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

db9893e3-6d77-4b0c-aeda-4931a448eef5 A national evaluation of Project Cautioning And Relationship Abuse (‘CARA’) awareness raising workshops for first time offenders of domestic violence and abuse Health Inequalities National Priority Project in conjunction with ARC West, ARC NENC, ARC WM, ARC Y & H Principle Investigator: Dr Sara A Morgan , ARC Wessex, Lecturer in Public Health, School of Primary Care, Population Sciences and Medical Education Faculty of Medicine, University of Southampton Email: s.a.morgan@soton.ac.uk Co Investigators: Dr Steph Scott, NIHR ARC NENC Senior Research Fellow, ARC North East and North Cumbria, Email: steph.scott@newcastle.ac.uk Dr Jessica Roy, Lecturer in Child and Family Welfare, ARC West, Email: jessica.roy@bristol.ac.uk Professor Kate Jolly, Professor of Public Health & Primary Care, ARC West Midlands, Email: c.b.jolly@bham.ac.uk Professor Rachel Armitage Professor of Criminology and Crime Prevention School of Human and Health Sciences University of Huddersfield Huddersfield HD1 3DH Email: r.a.armitage@hud.ac.uk Dr Joht Singh Chandan, NIHR Academic Clinical Lecturer in Public Health, Murray Learning Centre University of Birmingham Edgbaston Birmingham B15 2TT Email: j.s.chandan.1@bham.ac.uk Dr David Culliford, Senior Medical Statistician NIHR CLAHRC Data Science Hub School of Health Sciences University of Southampton Southampton General Hospital (Room AA71, MP11) Southampton SO16 6YD Email: djc202@soton.ac.uk Dr Tracey Long, Professor in Health Economics and Outcome Measurements School of Health and Related Research 208, West Court 2 Mappin Street Sheffield S1 4DT Email: t.a.young@sheffield.ac.uk Mrs Fiona Maxwell Public Health Registrar, School of Primary Care, Population Sciences and Medical Education Faculty of Medicine, University of Southampton Email: f.maxwell@soton.ac.uk Dr Ruth McGovern, Lecturer in Public Health Research/NIHR Post Doctorate Fellow Population Health Sciences Institute, Newcastle University Baddiley-Clark Building Richardson Road Newcastle upon Tyne NE2 4AX Email: r.mcgovern@newcastle.ac.uk Dr Will McGovern Senior Lecturer, Social Work, Education and Community Wellbeing M005 Manor House, Coach Lane Campus (West) Northumbria University, Newcastle upon Tyne NE7 7TR Email: william.mcgovern@northumbria.ac.uk Dr Jessica Roy, Lecturer in Child and Family Welfare School for Policy Studies, University of Bristol 8 Priory Road Bristol BS8 1TZ Email: jessica.roy@bristol.ac.uk Background: Over one year, nearly 1,200,000 incidents relating to domestic violence and abuse (DVA) in England and Wales were documented by police, with almost half recorded as criminal offences. DVA leads to an adversity package of poor health and social outcomes, such as alcohol misuse and poorer reproductive health. Stakeholder consultation suggests that the criminal justice system (CJS) are struggling to constructively support victims, deter offenders or reduce reoffending, by means of an early intervention. Victims have voiced dissatisfaction and, collectively, professionals feel that they could do better. Furthermore, recent evidence suggests that COVID-19 has had a huge impact on the CJS, creating a backlog of up to 10 years. Hampshire Constabulary were ambitious to test an alternative response via an early intervention that would improve outcomes for victims and their families. Project CARA was developed in 2011 as a conditional caution offered by the police to first time adult offenders of DVA of standard risk. Offenders are required to undertake two mandatory workshops that increase awareness of their abusive behaviour and the safety of partners and children. In contrast to restorative justice, CARA is an awareness raising intervention for offenders, that utilises a trauma informed approach and motivational interviewing techniques across the pair of workshops. In these workshops offenders are further signposted onto services that support improvements in the wider determinants of their offending behaviour, such as to their GP, drug and alcohol services or onto a community perpetrator programme. An initial randomised controlled trial of CARA was undertaken in Southampton custody suite, showing a reduction in the frequency of re-arrest and prevalence of domestic abuse in the intervention arm, one year following randomisation. What we found out We found that CARA is likely to reduce the likelihood of reoffending both in the long term and immediate term, using domestic arrests as the outcome. Further evidence indicates that CARA led to immediate changes in the number of overall re-arrests and their severity. As involvement in CARA led to a reduction in the likelihood of rearrests for domestic abuse, CARA can be cost effective: with an estimated £5402 additional spending avoided (per domestic abuse offence). When comparing risk categories of standard, medium and high risk, there was no difference in the DVA arrests between categories. Whilst policy discussions indicate that medium risk cases may not be offered to CARA, they were commonly included (50%) and findings from qualitative work indicate that CARA was the best option for such cases, where there was no alternative available. Despite being a condition, victims may not be informed, nor consented, during the CARA process. •Through our participation with the CARA National Oversight Group, we are informing future service/commissioning of CARA through our recommendations. •We are also informing the Joint Justice Plan that is due to be developed by contacts with the National Police Chiefs Council in October. •We have also been approached by commissioners in New South Wales (Australia) for emerging evidence as they develop their DVA strategy. Publication: A national evaluation of Project Cautioning And Relationship Abuse (‘CARA’) awareness raising workshops for first time offenders of domestic violence and abuse: protocol for a concurrent mixed-methods evaluation design - read

7a002421-31aa-4897-bd4d-da37a8b4cf6a Avoiding care escalations through targeted care coordination for people with multiple long-term conditions – a knowledge mobilisation project Chief Investigator: Simon Fraser, Professor of Public Health, University of Southampton Team: Nisreen Alwan, Professor of Public Health, University of Southampton, Lead for the Healthy Communities theme (from 1st Oct 2024), NIHR ARC Wessex. Robin Poole, Consultant in Public Health, Southampton City Council. Michael Boniface, Professorial Fellow of Information Technology, Director of the IT Innovation Centre, University of Southampton, and lead for the Workforce and Health Systems theme, NIHR ARC Wessex. Kelly Cheung, PPI lead, NIHR ARC Wessex and University Hospitals Southampton. Emilia Holland, Public Health Registrar, University of Southampton. Seb Stannard, Research Fellow, MELD-B project, University of Southampton. Claire Sheikh, Senior Pharmacist, Living Well Partnership, Southampton. Kelly Hislop Lennie, Principal Academic in Adult Nursing, Bournemouth University. Lynn Laidlaw, Patient and public contributor and researcher, PPI contributor MELD-B Sally Dace, PPI contributor MELD-B and Wessex ARC James McMahon, PPI contributor MELD-B, School of Primary Care Research UoS, South West Genomic Medicine Service. Lead PPIE for DIALOR, a digital intervention addressing frailty in Bournemouth University Partners: Hampshire and Isle of Wight Integrated Care Board, University Hospital Southampton NHS Foundation Trust, Bournemouth University, Southampton City Council, Living Well Partnership. Start: 1 October 2024 End: 31 March 2026 Summary This project is about taking knowledge that has been learned from two ongoing research studies about living with multiple long-term health conditions to see if we can apply it in a ‘real life’ setting in a large general practice in Southampton. Two research projects called ‘MELD-B’ and ‘the ARC Treatment Burden study’ have identified many aspects that make living with multiple long-term conditions challenging for people. This ‘workload’ might make it more likely that people feel overwhelmed by their health conditions. If people have a high workload, and particularly if they are frail, this can end up with them needing to be admitted to hospital. We have also identified that some aspects of people’s early life can make it more likely that they are admitted to hospital in middle age. If such challenges are recognised in advance and appropriate help provided, such unplanned admissions might be avoided. Care coordinators are people working in NHS settings, including GP surgeries, to identify and support people at risk of such admissions. They have a lot of people on their books and it can be challenging to know who needs what help, and who needs it most urgently. We want to see if the things we have learned from our previous research study can help the care coordinator make these decisions. In this short project we plan to do this in a large practice in Southampton, the Living Well Partnership, which looks after about 45,000 people. We plan to: · collate all the aspects identified in these studies that might make people more vulnerable · make sure we understand the current way care coordinators identify and engage with patients · work with all the relevant people in the practice to make sure we take people on this journey with us · undertake some workshops, co-led by PPI contributors, to co-develop the strategy for adding new aspects (such as the ‘workload’ and early life aspects mentioned above) to current approaches · test the addition of adding these in Living Well Partnership and evaluate the process We will share our findings at an event involving as many of the team from the Living Well Partnership as we can and get their feedback. This event will also include other relevant interested parties, such as those from the Integrated Care Board. PPI contributors have been deeply involved in the work of MELD-B, have helped to shape this proposal and will continue as co-investigators. They will be reimbursed for their contributions according to NIHR guidance. Read the public policy briefing

3832ef1c-ee61-4cdf-8362-5cdbe7212017 Wessex NHS Insights Prioritisation Programme Project (NIPP) Wessex NHS Insights Prioritisation Programme Project (NIPP) National Institute of Health and Care Research (NIHR) Applied Research Collaboration (ARC) Wessex and Wessex Academic Health Science Network (AHSN) Digital innovations for people living with frailty Read the Health Innovation Network report Project team Nicola Andrews (NIHR ARC Wessex), Cindy Brooks (NIHR ARC Wessex), Cheryl Davies (Wessex AHSN), Linda Du Preez (Wessex AHSN), Richard Finley (Wessex AHSN), David Kryl (NIHR ARC Wessex and Wessex AHSN), Susi Lund (NIHR ARC Wessex), Michelle Myall (NIHR ARC Wessex), Rebecca Player (Wessex AHSN) and Phoebe Woodhead (Wessex AHSN). Background to the project NIPP was funded by NHS England’s Accelerated Access Collaborative to enable ARCs and AHSNs to work together to accelerate the evaluation and implementation of innovations that support post-pandemic ways of working, build service resilience and deliver benefits to patients. The Wessex NIPP project focused on the use of digital interventions to support the care of people with frailty. We worked collaboratively with stakeholders from across the Integrated Care Systems in Dorset and Hampshire and Isle of Wight to identify system priorities in this area. The project had several components: 1 – Evaluation of uptake and use of the myCOPD app by older people We undertook a mixed methods evaluation of the myCOPD app , a digital monitoring and self-management tool, in relation to its use by older people. The findings showed a higher prevalence of COPD in the myCOPD eligible population than the general population, highlighting the importance of understanding the impact of frailty on uptake and use of the app. Those aged 75 and over, or living with moderate or severe frailty, were less likely to register with and more likely to decline the app. There was also evidence that follow-up support to promote use of the app could increase activation and help overcome technical barriers. Evaluation of myCOPD app - Summary of findings (ARC Wessex) .pdf Download PDF • 180KB Evaluation of myCOPD app - Full Report .pdf Download PDF • 368KB 2 – Development of a Theory of Change on use of data to enhance care of people with frailty Theory of Change is a method to develop understanding of how an initiative can achieve impact. This is displayed in a Theory of Change map. The development and refinement of the Theory of Change map drew on a review of the evidence and individual discussions with a wide range of stakeholders. Participants were from primary care, community services and acute care working in digital health or care, frailty, commissioning and population health management. Stakeholders identified that a lack of availability of routinely collected data from across organisations to inform decision-making impacted the care provided to people with frailty. Theory of Change map - Use of data to enhance frailty care .pdf Download PDF • 176KB Theory of Change Report - Use of data to enhance frailty care .pdf Download PDF • 461KB 3 - Investigation of the use, applicability and acceptability of digital remote monitoring for older people a) Listening activities with older people’s community groups to understand perceptions of digital remote monitoring We held face-to-face events at six older people’s community group meetings, including a carers’ group, an exercise class and a community group serving a majority black ethnic population. At these events we discussed benefits, concerns and barriers to the use of digital remote monitoring (the ability to monitor aspects of an individual’s health remotely using technology). We also asked group members how they thought their views might change as their health or abilities declined. b) Research study investigating use and acceptability of digital remote monitoring for older people with frailty in the community This mixed methods research study investigated digital monitoring at home approaches among older people with frailty, using Artificial Intelligence (AI)-facilitated sensors to monitor daily activities and routines. c) Evaluation of digitally enabled care within frailty virtual wards The evaluation used qualitative data from two frailty virtual wards ( NHS England » Virtual wards ) to explore the use, decision-making and impact of digital remote monitoring. We combined the qualitative data from the above three work packages (a, b and c) for thematic analysis. We found that a personalised approach is important, with a need to consider practicalities (such as cost and sensor positioning) and design of the technology. Face-to-face care is highly valued and should not be replaced by digital remote monitoring. Users and carers need to know what to expect, how the technology works, who is monitoring and when; this would aid trust. NIPP 2022-23 summary report .pdf Download PDF • 624KB NIPP 2022-23 Full report .pdf Download PDF • 838KB 4 - Co-production, piloting and evaluation of an online Implementation Toolkit Implementation is a complex process. For those tasked with introducing an innovation or a change to practice, service provision or delivery, there are a range of models, frameworks and tools to choose from to support the implementation journey. However, these can be inaccessible, specific to particular user groups, or fail to take implementation considerations into account at the outset. The Web-based Implementation Toolkit (WIT) was co-produced with a range of stakeholders by NIHR ARC Wessex. It is a user-friendly and accessible guide on what needs to be considered when implementing and how to achieve this. WIT can be accessed at: Helpful resources | NIHR ARC Wessex More details can be found at: Implementation | NIHR ARC Wessex Rapid Insights Guide for 2022/23 work A Rapid Insights Guide (with project highlights) was produced for NHS England at the end of the 2022/23 projects (work packages 3 and 4 above). Rapid insights report NHS E_for submission .pdf Download PDF • 322KB

Dr Preeti Dhuria (University of Southampton) and Professor Christina Vogel (The Centre for Food Policy, City St George’s, University of London) discuss how weak enforcement lets retailers bypass UK obesity regulations < Back Chocolate at the checkout Weak enforcement of obesity regulations is undermining public health Dr Preeti Dhuria (University of Southampton) and Professor Christina Vogel (The Centre for Food Policy, City St George’s, University of London) discuss how weak enforcement lets retailers bypass UK obesity regulations It’s far too easy to choose unhealthy options in retail stores in the UK. This isn’t just a personal challenge for citizens, it’s a public health crisis. The places we shop shape our food choices and quite frankly, the odds are stacked against us in selecting healthy food. There is a growing momentum for strong policies to rein in the aggressive promotion of unhealthy foods, and that’s a positive step. In fact, the UK government introduced a ban on placing unhealthy foods at checkouts, aisle-ends and store entrances in 2022. But you wouldn’t necessarily know it as a shopper. Our research shows there is a significant lack of resources for adequate enforcement. This situation means we still see chocolate at checkouts in some stores and alcohol at the aisle-ends in others because stores are either breaking the rules or using loopholes to continue making money at the expense of the country’s health. Regulating the food retail environment is an important part of the solution to lower levels of obesity but weak enforcement can undermine health goals. The Food (Promotion and Placement) Regulations 2021 are designed to limit the promotion of unhealthy foods in most retail stores and online equivalents in England. When 22 local government officers were asked about their approach to enforcement before the regulations came into effect, the clear narrative was that these regulations would not be robustly enforced because of a lack of staff and training. Our research showed the key obstacles to enforcing these regulations include: Staffing Constraints : There is limited capacity within local authority enforcement teams to enforce these regulations. Their scarce resources are used for immediate threats to life like knife crime rather than assessing breaches, issuing notices and processing fines for these anti-obesity regulations. Inadequate financial support: Funding constraints further hinder enforcement because only £281k in funding has been allocated across the 317 local authorities in England to support these enforcement tasks, leading to inconsistencies across regions. Minimal training: Enforcement officers are likely to rely on personal judgment and experience due to limited training and guidance on how to interpret the definitions in the regulations, leading to significant variations in the interpretation and enforcement of the rules across regions. Despite the regulations’ long-term health goals, it is clear that they are ranked as a low priority and the process of issuing infringement notices is cumbersome. This situation is leading to patchy enforcement, and businesses not being held accountable uniformly. The processes for reporting breaches are also unclear meaning even action by the public is usually difficult. A freedom of information request covering a three-month period showed that no improvement notices had been issued despite instances of non-compliance being observed. A Call for Stronger Enforcement Our research outlines actions at the national and local levels that could help to improve the level of enforcement being undertaken. National-level actions Provide adequate and dedicated funding to local authorities to recruit and allocate staff specifically for compliance assessment of these regulations. Provide centralised training and detailed guidelines for enforcement officers to ensure consistency and build confidence among enforcement teams. Streamline compliance assessments by requiring manufacturers to disclose nutrient profile scores for their products and retailers to provide key details, such as store square footage and employee count, to their local authorities. Local-level actions Instigate linkages within local authorities by supporting cross departmental activity between trading standards, environmental health and public health officers to make enforcement efficient. Raise regulations’ priority by incorporating into joint strategic needs assessment within local authorities to increase buy-ins from councillors and Directors of Public Health. Lack of enforcement compromises impact Investing in enforcement is essential to securing regulation compliance and achieving the level playing field that food businesses and public health advocates called for. Early enforcement ensures that businesses fully understand their obligations, comply with the rules, and help build a precedent for healthier retail environments. Proactive enforcement sends a clear message- the regulations are here to stay, and compliance is non-negotiable. But local authorities cannot achieve strong compliance without adequate funding and the right tools. A lack of enforcement risks being misinterpreted as a sign of regulatory failure and withdrawal of the regulations. This outcome would be detrimental to the health of British children and families. Here are a few instances recently where our research team have spotted non-compliance but do not know how to effectively report the instances, and even approaching the store manager has not led to an immediate removal of products from restricted areas. To truly make an impact, future food policies must incorporate robust enforcement strategies and dedicated funding from the outset to maximise the regulations’ impact and safeguard public health. Previous Next

b4eba41c-3299-4935-88f1-36d55163f934 MODIFY: The development and iMplementation Of a multidisciplinary medication review and Deprescribing Intervention among Frail older people in primarY care COMPLETED: MODIFY: The development and iMplementation Of a multidisciplinary medication review and Deprescribing Intervention among Frail older people in primarY care Principal Investigator: Dr Kinda Ibrahim Project team : Eloise Radcliffe, Dr Simon Fraser , Clare Howard , Professor Paul Rutter , Professor Susan Latter , Claire Sheikh , Dr Lawrence Brad , Dr Mark Lown , Dr Alejandra Recio-Saucedo , Dr Kat Bradbury , Dr David Culliford , Dr Maria Chorozoglou , Cynthia Russell (PPI lead). Further PPI involvement from:Pam Holloway, Neil Wilson, Rajneesh Kaur Additional support from Renee Servin and Lucy Murphy (Medical students) Partners: University of Portsmouth, Westbourne Medical Centre, Wessex Health Innovation Network, PresQiPP, NIHR CRN Wessex Summary of findings - download plain text summary 1 in 3 people aged 65 and older take 5 or more medicines every day (polypharmacy). Some of these drugs may no longer be appropriate. They could increase the risk of falls, hospital admission, or even death, especially among people who are frail (and less able to recover from injury and illness). Deprescribing (reducing, stopping or switching drugs) is safe for some conditions, medications and in settings such as primary care. But Health Care Professionals (HCPs) may face problems with carrying this out. Problems may include a lack of time for HCPs, and HCPs and patients may be concerned about stopping medication which was first prescribed by a specialist. Previous research highlights that this problem could be addressed by teams of HCPs from different disciplines, including practice pharmacists, working together on the medication review and deprescribing process. The research team reviewed 28 studies on older people in primary care to explore what makes medication review and deprescribing work best in a team of HCPs. Alongside this, the research team carried out in-depth interviews with ten older patients and three of their family carers, and focus groups with 26 health care professionals working in eight different GP practices. This helped the team to understand different experiences of medication reviews and deprescribing, and how this process can work best. Based on the results the team suggested ways to improve deprescribing in primary care. They include: clear roles and responsibilities for HCPs, with good communication between team members, and pharmacists integrated within teams training and education on deprescribing for HCPs routine discussions about deprescribing when prescribing, with medication reviews tailored to patients’ needs and preferences, and addressing any questions or concerns involvement of patients and informal carers, and trusted relationships with professionals allowing continuity of care. Based on the results the research team developed an intervention to improve medication review and deprescribing for older people with frailty and taking 10 or more medicines, to target those who would benefit most. The intervention has five phases: 1) Identification on practice databases of older patients aged 75 and over living with frailty, prescribed 10 or more medications, to be invited for a medication review 2) Preparation for HCPs, through using deprescribing tip sheets and a digital tool to help prioritise medication for deprescribing (with training provided) 3) Written information leaflet sent to patients and carers about the purpose of medication review and the reasons for potentially stopping or changing medications 4) The HCP (mainly a practice pharmacist) will conduct a person-centred medication review taking into account patient and carer needs and preferences. They will involve other HCPs members based on their expertise, and document and share any agreed changes with patients and other staff members if needed; 5) Tailored written follow-up plans to be given to patients and carer, and further contact arranged if needed. See NIHR Alert - How to deprescribe in Primary Care which features this research Downloads: Public Policy Briefing https://eprints.soton.ac.uk/509844/ Medicines Optimisation and Deprescribing in Older People policy brief Feb 2026 .pdf Download PDF • 2.09MB MODIFY poster ICP MODIFY poster 20.10.25 .pptx Download PPTX • 2.32MB MODIFY POSTER Plain English ICP poster Plain English version 17.9.25 .odt Download ODT • 10KB How we shared these findings Conferences and dissemination to Health Care Professionals •European Clinical Pharmacy Society conference, October 2022, Prague, Czech Republic 2022 (oral and poster) •Faculty of Medicine Conference, University of Southampton, June 2023 (oral and poster) •Health Services Research and Pharmacy Practice conference, Cork, Ireland 2023 (oral and poster) •ARC Wessex collaborating for impact showcase event, June 2023 •Society for Academic Primary Care conference, Brighton, July 2023 •South West Society for Academic Primary Care conference, Cardiff Wales, March 2024 •International Conference on Deprescribing, Nantes, France September 2024 Other presentations and talks •Invited to present MODIFY at the Society for Academic other presentations Primary Care Medicines Optimisation Special Interest Group, 12th March 2024 •Invited to present on deprescribing at the CRN national event on Multimorbidity in May 2023. •Invited to present MODIFY at the CRN coordination Wessex Pharmacy Research Network meeting, 28th February 2024 •Presented MODIFY during a meeting with Prof. Tony Avery, the National Clinical Director for Prescribing, 1st March 2024 •Shared learning on MODIFY with Prof David Alldred and his team at Leeds, Jan 2022 •Introduced MODIFY at the Health Innovation Network Polypharmacy Community of Practice meeting, July 2022 Publications: Implementing a medication review and deprescribing intervention for older people living with frailty and polypharmacy in general practice: a feasibility study We published our findings from our realist review in BMC Geriatrics: What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis Plos One publication (April 2025): Development of a complex multidisciplinary medication review and deprescribing intervention in primary care for older people living with frailty and polypharmacy Our publication was selected as an NIHR evidence alert, and promoted more widely on social media to health care professionals and policymakers: How to deprescribe inprimary care - NIHR Evidence Education of undergraduate an postgraduate students •Plenary talk on polypharmacy and deprescribing to year 1 medical students in May 2024 •Invited talk by University Hospital Southampton at a General Internal Medicine Training day 16th September 2024, MODIFY presented to over 100 trainees Public and patient engagement Presentation and discussion of MODIFY at a Community medical science engagement session with 12 older people (via Communicare, a local social service organisation on 4th September 2024) The project has prompted Bob Heath to write a song about deprescribing - which was played at the ARC Event 2025 https://vimeo.com/1125880005 Bob and Peter Heath wrote this song about deprescribing Lay Summary or research protocol Background: A third of older people take five or more regular medications (polypharmacy) potentially increasing the risk of side-effects, hospital admission and death. These effects are higher among people living with frailty who lose their in-built reserves and become vulnerable to changes triggered by small events such as a change in medication. National recommendations suggest that medications taken by frail older people should be reviewed annually by their GPs to identify and reduce/stop inappropriate medications (deprescribing).Yet this does not happen routinely due to GPs’ lack of time, increased workloads and worries about stopping medicines. Recent recommendations suggest involving other non-medical prescribers such as practice pharmacists and advanced nurse practitioners (ANPs) in reviewing medications. However, it is unknown how staff could work together most effectively and whether they have any training needs. Aim: This research will investigate how practice-pharmacists, ANPs and GPs could best work together with patients living with frailty to perform regular medication review. Methods The study involves four work packages (WPs). We will review previous literature to identify what makes a successful medication review and how to safely reduce/ stop inappropriate medications (WP1). Interviews with GPs, practice-pharmacists, ANPs, frail older patients and carers will be conducted (WP2). These will discover views about where medication review should take place, the role of each of the involved parties in the process, type of medications that could be deprescribed, staff development and training needs, barriers and facilitators for implementation, and strategies to address these barriers. Information gathered from WP1&2 will be used to develop the intervention: a structured medication review process using pharmacists, ANPs and GPs most effectively and involving frail patients and their families in decisions about medications (WP3). The intervention will be refined further through a series of workshops with service users, clinicians and commissioners. A training programme to implement the intervention and increase staff confidence in reducing/ stopping medications safely will be developed and delivered to GPs, practice-pharmacists and ANPs based on the Polypharmacy Action Learning Sets approach adopted by the Wessex Academic Health Science Network (AHSN) . Finally, we will assess whether itis feasible and acceptable for staff in four GP practices to be trained and to implement the intervention with their patients (WP4). Public Patient Involvement: Three PPI members have been involved in protocol development and refinement and will continue to contribute to the research study by for example being involved in developing research instruments and monitoring recruitment. Dissemination and Impact: Working with colleagues in the Wessex AHSN and local clinical commissioners, we will be able to share our findings and training programme to the wider research and clinical community in Wessex and potentially influence practices and policies both locally and nationally. Ibrahim, K., Cox, N.J., Stevenson, J.M. et al. A systematic review of the evidence for deprescribing interventions among older people living with frailty. BMC Geriatr 21, 258 (2021). https://doi.org/10.1186/s12877-021-02208-8 Pazan, F., Petrovic, M., Cherubini, A. et al. Current evidence on the impact of medication optimization or pharmacological interventions on frailty or aspects of frailty: a systematic review of randomized controlled trials. Eur J Clin Pharmacol 77, 1–12 (2021). https://doi.org/10.1007/s00228-020-02951-8 Radcliffe E, Servin R, Cox N, Lim S, Tan QY, Howard C, Sheikh C, Rutter P, Latter S, Lown M, Brad L, Fraser SDS, Bradbury K, Roberts HC, Saucedo AR, Ibrahim K. What makes a multidisciplinary medication review and deprescribing intervention for older people work well in primary care? A realist review and synthesis. BMC Geriatr. 2023 Sep 25;23(1):591 (2023). https://doi.org/10.1186/s12877-023-04256-8

af50ff28-5b02-41fa-bc1f-f9689464860e EnTech (Enabling Technology): Investigating the enabling and inhibiting factors to the use of internet-based support tools for caregivers of people with dementia, and how to promote engagement. ! Widget Didn’t Load Check your internet and refresh this page. If that doesn’t work, contact us.

df3a87da-ba5f-40cd-8109-9f23cf0662d9 Promoting person-centred care using the CHAT&PLAN conversation guide https://vimeo.com/469226317 Promoting person-centred care using the CHAT&PLANTMconversation guide Project leads: Professor Jackie Bridges (Professor of Older People's Care, School of Health Sciences, University of Southampton), Dr Teresa Corbett (Lecturer, Solent University) Team members: Professor Jackie Bridges (Professor of Older People's Care, School of Health Sciences, University of Southampton), Dr Teresa Corbett (Lecturer, Solent University), Professor Alison Richardson (School of Health Sciences, University of Southampton), Dr Jane Winter (Macmillan Consultant Colorectal Nurse, University Hospital Southampton NHS Foundation Trust), Start: 1 October 2019 Ends: 30 April 2022 Project Partners: University Hospital Southampton NHS Foundation Trust, Southern Health NHS Foundation Trust, Bournemouth University, Macmillan Cancer Support Lay summary The aim of this Wessex ARC project is to share a conversation guide we have developed through our research. The guide helps health and social care staff talk to older adults who have lots of different conditions. The guide has 8 steps that should be followed in a meeting with people about their needs and personal goals. We call the guide “CHAT&PLAN” and we’d like to make sure that people working in health and social care know about it and use it in their work. This website leads to resources to support people to use CHAT&PLAN in their work. We have a new project underway with the Wessex Cancer Alliance that tests out some new ways of supporting people with cancer, including the CHAT&PLAN. 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. (2020). Planning and optimising CHAT&PLAN: a conversation-based intervention to promote person-centred care for older people living with multimorbidity. PLOS One . https://doi.org/10.1371/journal.pone.0240516 The following people were involved in the research behind the CHAT&PLAN: Dr Hilary Boddington, Professor Jackie Bridges, Dr Lynn Calman, Dr Teresa Corbett, Dr Amanda Cummings, Dr Naomi Farrington, Vicky Fenerty, Professor Claire Foster, Dr Kellyn Lee, Lucy Lewis, Professor Alison Richardson, Dr Jane Winter, Professor Theresa Wiseman, Alexandra Young

0be5d40d-fcbc-4b27-971a-75e1967ce33d Development of a core outcome set for nurse wellbeing: a Delphi study Lead applicant: Dr Gemma Simons Co-applicants: Prof Jane Ball , Prof David Baldwin , Dr Emma Wadey, Dr Catherine Smith Participant Information Sheet : Download here Project Summary: Read project summary document (short summary) Read project summary document (long summary) Background : Little attention has been paid to the work lives and wellbeing of the nursing workforce, despite it being a priority area. Currently, there is no consensus on what wellbeing is or how it should be measured. An evidence-based, positive way of measuring wellbeing is through a Core Outcome Set. What is a Core Outcome Set? Outcomes are used to measure whether a strategy, intervention or action has had the required result. There are often multiple outcomes and ways of measuring them, which makes comparison difficult. A Core Outcome Set is an agreed, or consensus, set of outcomes and measurement tools that, when used, provide consistent and comprehensive focus as everyone is measuring and reporting the same outcomes in the same way. Aim: This project aims to develop a Core Outcome Set for Nurse Wellbeing. Objectives: Produce a list of potential wellbeing outcomes and help text to describe them in that are clear and meaningful for nurses [PPI panel] Develop a consensus between nurses and nurse wellbeing experts on a core outcome set for nurse wellbeing [Delphi Study] Identify and assess for quality measurement instruments for the core outcome set for nurse wellbeing identified by the Delphi study [Critical Literature Review] Select measurement tools for the identified core outcome set and agree on a final Core Outcome Set for Nurse Wellbeing [PPI panel and Study Advisory Group]. Implications and Impact: A Core Outcome Set for Nurse Wellbeing developed by nursing and nurse wellbeing experts will provide researchers and those undertaking governance with evidence-based and meaningful tools with which to evaluate wellbeing interventions. This study is registered on the Core Outcome Measures in Effectiveness Trials (COMET Initiative) database https://www.comet-initiative.org/Studies/Details/2433 Publiations The Mental Health of Medical Students: Supporting Wellbeing in Medical Education | Oxford Academic ( oup.com ) https://doi.org/10.1002/wps.21177

Sandra Bartolomeu Pires is doing her PhD and here she updates us in her third yearly update on the slightly eccentric world of studying and managing a young family < Back Truth or Dare? PhD "I'm Lovin' It", Sandra Bartolomeu Pires is doing her PhD and here she updates us in her third yearly update on the slightly eccentric world of studying and managing a young family Oopsy-daisy, sorry guys. I know you've been on the edge of your seat, barely able to focus on your own work, wondering what I have been up to. I'll put you out of your misery then. Ok, so, remember, I moved back to Portugal in the middle of my PhD ( Catch up with it here! ). My smile faded as we hit 45°C and I felt I was being cooked alive. Not easy to deliver level 8 thinking while melting like Olaf in the sun. I'll tell you what, I actually had a great 3rd year on the PhD (read this part while playing “I am on top of the world” , by Imagine Dragons). But today I want to tell you the behind the scenes, because what help am I, if I just show you the “makeup front”... Here is the not-so-sexy-backstage: 1. I got my first-author publication , on an impact factor journal of 3.36. The backstage: this was my 4th submission! 4th! It took me one year from first rejection to finally getting the paper accepted. I am definitely making a mug with a print-screen of my paper. "Bartolomeu Pires et al" aaaah, I like the sound of that… 2. I got another first-author paper accepted the same month I got first published! I went from not having a first-author publication to having two, in a few weeks. The backstage: I worked on this paper for the last 2 years (!!!), in my own time, as a “passion project”. Because of course, I rather write a paper on a Saturday or midnight, than watching "Somebody feed Phil" on Netflix. Of course not! But I was really driven by the accountability towards my patient group and clinical team, that made this work possible (thank you to everyone that supported the REACT-HD group). I tell you what is funny, I got this paper accepted without corrections... No corrections people! This was a service improvement project that I ran and wrote in my own time, and the paper comes back without corrections. Pretty sure those reviewers are angels sent to earth to make doctoral students feel better. 3. I wrote a book chapter for the Handbook Integrated Care right up my alley, focused on the needs of people living with neurological conditions. Backstage: I was pretty much with a month of continuous migraines due to this chapter. Every time I sat to write it my brain was in tears. Creating 10 000 words conscious that I had a PhD waiting to be done added pressure. I also wrote a massive chunk while at the beach. And by "at the beach", I mean I was at home writing while my beautiful sister was taking care of my daughter and entertaining her at the (actual) beach (Thank you, Tânia). I would do it all over again, but it wasn't easy. 4. I got a small grant with the European Huntington’s Disease Network working group (Multidisciplinary Treatment and Care) to run an inspired nominal group technique meeting with experts at the European Huntington Association Conference (and breathe). We worked on standards of care for people living with Huntington’s Disease. I led the meeting in Belgium last October and it was a great feeling to deliver on such a big event. The backstage: I was dying of fear that I would be embarrassed at European level. I travelled 2 days for a 4 hour meeting, nearly lost the train leaving Blankenberge, caught a cold, and was sick with some viral nastiness for the next… 4 months. This embryonic idea will feed into an actual research project, that I am very excited (and equally scared of), and so this under the pump opportunity was incredibly worth it. From left to right, the marvellous Huntington’s Disease Marvel-like team: Ruth Veenhuizen, Dina Sousa, Alexandra Fisher, (little hobbit Me), Annemiek Helmers and Asuncion Martinez Descals. Missing from the picture but equally awesome: Astri Arnesen and so many more members of the working group. I've done more stuff, but I'll stop the humble bragging now. There's something I want my PhD colleagues, particularly the newcomers, to think about. How much you give, and how much you take. See, every single one of these achievements, came with significant hurdles and personal sacrifice. You will be asked so much, constantly, and the more you deliver the more you will be asked to do. So for your own sake, I want you to think of how you will preserve your wellbeing throughout your journey. Here are two strategies that work for me. Don't agree to something right away. Ponder on the possibility. "I'll get back to you on that". "Should we schedule a meeting for next week to discuss that?". "Maybe, let me check my schedule". Never commit straight away. Asses the cost-benefit. Is it worth doing? What's in it for you? Do you need to give your all 100% or maybe 60% will do good enough? Think of how much energy and time you give to a task and make a choice on what to take on. [I had a mentorship session recently, so my mentor’s words are stuck with me (thank you, beautiful mentor).] I want you to have a good experience in your research journey, which, probably and hopefully, will be longer than your PhD. Set the boundaries you want for life, what are you comfortable living with? And make it work for you. I'm not sure I'll manage to write to you again, my scholarship is coming to an end, and I have this disease of wanting to save the world through my research… Impressive that on my 4th year I am still this perky. I blame my supervisors who are so supportive that I believe I can do anything (yes, I have the best supervisors, thank you!) I’m loving it. And somehow, I seem to be hungry at this thought… How about you? Truth or dare? Need me? Find me on socials: Instagram @integrate_hd LinkedIn https://uk.linkedin.com/in/sandra-bartolomeu-pires-841594190 Twitter @BartolomeuPires Email smbp1u20@soton.ac.uk Sandra Sandra Bartolomeu Pires Previous Next

2eeccab4-e624-4137-9443-6893d09b0589 Change in treatment burden among people with multimorbidity: Protocol of a follow up survey and development of efficient measurement tools for primary care Principal Investigator: Professor Simon Fraser Start Date: 01 October 2020 End Date: 30 September 2024 Background Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. It is likely treatment burden changes over time as circumstances change for patients and health services. However, there are a lack of population-level studies of treatment burden change and factors associated with this change over time. Furthermore, there are currently no practical screening tools for treatment burden in time-pressured clinical settings or at population level. This is a three-year follow-up study of a cross-sectional survey of 723 people with multimorbidity (defined as three or more long-term conditions; LTCs) registered at GP practices in in Dorset, England. The survey collected information on treatment burden (using the 10-item Multimorbidity Treatment Burden Questionnaire (MTBQ) and a novel single-item screening tool), sociodemographics, medications, LTCs, health literacy and financial resource, as at baseline. Descriptive statistics were used to compare change in treatment burden since the baseline survey in 2019 and associations of treatment burden change were assessed using regression methods. Diagnostic test accuracy metrics were used to evaluate the single-item treatment burden screening tool using the MTBQ as the gold-standard. Routine primary care data (including demographics, medications, LTCs, and healthcare usage data) were extracted from medical records for consenting participants. A forward-stepwise, likelihood-ratio logistic regression model building approach was used in order to assess the utility of routine data metrics in quantifying treatment burden in comparison to self-reported treatment burden using the MTBQ. What we found Out •Among over 800 people aged 55 or older, living with multiple long-term conditions across Dorset, high treatment burden was common (about a fifth of all survey respondents) •Making lifestyle changes and arranging appointments were particular sources of difficulty. Having limited health literacy and experiencing financial difficulty were strongly associated with greater treatment burden. Having more conditions and more prescribed regular medications were also associated. •A single-item treatment burden measure was only moderately good at discriminating between high and non-high burden. •Among 300 of these people who responded to a follow up survey after an average of two and a half years, about a third experienced an increase in treatment burden. This was linked to having more than five long-term conditions and living more than ten minutes from the GP, particularly for people with limited health literacy. •A slightly revised single-item measure still only performed moderately, so it needs more development before being used in general practice. •Using data from participants’ GP records also only performed moderately at reflecting high treatment burden, so further development is needed to use routine health records to identify those at risk of high treatment burden. What difference will this knowledge make? •Given the high prevalence of high treatment burden in people living with multiple long-term conditions, healthcare professionals can legitimately engage with patients on this issue to recognise and seek to minimise avoidable burden. •Health systems (including Integrated Care Boards/Systems) should include consideration of treatment burden in policies and in service design and commissioning, aiming for ‘minimally disruptive medicine’. •Healthcare professionals can anticipate that treatment burden tends to worsen over time in a significant proportion of people living with multiple long-term conditions. •Further development of the short treatment burden questionnaire is underway in a separate NIHR-SPCR-funded study and could be introduced in primary care if it performs better. •Identifying ‘burden’ in data will be investigated in much more detail in a further NIHR-funded study Why is this important for patients, health and care providers and policy makers ? •Factors such as improving access to primary care, particularly for those living further away from services, may reduce treatment burden. •Different modes of health service delivery to specifically meet the needs of those patients more likely to feel overburdened may be needed •Improving health literacy should be an important goal for the health system •Overburdened patients may be more likely to struggle with adherence to self-management •Being overburdened may result in greater use of unscheduled care. This is a priority for the NHS and the link needs further investigation In related work we published a paper on a systematic review of system factors influencing treatment burden, led by a Southampton MSc Public Health student. This has identified important gaps in the evidence map for treatment burden. Providers and policy makers need to recognise the financial and administrative burden for patients and the lack of evidence on this: doi.org Influence of health-system change on treatment burden: a systematic review Background Treatment burden is a patient-centred concept describing the effort required of people to look after their health and the impact this has on their functioning and wellbeing. High treatment burden is more likely for people with multiple long-term conditions (LTCs). Validated treatment burden measures exist, but have not been widely used in practice or as research outcomes. Aim To establish whether changes in organisation and delivery of health systems and services improve aspects contributing to treatment burden for people with multiple LTCs. Design and setting Systematic review of randomised controlled trials (RCTs) investigating the impact of system-level interventions on at least one outcome relevant to previously defined treatment burden domains among adults with ≥2 LTCs. Method The Embase, Ovid MEDLINE, and Web of Science electronic databases were searched for terms related to multimorbidity, system-level change, and treatment burden published between January 2010 and July 2021. Treatment burden domains were derived from validated measures and qualitative literature. Synthesis without meta-analysis (SWiM) methodology was used to synthesise results and study quality was assessed using the Cochrane risk-of-bias (version 2) tool. Results The searches identified 1881 articles, 18 of which met the review inclusion criteria. Outcomes were grouped into seven domains. There was some evidence for the effect of system-level interventions on some domains, but the studies exhibited substantial heterogeneity, limiting the synthesis of results. Some concern over bias gave low confidence in study results. Conclusion System-level interventions may affect some treatment burden domains. However, adoption of a standardised outcome set, incorporating validated treatment burden measures, and the development of standard definitions for care processes in future research would aid study comparability. What are we going to be doing next? Several related studies are already underway: In the NIHR-funded MELD-B study, more in-depth exploration of the experience of living with multiple long-term conditions is underway. This study is exploring in depth the representation of the work/burden in electronic health records. See short animation here: https://www.youtube.com/watch?v=7mZptrMAapY In the NIHR SPCR-funded SPELL study, a Short Treatment Burden Questionnaire is being developed and tested, building on our findings. https://spell.blogs.bristol.ac.uk/ Work has been instigated with the Dorset Public Health team and ICS to explore the value of adding treatment burden concepts to frailty indicators to identify people who might benefit from a ‘carousel clinic’ which supports people with frailty/prefrailty in various ways. This work is ongoing With some additional ARC funding we are working with care coordinators in primary care in Southampton to take forward the learning from this study and the MELD-B study ( https://www.meldbstudy.org.uk/ ) to support and enhance their work with people living with multiple long-term conditions (MLTC): Https://www.arc-wx.nihr.ac.uk/research-areas-list/avoiding-care-escalations-through-targeted-care-coordination-for-people-with-multiple-long-term-conditions-%E2%80%93-a-knowledge-mobilisation-project Publications https://doi.org/10.3399/bjgp.2020.0883 https://doi.org/10.3399/BJGP.2022.0103 Simon Fraser delivered a BJGP podcast on this work which can be found here: https://www.youtube.com/watch?v=MLqrp4HOb7s

c1df1831-b7ba-4277-88cf-bcbed05e91b7 Pharmacological And Non-Pharmacological treatment of ADHD in Pre-schoolers: a systematic review and network meta-analysis: the PANPAP study Lead applicant: Professor Samuele Cortese Co-applicants: Andrea Cipriani, Corentin Gosling, Luis Farhat, Cinzia Del Giovane Background: Children with Attention-Deficit/Hyperactivity Disorder (ADHD) have problems with attention and need to move more than most children. About 5% of school-aged children and 2% of pre-schoolers have ADHD, respectively. This translates into almost 10,000 pre-schoolers with ADHD in the South West England area. Interventions for ADHD include pharmacological and non-pharmacological treatments. When not treated, ADHD entails a significant burden to society, estimated at more than £20,000 per year. Therefore, it is important to detect and treat ADHD in the early years to prevent the negative consequences of ADHD later in life. Experts and ADHD support groups agree that the NHS does not meet the needs of pre-schoolers with ADHD. Currently, there are either long waiting lists or no services for pre-schoolers with ADHD in the NHS. To provide the best care for pre-schoolers with ADHD, we need to make sure that the NHS offers treatments that work well and are safe. In 2018, the National Institute for Health and Care Excellence (NICE) recommended mainly non-pharmacological interventions (behavioral interventions) for the treatment of pre-schoolers with ADHD. Back then, there was a paucity of studies on other non-pharamcological interventions and on medications for ADHD in pre-schoolers. Since 2018, there has been an increasing number of studies on other types of interventions (e.g., family-based interventions and diet) and on medications. There has also been an increasing trend in some countries (e.g., USA) to use medications for pre-schoolers with ADHD. Therefore, we need to understand which is the best intervention for pre-schoolers with ADHD. Aim: To compare the efficacy and safety of pharmacological and non-pharmacological interventions for ADHD in pre-schoolers. Methods: We will not do a new study, which would be very expensive. Rather, we will use a new type of research, called “network meta-analysis”. This approach uses data from available studies to compare different types of treatments even when they have not been compared directly in the individual available studies. Therefore, we will first systematically search for published and unpublished studies of any pharmacological or non-pharmacological treatment for pre-schoolers with ADHD. We will then combine the information from these studies with a state-of-the-art statistical approach. We will finally assess the quality of the studies included in the analysis and the strength of the evidence that we will generate. We are well known experts in this type of research. The study will be conducted at the University of Southampton, in collaboration with international researchers, including a statistician with renowned expertise in this type of analysis. Impact: The findings of our research are expected to inform future regional, national and international guidelines on the treatment of ADHD in pre-schoolers. As such, our results will be disseminated to local commissioners and policy makers, NICE, and international guidelines groups such as the European ADHD Guidelines Group. We will also disseminate our findings to associations of families with children with ADHD in the Wessex area, at the national (for example, National Attention Deficit Disorder Information and Support Service, ADDISS), and international level (ADHD Europe). Findings Our findings show that both New Forest Parent Training and Methylphenidate were significantly superior to placebo/active controls in reducing total ADHD symptoms. Methylphenidate was superior to New Forest Parent Training, while New Forest Parent Training outperformed executive/attention function training. Both pharmacological and specialised behavioural parent training (NFPT) are effective for preschoolers with ADHD. While current guidelines support prioritising behavioural interventions as first-line treatment in this age group, our Network Meta Analysis found evidence of methylphenidate showing the greatest symptom reduction. The findings can inform clinical guidelines and policy.