f5c7ef05-9a58-48a5-9c06-02ebd55d89cd Medicines optimisation Principal Investigator: Dr Simon Fraser Team members: Dr Simon Fraser (Associate Professor of Public Health. School of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital), Professor Chris Edwards (Professor of Rheumatology, Southampton and Associate Director of the NIHR Clinical Research Facility) Dr Chris Holroyd (Consultant Rheumatologist, University Hospital Southampton NHS Foundation Trust), Dr Kinda Ibrahim (Senior Research Fellow, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust), Dr Ravina Barrett (Pharmacist, University of Portsmouth), Dr Clare Howard (Chief Pharmacist, Medicines Optimisation, Wessex AHSN), Dr Mary O’Brien (NHS England, NHS Rightcare), Dr David Culliford (Senior Medical Statistician, Health Sciences, University of Southampton), Professor Paul Roderick (Professor of Public Health, Primary Care and Population Sciences, University of Southampton), Professor James Batchelor (Director Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton), Dr Matthew Stammers (Senior Endoscopy Fellow, University Hospital Southampton and Clinical Informatics Research Fellow at Clinical Informatics Research Unit) Start: 1 October 2019 Ends: 30 September 2024 Project Partners: University Hospital Southampton NHS Foundation Trust, NHS England (NHS Rightcare), University of Portsmouth, University of Southampton, Academic Health Sciences Network (AHSN) Wessex. Lay summary Painful conditions associated with age (such as arthritis) are common in the UK and safe pain relief options for older people are limited. Anti-inflammatory drugs such as ibuprofen are widely used – both bought from the pharmacy and prescribed by doctors, but they have significant risks, such as bleeding from the stomach and kidney damage. Older people and those with certain long-term medical conditions are at higher risk of experiencing bad effects from these drugs. Another issue concerns people who are taking one of a group of medications call ‘disease-modifying anti-rheumatic drugs’ (DMARDs). These drugs are often used for rheumatoid arthritis and work by slowing its progression, reducing the likelihood of severe joint damage and other related health problems. They are also used for inflammatory bowel diseases, such as Crohn’s disease. Methotrexate is one of the most commonly used DMARD in arthritis and azathioprine is one of the most commonly used in inflammatory bowel disease. Anti-TNF drugs are an important group of so called ‘biological agents’ – another type of DMARD. DMARDs are powerful drugs that require regular blood tests to check for adverse effects, such as liver problems, and guidelines advise how often these tests should be done. However, for most people, these blood tests are almost never abnormal, and could potentially be safely done less frequently. In addition, some people with inflammatory arthritis have an excellent response to DMARDs. Stopping DMARDs can lead to flare ups of disease, but the amount of therapy used may be tapered successfully to reduce dose-dependent adverse events and costs. This project involved two studies The first study showed that non-steroidal anti-inflammatory drugs (NSAIDs) are still sometimes prescribed for high-risk patients, such as older adults and those with chronic kidney disease. NSAIDs can cause acute kidney injury (AKI), leading to serious complications. This study developed a risk tool for practices to identify those who should not be prescribed NSAIDs. The second explored the frequency of blood testing for patients on Disease-Modifying Anti-Rheumatic Drugs (DMARDs) like methotrexate, commonly used for rheumatoid arthritis. Guidelines recommend 3-monthly blood tests due to potential liver issues. The research found that many tests were seldom abnormal, suggesting that low-risk patients might safely have less frequent tests if further research is done on the safety of risk-stratifying people. What did we learn? In the two different parts of the project we found that: About half of people taking the ‘disease modifying’ drugs (‘ DMARDs ’) methotrexate for rheumatoid arthritis or azathioprine for inflammatory bowel disease experienced no blood test abnormality over two years despite having to have blood tests every three months. Reducing testing frequency may therefore be safe for younger people and those without other long-term conditions. Among people taking non-steroidal anti-inflammatory drugs (‘ NSAIDs ’ like ibuprofen) the risk of kidney damage was highest among older people with combinations of long-term conditions including chronic kidney disease, diabetes, heart disease and heart failure, and high blood pressure. These people should avoid taking NSAIDs and we provided a way for GPs to identify them in their databases. What difference will this new knowledge make? DMARDs: Further investigation is needed on the safety and acceptability of reduced blood testing frequency testing for some people taking DMARDs but this could potentially result in reduced unnecessary patient anxiety and burden, fewer referrals to hospital and reduce resource use for the NHS. If testing could be reduced this would mean reduced treatment burden for patients and reduced cost and admin work for the NHS NSAIDs: GP practices can be provided with a search tool that helps identify those at highest risk of kidney damage from NSAIDs. Using this information they can review and stop NSAIDs to reduce the risk. If prescribing was stopped for some people at risk, this would reduce risk of acute kidney injury which can have lasting consequences or even be fatal What was the impact? Non-steroidal anti-inflammatory drugs (NSAIDs) As part of the medicines optimisation project we explored the risks of acute kidney injury (AKI) associated with taking non-steroidal anti-inflammatory drugs like ibuprofen and naproxen. There was a news article here about it: https://www.arc-wx.nihr.ac.uk/post/southampton-led-study-shows-need-for-painkiller-caution-to-prevent-kidney-damage and a publication here: https://bjgpopen.org/content/6/1/BJGPO.2021.0208 We developed a risk score that can help GP practices identify those patients at highest risk of NSAID-associated kidney injury. We have run this risk tool in the Dorset Intelligence and Insight Service (a database covering over 70 Dorset GP practices - more than 800,000 people) and along with colleagues from the AHSN we are running a masterclass with many of the GP practices involved to present the findings and to promote best practice in NSAID prescribing. The aim is to reduce NSAID prescribing in those at high risk of adverse outcomes like AKI. Rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) are prevalent inflammatory conditions, affecting 0.8% and 0.7% of the population, respectively. Disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate for RA and azathioprine for IBD, are commonly used to control disease activity. These drugs require regular safety blood-test monitoring for liver function abnormalities, kidney function, and bone marrow toxicity. Monitoring is frequent at initiation and less frequent once a maintenance dose is established. In the UK, initiation usually occurs in secondary care, with ongoing monitoring in primary care as recommended by NICE. Regular blood-test monitoring has been linked with anxiety and depression for some patients, incurs substantial costs for healthcare providers, and increases the workload for clinicians and laboratory staff. Despite guidelines, the optimal monitoring frequency has not been established, and the extent to which patients experience prolonged periods with no abnormal tests is unclear. This study aimed to assess the extent of persistently normal blood-test results among people with RA and IBD, and to describe the frequency of blood testing to indicate health-service and patient workload. Targeted monitoring of higher-risk individuals and reduced monitoring for lower-risk patients may improve efficiency and reduce patient workload. Our large, 2-year retrospective cohort study (over 700,000 people) assessed persistently normal blood tests among people with rheumatoid arthritis (RA) taking methotrexate and those with inflammatory bowel disease (IBD) taking azathioprine. Approximately half of the patients experienced no blood-test abnormalities using NICE-recommended tests. In the RA/methotrexate cohort, abnormalities were more common in older people with reduced renal function. For the IBD/azathioprine cohort, abnormalities were less common and mainly involved reduced renal function in older people with comorbidities. The absolute risk of persistently normal blood tests was lowest among older people and those with comorbidities. Since the study, a piece of work led by Nottingham cited our work ( https://www.bmj.com/content/381/bmj-2022-074678 ) and created a model to risk stratify patients taking methotrexate. This is quite likely to change clinical practice when NICE reviews its guidance on DMARDs in due course. This work was supported by representatives of the ‘Getting It Right First Time’ programme, who also linked this issue to sustainability: ‘Saving the planet with reduced routine DMARD blood monitoring frequency BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1645’ https://www.youtube.com/watch?v=uSriKPqdbvA&t=6s

18fd758f-b147-4294-acb1-07c88dc1baa9 PUNDIT – Predicting hospital Usage Numbers via a DIgital Twin Principal Investigator: Dr Carlos Lamas-Fernandez , Associate Professor in Business Analytics/ Management Science in Southampton Business School / Faculty of Social Sciences, University of Southampton. Team : Professor Christine Currie , School of Mathematics, Faculty of Social Sciences, University of Southampton. Dr Dan Burns , Innovation Centre, Electronics & Computer Science, University of Southampton. Dr Chris Duckworth , Innovation Centre, Electronics & Computer Science, University of Southampton. Professor Michael Boniface , I nnovation Centre, Electronics & Computer Science, University of Southampton. Professor Peter Griffiths , School of Health Sciences, University of Southampton. Dr Mark Wright , University Hospital Southampton NHS Foundation Trust. Starts: 1 April, 2024 Ends : 30 September 2024 Summary Hospitals in the UK are in crisis with high levels of occupancy. The percentage of occupancy in England during July-September was 88%, and in UHS it reached 92.2% . These levels exceed the safety threshold for hospital occupancy, which sits at around 85%. Together with difficulties to ensure a smooth patient flow across the hospital, this results in adverse effects for patients: elongated hospital stays, increasing the backlog of elective procedures, increasing delays in ambulance handovers and increased mortality. In practice, hospitals try and control high occupancy levels by certain interventions, such as dedicated discharge teams, re-scheduling or cancelling elective procedures or repurposing hospital wards. These measures, however, are reactive, i.e. when the occupancy is already reaching unsafe levels, rather than proactive, that is, when anticipating a high occupancy in the near future. Further, it is not clear whether occupancy levels have an effect on treatment and discharge times, but from frontline clinicians at UHS, there is the hypothesis that higher occupancy could make them longer (as clinicians are busier prioritising the sick over the well patients who could go home), compounding the occupancy issues. Higher occupancy also decreases likelihood of patients being in the optimal location. A related research project (PROCED) has shown early evidence that frequent ward/team changes increase delays in patient discharge. The aim of this project is to investigate the feasibility and build the foundations of a simulation model that can predict accurately future, short-term, hospital bed occupancy to inform interventions. The project will have a special focus on investigating the feasibility of a model to be tailored to use in practice as a “Digital Twin” (DT), which can anticipate hospital occupancy under different scenarios, some of which can reflect proposed interventions.

0ff85ad2-7ff5-49d4-b71c-0a912cb8f020 ADOPTED PROJECT: The Gateway Study a randomised controlled trial, economic and qualitative evaluation to examine the effectiveness of an out-of-court community-based Gateway intervention programme aimed at improving health and well-being for young adult offenders; victim satisfaction and reducing recidivism Completed A single-site pragmatic Randomised Control Trial to examine the effectiveness of an OCBI known as ‘Gateway’ on improving health and well-being of offenders aged 18-24, as well as reducing recidivism and improving victim satisfaction Chief Investigator: Professor Julie Parkes – University of Southampton Project Team Members Dr Sara Morgan – University of Southampton, Dr Inna Walker – University of Southampton, Professor Catherine Hewitt – University of York, Professor David Torgerson – University of York, Professor Jenny Fleming – University of Southampton, Professor James Raftery – University of Southampton, Inspector Stu Baker – Hampshire Constabulary Sergeant Caroline Chapman – Hampshire Constabulary, Dr Alison Booth – University of York, Mrs Ann Cochrane – University of York, Mr Alex Mitchell – University of York, Mrs Valerie Wadsworth – University of York, Mrs Megan Barlow-Pay – University of Southampton, Ms Lana Weir – University of Southampton. Organisations Involved: Hampton Trust charity, No Limits charity, Aurora New Dawn, Hampshire and Isle of Wight Constabulary Started: 1/3/2018 Ended: 31/8/2022 Background Young adult offenders commonly have a range of health and social needs, making them vulnerable to mental health problems. If you are aged between 18-24 years old and have committed a crime, you may need to attend court and face convictions or prison. However, many believe that more should be done to prevent young adults from entering the criminal justice system in the first place. The study aims to determine whether a new out of court programme, named Gateway, improves the health and wellbeing of young adult offenders aged 18-24, and influences their chance of offending again, and gives victim satisfaction. The Gateway programme is issued as a conditional caution and has been developed by Hampshire Constabulary (HC), in partnership with local community groups, with an aim to improve the life chances of young adult offenders. In the programme, a mentor assesses the needs of each adult and develops a care pathway with referrals to healthcare. The young adult offenders then participate in two workshops about empathy, and the causes and consequences of their behaviour. Such intervention programmes are believed to improve the health and well-being of young offenders and reduce criminal behaviour. However, there is currently little information about the extent of this improvement. To find out whether the programme works, this research study compares a group of young adult offenders taking part in the Gateway programme as a conditional caution with a group of non- participants who are required to appear in court or given a different conditional caution. Publications An out-of-court community-based programme to improve the health and well-being of young adult offenders: the Gateway RCT | NIHR Journals Library

f6f0f7ec-ab98-4c5c-9b52-2674a93b8c90 ADOPTED: A Study to Evaluate the Introduction of new Staffing Models in Intensive Care: a Realist evaluation (SEISMIC-R) Prinicipal Investigator: Professor Natalie Pattison, University Of Hertfordshire Team: Professor Peter Griffiths, Dr Chiara Dall'Ora, Dr Christina Saville, Dr Lisa Whiting, Dr Melanie Handley, Dr Susie Pearce, Dr Marion Penn, Dr Paul Mouncey, Professor Thomas Monks, Mrs Clare Leon-Villapalos, Professor Suzanne Bench, Professor Ruth Endacott, Mr Jeremy Dearling, Mrs Jennifer Gordon. University of Southampton, University of Hertforshire, University of Plymouth, Intensive Care National Audit & Research Centre, University of Exeter, Imperial College Healthcare NHS Trust, Guys & St Thomas' NHS Foundation Trust/London South Bank University, NIHR Clinical Research Network. Start Date: 01 May 2023 End Date: 31 August 2024 Background Staffing in intensive care units (ICU) has been in the spotlight since the pandemic. Having enough nurses to deliver safe, quality care in ICU is important. There is national guidance, re-issued in April 2021, on how many nurses should care for ICU patients. However, what the skill mix should be (how many should be qualified nurses or have an ICU qualification) is unclear. Very little research has been done to look at which nursing staff combinations and mix of skills works best in ICU to support patients (described as ‘staffing models’). Across ICUs in UK, various ratios of qualified and unqualified nursing staff are being tried (staff ratios refer to the number of nurses caring for a set number of patients). Hospitals vary; some use a high proportion of non-registered nurses and others a low proportion of ICU qualified nurses. Research shows that there is a link between the quality of nurse staffing and poor patient outcomes, including deaths. Aim : Our research plans to look at different staffing models across the UK. We aim to examine new staffing models in ICU across six very different Trusts. We will use a research technique called Realist Evaluation that examines what works best in different situations and helps us to understand why some things work for some people and not others. The design of this approach will help us to better understand the use of different staff ratios across different ICU settings. We will examine what combinations of staff numbers and skills result in better patient care and improved survival rates. Our aim is to produce a template that every ICU unit can use. To do this, we will compare staffing levels with how well patients recover, and seek to understand the decisions behind staffing combinations. Publications Nurse staffing configurations and sickness absence in English intensive care units: A longitudinal observational study - ScienceDirect ICU staffing and patient outcomes in English hospital Trusts: A longitudinal observational study examining ICU length of stay, re-admission and infection rates - ScienceDirect

3020cd35-d002-4b24-bc53-5ac051771722 Adopted Project: Paramedic delivery of end-of-life care (PARAID) Study Chief Investigator: Dr Natasha Campling, University of Southampton Funder: Marie Curie Research Grants Scheme Start Date: 1st March 2023 End Date: 7th January 2026 Partners: University of Southampton, University of the West of England, South East Coast Ambulance Service NHS Foundation Trust, University of Ulster, Northern Ireland Ambulance Service Health and Social Care Trust, Marie Curie. Why did we do this work? Demand for end-of-life care (for people in the last year of life) is rising, driven by ageing population and increasing rates of people living with multiple conditions. This is causing increases in 999 calls to ambulance services with rates highest in areas of deprivation. In line with this rise in 999 calls for those at end of life, rates of ambulances transporting people to hospital are also increasing, which can lead to hospital deaths, a place where most people say they do not wish to die. Despite this little is known about paramedic practice in this context and service provision varies widely. What did we do? The study has for the first time investigated how ambulance paramedics support people in the last year of life following a 999 call, what challenges they face, and how services can best enable effective, compassionate care. More than 1,100 paramedics responded to a survey and over 100 patients, carers and healthcare professionals were interviewed. What did we find out? Ambulance paramedics provide supportive and compassionate care to individuals at end of life, but practice hampered by limited access to essential resources (specialist advice, patient records, advance care planning documents and medicines). Fear and uncertainty regarding end-of-life care undermine paramedic confidence. Limited education and training in palliative and end of life care contribute to skill and knowledge gaps. Gaps in access to other healthcare professionals mitigate against shared professional decision-making. Challenges with medicines access and administration impede symptom control by paramedics. Service shortages in primary, community and specialist palliative care services drive paramedic call outs and challenges in interdisciplinary collaboration limit quality of care. We have: Contributed evidence to Government’s consultation on proposals to extend medicines responsibilities for paramedics. Submitted written evidence to Palliative Care Commission focused on increasing paramedic confidence and coordination of paramedic delivered care at end of life. Secured follow on funding to deploy the survey developed and used in the study to understand the situation for ambulance paramedics in Northern Ireland. Marie Curie led press release November 2025 (to coincide with the publication of the ParAid policy brief) Urgent reform needed to support ambulance delivered end of life care . This led to national and regional radio interviews by the ParAid study CI and Marie Curie’s Director of Policy and Research. University of Southampton and Marie Curie press release February 2025 (following the publication of the findings of the ParAid national survey in England). This led to a wide range of news outlet outputs including BBC news online . Publications: Campling, N., Turnbull, J., Richardson, A. et al. Paramedics providing end-of-life care: an online survey of practice and experiences. BMC Palliat Care 23 , 297 (2024). https://doi.org/10.1186/s12904-024-01629-7

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.

Senior Research Fellow < Back Miguel Garcia-Argibay Senior Research Fellow Healthy Communities Coming soon Previous Next

Professor Ruth Bartlett - National lead for DEM-COMM, post-doctoral training scheme for applied dementia researchers across the ARCs < Back Alzheimer's Europe Conference DEM-COMM researchers in Geneva Professor Ruth Bartlett - National lead for DEM-COMM, post-doctoral training scheme for applied dementia researchers across the ARCs DEM-COMM was out in force at the 34th Alzheimer’s Europe conference in Geneva. We weren’t all wearing DEM-COMM emblazoned bobble hats (next time, maybe?) but there were twenty of us, all presenting work, supporting each other, and generally making the most of being at this important annual event. Our headline act was Dr Esther Loseto-Gerritzen from the University of Nottingham, ARC East Midlands. Esther gave her first plenary talk: ‘Online peer support for people with young onset dementia’ in the largest auditorium I’ve ever been in; it was like the United Nations (see photo below). So very well done to Esther. We’re all proud of you and look forward to supporting you in your new role as Junior Board member and representative of the INTERDEM Academy . Other DEM-COMM fellows shared their work in a parallel session or one of the quick oral presentations (5 minutes), or like me, presented a poster. Some people gave two or three presentations - extra brownie points to you guys. Here’s a list of all works in the order they were presented at the conference, followed by a collage of photos of each person giving their talk. Oral presentations Hannah Wheat ‘Findings of the realist mixed methods, longitudinal evaluation of the D-PACT (dementia personalised care team), primary care based, post-diagnostic, dementia care model’. Amirah Akhtar ‘Depression and dementia risk: exploring the impact of cognitive dysfunction during recurrent depression in middle-aged British South Asians: A qualitative study. Orri McDermott ‘Co-working with local Caribbean communities to raise awareness and normalise talking about dementia’. Neil Chadborn ‘Yaad participatory project: exploring memories with South Asian Communities to understand the context of family of care for people with dementia’. Marie Poole ‘Understanding post-diagnostic dementia support through football organisations to provide person-centred, culturally appropriate support for underserved communities’. James Faraday ‘Better mealtimes for people living with dementia: working with care homes to share good practice’. Rasa Mikelyte ‘Inclusion from the start: co-development and application of a priority setting method for dementia care research’. Emma Elliot ‘Physical activity interventions for hospitalised patients with dementia: systematic review’. Orri McDermott ‘Lived experience of advance care planning and shared decision making’. Rasa Mikelyte ‘Co-designing an easy-read measure of care-related quality of life: reflections on involving people living with dementia and their supporters’. Megan Rose Readman ‘Understanding the experience of hearing loss for people living with lewy body or parkinson’s disease dementia. Emmanuel S. Nwofe ‘DEM-SAFE: co-designing information campaigns to promote brain health and reduce dementia risk in south Asian and African Caribbean communities in the UK’. Amirah Akhtar ‘DEM-SAFE: Living well with dementia for south Asian and African Caribbean communities in the UK’. Posters Jiamin Du ‘Prevalence and correlates of neuro-psychiatric symptoms in individuals referred to a memory clinic, and the distress experienced by their caregivers’. Hannah Wheat ‘Triadic communication during dementia care: a conversation analytical study. Megan Polden ‘Music Make Us! The impact of singing and dancing interventions on people living with dementia’. Tamara Backhouse ‘How can we improve personal care assistance for people living with dementia to reduce refusals of care? A realist synthesis Juanita Hoe ‘Risk Assessment in people living with dementia: a systematic review’. Esther Loseto-Gerritzen ‘Online peer support for people living with dementia: a scoping review’. Hannah Wheat ‘Supporting dementia support workers to adapt to their role within a primary care setting: what works, for whom and in what circumstances’. Ruth Bartlett ‘Building capacity in applied dementia research’. Chris Poyner ‘Personalising domiciliary dementia care via co-designed computational matching: a study protocol’. Ilianna Lourida ‘Data-driven discovery of associations between prescribed medication and dementia risk: a systematic review’. Emmanuel S. Nwofe ‘Dementia risk factors and brain health: a scoping review of interventions to reduce social isolation and loneliness among minority ethnic populations in OECD countries’. Thanks to Sarah Smith for darting around the venue to take these shots, great job! Previous Next

3a7ef7ca-de0e-49f1-be5c-8349df40131c ADOPTED: Community Alternatives to aCute Hospitalisation for Older People who have Fallen (CAtCH-Falls) Principal Investigator: Dr Sara McKelvie, GP & NIHR Clinical Lecturer at the Primary Care Research Centre, University of Southampton. Team members: Lois Woods, Southampton Health Technology Asessments Centre, University of Southampton. Dr Rachel Dewar-Haggart, Primary Care Research Centre, University of Southampton. Professor Peter Griffiths, Health Sciences, University of Southampton Associate Clinical Professor Jacqui Prieto, Health Sciences, University of Southampton Dr Dan Baylis, Chief Medical Officer, NHS Solent Foundation Trust Dr Syed Hasan, Clinical Lead for Virtual Wards, NHS England Dr Elizabeth Angier, PhD student Main funding: NIHR School For Primary Care Research Starts: 1 April 2024 Ends: 31 March 2026 Summary Each year 30% of older people living in the community fall and are often taken to hospital for assessment. National guidelines recommend that after a fall, older people have a thorough check up and help to prevent further falls. We currently don’t know what the best assessment is for older people who fall and are assessed at home. There are several health services which can assess people in the community without a hospital visit. These can be described as “Community Alternatives to aCute Hospitalisation” (CAtCH) services. In different areas in the country these services have different team members, resources and ways of working. Research is needed who and what is needed to work in CAtCH services, particularly to support older people who have fallen. This study plans to look at previous work in this area by looking at published articles, service reports, government documents and internet resources to find out what is essential for these services. We also plan to survey and interview people who work in CAtCH services in the UK to understand what is available for older people who have fallen. The research findings will be used to develop resources for patients, the public and healthcare workers to showcase CAtCH services. The team also plan to produce a report for healthcare commissioners and support policy-makers. It will also allow the team to apply for further research funding in this area including further projects to look at public awareness of CAtCH.

747d2c2b-5ef2-4aa3-91d2-49259acbc2a5 Refinement of an eFalls tool - a multivariable prediction model for the risk of ED attendance or in-hospital fall or fracture in individuals accessing mental health or learning disability services - eFalls Chief Investigators: Dr Luis Marino, South West Yorkshire Partnership NHS Foundation Trust Dr Stephen Lim, University of Southampton Co-investigators: Professor Andrew Clegg, ARC Yorkshire & Humber, University of Leeds Professor Sam Chamberlain, University of Southampton Professor Chris Kipps, University Hospital Southampton Start Date: 1st April 2025 End Date: 31st March 2026 Partners: University Hospital Southampton NHS Trust, South West Yorkshire Partnership NHS Foundation Trust, NIHR ARC Yorkshire & Humber, University of Leeds Our Research Falls have a significant impact on physical health with increased risk of morbidity including, dehydration, pain, chest infection and reduced ability to get on with daily activities of living. This may lead to reduced levels of activity, social isolation, depression and anxiety. Individuals with a mental health or learning disability diagnosis have an increased risk of falls. Although several falls screening tools are available, they usually need a healthcare professional to manually screen electronic health records, which may not always be done. Falls have a big impact on health and social care systems and is a leading reason for admission to hospital. Treatment for fractures also costs the NHS an estimated £4.5billion a year. This study aims to take an electronic tool (eFalls) which automatically predicts the risk of falls in older people (over the age of 65 years) and explore whether it accurately predicts the risk of falls in adults with a mental health or learning disability diagnosis. We will use routinely collected data from two health services covering the regions of West Yorkshire and Hampshire and Isle of Wight for this study. Data for patients aged 18 years and above with a known mental health diagnosis will be included in this study. We want to know whether this tool can be used to predict the falls risk among people living with mental health disorders or learning disability and how effective the tool is in predicting falls. If shown to be successful, we will share our findings with healthcare commissioners and policymakers and the following steps will be to pilot this tool in the healthcare setting to explore its impact on patient outcomes.

aeb3153c-5d74-4046-b64a-afed7e369f76 Understanding the Networks, Effects and Teams involved in Community Alternatives to ACute Hospitalisation for Older People in Hampshire and Isle of Wight Region – CAtCH-NET Chief Investigator: Dr Natalie Cox, NIHR Academic Clinical Lecturer Geriatric Medicine, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton Team: Dr Stephen Lim, Principal Clinical Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton & Honorary Consultant Geriatrician University Hospital Southampton NHS FT Dr Sara McKelvie, NIHR Clinical Lecturer Primary Care Research, Primary Care Research Centre, Faculty of Medicine, University of Southampton Dr Carole Fogg, Senior Research Fellow, School of Health Sciences, University of Southampton Start: 1 October 2024 End: 31 March 2026 Partners: Hampshire and Isle of Wight NHS Healthcare Foundation Trust, Isle of Wight NHS Trust, Portsmouth Hospitals University NHS Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton Background In Southern England, there are more older people than in many other parts of the country. Many of them live with several health conditions that can suddenly get worse. When this happens, they often need quick help from healthcare professionals. Whenever possible, it’s better for people to get this care at home rather than going to hospital. This matches the government’s plan to move more healthcare from hospital to the community. To support this, urgent care services have been set up across Hampshire and the Isle of Wight. These services aim to treat older people at home when they become unwell. But even with these services in place, many older people still go to hospital emergency departments. Some are sent home within 24 hours, which suggests they might have been safely treated at home instead. That’s why it’s important to understand how these urgent care services are working. Although they are close to each other, they are all set up differently. This research will look at the teams and networks of healthcare staff who help older people avoid hospital stays. We will interview people who work in these services and those who receive care from them. We’ll also study data from two local emergency departments to learn more about why some older people go to hospital and are sent home. By doing this, we hope to better understand how older people move through the urgent care system, and what helps or gets in the way of good care. We’ll also look at whether things like where someone lives, or whether they have a certain problem, affect their chances of going to hospital when it might not be needed. Our findings will help the NHS organisations design better urgent care services, so more older people can be safely cared for at home rather than in hospital. What have we found out? The analysis of the data is ongoing for CAtCH NET: We have data for UHS emergency department and have a cohort of 25,000 patients representing over 40,000 attendances. We are currently analyzing the data to understand the characteristics of these patients and factors related to discharge within 24 hours. We have completed interviews with staff who work within community urgent care services for older people, those who refer to them and those working closely with the emergency departments. Three main themes encompass the experiences of the participants: Complexity in urgent care service provision Complexity of work to avoid hospital admission Complexity of navigating an array of services and personnel What will we do with this new knowledge? We plan to create a report for the ICB and trust stakeholders. We will be working with HIW to conduct stakeholder meetings to discuss out findings and how they may inform ongoing service re-structuring. We have been conducting patient advisory groups meetings and have mapped their experiences to the findings of the qualitative data to aid in stakeholder discussions. We have also highlighted the study to a recent parliamentary call: 10.5258/SOTON/PP0162 10.5258/SOTON/PP0162 Publications Community alternatives to acute hospital (CAtCH) assessment services: Design principles and implementation challenges - Sara McKelvie, Margaret Glogowska, Daniel Lasserson, Joanne Reeve, 2026