Developing a behaviour change intervention using information about greenhouse gas emissions to reduce liquid antibiotic prescribing

\ua9 2025 The AuthorsIntroduction: The determinants of antimicrobial prescribing often involve social influence, which can be harnessed through behaviour change techniques (BCTs). While previous studies have used BCTs to address antimicrobial resistance, there is a lack of evidence regarding their application to address climate change-related issues in antibiotic prescribing. This study aimed to develop a behaviour change intervention (BCI) using information about greenhouse gas emissions to reduce liquid antibiotic prescribing. Methods: A convenience sample of participants from a primary care practice in North East England participated in semi-structured interviews. The intervention design was guided by the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation – Behaviour (COM-B) model. Data were analysed thematically, mapped to the TDF, and used to refine the BCI. Findings: Participants identified motivating factors related to high rates of liquid prescribing, climate change, and solid oral dosage form (pill) aversion. The broader context of practice, such as initiatives reduce cost and improve sustainability, provided opportunities for intervention. Participants demonstrated the capability to change prescribing behaviours and expressed willingness to share resources within their teams. Conclusion: This study underscores the potential of BCIs using greenhouse gas emissions data to reduce liquid antibiotic prescribing. Further research should focus on implementing and evaluating these interventions in practice settings

A qualitative study exploring experiences of treatment in paediatric rheumatology - children\u27s, young people\u27s, parents\u27 and carers\u27 perspectives

\ua9 2025. The Author(s). BACKGROUND: There is limited literature in paediatric rheumatology describing holistic lived experiences of medical treatment from perspectives of children and young people (CYP) and their parents or carers (PC). This is important as it could have implications for adherence. This study aimed to explore treatment experiences of CYP and PC in a paediatric rheumatology service. METHODS: Participants were recruited at a day-case unit for intravenous infusions at a tertiary paediatric rheumatology centre. Joint qualitative semi-structured interviews with CYP and PC were used to collect data. Data were transcribed, quality checked and thematically analysed using NVivo 12.4 to identify findings. RESULTS: Thirty-two participants (15 CYP between the ages of 6 and 16 years, 17 PC) took part in interviews lasting 41 min and 43 s, on average. Participants described experiences using infliximab, followed by tocilizumab and abatacept. Participants experienced a wave, oscillating between positive and negative trajectories. Experiences of medical treatments were described as temporary, eventually changing and leading to treatment changes or cessation. Behaviours were influenced through somatic factors (pain, function), social factors (advice from health professionals, encouragement from friends, family and teachers, practicality of using treatment in relation to school, work and finance) and cognitive factors (fear of needles, fear of specific medications, beliefs about necessity). CONCLUSIONS: Collectively, findings demonstrate experiences of medical treatment reflect the nature of many paediatric rheumatology conditions, oscillating between periods of positive and negative trajectories. Somatic, social and cognitive experiences can be positive, when treatment is considered \u27successful\u27. Negative somatic, social or cognitive experiences led to behaviours such as treatment non-adherence. A limitation of the study is interviews were conducted jointly with CYP and PC, which may have influenced what participants were willing to say in front of one another however this does mean findings relate to both CYP and PC and so could be suitable targets for interventions to improve adherence

Investigating the In Vivo Antimicrobial Activity of a Self-Assembling Peptide Hydrogel Using a Galleria mellonella Infection Model

Technological advances in protein biochemistry now enable researchers to modify the structure of peptides to enable them to possess self-assembling properties, forming hydrogels at low concentrations. Peptides can be altered further to provide multifunctional characteristics, for example, to demonstrate antimicrobial properties. The aim of this article is to investigate the in vivo toxicity and antimicrobial properties of a low molecular weight (naphthalene-2-ly)-acetyl-diphenylalanine-dilysine-OH (NapFFKK-OH) peptide hydrogel using an innovative waxworm (Galleria mellonella) model, as an alternative to mammalian/vertebrate testing. NapFFKK-OH hydrogels did not demonstrate any observable in vivo toxicity or death in G. mellonella larvae over 5 days at concentrations studied (≤2% w/v). A dose-dependent log10 reduction in viable (CFU/mL) Gram-positive (Staphylococcus aureus, Staphylococcus epidermidis) and Gram-negative (Escherichia coli, Pseudomonas aeruginosa) bacteria implicated in nosocomial infections was observed over 72 h. NapFFKK-OH was especially effective against in vivo infection models of S. aureus with a significant 4.4 log10 CFU/mL reduction in viable bacteria at 2% w/v after 72 h. Our results show G. mellonella to be a useful model for preliminary determination of in vivo toxicity and antimicrobial efficacy profiles of novel nanomaterials, including peptide-based hydrogels. This contributes to the 3R principles of animal testing, reduction, refinement, and replacement. The results also show NapFFKK-OH to be a promising alternative to standardly employed antimicrobials with the potential to be utilized as a novel therapeutic in the treatment and prevention of hospital infections

Pharmacokinetics and pharmacodynamics of direct oral anticoagulants

Introduction: Direct oral anticoagulants (DOACs) have overtaken vitamin K antagonists to become the most widely-used method of anticoagulation for most indications. Their stable and predictable pharmacokinetics combined with relatively simple dosing, and the absence of routine monitoring has made them an attractive proposition for healthcare providers. Despite the benefits of DOACs as a class, important differences exist between individual DOAC drugs in respect of their pharmacokinetic and pharmacodynamic profiles with implications for dosing and reversal in cases of major bleeding. Areas covered: This review summarizes the state of knowledge relating to the pharmacokinetics of dabigatran (factor IIa/thrombin inhibitor) and apixaban, edoxaban and rivaroxaban (factor Xa) inhibitors. We focus on pharmacokinetic differences between the drugs which may have clinically significant implications. Expert opinion: Patient-centered care necessitates a careful consideration of the pharmacokinetic and pharmacodynamic differences between DOACs, and how these relate to individual patient circumstances. Prescribers should be aware of the potential for pharmacokinetic drug interactions with DOACs which may influence prescribing decisions in patients with multiple comorbidities. In order to give an appropriate dose of DOAC drugs, accurate estimation of renal function using the Cockcroft-Gault formula using actual body weight is necessary. An increasing body of evidence supports the use of DOACs in patients who are obese, and this is becoming more routine in clinical practice

Developing a behaviour change intervention using information about greenhouse gas emissions to reduce liquid antibiotic prescribing

Introduction: The determinants of antimicrobial prescribing often involve social influence, which can be harnessed through behaviour change techniques (BCTs). While previous studies have used BCTs to address antimicrobial resistance, there is a lack of evidence regarding their application to address climate change-related issues in antibiotic prescribing. This study aimed to develop a behaviour change intervention (BCI) using information about greenhouse gas emissions to reduce liquid antibiotic prescribing. Methods: A convenience sample of participants from a primary care practice in North East England participated in semi-structured interviews. The intervention design was guided by the Theoretical Domains Framework (TDF) and the Capability, Opportunity, Motivation – Behaviour (COM-B) model. Data were analysed thematically, mapped to the TDF, and used to refine the BCI. Findings: Participants identified motivating factors related to high rates of liquid prescribing, climate change, and solid oral dosage form (pill) aversion. The broader context of practice, such as initiatives reduce cost and improve sustainability, provided opportunities for intervention. Participants demonstrated the capability to change prescribing behaviours and expressed willingness to share resources within their teams. Conclusion: This study underscores the potential of BCIs using greenhouse gas emissions data to reduce liquid antibiotic prescribing. Further research should focus on implementing and evaluating these interventions in practice settings

KidzMed e-learning to upskill student pharmacists to teach pill swallowing to children

Background: Appropriate medication use is essential in ensuring optimal pharmacotherapeutic outcomes. It is mistakenly assumed that adults can swallow solid oral dosage forms (SODFs, e.g.Tablets/ capsules colloquially referred to as 'pills'), without difficulty and that children cannot. KidzMed is a 'pill swallowing' training programme designed to teach effective SODF use in patients of all ages. It may be utilised by healthcare professionals to assist patients taking SODFs. E-learning was essential for training during COVID pandemic to reduce viral transmission. The aim of this study was to explore UK student pharmacists views of e-learning to support swallowing solid oral dosage forms. Methods: This study used pre-and post-intervention online surveys on Microsoft Forms to evaluate self-directed eLearning about pill swallowing on MPharm programmes at three UK Universities using a 13-item survey. A combination of five-point Likert Scales and free-Text items were used. The eLearning was available via the virtual learning environment at the University and embedded within existing curriculum. Descriptive statistical analysis was used to explore responses. Results: In total, 113 of 340 (33%) students completed the survey. Seventy-eight percent (n = 65) reported the eLearning would enable them to teach adults and children to swallow SODFs successfully. Learners either agreed or strongly agreed that they felt comfortable to teach patients (95%, n = 62/113) and parents or carers (94%, n = 60) to swallow medications having completed the e-learning. Student pharmacists generally found eLearning as an acceptable way to reflect on their own experiences of 'pill' swallowing and how to support patients to swallow SODFs. Conclusion: The KidzMed eLearning was well received by student pharmacists. Further work is needed to explore whether skills translates into real life application in the clinical settings

Quantification of Linalool in 3D Printed Fast-Dissolving Oral Films by A High-Pressure Liquid Chromatography Method

Introduction: Linalool has shown inhibitory effects against Candida albicans. Microbial resistance is developing towards the current antifungal drugs. Therefore, an oral formulation of linalool oil may be used to effectively treat oral thrush. A wide range of patients can use fast-dissolving oral films (FDFs). Three-dimensional printing (3DP) may be utilised for the manufacture of FDFs. Aims: to formulate linalool in FDFs and quantify it using high-pressure liquid chromatography (HPLC). Methods: A powder formulation containing linalool (5%w/w) was prepared and filaments were produced at 75°C and printed at 185°C. The films were dissolved either in methanol or deionised water, and linalool was quantified in the aqueous solutions. The mobile phase of a previously reported HPLC method was modified to quantify linalool in the aqueous solutions. The HPLC method was validated by measuring linalool in standard methanol and aqueous solutions. Results: Preparing aqueous solutions of filaments and films provided less variability in the analyses. 3D-printed FDFs had an average weight of 78.44 ± 6.84 mg. Applying the HPLC method revealed that the amounts of linalool changed from a theoretical 25 mg (per 0.5 g of filament) to the range of 23.98 ± 1.22 to 33.79 ± 2.43 mg. In contrast, the amounts of linalool were changed in films from theoretical 25 mg (per 0.5 g of film) to 13.82 ± 3.24 mg to 21.04 ± 0.92 mg. These observations indicated the evaporation of linalool considerably during printing at 185 °C. Conclusion: This work found that linalool FDFs should be printed at temperatures lower than 185 °C and dissolved in deionised water for better HPLC analytical consistency

The effects of statins on the function and differentiation of blood cells

Statins are inhibitors of β-hydroxy β-methylglutaryl-CoA (HMG-CoA) reductase (HMGCR). They are used in patients with cardiovascular risk and/ or suffering with cardiovascular disease. In addition to their efficient lipid-lowering effects, statins exhibit independent so called pleiotropic effects potentially affecting several immune response properties including immune cell activation, migration, cytokine generation, immune metabolism, and survival. Statins also regulate innate and acquired immunity. The focus of this review is to highlight the role of statins in modulating the function and differentiation of various blood cells. Given the proposed wider application of these medicines and their potentially important advantages in treatment of inflammatory and autoimmune disorders, more studies are needed with special focus on the molecular targets of statins included in regulating the immune response

A novel peptide for microRNA delivery to medulloblastoma cells

Medulloblastoma is a paediatric brain cancer categorised into various subtypes that have differing prognostic out-comes for patients. As with other cancers, microRNAs have been implicated in medulloblastoma pathogenesis and the loss of specific miRNAs appears to contribute to the disease. There is therefore an urgent need to develop miRNA-replacement therapies for medulloblastoma. However, methods for targeted delivery of small RNAs to medulloblastoma cells have not been fully established. As a step towards tackling this challenge, we have developed self-assembling peptide nanoparticles for small RNA delivery to medulloblastoma cells. We generated an amphiphilic peptide, TY-28, using solid-phase peptide synthesis and combined TY-28 with miR-124-3p. Analysis of the resulting complexes by electron microscopy and dynamic light scattering confirmed the formation of nanoparticles. The ability of the NPs to penetrate cells was monitored by labelling the miRNA with a fluorescent dye. The NP:miRNA complexes were readily internalised by group 3 medulloblastoma cells, and the accumulation of the complexes increased over time. Levels of uptake were 6-fold higher at 24 hours compared to 4 hours in serum-free medium. The uptake of the NPs complexes by the cells did not differ in the presence and absence of serum, suggesting the presence of serum did not affect complex stability. Our findings point to the translational potential of self-assembled NPs to delivery miR-NA mimics to medulloblastoma cells

Postgraduate pharmacist development- an evaluation of Jordanian pharmacist experiences to inform and shape an evidence-based professional development policy

Building capacity for developing skills as leadership, teamwork, and continuous academic support has become essential for fulfilling a successful pharmacy career. This study aims to assess Jordanian pharmacists’ views on professional development, namely: the continuous education infrastructure, strategies and programs for personal development, leadership skills, incentive schemes, drug information resources and digital services. As well as exploring options for better academic support delivered to pharmacists. To capture participant’s views, an online validated and reliable survey was developed. Non-probability sampling design was used. Participants were qualified pharmacists working at Royal Medical Services (RMS) and Community Pharmacists (CP). Comparison and descriptive statistics were used to report the results. A total of 271 pharmacists participated, 144 from RMS (8% more than the needed sample) and 127 CP (7% more than the needed sample). There was a strong desire amongst both RMS and PC groups for continuous educational training particularly in the following areas, first: Advanced counselling and communication skills (means = 8.99±0.145, CI 95% = 3.70–4.28 and 9.37±0.096, CI 95% = 4.18–4.56). Second: Personal development skills (mean = 8.92±0.142, CI 95% = 3.64–4.20 and 9.02±0.145, CI 95% = 3.73–4.30). Third, Pharmaceutical health promotion (mean = 8.05±0.180, CI 95% = 2.70–3.41 and 8.57±0.159, CI 95% = 3.26–3.89). Only 19.4% and 18.1% of the RMS and CPs respectively reported the presence of a written policy for personal development and leadership in their workplace. There were few incentives for pharmacists to participate in research. Few pharmacists used the available drug information and toxicology centers. The professional and continuous personal development of pharmacists support an evolving healthcare system. This study emphasizes the need for a tailored and documented postgraduate educational strategy, personal development, and leadership skills training in Jordan. Implementing a well-defined scheme of incentives should be encouraged to engage pharmacists in continuous professional development programs and pharmaceutical research. Such strategy and training should enhance both professional and personal performance