A pilot study of the S-MAP (Solutions for Medications Adherence Problems) intervention for older adults prescribed polypharmacy in primary care: Study protocol

Background: Adhering to multiple medications as prescribed is challenging for older patients (aged ≥ 65 years) and a difficult behaviour to improve. Previous interventions designed to address this have been largely complex in nature but have shown limited effectiveness and have rarely used theory in their design. It has been recognised that theory ('a systematic way of understanding events or situations') can guide intervention development and help researchers better understand how complex adherence interventions work. This pilot study aims to test a novel community pharmacy-based intervention that has been systematically developed using the Theoretical Domains Framework (12-domain version) of behaviour change. Methods: As part of a non-randomised pilot study, pharmacists in 12 community pharmacies across Northern Ireland (n = 6) and London, England (n = 6), will be trained to deliver the intervention to older patients who are prescribed ≥ 4 regular medicines and are non-adherent (self-reported). Ten patients will be recruited per pharmacy (n = 120) and offered up to four tailored one-to-one sessions, in the pharmacy or via telephone depending on their adherence, over a 3-4-month period. Guided by an electronic application (app) on iPads, the intervention content will be tailored to each patient's underlying reasons for non-adherence and mapped to the most appropriate solutions using established behaviour change techniques. This study will assess the feasibility of collecting data on the primary outcome of medication adherence (self-report and dispensing data) and secondary outcomes (health-related quality of life and unplanned hospitalisations). An embedded process evaluation will assess training fidelity for pharmacy staff, intervention fidelity, acceptability to patients and pharmacists and the intervention's mechanism of action. Process evaluation data will include audio-recordings of training workshops, intervention sessions, feedback interviews and patient surveys. Analysis will be largely descriptive. Discussion: Using pre-defined progression criteria, the findings from this pilot study will guide the decision whether to proceed to a cluster randomised controlled trial to test the effectiveness of the S-MAP intervention in comparison to usual care in community pharmacies. The study will also explore how the intervention components may work to bring about change in older patients' adherence behaviour and guide further refinement of the intervention and study procedures. Trial registration: This study is registered at ISRCTN: https://doi.org/10.1186/ISRCTN7383153

Theory-Based Interventions to Improve Medication Adherence in Older Adults Prescribed Polypharmacy: A Systematic Review

BACKGROUND: Previous interventions have shown limited success in improving medication adherence in older adults, and this may be due to the lack of a theoretical underpinning. OBJECTIVE: This review sought to determine the effectiveness of theory-based interventions aimed at improving medication adherence in older adults prescribed polypharmacy and to explore the extent to which psychological theory informed their development. DATA SOURCES: Eight electronic databases were searched from inception to March 2015, and extensive hand-searching was conducted. ELIGIBILITY CRITERIA: Interventions delivered to older adults (populations with a mean/median age of ≥65 years) prescribed polypharmacy (four or more regular oral/non-oral medicines) were eligible. Studies had to report an underpinning theory and measure at least one adherence and one clinical/humanistic outcome. REVIEW METHODS: Data were extracted independently by two reviewers and included details of intervention content, delivery, providers, participants, outcomes and theories used. The theory coding scheme (TCS) was used to assess the extent of theory use. RESULTS: Five studies cited theory as the basis for intervention development (social cognitive theory, health belief model, transtheoretical model, self-regulation model). The extent of theory use and intervention effectiveness in terms of adherence and clinical/humanistic outcomes varied across studies. No study made optimal use of theory as recommended in the TCS. CONCLUSIONS: The heterogeneity observed and inclusion of pilot designs mean conclusions regarding effectiveness of theory-based interventions targeting older adults prescribed polypharmacy could not be drawn. Further primary research involving theory as a central component of intervention development is required. The review findings will help inform the design of future theory-based adherence interventions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40266-016-0426-6) contains supplementary material, which is available to authorized users

A Medial Congruent Polyethylene Offers Satisfactory Early Outcomes and Patient Satisfaction in Total Knee Arthroplasty

Background Although a successful operation, almost 20% of patients are dissatisfied with total knee arthroplasty (TKA). The purpose of this retrospective cohort study was to see if a medial congruent (MC) polyethylene would offer satisfactory early outcomes and patient satisfaction after TKA. Methods We reviewed prospectively collected data on 327 TKAs using multiple bearings within the same implant system. Ninety-six received an MC bearing, 70 received a cruciate-retaining (CR) bearing, and 161 received a posterior-stabilized (PS) bearing. We evaluated the visual analog scale pain scores and range of motion (ROM) at 2 weeks, 6 weeks, 3 months, and 1 year; Patient-Reported Outcomes Measurement Information System (PROMIS-10) score and Knee Injury and Osteoarthritis Outcome Score (KOOS) at 3 months and 1 year; and Forgotten Joint Score (FJS-12) at 1 year. Results All groups had similar KOOS and PROMIS-10 scores. MC knees had lower visual analog scale scores than PS knees at all time points (P \u3c .05) and a higher ROM than PS at 2 weeks (98.6 vs 93.7, P = .002). MC knees had a significantly higher FJS-12 than CR knees (71.6 vs 58.7, P = .02). More MC knees were “very satisfied” than CR (92.6% vs 81.5%, P = .04). Fewer MC knees were “not at all satisfied” than CR (1.2% vs 9.2%, P = .04). There were similar satisfaction ratings with MC and PS. Conclusions An MC bearing provided similar or improved early pain, ROM, KOOS, PROMIS-10, FJS-12, and patient satisfaction as compared with standard bearings in TKA

Improving adherence to multiple medications in older people in primary care: Selecting intervention components to address patient-reported barriers and facilitators

Background: Medication adherence is vital to ensuring optimal patient outcomes, particularly amongst multimorbid older people prescribed multiple medications. Interventions targeting adherence often lack a theoretical underpinning and this may impact on effectiveness. The theoretical domains framework (TDF) of behaviour can aid intervention development by systematically identifying key determinants of medication adherence. Objectives: This study aimed to (i) identify determinants (barriers, facilitators) of adherence to multiple medications from older people's perspectives; (ii) identify key domains to target for behaviour change; and (iii) map key domains to intervention components [behaviour change techniques (BCTs)] that could be delivered in an intervention by community pharmacists. Method Focus groups were conducted with older people (>65 years) receiving ≥4 medications. Questions explored the 12 domains of the TDF (eg “Knowledge,” “Emotion”). Data were analysed using the framework method and content analysis. Identification of key domains and mapping to intervention components (BCTs) followed established methods. Results: Seven focus groups were convened (50 participants). A wide range of determinants were identified as barriers (eg forgetfulness, prioritization of medications) and facilitators (eg social support, personalized routines) of adherence to multiple medications. Eight domains were identified as key targets for behaviour change (eg “Social influences,” “Memory, attention and decision processes,” “Motivation and goals”) and mapped to 11 intervention components (BCTs) to include in an intervention [eg “Social support or encouragement (general),” “Self-monitoring of the behaviour,” “Goal-setting (behaviour)”]. Conclusion: This study used a theoretical underpinning to identify potential intervention components (BCTs). Future work will incorporate the selected BCTs into an intervention that will undergo feasibility testing in community pharmacies

Interpreting and acting upon home blood pressure readings: A qualitative study

This article is made available through the Brunel Open Access Publishing Fund. Copyright @ 2013 Vasileiou et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Recent guidelines recognize the importance of home blood pressure monitoring (HBPM) as an adjunct to clinical measurements. We explored how people who have purchased and use a home blood pressure (BP) monitor make sense of, and act upon, readings and how they communicate with their doctor about the practice of home monitoring. Methods: A qualitative study was designed and participants were purposively recruited from several areas in England, UK. Semi-structured in-depth interviews were conducted with 18 users of home BP monitors. The transcribed data were thematically analysed. Results: Interpretation of home BP readings is complex, and is often characterised by uncertainty. People seek to assess value normality using ‘rules of thumb’, and often aim to identify the potential causes of the readings. This is done by drawing on lay models of BP function and by contextualising the readings to personal circumstances. Based on the perceived causes of the problematic readings, actions are initiated, mostly relating to changes in daily routines. Contacting the doctor was more likely when the problematic readings persisted and could not be easily explained, or when participants did not succeed in regulating their BP through their other interventions. Most users had notified their doctor of the practice of home monitoring, but medical involvement varied, with some participants reporting disinterest or reservations by doctors. Conclusions: Involvement from doctors can help people overcome difficulties and resolve uncertainties around the interpretation of home readings, and ensure that the rules of thumb are appropriate. Home monitoring can be used to strengthen the patient-clinician relationship

Robust determination of the major merger fraction at z = 0.6 in Groth Strip

(Abridged) We measure the fraction of galaxies undergoing disk-disk major mergers (f_m) at intermediate redshifts (0.35 <= z < 0.85) by studying the asymmetry index A of galaxy images. Results are provided for B- and Ks-band absolute magnitude selected samples from the Groth strip in the GOYA photometric survey. Three sources of systematic error are carefully addressed: (i) we avoid morphological K-corrections, (ii) we measure asymmetries in artificially redshifted to z_d = 0.75 galaxies to lead with loss of morphological information with redshift, and (iii) we take into account the observational errors in z and A, that tend to overestimate the merger fraction, by maximum likelihood techniques. We find: (i) our data allow for a robust merger fraction to be provided for a single redshift bin centered at z=0.6. (ii) Merger fractions have low values: f_m = 0.045 for M_B <= -20 galaxies, and f_m = 0.031 for M_Ks <= -23.5 galaxies. And, (iii) failure to address the effects of the observational errors leads to overestimating f_m by factors of 10%-60%. Combining our results with those on literature, and parameterizing the merger fraction evolution as f_m(z) = f_m(0)(1+z)^m, we obtain that m = 2.9 +- 0.8, and f_m(0) = 0.012 +- 0.004$. Assuming a Ks-band mass-to-light ratio not varying with luminosity, we infer that the merger rate of galaxies with stellar mass M >= 3.5x10^10 M_Sun is R_m = 1.6x10^-4 Mpc^-3 Gyr^-1. When we compare with previous studies at similar redshifts, we find that the merger rate decreases when mass increases.Comment: Accepted for publication in ApJ. 11 pages, 7 figures, 3 tables. Formatted with emulateap

Population Genetics of Bowhead Whales (Baleana mysticetus) in the Western Arctic

Bowhead whales (Balaena mysticetus) in the Bering, Chukchi, and Beaufort seas experienced a severe reduction as a result of commercial whaling in the 19th century. Since the cessation of commercial whaling, the population has recovered to a size that is approaching pre-whaling estimates. Inupiat and Yupik communities in northern and western Alaska hunt these Western Arctic (WA) bowheads along their migratory path during spring and fall. This hunting is regulated by the International Whaling Commission. Recent but preliminary analysis of available genetic data (207 whales and 10 microsatellite markers) raised the question of the presence of multiple, genetically distinct populations within the WA bowheads. Here we re-examined this question on the basis of a study of 414 whales and 22 newly developed microsatellite loci. We identified widespread departures from Hardy-Weinberg equilibrium; however, we were unable to detect significant evidence of multiple genetic populations within the WA bowheads that could explain this Hardy-Weinberg disequilibrium, particularly when compared to the strength of evidence for differentiation between WA bowheads and other populations from distant regions such as the Okhotsk Sea and eastern Canada. There was conclusive evidence of genetic differentiation among the three regions. The statistical rejection of panmixia within the WA improves our understanding of bowhead whale biology, and the lack of evidence for multiple populations within the WA enables risk-averse management of aboriginal hunting of Western Arctic bowhead whales.La population de baleines boréales (Balaena mysticetus) des mers de Béring, de Tchoukotka et de Beaufort a enregistré un grave déclin en raison de la pêche commerciale à la baleine au XIXe siècle. Depuis que la pêche commerciale à la baleine a cessé, la population de baleines boréales a connu un certain essor au point où elle approche maintenant les estimations de la taille qu’elle avait avant la pêche commerciale à la baleine. Les collectivités Inupiat et Yupik du nord et de l’ouest de l’Alaska chassent les baleines boréales de l’ouest de l’Arctique le long de leur voie de migration au printemps et à l’automne. La chasse est réglementée par l’International Whaling Commission. Des analyses récentes, bien que préliminaires, des données génétiques disponibles (207 baleines et 10 marqueurs microsatellites) ont soulevé la question de la présence de multiples populations génétiquement distinctes au sein de la population de baleines boréales de l’ouest de l’Alaska. Ici, nous avons réexaminé cette question en fonction de l’étude de 414 baleines et de 22 locis microsatellites nouvellement mis au point. Nous avons remarqué d’importantes déviations de l’équilibre de Hardy-Weinberg; toutefois, nous n’avons pas pu trouver de preuve significative de populations génétiques multiples au sein des baleines boréales de l’ouest de l’Alaska qui pourrait expliquer ce déséquilibre de Hardy-Weinberg, plus particulièrement en comparaison avec la force de la preuve de différenciation entre les baleines boréales de l’ouest de l’Arctique et d’autres populations de régions distantes telles que la mer d’Okhotsk et l’est du Canada. Il y avait des preuves concluantes de différenciation génétique entre les trois régions. Le rejet statistique de la panmixie au sein de l’ouest de l’Arctique améliore notre compréhension de la biologie des baleines boréales, et le manque de preuves de populations multiples dans l’ouest de l’Arctique donne lieu à la gestion de l’aversion au risque de la chasse à la baleine boréale de l’ouest de l’Arctique par les Autochtones

Galaxy and Mass Assembly (GAMA): merging galaxies and their properties

We derive the close pair fractions and volume merger rates for galaxies in the Galaxy and Mass Assembly (GAMA) survey with −23 < Mr < −17 (ΩM = 0.27, ΩΛ = 0.73, H0 = 100 km s−1 Mpc−1) at 0.01 < z < 0.22 (look-back time of <2 Gyr). The merger fraction is approximately 1.5 per cent Gyr−1 at all luminosities (assuming 50 per cent of pairs merge) and the volume merger rate is ≈3.5 × 10−4 Mpc−3 Gyr−1. We examine how the merger rate varies by luminosity and morphology. Dry mergers (between red/spheroidal galaxies) are found to be uncommon and to decrease with decreasing luminosity. Fainter mergers are wet, between blue/discy galaxies. Damp mergers (one of each type) follow the average of dry and wet mergers. In the brighter luminosity bin (−23 < Mr < −20), the merger rate evolution is flat, irrespective of colour or morphology, out to z ∼ 0.2. The makeup of the merging population does not appear to change over this redshift range. Galaxy growth by major mergers appears comparatively unimportant and dry mergers are unlikely to be significant in the buildup of the red sequence over the past 2 Gyr. We compare the colour, morphology, environmental density and degree of activity (BPT class, Baldwin, Phillips & Terlevich) of galaxies in pairs to those of more isolated objects in the same volume. Galaxies in close pairs tend to be both redder and slightly more spheroid dominated than the comparison sample. We suggest that this may be due to ‘harassment’ in multiple previous passes prior to the current close interaction. Galaxy pairs do not appear to prefer significantly denser environments. There is no evidence of an enhancement in the AGN fraction in pairs, compared to other galaxies in the same volume

Walking the walk: a phenomenological study of long distance walking

Evidence suggests that regular walking can elicit significant psychological benefits although little evidence exists concerning long distance walking. The purpose of this study was to provide detailed accounts of the experiences of long distance walkers. Phenomenological interviews were conducted with six long distance walkers. Data were transcribed verbatim before researchers independently analyzed the transcripts. Participants reported a cumulative effect with positive feelings increasing throughout the duration of the walk. Long distance walking elicited positive emotions, reduced the effects of life-stress, and promoted an increased sense of well-being and personal growth. Results are aligned to theories and concepts from positive psychology

MASSIV: Mass Assembly Survey with SINFONI in VVDS. V. The major merger rate of star-forming galaxies at 0.9 < z < 1.8 from IFS-based close pairs

We aim to measure the major merger rate of star-forming galaxies at 0.9 < z <1.8, using close pairs identified from integral field spectroscopy (IFS). We use the velocity field maps obtained with SINFONI/VLT on the MASSIV sample, selected from the star-forming population in the VVDS. We identify physical pairs of galaxies from the measurement of the relative velocity and the projected separation (r_p) of the galaxies in the pair. Using the well constrained selection function of the MASSIV sample we derive the gas-rich major merger fraction (luminosity ratio mu = L_2/L_1 >= 1/4), and, using merger time scales from cosmological simulations, the gas-rich major merger rate at a mean redshift up to z = 1.54. We find a high gas-rich major merger fraction of 20.8+15.2-6.8 %, 20.1+8.0-5.1 % and 22.0+13.7-7.3 % for close pairs with r_p <= 20h^-1 kpc in redshift ranges z = [0.94, 1.06], [1.2, 1.5) and [1.5, 1.8), respectively. This translates into a gas-rich major merger rate of 0.116+0.084-0.038 Gyr^-1, 0.147+0.058-0.037 Gyr^-1 and 0.127+0.079-0.042 Gyr^-1 at z = 1.03, 1.32 and 1.54, respectively. Combining our results with previous studies at z < 1, the gas-rich major merger rate evolves as (1+z)^n, with n = 3.95 +- 0.12, up to z = 1.5. From these results we infer that ~35% of the star-forming galaxies with stellar masses M = 10^10 - 10^10.5 M_Sun have undergone a major merger since z ~ 1.5. We develop a simple model which shows that, assuming that all gas-rich major mergers lead to early-type galaxies, the combined effect of gas-rich and dry mergers is able to explain most of the evolution in the number density of massive early-type galaxies since z ~ 1.5, with our measured gas-rich merger rate accounting for about two-thirds of this evolution.Comment: Published in Astronomy and Astrophysics, 24 pages, 30 figures, 2 tables. Appendix with the residual images from GALFIT added. Minor changes with respect to the initial versio