.
Background: Polypharmacy is common in people living with dementia (PLwD) and associated with adverse outcomes. Although Structured Medication Reviews (SMRs) are recommended to optimise medication regimens, their delivery is often constrained by limited healthcare resources. Artificial intelligence (AI) may support SMRs, yet little is known about how it is perceived by PLwD and their carers. This study explored their experiences of polypharmacy, views on SMRs, and attitudes towards use of AI tools in SMRs. Methods: Semi-structured interviews with 12 PLwD experiencing polypharmacy and two focus groups with 14 carers were conducted via Microsoft Teams or telephone and analysed using Reflexive Thematic Analysis. Results: Two themes were constructed: experiences of SMRs, and attitudes towards AI in SMRs. Participants described challenges in managing polypharmacy, with carers often playing a central role in supporting adherence and monitoring side effects. Experiences of SMRs varied widely. SMRs were most valued when clinicians were empathetic and able to offer personalised guidance. Participants viewed AI use in SMRs positively, provided that such tools were well validated and used to assist rather than replace healthcare professionals. AI was viewed as having the potential to reduce administrative burden and support more person-centred care. However, some had concerns regarding patient safety and data security, highlighting the need for appropriate regulation and human oversight. Conclusion: Participants were supportive of AI use in SMRs, despite concerns about safety, data security and disclosure of AI use, and emphasised the importance of patient-clinician interactions and lived experience involvement in AI tool development. ### Competing Interest Statement The authors have declared no competing interest. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study received a favourable ethical opinion from the University of Oxford Medical Sciences Interdivisional Research Ethics Committee (MS IDREC) (ref: 788094). Participants provided either written or verbal informed consent prior to participation. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Interview transcripts from the current study will not be made publicly available as this could compromise the participant's privacy. Alzheimer's Society, https://ror.org/0472gwq90, grant number 647 JD, JG, NT, and SS are the recipients of a post-doctoral fellowship from the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (JD and SS from the Oxford and Thames Valley programme, JG from the Manchester programme, and NT from the Southampton 2023-2025 programme). This fellowship was part of an initiative funded by the NIHR and Alzheimers Society to support post-doctoral capacity building in applied dementia research.
RefluxStop surgery aims to restore a functional anti-reflux barrier in gastroesophageal reflux disease (GERD) without encircling the esophagus, purportedly limiting dysphagia and gas-bloating. This report presents safety outcomes from 602 patients at 22 centers across six European countries and up to 6.75 years follow-up (mean [SD] 2 [1.25] years). Serious safety outcomes and reoperation occurred in 1.99% (12/602), all satisfactorily resolved. Thereof, two-thirds were reherniations (1.33%), which manifested from total disruption of crural repair, resolved by straightforward fundic repositioning and redo hiatal repair with RefluxStop unaffected in its pouch. Non-operative safety events included 4/602 (0.66%) cases of asymptomatic erosion (without action) in the early postoperative phase (4 weeks) as the learning curve of a new procedure. Dilatation for new-onset dysphagia was performed in one patient. This report presents an analysis focused on safety data from the largest independent RefluxStop study to date (n = 602). Despite inter-surgeon variability, the learning curve for a new procedure, and sizable proportions of large hernia and/or dysmotility patients, results show low rates of serious safety outcomes with reoperations occurring in <2%. The overall experience of the RefluxStop Evaluation Group demonstrated a consistent and favorable mid-to-long-term safety profile for RefluxStop in real-world surgical treatment of GERD.
