Tailoring a complex intervention to reduce antidepressants in institutionalized older persons with dementia

INTRODUCTION: First-line treatment for behavioral and psychiatric symptoms of dementia is non-pharmacological. Still, psychotropic medication is widely used, despite its limited effect and harmful side-effects. More than half of all nursing home residents with dementia receive antidepressants, even though deprescribing is safe and feasible. Interventions to promote deprescribing of antidepressants in nursing homes are few and complex. To optimize the deprescribing process through an intervention, transparency for the development of the intervention is needed. We aim to describe the steps in the development and tailoring of an intervention targeting GPs, nursing home staff, and relatives to enhance collaboration on reducing the use of antidepressants in institutionalized older persons with dementia in Denmark. METHOD: A step-wise process guided by the core elements in the Medical Research Council constituted the tailoring process. Five steps were included; 1) a literature search, 2) interviews with stakeholders, 3) drafting the intervention prototype, 4) professionals’ assessment of the intervention, and 5) refinement of the intervention. The steps were conducted from June 2020 to June 2022. RESULTS: Based on the literature search, interviews with stakeholders, and professionals’ assessment of the intervention, four main themes were identified; 1) focusing on antidepressants, 2) importance of professional qualifications, 3) collaboration and communication, and 4) patient and relative involvement. They guided intervention development and refinement of the final intervention, which included 1) a case-based training course and 2) a dialog tool including a symptom assessment scale to be used in a structured consultation at the nursing home. CONCLUSION: This study presents a detailed account of the tailoring process for a complex intervention to optimize deprescribing of antidepressants for older persons with dementia at nursing homes. By presenting a thorough development process, we expect to achieve increased adherence to the intervention which is currently being tested in an ongoing cluster randomized controlled trial. The transparency of the process will also increase the future development of other similar complex interventions. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-022-08961-9

Identifying behavioural determinants to uptake and adherence to a whey protein supplement for the management of type 2 diabetes: A qualitative interview study

Interventions targeting diet and physical activity have demonstrated to be effective for improving glycaemic control in adults with type 2 diabetes. However, initiating and sustaining these changes remains a challenge. Ingestion of whey protein has shown to be effective for improving glycaemic control by increasing insulin and incretin secretion, and influencing appetite regulation; however, little is known about what influences uptake and adherence. We conducted a qualitative interview study to explore behavioural determinants of uptake and adherence to a commercially made whey protein supplementation. In total, 16/18 adults with type 2 diabetes who participated in an RCT took part in a semi-structured interview. Seven themes were generated from the data following thematic analyses. The most frequently reported determinant of uptake was the expectation that the supplement would improve health status (e.g., type 2 diabetes management), as a consequence of appetite suppression and weight loss. Determinants of adherence included palatability; the belief that the supplement was an appetite suppressant; and receiving positive reinforcement on the effects of the supplement. Frequency of consumption led to reduced adherence with some participants. Findings support that the whey protein supplement is a viable management option for adults with type 2 diabetes; however, uptake will be driven by conveying information on the positive effects of the supplement on appetite suppression and glycaemic control. Adherence will be determined by palatability, behavioural prompting, and positive reinforcement

Involving patients in medicines optimisation in general practice:a development study of the "PREparing Patients for Active Involvement in medication Review" (PREPAIR) tool

BACKGROUND: Many patients have multiple health conditions and take multiple medications (polypharmacy). Active patient involvement may improve treatment outcomes and ensure patient-centred care. Yet, patient involvement remains a challenge in clinical practice. We aimed to develop and pilot test a questionnaire-based preparation and dialogue tool, the PREparing Patients for Active Involvement in medication Review (PREPAIR) tool, to encourage the involvement of patients with polypharmacy in medicines optimisation in general practice. METHODS: We conducted a literature review followed by a co-production process to develop the tool: a workshop with six GPs and pilot testing, including observations and interviews, with 22 patients, three GPs and three practice staff. During this process, we made continuous adaptations to the prototype. We analysed the qualitative data thematically, focusing on the development process and mechanisms of impact. FINDINGS: The final PREPAIR tool included five items concerning the patient’s experience of 1) adverse drug reactions, 2) excess medication, 3) unnecessary medication, 4) medication satisfaction and 5) medication-related topics to discuss with the GP (open-ended question). The applied workflow during testing was as follows; the patient completed the PREPAIR tool at home, to encourage reflection on the medication, and brought it to the GP consultation. During the consultation, the GP and the patient reviewed the patient’s responses and discussed potential medication-related problems. For some patients, the increased reflection led to worries about the medications. Still, the pilot testing showed that, when using the PREPAIR tool, the patients arrived at the clinic well prepared and empowered to speak. From the PREPAIR-supported dialogue, the GPs obtained a better understanding of patients’ perspectives and provided a more patient-centred consultation. For the patients, the PREPAIR-supported dialogue ultimately promoted an increased sense of security, satisfaction and insight into their medication, despite initial worries for some patients. CONCLUSIONS: We developed a brief tool to support active patient involvement in medication review in general practice. The PREPAIR-tool was well received by both patients and GPs and fitted well into the existing clinical practice. Our findings suggest that the PREPAIR-tool can support patient involvement during consultations and facilitate patient-centred care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12875-022-01733-8

Bismuth molybdate catalysts prepared by mild hydrothermal synthesis: Influence of pH on the selective oxidation of propylene

A series of bismuth molybdate catalysts with relatively high surface area was prepared via mild hydrothermal synthesis. Variation of the pH value and Bi/Mo ratio during the synthesis allowed tuning of the crystalline Bi-Mo oxide phases, as determined by X-ray diffraction (XRD) and Raman spectroscopy. The pH value during synthesis had a strong influence on the catalytic performance. Synthesis using a Bi/Mo ratio of 1/1 at pH ≥ 6 resulted in γ-Bi2MoO6, which exhibited a better catalytic performance than phase mixtures obtained at lower pH values. However, a significantly lower catalytic activity was observed at pH = 9 due to the low specific surface area. γ-Bi2MoO6 synthesized with Bi/Mo = 1/1 at pH = 6 and 7 exhibited relatively high surface areas and the best catalytic performance. All samples prepared with Bi/Mo = 1/1, except samples synthesized at pH = 1 and 9, showed better catalytic performance than samples synthesized with Bi/Mo = 2/3 at pH = 4 and 9 and γ-Bi2MoO6 synthesized by co-precipitation at pH = 7. At temperatures above 440 °C, the catalytic activity of the hydrothermally synthesized bismuth molybdates started to decrease due to sintering and loss of surface area. These results support that a combination of the required bismuth molybdate phase and a high specific surface area is crucial for a good performance in the selective oxidation of propylene

A robust linkage map of the porcine autosomes based on gene-associated SNPs

<p>Abstract</p> <p>Background</p> <p>Genetic linkage maps are necessary for mapping of mendelian traits and quantitative trait loci (QTLs). To identify the actual genes, which control these traits, a map based on gene-associated single nucleotide polymorphism (SNP) markers is highly valuable. In this study, the SNPs were genotyped in a large family material comprising more than 5,000 piglets derived from 12 Duroc boars crossed with 236 Danish Landrace/Danish Large White sows. The SNPs were identified in sequence alignments of 4,600 different amplicons obtained from the 12 boars and containing coding regions of genes derived from expressed sequence tags (ESTs) and genomic shotgun sequences.</p> <p>Results</p> <p>Linkage maps of all 18 porcine autosomes were constructed based on 456 gene-associated and six porcine EST-based SNPs. The total length of the averaged-sex whole porcine autosome was estimated to 1,711.8 cM resulting in an average SNP spacing of 3.94 cM. The female and male maps were estimated to 2,336.1 and 1,441.5 cM, respectively. The gene order was validated through comparisons to the cytogenetic and/or physical location of 203 genes, linkage to evenly spaced microsatellite markers as well as previously reported conserved synteny. A total of 330 previously unmapped genes and ESTs were mapped to the porcine autosome while ten genes were mapped to unexpected locations.</p> <p>Conclusion</p> <p>The linkage map presented here shows high accuracy in gene order. The pedigree family network as well as the large amount of meiotic events provide good reliability and make this map suitable for QTL and association studies. In addition, the linkage to the RH-map of microsatellites makes it suitable for comparison to other QTL studies.</p

The Importance of the Outdoor Environment for the Recovery of Psychiatric Patients: A Scoping Review

(1) Background: Research has shown that patients with mental health diagnoses experience less anxiety and depressive symptoms and higher levels of &lsquo;well-being&rsquo; when they spend time in natural environments as part of their treatment. It has been suggested that there is a relationship between the outdoor settings and the recovery of psychiatric patients. Recovery describes an individual process, which can vary from person to person. (2) Methods: This scoping review examined the relationship between the physical environment and the recovery of psychiatric patients. Systematic searches in three online databases, namely Medline, Embase, and PsycINFO, were performed using a selection of psychiatric, environmental, and recovery terms and included both quantitative and qualitative studies. In general, &lsquo;well-being&rsquo; serves as an overarching indicator when it comes to research on how outdoor settings can affect mental health. Well-being was expressed in terms of mood, social relations, and autonomy. (3) Results: A total of 8138 records were screened, 85 studies were included for full-text reading, and five articles were included in the final analysis. The review showed in general that outdoor settings, more specifically gardening, contact with nature, and a safe environment can be related to the well-being of patients on psychiatric wards. (4) Conclusions: The five reviews allow us to conclude that outdoor settings can be seen as a comprehensive resource for mental health

Sensitivity of live microalgal aquaculture feed to singlet oxygen-based photodynamic therapy

Highly nutritional microalgal species are extensively used in aquaculture as live feedstock. Due to difficulties in maintaining microalgae in axenic conditions, they represent a potential pathogen carrier and disease vector in aquaculture ponds. Photodynamic therapy (PDT) via singlet oxygen (1O2) production is a promising sterilization technique in aquaculture. Here, we report on the sensitivity of aquaculture-relevant microalgae towards 1O2 generated by the cationic photosensitizer TMPyP. Possible PDT sterilization protocols of contaminated microalgae cultures were evaluated using the luminescent bacterium Vibrio campbellii ISO7 as a model aquaculture pathogen. Species specific sensitivity of microalgae to TMPyP-mediated PDT was demonstrated and found to be strongly influenced by the nature and architecture of their respective cell wall. While cytotoxicity was not evident against Nannochloropsis oculata, toxicity of 1O2 was dose-, time- and light activation-dependent against Tisochrysis lutea, Tetraselmis chui, Chaetoceros muelleri and Picochlorum atomus. The 1O2-resilient N. oculata was sterilized when incubated under light in the presence of V. campbellii ISO7 (up to 107 CFU mL−1) and 20 μM TMPyP; hence, TMPyP based PDT sterilization of N. oculata could be suitable for aquaculture hatcheries. This study also suggests that PDT using cationic porphyrins such as TMPyP holds potential as an algicidal treatment in aquaria and aquaculture systems (but more research using opportunistic and toxic species is needed for confirmation)