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IntroductionAround 885 000 people live with dementia in the UK, of whom around 50% experience a fall each year. ‘Keep On Keep Up’ (KOKU) is a National Health Service-approved gamified, digital health programme designed to maintain function and reduce falls through strength and balance exercises (Fitness and Mobility Exercise/OTAGO Exercise Programme (OTAGO)), and health literacy games. KOKU has been adapted to the needs of people living with dementia in the community (known as KOKU-LITE). This trial aims to test the feasibility and acceptability of trial processes and usability of KOKU-LITE.Methods and analysisA two-arm, parallel, non-blinded feasibility randomised controlled trial will be conducted using mixed methods. Participants aged ≥55 years with any type but varying levels of dementia from mild to moderate stages (ratings 1 and 2 on clinical dementia rating (CDR) scale) and meeting the eligibility criteria will be recruited from patient organisations across Greater Manchester, UK. The target sample size is 60 for the trial. Participants randomised into the intervention arm will use the KOKU-LITE programme for 30 min, 3 times a week for 6 weeks plus dementia-specific falls prevention leaflet and participants randomised into the control arm will receive dementia-specific falls prevention leaflet. Outcome measures: primary outcomes: recruitment, retention and adherence rates; secondary outcomes: quality of life, participants’ activities of daily living, physical activity levels, functional ability, lower limb strength, concerns about falling, falls risk, mood and user’s experience of the technology. Post-intervention interviews or focus groups with participants and health and social care professionals will explore the feasibility of trial processes and technology and evaluate the usability and acceptability of the intervention, respectively. Analyses will be descriptive.Trial status: the first participants were recruited on 20 March 2024. Data collection is currently ongoing.Ethics and disseminationThis feasibility trial has been reviewed and received favourable ethical approval from Yorkshire & The Humber—Bradford Leeds Research Ethics Committee, Newcastle upon Tyne (REC reference 23/YH/0262). The findings of the study will be disseminated through peer-reviewed scientific journals, at conferences, publication on University of Manchester, Applied Research Collaboration Greater Manchester and KOKU websites.Trial registration number NCT06149702.

Background The use of Patient Reported Outcome Measures (PROMS) in clinical practice has the potential to promote patient-centred care and improve patients’ quality of life. Individualized PROMs may be particularly helpful in identifying, prioritizing and monitoring health problems of patients with multimorbidity. We aimed to develop an intervention centred around PROMs feedback as part of Primary Care annual reviews for patients with multimorbidity and evaluate its feasibility and acceptability. Methods We developed a nurse-oriented intervention including (a) training of nurses on PROMs; (b) administration to patients with multimorbidity of individualized and standardized PROMS; and (c) feedback to both patients and nurses of PROMs scores and interpretation guidance. We then tailored the intervention to patients with two or more highly prevalent conditions (asthma, COPD, diabetes, heart failure, depression, and hip/knee osteoarthritis) and designed a non-controlled feasibility and acceptability evaluation in a convenience sample of primary care practices (5). PROMs were administered and scores fed back immediately ahead of scheduled annual reviews with nurses. Patients and nurses rated the acceptability of the intervention using with a brief survey including optional free comments. Thematic analysis of qualitative interviews with a sample of participating patients (10) and nurses (4) and of survey free comments was conducted for further in-depth evaluation of acceptability. Feasibility was estimated based on rates of participation and completion. Results Out of 68 recruited patients (mean age 70; 47% female), 68 completed the PROMs (100%), received feedback (100%) and confirmed nurse awareness of their scores (100%). Most patients (83%) “agreed”/”strongly agreed” that the PROMs feedback had been useful, a view supported by nurses in 89% of reviews. Thematic analysis of rich qualitative data on PROMS administration, feedback and role in annual reviews indicated that both patients and nurses perceived the intervention as acceptable and promising, emphasizing its comprehensiveness and patient-centredness. Conclusions We have developed and tested an intervention focusing on routine PROM assessment of patients with multimorbidity in Primary Care. Preliminary findings support its feasibility and a high degree of acceptability from both patients and nurses. The next step is to conduct a full-scale trial for evaluating the effectiveness of the proposed intervention.

ObjectivesThe aim of this study was to explore the public’s current awareness of the safe use of medicines in general, and over-the-counter (OTC) analgesics (painkillers) in particular, as well as their information-seeking and advice-seeking, medicine use and disposal.SettingGeneral population, Scotland.ParticipantsAdults (aged >16 years) living in Scotland.InterventionsA cross-sectional survey was undertaken in collaboration with Ipsos MORI (a market research company). The content was informed by a multi-stakeholder prioritisation event and supplemented with information from earlier studies.ResultsThe survey was completed in March 2020 by 1000 respondents, most of whom had used a pharmacy in the previous 12 months to obtain a medicine. Of the 1000 respondents, 39% (n=389) were 55 years and over; 52% (n=517) were women; and 58% were degree-educated.On receipt of a new prescription, up to 29.8% (95% CI 27.0% to 32.7%) of respondents proactively sought specific information or advice from the pharmacist. Few (5.2% (95% CI 4.0% to 6.8%) respondents ‘always’ discussed their new prescription medicine with pharmacy staff and 28.9% (95% CI 26.2% to 31.8%) reported ‘never’ engaging in this behaviour. Respondents aged >35 years were less likely to engage in this behaviour.Just over half (53% (95% CI 50.5% to 56.7%)) the respondents reported oral OTC analgesic use at least once in the previous month.In terms of medicine disposal, 29.3% (95% CI 26.6% to 32.2%) of respondents considered waste bin disposal to be of low or no harm.ConclusionsThis study identified low levels of information-seeking and advice-seeking from pharmacy personnel especially on receipt of new prescription medicines. Potentially unsafe behaviours were identified in the use and disposal of medicines. These results will inform the development of interventions to promote advice-seeking and increase awareness regarding safe medicine use.

Background Lateral elbow tendinopathy (LET) is a common condition affecting adults. Although a lack of treatment consensus continues to prompt numerous effectiveness studies, there is a paucity of clear guidance on the choice of outcome measure. Our aim was to undertake a standardised evaluation of the available clinical rating systems that report patient-centred outcomes in LET. Methods A systematic review of studies reporting the development, assessment of metric properties and/or use of instruments aiming to quantify LET-specific patient-centred outcome measures was conducted in MEDLINE, Embase and CINAHL (inception-2017) adhering to PRISMA guidance. The evidence for each instrument was independently assessed by two reviewers using the standardised evaluating measures of patient-reported outcomes (EMPRO) method evaluating overall and attribute-specific instrument performance (metric properties and usability). EMPRO scores > 50/100 were considered indicative of high performance. Results Out of 7261 references, we identified 105 articles reporting on 15 instruments for EMPRO analysis. Median performance score was 41.6 (range 21.6–72.5), with four instruments meeting high-performance criteria: quick Disabilities of the Arm Shoulder and Hand score (qDASH) (72.5), DASH (66.9), Oxford Elbow Score (OES) (66.6) and Patient-Rated Tennis Elbow Evaluation (PRTEE) (57.0). One hundred seventy-nine articles reported instrument use internationally with DASH as the most frequent (29.7% articles) followed by PRTEE (25.6%), MEPS (15.1%) and qDASH (8.1%). The correlation between frequency of use and performance was r  = 0.35 (95%CI − 0.11; 0.83). Conclusions This is the first study to provide standardised guidance on the choice of measures for LET. A large number of clinical rating systems are both available and being used for patients with LETs. Robust evidence is available for four measures, the DASH, QDASH, PRTEE and OES. The use of instruments in the literature is only in part explained by instrument performance.

Background The definition of population-specific outcomes is an essential precondition for the implementation of value-based health care. We developed a minimum standard outcome set for overall adult health (OAH) to facilitate the implementation of value-based health care in tracking, comparing, and improving overall health care outcomes of adults across multiple conditions, which would be of particular relevance for primary care and public health populations. Methods The International Consortium for Health Outcomes Measurement (ICHOM) convened an international panel (patients, clinicians, and topic experts). Following the development of a conceptual framework, a modified Delphi method (supported by public consultations) was implemented to identify, in sequence, the relevant domains, the best instruments for measuring them, the timing of measurement, and the relevant adjustment variables. Findings Outcomes were identified in relation to overall health status and the domains of physical, mental, and social health. Three instruments covering these domains were identified: PROMIS Scale v1.2—Global Health (10 items), WHO Wellbeing Index (5 items), and the WHO Disability Assessment Schedule 2.0 (12 items). Case-mix variables included a range of sociodemographic and biometric measures. Yearly measurement was proposed for all outcomes and most case-mix variables. Interpretation The ICHOM OAH Standard Set has been developed through consensus-based methods based on predefined criteria following high standards for the identification and selection of high-quality measures The involvements of a wide range of stakeholders supports the acceptability of the set, which is readily available for use and feasibility testing in clinical settings.

Background: ePrescribing was developed to reduce medication errors and adverse drug events (ADEs) in intensive care units (lCU). Even though ePrescribing is effective in reducing medication errors and ADEs in ICUs, it is clear from the literature that ePrescribing may introduce new errors which could have been caused by the design and interface of the systems. Therefore, it is important to explore ePrescribing systems to improve their design and efficiency, and improve patient safety based on the assistance that such systems provide to professionals in making clinical decisions from a multi-level perspective: at drug level, process level and system level. Methods: A mixed methods design was used to address the multi-level approach. In a quantitative phase, a systematic review was conducted to identify drugs/drug groups and errors most commonly associated with preventable adverse drug events (PADEs) in ICU patients at a drug level, and an eDelphi study to identify high-risk prescribing safety indicators specific to ICU with experts in pharmacotherapy/adverse drug events to address the process level. In a qualitative phase, semi-structured interviews were conducted with staff members to explore the benefits of using the ePrescribing system, problems encountered with the use of the ePrescribing system and elicit users' recommendations to improve the efficiency of the ePrescribing system in the ICU of Royal Berkshire National Health Services Foundation Trust at the system level. Results: Sedatives and analgesics were the drugs/drug groups most frequently associated with pADEs in ICU patients, and dosing errors were the errors most commonly associated with pADEs in ICU patients. Eleven high-risk prescribing safety indicators specific to the ICU and which are amenable to clinical decision support were identified. The prescribing indicators list could be used as a standardised tool for the routine collection of prescribing error data from both paper based and electronic systems. The prescribing indicators list could also be used to evaluate the impact of safety improvement initiatives such as implementing ePrescribing with or without clinical decision support. The benefits of the ePrescribing system reported in this study included accuracy ofthe ePrescribing system and ease ofaccess using the ePrescribing system. Problems encountered with the ePrescribing system in this study included the mixed system (both paper and electronic) of prescribing and inefficiencies (incomplete drug database and absence of automatic functions) of the system. The benefits and issues about the use of ePrescribing reported in this study were consistent with the current literature. New issues were also noted in this study and these include: co-signing of drugs, deskilling of professionals and changes to pharmacists' work practices. This could be addressed by improving the design of the systems in response to feedback from the users of the system and also involving users at every stage of the design and refinement processes. Therefore, a user-centred systems approach that takes into account the needs of the users and their work environment should be used when designing and implementing ePrescribing systems. Conclusions: Errors can be understood at the drug, process and system levels, to inform the design of strategies to reduce ADEs and medication errors at a whole system level. The findings from this study could inform the basis for designing and developing strategies to improve patient safety and utilisation of the ePrescribing system.

Table of contents S1 Using computerized adaptive testing Tim Croudace S2 Well-being: what is it, how does it compare to health and what are the implications of using it to inform health policy John Brazier O1 “Am I going to get better?”—Using PROMs to inform patients about the likely benefit of surgery Nils Gutacker, Andrew Street O2 Identifying Patient Reported Outcome Measures for an electronic Personal Health Record Dan Robotham, Samantha Waterman, Diana Rose, Safarina Satkunanathan, Til Wykes O3 Examining the change process over time qualitatively: transformative learning and response shift Nasrin Nasr, Pamela Enderby O4 Developing a PROM to evaluate self-management in diabetes (HASMID): giving patients a voice Jill Carlton, Donna Rowen, Jackie Elliott, John Brazier, Katherine Stevens, Hasan Basarir, Alex Labeit O5 Development of the Primary Care Outcomes Questionnaire (PCOQ) Mairead Murphy, Sandra Hollinghurst, Chris Salisbury O6 Developing the PKEX score- a multimodal assessment tool for patients with shoulder problems Dominic Marley, James Wilson, Amy Barrat, Bibhas Roy O7 Applying multiple imputation to multi-item patient reported outcome measures: advantages and disadvantages of imputing at the item, sub-scale or score level Ines Rombach, Órlaith Burke, Crispin Jenkinson, Alastair Gray, Oliver Rivero-Arias O8 Integrating Patient Reported Outcome Measures (PROMs) into routine primary care for patients with multimorbidity: a feasibility study Ian Porter, Jaheeda Gangannagaripalli, Charlotte Bramwell, Jose M. Valderas O9 eRAPID: electronic self-report and management of adverse-events for pelvic radiotherapy (RT) patients Patricia Holch, Susan Davidson, Jacki Routledge, Ann Henry, Kevin Franks, Alex Gilbert, Kate Absolom & Galina Velikova O10 Patient reported outcomes (PROMs) based recommendation in clinical guidance for the management of chronic conditions in the United Kingdom Ian Porter, Jose M.Valderas O11 Cross-sectional and longitudinal parameter shifts in epidemiological data: measurement invariance and response shifts in cohort and survey data describing the UK’s Quality of Life Jan R. Boehnke O12 Patient-reported outcomes within health technology decision making: current status and implications for future policy Andrew Trigg, Ruth Howells O13 Can social care needs and well-being be explained by the EQ-5D? Analysis of Health Survey for England dataset Jeshika Singh, Subhash Pokhrel, Louise Longworth O14 Where patients and policy meet: exploring individual-level use of the Long-Term Conditions Questionnaire (LTCQ) Caroline Potter, Cheryl Hunter, Laura Kelly, Elizabeth Gibbons, Julian Forder, Angela Coulter, Ray Fitzpatrick, Michele Peters

Table of contents S1 Using computerized adaptive testing Tim Croudace S2 Well-being: what is it, how does it compare to health and what are the implications of using it to inform health policy John Brazier O1 \"Am I going to get better?\"--Using PROMs to inform patients about the likely benefit of surgery Nils Gutacker, Andrew Street O2 Identifying Patient Reported Outcome Measures for an electronic Personal Health Record Dan Robotham, Samantha Waterman, Diana Rose, Safarina Satkunanathan, Til Wykes O3 Examining the change process over time qualitatively: transformative learning and response shift Nasrin Nasr, Pamela Enderby O4 Developing a PROM to evaluate self-management in diabetes (HASMID): giving patients a voice Jill Carlton, Donna Rowen, Jackie Elliott, John Brazier, Katherine Stevens, Hasan Basarir, Alex Labeit O5 Development of the Primary Care Outcomes Questionnaire (PCOQ) Mairead Murphy, Sandra Hollinghurst, Chris Salisbury O6 Developing the PKEX score- a multimodal assessment tool for patients with shoulder problems Dominic Marley, James Wilson, Amy Barrat, Bibhas Roy O7 Applying multiple imputation to multi-item patient reported outcome measures: advantages and disadvantages of imputing at the item, sub-scale or score level Ines Rombach, Ãrlaith Burke, Crispin Jenkinson, Alastair Gray, Oliver Rivero-Arias O8 Integrating Patient Reported Outcome Measures (PROMs) into routine primary care for patients with multimorbidity: a feasibility study Ian Porter, Jaheeda Gangannagaripalli, Charlotte Bramwell, Jose M. Valderas O9 eRAPID: electronic self-report and management of adverse-events for pelvic radiotherapy (RT) patients Patricia Holch, Susan Davidson, Jacki Routledge, Ann Henry, Kevin Franks, Alex Gilbert, Kate Absolom & Galina Velikova O10 Patient reported outcomes (PROMs) based recommendation in clinical guidance for the management of chronic conditions in the United Kingdom Ian Porter, Jose M.Valderas O11 Cross-sectional and longitudinal parameter shifts in epidemiological data: measurement invariance and response shifts in cohort and survey data describing the UK's Quality of Life Jan R. Boehnke O12 Patient-reported outcomes within health technology decision making: current status and implications for future policy Andrew Trigg, Ruth Howells O13 Can social care needs and well-being be explained by the EQ-5D? Analysis of Health Survey for England dataset Jeshika Singh, Subhash Pokhrel, Louise Longworth O14 Where patients and policy meet: exploring individual-level use of the Long-Term Conditions Questionnaire (LTCQ) Caroline Potter, Cheryl Hunter, Laura Kelly, Elizabeth Gibbons, Julian Forder, Angela Coulter, Ray Fitzpatrick, Michele Peters