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Chronic pain affects around 28 million adults in the UK and is associated with impaired work ability, reduced productivity and increased sickness absence. Access to work-focused support within healthcare services is limited, and most employers do not routinely provide structured assistance for employees living with chronic pain. The Pain-at-Work Toolkit is a co-created, web-based intervention designed to improve work ability, self-management, and workplace experiences for employees living with chronic pain. A feasibility trial demonstrated strong acceptability, exceptional recruitment and potential improvements in work ability, providing clear justification for progression to a fully powered evaluation. This paper describes the protocol for a definitive cluster randomised controlled trial to evaluate the effectiveness, cost-effectiveness and implementation of the Pain-at-Work Toolkit.
This two-arm, open-label cluster-randomised controlled trial will recruit at least 70 organisations (minimum 35 clusters per arm) and at least 685 participants. Organisations will be randomised 1:1 to (a) support-as-usual (SAU) or (b) SAU plus the Pain-at-Work Toolkit, and Pain-at-Work Manager’s Toolkit as an implementation-support component. The primary outcome is work ability at 3 months, measured using the Work Ability Index (three-item version). Secondary outcomes include work self-efficacy, sickness absence, presenteeism, productivity loss, job satisfaction, job stressfulness, turnover intentions, anxiety, depression and health-related quality of life. A mixed-methods process and implementation evaluation will assess fidelity, contextual influences and mechanisms of impact. A health economic evaluation will estimate cost-effectiveness from employer and societal perspectives. Analyses will follow intention-to-treat principles using multilevel modelling.
Ethical approval was granted by the University of Nottingham Faculty of Medicine and Health Sciences Research Ethics Committee (Ref: FMHS 1200226) and the UK Health Research Authority and Health and Care Wales (IRAS 367449). Findings will be disseminated through peer-reviewed publications, conference presentations, stakeholder reports and public summaries.
To examine the geographical and temporal distribution of safeguarding concerns and enquiries among older adults living with dementia in England, and to assess variation by sex, age and region.
Population-based, repeated cross-sectional study.
England, using national administrative datasets.
Older adults living with dementia in England, identified using national dementia prevalence estimates; safeguarding activity was analysed at local authority and regional level.
Primary outcomes were the number of safeguarding concerns and Section 42 safeguarding enquiries recorded by local authorities. Secondary outcomes included other safeguarding enquiries and variation by age, sex and geographic region.
Safeguarding concerns more than doubled between 2015 and 2022 across the adult population. Among adults with dementia, safeguarding concerns increased by 55.5% between 2015/2016 and 2019/2020, with a temporary decline during the COVID-19 pandemic. Women with dementia, particularly those aged 85 and older, had higher rates of safeguarding concerns and enquiries than men. Spatial analysis revealed substantial variation across England, with higher safeguarding activity in urban and more deprived regions, such as parts of the North West (eg, Manchester, Liverpool), Yorkshire and the Humber, and the Midlands, while lower activity was observed in more rural and less deprived areas such as the North East and South West.
This study provides the first national analysis of safeguarding patterns for people living with dementia in England. The findings found demographic and geographic disparities in safeguarding activity, highlighting the need for more detailed and individual-level data to inform responsive, dementia-sensitive safeguarding policies.
To explore parent/caregivers’ perceptions of procedures in which their child was held still and the reported impact of these experiences on both the child and parent.
Qualitative descriptive study using an online survey.
Three research teams (United Kingdom (UK), New Zealand (NZ), and Australia) administered a qualitative survey to parents/caregivers of a child who had been held for a procedure in the last 2 years. Data were analysed using inductive thematic analysis.
One hundred and twenty parents and three caregivers described 215 clinical procedures during which their child had been held. Four themes, conceptualised as procedural journeys, captured how parents described experiences unfolding over time: (1) Unravelling restraint, (2) Inevitable restraint led by professionals, (3) Inevitable restraint led by parents/caregivers, and (4) Child-centred holding. Parent/caregivers'accounts highlighted how procedures characterised by limited planning, rapid escalation, reduced responsiveness to child distress and restraint were experienced as particularly challenging and linked to feelings of guilt, regret and trauma. Procedures involving preparation, communication, flexibility and supportive comfort holds were described more positively and as less traumatic.
The use of restraint was described as distressing for both the child and the parent/caregiver, particularly when procedures unfolded without adequate planning. Approaches that prioritised preparation and collaboration were perceived to support more positive experiences.
There is a need to move away from default or reactive restraint practices towards more deliberate, rights-based, trauma-informed procedural care.
The Consolidated Criteria for Reporting Qualitative Research (COREQ) were utilised when reporting findings.
To ensure that study materials and survey questions were clear and relevant, consultation occurred with two parents in the UK and three parents in NZ. The study design and questions were also presented to the New Zealand Mātauranga Māori Committee for feedback to ensure cultural appropriateness.
by Ciaran M. Fairman, Alex M. Brooks, Darren G. Candow, Kylah E. Jackson, Genevieve Bottone, Brett Scott, Kenneth S. Anderson, Katie R. Hirsch, Thomas D. Cardaci, Brandon N. VanderVeen, Christine E. Blake, Tiejun Zhang, Jiajia Zhang, E. Angela Murphy
PurposeThe purpose of this trial was to assess the feasibility, acceptability and safety of a 10-week hybrid (in-clinic and virtual) resistance exercise training RET program with or without CrM in individuals treated for colorectal cancer.
MethodsTwenty-seven participants were randomized to RET plus 5 grams/day of CrM (EXSUPP; n = 13) or 5 grams/day corn-starch maltodextrin placebo (EXPLA; n = 14). RET was performed three times per week. Feasibility was assessed through recruitment, retention and fidelity (percentage of prescribed RET and supplementation completed). Acceptability was evaluated using a 5-point Likert scale, and safety was monitored through adverse event reporting. Secondary outcomes (body composition, muscular strength, physical function) were assessed pre- and post-intervention using baseline-adjusted ANCOVA models and focus group interviews.
ResultsRegistry-based recruitment identified 1378 potentially eligible individuals and 27 of 410 assessed (6.6%) enrolled, highlighting recruitment challenges. Retention was high (24/27; 88.9%). Adherence to RET and supplementation was strong (both > 85%) with no serious adverse events reported. Participants reported high acceptability for both in person and virtual components. No significant between group differences were observed for secondary outcomes; however, both groups demonstrated modest improvements in muscular strength and short physical performance battery (SPPB) scores.
ConclusionsA hybrid RET program with CrM was feasible, acceptable and well tolerated in individuals with colorectal cancer who were previously treated with chemotherapy.
Implications for Cancer SurvivorsHybrid supervised RET is safe, acceptable, and associated with modest improvements in strength and physical function among individuals treated for colorectal cancer. While creatine supplementation did not demonstrate clear additive effects in this pilot trial, further adequately powered studies are warranted.Trial Registration: NCT06420726.
Same-day emergency care (SDEC) has been rolled out as a model of care in England with a limited evidence base. This study examined conversion to inpatient admission, 30-day reattendance and 30-day mortality, among adults managed through SDEC compared with those admitted for ≤48 hours, as a proxy for low acuity, over a 4-year period, to assess safety and effectiveness in a real-world operational setting across two acute hospital sites.
Retrospective cohort study.
Two acute hospital sites within one National Health Service (NHS) trust in England, UK.
Adults aged ≥18 years attending acute medical services between April 2021 and March 2025, managed via SDEC or admitted for ≤48 hours (n=43 970).
Conversion to inpatient admission, 30-day reattendance and 30-day mortality.
The crude conversion rate from SDEC to inpatient admission was 5.8%. In the multivariable model, increasing age (OR1.02, 95%CI 1.01 to 1.02), male sex (OR1.42, 95%CI 1.29 to 1.57) and attendance at the Boston site (OR1.71, 95%CI 1.55 to 1.90) were associated with higher odds of admission.
30-day prefix-concordant reattendance occurred in around 10% of patients in both pathways. After adjustment, SDEC patients had substantially lower odds of reattendance than those admitted for ≤48 hours (OR0.26, 95% CI 0.19 to 0.36). The effect of SDEC varied by age (interaction OR1.02, 95% CI 1.01 to 1.02) and site, with a weaker protective effect at Lincoln compared with Boston (interaction OR2.12, 95% CI 1.74 to 2.60). Age was associated with a reduction in reattendance (OR 0.99 per year increase, 95% CI 0.98 to 0.99).
30-day mortality was lower in SDEC than in short-stay admission (0.6% vs 8.2%), with pathway remaining a strong predictor after adjustment (OR0.05, 95%CI0.04 to 0.07). Younger age was protective, while male sex was associated with higher mortality. Pathway by sex interaction indicated a less pronounced protective effect of SDEC in men.
SDEC was associated with very low conversion to inpatient admission and substantially better short-term outcomes than short-stay admission, including markedly reduced diagnosis-concordant reattendance and lower 30-day mortality. These findings indicate that SDEC is a safe and effective model for managing selected acute medical patients. The consistently favourable outcomes among SDEC attenders suggest that patient selection and operational factors within the emergency pathway may be directing lower-risk patients towards SDEC, highlighting the need to review how SDEC capacity is targeted to ensure alignment with its intended clinical role.
Anxiety and depression are common and associated with higher use of general healthcare services. The aims of this systematic review were to (1) estimate the prevalence of anxiety and depression in adults who are high or costly users of general healthcare services in comparison to routine users and (2) estimate the magnitude of healthcare costs associated with the presence of anxiety and depression.
Systematic review of the available literature.
MEDLINE, PsycINFO, EMBASE, CINAHL, PROSPERO and Cochrane Library were systematically searched without language restriction from inception to 1 April 2019 and updated on 25 October 2022, 16 October 2024 and 18 February 2026.
Eligible studies described adults aged ≥18 years who were defined as high or costly general healthcare users and where the prevalence and/or associated costs of anxiety and/or depression were quantified.
Three reviewers independently extracted information on study characteristics, exposure and outcomes.
From the 38 412 identified articles, 27 studies from 10 countries (in Europe, North America and Asia) involving 6 145 907 participants met eligibility criteria and were included. There were wide variations in the estimated prevalence of anxiety (3.8–67.2%) and depression (4.7–77.9%) among high healthcare users. The prevalence of both disorders was higher among high healthcare users than routine users in all studies with non-high user comparator groups. Only four studies investigated healthcare costs associated with depression. These uniformly reported that general healthcare costs are higher for those with depression than those without. No studies investigated costs associated with anxiety.
Anxiety and depression are over-represented among high or costly healthcare users, although accurate quantification of the magnitude of difference is precluded by significant methodological heterogeneity and variability in definitions used. Improved identification of covert mental health problems is essential for the provision of effective interventions for patients and healthcare expenditure reduction. Future research should prioritise a standardised approach, with agreed definitions for high and/or costly healthcare use in different contexts.
CRD42018102628.
by Mehmet Yildirim, Timothy Carter, Holly Blake
Poor mental well-being is common among healthcare workers, affecting individual health, patient safety, and organisational performance. Mobile app-based self-care interventions are promising due to their accessibility, low cost, and ease of use. This study aimed to assess the feasibility of a self-monitoring mobile app called MYARKEO, to improve mental well-being among healthcare workers and healthcare trainees in the United Kingdom (UK). The study evaluated recruitment and retention rates, variability of key outcomes to inform a future randomised controlled trial (RCT), intervention engagement, barriers and facilitators to engagement, and potential refinements to the mobile app. A mixed-method feasibility RCT was conducted with two groups: an intervention group using MYARKEO to monitor mental well-being over 6 weeks, and a non-intervention control group. Data were collected at baseline and post-intervention and included the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), the Depression Anxiety and Stress Scale (DASS-21), and the mHealth App Usability Questionnaire (MAUQ). Qualitative data were collected through semi-structured interviews (n = 13) and analysed using thematic analysis. Forty-nine participants (32 workers, 17 trainees; aged 18–60+) were included in the trial, with a 20.5% dropout rate. Daily app usage averaged 64.5%. Participants frequently monitored mood, sleep, food, and exercise. Interviews identified themes of “Usefulness,” “Enablers of engagement,” “Barriers to engagement,” and “Suggested intervention improvements.” This study demonstrates the feasibility of using a mobile app to monitor and promote mental well-being among healthcare workers and trainees. While app engagement was promising, challenges were identified, highlighting the need for refinements to the app’s content, interface, and design for future trials.This study engaged key stakeholders—older adults, family caregivers, home care support workers, nurses, and home healthcare leaders—to explore perspectives on essential components and integration into home care models, and to explore the role of their technology readiness for health smart homes adoption.
A qualitative methodology with a quantitative component, early-phase exploratory design.
Semi-structured interviews underwent qualitative thematic analysis, with cross-case analysis comparing stakeholder perspectives to identify convergences and divergences. Descriptive statistics were used to analyse Technology Readiness Index (TRI 2.0) survey data to provide background and context to the qualitative findings.
Among 18 participants—older adults (n = 6), family caregivers (n = 2), nurses (n = 7), and support workers/healthcare leaders (n = 3)—findings reflected optimism for health smart home adoption and its potential to support ageing in place. Nurses and care workers saw health smart home as a tool for improving care coordination and quality of life. Key adoption considerations included education, data visualisation, privacy, and security. Technology readiness scores were moderate, with nurses scoring highest (3.52), followed by caregivers (3.41), support workers (3.13), and older adults (3.10).
While stakeholders were open to integrating health smart home into home care, concerns around usability, security, and training must be addressed to facilitate adoption.
Findings suggest that while health smart home technology holds promise for enhancing ageing in place, varying levels of technology readiness across stakeholders highlight the need for tailored education and support strategies to ensure successful implementation.
Despite a strong preference for ageing in place among older adults, integrating health smart home technologies into home care remains challenging. Key issues include ensuring intuitive functionality, protecting privacy, and clarifying the roles of caregivers and healthcare professionals in a technology-enhanced care model. This study addresses the critical gap in understanding how health smart home solutions can be effectively tailored to support the diverse needs of older adults, family caregivers, and home care nurses and support workers.
Stakeholders were generally optimistic about health smart home technologies supporting ageing in place and improving quality of life. Nurses and support workers highlighted the need for tailored data visualisations, alert parameters, and clear role guidelines. A novel finding was that older adults and family caregivers viewed health smart home as a way to reduce intrusive monitoring, promote independence, and maintain a familiar living environment. Family caregivers valued the ability to stay involved remotely through activity data, offering reassurance and peace of mind. Across all groups, privacy safeguards were seen as essential, with strong concerns about data security, transparent usage policies, and user control over data sharing.
Findings have implications for community-dwelling older adults, family caregivers, home care professionals, researchers, and technology developers. Insights from this study can inform the design of user-friendly health smart home technologies, shape future research, and guide tailored implementation strategies in home care settings.
An advisory group of community-dwelling older adults in Western Australia provided input on study design and methodology. Their recommendations led to the use of one-on-one interviews to ensure accessibility and relevance for older adults when exploring technology readiness and smart home integration. While the advisory group did not contribute to the data itself or its analysis, their feedback shaped the method of engagement to ensure its relevance and accessibility to potential participants.
To explore how Early Career Nurses perceive their preparedness for nursing practice, the teaching and learning experiences, and the role of professional experience placements on their professional development.
A qualitative study using a hermeneutic phenomenological approach.
The study involved 25 Early Career Nurses who participated in follow-up interviews 4 years post-graduation in Australia between 2022 and 2024. Data were collected through semi-structured interviews and analysed using Thematic Analysis.
Three key themes emerged: gaps in preparedness, the power of being embedded and too many balls to juggle. Participants indicated a mixed sense of preparedness with significant gaps in clinical skills. They emphasised the critical role of professional experience placements and mentorship to bridge the gap between theoretical knowledge and practical application. Placements and mentorship opportunities were considered essential to develop confidence and competence for effective nursing practice.
The study highlights the necessity for nursing curricula to address significant gaps in clinical skills, particularly in surgical and emergency nursing. By incorporating more simulation-based learning, interprofessional education and robust mentorship programmes, nursing education can better prepare graduates for the realities of clinical practice. These enhancements will help ease the transition from academic training to clinical practice, reducing reality shock and fostering a more confident, competent and resilient nursing workforce.
Nursing education must integrate more simulation-based learning and interprofessional education opportunities, which are crucial for bridging the gap between theoretical knowledge and practical application, ensuring that graduates are adequately prepared for the demands of clinical practice. Additionally, professional experience placements and mentorship should be prioritised to develop the confidence and competence for effective nursing practice.
This study adheres to the Consolidated criteria for reporting qualitative research guidelines.
No Patient or Public Contribution.
To examine the direct and indirect predictors of thriving at work and its impact on intention to leave the organisation or profession among early career nurses.
A repeated cross-sectional design.
A sub-study of early career nurses as part of an Australian longitudinal follow up study, commenced in 2018, was conducted. The sub-study asked early career nurses between their second and sixth year after graduating to complete a structured online questionnaire assessing thriving at work and several predictor variables. Data were analysed using Pearson's correlation, multiple linear regression, and path analysis.
Among the 67 participants (response rate of 42.9%), thriving at work was positively correlated with occupational hardiness, social support from colleagues, and wellbeing, while negatively correlated with compassion fatigue. Thriving at work and perceived organisational support were the significant predictors of intention to leave the organisation, while perceived organisational support was the only significant predictor of intention to leave the profession.
The importance of strong collegial relationships, compassion fatigue, and improving wellbeing to enhance thriving at work are highlighted. Fostering an environment where employees can thrive is crucial to reduce the intentions to leave an organisation. Relationships with the managers and quality of care provision also play a crucial role in reducing turnover and leave intentions. Perceived organisational support enhances employee wellbeing, thereby reducing turnover intentions. Future strategies should focus on comprehensive support systems to retain nurses in their organisation and the profession.
Enhancing thriving at work and perceived organisational support can reduce early career nurses' intention to leave their organisation. However, job stressors and interpersonal conflicts also influence professional leave decisions.
This study has adhered to the STROBE guidelines.
No Patient or Public Contribution.
FreshRSS 