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Objectives: (1) Explore the challenges of providing daily oral care in care homes; (2) understand oral care practices provided by care home staff; (3) co‐design practical resources supporting care home staff in these activities. Methods: Three Sheffield care homes were identified via the "ENRICH Research Ready Care Home Network," and three to six staff per site were recruited as co‐design partners. Design researchers led three co‐design workshops exploring care home staff's experiences of providing daily oral care, including challenges, coping strategies and the role of current guidelines. New resources were prototyped to support the use of guidelines in practice. The design researchers developed final resources to enable the use of these guidelines in‐practice‐in‐context. Findings: Care home staff operate under time and resource constraints. The proportion of residents with dementia and other neurodegenerative conditions is rapidly increasing. Care home staff face challenges when residents adopt "refusal behaviours" and balancing daily oral care needs with resident and carer safety becomes complex. Care home staff have developed many coping strategies to navigate "refusal behaviours." Supporting resources need to "fit" within the complexities of practice‐in‐context. Conclusions: The provision of daily oral care practices in care homes is complex and challenging. The co‐design process revealed care home staff have a "library" of context‐specific practical knowledge and coping strategies. This study offers insights into the process of making guidelines usable for professionals in their contexts of practice, exploring the agenda of implementing evidence‐based guidelines. [ABSTRACT FROM AUTHOR]

Background: Evidence for interventions promoting oral health amongst care home residents is weak. The National Institute for Health and Care Excellence (NICE) guideline NG48 aims to maintain and improve the oral health of care home residents. A co-design process that worked with residents and care home staff to understand how the NG48 guideline could be best implemented in practice has been undertaken to refine a complex intervention. The aim of this study is to assess the feasibility of the intervention to inform a future larger scale definitive trial. Methods: This is a protocol for a pragmatic cluster randomised controlled trial with a 12-month follow-up that will be undertaken in 12 care homes across two sites (six in London, six in Northern Ireland). Care homes randomised to the intervention arm (n = 6) will receive the complex intervention based on the NG48 guideline, whilst care homes randomised to the control arm (n = 6) will continue with routine practice. The intervention will include a training package for care home staff to promote knowledge and skills in oral health promotion, the use of the Oral Health Assessment Tool on residents by trained care home staff, and a 'support worker assisted' daily tooth-brushing regime with toothpaste containing 1500 ppm fluoride. An average of ten residents, aged 65 years or over who have at least one natural tooth, will be recruited in each care home resulting in a recruited sample of 120 participants. Assessments will be undertaken at baseline, 6 months and 12 months, and will include a dental examination and questionnaires on general health and oral health administered by a research assistant. A parallel process evaluation involving semi-structured interviews will be undertaken to explore how the intervention could be embedded in standard practice. Rates of recruitment and retention, and intervention fidelity will also be recorded. A cost-consequence model will determine the relevance of different outcome measures in the decision-making context. Discussion: The study will provide valuable information for trialists, policymakers, clinicians and care home staff on the feasibility and associated costs of oral health promotion in UK care homes. Trial registration: ISRCTN10276613. Registered on 17th April 2020. http://www.isrctn.com/ISRCTN10276613. [ABSTRACT FROM AUTHOR]

Purpose – Research into the difficulties of post-combat service personnel adjusting to civilian society has largely focussed on quantifiable symptoms including post combat stress disorder. This paper aims to present qualitative data on experiences of military personnel who have served in combat, concentrating on how events in combat impacted on their subsequent transition back to the UK. Design/methodology/approach – The authors asked participants to focus on stressful experiences in combat and their ensuing experiences of work, family relationships, civilian society and emotional health. Semi-structured interviews were conducted with 15 military personnel who had returned from active combat. Transcripts were analysed using thematic analysis. Findings – Six major themes were found: the importance of being part of a group – this provided collective identity, as well as providing a context for legalised violent behaviour; shared experience – personnel prefer to seek support from individuals with similar experiences; help-seeking – personnel prefer to seek help from friends as opposed to professionals; professionalism and emotional processing – the "macho" approaches in the military may prevent real help-seeking and emotional disclosure; relationships and family – there were adjustments to be made in regard to personal relationships; civilian society – participants found civilian society to be lacking in real challenge and some engaged in risk-taking behaviour. Research limitations/implications – The research is limited by the small sample, mainly with commissioned officers. Practical implications – It would be of benefit to service personnel if those in helping professions who are working with them, also had experience of combat. Pre-combat training and post-combat debriefing may assist smoother transitions. Family counselling may be of benefit for personnel and their families. Originality/value – The research provides new and important insights into the difficulties facing personnel returning from stressful combat situations, and how they may best be helped. [ABSTRACT FROM AUTHOR]