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Article ; Online: Implementing the use of objective medication adherence data in routine clinical practice via the digital CFHealthHub platform

Carla Girling / Anna Packham / Louisa Robinson / Madelynne A. Arden / Daniel Hind / Martin J. Wildman

Implementation Science Communications, Vol 3, Iss 1, Pp 1-

situation analysis and strategy development using the theoretical domains framework

2022 Volume 16

Abstract: Abstract Background Preventative inhaled treatments preserve lung function and reduce exacerbations in cystic fibrosis (CF). Self-reported adherence to these treatments is over-estimated. An online platform (CFHealthHub) has been developed with patients ... ...

Abstract	Abstract Background Preventative inhaled treatments preserve lung function and reduce exacerbations in cystic fibrosis (CF). Self-reported adherence to these treatments is over-estimated. An online platform (CFHealthHub) has been developed with patients and clinicians to display real-time objective adherence data from dose-counting nebulisers, so that clinical teams can offer informed treatment support. Methods In this paper, we identify pre-implementation barriers to healthcare practitioners performing two key behaviours: accessing objective adherence data through the website CFHealthHub and discussing medication adherence with patients. We aimed to understand barriers during the pre-implementation phase, so that appropriate strategy could be developed for the scale up of implementing objective adherence data in 19 CF centres. Thirteen semi-structured interviews were conducted with healthcare practitioners working in three UK CF centres. Qualitative data were coded using the theoretical domains framework (TDF), which describes 14 validated domains to implementation behaviour change. Results Analysis indicated that an implementation strategy should address all 14 domains of the TDF to successfully support implementation. Participants did not report routines or habits for using objective adherence data in clinical care. Examples of salient barriers included skills, beliefs in consequences, and social influence and professional roles. The results also affirmed a requirement to address organisational barriers. Relevant behaviour change techniques were selected to develop implementation strategy modules using the behaviour change wheel approach to intervention development. Conclusions This paper demonstrates the value of applying the TDF at pre-implementation, to understand context and to support the development of a situationally relevant implementation strategy.
Keywords	Cystic fibrosis ; Adherence ; Implementation ; Theoretical domains framework ; Intervention ; Medicine (General) ; R5-920
Subject code	005
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Making the invisible visible

Louisa Robinson / Chin Maguire / Zhe Hui Hoo / Martin J. Wildman

F1000Research, Vol

the availability and desirability of adherence data in routine CF care– findings from a national questionnaire survey [version 2; peer review: 2 approved]

2020 Volume 8

Abstract: Background: Inhaled medications for cystic fibrosis (CF) are effective but adherence is low. Clinicians find it difficult to estimate how much treatment people with CF (PWCF) take, whilst objective adherence measurement demonstrates that patients are ... ...

Abstract	Background: Inhaled medications for cystic fibrosis (CF) are effective but adherence is low. Clinicians find it difficult to estimate how much treatment people with CF (PWCF) take, whilst objective adherence measurement demonstrates that patients are poorly calibrated with a tendency to over-estimate actual adherence. The diagnostic approach to a PWCF with deteriorating clinical status and very low adherence is likely to be different to the approach to a deteriorating patient with optimal adherence. Access to objective adherence data in routine consultations could help to overcome diagnostic challenges for clinicians and people with CF. Attitudes of clinicians to the use and importance of routinely available adherence data is unknown. Methods: We conducted an online questionnaire survey with UK CF centres. We asked five questions relating to the current use and perception of objective measurements of adherence in routine care. Results: A total of eight CF centres completed the questionnaire. Few of the responding centres have adherence data readily available in routine clinics (13% of centres use medicines possession ratio; of centres with access to I-nebs® it was estimated that 17% of patients had I-neb data regularly available in clinics). All centres considered the availability of objectively measured adherence data to be important. Respondents identified that systems developed to provide adherence data in clinical practice must provide data to both clinicians and patients that is readily understood and easy to use. Conclusions: Centres perceived the availability of adherence data in routine care to be important but objective measures of adherence is rarely available at present.
Keywords	Medicine ; R ; Science ; Q
Subject code	310
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	F1000 Research Ltd
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Inoculation of drought-stressed strawberry with a mixed inoculum of two arbuscular mycorrhizal fungi: effects on population dynamics of fungal species in roots and consequential plant tolerance to water deficiency

Boyer, Louisa Robinson / Brain, Philip / Xu, Xiang-Ming / Jeffries, Peter

Mycorrhiza. 2015 Apr., v. 25, no. 3

2015

Abstract: The effect of inoculation with two arbuscular mycorrhizal fungi (AMF) on growth and drought tolerance of cultivated strawberry (Fragaria × ananassa) was studied. Three treatments (a single treatment either of Funneliformis mosseae BEG25, Funneliformis ... ...

Abstract	The effect of inoculation with two arbuscular mycorrhizal fungi (AMF) on growth and drought tolerance of cultivated strawberry (Fragaria × ananassa) was studied. Three treatments (a single treatment either of Funneliformis mosseae BEG25, Funneliformis geosporus BEG11 or a 50:50 mixed inoculation treatment of both species) were compared to uninoculated plants. Species-specific primers for qPCR quantification of F. geosporus and F. mosseae DNA were developed to quantify the relative abundance of each fungus in roots of strawberry under different conditions of water stress. Co-occupation of the same root by both species was shown to commonly occur, but their relative abundance varied with water stress (reduced irrigation of up to 40 %). Greater root colonisation was observed microscopically under water stress, but this increased colonisation was often accompanied with decreased amounts of fungal DNA in the root. F. mosseae tended to become more abundant under water stress relative to F. geosporus. There was significant correlation in the fungal colonisation measurements from the microscopic and qPCR methods under some conditions, but the nature of this relationship varied greatly with AMF inoculum and abiotic conditions. Single-species inoculation treatments gave similar benefits to the host to the mixed inoculation treatment regardless of irrigation regime; here, amount of colonisation was of greater importance than functional diversity. The addition of AMF inocula to plants subjected to reduced irrigation restored plant growth to the same or higher values as the non-mycorrhizal, fully-watered plants. The water use efficiency of plants was greater under the regulated deficit irrigation (RDI) regime and in AMF-inoculated plants, but there were no significant differences between plants inoculated with the single or combined inoculum. This study demonstrated that the increase in plant growth was directly influenced by an increase in root colonisation by AMF when individual plants were examined.
Keywords	DNA ; Fragaria ; Glomus mosseae ; deficit irrigation ; drought tolerance ; functional diversity ; inoculum ; irrigation management ; mycorrhizae ; mycorrhizal fungi ; plant growth ; population dynamics ; quantitative polymerase chain reaction ; roots ; strawberries ; water stress ; water use efficiency
Language	English
Dates of publication	2015-04
Size	p. 215-227.
Publishing place	Springer-Verlag
Document type	Article
ZDB-ID	1087945-6
ISSN	1432-1890 ; 0940-6360
ISSN (online)	1432-1890
ISSN	0940-6360
DOI	10.1007/s00572-014-0603-6
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Inoculation of drought-stressed strawberry with a mixed inoculum of two arbuscular mycorrhizal fungi: effects on population dynamics of fungal species in roots and consequential plant tolerance to water deficiency.

Boyer, Louisa Robinson / Brain, Philip / Xu, Xiang-Ming / Jeffries, Peter

Mycorrhiza

2014 Volume 25, Issue 3, Page(s) 215–227

Abstract	The effect of inoculation with two arbuscular mycorrhizal fungi (AMF) on growth and drought tolerance of cultivated strawberry (Fragaria × ananassa) was studied. Three treatments (a single treatment either of Funneliformis mosseae BEG25, Funneliformis geosporus BEG11 or a 50:50 mixed inoculation treatment of both species) were compared to uninoculated plants. Species-specific primers for qPCR quantification of F. geosporus and F. mosseae DNA were developed to quantify the relative abundance of each fungus in roots of strawberry under different conditions of water stress. Co-occupation of the same root by both species was shown to commonly occur, but their relative abundance varied with water stress (reduced irrigation of up to 40%). Greater root colonisation was observed microscopically under water stress, but this increased colonisation was often accompanied with decreased amounts of fungal DNA in the root. F. mosseae tended to become more abundant under water stress relative to F. geosporus. There was significant correlation in the fungal colonisation measurements from the microscopic and qPCR methods under some conditions, but the nature of this relationship varied greatly with AMF inoculum and abiotic conditions. Single-species inoculation treatments gave similar benefits to the host to the mixed inoculation treatment regardless of irrigation regime; here, amount of colonisation was of greater importance than functional diversity. The addition of AMF inocula to plants subjected to reduced irrigation restored plant growth to the same or higher values as the non-mycorrhizal, fully-watered plants. The water use efficiency of plants was greater under the regulated deficit irrigation (RDI) regime and in AMF-inoculated plants, but there were no significant differences between plants inoculated with the single or combined inoculum. This study demonstrated that the increase in plant growth was directly influenced by an increase in root colonisation by AMF when individual plants were examined.
MeSH term(s)	Agricultural Irrigation ; Biodiversity ; Droughts ; Fragaria/growth & development ; Fragaria/microbiology ; Fragaria/physiology ; Glomeromycota/genetics ; Glomeromycota/isolation & purification ; Glomeromycota/physiology ; Mycorrhizae/genetics ; Mycorrhizae/isolation & purification ; Mycorrhizae/physiology ; Plant Roots/growth & development ; Plant Roots/microbiology ; Plant Roots/physiology ; Water/metabolism
Chemical Substances	Water (059QF0KO0R)
Language	English
Publishing date	2014-09-04
Publishing country	Germany
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1087945-6
ISSN	1432-1890 ; 0940-6360
ISSN (online)	1432-1890
ISSN	0940-6360
DOI	10.1007/s00572-014-0603-6
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Feasibility study for supporting medication adherence for adults with cystic fibrosis

Daniel Hind / Madelynne A Arden / Simon Waterhouse / Chin Maguire / Jane Dewar / Martin J Wildman / Sarah J Drabble / Hannah Cantrill / Louisa Robinson / Daniel Beever / Marlene Hutchings / Judy Bradley / Julia Nightingale / Mark I Allenby / Pauline Whelan

BMJ Open, Vol 10, Iss

mixed-methods process evaluation

2020 Volume 10

Abstract: Objectives To undertake a process evaluation of an adherence support intervention for people with cystic fibrosis (PWCF), to assess its feasibility and acceptability.Setting Two UK cystic fibrosis (CF) units.Participants Fourteen adult PWCF; three ... ...

Abstract	Objectives To undertake a process evaluation of an adherence support intervention for people with cystic fibrosis (PWCF), to assess its feasibility and acceptability.Setting Two UK cystic fibrosis (CF) units.Participants Fourteen adult PWCF; three professionals delivering adherence support (‘interventionists’); five multi-disciplinary CF team members.Interventions Nebuliser with data recording and transfer capability, linked to a software platform, and strategies to support adherence to nebulised treatments facilitated by interventionists over 5 months (± 1 month).Primary and secondary measures Feasibility and acceptability of the intervention, assessed through semistructured interviews, questionnaires, fidelity assessments and click analytics.Results Interventionists were complimentary about the intervention and training. Key barriers to intervention feasibility and acceptability were identified. Interventionists had difficulty finding clinic space and time in normal working hours to conduct review visits. As a result, fewer than expected intervention visits were conducted and interviews indicated this may explain low adherence in some intervention arm participants. Adherence levels appeared to be >100% for some patients, due to inaccurate prescription data, particularly in patients with complex treatment regimens. Flatlines in adherence data at the start of the study were linked to device connectivity problems. Content and delivery quality fidelity were 100% and 60%–92%, respectively, indicating that interventionists needed to focus more on intervention ‘active ingredients’ during sessions.Conclusions The process evaluation led to 14 key changes to intervention procedures to overcome barriers to intervention success. With the identified changes, it is feasible and acceptable to support medication adherence with this intervention.Trial registration number ISRCTN13076797; Results.
Keywords	Medicine ; R
Subject code	796
Language	English
Publishing date	2020-10-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: PCR-SSCP analysis of Fusarium diversity in asparagus decline in Japan

Nahiyan, Abu Shamim Mohammad / Boyer, Louisa Robinson / Jeffries, Peter / Matsubara, Yoh-ichi

European journal of plant pathology. 2011 June, v. 130, no. 2

2011

Abstract: The diversity of Fusarium populations in asparagus (Asparagus officinalis L.) decline fields in Japan was estimated by PCR-SSCP (single-stranded conformational polymorphism) analysis of the ITS2 regions of the nuclear rRNA genes. This method was used to ... ...

Abstract	The diversity of Fusarium populations in asparagus (Asparagus officinalis L.) decline fields in Japan was estimated by PCR-SSCP (single-stranded conformational polymorphism) analysis of the ITS2 regions of the nuclear rRNA genes. This method was used to rapidly and objectively identify pathogens associated with roots of plants showing symptoms of asparagus decline collected from fields in five regions across Japan. Over 651 fusarial isolates were obtained, and were easily differentiated into three principal species. Fusarium oxysporum f. sp. asparagi was most frequently isolated from the domestic five regions (68%), whereas Fusarium proliferatum (28.6%) was less frequent. Fusarium solani was found much rarely (2.5%). The frequency of isolation of Fusarium proliferatum increased gradually from the north to the south of Japan, though considerable differences were found between fields in each region, as well as regional differences among the Fusarium populations. Most of the fusarial isolates were highly pathogenic in vitro. These results reveal that Fusarium oxysporum f. sp. asparagi and Fusarium proliferatum are important biotic factors which lead to asparagus decline in Japan.
Keywords	Asparagus officinalis ; Fusarium oxysporum ; Fusarium proliferatum ; Fusarium solani ; decline ; ribosomal RNA ; signs and symptoms (plants) ; single-stranded conformational polymorphism ; Japan
Language	English
Dates of publication	2011-06
Size	p. 197-203.
Publisher	Springer Netherlands
Publishing place	Dordrecht
Document type	Article
ZDB-ID	1196520-4
ISSN	0929-1873
ISSN	0929-1873
DOI	10.1007/s10658-011-9745-y
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: The use of arbuscular mycorrhizal fungi to improve strawberry production in coir substrate

Boyer, Louisa Robinson / Feng, Wei / Gulbis, Natallia / Hajdu, Klara / Harrison, Richard J. / Jeffries, Peter / Xu, Xiangming

Frontiers in Plant Science

2016 Volume 7

Abstract: Strawberry is an important fruit crop within the UK. To reduce the impact of soil-borne diseases and extend the production season, more than half of the UK strawberry production is now in substrate (predominantly coir) under protection. Substrates such ... ...

Abstract	Strawberry is an important fruit crop within the UK. To reduce the impact of soil-borne diseases and extend the production season, more than half of the UK strawberry production is now in substrate (predominantly coir) under protection. Substrates such as coir are usually depleted of microbes including arbuscular mycorrhizal fungi (AMF) and consequently the introduction of beneficial microbes is likely to benefit commercial cropping systems. Inoculating strawberry plants in substrate other than coir has been shown to increase plants tolerance to soil-borne pathogens and water stress. We carried out studies to investigate whether AMF could improve strawberry production in coir under low nitrogen input and regulated deficit irrigation. Application of AMF led to an appreciable increase in the size and number of class I fruit, especially under either deficient irrigation or low nitrogen input condition. However, root length colonization by AMF was reduced in strawberry grown in coir compared to soil and Terragreen. Furthermore, the appearance of AMF colonizing strawberry and maize roots grown in coir showed some physical differences from the structure in colonized roots in soil and Terragreen: the colonization structure appeared to be more compact and smaller in coir.
Keywords	AMF ; Class I yield quality ; Coir ; Growing substrate ; Strawberry ; Yield
Subject code	630
Language	English
Publishing country	nl
Document type	Article ; Online
ZDB-ID	2613694-6
ISSN	1664-462X
ISSN	1664-462X
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Ultrastructure of spore development in Scutellospora heterogama

Jeffries, Peter / Louisa Robinson-Boyer / Paul Rice / Ray J. Newsam / John C. Dodd

Mycorrhiza. 2007 July, v. 17, no. 5

2007

Abstract: The ultrastructural detail of spore development in Scutellospora heterogama is described. Although the main ontogenetic events are similar to those described from light microscopy, the complexity of wall layering is greater when examined at an ... ...

Abstract	The ultrastructural detail of spore development in Scutellospora heterogama is described. Although the main ontogenetic events are similar to those described from light microscopy, the complexity of wall layering is greater when examined at an ultrastructural level. The basic concept of a rigid spore wall enclosing two inner, flexible walls still holds true, but there are additional zones within these three walls distinguishable using electron microscopy, including an inner layer that is involved in the formation of the germination shield. The spore wall has three layers rather than the two reported previously. An outer, thin ornamented layer and an inner, thicker layer are both derived from the hyphal wall and present at all stages of development. These layers differentiate into the outer spore layer visible at the light microscope level. A third inner layer unique to the spore develops during spore swelling and rapidly expands before contracting back to form the second wall layer visible by light microscopy. The two inner flexible walls also are more complex than light microscopy suggests. The close association with the inner flexible walls with germination shield formation consolidates the preferred use of the term ‘germinal walls’ for these structures. A thin electron-dense layer separates the two germinal walls and is the region in which the germination shield forms. The inner germinal wall develops at least two sub-layers, one of which has an appearance similar to that of the expanding layer of the outer spore wall. An electron-dense layer is formed on the inner surface of the inner germinal wall as the germination shield develops, and this forms the wall surrounding the germination shield as well as the germination tube. At maturity, the outer germinal wall develops a thin, striate layer within its substructure.
Keywords	Scutellospora ; developmental stages ; electron microscopy ; germination ; hyphae ; light microscopy ; mycorrhizae ; ontogeny ; spores ; ultrastructure
Language	English
Dates of publication	2007-07
Size	p. 395-403.
Publishing place	Springer Berlin Heidelberg
Document type	Article
ZDB-ID	1087945-6
ISSN	1432-1890 ; 0940-6360
ISSN (online)	1432-1890
ISSN	0940-6360
DOI	10.1007/s00572-007-0112-y
Database	NAL-Catalogue (AGRICOLA)

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Article: Genetic, phenotypic and functional variation within a Glomus geosporum isolate cultivated with or without the stress of a highly alkaline anthropogenic sediment

Oliveira, Rui S / Boyer, Louisa Robinson / Carvalho, Maria F / Jeffries, Peter / Vosátka, Miroslav / Castro, Paula M.L / Dodd, John C

Applied soil ecology. 2010 May, v. 45, no. 1

2010

Abstract: Genetic, phenotypic and functional variation in a Glomus geosporum isolate obtained from a highly alkaline anthropogenic sediment was investigated. Two cultivation lineages of G. geosporum (BEG199 and BEG211) were created by sub-culturing with or without ...

Abstract	Genetic, phenotypic and functional variation in a Glomus geosporum isolate obtained from a highly alkaline anthropogenic sediment was investigated. Two cultivation lineages of G. geosporum (BEG199 and BEG211) were created by sub-culturing with or without the stress of the sediment. Genetic variation was assessed on spores from both cultivation lineages in the large sub-unit rRNA gene D2 region using PCR-single strand conformational polymorphism (PCR-SSCP) and sequencing. Phenotypical and functional variation of the cultivation lineages were assessed after inoculation onto Conyza bilbaoana. The sequence diversity obtained in G. geosporum BEG211 was significantly different from that obtained in G. geosporum BEG199. Glomus geosporum BEG199 was more effective than G. geosporum BEG211 in promoting the growth of C. bilbaoana in inert substrate and in increasing its leaf phosphorus concentration when the plant was grown in sediment. After inoculation onto C. bilbaoana, G. geosporum BEG199 colonised the roots to a greater extent, produced a significantly larger number of spores and presented a greater length of extraradical mycelium than G. geosporum BEG211. The results indicate that environmental conditions under which arbuscular mycorrhizal fungi (AMF) are cultivated can influence their effects in host plants. Also, AMF might quickly lose gained-tolerance to environmental stresses when maintained without the selective pressure of those stresses. This study has implications for the production of commercial inoculum of AMF and for the maintenance of AMF cultures. The results indicate that inoculum of AMF should be produced and AMF cultures should be maintained in substrates or media containing the original edaphic stresses.
Keywords	Glomus ; strain differences ; genetic variation ; phenotypic variation ; anthropogenic soil types ; sedimentary soils ; alkaline soils ; fungal spores ; plant morphology ; ribosomal RNA ; nucleotide sequences ; polymerase chain reaction ; Conyza ; host plants ; roots ; symbiosis ; mycorrhizal fungi ; mycelium ; cell growth ; vesicular arbuscular mycorrhizae ; culture media
Language	English
Dates of publication	2010-05
Size	p. 39-48.
Publishing place	[Amsterdam]: Elsevier Science
Document type	Article
ZDB-ID	1196758-4
ISSN	0929-1393
ISSN	0929-1393
DOI	10.1016/j.apsoil.2010.01.008
Database	NAL-Catalogue (AGRICOLA)

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Article: Inoculation of drought-stressed strawberry with a mixed inoculum of two arbuscular mycorrhizal fungi: effects on population dynamics of fungal species in roots and consequential plant tolerance to water deficiency

Boyer, Louisa Robinson / Brain, Philip / Xu, Xiang-Ming / Jeffries, Peter

Mycorrhiza

Volume v. 25,, Issue no. 3

Abstract	The effect of inoculation with two arbuscular mycorrhizal fungi (AMF) on growth and drought tolerance of cultivated strawberry (Fragaria × ananassa) was studied. Three treatments (a single treatment either of Funneliformis mosseae BEG25, Funneliformis geosporus BEG11 or a 50:50 mixed inoculation treatment of both species) were compared to uninoculated plants. Species-specific primers for qPCR quantification of F. geosporus and F. mosseae DNA were developed to quantify the relative abundance of each fungus in roots of strawberry under different conditions of water stress. Co-occupation of the same root by both species was shown to commonly occur, but their relative abundance varied with water stress (reduced irrigation of up to 40 %). Greater root colonisation was observed microscopically under water stress, but this increased colonisation was often accompanied with decreased amounts of fungal DNA in the root. F. mosseae tended to become more abundant under water stress relative to F. geosporus. There was significant correlation in the fungal colonisation measurements from the microscopic and qPCR methods under some conditions, but the nature of this relationship varied greatly with AMF inoculum and abiotic conditions. Single-species inoculation treatments gave similar benefits to the host to the mixed inoculation treatment regardless of irrigation regime; here, amount of colonisation was of greater importance than functional diversity. The addition of AMF inocula to plants subjected to reduced irrigation restored plant growth to the same or higher values as the non-mycorrhizal, fully-watered plants. The water use efficiency of plants was greater under the regulated deficit irrigation (RDI) regime and in AMF-inoculated plants, but there were no significant differences between plants inoculated with the single or combined inoculum. This study demonstrated that the increase in plant growth was directly influenced by an increase in root colonisation by AMF when individual plants were examined.
Keywords	mycorrhizal fungi ; drought tolerance ; roots ; deficit irrigation ; functional diversity ; Glomus mosseae ; Fragaria ; water stress ; irrigation management ; strawberries ; plant growth ; DNA ; inoculum ; water use efficiency ; mycorrhizae ; population dynamics ; quantitative polymerase chain reaction
Language	English
Document type	Article
ISSN	0940-6360
Database	AGRIS - International Information System for the Agricultural Sciences and Technology

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