Inappropriate prescribing is a major health care issue, especially regarding older patients on polypharmacy. Multiple implicit and explicit prescribing tools have been developed to improve ...prescribing, but these have hardly ever been used in combination. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) combines implicit prescribing tools with the explicit Screening Tool to Alert physicians to the Right Treatment and Screening Tool of Older People's potentially inappropriate Prescriptions criteria and has shared decision‐making with the patient as a critical step. This article describes the STRIP and its ability to identify potentially inappropriate prescribing.
The STRIP improved general practitioners' and final‐year medical students' medication review skills. The Web‐application STRIP Assistant was developed to enable health care providers to use the STRIP in daily practice and will be incorporated in clinical decision support systems. It is currently being used in the European Optimizing thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly (OPERAM) project, a multicentre randomized controlled trial involving patients aged 75 years and older using multiple medications for multiple medical conditions.
In conclusion, the STRIP helps health care providers to systematically identify potentially inappropriate prescriptions and medication‐related problems and to change the patient's medication regimen in accordance with the patient's needs and wishes. This article describes the STRIP and the available evidence so far. The OPERAM study is investigating the effect of STRIP use on clinical and economic outcomes.
What is already known about this topic?
Use of prescribing criteria decreases potentially inappropriate prescriptions.
Explicit prescribing criteria do not require specific clinical expertise. These tools focus on medication and usually do not address patient‐related risk factors common in older people, nor do they take into account patient preferences or previously unsuccessful treatment approaches.
Implicit prescribing tools are time-consuming to use and require clinical expertise. Their main advantage is that they focus on the patient and decisions about prescribing appropriateness are made at an individual level.
What this paper adds:
The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) is the first prescribing tool that combines explicit and implicit prescribing criteria.
The STRIP improves the prescribing skills of general practitioners and final‐year medical students.
The effect of STRIP on relevant clinical and economic outcomes is currently under investigation in a large European multicentre randomized controlled trial.
Ageing is associated with several changes in human organs, which result in altered medication pharmacokinetics and pharmacodynamics. Ageing is also associated with changes in human body functions, ...such as impaired vision, hearing, swallowing, motor and cognitive functions, which can affect the adequate intake and administration of drugs. As a consequence, older people, and especially patients older than 75 years, are the main users of many drugs and they frequently use 5 drugs or more long‐term (i.e. polypharmacy). All this increases the complexity of adequate drug intake, administration and adherence. However, there is a lack of evidence on the considerations that should be taken into account to ensure appropriate drug prescribing to older people. This review article summarizes the most clinically relevant changes in human organ and body functions and the consequential changes in pharmacokinetics and pharmacodynamics in older people, along with possible dosing consequences or alternatives for drugs frequently prescribed to this patient population. Recommendations are given on how ageing could be considered in clinical drug development, drug authorization and appropriate prescribing.
Abstract
The Australian Monsoon Tropics (AMT) contain some of the most biodiverse forests on the continent. Little is known about the dynamics of rainforest plant microbiomes in general, and there ...have been no community‐level studies on Australian rainforest endophytes, their seasonality, tissue and host specificity.
We tested whether community composition of tropical tree endophytes (fungi and bacteria) differs: (i) at different points during a monsoon cycle, (ii) between leaf and stem tissues, (iii) between forest microclimates (gully/ridge), and between (iv) host plant species, and (v) host plant clade, using amplicon sequencing of the bacterial 16S and fungal ITS2 gene regions.
Results indicated that the composition of rainforest plant microbiomes differs between wet and dry seasons, which may be explained by physiological shifts in host plants due to annual climate fluctuations from mesic to xeric. Endophyte microbiomes differed between leaves and stems. Distinct fungal communities were associated with host species and clades, with some trees enriched in a number of fungal taxa compared to host plants in other clades. Diversity of bacterial endophytes in plant stems increased in the dry season.
We conclude that the microbiomes of tropical plants are responsive to monsoonal climate variation, are highly compartmentalised between plant tissues, and may be partly shaped by the relatedness of their host plants.
Characterisation of husk rot in macadamia Akinsanmi, O.A.; Drenth, A.
Annals of applied biology,
January 2017, 2017-01-00, 20170101, Letnik:
170, Številka:
1
Journal Article
Recenzirano
The causal agent of husk rot of macadamia is often attributed to Colletotrichum gloeosporioides sensu lato. However, in recent husk rot outbreaks, the characteristic concentric ring of pycnidia of C. ...gloeosporioides that is associated with the disease was often absent. Due to its sporadic occurrence, the importance of husk rot is often underrated and attributed to environmental and physiological factors. In order to determine the significance, prevalence and factors that influence husk rot in macadamia, this study examined the aetiology of husk rot in Australia. The relative incidence and severity of husk rot was evaluated in several macadamia orchards over eight consecutive years. Pathogenicity assays were developed to confirm the identity of the causal agent. A range of fungi from several genera including: Diaporthe, Lasiodiplodia, Colletotrichum, Pestalotiopsis, Aspergillus, Alternaria, Nigrospora and Epicoccum were isolated from samples of macadamia pericarps with husk rot symptoms from different orchards. Fungi in the genus Diaporthe were most frequently isolated, often from symptomatic fruit. Results from pathogenicity trials showed the characteristic soft or spongy black lesions characteristic of husk rot symptoms in wounded fruits that were incubated with the diseased fruit or inoculated with a conidial suspension of Diaporthe spp. Our results suggest that injury to the macadamia fruit pericarp not only predisposes the pericarp to pathogen infection but it is a prerequisite for infection. Large variations in husk rot severity were observed over years. Husk rot severity was linked to days after anthesis and was associated with mean weekly relative humidity and minimum temperatures. This study confirmed that Diaporthe species cause husk rot in macadamia, hence, a rationale for adopting Phomopsis husk rot as the name of the disease is discussed.
To determine the prevalence, determinants, and potential clinical relevance of adherence with the Dutch dosing guideline in patients with impaired renal function at hospital discharge.
Retrospective ...cohort study between January 2007 and July 2011.
Academic teaching hospital in the Netherlands.
Patients with an estimated glomerular filtration rate (eGFR) between 10-50 ml/min/1.73 m(2) at discharge and prescribed one or more medicines of which the dose is renal function dependent.
The prevalence of adherence with the Dutch renal dosing guideline was investigated, and the influence of possible determinants, such as reporting the eGFR and severity of renal impairment (severe: eGFR<30 and moderate: eGFR 30-50 ml/min/1.73 m(2)). Furthermore, the potential clinical relevance of non-adherence was assessed.
1327 patients were included, mean age 67 years, mean eGFR 38 ml/min/1.73 m(2). Adherence with the guideline was present in 53.9% (n=715) of patients. Reporting the eGFR, which was incorporated since April 2009, resulted in more adherence with the guideline: 50.7% vs. 57.0%, RR 1.12 (95% CI 1.02-1.25). Adherence was less in patients with severe renal impairment (46.0%), compared to patients with moderate renal impairment (58.1%, RR 0.79; 95% CI 0.70-0.89). 71.4% of the cases of non-adherence had the potential to cause moderate to severe harm.
Required dosage adjustments in case of impaired renal function are often not performed at hospital discharge, which may cause harm to the majority of patients. Reporting the eGFR can be a small and simple first step to improve adherence with dosing guidelines.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The Fusarium oxysporum species complex (FOSC) is a group of closely related plant pathogens long-considered strictly clonal, as sexual stages have never been recorded. Several studies have questioned ...whether recombination occurs in FOSC, and if it occurs its nature and frequency are unknown. We analysed 410 assembled genomes to answer whether FOSC diversified by occasional sexual reproduction interspersed with numerous cycles of asexual reproduction akin to a model of predominant clonal evolution (PCE). We tested the hypothesis that sexual reproduction occurred in the evolutionary history of FOSC by examining the distribution of idiomorphs at the mating locus, phylogenetic conflict and independent measures of recombination from genome-wide SNPs and genes. A phylogenomic dataset of 40 single copy orthologs was used to define structure a priori within FOSC based on genealogical concordance. Recombination within FOSC was tested using the pairwise homoplasy index and divergence ages were estimated by molecular dating. We called SNPs from assembled genomes using a k-mer approach and tested for significant linkage disequilibrium as an indication of PCE. We clone-corrected and tested whether SNPs were randomly associated as an indication of recombination. Our analyses provide evidence for sexual or parasexual reproduction within, but not between, clades of FOSC that diversified from a most recent common ancestor about 500 000 years ago. There was no evidence of substructure based on geography or host that might indicate how clades diversified. Competing evolutionary hypotheses for FOSC are discussed in the context of our results.
The predominant disease affecting oil palms in Colombia is bud rot, a decay of the growing leaf tissues that may eventually reach the meristem. Previous studies have suggested many biotic and abiotic ...causes, but Koch’s Postulates have recently confirmed Phytophthora palmivora as the primary pathogen of bud rot. In this paper, we describe the infection process in immature leaflets inoculated with zoospores of P. palmivora using light microscopy and scanning electron microscopy. Initially, zoospores were attracted primarily to leaf trichomes, where some developed appressorium-like structures and subsequently penetrated the tissue. Germinated zoospores were also observed penetrating the stomata or intercellular spaces. After penetration hyphae colonized the intercellular leaf spaces, followed by intracellular invasion, penetrating to the vascular bundles and then spreading throughout the host tissue. Between 12 and 24 h after inoculation, hyphae emerged from the surface of the leaflet through the stomata, trichomes and intercellular spaces. Within 36 and 48 h, sporangia, chlamydospores, and newly released zoospores were observed, starting a new cycle of secondary infections. This sequence was consistently observed in repeated experiments. We suggest that in the field collection of moisture at the base of emerging leaflets stimulates the release of zoospores and infection. Colonization is restricted once the leaflet emerges, leaving dormant chlamydospores and hyphae in small necrotic lesions. Successive rain events stimulate the formation of new generations of sporangia, zoospores and infections, which, if frequent enough, may completely colonize the bud area. Subsequent colonization of infected tissues by opportunistic bacteria and fungi increases the severity of bud rot symptoms. The information presented here provides an overview of histopathological aspects of the early infections process of P. palmivora in detached immature leaflets.
Leaf blotch and fruit spot of apple caused by Alternaria species occur in apple orchards in Australia. However, there is no information on the identity of the pathogens and whether one or more ...Alternaria species cause both diseases in Australia. Using DNA sequencing and morphological and cultural characteristics of 51 isolates obtained from apple leaves and fruit with symptoms in Australia, Alternaria species groups associated with leaf blotch and fruit spot of apples were identified. Sequences of Alternaria allergen a1 and endopolygalacturonase gene regions revealed that multiple Alternaria species groups are associated with both diseases. Phylogenetic analysis of concatenated sequences of the two genes resulted in four clades representing A. arborescens and A. arborescens‐like isolates in clade 1, A. tenuissima/A. mali isolates in clade 2, A. alternata/A. tenuissima intermediate isolates in clade 3 and A. longipes and A. longipes‐like isolates in clade 4. The clades formed using sequence information were supported by colony characteristics and sporulation patterns. The source of the isolates in each clade included both the leaf blotch variant and the fruit spot variant of the disease. Alternaria arborescens‐like isolates were the most prevalent (47%) and occurred in all six states of Australia, while A. alternata/A. tenuissima intermediate isolates (14%) and A. tenuissima/A. mali isolates (6%) occurred mostly in Queensland and New South Wales, respectively. Implications of multiple Alternaria species groups on apples in Australia are discussed.
Phylogenetic relationships among 50 Phytophthora species and between Phytophthora and other oomycetes were examined on the basis of the ITS sequences of genomic rDNA. Phytophthora grouped with ...Pythium, Peronospora, and Halophytophthora, distant from genera in the Saprolegniales. Albugo was intermediate between these two groups. Unlike Pythium, Phytophthora was essentially monophyletic, all but three species forming a cluster of eight clades. Two clades contained only species with nonpapillate sporangia. The other six clades included either papillate and semipapillate, or semipapillate and nonpapillate types, transcending traditional morphological groupings, which are evidently not natural assemblages. Peronospora was related to P. megakarya and P. palmivora and appears to be derived from a Phytophthora that has both lost the ability to produce zoospores and become an obligate biotroph. Three other Phytophthoras located some distance from the main Phytophthora–Peronospora cluster probably represent one or more additional genera.
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