The barriers and facilitators to stopping inappropriate medicines ('deprescribing') for older people living in care homes

Background: UK care home residents are prescribed an average of 8-10 medicines daily with evidence that inappropriate prescribing is prevalent leading to problematic polypharmacy. This increases the risk of adverse drug events that negatively affect resident outcomes, quality-of-life and have financial costs to the NHS. Deprescribing (the cessation of inappropriate medicines) can reduce inappropriate prescribing, however, there are significant barriers to its implementation in this setting. Identifying and understanding barriers and facilitators of stopping inappropriate medicines is necessary to improve the implementation of deprescribing in care homes. Methods: A literature review was conducted to synthesise existing evidence. Semi-structured interviews were conducted with residents, relatives, care home staff, GPs and pharmacists. Themes and explanations were developed using Framework Analysis. Theoretical models of behaviour change were applied to identify candidate components for a novel intervention for deprescribing in care homes. Findings: The literature review highlighted a lack of evidence regarding residents’ and relatives’ attitudes to deprescribing, and a lack of depth regarding barriers and facilitators to deprescribing. Three themes were identified from the empirical data: 1) individuals involved in the deprescribing process; 2) social barriers; 3) logistical barriers. Theme 1 highlighted the complexity of the deprescribing process and themes 2&3 identified and explained systematic barriers and facilitators to deprescribing. Social barriers included a reluctance to discuss life expectancy and healthcare professionals’ perceptions of residents and relatives. Logistical barriers included the unavailability of key stakeholders and navigating health and social care systems. Potential intervention components included; demonstrating the behaviour of deprescribing, providing feedback on its outcomes plus provision of prompts. Conclusions: This thesis has provided novel, in-depth explanation and insight of the barriers and facilitators to deprescribing from the perspective of key stakeholders. This was utilised to identify potential components of a deprescribing behaviour change intervention for implementation and evaluation in care homes

Reaction Data in PubChem

A presentation at the enviPathPlus workshop (held online) on "Reaction Data in PubChem". Presented by E. Schymanski on behalf of all authors. See slides for details and many hyperlinks - thanks to Kathrin Fenner for the opportunity

The burden of chronic respiratory diseases in adults in Nepal:A systematic review

While chronic lung disease causes substantial global morbidity and mortality, global estimates have primarily been based on broad assumptions. Specific country data from low-income countries such as Nepal are limited. This review assessed primary evidence on chronic respiratory disease burden among adults in Nepal. A systematic search was performed in June 2019 (updated May 2020) for studies through nine databases. High levels of heterogeneity deemed a narrative synthesis appropriate. Among 27 eligible studies identified, most were low-moderate quality with cross-sectional and retrospective study design. Chronic lung diseases identified were chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis and restrictive lung diseases. Studies were categorised as: (i) community-based, (ii) hospital-based and (iii) comorbidity-related and disease burden. Reported disease prevalence varied widely (COPD, 1.67–14.3%; asthma, 4.2–8.9%). The prevalence of airflow obstruction was higher among rural dwellers (15.8%) and those exposed to household air pollution from domestic biomass burning as opposed to liquid petroleum gas users (Odds Ratio: 2.06). Several comorbidities, including hypertension and diabetes mellitus added to the disease burden. The review shows limited literature on lung disease burden in Nepal. Publications varied in terms of overall quality. Good quality research studies with prospective cohorts related to respiratory conditions are required

PARMELA VS MEASUREMENTS FOR GTF AND DUVFEL

The particle-pushing PARMELA was used to design the photo-injector beamline of the Linac Coherent Light Source (LCLS) to be built at SLAC in 2005. PARMELA predicts that projected emittances smaller than 1.2 mm.mrad and slice emittance smaller than 1.0 mm.mrad will be achievable for 1nC, 10ps electron bunches with an S-band RF gun and an emittance compensating system. To benchmark PARMELA, comparisons between simulations and measurements for two photo-injector test facilities, the Gun Test Facility (GTF) at SLAC and the Deep Ultra Violet FEL (DUVFEL) at BNL, have been performed. Aspects of the modeling of fields and initial distributions are discussed. The agreement between measured and simulated beam parameters (projected and slice emittance, Twiss parameters) is satisfying. Accordingly, it gives credibility to the extrapolation made for studying the LCLS case. PARMELA also indicates possible improvements in the tuning of those facilities to achieve the LCLS required beam properties.

ShinyTPs: Curating Transformation Products from Text Mining Results.

peer reviewedTransformation product (TP) information is essential to accurately evaluate the hazards compounds pose to human health and the environment. However, information about TPs is often limited, and existing data is often not fully Findable, Accessible, Interoperable, and Reusable (FAIR). FAIRifying existing TP knowledge is a relatively easy path toward improving access to data for identification workflows and for machine-learning-based algorithms. ShinyTPs was developed to curate existing transformation information derived from text-mined data within the PubChem database. The application (available as an R package) visualizes the text-mined chemical names to facilitate the user validation of the automatically extracted reactions. ShinyTPs was applied to a case study using 436 tentatively identified compounds to prioritize TP retrieval. This resulted in the extraction of 645 reactions (associated with 496 compounds), of which 319 were not previously available in PubChem. The curated reactions were added to the PubChem Transformations library, which was used as a TP suspect list for identification of TPs using the open-source workflow patRoon. In total, 72 compounds from the library were tentatively identified, 18% of which were curated using ShinyTPs, showing that the app can help support TP identification in non-target analysis workflows.U-AGR-8049 - H2020 - ZeroPM (01/10/2021 - 30/09/2026) - SCHYMANSKI Emm

Insufficient evidence of benefit: a systematic review of home telemonitoring for COPD

Rationale, aims and objectives The evidence to support the effectiveness of home telemonitoring interventions for patients with chronic obstructive pulmonary disease (COPD) is limited, yet there are many efforts made to implement these technologies across health care services. Methods A comprehensive search strategy was designed and implemented across 9 electronic databases and 11 European, Australasian and North American telemedicine websites. Included studies had to examine the effectiveness of telemonitoring interventions, clearly defined for the study purposes, for adult patients with COPD. Two researchers independently screened each study prior to inclusion. Results Two randomized trials and four other evaluations of telemonitoring were included. The studies are typically underpowered, had heterogeneous patient populations and had a lack of detailed intervention descriptions and of the care processes that accompanied telemonitoring. In addition, there were diverse outcome measures and no economic evaluations. The telemonitoring interventions in each study differed widely. Some had an educational element that could itself account for the differences between groups. Conclusions Despite these caveats, the study reports are themselves positive about their results. However, given the risk of bias in the design and scale of the evaluations we conclude that the benefit of telemonitoring for COPD is not yet proven and that further work is required before wide-scale implementation be supported

Open and FAIR transformation product data for improved suspect/non-target screening: REFTPs in the NORMAN-SLE, PubChem and patRoon

peer reviewedPresentation given at ICCE, Venice, 11 - 15 June 2023