Shared decision making and experiences of patients with long-term conditions : has anything changed?

Background Medication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services. Methods A mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George’s and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics. Results The response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service. Conclusion Although patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals

Transient and persistent behavioral and molecular changes in primiparous female Wistar rats

Motherhood brings about a multitude of behavioral and physiological changes in dams and some of these persist until after weaning. We studied behavioral changes associated with reproductive experience at lactating day (LD)8, at weaning (LD21), and 28days post-weaning (PW28) compared to nulliparous (NP) females. Furthermore, in another cohort of animals, we quantified mRNA expression of five target genes known to be associated with maternal experience: arginin-vasopressin(Avp) and its 1A receptor(Avpr1a), oxytocin(Oxt) and its receptor(Oxtr), and corticotropin-releasing hormone(Crh) in three key maternal region: the medial preoptic area (MPOA), bed nucleus of the stria terminalis (BNST) and paraventricular hypothalamic nucleus(PVN). Although dams were slightly less anxious than NP at LD8, this effect did not persist at LD21 and PW28. No differences in social preference were found between the four groups. In the maternal responsiveness test (MRT), LD8 and LD21 dams were immediately responsive to pups whereas NP largely avoided the pups throughout 12-day period. PW28 females were significantly more responsive to pups than NP females, but less than LD8 and LD21 females. The mRNA expression of Avp in the PVN, Avpr1a in the BNST and Oxtr in the MPOA and BNST was increased, whereas mRNA expression of Avpr1a was reduced in the PVN, at LD8 compared to NP. Although Oxtr in the BNST and Avp in the PVN were still somewhat (non-significantly) increased at LD21, all levels of gene expression had normalized at PW28. Our results emphasize the transient nature of these behavioral and molecular adaptations, except for a persistent up-regulation of maternal responsiveness

Selective breeding for high anxiety introduces a synonymous SNP that increases neuropeptide S receptor activity

Neuropeptide S (NPS) has generated substantial interest due to its anxiolytic and fear-attenuating effects in rodents, while a corresponding receptor polymorphism associated with increased NPS receptor (NPSR1) surface expression and efficacy has been implicated in an increased risk of panic disorder in humans. To gain insight into this paradox, we examined the NPS system in rats and mice bred for high anxiety-related behavior (HAB) versus low anxiety-related behavior, and, thereafter, determined the effect of central NPS administration on anxiety- and fear-related behavior. The HAB phenotype was accompanied by lower basal NPS receptor (Npsr1) expression, which we could confirm via in vitro dual luciferase promoter assays. Assessment of shorter Npsr1 promoter constructs containing a sequence mutation that introduces a glucocorticoid receptor transcription factor binding site, confirmed via oligonucleotide pull-down assays, revealed increasedHAB promoter activity—an effect that was prevented by dexamethasone. Analogous to the human NPSR1 risk isoform, functional analysis of a synonymous single nucleotide polymorphism in the coding region of HAB rodents revealed that it caused a higher cAMP response to NPS stimulation.Assessmentof the behavioralconsequenceof these differences revealed that intracerebroventricularNPSreversed thehyperanxiety of HAB rodents as well as the impaired cued-fear extinction in HAB rats and the enhanced fear expression in HAB mice, respectively. These results suggest that alterations in the NPS system, conserved across rodents and humans, contribute to innate anxiety and fear, and that HAB rodents are particularly suited to resolve the apparent discrepancy between the preclinical and clinical findings to dat

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Mitochondrial control of microglial phagocytosis by the translocator protein and hexokinase 2 in Alzheimer's disease

Microglial phagocytosis is an energetically demanding process that plays a critical role in the removal of toxic protein aggregates in Alzheimer’s disease (AD). Recent evidence indicates that a switch in energy production from mitochondrial respiration to glycolysis disrupts this important protective microglial function and may provide therapeutic targets for AD. Here, we demonstrate that the translocator protein (TSPO) and a member of its mitochondrial complex, hexokinase-2 (HK), play critical roles in microglial respiratory-glycolytic metabolism and phagocytosis. Pharmacological and genetic loss-of-function experiments showed that TSPO is critical for microglial respiratory metabolism and energy supply for phagocytosis, and its expression is enriched in phagocytic microglia of AD mice. Meanwhile, HK controlled glycolytic metabolism and phagocytosis via mitochondrial binding or displacement. In cultured microglia, TSPO deletion impaired mitochondrial respiration and increased mitochondrial recruitment of HK, inducing a switch to glycolysis and reducing phagocytosis. To determine the functional significance of mitochondrial HK recruitment, we developed an optogenetic tool for reversible control of HK localization. Displacement of mitochondrial HK inhibited glycolysis and improved phagocytosis in TSPO-knockout microglia. Mitochondrial HK recruitment also coordinated the inflammatory switch to glycolysis that occurs in response to lipopolysaccharide in normal microglia. Interestingly, cytosolic HK increased phagocytosis independent of its metabolic activity, indicating an immune signaling function. Alzheimer’s beta amyloid drastically stimulated mitochondrial HK recruitment in cultured microglia, which may contribute to microglial dysfunction in AD. Thus, targeting mitochondrial HK may offer an immunotherapeutic approach to promote phagocytic microglial function in AD

Analisis del proceso de transferencia de tecnologia en tres fincas de ganado de doble proposito en Moroceli, Honduras

87 p.Es una investigación social que analiza el cambio de comportamiento de tres estudios de caso en el proceso de transferencia de tecnología para ganado de doble propósito con la meta mantener la producción de estos hatos en verano en Moroceli, Honduras. La metodología usada se rigió por los pasos de la transferencia: diagnóstico, realizado en un estudio anterior, la determinación de las opciones técnicas y difusión. Para lograr esta se realizó una encuesta semi estructurada, un taller, capacitaciones y visitas de campo. E n el taller se trabajó con el problema de la deficiente alimentación por ser el más sentido por e l productor, se analizaron las causas y efectos de este problema y las posibles soluciones. Se presentaron algunas prácticas de alimentación más adecuadas, teniendo en cuenta los recursos y analizando cada alternativa desde el punto de vista económico y operacional

Students' participation in collaborative research should be recognised

Letter to the editor