Introduction older adults are at risk of adverse outcomes due to a high prevalence of polypharmacy and potentially inappropriate medications (PIMs). Deprescribing interventions have been demonstrated to reduce polypharmacy and PIMs. However, deprescribing is not performed routinely in long-term care facilities (LTCFs). This qualitative evidence synthesis aims to identify the factors which limit and enable health care workers’ (HCWs) engagement with deprescribing in LTCFs. Methods the ‘best-fit’ framework approach was used to synthesise evidence by using the Theoretical Domains Framework (TDF) as the a priori framework. Included studies were analysed qualitatively to identify LTCF barriers and enablers of deprescribing and were mapped to the TDF. Constructs within domains were refined to best represent the LTCF context. A conceptual model was created, hypothesising relationships between barriers and enablers. Results of 655 records identified, 14 met the inclusion criteria. The ‘best-fit’ framework included 17 barriers and 16 enablers, which mapped to 11 of the 14 TDF domains. Deprescribing barriers included perceptions of an ‘established hierarchy’ within LTCFs, negatively affecting communication and insufficient resources which limited HCWs’ engagement with deprescribing. Enablers included tailored deprescribing guidelines, interprofessional support and working with a patient focus, allowing the patients’ condition to influence decisions. Discussion this study identified that education, interprofessional support and collaboration can facilitate deprescribing. To overcome deprescribing barriers, change is required to a patient-centred model and HCWs need to be equipped with necessary resources and adequate reimbursement. The LTCF organisational structure must support deprescribing, with communication between health care systems.

Objectives The main objective of this study was to assess community pharmacists’ thoughts regarding the role they can play in effectively integrating deprescribing into clinical practice in Ireland. The aim was to assess pharmacists’ (1) knowledge of deprescribing, (2) confidence in deprescribing, (3) attitudes towards deprescribing and (iv) barriers and facilitators to deprescribing in a community pharmacy setting. Methods An online questionnaire was disseminated to pharmacists currently registered with the Pharmaceutical Society of Ireland, with instruction only to complete if working in community pharmacy. Statistical analysis was conducted on the quantitative data, whereas thematic analysis was carried out on the open-ended responses. Key findings Results indicate good knowledge scores and positive attitudes surrounding deprescribing, with demographic factors having no significant effect on results. Although deprescribing knowledge is high, willingness to engage is hindered by obstacles such as time. Remuneration was identified as an enabler for deprescribing. Interdisciplinary educational opportunities and bidirectional communication channels with prescribers are viewed as the major facilitators of deprescribing. Conclusions Community pharmacists demonstrate that they possess sufficient knowledge, confidence and willingness to play a greater role in facilitating deprescribing. To enable this role expansion, enablers such as education and funding need to be implemented, to overcome barriers such as insufficient time. Further studies are required to assess community pharmacists’ deprescribing competence, to demonstrate their ability to fulfil this role in clinical practice in Ireland.

Background Pharmacists are being increasingly employed as part of general practice teams globally, and their input has been associated with several clinical and economic benefits. However, there is a paucity of research focussing on general practitioners’ (GPs’) perceptions of pharmacist integration into practices in countries where this novel role for pharmacists is yet to become commonplace. Objective To explore GPs’ perceptions of integrating pharmacists into general practices and to identify the behavioural determinants of GPs integrating pharmacists into practices. Methods Semistructured interviews were conducted with GPs practising in Ireland, who were sampled using a combination of purposive, convenience, and snowball sampling. Interviews were audio-recorded and transcribed verbatim, which then were analysed using conventional content analysis and directed content analysis employing the Theoretical Domains Framework (TDF). Results Seventeen GPs were interviewed between November 2021 and February 2022. Seven TDF domains were identified as predominant in influencing GPs’ perceptions of pharmacist integration into general practices. These perceptions were mostly positive, especially regarding patient outcomes, cost savings, and improving access to care. However, there were concerns about funding the role, affecting others’ workloads, and pharmacists’ training needs to work in practices. Conclusion This study’s theory-informed insight provides a deeper understanding of GPs’ perceptions of pharmacists working in general practice and behaviours which can be targeted to help optimize integration. These findings should be utilized in future service development to preempt and address GPs’ concerns ahead of pharmacist integration, as well as to inform the development of general practice-based pharmacist roles going forward.

Understanding the ontogeny of a taxon is a crucial step to properly elucidate its taxonomy and evolution. However, aside from histological data, osteological criteria for assessing maturity are considered lineage specific or controversial. The sequence of neurocentral suture closure of the axial skeleton of extant crocodilians, which occurs in a posterior–anterior sequence, is a non‐destructive method used to determine maturity in extinct reptiles. However, its use in extinct archosaurs not closely related to crocodilians is debatable, as the ancestral condition of Archosauria is unknown and variation occurs in timing and sequence orientation within the clade. We have assessed the pattern of neurocentral suture closure of Hyperodapedontinae rhynchosaurs, an early archosauromorph clade distantly related to archosaurs. Unlike extant crocodilians, they exhibit an anterior–posterior sequence neurocentral suture closure. Relative size and other ontogenetic markers suggest that neurocentral closure in the Hyperodapedontinae correlates with aging, although closed sutures were rare in the sample. A high number of open or partially open sutures in mature individuals indicate that they remained open during most of their life. Our study indicates that: (1) the delayed neurocentral closure may be a paedomorphic heterochronic process in Hyperodapedontinae, as it contrasts with the fully closed neurocentral sutures of early diverging non‐hyperodapedontine rhynchosaurs; (2) the assumption that open neurocentral sutures indicates immaturity in extinct reptiles is not always correct; and (3) the delayed closure may have originated independently in several archosauromorph lineages, but the ancestral condition of Archosauria probably follows the crocodilian closure pattern.

Two deprescribing search filters for MEDLINE and one deprescribing search filter for Embase have been recently developed, including objectively developed search filters. The objective of this case study was to implement these three deprescribing search filters in systematic review (SR) search strategies and to assess their effect on performances. SR that independently developed original search strategies (OSS) were selected. The deprescribing filters were implemented in each OSS, generating two implemented search strategies (ISS1 and ISS2) in MEDLINE and one ISS (ISS3) in Embase. OSS were re‐run on the same date as ISS. The performances of ISS and OSS were calculated and compared. Two SR were included (SR1 and SR2). For MEDLINE, SR1 included 12 articles. The sensitivity was 50% for OSS, 58% for ISS1 and 42% for ISS2. SR2 included four articles. The sensitivity of OSS, ISS 1 and 2 was 25%. For Embase, SR1 included 12 articles. The sensitivity was 33% for OSS and 58% for ISS3. SR2 included four articles. None of the four included articles were retrieved with OSS or ISS3. While sensitivity of OSS was moderate, the objectively developed deprescribing filters maintained or slightly improved this sensitivity when implementing.