Multicompartment compliance aids in the community: the prevalence of potentially inappropriate medications.

The aim of this study was to assess the prevalence of potentially inappropriate medications (PIMs) use in a population of community-based multicompartment compliance aid (MCA) users in north-east Scotland. The research recorded data for MCAs dispensed by 48 of the 50 community pharmacies in Aberdeen City, between 1st June to 31st October 2014, together with concurrently prescribed medications, patient demographics and Carstairs index of social deprivation. Drug-specific quality indicators for PIMs from the Swedish National Board of Health and Welfare were applied, and bivariate logistic regression analysis was used to investigate associations with demographic variables. The median age was 82 years (range 12-105 years, 59% female). A total of 1977 PIMs were identified, affecting 57.8% of patients. A quarter of patients were prescribed >10 medications and 43% had a prescription containing at least one clinically significant drug-drug interaction (DDI). Ten drug groups accounted for 76% of all DDIs. A significant increase in the risk for at least one PIM was associated with female sex (for all indicators of PIM use), age 10 medications [OR: 1.43, 95% CI: 1.16-1.78], prescription of a long-acting benzodiazepine [OR: 1.84, CI: 1.14-2.98]). The study concluded that MCA use is associated with a significant incidence of PIMs, particularly affecting those younger than 80 years and those living in deprived areas. Our findings indicate the need for a more aggressive multidisciplinary approach to the review of the medications prescribed to MCA users

How an Arts-Based Clinical Skills Set Can Be Assessed During OSCEs

Background: Arts-based activities’ roles in medical education is to challenge students to cultivate clinical skills using ART (aesthetics, reflection, time). ART activities offer opportunities for students to cultivate creative dimensions of their clinical skills and to reflect on their responses to uncertainty and ambiguity. Faculty, however, are challenged to structure these learning activities in diverse, sometimes unfamiliar, health care settings. Methods: This study explored preclerkship medical students’ responses to participating in ART activities presented in the common medical educational format of an objective structured clinical exam (OSCE). Activities included interpreting fine art (eg, images and poetry) and drawing a simulated patient. The discussion section transcript and student sketchbooks were analyzed to identify themes related to participating in the study. Results: Use of arts-based activities elicited behaviors similar to those observed in students’ responses to formal summative OSCEs, although students also wrestled with challenges and expressed their subjective impressions. Conclusions: This study offers an arts-based tool set capable of being delivered within the familiar medical education setting and established structure of the OSCE

When you are homeless, you are not thinking about your medication, but your food, shelter or heat for the night: behavioural determinants of homeless patients' adherence to prescribed medicines.

Objectives This study aimed to explore behavioural determinants of homeless patients' adherence to prescribed medicines using Theoretical Domains Framework (TDF). Study design A qualitative study using semi-structured, face-to-face interviews. Methods Participants were recruited from a homelessness primary healthcare centre in Aberdeen, United Kingdom (UK). Face-to-face interviews were audio-recorded and transcribed verbatim. Thematic analysis of the interview data was conducted using the Framework Approach based on the Theoretical Domains Framework. National Health Service ethical and Research and Development (R&D) approval was obtained. Results Twenty-five patients were interviewed, at which point data saturation was achieved. A total of 13 out of 14 Theoretical Domains Framework domains were identified that explained the determinants of adherence or non-adherence to prescribed medicines. These included: beliefs about consequences (e.g. non-adherence leading to poor health); goals of therapy (e.g. being a normal person with particular reference to methadone adherence); and environmental context and resources (e.g. stolen medicines and the lack of secure storage). Obtaining food and shelter was higher priority than access and adherence to prescribed medicines while being homeless. Conclusions Behavioural determinants of non-adherence identified in this study were mostly related to participants' homelessness and associated lifestyle. Results are relevant to developing behaviour change interventions targeting non-adherent homeless patients and to the education of healthcare professionals serving this vulnerable population

'If I die, I die, I don't care about my health': perspectives on self-care of people experiencing homelessness.

Self-care, which refers to what people do to prevent disease and maintain good health, can alleviate negative health consequences of people experiencing homelessness. The aim of the study was to apply a theoretically informed approach in exploring engagement of people experiencing homelessness in self-care and to identify factors that can be targeted in future health and social care interventions. Qualitative semi-structured interviews were conducted with 28 participants opportunistically recruited from a specialist homelessness healthcare centre of North East Scotland, the United Kingdom (UK). An interview schedule was developed based on the theoretical domains framework (TDF). Interviews were audio-recorded and transcribed verbatim. Six aspects of self-care were explored, including (a) self-awareness of physical and mental health, (b) health literacy, including health seeking behaviour, (c) healthy eating, (d) risk avoidance or mitigation, (v) physical activity and sleep and (e) maintaining personal hygiene. Thematic analysis was conducted by two independent researchers following the Framework Approach. Participants described low engagement in self-care. Most of the barriers to engagement in self-care by participants were related to 'environmental context and resources' domain of TDF. Participants often resorted to stealing or begging for food. Many perceived having low health literacy to interpret health-related information. Visits to churches and charities to get a shower or to obtain free meals were commonplace. Participants expressed pessimism that there was ‘nothing’ they could do to improve their health and described perceived barriers often too big for them to overcome. Alienation, lack of social support and the perception that they had done irreversible damage to their health prevented their involvement in self-care. The theme of ‘social circle’ held examples of both enabler and barriers in participants’ uptake of risky behaviours. Health and social services should work with persons experiencing homelessness in designing and delivering targeted interventions that address contextual barriers, multi-morbidity, health literacy and self-efficacy

Socioeconomic risk, parenting during the preschool years and child health age 6 years

Parent–child relationships and parenting processes are emerging as potential life course determinants of health. Parenting is socially patterned and could be one of the factors responsible for the negative effects of social inequalities on health, both in childhood and adulthood. This study tests the hypothesis that some of the effect of socioeconomic risk on health in mid childhood is transmitted via early parenting. Methods: Prospective cohort study in 10 USA communities involving 1041 mother/ child pairs, selected at birth at random with conditional sampling. Exposures: income, maternal education, maternal age, lone parenthood, ethnic status and objective assessments of mother child interaction in the first 4 years of life covering warmth, negativity and positive control. Outcomes: mother’s report of child’s health in general at 6 years. Modelling: multiple regression analyses with statistical testing of mediational processes. Results: All five indicators of socioeconomic status (SES) were correlated with all three measures of parenting, such that low SES was associated with poor parenting. Among the measures of parenting maternal warmth was independently predictive of future health, and among the socioeconomic variables maternal education, partner presence and ‘other ethnic group’ proved predictive. Measures of parenting significantly mediated the impact of measures of SES on child health. Conclusions: Parenting mediates some, but not all of the detectable effects of socioeconomic risk on health in childhood. As part of a package of measures that address other determinants, interventions to support parenting are likely to make a useful contribution to reducing childhood inequalities in health

Improving research quality: the view from the UK Reproducibility Network institutional leads for research improvement

The adoption and incentivisation of open and transparent research practices is critical in addressing issues around research reproducibility and research integrity. These practices will require training and funding. Individuals need to be incentivised to adopt open and transparent research practices (e.g., added as desirable criteria in hiring, probation, and promotion decisions, recognition that funded research should be conducted openly and transparently, the importance of publishers mandating the publication of research workflows and appropriately curated data associated with each research output). Similarly, institutions need to be incentivised to encourage the adoption of open and transparent practices by researchers. Research quality should be prioritised over research quantity. As research transparency will look different for different disciplines, there can be no one-size-fits-all approach. An outward looking and joined up UK research strategy is needed that places openness and transparency at the heart of research activity. This should involve key stakeholders (institutions, research organisations, funders, publishers, and Government) and crucially should be focused on action. Failure to do this will have negative consequences not just for UK research, but also for our ability to innovate and subsequently commercialise UK-led discovery

The Impact of an In-Service Workshop on Cooperating Teachers’ Perceptions of Culturally Responsive Teaching

Culturally responsive teaching values students’ identities, backgrounds, and cultural references as key tools for building meaningful learning environments. It has been adopted by many educators globally, but has not been incorporated consistently by music educators. Few researchers in music education have investigated the impact of culturally responsive teaching and misconceptions exist about what it means to teach music in a culturally responsive manner. The purpose of this research was to investigate the impact of an in-service program on cooperating teachers’ perceptions of culturally responsive teaching. At the conclusion of the workshop, participants rated familiarity and importance of culturally responsive teaching higher than they did prior to the workshop. Sixteen of the 18 participants indicated that the workshop had changed their understanding of culturally responsive teaching

ACCERT: Auckland's cancer cachexia evaluating resistance training study

Background: Cancer Cachexia (CC) is a common problem seen in many advanced malignancies including Non- Small-Cell Lung Cancer (NSCLC). In CC there is a significant loss of adipose tissue and skeletal muscle mass. Muscle wasting is the main cause of impaired function, leading to respiratory complications and fatigue. The optimal treatment for CC is the complete removal of the tumour; unfortunately with advanced NSCLC this is unachievable. The next best options are to increase nutritional intake to counteract weight loss, address the anorexia, inflammation, and metabolic alterations i.e. loss of body fat and the skeletal muscle wasting. This requires the need to utilise a multi-targeted approach to decrease the inflammation and to stimulate the skeletal anabolic pathways with the use of progressive resistance training (PRT). PRT has shown acceptability and benefits in other cancer populations. This study aims to identify a novel multi-targeted treatment regimen that will alleviate and/or stabilise CC weight loss. Methods: This is a randomised, open-label study to investigate whether 2 sessions each week of PRT followed by essential amino acids (EAA's) high in leucine, when administered in addition to Eicosapentaenoic Acid (EPA) and a Cox-2 inhibitor is acceptable to NSCLC cachectic patients for a period of 20 weeks (primary endpoint). Secondary endpoints include Lean Body Mass, MRI thigh skeletal muscle values, QoL and Fatigue questionnaires, serum pro-inflammatory cytokine profiles, and hand and leg strength. Safety data will also be collected. Outcome measures to power a future study will be determined from the trend in difference between the two groups. 21 patients are planned to be randomised in a 1:2 ratio Arm A EPA and Cox-2 inhibitor vs. Arm B EPA, Cox-2 inhibitor, PRT followed by EAA's. All patients are offered to continue with the study medications and/or PRT sessions on compassionate use. Main inclusion criteria include: histological proven NSCLC patients who have at least 5% weight loss and fulfil the following cachectic definition (Evans Clin Nut 2008 27). A guest patient was enrolled in May 2012, followed by study participants in June 201