Wessex ARC 2020 Applied Research Collaboraঞon - NIHR
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Applied Research Collaboraon Wessex Applied Research Collaboraon Wessex Applied Research Collaboraon Wessex Applied Research Collaboraon ARC 2020 Wessex Setting the agenda for the future of health & care research in Wessex Stakeholder event Tuesday 3rd March 2020 Novotel, Southampton @arc wessex #letstalkwessex
Welcome “Thank you for coming today. This is the start of us thinking about the direction of applied health and care research of ARC Wessex. At this crucial point in our programme we have the opportunity to decide how best to reflect the needs of Wessex, build on our strengths and target our research efforts.” Professor Alison Richardson, Director ARC Wessex This booklet outlines the main research programme for ARC Wessex from 2019 until 2021 across our four research theme areas Ageing & dementia Healthy communities Workforce & Long term conditions health systems You will find the details of the 14 main projects from each theme which will be useful when we begin to scope our future research programme from 2021-2024 At the back you will find a chart explaining how research ideas will be prioritised in order to choose the final 3 years of the ARC Wessex research programme
Ageing & dementia Improving physical activity of older people in the community through trained volunteers: The ImPACt study Principal Investigator: Dr Stephen Lim Team members: Dr Stephen Lim (NIHR Clinical Lecturer in Geriatric Medicine, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Professor Helen Roberts (Professor of Medicine for Older People, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Dr Kinda Ibrahim (Senior Research Fellow, Academic Geriatric Medicine, Faculty of Medicine, University of Southampton), Esther Clift (Consultant Practitioner in Frailty, Southern Health NHS Foundation Trust, Lymington New Forest Hospital), Samantha Agnew (Head of Clubs Services, The Brendoncare Foundation, Winchester) Start: 1 February 2020 Ends: 31 October 2021 Project Partners: University of Southampton, University Hospital Southampton NHS Foundation Trust, Southern Health NHS Foundation Trust, Brendoncare. Lay summary Physical activity is important for older people. It has many benefits including maintaining older people’s ability to perform activities of daily living, be independent, and improve their well-being. However, many older adults living in the community do not engage in regular physical activity. Aims We want to know if we can train volunteers to run exercise sessions for older people who attend community clubs with a focus on social interaction. We are interested in finding out the views and experiences of older people and volunteers taking part and what factors may promote or hinder the delivery and uptake of the exercise sessions. Design and methods used The study will take place in community social clubs managed by Brendoncare. We will invite older adults (members) who attend these clubs to join an exercise session during their usual weekly meeting. We will develop and evaluate a training package for the volunteers who lead these clubs to enable them to run the exercise sessions. Participants will be encouraged to performed exercises to help improve their muscle strength and balance, with the use of elastic resistance bands. We will measure how active and physically able the club members are before we introduce the exercise sessions. After 6 months of these exercise sessions, we will repeat these measurements to see if this has improved their physical activity levels and physical abilities. We will also interview volunteers and club members to gain their views and experience of the exercise sessions. Findings from this study will help us understand if it is feasible for volunteers to deliver exercises for older adults in community clubs and how acceptable the intervention is for older adults and volunteers. This study will begin in February 2020 and is expected to conclude in October 2021.
Ageing & dementia INVOLVing pEople with cognitive impaiRment in decisions about their hospital nursing care (INVOLVER): a pilot study Principal Investigator: Professor Jackie Bridges Team members: Professor Jackie Bridges (Professor of Older People’s Care, School of Health Sciences, University of Southampton), Dr Jo Hope (Research Fellow, School of Health Sciences, University of Southampton), Dr Tula Brannelly (Senior Lecturer, Bournemouth University), Dr Teresa Corbett (Research Fellow, School of Health Sciences, University of Southampton) Start: 1 January 2020 Ends: 31 December 2021 Project Partners: University Hospital Southampton NHS Foundation Trust, Solent NHS Trust, Bournemouth University, Centre for Implementation Science, University of Southampton Lay summary We want to help nurses look after their patients in hospital. We want to help them find out how each patient likes to do things like getting clean, going to the toilet, eating and drinking. Some people have to go into hospital to get better. Sometimes, when they are in hospital, the nurses don’t ask them enough about the way they like to do things. For example, if they like a bath or a shower. Or if they need help going to the toilet. Or if they would like to walk about. Or what food or drink they like. Not being asked about these things is not helpful. It might mean that people end up getting sicker and staying in hospital longer. Or they may go home needing more help from their family. People with dementia, learning disabilities or stroke may not be asked these questions about what they like. Sometimes the nurses don’t know how to do this well. Sometimes they know how to do it but can’t do it. The reasons they can’t do it are not well understood. We are a group of people who want to make this better. Some of us work at a university finding things out. Some of us are nurses. We want to include people with dementia, learning disabilities or stroke in our group. This will help us think about how to make things better. We think we can help nurses by using ideas that have worked in other places. When people like us have an idea about how something can be made better, we try the idea out and see if it works. An example of an idea we might try is a training day for nurses. A teacher in a classroom shows the nurses how to do something new. Then the nurses see if they can do the new thing when they go to work. We will write down the story of what happens. The story gets printed in a magazine or a book. Or the story might get shared in meetings with other people or on the internet. This is our plan to make an idea that will help nurses to help patients: • Find and read the stories of ideas tried in other places that might be useful. • Talk to patients, nurses and others to make an idea that we think will work. • Talk to patients, nurses and others to see what they think about the idea. • When we’ve done this work, we will be ready to try this idea out. If it works, when people go into hospital, they will be asked about what they like. And the nurses will be helpful. And the care will be a little more like being at home.
Ageing & dementia PerCent Care - Developing training for person-centred care: A pilot study Principal Investigator: Professor Jackie Bridges Team members: Professor Jackie Bridges (Professor of Older People’s Care, School of Health Sciences, University of Southampton), Dr Teresa Corbett (Research Fellow, School of Health Sciences, University of Southampton), Professor Alison Richardson (Professor of Cancer Nursing and End of Life Care, University of Southampton and University Hospital Southampton NHS Foundation Trust), Dr Jane Winter (Macmillan Consultant Colorectal Nurse, University Hospital Southampton NHS Foundation Trust) Start: 1 October 2019 Ends: 30 September 2021 Project Partners: University Hospital Southampton NHS Foundation Trust, Southern Health NHS Foundation Trust, Bournemouth University. Lay summary The aim of this research is to find out what type of information we should include in a training package for health and social care staff. The training will help staff to ask questions about an older adults’ goals and care needs. Once we have put the training course together, we will test it out to see if care staff can manage it and find it useful. This study will help us to make a useful training course that we can use to train health and social care staff in future research. Background to the research We have made a tool to help health and social care staff to talk to older adults who have lots of different conditions. This tool has 8 steps that should be followed in a meeting with people about their needs and personal goals. In a previous study, when we spoke to health and social care staff they said that they would like training in how to use the tool. Design and methods used We will study similar courses, workshops and training so that we can find out more about how we should plan our training. We will make a draft of what will be included in the training. Experts will be consulted to discuss the training draft and we will make changes based on what they say. When all agree with it, we will try out the training 2-3 times. Up to 10-15 health and social care staff will take part. They will fill in a survey before and after the training. We will then send them another survey after a month. We will ask them if they found the training useful and if they have used their new skills. We will also talk to some of the people who took part to find out more detail about what they liked or did not like about the training. Patient, public and community involvement Members of the public have been part of the study so far in many ways. They have helped us to produce the tool that we will train health and social care staff to use. We also intend to work with group of people from the community who have agreed to help us to in several ways. These include: • Looking over content in the training and letting us know what they think • Coming to project meetings • Helping us to plan the pilot study • Looking over study information that we will send to participants • Helping us to make sense of the research findings • Dissemination We intend to present our findings: in papers that will be published in academic journals, at conferences and at events with audiences who are interested in our study.
Healthy communities Testing the effects of food product placement changes on customers’ intended product purchases: an experimental trial in a virtual supermarket setting Principal Investigators: Professor Janis Baird and Dr Christina Vogel Team members: Professor Janis Baird (Professor of Public Health and Epidemiology, Medical Research Council Lifecourse Epidemiology Unit, University of Southampton), Dr Christina Vogel (Principal Research Fellow in Public Health Nutrition, Medical Research Council Lifecourse Epidemiology Unit, University of Southampton), Dr Sarah Crozier (Senior Statistician, Medical Research Council Lifecourse Epidemiology Unit, University of Southampton). Professor Marcus Munafo (Professor of Biological Psychology, Medical Research Council, University of Bristol), Dr Olivia Maynard (Lecturer in Experimental Psychology, Medical Research Council, University of Bristol), Ravita Taheem, (Southampton City Council, Sure Start Children’s Centres) Start: 1 October 2019 Ends: 30 September 2020 Project Partners: University of Southampton, University of Bristol, Southampton City Council, Sure Start Children’s Centres Lay summary Poor diet is linked to an increased risk of obesity, diabetes and heart disease. Most adults in England consume too much salt, saturated fat and free sugar, and do not eat the recommended five daily portions of fruit and vegetables. People with lower education and income levels are more likely to have poor diet and to experience health problems as a result. Women of childbearing age are primarily responsible for domestic food tasks such as shopping and cooking, and their diets are closely linked to those of their children. Most families buy their food from supermarkets and their food choices can be influenced by placement of items in-store and by promotions. We want to find out how the placement and packaging of healthy and unhealthy foods influence the foods that women choose to buy. We will do this by creating a ‘virtual’ supermarket layout that participants will interact with on a computer screen. We will recruit women attending Sure Start Children’s Centres in Hampshire – a county with some relatively deprived areas within the Wessex region. We will choose centres located in areas of higher deprivation. Local data suggests that 70% of families with young children are engaged with these centres. Women using the virtual supermarket will be shown images of healthy and unhealthy foods and non-food items that are placed in noticeable locations in the supermarket like checkouts. We will measure what aspects of the images women look at using experimental techniques such as eye tracking, which records their gaze point, and heat-mapping which records where women click on the screen and then creates a graph to show their areas of interest. The eye tracker is positioned close to the computer screen allowing it to record where women look. We will then ask women to tell us the products that they saw for sale, the name of the products they considered purchasing, and aspects of the supermarket that took their interest, and why. Our findings will tell us how people respond to the placement and packaging of different types of food products. These findings help us to design ways to layout supermarkets to help families eat more healthy foods. Our research will begin in October 2019 and end in late 2020. We will share the findings from our study with local families attending Sure Start Children’s Centres. We will inform local and national government employees about our findings which could help to refine current government policies to address childhood obesity.
Healthy communities The Wessex FRIEND Toolbox (Family Risk IdEntificatioN and Decision) Principal Investigator: Dr Nisreen Alwan and Dr Dianna Smith Team members: Dr Nisreen Alwan (Associate Professor in Public Health, School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Dr Dianna Smith (Lecturer in Geographic Information Science, Geography & Environment, University of Southampton), Professor Paul Roderick (Professor of Public Health, School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Dr Ivaylo Vassilev (Principal Research Fellow, School of Health Sciences, University of Southampton) Start: 21 October 2019 Ends: 20 September 2021 Project Partners: University of Southampton, Solent NHS Trust, Southampton City Council, Portsmouth City Council, Hampshire County Council, Health Education England, Oxford Brookes University Lay summary Nearly a third of all UK children are overweight. Obesity in children is strongly linked to obesity in adulthood, and hence diabetes, heart disease and stroke. Children living in the most deprived areas in England are twice as likely to live with obesity compared to children in the least deprived areas. Cost of a healthy and varied diet is a major barrier against the prevention of childhood obesity and poor health more widely, with an estimated 4 million UK children living in poverty, following a rapid rise within the last 5 years. Food poverty is on the rise with a record 1.6 million food parcels given to people in the last year. Although we know that poor health including obesity is shaped early in life, and even before birth, the current system has no means of identifying families whose children are at risk of obesity in order to focus support efforts early on. We have created a tool to predict childhood obesity at school age which can be calculated at multiple time points; pregnancy, birth and during the first two years of life. We have used large-scale Hampshire data from our SLOPE project (Studying Lifecourse Obesity PrEdictors) to generate those risk scores. This project aims to produce a user-friendly version of this tool, called the SLOPE CORE (Childhood Obesity Risk Estimation) Tool, built into a website and a smart-phone app, for the use of health and care professionals interacting with young families as well as parents/carers. We will update and derive locally sensitive area-based measures of child poverty, food poverty and access to green space. These will be available for utilisation by the local council to identify areas and populations where resources are most needed to reduce existing health inequalities and will aid the SLOPE CORE Tool in targeting preventive action and support towards disadvantaged families. The intention is to address social inequalities (food, child poverty and poor access to greenspace) which in turn will positively impact obesity and ill health risk in disadvantaged households. We will provide these tools on one platform, the Wessex FRIEND (Family Risk IdEntificatioN and Decision) Toolbox, along with a social networking intervention, Genie, which will be made relevant to families with young children and tested to see if it supports more engagement with existing community members, activities and resources, and develop links with new network members. We have involved mothers of young children in discussions around the acceptability and delivery mode of the SLOPE CORE. We will have two public contributors on our steering committee who will help shape the detailed steps of the project. We will disseminate our findings to regional and national agencies, with the support of our public contributors, stakeholders and collaborators.
Healthy communities The feasibility of community pharmacies testing for Hepatitis C in people who inject performance and image enhancing drugs (PIEDs) Principal Investigators: Dr Ryan Buchanan Team members: Dr Ryan Buchanan (Academic Clinical Lecturer Hepatology, Faculty of Medicine, University of Southampton), Professor Salim Khakoo (Professor of Hepatology, Faculty of Medicine, University of Southampton), Dr Charlotte Cook (Hepatology Research Fellow, University Hospital Southampton), Dr Mark Wright (University Hospital Southampton NHS Foundation Trust), Charlotte Matthews (Southampton City Council), Dr Gemma Ward (Public Health England), Colin McAllister (Southampton City CCG), Stuart Smith (Hepatitis C Trust), Pamela Campbell (Solent NHS Trust, Homeless Healthcare Team) Start: 1 October 2019 Ends: 30 September 2021 Project Partners: University of Southampton, University Hospital Southampton NHS Foundation Trust, Solent NHS Trust, NHS England, Public Health England, Southampton City CCG, Southampton City Council, Hepatitis C Trust. Lay summary: The people at highest risk of Hepatitis C (HCV) in the United Kingdom (UK) are those who are sharing needles, syringes or injecting equipment. This includes people who inject performance and image enhancing drugs (PIEDs) such as steroids. This population are high users of needle and syringe programmes, however, the risks taken by this population and their access to testing for HCV are poorly understood. The information that is available is not consistent, with the proportion of people with HCV varying widely but may be as high as one in seven PIED users. The study has been discussed in detail with body-builders, a gym owner, pharmacists and people who work at needle and syringe programmes (NSPs). The body-builders were very keen to be involved in the study as they want to have accurate, scientifically performed studies. They feel strongly that the information that is out there currently is not representative of their community that use PIEDs. They also felt that it was important that to have a focus on HCV but they were keen to be involved in a study that also addresses at other elements of liver health. The methodology for the study were discussed and adapted after patient and public involvement (PPI) meetings. The aim of this study is to see if widening access to testing of HCV based in community pharmacies with a pathway into specialist care is able to provide improved and acceptable access to testing and treatment compared with standard care. We also want to gain a better understanding of the burden of HCV in this group of people who are using PIEDs, and an understanding of risk behaviours. We will also investigate knowledge of liver disease caused by other factors (e.g. alcohol and obesity). This will be done via interviews with body-builders to understand more about their behaviour and the risks they take. This will be followed by a survey with an associated HCV test and measurement of liver scarring. The information gained from the interviews, surveys and tests will give a far greater understanding of this population and their risk of HCV. This information can then be used to target at-risk groups and to adapt current approaches with the aim of elimination. The results will be disseminated in medical journals and presented at medical conferences.
Healthy communities A public health approach to crime: secondary and tertiary prevention schemes for females victims and offenders in Hampshire and Dorset Principal Investigators: Dr Sara Morgan Team members: Dr Sara Morgan (Lecturer in Public Health, School of Primary Care and Population Sciences Faculty of Medicine, University of Southampton), Fiona Maxwell (Public Health Registrar, School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Sergeant Ali Attwood (Restorative Justice Lead, Hampshire Constabulary) , Debbie Willis (Domestic Abuse Service Manager, Hampton Trust charity), Vicky Atkinson (Domestic Abuse Project Coordinator, Hart District Council), Patricia Durr (One Small Thing), Mona Samiy (Project Manager, Stop Domestic Abuse charity) Start: 11 November 2019 Ends: 11 November 2021 Project Partners: University of Southampton, University Hospital Southampton NHS Foundation Trust, Hampshire Constabulary, Hampton Trust, Hart District Council, One Small Thing, Stop Domestic Abuse. Lay summary: Background and study aims Compared to the previous year, in 2018 there was an overall 8% increase in theft in England and Wales and a 6% increase in crimes involving sharp instruments or knives. In order to tackle this increase in crime, many believe that more needs to be done to address the reasons why people commit crime in the first place, as well as the damage it causes to peoples’ lives. This means working together in the community to offer solutions to those affected by crime, including victims and offenders. When we discussed possible solutions with local service providers, it was felt that a tailored approach is needed for women, as their needs are unique. Women in prison are very likely to be both victims and offenders, whilst in the general population, one in four women are also victims of abuse within the home and more than half the women in prison have experienced domestic abuse themselves. In response, three projects are being piloted in Hampshire and Dorset to address the needs of women affected by crime. What does the study involve? To understand how these projects are working, we plan to carry out group interviews with those delivering the pilot intervention projects in the community. This will primarily be to understand how the projects are working. We will also use information gathered from the project staff about the women using the service to understand whether women go on to seek further assistance in the community, what sort of women engage with the project, and what changes for them as a result of using the service. This study proposal was developed in collaboration with public representatives; including offenders, victims, social care workers, domestic abuse service managers, and police officers. They have all shaped the design of the study; by informing us what types of research questions we should be asking. Going forward, we will continue to involve similar representatives throughout the research study; for example, to co-produce the materials used in the study, such as information sheets, and to gain feedback on the write up of the study. What will we do with the study findings? It is important that the information gained from the study reaches the widest number of people. We will therefore consider who to engage, and how to reach them, from the very start of the study. The main findings will be developed into a short summary report, which will be accessible to the general public through our public representatives and collaborators. They might include charitable organisations in the community (e.g. Stop Domestic Abuse, Hampton Trust) or services that work directly with women affected by crime (e.g. NHS, probation services).
Long term conditions Using the Wessex Activation and Self-Management (WASP) Tool to design and implement system wide improvements in self-management support for people with long term conditions Principal Investigator: Professor Mari-Carmen Portillo Team members: Professor Mari-Carmen Portillo (Professor of Long Term Conditions, School of Health Sciences, University of Southampton), Dr Hayden Kirk (Consultant Physiotherapist and Clinical Director Adults Southampton, Solent NHS Trust), Dr Chris Allen (Lecturer, School of Health Sciences, University of Southampton), Stephanie Heath (WASP Clinical Lead, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust), Dr David Culliford (Senior Medical Statistician, School of Health Sciences, University of Southampton), Dr Louise Johnson (WASP Project Manager, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust), Dr David Kryl (Director, Centre for Implementation Science, University of Southampton), Professor Alison Richardson (Professor of Cancer Nursing and End of Life Care, University of Southampton and University Hospital Southampton NHS Foundation Trust), Anya de Iong (Senior Self- Management Coach and Primary Care Development Lead, Patient Editor for the BMJ) Start: 1 October 2019 Ends: 31 December 2020 Project Partners: Solent NHS Trust, Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton Lay summary The NHS wants to achieve better health outcomes, improved experience for patients, and more effective use of services and resources for people living with a long-term health condition. Helping people to self-manage their condition helps improve people’s health and their experience of managing the condition in everyday life. Increasing people’s knowledge, skills and confidence may help them to be more actively involved in self- management of their condition. This is sometimes referred to as ‘patient activation’. The Wessex Activation Self-Management Programme (WASP) Self-Assessment Tool has been developed to help health teams understand where their service could do more to help people be more active in the management of their condition. The tool can be used by people who use services and people who plan, manage and deliver care and services. It asks about behaviour: WHAT people actually do, and WHY they do (or don’t do) certain things. The answers can help health teams decide how to improve their service. We have already tested the tool in several different services. Early findings show differences across health services, e.g. managers reported ways in which their services helped people to be more active in the management of their condition, but front-line staff (such as nurses and doctors) and patients often had different experiences of this. The next stage is to use the tool to help teams identify aspects of support in their service that require improvement and help services to make these improvements. We will do this by: Assessing the services current practice in relation to self-management support, using the Wessex Self-Assessment Tool. Providing bespoke coaching and support (over a 10-month period) to enable teams (consisting of those who fund the service, managers, front-line staff (such as doctors, nurses and physiotherapists those who deal directly with patient) and patients themselves) to identify areas for improvement and support them to make improvements that benefit patients. We will re-assess self-management support by repeating the WASP Self-Assessment Tool. Several ways will be used together to decide if this works, how it works and how it can be improved. These will help us understand if this coaching and support can benefit other health services. Firstly, members of healthcare team (including those who provide funding for the service, the services managers, front line staff and patients themselves) will complete a questionnaire. At the end of the study, following the teams coaching and support, this questionnaire will be completed again by all members of the team and the answers will be compared with those provided at the beginning to see if improvements have been made. We expect 8 teams to take part in this. In addition, a small number of teams will be observed during the coaching and support sessions and will be given the opportunity to share their experiences of the service in an interview at the start of the project, as well as of the coaching and support that they have received during an interview at the end of the project. This will help us understand how the coaching and support works and how it can be improved. We expect to work with 3 of the 8 teams in this part of the project.
Long term conditions Validation of the living with chronic illness scale in an English-speaking population with long term conditions Principal Investigator: Professor Mari-Carmen Portillo Team members: Professor Mari-Carmen Portillo (Professor of Long Term Conditions, School of Health Sciences, University of Southampton), Dr Kelly Hislop-Lennie (Lecturer, School of Health Sciences. University of Southampton), Dr Emily Arden-Close (Department of Psychology, Bournemouth University), Dr Jo Hope (Research Fellow, School of Health Sciences, University of Southampton), Dr David Culliford (Senior Medical Statistician, School of Health Sciences, University of Southampton), Dr James Bennett (Primary Care Research Locality Lead, Clinical Research Network Wessex), Dr Simon Fraser (Associate Professor of Public Health, Faculty of Medicine, University of Southampton), Dr Leire Ambrosio (Lecturer, Faculty of Nursing, University of Navarra, Spain) Start: 1 October 2019 Ends: 30 September 2021 Project Partners: Clinical Research Network (CRN) Wessex, Primary Care Dorset, Bournemouth University, University Hospital Southampton NHS Foundation Trust, University of Southampton, University of Navarra, Spain Lay summary Long term conditions (LTCs) are a worldwide challenge because of their complications, increasing numbers, costs and impact on people’s lives. In order to develop interventions that improve the adaptation to illness and quality of life, we need appropriate, reliable and valid tools, which reflect cultural and language diversities and individual needs. This would benefit both patients and health/social care professionals in the management of LTCs, by allowing the patients a way to express their needs and therefore, allow the health/social care professional to direct the patient to specific, relevant resources. The present study aims to produce an English version of the Living with Chronic Illness Scale and establish if it can be useful and applicable to English speaking people with LTCs in the UK. The Living with Chronic Illness Scale is the only available tool, which comprehensively evaluates the experience of living with a long term condition, focusing on the person and not on the disease. This scale was created after previous research, and successfully used with people with Parkinson’s Disease from Spain and South America. In this study we will first translate the Spanish version of the scale into English, making any necessary cultural changes. After this, we will test the understanding of the approved English version with 15 people with LTCs. Then, we will use the final English version of the scale with at least 1,650 people with different LTCs in Wessex community settings. Apart from the Living with Chronic Illness Scale, we will ask participants about perceived social support, life satisfaction, quality of life, and the perceived severity of their LTC(s), using tools for English speakers. Finally, 2 discussion groups will take place with people with LTCs, 2 with family-carers and 2 with health professionals to explore and compare their views about the usefulness of this scale in the daily management of LTCs. People with long term conditions and associations have contributed to the choice of topic, research and dissemination plan.
Long term conditions Medicines optimisation: improving safety and reducing treatment burden among people taking non-steroidal anti-inflammatory drugs or disease modifying anti-rheumatic drugs Principal Investigator: Dr Simon Fraser Team members: Dr Simon Fraser (Associate Professor of Public Health, Faculty of Medicine, University of Southampton), Professor Chris Edwards (Professor of Rheumatology, University of 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, School of Health Sciences, University of Southampton), Professor Paul Roderick (Professor of Public Health, Faculty of Medicine, University of Southampton), Prof James Batchelor (Director Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton), Dr Matthew Stammers, (Senior Endoscopy Fellow, University Hospital Southampton NHS Foundation Trust and Clinical Informatics Research Fellow at Clinical Informatics Research Unit) Start: 1 October 2019 Ends: 30 September 2021 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, like 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. In one part of this research we will use an anonymous database of about half a million people from GP practices in Hampshire to identify how many people are prescribed anti-inflammatory drugs, particularly those who may be at high risk of complications by being older or having other conditions. The aim is to help doctors transfer high risk patients to other pain relief options. In another part, we will use the same dataset and also data from people who have attended University Hospital Southampton NHS Foundation Trust who take Methotrexate, Azathioprine and anti-TNF drugs. We will look at their blood results to see if some people might not need blood tests so frequently. Patients may be understandably nervous that problems could be missed if the blood check is not done so often, so we plan future research asking patients and doctors whether such reduction in checks would be acceptable. We will also investigate the possibility of successful dose reduction strategies for anti-TNF drugs. Specifically, we will identify which kinds of patients tend to succeed in being able to reduce the dose. This research has potential to reduce the burden on patients and on the NHS by reducing the frequency of blood tests and/or medication burden for some people and avoiding hospital admissions for anti-inflammatory drug complications. Through connections our team has already, the results of this research will be shared with relevant doctors, nurses and patient groups across Wessex so it makes a difference locally. It will also be published in academic journals and presented at conferences.
Long term conditions Digital and non-digital behaviour change interventions to support the maintenance of physical activity for adults with long term conditions: mixed methods studies Principal Investigator: Professor Maria Stokes Team members: Professor Maria Stokes (Professor of Musculoskeletal Rehabilitation, School of Health Sciences, University of Southampton, UK Head of Active Living Research Group), Dr Paul Clarkson (Research Fellow, School of Health Sciences, University of Southampton), Dr David Culliford (Senior Medical Statistician, School of Health Sciences, University of Southampton), Mr Paul Muckelt (Research Fellow, School of Health Sciences, University of Southampton, Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis), Mr Jem Lawson (Patient and Public Involvement (PPI) Representative,) Mr Ranj Parmar (Patient and Public Involvement (PPI) Representative), Carol Clark (Associate Professor and Head of Department, Human Sciences and Public Health, Bournemouth University), Dr Katherine Cook (Senior Physiotherapy Lecturer, University of Winchester), Dr Hazel Everitt (Associate Professor, Faculty of Medicine, University of Southampton), Dr Zoe Saynor (Senior Lecturer in Physical Activity, Exercise and Health, University of Portsmouth), Professor Mari-Carmen Portillo (Professor of Long Term Conditions, School of Health Sciences, University of Southampton), Dr Simon Fraser (Associate Professor of Public Health, School of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton), Professor Suzanne McDonough (Professor of Health and Rehabilitation, Royal College of Surgeons, Ireland) Start: 1 October 2019 Ends: 30 September 2020 Project Partners: University of Southampton, Bournemouth University, University of Winchester, Portsmouth University, University Hospital Southampton NHS Foundation Trust, Salisbury NHS Foundation Trust, Portsmouth Hospitals NHS Trust, Royal College of Surgeons, Ireland Lay summary For people living with a long-term condition (LTC) research has shown that physical activity can be beneficial for managing symptoms and preventing future problems. However, many people with a LTC are not active enough to achieve these benefits. The reasons for this may be symptoms that restrict activity such as fatigue or pain, or fear of activity making things worse. Supporting people with LTCs to undertake physical activity is therefore important. While programmes do exist to help, they are not always effective at improving the physical activity levels. Additionally, results are often measured in the short-term and it is less clear whether the benefits can be maintained over an extended period. Digital interventions defined as “devices and programs using digital technology to foster or support behaviour change” have become increasingly accessible for health-related information, to help support people to manage their own conditions. There is some evidence that web-based programmes for promoting physical activity can be effective. We are interested in finding out how effective digital interventions are at helping people with LTCs to maintain physical activity beyond three months. We will review studies published over the past 10 years that test digital interventions using statistics and those that report people’s experiences of undergoing the interventions to find out if these interventions have been effective in the longer term and if so, what has made them effective. Our searches will be conducted in a systematic manner and we will include the most widespread LTCs. This review will only include studies that have been conducted with adults. Our team is made up with people who have expertise in living with a LTC and clinicians and academics with expertise across a range of LTCs. We will review the quality of each study, explore the results to find out if they are truthful and robust and then report on the findings. We will publish the review to facilitate the design of more effective interventions. With PPI representatives, we will co-develop key messages from the findings and activities to reach different populations. We will present the results of this review at both research conferences and public events to highlight the potential benefits of digital interventions to maintain physical activity. This may ultimately help to reduce the burden and improve the quality of life of people living with LTCs, while also providing resources for NHS services.
Workforce & health systems Improving community health care logistics using Operational Research Principal Investigator: Dr Carlos Lamas-Fernandez Team members: Dr Carlos Lamas-Fernandez, (Research Fellow in Operational Research, University of Southampton), Professor Peter Griffiths (Chair of Health Services Research, School of Health Sciences, University of Southampton), Dr Antonio Martinez-Sykora (Associate Professor of Business Analytics. Southampton Business School, University of Southampton) Start: 1 October 2019 Ends: 30 September 2021 Partners: University of Southampton, Solent NHS Trust Lay summary Operational Research (OR) is the application of computer and mathematical modelling to support decision making. In health services research, OR aims to improve patient outcomes, increase efficiency and enhance health professionals’ and public understanding of how an NHS service achieves good performance. In this study, we will use OR to improve the quality of patient care by supporting community nursing teams organise how they visit people in their own home. Community nursing teams in England are part of an NHS Community Trust. Everyday each trust sends nurses out to visit hundreds of people at home to provide care. The process of planning home visits is largely manual (paper and pencil) and planned a day in advance. Nurses of different bands and even within the same band have different skills, for example some nurses are able to deliver wound care and some nurses are not. Home visits are allocated to nurses in a way that makes sure that patients care needs are met (e.g, an insulin injection must be administered between 9am and 11am ), that the cost of delivering care is minimised (e.g, by clustering patients by geographic location) and that nurses and patient preferences are met (e.g, variation in care activity for nurses, and continuity of care for patients). Much of community nursing work is planned, however, it is common for teams to receive urgent referrals during the day. This type of planning problem is well known to OR. It is very difficult for manual planning of home visits to achieve all its aims. To make this problem simpler in practice large regions are broken down into smaller regions and planning takes place only for the next day. Such an approach works but is likely to miss benefits for patients and any efficiency savings for the NHS offered by looking at the problem as a whole. To address this gap, academic OR recently developed algorithms to automate the solution of what it has called the ‘Home Health Care Routing and Scheduling Problem’. In 2018, Dr Carlos Lamas-Fernandez worked with Solent NHS Trust to learn from both academic research and the practice of community nursing to develop a novel decision support tool (DST) to help community teams to improve patient care and efficiency. This study aims to scale up this work in the following ways: the decision support tool will be tested with nursing teams in Portsmouth, Southampton and Dorset, to evaluate the feasibility of comparing a sample of historical patient home visit schedules to those generated by the DST. Evaluate the acceptability of schedules generated by the tool to clinical practitioners. Identify the adaptations needed to model urgent referrals. Identify, by modelling, the benefits for NHS trust to centralise their planning across larger regions and to plan further ahead than a single day. We will achieve these aims by: collecting primary data to quantify the benefits (and/or disadvantages) of an OR approach over manual planning, making use of a Turing Test* framework to explore nurse planners’ views on automated home visit plan, using OR mathematical and computational approaches to adapt the DST for new setting and developing novel approaches for planners to handle urgent (unplanned) daily referrals * The Turing Test - a test set by the computer pioneer Alan Turing which challenged programmers to design a computer program that could fool a human being into thinking they were interacting with another human.
Workforce & health systems Nursing shift patterns in acute, community and mental health hospital wards: A feasibility study and survey Principal Investigator: Dr Chiara Dall’Ora Team members: Dr Chiara Dall’Ora (Senior Research Fellow in Nursing Workforce, School of Health Sciences, University Of Southampton), Professor Peter Griffiths (Chair of Health Services Research, School of Health Sciences, University of Southampton), Ms Nicky Sinden (Head of Nursing Workforce at Portsmouth Hospitals NHS Trust), Dr Sarah Williams (Associate Director of Research and Improvement, and Academy Lead at Solent NHS Trust), Ms Catherine Smith (Associate Director, Workforce Research and Innovation, Southern Health NHS Foundation Trust), Professor Jane Ball (Deputy Head of School (Research & Enterprise), School of Health Sciences, University of Southampton), Dr David Culliford (Senior Medical Statistician, School of Health Sciences, University of Southampton) Start: 1 October 2020 Ends: 30 September 2022 Partners: University of Southampton, Portsmouth Hospitals NHS Trust, Solent NHS Trust, Southern Health NHS Foundation Trust. Lay summary Nurses and care assistants form the largest group of NHS staff. Most work in services that provide care across 24 hours of the day. Research indicates that the organisation of nursing shift patterns might affect the productivity of health services. The introduction of long shifts in nursing was offered as a strategy to maintain service levels while eliminating overlaps. However, research has found that long shifts are associated with higher rates of sickness and poorer patient care. So far, there has been little research exploring individual factors influencing shift work experiences among nurses, and research has been largely confined to acute hospitals. Aims of the research The aim of this research is to provide evidence to support decision making about deployment of nursing shift patterns on acute, mental health and community hospital wards in England. To do this we will: • Understand how shift work may impact on the experience of work and productivity from the nurses’ perspective, including an assessment of preferences and constraints through a survey • Determine the availability and quality of nurse and patient routinely collected data • If data are of good quality, measure associations between shift patterns, workforce characteristics and outcomes including nurses’ sickness Design and methods This research will consist of three parts: • A survey • Routinely collected data extraction from trusts • Data analysis We will work with our partner trusts to access routine data. We will assess feasibility and data quality of such data. Patient, public and community involvement We will work with one acute and two community providers, who both participated in the development of this project. Patient and public representatives were involved in preparing this research, by offering their views. They will continue to be involved throughout the project, and nurses will help inform the survey design.
Workforce & health systems Identifying wards for which the Safer Nursing Care Tool is appropriate for assessing nurse staffing requirements Principal Investigator: Dr Christina Saville Team members: Dr Christina Saville (Research Fellow, School of Health Sciences, University of Southampton) Professor Peter Griffiths (Chair of Health Services Research, School of Health Sciences, University of Southampton), Rosemary Chable RN (Deputy Director of Nursing, Education & Workforce, University Hospital Southampton NHS Foundation Trust) Ms Nicky Sinden (Head of Nursing Workforce at Portsmouth Hospitals NHS Trust), Tracy Moran (Lead Nurse for Nursing Workforce, Education & Practice, Poole Hospital NHS Foundation Trust) Start: 1 December 2020 Ends: 1 August 2021 Partners: University of Southampton, Portsmouth Hospitals NHS Trust, Poole Hospital NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust Lay summary It is important to have enough qualified (registered) nurses looking after patients staying on hospital wards, because having too few is associated with worse patient care and more patient deaths. On the other hand, there are extreme shortages of nurses, so having “too many” on a ward could be considered a waste. The Safer Nursing Care Tool is used in many hospital wards in England to work out the number of nursing staff (including nursing assistants) needed. However, a recent study showed that it is more suitable on some wards than on others. For example, we found that factors not accounted for in the tool, e.g. whether a ward is surgical or medical, and the proportion of single rooms, also affected professional judgement of whether staffing was adequate. Aim This study aims to understand which ward characteristics mean that the Safer Nursing Care Tool gives a good estimate of the nursing staff required, and which ward characteristics mean that the number might need to be adjusted or further considered by taking into account the expertise of ward leaders. It also aims, if possible, to provide some general rules or an add-on tool to help nursing managers with setting staffing levels. Methods We will analyse the data that were collected for a previous study in a different way. This time we will focus on differences between wards rather than hospitals. We will use analytical techniques for finding patterns in data to identify similar wards. In our team we have experienced leaders in nursing who will provide expert professional insights into ward characteristics. Patient, public and community involvement and sharing results We will involve nursing managers in the study because they are the potential users of any rules or tools we develop. We plan to develop a resource (rules or a tool) for nursing ward managers and to run a workshop to test use of this resource. We plan to write one academic paper about what we find out. We will also share the plans for this with lay members from the PPI group as appropriate. We are developing a smaller user group across Workforce and Frailty and Older People teams.
NIHR ARC Wessex Research prioritisation process for years 3-5 (2021-2024) Stakeholder engagement event March 2020 • Theme focused workshops to discuss topics or problems needing solutions • Results of workshops posted on firstname.lastname@example.org and shared ARC ‘Pitch a Proposal’ events By July 31 Ageing & Long term Healthy Workforce & 2020 dementia conditions communities health systems By September 30 Call for submission of outline applications 2020 Stage 1 Assessement By December 1 2020 • Degree of fit with ARC programme & ICS/STP priorities • Research impact By February 14 Research teams submit full application 2021 By May 30 Stage 2 Expert panel review 2021 By June 30 ARC Wessex Partnership Board consider 2021 panel recommendations If successful research begins October 1, 2021
Applied Research Collaboraon Wessex Our mission is to improve health & well-being of people of Wessex across the life course targeting quality, safety, effectiveness & efficiency of health & care services. Through conduct, application & dissemination of applied health research for patient, community & population benefit. We will bring together the public & expert researchers from a wide range of disciplines, clinical leaders of health & care systems & other stakeholders. We will work across the Wessex health & care system to ensure local reach & national impact. Thanks to our Partners: Commissioners Dorset Integrated Care System (ICS), Bournemouth, Christchurch & Poole Council, Dorset Clinical Commissioning Group, Dorset Council, Hampshire & Isle of Wight Sustainability and Transformation Partnership, Hampshire County Council, Isle of Wight Council, Portsmouth City Council, Southampton City Council, West Hampshire CCG, Southampton City CCG, Portsmouth CCG, Fareham & Gosport CCG, North East Hampshire & Farnham CCG, North Hampshire CCG, South Eastern Hampshire CCG, Isle of Wight CCG NHS Trusts Dorset County Hospital NHS Foundation Trust, Dorset HealthCare University NHS Foundation Trust, Hampshire Hospitals NHS Foundation Trust, Isle of Wight NHS Trust, Portsmouth Hospitals NHS Trust, The Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust, Poole Hospital NHS Foundation Trust, Salisbury NHS Foundation Trust, Solent NHS Trust, Southern Health NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust Universities Bournemouth University, University of Portsmouth, University of Southampton, University of Winchester email@example.com @arc_Wessex Email: firstname.lastname@example.org Telephone: 02380 597983
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