Exploring the evidence base for how people with dementia and their informal carers manage their medication in the community:a mixed studies review

BACKGROUND: Little is known about the general medicines management issues for people with dementia living in the community. This review has three aims: firstly to explore and evaluate the international literature on how people with dementia manage medication; assess understanding of medicines management from an informal carers perspective; and lastly to understand the role that healthcare professionals play in assisting this population with medicines management. METHODS: A mixed studies review was conducted. Web of Knowledge, PubMed and Cochrane Library were searched post-1999 for studies that explored medicines management in people with dementia dwelling in the community, and the role healthcare professionals play in supporting medicines management in people with dementia. Following screening, nine articles were included. Data from included studies were synthesised using a convergent synthesis approach and analysed thematically to combine findings from studies using a range of methods (qualitative, quantitative and mixed methods). RESULTS: Four themes were generated from the synthesis: The nature of the disease and the effects this had on medicines management; the additional responsibilities informal carers have; informal caregivers' knowledge of the importance of managing medication and healthcare professionals' understanding of medicines management in people with dementia. Consequently, these were found to affect management of medication, in particular adherence to medication. CONCLUSIONS: This review has identified that managing medication for people with dementia dwelling in the community is a complex task with a frequently associated burden on their informal caregivers. Healthcare professionals can be unaware of this burden. The findings warrant the need for healthcare professionals to undergo further training in supporting medicines management for people with dementia in their own homes

Seascape Genomics: Contextualizing Adaptive and Neutral Genomic Variation in the Ocean Environment

Seventy-one per cent of the earth’s surface is covered by ocean which contains almost 80% of the world’s phyla – “seascape genomics” is the study of how spatial dependence and environmental features in the ocean influence the geographic structure of genomic patterns in marine organisms. The field extends from seascape genetics where the study of small numbers of neutral loci predominates, to additionally consider larger numbers of loci from throughout the genome that may be of some functional or adaptive significance and are subject to selection. Seascape genomics is conceptually similar to landscape genomics; the disciplines share theoretical underpinnings, and the genetic measures and analytical methods are often the same. However, the spatio-temporal variability of the physical ocean environment and the biological characteristics of marine organisms (e.g. large population sizes and high dispersal ability) present some characteristic challenges and opportunities for spatial population genomics studies. This chapter provides an overview of the field of seascape genomics, outlines concepts and methods to consider when conducting seascape genomics studies, and highlights future research avenues and opportunities for the application of seascape genomics to global issues affecting our marine environment