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Barriers and strategies for pain management in non-verbal people with dementia in residential care facilities: protocol for an e-Delphi study

Por: Felix · I. B. · Ramos · C. · Guerreiro · R. · Hughes · J. D. · Hoti · K. · Andrade · T. · Guerreiro · M.
Introduction

Pain is a prevalent symptom in people living with dementia. Evidence shows that pain frequently remains unrecognised and untreated in this vulnerable population, leading to avoidable suffering. Effective pain management is hindered by multifactorial barriers at the individual, organisational and policy level. This study aims to achieve expert consensus on the key barriers to pain management in non-verbal people living with dementia and strategies to address these barriers within Portuguese residential care facilities.

Methods and analysis

An e-Delphi study will be conducted using two rounds of online questionnaires. The Behaviour Change Wheel (BCW) framework guided the development of e-Delphi statements by linking identified determinants (i.e., barriers and facilitators) to intervention functions. Barriers were extracted from the literature reviews and mapped into the capability, opportunity and motivation–behaviour model. Intervention functions were then selected using the BCW linkage matrices and operationalised into practical strategies. A purposive and snowball sampling approach will be used to recruit a heterogeneous panel of experts across national residential care facilities, including nurses, physicians, managers and policymakers with relevant experience in dementia. During the e-Delphi rounds, participants will be invited to rate the relevance of each barrier and associated strategy(ies) on a five-point Likert scale and provide comments or suggestions. Consensus will be defined as ≥75% agreement on each statement.

Ethics and dissemination

Ethical approval for this study was obtained from the Egas Moniz Ethics Committee (Ref. 1586), and all procedures will comply with the Declaration of Helsinki. Informed consent will be obtained from all participants. The findings will be disseminated through a peer-reviewed publication, scientific events and stakeholder networks, including residential care facilities, to inform future practice and policy in dementia care.

Mass spectrometry-based metabolomics uncovers distinct metabolic signatures and potential therapeutic targets in <i>Plasmodium knowlesi</i>

by Naphatsamon Uthailak, Sadudee Chotirat, Ammarind Anatjitsupha, Waraporn Thongyod, Phornpimon Tipthara, Jetsumon Sattabongkot, Joel Tarning, Wang Nguitragool, Onrapak Reamtong

Malaria remains a major global health challenge, caused by several Plasmodium species and transmitted via mosquito vectors. Among these, Plasmodium knowlesi is notable for its zoonotic nature, capable of infecting both macaques and humans. The incidence of P. knowlesi infections has been rising, particularly in Southeast Asia, raising public health concerns. However, compared to other Plasmodium species, the biology, pathophysiology, and transmission dynamics of P. knowlesi remain poorly understood. Given the absence of a licensed vaccine and the increasing threat of drug resistance, a deeper understanding of P. knowlesi biology is essential for effective control and management strategies. This study investigates the metabolomic landscape of P. knowlesi across three intraerythrocytic stagesring, trophozoite, and schizont using mass spectrometry-based metabolomics to gain insights into parasite biology. The analysis revealed distinct metabolic profiles, particularly in the ring stage compared to the other two stages. While glycerophospholipid metabolism and sphingolipid de novo biosynthesis emerged as key pathways associated with common metabolites across all stages, phosphatidylserine synthesis was specifically linked to ring-stage-biased metabolites. Notably, CDP-diacylglycerol-inositol 3-phosphatidyltransferase was highlighted as a promising target based on shared and stage-biased metabolites. Collectively, our findings offer a comprehensive metabolomic profile of P. knowlesi blood-stage development, enhancing our understanding of its biology and identifying potential drug targets that could support the development of novel therapeutic strategies against P. knowlesi malaria.
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