CompreHensive geriAtRician-led MEdication Review (CHARMER): protocol for a feasibility study of a hospital deprescribing behaviour change intervention

Introduction Over 50% of older adults are prescribed a medicine where the risk of harm outweighs the chances of benefit. During a hospital admission, older adults and carers expect medicines to be reviewed for appropriateness and any inappropriate medicines proactively deprescribed. While the principle of proactive deprescribing is an expectation of good prescribing practice, it is yet to become routine. The CompreHensive geriAtRician-led MEdication Review (CHARMER) study aims to develop and test a five-component behaviour change intervention to equip geriatricians and pharmacists to proactively deprescribe inappropriate medicines with older adults in hospital. This study aims to test the feasibility and acceptability of study processes and CHARMER implementation. Methods and analysis A two-arm purposive allocation feasibility study is being undertaken at four acute hospitals in England, UK (three intervention and one control). The target sample is 400 patients across all hospitals. Primary outcome measures are: (1) participant recruitment rate and (2) participant attrition rate. Secondary outcome measures are: (1) hospital readmission rate; (2) mortality rate and (3) quality of life. Quantitative data will be checked for completeness and quality, and practitioner and patient demographics descriptively analysed. We will undertake a rapid qualitative analysis on observations, interviews and study meeting minutes data. A subsequent thematic analysis will be undertaken with codes mapped to the Theoretical Domains Framework and Normalisation Process Theory. Triangulation of qualitative and quantitative data will be undertaken. Ethics and dissemination Ethics approval was obtained from Wales Research Ethics Committee 1 (IRAS ID 312494) and study approval from the Health Research Authority (22/WA/0087). Informed consent will be sought from all hospital staff involved in data collection activities and for patients involved in enhanced data collection activities. The findings of this study will be disseminated in peer-reviewed journals and conference presentations

New horizons in the role of digital data in the healthcare of older people

There are national and global moves to improve effective digital data design and application in healthcare. This New Horizons commentary describes the role of digital data in healthcare of the ageing population. We outline how health and social care professionals can engage in the proactive design of digital systems that appropriately serve people as they age, carers and the workforce that supports them. Key Points Healthcare improvements have resulted in increased population longevity and hence multimorbidity. Shared care records to improve communication and information continuity across care settings hold potential for older people. Data structure and coding are key considerations. A workforce with expertise in caring for older people with relevant knowledge and skills in digital healthcare is important

Television viewing, walking speed, and grip strength in a prospective cohort study

Purpose: Television (TV) watching is the most prevalent sedentary leisure time activity in the United Kingdom. We examined associations between TV viewing time, measured over 10 yr, and two objective measures of physical capability, usual walking speed (UWS) and grip strength.Methods: Community-based participants (n = 8623; 48–92 yr old) enrolled in the European Prospective Investigation of Cancer—Norfolk study attended a third health examination (3HC, 2006–2011) for measurement of maximum grip strength (Smedley dynamometer) and UWS. TV viewing time was estimated using a validated questionnaire (n = 6086) administered during two periods (3HC, 2006–2007; 2HC, 1998–2000). Associations between physical capability and TV viewing time category (&lt;2, 2 &lt; 3, 3 &lt; 4, and ?4 h·d?1) at the 3HC, 2HC, and using an average of the two measures were explored. Sex-stratified analyses were adjusted for age, physical activity, anthropometry, wealth, comorbidity, smoking, and alcohol intake and combined if no sex–TV viewing time interactions were identified.Results: Men and women who watched the least TV at the 2HC or 3HC walked at a faster usual pace than those who watched the most TV. There was no evidence of effect modification by sex (Pinteraction = 0.09), and in combined analyses, participants who watched for &lt;2 h·d?1 on average walked 4.29 cm·s?1 (95% confidence interval, 2.56–6.03) faster than those who watched for ?4 h·d?1, with evidence of a dose–response association (Ptrend &lt; 0.001). However, no strong associations with grip strength were found.Conclusions: TV viewing time predicted UWS in older adults. More research is needed to inform public health policy and prospective associations between other measures of sedentariness, such as total sitting time or objectively measured sedentary time, and physical capability should be explored.<br/

New horizons in the role of digital data in the healthcare of older people

There are national and global moves to improve effective digital data design and application in healthcare. This New Horizons commentary describes the role of digital data in healthcare of the ageing population. We outline how health and social care professionals can engage in the proactive design of digital systems that appropriately serve people as they age, carers and the workforce that supports them. KEY POINTS: Healthcare improvements have resulted in increased population longevity and hence multimorbidity. Shared care records to improve communication and information continuity across care settings hold potential for older people. Data structure and coding are key considerations. A workforce with expertise in caring for older people with relevant knowledge and skills in digital healthcare is important.Published version, accepted version (12 month embargo), submitted versionThe article is available via Open Access. Click on the 'Additional link' above to access the full-text

Pipe Scales and Biofilms in Drinking-Water Distribution Systems: Undermining Finished Water Quality

Safety and security are two important features of urban drinking-water distribution systems (UDWDS), worldwide, that are often compromised by a suite of physical, hydraulic, and chemical factors adversely impacting quality of potable water reaching consumer taps. Growth of scales and biofilm conglomerates (SBC) coupled with sorption of water chemicals and planktonic microorganisms by SBC has been increasingly recognized as underestimated contaminant sources in aging pipe networks of UDWDS. The main objective of this study was to provide an updated review of factors and processes associated with the increasing frequency of deteriorated finished water quality incidences as a result of SBC effects in UDWDS. This critical review integrated scattered knowledge on the effects of either pipe scales or pipe-anchored biofilm systems on contaminant destabilization and subsequent release into water. It was emphasized that little information exists on combined or concomitantly studied effects of SBC on finished water quality. Important synergistic SBC effects on finished water quality were identified as: (i) those promoting chemical release from pipe scales due to biofilm-induced alterations at the pipe surface/water interface, (ii) the synergistic SBC action on promoting increased release rates of pathogens or toxic chemicals into water, and (iii) the microbially enhanced corrosive phenomena on pipe scales and their constituents. Substantial room for improvement is anticipated for the water and global health research agenda by formulating innovative hypotheses and research designs that water authorities could benefit from as they strive towards further securing access to safe water in urban settings