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FORTH – FORecasting Turbulence in Hospitals Chief Investigator: Edilson Arruda, Associate Professor, University of Southampton Team: Christine Currie University of Southampton Alexandra Hogan NHS Salisbury/ University of Southampton Jamie MacNamara University Hospital Southampton Mark Wright University Hospital Southampton Michael Boniface University of Southampton Carlos Lamas-Fernandez University of Southampton Partners: Salisbury Hospitals NHS Foundation Trust, University of Southapton, University Hospital NHS Foundation Trust. Start: 1 October 2024 End: 31 March 2026 Summary Over time, health systems face changes. Population grows older or hospitals can perform new treatments. It is difficult to match the resources of hospitals with population needs. If they do not match, waiting times for treatment increase and hospitals become fuller. Hospitals being too full can result in worse care for patients. For example, hospitals might need to cancel surgeries. Aim(s) of the research When the usual demand for hospital resources changes, it becomes difficult for hospitals to provide care. We call this turbulence. Our first objective is to define how turbulence can be measured from data. Then, we will use artificial intelligence to understand the causes of turbulence. We will also create models for short-term prediction of turbulence. This will help hospital plan better. Design and methods used This project will look at the records of patients in hospitals to understand what resources they use. The data will give us an understanding of how long certain activities take. For example, the recovery from surgery. We will predict when these times are changing using artificial intelligence. This can help hospitals be alert of upcoming changes, so they choose the best way to react. Patient, public and community involvement (PPCI) We will engage with the views of public, patients and communities during the project execution phase. We will hold workshops with patient groups that have been to hospital. We will understand their views on the planning services. We will also take into account their ideas when defining turbulence. Dissemination This project was co-designed and will be supported by University Hospital Southampton (UHS) and Salisbury Hospital. The results will be disseminated and championed within the partnering institutions, and further presented in workshops involving neighbouring NHS Trusts in Wessex and in the south east and south west of England. We will also publish papers and reports to disseminate the work to a larger audience within the UK and internationally.

COMPLETED: Improving community health care planning 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. University of Southampton), Dr Antonio Martinez-Sykora (Associate Prof of Business Analytics. Southampton Business School, University of Southampton), Dr Tom Monks (Associate Professor of Health Data Science, University of Exeter) Start: 1 October 2019 Ended: 30 September 2021 Partners: University of Southampton, Solent NHS Trust and Abicare 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 citizens 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. What did we acheive? We found that it is possible to develop algorithms that create routes and schedules automatically for district nurses. These algorithms can incorporate many practical constraints that nurses encounter during planning, and produce solutions that are optimised to use their time efficiently. We found out that, with minor modifications, the algorithm can also support social care workers in a similar manner. What difference can this new knowledge make? These algorithms are a stepping stone that bring closer the academic research (typically on idealized problems that do not work on practice) to the reality of nurses that currently organise their workload on a laborious manual process. Both their planning time and the extra time spent on the road (e.g. by doing a route larger than it could have been) can be saved and utilized to care for patients. Why is this important? Patients will benefit from a more efficient workforce, who can as a result have more time to care for them. Further, they might also benefit from better planned visits which might include their preferences. Care providers can use these kind of tools to plan their workload more efficiently, save costs on their operations and reduce the burnout of the nurses in charge of doing manual planning. Policy makers can run these kind of tools to test hypothetical scenarios (e.g. how does service delivery change with an increase of the demand, when we hire more district nurses or if we train part of our staff?). Care providers can also assess What's next? We continue working to improve our algorithms and liaise with social care companies to explore how they can be used in practice. We are looking into integrating them as demand estimation tools in other relevant problems, such as complex discharge from hospital. Publications https://www.nursingtimes.net/news/community/home-healthcare-are-nurses-wasting-their-time-on-the-road-26-04-2021/

ADOPTED: Investigating the impact of food vouchers on diet composition and the prevention of childhood obesity Principal Investigator: Grace Grove Start Date: 10 May 2021 End Date: 9 May 2023 Background: Childhood obesity is increasing in the UK, and children from disadvantaged backgrounds are more likely to live with obesity. Obesity in childhood is linked to obesity in adulthood and poor health outcomes. It is therefore vital that we work to prevent and reduce inequalities in childhood obesity. We know that children from disadvantaged backgrounds are more likely to have poor diets, and children who have poor diets are more likely to be obese. Therefore, improving diet quality of young families may contribute to preventing the development of childhood obesity. Healthy Start is a scheme in England that aims to improve diet quality by providing vouchers to spend on milk, fruit and vegetables to disadvantaged families. However, the voucher value is modest and has not changed for a decade, despite increasing food prices. The scheme needs assessing to consider how it can best support families, as uptake among eligible families is very low, at 54% nationally. Health visitors support young families, and give extra support to those with increased needs, including those from deprived groups. This provides a unique opportunity to support young families who are at risk of childhood obesity and eligible for Healthy Start. The aim of this research is to understand if voucher schemes can have a positive effect on diet quality of disadvantaged families. This research will contain several elements, including reviewing the literature for evidence on the effectiveness of voucher schemes, speaking to families and health visitors, collecting diet and shopping information from families, and modelling the best approach to a modified Healthy Start scheme.

< Back TBC Research Fellow Healthy Communities Previous Next

< Back Rebecca Band Research Fellow Ageing & Dementia Becky is a Senior Research Fellow at the University of Southampton. She is a psychologist and expert in the role of interpersonal processes in health, and her research focuses on how the relationships in people’s lives are important for wellbeing, health management and health outcomes. She also has expertise in behaviour change and the development and optimisation of complex interventions. Becky is currently the Principal Investigator on the NIHR funded PALS project – a community based research trial exploring whether a social network intervention can help connect people who feel lonely and isolated to people and activities within their network and local community. She is also currently a co-applicant on the Research for Public Benefit funded HI-COVE project exploring the impact of long-covid black and minority ethnic groups in the UK. Previous Next

ADOPTED PROJECT: Comparing pharmacological and non-pharmacological interventions for adults with Attention-Deficit/Hyperactivity Disorder (ADHD): systematic review and network meta-analysis Chief Investigator: Professor Samuele Cortese – University of Southampton Project Team Members: Professor Andrea Cipriani – University of Oxford, Associate Professor Corentin Gosling – University of Paris Nanterre, France, Dr Luis Faraht – University of São Paulo, Brazil / Yale University Child Study Center, USA, Dr Cinzia Del Giovane – University of Modena and Reggio, Italy Background: It is currently unclear how different treatment options for preschool children with ADHD compare with each other in terms of efficacy and safety. We will use data from available randomised controlled trials (RCTs) and apply an advanced and innovative statistical approach (network meta-analysis) to answer this question. The project started in 2022. Expected outcomes: We will understand how pharmacological and non-pharmacological interventions (including behaviour intervention, family-based systematic approaches and dietetic interventions) compare with each other in terms of their beneficial effects on ADHD symptoms and safety. Project Status: Ongoing.

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

PARTNERS Project: Development and implementation of a digital tool for multisectoralsupport and management of long-term condition PARTNERS Project: Development and implementation of a digital tool for multisectoralsupport and management of long-term condition Principal Investigator: Professor Mari-Carmen Portillo Co Applicants : Line Bragstad, Dr Dorit Kunkel, Dr Kat Bradbury, Dr Lindsay Welch, Hayden Kirk, Dr Caroline Barker, Sandra Bartolomeu Pires, Christopher Edwards, Lindsay Cherry, Francesca White, Caroline Aylott, Cathal Doyle. Partners: University of Southampton, University of Oslo, Solent NHS Trust, University Hospital Southampton NHS Foundation Trust, Hampshire and Isle of Wight ICS, Versus Arthritis, and Parkinson’s UK. Lay Summary Background to the research : Self-management is an approach to help people with long term conditions manage their health daily. Existing NHS self-management tools focus on healthcare (medication management, appointments) and fail to capture aspects of how people live with and adjust to long-term conditions. This includes social support (family/friends) and other resources and networks available like the voluntary sector, industry and community groups.We have created an intervention (an action to improve a situation or prevent it getting worse) to support self-management for people with Parkinson’s Disease and their family/carers. This intervention recognises the role of social support, voluntary sector, industry, and community groups in adjusting to living with a condition. Our next step is toadapt this intervention to the needs of people living with other conditions like Arthritis and for those living with more than one condition and create a digital tool. Aim of the research : To develop, implement and evaluate a digital tool that supports the management of people with Parkinson’s Disease and/or Arthritis. The tool will support professionals and other organisations to connect, share resources and optimise communication and referrals, leading to more personalised and cost-effective use of resources (beyond healthcare) in the community. Design and methods: The research will take place in community settings in Wessex. We will prioritise disadvantaged groups (those less comfortable using technology and less able toaccess available resources and support). We will : 1. Work with our patient and public involvement (PPI) representatives, relevant voluntary organisations, health and social care providers, and key people involved in policy making and NHS strategy. They will have a voice ineach decision to ensure our tool is relevant and acceptable to those using it. 2. Host discussion groups with people with Parkinson’s Disease and/or Arthritis and theirfamily/carers to understand the positive and negative aspects of existing digital tools, from a patient perspective. 3. Design our self-management tool. 4. Test the tool through two primary care surgeries (GP) and voluntary organisations (Parkinson’s UK and Versus Arthritis).Testing will help understand how the tool is used and what helps or hinders its success. Deliverables : The research will generate: a digital tool to support more effective self-management of Parkinson’s Disease and/or Arthritis, recommendations for policy development, evidence for how to improve NHS services. Public Patient Involvement: We willwork with people with Parkinson’s Disease and/or Arthritis and their families/carers. We will work together as equal partners to define their level of involvement, roles, methods to input and training needs. We will also explore what works best or what we should do differently intheir involvement. Dissemination : We will share our learning across the different groups involved. This will include presentations, policy briefings, newsletters, and public events.

SOCIAL CARE: Evaluation of Southampton City Council’s Male Engagement Worker (MEW) Project Chief Investigator: Dr Michelle Myall, Principal Research Fellow, University of Southampton Co-Investigators: Dr Sophia Taylor, Senior Research Assistant, University of Southampton; Dr Susi Lund, Visiting Research Fellow, University of Southampton Partners who will collaborate on the research: Anjelica Finnegan, Senior Male Engagement Worker, Southampton City Council; Caroline Bate, Domestic Abuse Coordinator, Southampton City Council; Colin McAllister, Senior Public Health Practitioner, Southampton City Council; Francesca Mountfort, Male Engagement Worker, Southampton City Council Start Date: 19 October 2023 End date: 30 September 2024 Why is this research needed? An estimated 2.4 million adults experienced domestic abuse in 2019 in England and Wales. In April 2021 the Domestic Abuse Act was introduced in England and Wales. This created a new definition of domestic abuse to include “any incidents or patterns of incidents of controlling, coercive, or threatening behaviour, violence or abuse between those aged 16 or over, who are or have been, intimate partners or family members regardless of gender or sexuality. Domestic abuse can encompass, but is not limited to psychological, physical, sexual, financial and emotional abuse”. The Act required local authorities to expand their support and provision available to those experiencing domestic abuse. As part of a review by Southampton City Council into whether it meets the requirements of the new Act it found that alleged perpetrators of domestic abuse are not being effectively assessed or adequately supported. This is particularly true of young (step-) fathers. To address this gap, in 2020 Southampton City Council established a Male Engagement Worker (MEW) Project to work with high-risk male perpetrators of domestic abuse who have (step-) children and have local authority children’s services involved. This newly established service has yet to be evaluated. What are the aims? To evaluate Southampton City Council’s new domestic abuse service focusing around the newly created Male Engagement Worker Project. How will the study be carried out? We will carry out interviews with key informants and relevant stakeholders and analyse audit data collected about the service. What will happen to the findings? We will work with our project partners to identify who we need to engage and how to reach them. We will share findings with stakeholders through a presentation. We will produce a report and executive summary of findings and recommendations for Southampton City Council and share learnings with other relevant local authority and third sector organisations. Findings will also be reported on social media posts for the wider public, publications in academic and professional journals and attendances at conferences.

< Back Traveling back in time: exploring the Netley Red Cross Hospital during World War I Nestor Serrano-Fuentes Nestor Serrano-Fuentes RN, PhD student and Research assistant for the Long-Term Conditions Research Group, Health Sciences, University of Southampton November is remembered as the month in which the First World War ended; a time to remember our loved ones who fell in battle. Between 1914 and 1918, many stories unfolded: stories of life, death, love, births, feelings and emotions. Those feelings flourish today when walking through the green park and woodland at Netley on the Southampton shoreline. I look at the sea, that little orange chapel in the middle of the great esplanade, I close my eyes and visualise the protagonists of this story, talking among themselves, laughing, shouting, touching and hugging… My name is Nestor, I am a young man, nurse and researcher at the University of Southampton. Two years ago, while running on a cold winter morning along the south coast at Netley, something drew my attention. What was a lonely chapel doing here? I stopped to read some information panels and discovered that, in that place had been the Netley Hospital or Royal Victoria Hospital. According to some books, this was the largest British military hospital of all time. Furthermore, with the arrival of the war-wounded its capacity grew yet further Leading to the building of the British Red Cross Hospital just behind the main building and the recruitment of volunteers in the UK and overseas. Netley Hospital in 1918 Sister Harvey and some of the patients from 41 Hut A Japanese nurse who worked at Netley in 1918 - unnamed I needed more information and began to browse the historical archives online. Later I came across a treasure; The Netley British Red Cross Magazine . It was December and I was combing the historical archives in Winchester and there in my hands were prints of those magazines from 1918. They were filled with poems written by soldiers and nurses, cartoons, real photos and countless stories told in the first person. A few days later, I phoned my friend Elena Andina, lecturer of nursing at the University of Leon (Spain). She is a dreamer, humanist, and a person with whom I share a passion for the history of the nursing profession. I said: “You’re not going to believe what I have found! We’ve got some work to do!” We decided to read those six issues of the magazine. We were filled with great affection for the people and stories. We set about starting to analyse and contextualise the data and information, and began to write an article on the history of nursing telling the story of how care was delivered to soldiers during World War I. We were so lucky, it was like travelling in a time machine, an incomparable feeling. After a first analysis, we realised that there was a relationship between what was happening at Netley and the revolutionary thinking and ideas of Florence Nightingale, who is considered the creator of modern nursing. The focus on the environment on care - sunlight, humidity, fresh air, silence during a night shift, empathy, the smallest details that nurses took care of, such as the size of pyjamas for their patients, the use of small boats as a source of leisure for patients and nurses, are just some of the aspects that we glimpsed between those pages. Throughout history, wars and pandemics have shaped and changed the way nursing care has been delivered. If we look back, many of the measures that were applied we continue to use today. During this covid19 pandemic, the importance of open spaces and physical spaces between people, fresh air or sunlight are the same – echoes of the voices speaking from the pages of the Netley magazines in 1918. They say history tends to repeat itself, for better or for worse. What can we learn from it? Let us continue to lovingly preserve it and keep it in mind to acknowledge our ancestors and as inspiration in the search for current and future answers. Nestor Exploring The Netley British Red Cross Magazine: An example of the development of nursing and patient care during the First World War - Nestor Serrano-Fuentes& Elena Andina-Diaz (download below) serranoandina_2020_netley-hospital .pdf Download PDF • 768KB Elena Andina-Diaz - co-researcher Previous Next

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

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