Does the advertisement in Swiss pharmacy windows rest on evidence-based medicine? An observational study.

OBJECTIVES: The aim of the study was to analyse the proportion of evidence-based medication displayed in pharmacies and compare it between the different linguistic regions of the country, at different times of the year to determine the amount of proven effective medications indirectly recommended to the public in different parts of Switzerland. DESIGN: This is an observational study conducted by medical doctors in the department of internal medicine at the Spitalzentrum Biel, Switzerland. SETTING: The observation took place from July 2019 to May 2020. From a total of 1800 pharmacies in Switzerland, 68 different pharmacies were selected across the 3 main linguistic regions and the medication on display in their windows were examined 4 times a year regarding their efficacy. The displays of medication with or without evidence-based efficacy were described using absolute numbers and proportions and compared between the different linguistic regions at different seasons using χ2. PARTICIPANTS: There were no human or animal participants involved in this study. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome is the proportion of medication displayed in pharmacy windows with a proven effectiveness in medical literature. The secondary outcome was the variability of the primary outcome over time (seasonal changes), over the different linguistic regions of Switzerland and between chains and privately owned pharmacies. RESULTS: We examined 970 medications and found that over the whole year, there is a high proportion of non-evidence-based drugs (56,9%) displayed in pharmacies. Swiss German cantons display significantly more non-evidence-based medications in winter. We found no statistical difference for other seasons or between chains and privately owned pharmacies. CONCLUSION: Pharmacies in Switzerland tend to display significantly more non-evidence-based drugs, thus indirectly recommending them to the public. In a time of necessary expansion of self-medication by the population, this could incite consumers to buy drugs without proven effectiveness.

How might Covid-19 affect the biology curricula of the future? Two principles for curriculum developers to consider.

Understanding the lifestyle changes that authorities have requested or required in response to Covid-19 requires some biological knowledge. Therefore, articulations of intended biology learning at the school level will need to be evaluated, to see if they continue to be fit for purpose in light of the pandemic. This article proposes two principles of curriculum development and applies them to the (re)development of biology curricula in response to Covid-19. Firstly, while Covid-19 provides a vivid contextualisation of many biological concepts, it does not change the underlying concepts themselves. Moreover, it will not take long before it passes from being contemporary experience to a historical case study. Care is, therefore, needed to retain focus on the core concepts of biology, rather than allocating too much time to the particulars of the Covid-19 case. Secondly, biology curricula are often used to educate a population about public health. However, policymakers should be aware that knowledge alone is often insufficient to generate healthy behaviours.

The benefits of errorless learning for people with amnestic mild cognitive impairment.

The aim of this study was to explore whether errorless learning leads to better outcomes than errorful learning in people with amnestic mild cognitive impairment (MCI), and to examine whether accuracy in error recognition relates to any observed benefit of errorless over errorful learning. Nineteen participants with a clinical diagnosis of amnestic MCI were recruited. A word-list learning task was used and learning was assessed by free recall, cued recall and recognition tasks. Errorless learning was significantly superior to errorful learning for both free recall and cued recall. The benefits of errorless learning were less marked in participants with better error recognition ability. Errorless learning methods are likely to prove more effective than errorful methods for those people with MCI whose ability to monitor and detect their own errors is impaired.

Can a mindfulness-informed intervention reduce aggressive behaviour in people with intellectual disabilities? Protocol for a feasibility study.

BACKGROUND: Approximately 10-20 % of adults with intellectual disabilities engage in challenging behaviours such as aggression, destructiveness, and self-injury, which are often accompanied by feelings of anger. The inability to manage anger can reduce quality of life. For example, aggression is a strong predictor of out-of-area placements and is a risk variable for abuse. Recent research suggests that mindfulness-based therapies (specifically, Singh's Soles of the Feet meditation) can help people with intellectual disabilities manage angry emotions, with resultant reductions in challenging behaviour. However, previous research has been single-case design studies, and no group studies have been published with people with intellectual disabilities and aggressive behaviour. METHODS/DESIGN: For this feasibility study, a UK protocol will be developed for use by health professionals within National Health Service (NHS) Intellectual Disability (ID) teams, based upon Singh's Soles of the Feet manual. Twenty adults with intellectual disabilities and identified problems with anger control will be recruited and six sessions will be delivered by a trained ID clinician. The study will monitor participant's aggressive behaviour, health-related quality of life, anxiety, depression, and use of support services (medication, hospital appointments etc.). These will be measured at three time points: (1) Baseline (within 2 weeks prior to the first session of the intervention), (2) 2 months post-baseline, and (3) 6 months post-baseline. Qualitative interviews will be conducted with participants, their carers, and the therapists who delivered the intervention. In order to help design an economic evaluation alongside a future full trial, we will cost the intervention and test the acceptability and validity of health economics measures to record resource use and health-related quality of life outcomes. DISCUSSION: The data from this study will inform the feasibility of the project protocol and intervention, which will help develop future research and to determine whether a larger, randomised controlled trial with concurrent economic evaluation is feasible. TRIAL REGISTRATION: UKCERN: 16743.

An informatics-enabled approach for detection of new tumor registry cases.

Tumor registries are held to a very high standard for identifying and reporting new analytic cancer cases. However, current approaches to new case detection are often inefficient and costly. Efficient and effective detection of new cancer cases has the potential to maintain a high accuracy of reporting while reducing costs, increasing timeliness of reporting, and ultimately advancing cancer research. We describe the development, implementation, and evaluation of an informatics tool that integrates multiple data sources to support the workflow of new case identification at the Vanderbilt University Medical Center (VUMC) tumor registry office. The new system reduced the total number of potential cases to analyze from roughly 13,000 to 2,500 records per month. This resulted in an efficiency gain of roughly 80 man hours per month with a respective annual savings of approximately 50,000 dollars. Further iterative refinement of this approach along with support for case abstraction could result in further efficiencies.

What contributes to a good quality of life in early dementia? Awareness and the QoL-AD: a cross-sectional study.

BACKGROUND: Self-report quality of life (QoL) measures for people with dementia are widely used as outcome measures in trials of dementia care interventions. Depressed mood, relationship quality and neuropsychiatric symptoms predict scores on these measures, whereas cognitive impairment and functional abilities typically do not. This study examines whether these self-reports are influenced by personality and by the person's awareness of his/her impairments. A strong negative association between QoL and awareness of deficits would have implications for the validity of self-report in this context and for therapeutic interventions aiming to increase adjustment and coping. METHODS: Participants were 101 individuals with early‒stage dementia and their family carers participating in the Memory Impairment and Dementia Awareness (MIDAS) Study. QoL was assessed using the QoL-AD scale, and awareness was assessed in relation to memory, activities of daily living and social functioning. Self-concept, conscientiousness, quality of relationship and mood were assessed and a brief neuropsychological battery administered. Carers rated their own stress and well-being and reported on neuropsychiatric symptoms. A series of regression analyses predicting QoL-AD were carried out, identifying key variables in each domain of assessment to take forward to an overall model. RESULTS: Cognitive impairment was not related to QoL. The final model accounted for 57% of the variance in QoL-AD scores, with significant contributions from depressed mood, severity of irritability shown by the person with dementia, self-concept, quality of relationship (rated by the person with dementia) and male gender. The bivariate relationships of QoL-AD with awareness of memory function, awareness of functional abilities and conscientiousness were mediated by both depressed mood and self-concept. CONCLUSIONS: This study reports the most comprehensive approach to evaluation of awareness to date. Most of the indices of awareness used are not related to self-reported QoL. Discrepancies in evaluative judgements of memory function and functional abilities between people with dementia and carers are related to QoL, but this relationship is mediated by both depressed mood and self-concept, which have a much stronger relationship with QoL. The validity of self-report measures of QoL in people with early stage dementia is supported by these results.

Phenomena of awareness in dementia: heterogeneity and its implications.

Despite much research on the relationship between awareness and dementia little can be concluded concerning their relationship and the role of other factors. It is likely that studies capture different phenomena of awareness. This study aimed at identifying and delineating such variation by analysing data from three questionnaires obtained during the longitudinal study of awareness in 101 people with early-stage dementia. The data concerned awareness in relation to memory, activities of daily living and socio-emotional function. Significant differences in patterns of discrepancies were obtained. This suggests that the awareness phenomena involved were structurally different; and that, in turn, this may reflect variation in the intrinsic linking between awareness and its 'object' (different 'objects' determining different kinds of judgements). The identification of such differences is necessary so that appropriate methodologies can be applied to the study of awareness in different contexts.

Memory awareness profiles differentiate mild cognitive impairment from early-stage dementia: evidence from assessments of performance monitoring and evaluative judgement.

BACKGROUND: Measures of memory awareness based on evaluative judgement and performance monitoring are often regarded as equivalent, but the Levels of Awareness Framework suggests they reflect different awareness phenomena. Examination of memory awareness among groups with differing degrees of impairment provides a test of this proposition. METHOD: Ninety-nine people with dementia (PwD), 30 people with mild cognitive impairment (PwMCI), and their relatives completed isomorphic performance monitoring and evaluative judgement measures of memory awareness and were followed up at 12 and (PwD only) 20 months. In addition to the resulting awareness indices, comparative accuracy scores were calculated using the relatives' data to establish whether any inaccuracy was specific to self-ratings. RESULTS: When making evaluative judgements about their memory in general, both PwD and PwMCI tended to overestimate their own functioning relative to informant ratings made by relatives. When monitoring performance on memory tests, PwD again overestimated performance relative to test scores, but PwMCI were much more accurate. Comparative accuracy scores indicated that, unlike PwD, PwMCI do not show a specific inaccuracy in self-related appraisals. CONCLUSIONS: The results support the proposition that awareness indices at the levels of evaluative judgement and performance monitoring should be regarded as reflecting distinct awareness phenomena.

Meta-representational awareness in mild cognitive impairment: an interpretative phenomenological analysis.

Awareness in mild cognitive impairment (MCI) has been studied primarily from a quantitative perspective, which has yielded inconclusive results. A qualitative approach may provide a more in-depth profile of awareness of symptoms and changes among people living with MCI. Few qualitative studies have considered awareness in MCI; therefore, the focus here will be on the experience of living with MCI, and particularly on the psychological impact of living with memory difficulties and how these impact on daily life. Twenty five participants with a clinical diagnosis of MCI who had been informed of their diagnosis were interviewed. Interpretative phenomenological analysis was used to analyse interview transcripts. Four higher order themes were identified. An exploratory model is proposed with a dominant theme of 'Fear and uncertainty'; this underpins 'Interdependence', 'Life goes on as normal' and 'Disavowal of difficulty' which are representative of coping responses resulting from appraisal of memory and cognitive difficulties. Participants did not use the term 'MCI', suggesting that this term had little meaning for them; nevertheless, there was a wish for a definitive explanation of the difficulties. The themes elicited from participant accounts indicate that the symptoms of MCI are perceived as a threat to psychological well-being which results in context-specific appraisal of the symptoms of MCI.

Contributions of frontal and medial temporal lobe functioning to the errorless learning advantage.

Among individuals with episodic memory impairments, trial-and-error learning is less successful than when errors are avoided. This "errorless learning advantage" has been replicated numerous times, but its neurocognitive mechanism is uncertain, with existing evidence pointing to both medial temporal lobe (MTL) and frontal lobe (FL) involvement. To test the relative contribution of MTL and FL functioning to the errorless learning advantage, 51 healthy older adults were pre-experimentally assigned to one of four groups based on their neuropsychological test performance: Low MTL-Low FL, Low MTL-High FL, High MTL-Low FL, High MTL-High FL. Participants learned two word lists under errorless learning conditions, and two word lists under errorful learning conditions, and memory was tested via free recall, cued recall, and source recognition. Performance on all three tests was better for those with High relative to Low MTL functioning. An errorless learning advantage was found in free and cued recall, in cued recall marginally more so for those with Low than High MTL functioning. Participants with Low MTL functioning were also more likely to misclassify learning errors as target words. Overall, these results are consistent with a MTL locus of the errorless learning advantage. The results are discussed in terms of the multi-componential nature of neuropsychological tests and the impact of demographic and mood variables on cognitive functioning.

The influence of psychological, social and contextual factors on the expression and measurement of awareness in early-stage dementia: testing a biopsychosocial model.

BACKGROUND: Insufficient attention has been paid to the influence of psychological and social factors on discrepancy-based measures of awareness. OBJECTIVES: The present study tested a biopsychosocial model of awareness in early-stage dementia by gathering evidence regarding the relative contributions of neuropsychological, individual psychological and social factors to the level of scoring on measures used to index awareness. METHOD: Awareness was assessed in relation to memory, activities of daily living and social functioning in 101 individuals with early-stage dementia participating in the Memory Impairment and Dementia Awareness (MIDAS) Study. People with dementia (PwD) and carers also completed measures of individual psychological and social variables, and PwD completed measures of neuropsychological functioning. RESULTS: Scores on discrepancy-based indices of awareness and on the self-ratings and informant ratings contributing to these indices were associated with a range of factors including neuropsychological functioning of PwD, individual traits and dispositions and current affective functioning of PwD, socio-demographic characteristics of PwD and carers, carer well-being and carer perceptions of PwD and of quality of relationship with PwD. Patterns of association varied across domains of functioning. CONCLUSIONS: The findings support the relevance of a biopsychosocial approach to understanding the factors that influence unawareness of impairment in dementia.

Dissociation between implicit and explicit manifestations of awareness in early stage dementia: evidence from the emotional Stroop effect for dementia-related words.

OBJECTIVE: To determine whether people with dementia (PwD), and carers of PwD, show a processing bias to dementia-related words in an emotional Stroop task, and if so, whether the presence of such a bias is related to level of explicit awareness of the condition. METHOD: Seventy-nine people with early stage Alzheimer's disease (AD), vascular or mixed dementia, and their carers, completed an emotional Stroop task. Time taken to colour-name dementia-related and neutral words was compared within and between groups. Additionally, as a comparison, ratings of the awareness of the condition shown by PwD were made on the basis of a detailed interview with each PwD and his/her carer. RESULTS: PwD and carers showed the same level of increase in response times to salient compared to neutral words. In the PwD this effect was unrelated to the degree of awareness that they demonstrated regarding the condition. CONCLUSIONS: The emotional Stroop effect in response to dementia-related words in PwD indicates that preserved implicit awareness of the condition can be elicited even where there is reduced explicit awareness.

Verbatim and gist recall of sentences by dyslexic and non-dyslexic adults.

Forty-eight college students, 24 of them dyslexic, were presented with four sentences of increasing complexity. Participants were asked to repeat each sentence and a record was kept of the number of repetitions required before 100% correct accuracy was achieved. None of the 24 control participants required a total of more than eight repetitions over the four sentences, whereas among the dyslexics the total number of repetitions needed ranged from one to 25. Dyslexic participants were unpredictable in their performance from one level of difficulty to the next and inter-individual variability was far greater in the dyslexic group than in the control group. Overall, despite their relatively poor performance in achieving verbatim accuracy relative to non-dyslexic participants, dyslexic individuals regularly managed to preserve the gist of the sentences. Some theoretical issues arising from these results are discussed.

Effect of a novel integrated power toothbrush and toothpaste oral hygiene system on gingivitis.

The purpose of this article is to compare the gingivitis reduction efficacy relative to baseline of an integrated power toothbrush/toothpaste dispensing system prototype, the IntelliClean System from Sonicare and Crest. This was a randomized, controlled, parallel-group, examiner-blind study that examined the gingivitis reduction efficacy of a novel integrated system compared to a positive control consisting of manual toothbrushing coupled with daily flossing over a 4-week period. Mean change from baseline for gingival index (GI) and bleeding scores were tested using paired t tests for each treatment group, separately. Between-group comparisons were made with respect to change from baseline using analysis of covariance. Baseline values were used as the covariate. All tests were 2-sided with a 0.05 level of significance. A total of 66 subjects (61 women and 5 men) completed the study. The subjects ranged in age from 20 to 64 years with an overall mean age of 39.4 years. Baseline GI and bleeding scores were not statistically significantly different (P > .2) between the experimental integrated system group and the positive-control group. Both treatment regimen groups demonstrated highly statistically significant reductions in GI and bleeding scores vs baseline (P < .0001) at weeks 2 and 4. After 4 weeks, there was a 28% mean reduction in GI for the experimental group and a 23% mean reduction for the positive-control group. Similarly, there was a 28% mean reduction in bleeding for the experimental integrated system group and a 23% reduction for the positive-control group. However, no statistically significant treatment difference was found between the 2 groups (P > .5) for either measure at week 2 or week 4. This study demonstrated the efficacy of the IntelliClean System from Sonicare and Crest in significantly reducing gingivitis and bleeding relative to baseline after 4 weeks of use according to the manufacturer's instructions.

Multi-agency training for quality: reflections and recommendations.

Clinical governance within the National Health Service (NHS) and best value across local authorities in England have emphasised the need for decisions and actions being demonstrably evidence based. In an attempt to progress these related initiatives and facilitate a closer working relationship between NHS Trusts and local government departments, a multi-agency and interprofessional training event on evidence-based practice (EBP) was organised across three boroughs within Tyne and Wear. While there are advantages to different agencies learning and working in partnership to develop quality systems for health improvement, the reality of introducing EBP concepts and creating an evaluative culture within and across public sector organisations represents a major challenge. This article has adopted a case study approach to describe the key lessons learnt through critically reflecting on the planning and delivery of this training event, and it is hoped that it will be of value to other attempting similar projects in the future.