effectiveness, and identify the methods of appetite assessment. External web link - https://pubmed.ncbi.nlm.nih.gov/30641897/ Theme: Ageing & Dementia The Experiences of Treatment Burden in People with Parkinson's Disease and Their Caregivers: A Systematic Review of Qualitative Studies Qian Yue Tan, Natalie J Cox, Stephen E R Lim, Laura Coutts , Simon D S Fraser, Helen C Roberts, Kinda Ibrahim (July 2021) Abstract BackgroundHigh treatment burden is associated with poor adherence, wasted resources, poor quality of life and poor health outcomes. Identifying factors that impact treatment burden in Parkinson's disease can offer insights into strategies to mitigate them.ObjectiveTo explore the experiences of treatment burden among people with Parkinson's disease (PwP) and their caregivers.MethodsA systematic review of studies published from year 2006 was conducted. Qualitative and mixed-method studies with a qualitative component that relate to usual care in Parkinson's disease were included. Quantitative studies and grey literature were excluded. Data synthesis was conducted using framework synthesis.Results1757 articles were screened, and 39 articles included. Understanding treatment burden in PwP and caregivers was not the primary aim in any of the included studies. The main issues of treatment burden in Parkinson's disease are: 1) work and challenges of taking medication; 2) healthcare provider obstacles including lack of patient-centered care, poor patient-provider relationships, lack of care coordination, inflexible organizational structures, lack of access to services and issues in care home or hospital settings; and 3) learning about health and challenges with information provision. The treatment burden led to physical and mental exhaustion of self-care and limitations on the role and social activities of PwP and caregivers.Conclusion:There are potential strategies to improve the treatment burden in Parkinson's disease at an individual level such as patient-centered approach to care, and at system level by improving access and care coordination between services. Future research is needed to determine the modifiable factors of treatment burden in Parkinson's disease. External web link - https://pubmed.ncbi.nlm.nih.gov/34334419/ Theme: Ageing & Dementia A systematic review of the evidence for deprescribing interventions among older people living with frailty Kinda Ibrahim, Natalie J. Cox, Jennifer M. Stevenson, Stephen Lim, Simon D. S. Fraser & Helen C. Roberts (April 2021) Background Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty. External web link - https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-021-02208-8 Theme: Ageing & Dementia Older individual's perceptions of appetite, its loss, influencing factors and adaptions to poor appetite. A qualitative study Natalie J Cox, Leanne Morrison , Sian M Robinson , Helen C Roberts , Kinda Ibrahim (December 2021) Abstract Appetite loss in later life is common and associated with malnutrition; however, there is limited knowledge on older individuals' perspectives of appetite. This study aimed to explore what 'appetite' means to older adults, how they experience its change and perceived influences on this experience. Semi-structured interviews were conducted with thirteen participants, aged ≥65 years, in their own home, following a recent arm fracture. Transcripts were analysed using reflexive thematic analysis with inductive coding resulting in three themes. 1. 'Appetite as an emotional experience' encompassed positive or negative thoughts and feelings driving or undermining desire to eat. Mood, the appeal of food, cooking and effects of interaction and experiences with other people were factors in this narrative. 2. 'Appetite reflects a physical need' comprised physical bodily sensations or requirements as a driver for appetite with poor appetite resulting from early or over fullness. Declines with age, illness and less activity, were factors in this narrative. 3. 'Adaption to poor appetite aligns with perception of appetite and wider physical health' accounts for how experiential strategies, or practical strategies were used to mitigate poor appetite depending on the narrative of appetite loss, alongside perceptions of physical health and unplanned weight loss. Most individuals used one narrative in their discussions and reflections but for some, perceptions of appetite and its change were more complex. Understanding relationships between these perceptions of appetite and influential factors could facilitate development of multi-component, person-centred, strategies that are optimally meaningful and relevant to address appetite loss in later life. External web link - https://pubmed.ncbi.nlm.nih.gov/34311002/ Theme: Ageing & Dementia Older individual's perceptions of appetite, its loss, influencing factors and adaptions to poor appetite. A qualitative study Kinda Ibrahim, Mark A Mullee, Natalie Cox, Cynthia Russell, Mark Baxter, Simon Tilley, Guiqing Lily Yao, Shihua Zhu, Helen C Roberts December 30, 2021 Background: Sarcopenia and frailty are associated with increased risk of falls and fractures. This study evaluated the feasibility of assessing sarcopenia and frailty among older people attending fracture clinics. External web link - https://pubmed.ncbi.nlm.nih.gov/34977920/ Theme: Ageing & Dementia A Comprehensive Literature Search of Digital Health Technology Use in Neurological Conditions: Review of Digital Tools to Promote Self-management and Support Autho r John Henry Spreadbury, BSc, MSc, PhD, Alex Young, MSc, PhD and Christopher Myles Kipps, MBBS, PhD Published: July 2022 Background The use of digital health technology to promote and deliver postdiagnostic care in neurological conditions is becoming increasingly common. However, the range of digital tools available across different neurological conditions and how they facilitate self-management are unclear. External web link - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9377435/ Theme: Ageing & Dementia Exploring the prevalence and types of fall-risk-increasing drugs among older people with upper limb fractures Natalie Cox, Isra Ilyas, Helen C Roberts, Kinda Ibrahim Published: 10 November 2022 Background Medications and specifically fall-risk-increasing drugs (FRIDs) are associated with increased risk of falls: reducing their prescription may improve this risk. This study explored patient characteristics associated with FRID use, prevalence and type of FRIDs and changes in their prescriptions among older people with arm fractures over 6 months External web link - https://academic.oup.com/ijpp/advance-article/doi/10.1093/ijpp/riac084/6821269 Theme: Ageing & Dementia Multidisciplinary team healthcare professionals’ perceptions of current and optimal acute rehabilitation, a hip fracture example A UK qualitative interview study informed by the Theoretical Domains Framework Stefanny Guerra, Kate Lambe, Gergana Manolova, Euan Sadler, Katie J. Sheehan 7 November 2022 Objective To understand multidisciplinary team healthcare professionals’ perceptions of current and optimal provision of acute rehabilitation, perceived facilitators and barriers to implementation, and their implications for patient recovery, using hip fracture as an example. External web link - https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0277986 Theme: Ageing & Dementia Mood and physical activity are associated with appetite in hospitalised older men and women Cox NJ, Howson F, Ibrahim K, Morrison L, Sayer AA, Roberts HC, Robinson SM. Mood and physical activity are associated with appetite in hospitalised older men and women. Age Ageing. 2022 Dec 5 Background: The anorexia of ageing is important in the development of malnutrition, frailty and sarcopenia amongst the older population and is a particular problem for hospital inpatients. This study assessed appetite-related factors in a group of hospitalised older adults, to identify potential preventive strategies. External web link - https://pubmed.ncbi.nlm.nih.gov/36580556/ Theme: Ageing & Dementia Moving our care home: A qualitative study of the views and experiences of residents, relatives and staff Kinda Ibrahim PhD, Sophie Baron BMedSci, BMBS, Judith Lathlean PhD, Jackie Bridges PhD, Nuala McGrath PhD, Helen C. Roberts PhD April 2022 Introduction Involuntary relocation when care homes close can be detrimental to residents’ health and well-being and is associated with increased mortality. There is little formal evidence to support whether planning can mitigate the impact of such moves. This study aimed to understand the experiences of a whole care home relocation where staff and residents relocated together using existing published guidance. External web link - https://onlinelibrary.wiley.com/doi/10.1111/opn.12466 Theme: Ageing & Dementia Sarcopenia is associated with a greater risk of polypharmacy and number of medications: a systematic review and meta-analysis Konstantinos Prokopidis, Panagiotis Giannos, Jean Yves Reginster, Olivier Bruyere, Mirko Petrovic, Antonio Cherubini, Konstantinos K. Triantafyllidis, Konstantinos S. Kechagias, Yannis Dionyssiotis, Matteo Cesari, Kinda Ibrahim, David Scott, Mario Barbagallo, Nicola Veronese, Special interest group in Systematic Reviews and Meta-analyses and the Task Force on Pharmaceutical Strategy of the European Geriatric Medicine Society (EuGMS) February 13 2023 Theme: Long Term Conditions Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study Soilemezi D, Palmar-Santos A, Navarta-Sánchez MV, Roberts HC, Pedraz-Marcos A, Haahr A, Sørensen D, Bragstad LK, Hjelle EG, Haavaag SB, Portillo MC. Understanding support systems for Parkinson's disease management in community settings: A cross-national qualitative study. 2022 Dec 27. Background: Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long-term conditions such as Parkinson's disease. Theme: Healthy Communities UK government’s new placement legislation is a ‘good first step’: a rapid qualitative analysis of consumer, business, enforcement and health stakeholder perspectives Sarah Muir, Preeti Dhuria, Emma Roe, Wendy Lawrence, Janis Baird & Christina Vogel January 26.2023 Background The current food system in England promotes a population diet that is high in fat, sugar and salt (HFSS). To address this, the UK government has implemented legislation to restrict the promotion of HFSS products in prominent locations (e.g. store entrances, checkouts) in qualifying retailers since October 2022. This study investigated the perceived impact of the legislation for affected stakeholders. Theme: Ageing & Dementia Enhancing the management of anorexia of ageing to counteract malnutrition: are physical activity guidelines optimal? Crabtree, D.R., Cox, N.J., Lim, S.E.R. et al. Enhancing the management of anorexia of ageing to counteract malnutrition: are physical activity guidelines optimal?. Aging Clin Exp Res (2023). https://doi.org/10.1007/s40520-022-02317-3 January 20, 2023 Introduction Poor appetite in later life—termed “anorexia of ageing”—is acknowledged as a key determinant of age-related malnutrition. While physical activity (PA) is often recommended for increasing drive to eat, these recommendations are not well-evidenced in the older population. In this opinion piece we outline limitations to physical activity recommendations in anorexic older adults. We then discuss current evidence for the relationship between physical activity and appetite amongst younger adults and postulate how this relationship may change in later life, with implications regarding future recommendations and research. Back to top

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Home > About us Case studies Dr Dominique Mylods Journey to becoming a researcher Dr Dominique Mylod, is a lecturer in Midwifery at Bournemouth University. In an interview with Jamie Stevenson she talks openly, passionately and with great humour about her journey from Teaching English as a Foreign Language to qualifying ad a midwife at 40, then making a start on her research career. Anna Badley Community nursing to PhD I love research and I always have done, but my journey to being awarded an ARC Wessex PhD Scholarship has been far from traditional. Read more

Role of patient-assessed functioning as a predictor of health service use in patients with long term mental health conditions Lead applicants: Prof David Baldwin, Prof Mari Carmen Portillo Co-applicants: Dr Leire Ambrosio, Dr Bethan Impey ​ ​ Project Summary: Read a long summary Read a short summary Treatments for patients with long term medical conditions are often disappointing in their effectiveness and acceptability in clinical practice. This is perhaps because they tend to be targeted at reducing troublesome symptoms rather than directed at improving everyday functioning. ​ We have previously shown that self-assessed functioning (using a self-report scale known as the PARADISE-24) was a better predictor of health service use than is anxiety and depressive symptom severity, among a group of patients attending a Mood Disorders Service in Southampton. That research was undertaken with patients with a primary diagnosis of an anxiety or depressive disorder, and we are now interested in conducting a similar study of functioning in patients with other long-term health conditions in which anxiety and depressive symptoms are common, to understand if functioning will also be a useful predictor of health service use in these conditions. ​ Hearing function is not one of the measures included within PARADISE-24, however, hearing loss is associated with increased likelihood of anxiety and depression and increased use of health services and our PPIE representatives highlighted sensory function as an important measure. We will therefore also include a self-report measure of hearing difficulties as well as some further questions about hearing function to see whether they also are useful in predicting use of health services in our cohorts. ​ The long-term conditions we are going to study are gambling disorder, alcohol use disorder, ‘long-covid’ and hearing loss (those attending the University of Southampton Auditory Implant Service, USAIS). We have chosen these populations since anxiety and depression are common in all of them, and because these populations are available to us (large convenience samples). These groups would have a variety of functional symptoms: for example, memory problems might be more likely in those with alcohol use disorder, attention deficit might be common in those with gambling disorder, sleep and energy problems common in those rehabilitating after Covid-19, and independence might be relevant for those with hearing loss in later life (in addition to the hearing loss itself). ​ Participation in the research should not be too onerous for patients. Clinical diagnoses will be identified from the medical records, and participants will report the severity of anxiety and depressive symptoms and other symptoms associated with the condition and whether they have hearing difficulties and will report on their everyday functioning using the PARADISE-24 scale at Baseline. They will be followed-up twice (at three and six months after the Baseline assessment), with further queries relating to symptom severity and functioning. The use of health services will be ascertained by self-report and through inspection of electronic health records. ​ The findings from this study could influence clinical practice. It should help to better understand the burden of illness and could ascertain the relative importance of symptom severity and degree of functioning in predicting health service use by groups of patients with a range of long-term conditions. It could therefore result in more targeted delivery of health and social care interventions, to both improve the patient’s quality of life and reduce their need for health service use. It would also contribute to addressing the objectives of the National Institute of Health Research Applied Research Collaborative Mental Health Infrastructure programme.

Understanding psychosocial determinants of alcohol use disorder (AUD) in older adults: exploring the role of social networks and loneliness in living with AUD (OLA study 2). Lead applicant : Professor Julia Sinclair Co-applicants : Dr Rebecca Band, Professor Jackie Bridges Implementation Champion: Dr Stephen Lim Starts: 01/01/2023 Ends: 01/07/2024 Summary Alcohol use disorders (AUD) in older adults is a growing problem which is currently under-recognised and under-treated. With little research into this area, there is no in-depth understanding about the factors that may contribute to AUD in older adults, nor the lived experiences of this group. Some have suggested that factors such as social isolation, loneliness and loss associated with older age may be important in understanding alcohol use. We know that in general, limited social contact and loneliness have a negative impact on both mental and physical health. One way to understand the amount and types of social connections someone has is to map their personal social network. This might include a whole range of people such as important family, friends, neighbours and acquaintances, pets, community places, groups or activities. This helps people to think about who is important in their daily lives, the roles that different relationships play, how this might have changed over time and how this might be improved, for example, by exploring ways to obtain additional support in the future. In this study we will invite older adults who have participated in a linked study to take part in an interview. The linked study will follow-up older adults with AUD for 6 months after being admitted into hospital. The people invited to this study will be selected based on lots of different factors, such as their age, how many people they live with, or how lonely they are, to ensure we are able to capture a variety of experiences within this group. Only those who have given permission to be contacted will be approached. The interviews will be 1:1 with a researcher and might happen in person, over the phone or through an online video call. Participants will first be guided through the process of mapping their current social network with the researcher. The interview will then discuss the support received from the person’s social network, as well as talking about the participants’ daily lives (including daily routines, physical and mental wellbeing and valued activities) and additional support needs. Interviews will last around 1 hour. They will be audio-recorded, transcribed and anonymised before analysis.

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/10.1093/ijpp/riac064 http://dx.doi.org/10.1136/gutjnl-2022-BASL.130 http://dx.doi.org/10.1136/gutjnl-2021-BASL.40

ADOPTED PROJECT: EnablExercise in Crohns: A qualitativE study to uNderstAnd the Barriers and faciLitators to physical activity and Exercise IN children and adolescents with CROHN’S disease ADOPTED PROJECT: EnablExercise in Crohns: A qualitativE study to uNderstAnd the Barriers and faciLitators to physical activity and Exercise IN children and adolescents with CROHN’S disease Principal Investigator: Dr Zoe Saynor Co Applicants : Dr Nadeem Afzal , Dr Christopher Roberts , Professor Kelly Mackintosh , Dr Danielle Lambrick , Professor James Faulkner , Mr William Freer (PPI Contributor) Partners: University of Portsmouth, University Hospital Southampton NHS Foundation Trust, Swansea University, University of Winchester, For Crohns (charity), Guts UK (Charity) Duration : 12 Months Background: We know that people with inflammatory bowel disease (IBD), of which one of the main forms is Crohns, are at a high-risk of not meeting the physical activity recommendations for health, due to a combination of bowel and general physical symptoms (e.g. abdominal pain, diarrhoea and fatigue). Additionally, there are currently no physical activity and exercise guidelines for young people with IBD – making it difficult to advise what people should be doing. Researchers within our team have been monitoring the effects of COVID-19 and associated lockdowns on physical activity and mental health on a global scale, and saw negative impacts in both people with long-term conditions and in the wider population. However, there is currently no data to tell us how young people with e.g. Crohns have been impacted during this time. in our centre, we are seeing an increasing number of people with Crohns transitioning from paediatric to adult care with metabolic syndrome and we anticipate this will rise in response to the COVID-19 pandemic. Objectives: Assess the barriers to, and facilitators of, physical activity and exercise participation in young people with Crohns disease. Additionally, comparing their views to their parents/guardians and clinicians. Design and Methods: The proposed research will be a qualitative cross-sectional study consisting of individual semi-structured interviews with the three participant groups (in clinic for young people; videoconference for parents/guardians and clinicians). The interview schedule will be co-developed with people living with Crohns. Information from the interview will be digitally recorded, transcribed verbatim and thematically analysed. For the young people with Crohns involved in the study, we are interested in documenting their disease activity and nutritional/growth status at the time of interview so will use the Paediatric Crohns Disease Activity Index (PCDAI) to determine remission, mild activity, or moderate-to-severe activity and growth ‘weight height and BMI’ Z-scores for this. Clinical and Scientific Impact: Physical activity is important for both mental and physical health and is particularly important in people with a long-term condition. This work will provide important understanding of the views and experiences of young people with Crohns, their parents/guardians and clinicians surrounding physical activity and exercise. The findings from this qualitative study will provide insight as to why young people with Crohns may not undertake physical activity and exercise and will help inform the design and delivery of future appropriate physical activity and exercise programmes for this population. This information would complement our ongoing research (The ACTIVE-IBD Study), and will inform future funding applications to develop, evaluate and implement educational and interventional resources to increase the physical activity and exercise undertaken by young people living with Crohns. This funding award will help expedite our journey to the end goal of improving this provision and, ultimately, the quality of lives of people with Crohns

Adolescent Resilience to OVercome Adversity: EmpoweRment and intervention development – the ROVER study Lead applicant: Anne-Sophie Darlington Co-applicants : Professor Graham Roberts , Professor Mary Barker , Dr Ivo Vassilev University of Southampton, Dr Catherine Hill Associate Professor in Child Health at the University of Southampton, Dr Jana Kreppner Associate Professor in Developmental Psychopathology within Psychology at the University of Southampton , Dr Luise Marino ​, Abigail Oakley ​ Project Summary: Mental health conditions and symptoms in children and young people are increasing. Children and young people (CYP) with a chronic physical health condition often report having mental health problems such as feelings of anxiety and depression. A lot of research has focused on risk – circumstances that make it more likely for young people to experience mental health problems. In this project we want to focus on resilience - the young person’s ability to use their strengths and support from family and friends to overcome challenges in their life. ​ Resilience has not often been a focus of support programmes for CYP with a physical condition. We would like to find out what experiences are common for young people living with physical health conditions, so that we can develop a support programme that applies across Child Health. We will use knowledge from these shared experiences to co-create the support programme with young people – called ‘tools for life’ (suggestion by CYP). We will also partner with national charities (partnerships have already been developed) who have worked with us before and who are very interested in supporting CYP around their mental health. The charity partners could help us to develop support components that are very specific to the condition (for example, fear of cancer coming back), which can be included in the overall support programme. Finally, work with young people has taught us that flexibility is very important: flexibility in when they access support, the way they access it and how it is offered to them. We will work together with young to shape this flexibility in support. The project will have four parts: ​ Part 1 – Finding out what might work: List successful support components from 15 existing summaries of the evidence (reviews of the literature) to date and a report from Wellcome (an independent global charitable foundation which focuses on research), and identify the support elements (e.g., building confidence) which work well, and are acceptable to young people. ​ Part 2 – Developing partnerships: Develop a partnership with local stakeholders (e.g., Paul Hughes and Laura Renishaw-Villier – Hub stakeholders; SolentMind, No Limits) and national charities (e.g., Children’s Cancer and Leukaemia Group, Kidney Care UK, Asthma UK). who can support the development of the support programme, both the general as disease-specific elements. We will hold several workshops with stakeholders to develop the partnership and agree on the goals of the partnership and ways to work together. ​ Part 3 – Developing the support programme: We will co-create (develop together with young people) the support programme– ‘tools for life’ - to increase resilience. We will focus on flexibility in the way the programme is offered to young people, and when young people access the programme, to suit their needs. This flexibility will make young people more likely to use the programme. ​ Part 4: Testing the support programme: We will test the support programme with 30 young people, to find out how many young people use the programme, if the programme is acceptable, how they use the programme, and how much they use the programme. We will also find out what the most important indicators of success are for the programme, such as young people experiencing less symptoms of anxiety and depression, and a better quality of life.