056e2237-0346-49fe-b123-4999c149156a Comparative Effectiveness of Methylphenidate vs. Second‑ and Third‑Line Medications for Children with Attention- Deficit/Hyperactivity Disorder and Autism Chief Investigator: Professor Samuele Cortese, NIHR Research Professor, University of Southampton Co-Investigator: Miguel Garcia Argibay, Senior Research Fellow, University of Southampton Team: Laura Nisbet, Mental Health Nurse, lead neurodevelopmental pathway, Hampshire and Isle of Wight Foundation NHS Trust Partners : Hampshire and Isle of Wight Foundation NHS Trust, University of Southampton Start: 1 10 2024 End: 31 3 2026 Aims of the study: This study wants to find out which medications work best for children who have both Attention Deficit/Hyperactivity Disorder (ADHD) and autism. We are especially interested in learning whether the most commonly used medication for ADHD (called methylphenidate) works well for children who have both ADHD and autism, or if a different medication would be better. Background: Many children with ADHD also have autism. Right now, doctors usually treat ADHD with methylphenidate, but the studies that recommended this medicine didn't include children who have both ADHD and autism. So, we need to see if this medication works as well for children with both conditions. How We Will Do the Study: We are going to look at existing information (data) from the UK and abroad (Sweden), about thousands of children who have both ADHD and autism. We will compare different groups of children: Those who started with methylphenidate (the usual ADHD medicine). Those who started with other types of medication. Those who switched between different medications. Those who did not take any medication. We'll check how often these children needed to go to the hospital or emergency room, if they had any injuries, or if they had issues with self-harm. This will help us figure out which medicines work better and are safer. We will also use special techniques to make sure the comparison between the groups is fair and considers any other factors that might affect the results. Patient, public and community involvement : We believe this study will help doctors treat children with both ADHD and autism better. That’s why we’ll work closely with people who have lived experience of these conditions, both locally and internationally. Locally, we will involve people with lived experience from the Solent Academy of Research and Improvement team and Southampton Primary Care Research Centre. Nationally, we will work with representatives of the ADHD Foundation- Neurodiversity charity, the largest association people with lived experience of ADHD and autism in the UK. Internationally, we’ll partner with representatives of ADHD Europe, which is the largest European group for people with neurodiverse conditions like ADHD and autism. Professor Cortese has ongoing collaborations with all these partners. These people will help us at every stage of the research: designing the study, choosing what results to focus on, and sharing the findings with others. Sharing the Results: Once the study is finished, we will share the results with doctors and healthcare providers to help them make better decisions for treating children with both ADHD and autism. This may lead to changes in treatment guidelines and improve care for these kids. The findings will be published in medical journals, presented at conferences, and shared on public websites and in publications, especially those aimed at families of children with ADHD and autism.

Clare Phillips - Hepatology Nurse Specialist, MSc Global Health < Back My journey into research My interest in research came as a bit of a surprise. Clare Phillips - Hepatology Nurse Specialist, MSc Global Health My interest in research came as a bit of a surprise. In 2016, I started an MSc in Global Health part-time at BSMS. I had previously completed the Diploma of Tropical Nursing at London School of Health and Tropical Medicine and was working as a clinical nurse specialist in viral hepatitis at the time. I started the MSc thinking I’d be more interested in the policy side of the course or, where it might take me from a clinical perspective. But, it was working with Prof Gail Davey’s research group, for my MSc dissertation, that was the game changer. Prof Davey’s work in Ethiopia had shed light on the neglected tropical disease, podoconiosis , in quite a remarkable way - improving care for those living with the condition, giving a voice to the seldom heard, influencing national policy, challenging stigmatising attitudes and building research capacity (across disciplines) within Ethiopia. It was hugely inspiring and a clear example of how research had enormous scope to influence change. Having completed my MSc, I began voluntarily joining various research projects that were going on at work – collecting data for some, writing manuscripts for others. This helped me build my CV and confirmed that a career in research was right for me. I moved back to Southampton in summer 2019 and began working for the Alcohol Care Team at University Hospital Southampton. Inadvertently, I stepped into a research-focused team, who wanted to use research to make a difference to our patient group. And it made all the difference. In 2021, with my manger, Anya Farmbrough, and Richard Darch from Adult Safeguarding, I wrote a paper challenging perceptions of self-neglect in patients with alcohol use disorder ( More than a ‘lifestyle’ choice? Does a patient's use of alcohol affect professionals' perceptions of harm and safeguarding responsibilities when it comes to self-neglect? A case study in alcohol-related liver disease | Gastrointestinal Nursing ( magonlinelibrary.com ) ). With support from Anya and our medical lead, Prof Julia Sinclair, I applied for the ARC Wessex Mental Health (Alcohol) Internship in 2022. My internship focused on older adults with alcohol use disorder (AUD), analysing some pre-collected service evaluation data and working on a systematic review of AUD interventions in this cohort. The internship gave me the time (and funds) to focus on developing gaps in my skillset e.g. I took an online statistics course and had the opportunity to work 1:1 with the ARC statistician to refresh my statistics skills. I am not sure how or when I would have been able to do this without the internship. The internship also provided opportunities to present my work, from academic conferences to departmental meetings and PPI groups. This allowed me to get familiar with answering direct questions about my research, and how to deal with the trickier ones! As a result of the ARC Wessex Internship, I had 2 abstracts accepted at national conferences this year ( 1586 OLDER AGE IS AN IMPORTANT PREDICTOR OF NON-REFERRAL TO COMMUNITY ALCOHOL SERVICES FOLLOWING AN INPATIENT EPISODE: FINDINGS FROM | Age and Ageing | Oxford Academic ( oup.com ) , P28 Mortality and cause of death in patients aged 50–59, 12 months after review by an alcohol care team | Gut ( bmj.com ) ). The internship also got me thinking about my next steps and enabled some key conversations to take place. I am certain my future career is a research-focused one and am currently working on my application for Round 11 of the NIHR Doctoral Fellowship programme. I have an important research question that needs answering, and so its full steam ahead! More about Clare Previous Next

03ec3658-b736-400b-ba5c-c0762b7b0f06 Understanding, addressing, and meeting the complex needs of people living with long term physical and mental health conditions: a qualitative study Lead applicant: Prof Mari Carmen Portillo and Dr Leire Ambrosio Co-applicants: Prof David Baldwin, Dr Lindsey Cherry, Dr Kate Lippiett, Dr Pritti Aggarwal, Mr William Barnaby Jones, Dr Sara McKelvie What problem will the research address and what evidence do you have this is a major concern for the public and health and care providers of Wessex? People with long term physical conditions are 2-3 times more likely to have mental health problems than the general population: at least 30% of adults with such conditions also have mental health problems (like anxiety and depression). People living with physical and mental long term conditions experience hardships relating to health, and have complex psychosocial, environmental, financial, and spiritual needs. Healthcare professionals find it difficult to provide fully integrated care for these populations, due to systematic barriers and fragmentation of services. The NHS has incorporated an initiative involving Social Prescribing Link Workers (SPLW) in response to these complex needs. SPLWs connect people to community local services to meet needs through a comprehensive person-centred approach. However, the way in which this initiative occurs in different areas and services is variable, and there is unclear guidance for primary care services about how to integrate this novel workforce into wider efforts to address and meet the complex needs of people living with long term physical and mental conditions. Where will the research take place and who will you involve? The project will be undertaken in primary care practices in Hampshire, the Isle of Wight and Oxfordshire, and with a range of local third sector organizations (e.g., Anxiety UK, Mind). Semi-structured interviews will be undertaken with people living with long term physical and mental health conditions. Subsequent focus groups will explore the range of care provider perspectives (e.g., social prescribing link workers, GPs, nurses, practice managers). We expect to interview 20-25 individuals and conduct 4-6 focus groups with 6-8 participants per group. Maximum variation sampling will focus on sociodemographic characteristics (age, sex, ethnicity, socioeconomic background), with a sharp focus on disadvantage and deprivation. Overall aim: To determine the barriers and facilitators to successful implementation of the SPLW role in primary care for individuals living with long term physical and mental conditions. Specific objectives. Identify the range of health and social needs of people living with long term physical and mental conditions. Explore provider perspectives about social prescribing link workers role implementation and effectiveness for people living with long term physical and mental conditions. Explore user perspectives about social prescribing link workers role implementation and effectiveness Explore how, SPLW implementation methods can be adapted to better meet the needs of culturally diverse populations including those living within deprived areas. Explore potential limitations of SPLW model for people living with long term physical and mental conditions. Co-produce recommendations to enable effective implementation of social prescribing link workers to address health and social needs of people living with long term physical and mental conditions. A qualitative design, utilising semi-structured interviews and focus groups will be conducted. Patients and the public will contribute to all aspects of the research process. How will the findings inform improvements in population health and patient care. Following this study, a comprehensive tailored programme will be developed to address the complex needs of people with long term physical and mental conditions including those living in deprived areas. Plans for its implementation will be explored involving key stakeholders from and integrated Care System (ICS), Primary care Networks (PCNs), Local Authorities and any other organizations/sectors that may benefit from the findings. Publications https://doi.org/10.1155/2023/7191247

9651ede0-0793-4179-aed8-009aca83e877 Developing Pathways for older adults who are also drinking at increased-risk levels: Hampshire Older adults Alcohol Pathway (HOAAP) Chief Investigator: Julia Sinclair , Professor of Addiction Psychiatry, Faculty of Medicine, University of Southampton. Co-Investigators: Skaiste Linceviciute, Research Fellow, NIHR ARC Wessex, University of Southampton Gabrielle A Palermo, Senior Research Assistant, NIHR ARC Wessex, University of Southampton Stephanie Hughes, Research Fellow, NIHR ARC Wessex, University of Southampton Becky Band, Associate Professor, University of Swansea Melinda King, Lived Experience Consultant Stephen Lim, Consultant Geriatrician, NIHR ARC Wessex Ageing and Dementia Theme Lead, University Hospital Southampton Partners: Hampshire and Isle of Wight Integrated Care Board, Hampshire and Isle of Wight NHS Foundation Trust, Hampshire Hospitals NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton, Hampshire County Council, Southampton City Council, Wessex Health Partners, Inclusion (community treatment provider of addiction services), CGL, ‘With you’ Community Addiction Services Bournemouth and Poole, NIHR School of Primary care Start: 1 October 2024 End: 31 March 2026 Summary Alcohol once swallowed is absorbed into every organ of the body as well as affecting the mind. Although approximately 80% of people in Wessex drink alcohol, many people remain unaware of the harm it causes even at relatively low levels. As people age, they are more likely to develop long term health conditions, which alcohol can adversely affect as well as putting them at increased risk of medication interactions, memory problems, and falls. We know that older adults may feel more uncomfortable talking about their alcohol use compared with younger people. This can create barriers to accessing help. Beyond this, very little is known about the reasons why older adults drink alcohol and how this may interact with other aspects of their lives. The aim of this project was to build on our first study funded by the ARC Wessex, Older Adults, Loneliness and Alcohol (OLA), which recruited individuals over 65 years admitted to University Hospital Southampton (UHS) whose alcohol consumption was at increased risk levels. In collaboration with local clinicians and researchers, the study generated evidence that informed a follow-on project focused on alcohol use among community-dwelling older adults. To date we have undertaken the following studies: “Modelling the Impact of People with Alcohol Use Disorder on Clinical Outcomes and Healthcare Use” - in collaboration with Southampton Emerging Therapies and Technologies (SETT) Centre, and the Wessex Secure Data Environment (SDE). We have accessed and begun the analysis of retrospective, routinely collected data from all patients admitted to UHS between January 2017 - June 2025. There are over 95,000 inpatient discharges during this time. This work is supporting the investigation of associations between alcohol use disorder, clinical outcomes and healthcare use, as well as helping to refine the processes required to analyse data in the SDE. “Understanding lifestyle and alcohol consumption in older adults: a qualitative study” - We interviewed a community sample of individuals across Wessex over the age of 65 years, who consume alcohol and experience other potentially challenging contributing factors, to learn about their lifestyle choices, daily routines and demands with a scope for exploring alcohol consumption and related experiences. This study identified a range of alcohol consumers with diverse life factors, demonstrating the need for tailored health messaging/ advice and wellbeing support. Brought together an engaged and active stakeholder group of experts by experience and training in this field; including patients, carers, clinicians, social care workers, community support providers, commissioners and academics to inform our research planning and undertaking, to exchange and disseminate the learning and to build a network of collaborations to apply for further funding to take this work forward. These three strands of work have supported necessary evidence and partnership infrastructure building that will now require to be taken forward.

c585330f-e35f-4618-bc81-287d81f85239 The PD Life Study: Exploring the treatment burden and capacity of people with Parkinson’s and their caregivers Principal Investigator: Professor Helen Roberts Research team: Dr Qian Yue Tan (Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Professor Helen Roberts (Professor of Medicine for Older People, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Dr Kinda Ibrahim (Senior Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Dr Simon Fraser (Associate Professor of Public Health. School of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital), Dr Khaled Amar (Consultant Geriatrician and Honorary Senior Lecturer at Bournemouth University, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust) Start: October 2020 Ends: October 2022 Project Partners: University of Southampton, Bournemouth University, University Hospital Southampton NHS Foundation Trust, Royal Bournemouth and Christchurch Hospitals NHS Foundation . Lay Summary People with Parkinson’s (PwP) have many symptoms including tremor, stiffness, slow movements, constipation, urinary incontinence and mental health issues. They are often older and have other long-term health conditions. PwP need to do many things to look after their health including manage multiple medications, attend healthcare appointments and lifestyle changes such as improving diet and exercise. The effort of looking after their health and its impact on them is termed ‘treatment burden’. Some PwP need help from their family or friends (caregiver) to complete these tasks. Caregivers may also experience treatment burden themselves when caring for someone with Parkinson’s. People’s ability to manage treatment burden is termed ‘capacity’ and is influenced by physical, mental, social and economic factors. People are overburdened when the workload of looking after their health exceeds their capacity. This can lead to poor adherence with treatment, poor quality of life and worse health outcomes. Aim We aim to understand the factors that influence treatment burden and capacity in PwP and their caregivers. Methods Interviews with 15 PwP and 15 caregivers will identify factors that influence treatment burden and capacity. These factors will be explored further in a national survey for PwP and caregivers with support from Parkinson’s UK. We will then form focus groups with PwP, caregivers, voluntary sector representatives, healthcare professionals, policymakers and managers through Parkinson’s Excellence Networks to discuss the findings and prioritise recommendations for change. This study will enable to us develop recommendations of ways to reduce treatment burden and improve future experiences of PwP and their caregivers. This research is also supported by a legacy in memory of Carolyn and Tore-Jan Myhre

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

8f830c4b-12f3-482a-9f50-095a9cd14973 ADOPTED: Gambling in the UK: An analysis of data from individuals seeking treatment at the NHS Southern Gambling Service Principal Investigator: Professor Sam Chamberlain, Professor of Psychiatry at University of Soutampton & Honorary Consultant Psychiatrist at Southern Health NHS Foundation Trust. Co-investigators: Professor David Baldwin, University of Southampton, Professor Jon Grant , University of Chicago, Dr Konstantinos Ioannidis, Southern Health NHS Foundation Trust, Dr Mat King, Southern Health NHS Foundation Trust. Partners : University of Southampton & Southern Health NHS Foundation Trust Summary Gambling disorder is a growing problem amongst adult gamblers. Although previous research has identified some of the harms associated with gambling, few studies have documented how these harms in a large, UK clinical sample. Moreover, It is critical to investigate the socioeconomic determinants of gambling disorder via geospatial analyses, bringing together clinical and socio-economic parameters, to identify areas of need and inform the strategic development of the regional service as well as influence policy making more widely. Furthermore, little is known regarding the evolution of factors that predict treatment success dropout or relapse and how individual vulnerabilities interact with environmental risk. This research aims to fill this gap, by analysing a large existing dataset of treatment seeking gamblers. The service has a purpose to provide clinical excellence, while adopting innovative methods (digital pre-assessment, digital monitoring, virtual individual and group therapies etc.) in the clinical setting and to spearhead cutting-edge research which will inform and enhance clinical practice locally, nationally, and globally. The long-term goal of the service is to establish a world-renowned centre that minimises gambling harms through comprehensive evidence-based treatments, research, outreach, and prevention (including early interventions). The clinical focus of the Southern Gambling Service (SGS) is on minimising gambling harms, which involves treating disordered gambling using evidence-based approaches, as well as providing support aimed to promote or replenish recovery capital in individuals (e.g. detecting comorbidities and signposting individuals to other sources of support, enhance social connectedness, promote liaison with sources of financial, social and wellbeing support, setting out the scaffolding of follow up arrangements).

Ageing & Dementia Publications A randomised controlled crossover study to assess adherence and palatability of a porridge supplement compared to a drink-based supplement in hospitalised older adults at risk of malnutrition Meredith SJ, Sheppard KA, Calder PC, Patel HP, Lim SER This study examined whether older hospital patients preferred and adhered better to a porridge-style oral nutritional supplement (PS) compared to a standard drink supplement (DS). In a crossover trial involving 27 adults aged 65+, participants consumed both supplements over separate periods. Results showed that adherence was significantly higher for the drink supplement (about 67%) than for the porridge (about 26%). The porridge was less liked, particularly due to its texture, although the overall amount consumed did not differ significantly between the two. Neither supplement replaced normal food intake. Factors affecting acceptance included patients’ appetite, physical condition, hospital environment, staff attitudes, and the taste and texture of the products. Participants expressed a desire for a broader range of more natural, food-based options and better staff training in nutritional care https://doi.org/10.1017/jns.2026.10108 June 2026 Ageing & Dementia Association between opioid infusion use and duration of mechanical ventilation and related outcomes in critically ill adults: a systematic review and meta-analysis Ong JP, Devlin JW, Culliford D, Cusack R, Grocott M, Ibrahim K, McKenzie CA Doctors in intensive care units often give patients on breathing machines (ventilators) continuous opioid drugs through an IV to help with pain and sedation. This has been standard practice for many years. There are growing concerns about how safe and effective this approach really is. Patients can react differently to opioids, and it’s not always clear how well these drugs control pain or sedation. Over time, patients may build up tolerance, meaning the drugs become less effective. Opioids can also cause problems such as worsened breathing coordination with the ventilator, slowed gut function, and difficulty with feeding. Serious side effects are also common. These include a higher risk of delirium (confusion), physical dependence after only a few days, and a greater chance of long-term opioid use after leaving the hospital. Although some studies have looked at using opioids as the main sedation method, most compare one opioid drug to another. This makes it hard to know whether using continuous opioid infusions at all is beneficial or harmful. Because of this gap in knowledge, we carried out a systematic review and meta-analysis to compare ICU sedation strategies that use continuous opioid infusions with those that do not, to better understand their impact on patient outcomes. https://doi.org/10.1016/j.aicoj.2026.100089 June 2026 Ageing & Dementia Projected trends in frailty prevalence and associated health service use and costs in the over-50s in England, 2025 to 2040: a simulation modelling study Walsh B, England T, Brailsford S, Fogg C, Fraser S, Roderick PJ, de Lusignan S, Harris S, Clegg A The UK Government aims to build a national health service in which everyone lives well for longer, requiring a focus on ensuring people enter older age in better health to maximise independence. There is similar attention internationally on maintaining health and wellbeing in ageing populations, with a shared goal to improve the lives of older people set out in the United Nations Decade of Healthy Ageing collaboration. Central to this aim is the prevention and management of frailty, a condition characterised by reduced physiological reserves and resulting vulnerability to adverse outcomes, including loss of independence. Frailty is expected to become more prevalent as populations age, becoming a significant issue for health services worldwide, and identified in the 2023 Chief Medical Officer’s Report on Health in an Ageing Society as a crucial consideration for the UK health service. Frailty is associated with adverse outcomes, such as high health and social care service use, unplanned admissions and transfer to residential care. Since 2017, general practices in England have screened their populations for moderate/severe frailty, targeting patients with appropriate interventions, such as medication reviews, falls risk assessments and Comprehensive Geriatric Assessment (CGA), which have the potential to slow or prevent decline. While consensus guidelines have emphasised the importance of identification and clinical management of frailty, there is less evidence to support planning of service configuration and delivery to achieve these goals at population level, particularly in relation to the future impact of developing frailty in middle age at a population level, crucial considerations for health policy and commissioning decisions. Previous analyses indicate that despite lower individual costs, mild to moderate frailty in people aged up to 65 are a greater driver of costs. The aim of this study was, therefore, to develop a simulation model of healthcare demand, service use and costs in people aged 50 and over living with frailty in England, to enable prediction of future health service impact of frailty in the ageing population and examine the impact of different health care policy priorities. https://doi.org/10.1093/ageing/afag109 May 2026 Ageing & Dementia Palliative care conversations with people with dementia who live alone: untapped dimensions from a lived experience. Williamson LE, Horne D, Mikelyte R, Grey EB, Collins P, Poyner C, Farnood A, Oh TM Dementia is a life-limiting condition, and a palliative care approach can improve both quality of life and quality of care for people living-and dying-with dementia. Research has consistently shown that, compared with other terminal conditions such as cancer, dementia is under-recognised and under-treated within palliative care systems. Considerable attention has been paid to this overall under-representation; however, further inequities exist within palliative dementia care research and practice itself. This position paper draws on an in-depth conversation with a person living alone with Alzheimer's disease and vascular dementia, alongside a critical engagement with existing literature. Using lived experience as a starting point, we identify two untapped dimensions of palliative dementia care: (1) barriers in palliative care conversations when a person with dementia attends clinical appointments unaccompanied; and (2) intersectional disadvantage arising from dementia, living alone, and health and social care systems that overly rely on informal carers or supporters. These contribute to exclusionary research practices that marginalise people living with dementia without close care partners. While the involvement of carers and supporters in shared decision-making should be encouraged when they are present, high-quality palliative care and research must not depend on their presence and should be equally accessible to people living with dementia who attend services alone. We argue that addressing this neglected area requires the meaningful involvement of people with lived experience in shaping both research agendas and clinical practice. https://doi.org/10.3389/frdem.2026.1791608 May 2026 Ageing & Dementia REMOTE-Neuro: co-produced recommendations to optimise remote neurology Fuller P, Fearn S, Dace S, Wollam A, Zarkali A, Cowan A, Mountney S, Carr G, Eriksson SH, Kipps C The COVID-19 pandemic necessitated a rapid shift to remote healthcare delivery. Despite historical concerns about the limitations of remote neurology appointments, increasing evidence indicates that remote appointments, when appropriately triaged, can be both safe and effective with clear advantages to patients, clinicians and the wider healthcare system. What remains unclear is how best to combine face-to-face (F2F), telephone, video and asynchronous communication in ways that optimise safety, equity and efficiency. Most existing studies are based on small samples from single centres and tend to present either the patient or clinician perspective. At UK national level, strategic initiatives such as Getting It Right First Time provide valuable and detailed service-wide recommendations for neurology. Broader programmes including the NHS Long-Term Plan, the Outpatient Recovery and Transformation Programme and the Topol Review promote digital innovation and more personalised outpatient care across the NHS. In parallel, WHO and NHS England endorse co-producing new models of care with service users. What is missing so far is a single framework to bring these strands together in a way that reflects the lived realities of those delivering and receiving remote neurology care. To address this gap, we synthesised three national surveys comprising over 3000 stakeholder perspectives and convened a series of iterative co-production workshops with patients, carers and healthcare professionals (HCPs). These workshops validated and enriched the national findings and informed a co-produced set of REcommendations for optimising Modality, Operational efficiency, Training and Equity in NEUROlogy (REMOTE-Neuro framework). By integrating lived experience with clinical insight at scale, the framework delivers practical and stakeholder-endorsed recommendations for optimising remote neurology care. https://doi.org/10.1136/bmjno-2025-001518 April 2026 Ageing & Dementia Implementing a medication review and deprescribing intervention for older people living with frailty and polypharmacy in general practice: a feasibility study Radcliffe E, Kandala N, Sach T, Mccloskey S, Howard C, Sheikh C, Bradbury K, Latter S, Recio Saucedo A, Lown M, Brad L, Fraser SD, Ibrahim K Polypharmacy in older adults with frailty increases risks of adverse outcomes. Evidence supports proactive structured medication reviews (SMRs) for medicines optimisation, including deprescribing, however challenges exist in general practice. Polypharmacy (taking five or more regular medications on daily basis) affects nearly half of people in England aged 65 and over. Polypharmacy in older people is associated with increased potentially inappropriate medications (PIMs) leading to increased risk of falls, cognitive impairment, functional decline, hospital admission and death. In older people living with frailty medications harm can be amplified and can outweigh benefits or the known time to benefit exceeds projected life expectancy e.g. statins. Additionally, the goals of drug treatment in this population may change from reducing the risk of disease and prolonging life to reducing the burden of treatment and maintaining quality of life. Frailty may influence factors such as drug pharmacokinetics and pharmacodynamics, toxicity, and therapeutic efficacy. In turn, these factors may be involved in the development of frailty. Therefore, it has been recommended that people living with frailty and those with complex and problematic polypharmacy should receive a structured medication review (SMR) annually by their general practice team, specifically a clinical pharmacist referred to throughout as a ‘pharmacist’. An important aspect of SMR is deprescribing which involves tapering /dose reduction, stopping, or switching drugs with the goal of improving outcomes. Deprescribing has been shown to be feasible and safe across a wide range of conditions, medications, settings and with the use of different deprescribing tools. Deprescribing can lead to a reduction in polypharmacy and PIMs and for those living with frailty, can result in important benefits in relation to depression, function and frailty status. Implementing deprescribing in primary care can be challenging, but several facilitating factors have been identified. These include collaboration within well-integrated multidisciplinary teams (MDTs) with clear roles, where pharmacists lead with input from other professionals as needed. Effective digital and face-to-face communication, co-location, access to patient records, systems to identify high-risk patients, and use of tools to support SMRs further facilitate deprescribing. Face-to-face consultations are particularly valuable for discussing deprescribing, although communication should be tailored to patient and carer needs. Patient and carer education, shared decision-making, and trust in HCPs are also key facilitators. Clear plans for monitoring and follow-up after SMRs support continuity of care. Despite this growing evidence, no intervention has yet been developed and tested that integrates these facilitators and is feasible for implementation in routine primary care. To address this, a complex intervention to support medication review and deprescribing in primary care for older people living with frailty and polypharmacy was co-developed with key stakeholders, including patients, carers and health care professionals (HCPs) (MODIFY). This was achieved through three iterative stages of: reviewing the evidence; collecting and analysing primary qualitative data; and collaborating with stakeholders, guided by the principles of realist synthesis and the person-based approach. This paper presents the research conducted which aimed to assess the feasibility and acceptability of implementing the intervention in general practice among older people living with frailty, to inform a future substantive trial. https://doi.org/10.3399/bjgpo.2025.0175 Ageing & Dementia A European paramedic curriculum for geriatric emergency medicine developed via a modified Delphi technique Krohn JN, Barrett J, Heeren P, Lim S, Moloney E, Nickel CH, van Oppen J, Sandig N, Ünlü L, Singler K. Older emergency patients currently account for most European emergency medical service dispatches. Due to demographic changes and increasing comorbidities in advanced age, this number is expected to rise substantially in the coming years. Prehospital professionals require specialised training to provide high-quality care for complex, multimorbid patients. The aim of this study is to define minimum competencies for paramedic education in Europe on the management of emergencies in older adults. https://doi.org/10.1186/s13049-026-01550-3 January 2026 Ageing & Dementia Focussing on appetite decline to optimise management of undernutrition in later life- A geriatric medicine perspective Cox NJ, Jones L, Lim SE. Undernutrition is common amongst older people and can lead to adverse health outcomes and increased dependence. This review focuses on an aspect of undernutrition that is often overlooked, namely loss of appetite, and will discuss the challenges in this under-researched field from the perspective of geriatric medicine. Appetite decline is common in later life and predicts undernutrition in older populations. As such, timely identification and intervention on poor appetite could delay onset or progression of undernutrition to optimise healthy ageing and maintain independence. In addition, management of undernutrition ultimately requires the individual to meet their nutritional requirements. However, unless attention is paid to mitigating appetite decline, strategies to improve intake are likely to be ineffective. Treatment for appetite decline is challenging due to the multiple and complex underlying mechanisms. Current evidence is limited to a few trials targeting older people including flavour enhancement and fortification or supplementation, lifestyle measures such as increasing physical activity and social interaction, and medications, all with mixed results. Progress on treatments for appetite decline has been hampered by a lack of distinction from undernutrition, but also perhaps the approach to it as a concept. Categorising appetite decline in ageing as a geriatric syndrome could aid progress in the unification of approaches to mechanistic research, assessment and management strategies, which are likely to be most effective when in multi-component form and underpinned by the principles of Comprehensive Geriatric Assessment (CGA). https://doi.org/10.1017/s0029665125102115 January 2026 Ageing & Dementia An intervention to provide nutritional care for people living with dementia at home receiving home care (TOMATO): study protocol for a single-arm feasibility study Yinusa G, Surr C, Thomas S, Fenge LA, Howdon D, Major J, Heward M, Taylor G, Knight H, Townson J, Murphy J. In the UK, over 980,000 people are living with dementia, and two-thirds of them live in their own homes. Up to 60% of this population is estimated to be at risk of or already experiencing malnutrition, with 45% facing significant weight loss. As dementia progresses, ensuring that people eat and drink well becomes challenging. Many families affected by dementia access home care services, with home care professionals playing a vital role in supporting and enhancing overall quality of life. Training in identifying nutritional problems and supporting family carers to prevent malnutrition is an identified research need; however, research on the contribution of home care professionals in this area is limited. This study aims to assess the feasibility and acceptability of a nutritional intervention for people living with dementia receiving home care from the perspectives of people with dementia, family carers (dyads), and home care professionals (including home care managers). https://doi.org/10.1186/s40814-025-01722-5 November 2025 Ageing & Dementia The Importance of a Relationship-Centred Approach to Deprescribing for People with Dementia or Mild Cognitive Impairment in Primary Care: A Qualitative Study Andrews N, Brooks C, Amin J, Lim R, Board M, Latter S, Fraser S, Ibrahim K Polypharmacy (taking five or more regular medications) is common in people with dementia or mild cognitive impairment (MCI) and is associated with poor outcomes such as decline in cognitive and physical functioning, falls and hospital admission. Reducing or stopping unnecessary medications (deprescribing) can help improve outcomes but limited research has been undertaken with people with dementia or MCI, especially in primary care. This study explored the perspectives and experiences of people with dementia or MCI, informal carers and healthcare professionals on deprescribing decision-making in this setting https://doi.org/10.1177/14713012251376227 November 2025 Ageing & Dementia Potentially inappropriate prescribing and falls-risk increasing drugs in people who have experienced a fall; a systematic review and meta-analysis O'Reilly T, Gómez Lemus J, Booth L, Clyne B, McCarthy C, Ibrahim K, Thompson W, McAuliffe C, Moriarty F As certain medications increase risk of falls, it is important to review and optimise prescribing in those who have fallen to reduce risk of recurrent falls. The obective of this study was to systematically review evidence on the prevalence and types of potentially inappropriate prescribing (PIP), including falls-risk increasing drug (FRID) use, in fallers. A systematic search was conducted in July 2024 in MEDLINE, EMBASE, CINAHL and Google Scholar using keywords for fall events, inappropriate prescribing and FRIDs. Observational studies (cohort, case-control, cross-sectional, before-after) and randomised trials were included. Studies were eligible where participants had experienced a fall and PIP (including FRID use) was reported. Random-effects meta-analyses were conducted to pool prevalence of inappropriate prescribing and mean number of inappropriate prescriptions across studies. https://doi.org/10.1093/ageing/afaf300 October 2025 Ageing & Dementia Implementing a digital physical activity intervention for older adults: a qualitative study. Boxall C, Dennison L, Miller S, Joseph J, Morton K, Corser J, Kesten J, Electicwala A, Western MJ, Lim S, Grimmett C, Yardley L, Bradbury K Physical activity (PA) in older adults can prevent, treat, or offset symptoms and deterioration from various health conditions and help maintain independence. However, most older adults are insufficiently active. Digital interventions have the potential for high reach at low cost. This paper reports on the implementation of "Active Lives," a digital intervention developed specifically for older adults. https://doi.org/10.2196/64953 October 2025 Ageing & Dementia

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

45c5bd14-475f-4afa-ac9a-403f77123c69 CHAMPION: Children whose mothers are involved in the criminal justice system in Dorset & Hampshire: developing health and social care outcome indicators Chief Investigator Professor Julie Parkes Professor in Public Health Head of School of Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton, South Academic Block, Southampton General Hospital, Tremona Road, Dr Emma Plugge Associate Professor in Public Health School of Primary Care, Population Sciences and Medical Education Faculty of Medicine University of Southampton, Co-Investigators Dr Donna Arrondelle , Research Fellow, University of Southampton Dr Naomi Gadian, Public Health Specialist Registrar, University of Southampton Donna Gipson, Director EP:IC Consultants Ltd, West Malling, Kent Dr James Hall , Associate Professor of Educational Psychology, University of Southampton Paula Harriott , EP:IC Professor Kathleen Kendall , Professorial Fellow of Sociology as Applied to Medicine, University of Southampton Dr Sara Morgan , Associate Professor in Public Health, Faculty of Medicine, University of Southampton Professor James Raftery , Faculty of Medicine, University of Southampton, Dr Lucy Wainwright , Director of Research, EP:IC Consultants Ltd, West Malling, Kent Ms Natalie Austin , Public Health Specialist Registrar, University of Southampton Starts: 1st April 2023 Ends: 30th September 2024 Summary In this study, we will identify important features of children’s health and wellbeing that are affected when their mother is sent to prison. For example, it might be their mental wellbeing or their behaviour. If we know what the important features are, then researchers and organisations providing services (such as the NHS) can monitor these for change; this is important to see how the child is but also to see if services are helping him or her. In the past, researchers have not looked in depth at the health and wellbeing of these children. We want to look at all the studies conducted so far to see what areas of their health have been looked at and also to find out areas of their health where the evidence is lacking. We will also speak with adults who were children when their mother was imprisoned to hear their views about what health issues are important and what would have helped them at that time. We will also speak to children who are living with their mother in a prison alternative in the community to find out from them about their health and what has helped them in this particular place. Finally, we will speak with a range of professionals, from doctors to teachers, who work with children whose mother has been imprisoned. We will ask them to tell us about the aspects of these children’s health and wellbeing that they think are important and likely to be affected by the child’s mother going to prison. When we have the information from published studies, from the children themselves and from the professionals, we will bring together a group of people with experience of their mother being imprisoned and also professionals. We will work with them to agree the most important features of children’s health and wellbeing that are affected when their mother is sent to prison. These ‘outcome measures’ are helpful to developing services for these children. People with experience of their mother being imprisoned have helped design the project and will lead on data collection and analysis. They will also be important in spreading the word about the study. This will enable us to reach not just academic audiences and policy makers through publishing in journals or presenting at research conferences, but also people with lived experience and charities that work in this area. Informing a wide range of people will be important in ensuring that the findings from this study are acted on.

55265102-c760-4322-93ed-ed8448f1546f Non-digital support for maintaining physical activity in people with long-term conditions – within Maintenance Of physical acTivity beHaviour (MOTH) programme Start Date 02/10/21 End Date 30/09/23 Researchers: Lead - Professors Mary Barker and Maria Stokes Joint Lead - Professor Suzanne McDonough Co-Applicants - Professor Maria Stokes, Dr Paul Clarkson, Dr Chloe Grimmett, Dr Euan Sadler, Dr Nisreen Alwan, Dr Aoife Stephenson, Dr Katherine Bradbury, Dr James Faulkner, Mr Paul Muckelt, Dr Dorit Kunkel, Mrs Luisa Holt amd Dr James Gavin Summary Being active is important to prevent and help manage long-term conditions (LTC). Previous research shows that being active can help people to do the things that they want to do for longer, reduce pain and improve quality of life. There are many community and NHS programmes that help people with a LTC to start being active, however, these programmes only last for a short period of time. Staying active in the longer-term is more difficult and there is often a decrease in activity over time following the completion of a programme or service. Previous research has shown that programmes or interventions that help people to start being active may not necessarily have the right components to help people to stay active. This project will plan and develop a new intervention that will support people with one or more LTCs to stay active, after taking part in an NHS and/or third sector ERSsphysical activity referral scheme (PARS). Our current research explores factors that help people with LTCs to stay active to allow these to be integrated into plans for the new intervention. The intervention will be non-digital to ensure that it is available to as many people as possible, regardless of access to the internet or a digital device. We know from previous work that it is important that any new intervention fits in with healthcare systems and how people manage their condition. We are therefore currently working with people with LTCs and health and social care professionals to understand how such an intervention could be delivered in practice. In this project we will use previously gathered information to plan the new service. We will recruit people with LTCs from ERSs PARS to take part in interviews to understand their needs and expectations for the intervention. We will also undertake interviews with health and social care professionals and ERSPARS practitioners to develop the intervention’s content. This will allow us to develop the prototype of the intervention and then ask people with LTCs who have taken part in a programme to pilot it and provide feedback through interviews. Once developed, we will plan a larger study to test the intervention’s potential with groups of people who have come to the end of an ERS PARS in the NHS and/or the third sector. This study will help us to gain feedback from people with LTCs using the intervention in real life settings to make further changes. It will also help us to understand whether the approaches to the research, such as how to recruit people to take part, are successful. This information will be used to improve the intervention and to support a larger trial to assess the effectiveness and cost-effectiveness of the intervention. What did we find out? This research included: • Phase 1: We interviewed 15 people living with long-term health conditions (LTCs) and nine NHS healthcare professionals to find out their experiences of being involved in an exercise referral scheme. This included what support they would want in future, as a participant (i.e., people with LTCs) and provider (i.e., healthcare professionals). • Phase 2: Follow-up workshops with LTC patients and multi-sectoral professionals to begin designing a pathway to support physical activity maintenance for people living with LTCs. Professionals shared their experiences from healthcare, leisure and community and voluntary sectors. This research has created a better understanding of the ways in which we might best support people with LTCs to stay physically active, and improve their health and wellbeing following an exercise referral scheme. Two areas of improvement were identified: 1) Better partnership working between people with LTCs, health and social care, leisure and voluntary sectors within Wessex 2) Ensuring people with LTCs have appropriate support with self-management of their lifelong physical activity levels What difference can this new knowledge make? • Better understanding of the factors preventing and enabling participation in exercise referral schemes across Wessex, can help us identify how structured exercise can benefit people with LTCs long-term, especially by highlighting the benefits and future support needs in physical activity. • It gave us understanding of people’s experiences of undertaking a physical activity referral scheme to help manage their LTC(s). This was supported by health professional’s views, having referred, delivered and/or commissioned an activity scheme • In future, this knowledge can inform the development of an integrated care pathway interlinking healthcare, social and community services to support people with LTCs to maintain their health and physical activity long-term, from a view to change physical activity behaviours. What did we do with our new Knowledge • We presented the results at the Health Enhancing Physical Activity (HEPA) Europe 2024 Conference in Dublin (August 2024) • We submitted a research paper for journal publication • Dr James Gavin ran a series of ‘Active Living’ community cafés across Southampton to share the research with the public living with LTCs and their carers. • This has led to additional grant funding and partnerships with Energise Me, Saints Foundation, Communicare, and Southampton City Council, to begin co-designing a multi-sectoral pathway within the city for the wider LTC population, not just those having undertaken an exercise referral scheme. • On January 8th 2025, we will run workshops with professional stakeholders including the HIOW Integrated Care Board, to find agreement on a ‘prototype’ pathway. Where next? •We have submitted the findings to the journal, Int J Behav Nutr Phys Activ December 2024. •Move Consulting Ltd. are supporting us with our professional stakeholder workshops (Jan 2025). •The co-lead, James Gavin, has secured £14,900 Wessex Health Partners funding to continue the community cafes and develop a pathway plan. •We will build upon our community-based partnerships with Saints Foundation, Communicare, Thornhill Baptist Church, and Energise Me as the HIOW Living Well Partnership. •Follow-on funding will be sought from the NIHR Research for Patient Benefit programme (tiers 2/3) in Spring 2025. Testimonials for Active Living Cafes "it's really good that you don't want to reinvent the wheel. My slight critique of the community cafes that have been set up is that you don't have to reinvent them .” “There are already community groups doing very similar things around…I know it's been brilliant that you have been partnering with people like Thornhill Baptist Church. They do wonderful things, some wonderful community events… My recommendation is to join and work with them , and that's what you're doing.” “It's a better strategy than trying to set up something new and try and hope that people come to it with a long-term condition. I think it's much better to go to people rather than expect people to come to you ."

84be43ab-b507-48d9-88f1-af7fc1ff89d7 ADOPTED PROJECT: INvolvement and engagement to build capacity and CO-create research into Digital INterventions for Gambling that harms (INCODING) Principal Investigators: Professor Sam Chamberlain and Dr Jeremy Solly University of Southampton/Hampshire and Isle of Wight Healthcare NHS Foundation Trust Start Date: July 2025 End Date: June 2026 Summary We planned to increase our ability to engage with people with lived experience of gambling harms and improve our future research projects. We achieved this through three types of activity over the course of a year: 1. We set up a Lived Experience Advisory Group and substantially increased the number and diversity of its members. We developed new and more inclusive ways to tell people about the group and for them to sign up. 2. We identified >100 organizations across our catchment area relevant to gambling harms. We have developed new relationships with local authorities and charities to learn from their expertise and raise the profile of our service. 3. Our Lived Experience Advisory Group has helped us to develop six research grants. What we did with our new knowledge Our Lived Experience Advisory Group has already contributed to a number of ongoing service development projects, including those related to treatment pathways and digital communication with patients. The Group is currently working with us to co-produce a new workbook for one of our treatment programmes. By working with local authority and charity partners, we have focused on learning how to better support those experiencing digital exclusion, those experiencing homelessness, and those who are going through criminal justice proceedings. Our Lived Experience Advisory Group is now a key part of our service and we aim for the group to have a voice in all our future service development and research activities. We have initiated new service evaluation projects looking specifically at digital inclusion and homelessness, so we can identify new ways to effectively support people. We will continue to build our network across the region, to learn from partner organisations and ensure that people working to support those affected by gambling harms are aware of our service.