Training direct care staff to empower adults with intellectual disabilities and their families to reduce overmedication

Objectives People with intellectual and developmental disabilities (IDD) and autism are subject to restrictive practices like physical restraint and the overuse of psychotropic medications for challenging behavior. People with disabilities and their families are often not involved in shared decision-making for prescription and other care planning, which may violate the UN Human Rights Charter. Methods One way of reducing overmedication is by empowering adults with IDD and their family caregivers to collaborate in the decision to use medications. SPECTROM (https://spectrom.wixsite.com/project), a training program for direct care workers, was developed to help reduce the overmedication of these people. This article presents ideas on how SPECTROM resources could empower adults with IDD and their families to influence their care decisions, including psychotropic prescribing. Results Information provided in 32 easy-read leaflets in SPECTROM on psychotropic medications can be used to improve shared decision-making involving people with IDD and their families. Similarly, the Yellow Passport, an easy-read health record, could help information sharing among care service providers, thus improving their health care. SPECTROM has one module devoted to effectively engaging with people with IDD to improve their communication and help them with their skills building. Conclusions Currently, very limited evidence exists on the effects of SPECTROM to empower individuals with IDD and their families in reducing psychotropic medications for challenging behaviors. In addition to the two pilot studies on SPECTROM from UK and Australia, further research is needed to explore the evidence supporting the above suggestions

Randomised controlled trials of antidepressant and anti-anxiety medications for people with autism spectrum disorder: a systematic review and meta-analysis.

Background Although used widely the current evidence for the efficacy of antidepressant and antianxiety medications for people with autism spectrum disorder (ASD) is limited and conflicting. Aims We have carried out a systematic review and meta-analysis of the RCTs that assessed the effectiveness of these medications in people with ASD. Method We have searched the following databases: Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, DARE, and ClinicalTrials.gov. Additionally, we have hand-searched 11 relevant journals. We used the Cochrane Risk of Bias and Jadad score to assess the quality of each included RCT. We have carried out a meta-analysis using a random-effects model. Results We have included 15 RCTs (13 on antidepressants and two on antianxiety medications) that included a total of 958 people with ASD. Data showed contradictory findings among the studies with larger studies mostly showing a non-significant difference in outcomes between the treatment and the placebo group. Meta-analysis of pooled Yale-Brown Obsessive Compulsive Scale and Clinical Global Impression Scale data from nine studies (60%) did not show any statistically significant intergroup difference on either of the outcome measures. The adverse effects reported were mild and, in most studies, their rates did not show any significant intergroup difference. Conclusions Given the methodological flaws in the most included studies and contradictory findings it is difficult to draw any definitive conclusion about the effectiveness of either antidepressant or antianxiety medications to treat either ASD core symptoms or associated behaviors. Robust large-scale RCTs are needed in the future to address this issue

Short-term PsychoEducation for Carers To Reduce Over Medication of people with intellectual disabilities (SPECTROM): study protocol

Introduction Psychotropic medications that are primarily licenced for the treatment of psychiatric disorders are used widely (32%–85%) among people with intellectual disabilities (ID) often for the management of problem (challenging) behaviour in the absence of a psychiatric disorder. Care staff play a pivotal role in the prescribing process. Currently, no staff training programme exists to address the issue of overprescribing of psychotropic medication in people with ID, thus highlighting an urgent need for developing a psychoeducational programme (PEP) specifically designed to address this issue. We propose to develop a PEP for care staff using the methodology described in the UK Medical Research Council guide for complex interventions. Methods and analysis The development of the PEP will involve (1) gathering information on available relevant training programmes, (2) running four focus groups with care staff and other professionals to establish the content and format of the PEP, and (3) organising a co-design event involving all relevant stakeholders to discuss the format of the PEP. A core project team will develop the PEP under guidance from the PEP Development Group which will consist of 10–12 relevant stakeholder representatives. Feedback from selected stakeholders on a draft PEP will allow us to refine the PEP before implementation. The PEP will have web-based modules supplemented by face to face training sessions. When the final draft is ready, we will field test the PEP on six to eight care staff from community care homes for people with ID. After completing the field test, we will run a focus group involving participants in the PEP to get feedback on the PEP. Ethics and dissemination Ethics approval for this study was waived by the UK Health Regulatory Authority as the study does not collect any patient related information and only include care staff outside the UK NHS. This will be the first ever such universally freely available PEP supported by training manual and slides

Causes of and alternatives to medication for behaviours that challenge in people with intellectual disabilities: direct care providers' perspectives

Behaviours that challenge (BtC), such as aggression and self-injury, are manifested by many people with intellectual disabilities (ID). National and international guidelines recommend non-pharmacological psychosocial intervention before considering medication to address BtC. Support staff play a pivotal role in the prescription process. Using coproduction, we developed a training programme for support staff, called SPECTROM, to give them knowledge and empower them to question inappropriate prescriptions and ask for the discontinuation of medication if appropriate and instead look for ways to help people with ID when they are distressed without relying on medication. We have presented data from two focus groups that we conducted during the development of SPECTROM: one that included support staff, and another that had service managers and trainers. In these focus groups, we explored participants’ views on the use of medication to address BtC with a particular emphasis on the causes of and alternatives to medication for BtC. Along with the participants’ views, we have also presented how we have addressed these issues in the SPECTROM resources

Ethical prescribing of psychotropic medications for people with neurodevelopmental disorders

Objectives People with neurodevelopmental disorders (NDDs) such as intellectual and developmental disabilities (IDD) and autism are subjected to restrictive practices like physical restraint and the overuse of psychotropic medications for challenging behaviour in the absence of a psychiatric disorder. This practice may lead to human rights violations. Rational and evidence-based shared decision-making for person-centred planning will help reduce this practice. Methods We have discussed in this paper the issue of the overmedication of people with NDD, explaining how this practice may violate the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). Results We have discussed how the following UN CRPD Articles may be affected by overmedication, including Article 15 (degrading treatment or punishment), 16 (abuse), 17 (the integrity of the person), and 25 (health). The other Articles that may be indirectly affected by this practice are 5 (equality and non-discrimination), 9 (accessibility), 19 (independent living and community inclusion), 21 (access to information), 24 (education), 26 (rehabilitation), 27 (work and employment), 28 (adequate living standard), and 30 (participation in recreation and leisure). Conclusions Overmedication of people with NDD, particularly the off-licence use of psychotropics for challenging behaviour, the side effects of these medications impacting the person’s quality of life are likely to violet several UN Articles on Rights of Persons with Disabilities. Following the right guidelines may help reduce these human rights violations

The Influence of Statistical versus Exemplar Appeals on Indian Adults’ Health Intentions: An Investigation of Direct Effects and Intervening Persuasion Processes

In two separate investigations, we examined the persuasive effectiveness of statistical versus exemplar appeals on Indian adults’ smoking cessation and mammography screening intentions. To more comprehensively address persuasion processes, we explored whether message response and perceived message effectiveness functioned as antecedents to persuasive effects. Results showed that statistical appeals led to higher levels of health intentions than exemplar appeals. In addition, findings from both studies indicated that statistical appeals stimulated more attention and were perceived as more effective than anecdotal accounts. Among male smokers, statistical appeals also generated greater cognitive processing than exemplar appeals. Subsequent mediation analyses revealed that message response and perceived message effectiveness fully carried the influence of appeal format on health intentions. Given these findings, future public health initiatives conducted among similar populations should design messages that include substantive factual information while ensuring that this content is perceived as credible and valuable. [ABSTRACT FROM PUBLISHER

Hot Filament Chemical Vapor Deposition: Enabling the Scalable Synthesis of Bilayer Graphene and Other Carbon Materials

The hot filament chemical vapor deposition (HFCVD) technique is limited only by the size of the reactor and lends itself to be incorporated into continuous roll-to-roll industrial fabrication processes. We discuss the HFCVD reactor design and the interplay between the reactor parameters, such as filament and substrate temperatures, filament-to-substrate distance, and total pressure. Special attention is given to the large-area synthesis of bilayer graphene on copper, which is successfully grown by HFCVD with transmittance greater than 90% in the visible region and no gaps. We also discuss the HFCVD synthesis of carbon nanotubes, microcrystalline diamond, and nanocrystalline diamond

What influences consumers’ online medication purchase intentions and behavior? A scoping review

Objective: Consumers increasingly buy pharmaceuticals online. No scoping review has been carried out to summarize and synthesize the studies that have identified drivers of consumers’ purchase intention and behavior from online pharmacies. Thus, we conducted a scoping review to explore the extent to which prior research has studied consumer purchase intentions and behavior related to online pharmacies, the drivers previously identified to explain consumers’ online pharmacy purchase intentions and behavior, and how these antecedents differ between OTC and prescription medications. Then, we identified gaps in the published literature to form a comprehensive theory-based agenda for future research.Methods: We searched PubMed, Web of Science, and Scopus to retrieve relevant studies published in English in peer-reviewed journals. The search strategy identified forty-eight eligible studies.Results: We identified twelve types of factors influencing purchase intentions and behaviors from online pharmacies: demographics, convenience, availability, price, evaluations of the purchase environment, information sources, internet usage, prior experience, perceived risk, health insurance, privacy, and product. Our analysis also revealed differences between OTC and prescription medications in drivers of purchase intentions and behaviors.Conclusion: While demographic factors tended to be the most often measured influences on intentions and behavior, their role was generally inconsistent, with many contradictory results. However, other factors (e.g., convenience, availability, lower prices, and favorable evaluations toward the purchase environment) more consistently enhanced online medication purchase intentions and behavior. An extensive agenda for future research is advanced

Nutrition Knowledge, Personal Motivation, And Food Label Use Among Indian Adults With Multiple Chronic Conditions: A Moderated Mediation Model.

Background: There has been little research conducted within developing nations examining the link between knowledge and diet-related perceptions and behaviors. In addition, prior investigations have rarely examined interrelationships between knowledge and other nutrition-related factors. Purpose: This study explored the relationship between nutrition knowledge, social/informational factors, and diet-related outcomes among Indian adults with multiple chronic conditions. Methods: A snowball sampling technique was employed to recruit individuals. Hierarchical regression analysis was employed to examine mediating and moderating relationships. Results: Results from a cross-sectional survey indicated that knowledge only predicted use among those reporting greater pressure/concern from close others. Furthermore, social support and social trust were found to moderate the relationship between knowledge and diet-related perceptions and behaviors. Discussion: Results suggest that social factors may play a critical role in moderating the impact of nutritionknowledge on diet-related perceptions and behaviors. Translation to Health Education Practice: Public Health Education interventions targeting developing nations should aim to maximize consumers\u27 nutritionknowledge while identifying valued close others who can help encourage positive health action. Furthermore, Health Educators as well as government and local communities must engage in outreach efforts to reinforce or, if necessary, change public perceptions regarding the food industry