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Background Improving the quality of care in hospitals continues to be a key priority within national dementia strategies. Dementia care, and in particular, dementia training are rapidly developing and dynamic fields of study. Different training packages have been developed, and these are often evaluated using varying methods. Understanding the relationships between the inputs and outputs of a programme (dementia training) is critical if we are to develop theory-based, programmatic models for intervention and policies. Aims and (where relevant) research/evaluation/project questions The primary aim of the study is to develop a logic model using the principles of programme theory to identify contextual factors, mechanisms, interaction, facilitators and barriers to dementia training in the hospital setting. Methods This study uses a two-phase mixed-methods design: 1 – The ‘experiential review and consultation’ stage (n=30, workshops and one-to-one consultations): The primary purpose of this stage was to consult and reflect with researchers, academics, dementia trainers, clinicians involved in development, implementation and evaluation of dementia training packages in hospital settings, and people living with dementia and carers to identify mechanisms, interaction, facilitators and barriers to dementia training in the hospital setting. This was the key stage to the development of the ‘initial’ programme theory for dementia training in hospital settings. 2 – Critical Interpretive Synthesis review of literature (qualitative, quantitative and mixed study), which aims to provide a systematic review of the current evidence base for dementia training in hospitals and the broader range of structures and dementia initiatives within hospitals. A further developmental step to the programme theory (logic model) was undertaken following review to further develop the ‘initial’ programme theory. Results There were various barriers to and facilitators of dementia training in hospitals

BACKGROUND: Pain and dementia are common in older people, and impaired cognitive abilities make it difficult for them to communicate their pain. Pain, if poorly managed, impairs health and well-being. Accurate pain assessment in this vulnerable group is challenging for hospital staff, but essential for appropriate management. Robust methods for identifying, assessing and managing pain are needed.AIMS AND OBJECTIVES: Two studies were undertaken to inform the development of a decision support tool to aid hospital staff in the recognition, assessment and management of pain. The first was a meta-review of systematic reviews of observational pain assessment instruments with three objectives: (1) to identify the tools available to assess pain in adults with dementia; (2) to identify in which settings they were used and with what patient populations; and (3) to assess their reliability, validity and clinical utility. The second was a multisite observational study in hospitals with four objectives: (1) to identify information currently used by clinicians when detecting and managing pain in patients with dementia; (2) to explore existing processes for detecting and managing pain in these patients; (3) to identify the role (actual/potential) of carers in this process; and (4) to explore the organisational context in which health professionals operate. Findings also informed development of health economics data collection forms to evaluate the implementation of a new decision support intervention in hospitals.METHODS: For the meta-review of systematic reviews, 12 databases were searched. Reviews of observational pain assessment instruments that provided psychometric data were included. Papers were quality assessed and data combined using narrative synthesis. The observational study used an ethnographic approach in 11 wards in four UK hospitals. This included non-participant observation of 31 patients, audits of patient records, semistructured interviews with 52 staff and four

Historically, the involvement of people living with dementia in research has predominantly focused on involvement as ‘participants’. In the ESRC/NIHR-funded (2014-2019) Neighbourhoods and Dementia Research Study (led by The University of Manchester), people living with dementia are involved as co-researchers across the Study’s eight work programmes and are currently designing and undertaking their own research projects. We are currently working alongside four groups of people living with dementia: EDUCATE from Stockport, Greater Manchester; Open Doors from Salford, Greater Manchester; Salford INSPIRE from Salford, Greater Manchester and; the Scottish Dementia Working Group (SDWG), who are based in Glasgow. This presentation will outline the development of a ‘Co-researcher Involvement and Engagement Model’, which was co-produced by the groups. The model illustrates a variety of ways in which people living with dementia within the groups would like to contribute to each of the work programmes for the duration of the Study.

Background: Pain is often poorly managed in people who have a dementia. Little is known about how this patient population is managed in hospital, with research to date focused mainly on care homes. This study aimed to investigatehow pain is recognised, assessed and managed in patients with dementia in a range of acute hospital wards, to inform the development of a decision support tool to improve pain management for this group.Methods: A qualitative, multi-site exploratory case study. Data were collected in four hospitals in England and Scotland. Methods included non-participant observations, audits of patient records, semi-structured interviews with staff and carers, and analysis of hospital ward documents. Thematic analysis was performed through the lens of decision making theory.Results: Staff generally relied on patients’ self-report of pain. For patients with dementia, however, communication difficulties experienced because of their condition, the organisational context, and time frames of staff interactions,hindered patients’ ability to provide staff with information about their pain experience. This potentially undermined the trials of medications used to provide pain relief to each patient and assessments of their responses to these treatments.Furthermore, given the multidisciplinary environment, a patient’s communication about their pain involved several members of staff, each having to make sense of the patient’s pain as in an ‘overall picture’. Information about patients’ pain, elicited in different ways, at different times and by different health care staff, was fragmented in paper-based documentation. Re-assembling the pieces to form a ‘patient specific picture of the pain’ required collective staff memory, ‘mental computation’ and time.Conclusions: There is a need for an efficient method of eliciting and centralizing all pain-related information for patients with dementia, which is distributed in time and between personnel. Such a method should give an

Background Improving the quality of care in hospitals continues to be a key priority within national dementia strategies. Dementia care, and in particular, dementia training are rapidly developing and dynamic fields of study. Different training packages have been developed, and these are often evaluated using varying methods. Understanding the relationships between the inputs and outputs of a programme (dementia training) is critical if we are to develop theory-based, programmatic models for intervention and policies. Aims and (where relevant) research/evaluation/project questions The primary aim of the study is to develop a logic model using the principles of programme theory to identify contextual factors, mechanisms, interaction, facilitators and barriers to dementia training in the hospital setting. Methods This study uses a two-phase mixed-methods design: 1 – The ‘experiential review and consultation’ stage (n=30, workshops and one-to-one consultations): The primary purpose of this stage was to consult and reflect with researchers, academics, dementia trainers, clinicians involved in development, implementation and evaluation of dementia training packages in hospital settings, and people living with dementia and carers to identify mechanisms, interaction, facilitators and barriers to dementia training in the hospital setting. This was the key stage to the development of the ‘initial’ programme theory for dementia training in hospital settings. 2 – Critical Interpretive Synthesis review of literature (qualitative, quantitative and mixed study), which aims to provide a systematic review of the current evidence base for dementia training in hospitals and the broader range of structures and dementia initiatives within hospitals. A further developmental step to the programme theory (logic model) was undertaken following review to further develop the ‘initial’ programme theory. Results There were various barriers to and facilitators of dementia training in hospitals

Background: Pain is often poorly managed in people who have a dementia. Little is known about how this patient population is managed in hospital, with research to date focused mainly on care homes. This study aimed to investigatehow pain is recognised, assessed and managed in patients with dementia in a range of acute hospital wards, to inform the development of a decision support tool to improve pain management for this group.Methods: A qualitative, multi-site exploratory case study. Data were collected in four hospitals in England and Scotland. Methods included non-participant observations, audits of patient records, semi-structured interviews with staff and carers, and analysis of hospital ward documents. Thematic analysis was performed through the lens of decision making theory.Results: Staff generally relied on patients’ self-report of pain. For patients with dementia, however, communication difficulties experienced because of their condition, the organisational context, and time frames of staff interactions,hindered patients’ ability to provide staff with information about their pain experience. This potentially undermined the trials of medications used to provide pain relief to each patient and assessments of their responses to these treatments.Furthermore, given the multidisciplinary environment, a patient’s communication about their pain involved several members of staff, each having to make sense of the patient’s pain as in an ‘overall picture’. Information about patients’ pain, elicited in different ways, at different times and by different health care staff, was fragmented in paper-based documentation. Re-assembling the pieces to form a ‘patient specific picture of the pain’ required collective staff memory, ‘mental computation’ and time.Conclusions: There is a need for an efficient method of eliciting and centralizing all pain-related information for patients with dementia, which is distributed in time and between personnel. Such a method should give an

BACKGROUND: Pain and dementia are common in older people, and impaired cognitive abilities make it difficult for them to communicate their pain. Pain, if poorly managed, impairs health and well-being. Accurate pain assessment in this vulnerable group is challenging for hospital staff, but essential for appropriate management. Robust methods for identifying, assessing and managing pain are needed.AIMS AND OBJECTIVES: Two studies were undertaken to inform the development of a decision support tool to aid hospital staff in the recognition, assessment and management of pain. The first was a meta-review of systematic reviews of observational pain assessment instruments with three objectives: (1) to identify the tools available to assess pain in adults with dementia; (2) to identify in which settings they were used and with what patient populations; and (3) to assess their reliability, validity and clinical utility. The second was a multisite observational study in hospitals with four objectives: (1) to identify information currently used by clinicians when detecting and managing pain in patients with dementia; (2) to explore existing processes for detecting and managing pain in these patients; (3) to identify the role (actual/potential) of carers in this process; and (4) to explore the organisational context in which health professionals operate. Findings also informed development of health economics data collection forms to evaluate the implementation of a new decision support intervention in hospitals.METHODS: For the meta-review of systematic reviews, 12 databases were searched. Reviews of observational pain assessment instruments that provided psychometric data were included. Papers were quality assessed and data combined using narrative synthesis. The observational study used an ethnographic approach in 11 wards in four UK hospitals. This included non-participant observation of 31 patients, audits of patient records, semistructured interviews with 52 staff and four

Historically, the involvement of people living with dementia in research has predominantly focused on involvement as ‘participants’. In the ESRC/NIHR-funded (2014-2019) Neighbourhoods and Dementia Research Study (led by The University of Manchester), people living with dementia are involved as co-researchers across the Study’s eight work programmes and are currently designing and undertaking their own research projects. We are currently working alongside four groups of people living with dementia: EDUCATE from Stockport, Greater Manchester; Open Doors from Salford, Greater Manchester; Salford INSPIRE from Salford, Greater Manchester and; the Scottish Dementia Working Group (SDWG), who are based in Glasgow. This presentation will outline the development of a ‘Co-researcher Involvement and Engagement Model’, which was co-produced by the groups. The model illustrates a variety of ways in which people living with dementia within the groups would like to contribute to each of the work programmes for the duration of the Study.

Background: People with psychosis often experience weight gain, which places them at risk of cardiovascular disease, diabetes, and early death. Objective: To determine the uptake, adherence, and clinical effectiveness of a healthy living intervention designed to reduce weight gain. Method: An exploratory randomized controlled trial, comparing the intervention with treatment as usual (TAU) in 2 early intervention services for psychosis in England. DSM-IV classification was the diagnostic criteria used to assign the psychiatric diagnoses. The primary outcome was change in body mass index (BMI) from baseline to 12-month follow-up. The study was conducted between February 2009 and October 2012. Results: 105 service users, with a BMI of ≥ 25 (≥ 24 in South Asians), were randomized to intervention (n = 54) orTAU (n = 51) after stratification by recent commencement of antipsychotic medication. Ninety-three service users (89%) were followed up at 12 months. Between-group difference in change in BMI was not significant (effect size = 0.11).The effect of the intervention was larger (effect size = 0.54, not significant) in 15 intervention (28%) and 10TAU (20%) participants who were taking olanzapine or clozapine at randomization. Conclusions: The healthy living intervention did not show a significant difference in BMI reduction compared to the TAU group. © Copyright 2014 Physicians Postgraduate Press, Inc.

Aim. The study aimed to develop, deliver, and evaluate a training programme in care homes to enhance the quality of care for people living with dementia based on the principles of relationship-centred care expressed through the Senses Framework. Background. There are increasing numbers of people living with dementia worldwide with a growing proportion requiring residential long-term care. This makes the quest for enhancing the quality of care and quality of life for people with dementia ever more pressing. Design. A mixed-methods design was used adopting a Practice Development approach. The findings from one care home in the North West of England are reported. Methods. Eight facilitated workshops based on the principles of relationship-centred care were completed and evaluated in 2010, using pre- and postintervention design. A focus group was undertaken with staff on completion of the study to gain a more comprehensive understanding of the practice/training context, augmented by case examples of changes in practice identified from the study workshops. Results. Structured questionnaires were used to profile the care home before and after the training. Following the workshops, staff felt more able to collect and use biographical information. In particular, staff reported how this information supported them to initiate meaningful conversations with the person with dementia as part of everyday care routines, thus improving overall feelings of well-being. Conclusion. Using a biographical approach to care planning structured through the Senses Framework helped staff to develop a greater understanding of the person with dementia. © 2012 Blackwell Publishing Ltd.

Aim. The study aimed to develop, deliver, and evaluate a training programme in care homes to enhance the quality of care for people living with dementia based on the principles of relationship-centred care expressed through the Senses Framework. Background. There are increasing numbers of people living with dementia worldwide with a growing proportion requiring residential long-term care. This makes the quest for enhancing the quality of care and quality of life for people with dementia ever more pressing. Design. A mixed-methods design was used adopting a Practice Development approach. The findings from one care home in the North West of England are reported. Methods. Eight facilitated workshops based on the principles of relationship-centred care were completed and evaluated in 2010, using pre- and postintervention design. A focus group was undertaken with staff on completion of the study to gain a more comprehensive understanding of the practice/training context, augmented by case examples of changes in practice identified from the study workshops. Results. Structured questionnaires were used to profile the care home before and after the training. Following the workshops, staff felt more able to collect and use biographical information. In particular, staff reported how this information supported them to initiate meaningful conversations with the person with dementia as part of everyday care routines, thus improving overall feelings of well-being. Conclusion. Using a biographical approach to care planning structured through the Senses Framework helped staff to develop a greater understanding of the person with dementia. © 2012 Blackwell Publishing Ltd.

Aims. This article is a report of a study that aimed to establish a national picture of the implementation of Review recommendations over time in both Mental Health Trusts and Higher Education Institutions (Universities) in England. Background. The 2006 Review of Mental Health Nursing in England by the Chief Nursing Officer made 17 key recommendations for Mental Health Trusts and Universities to improve mental health nursing. This article outlines key findings from a national survey of National Health Service Trusts and Universities in England with regard to prioritization and progress on implementation of these recommendations. Methods. An e-survey was carried out in 2008-2009 based on the Chief Nursing Officer review recommendations and guidance. Participants included all Trusts which delivered mental health services (n=68) and Universities which delivered pre-registration mental health nursing education (n=50) in England. Results. There appears to be some evidence that the Chief Nursing Officer review of Mental Health Nursing in England continues to be implemented in both Mental Health Trusts and Universities. There is variety in levels of implementation, but Mental Health Trusts and Universities broadly agree on priority areas. Conclusions. The Chief Nursing Officer review has been influential in focusing the care and education of mental health nurses and services in England. There appears to be a range of barriers and facilitators which aid the implementation of healthcare policy. More attention is required from researchers to enhance and evaluate the impact of policy implementation on the quality of care provided. © 2011 Blackwell Publishing Ltd.

Objectives: The aim of this study was to examine knowledge of dementia in South Asian older people, as compared with Caucasian older people. Methods: Attendees, not known to suffer from dementia, of one South Asian and two predominantly Caucasian day centres for older people in Manchester (UK) were asked to complete the Dementia Knowledge Questionnaire (DKQ). The DKQ was translated into Gujarathi and Urdu by the professional translators. Results: One hundred and ninety-one DKQs from Indian and 55 DKQs from Caucasian (white UK/Irish/European) older people were included in the analyses. Knowledge of dementia was poor in both Indian and Caucasian older people, especially so in the former. The median (25th-75th percentile) total DKQ scores were 3 (2-5) in Indians and 6 (3.5-9) in Caucasians (p

Background: In the UK, the National Institute for Health and Clinical Excellence (NICE) is currently reviewing cost-effectiveness of cholinesterase inhibitors (ChEIs) for Alzheimer's disease (AD) in the NHS. The implementation of the original NICE (2001) guidance that made these drugs available in the UK was not examined in this review process, and was the objective of this study. Method: Ten hospitals in and around Manchester participated in the audit. Case records of all patients who were started on ChEIs between January 2002 and the date of the audit (November 2003 to December 2004) were examined to assess adherence to the NICE (2001) guidance. Information about available resources was gathered from lead clinicians of each hospital. Results: A total of 1092 case records were examined. The treatment of AD with ChEIs varied considerably with regard to pre-treatment investigations, waiting period for treatment, scales used to assess efficacy, adherence to the NICE (2001) guidance, and available resources. The actual number of patients with mild to moderate AD receiving ChEIs was much lower than that expected from known prevalence rates. Non-uniformity of clinical practice and missing data were the main limitations of the audit. Conclusion: There is a need to harmonise the use and monitoring of ChEIs for AD in the NHS so that the data from routine clinical practice could feed into future clinical and cost-effectiveness analyses. Copyright © 2006 John Wiley & Sons, Ltd.

Background: In the UK, the National Institute for Health and Clinical Excellence (NICE) is currently reviewing cost-effectiveness of cholinesterase inhibitors (ChEIs) for Alzheimer's disease (AD) in the NHS. The implementation of the original NICE (2001) guidance that made these drugs available in the UK was not examined in this review process, and was the objective of this study. Method: Ten hospitals in and around Manchester participated in the audit. Case records of all patients who were started on ChEIs between January 2002 and the date of the audit (November 2003 to December 2004) were examined to assess adherence to the NICE (2001) guidance. Information about available resources was gathered from lead clinicians of each hospital. Results: A total of 1092 case records were examined. The treatment of AD with ChEIs varied considerably with regard to pre-treatment investigations, waiting period for treatment, scales used to assess efficacy, adherence to the NICE (2001) guidance, and available resources. The actual number of patients with mild to moderate AD receiving ChEIs was much lower than that expected from known prevalence rates. Non-uniformity of clinical practice and missing data were the main limitations of the audit. Conclusion: There is a need to harmonise the use and monitoring of ChEIs for AD in the NHS so that the data from routine clinical practice could feed into future clinical and cost-effectiveness analyses. Copyright © 2006 John Wiley & Sons, Ltd.