3 research outputs found

    Quality of anticholinergic burden scales and their impact on clinical outcomes: a systematic review.

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    Older people are at risk of anticholinergic side effects due to changes affecting drug elimination and higher sensitivity to drug's side effects. Anticholinergic burden scales (ABS) were developed to quantify the anticholinergic drug burden (ADB). We aim to identify all published ABS, to compare them systematically and to evaluate their associations with clinical outcomes. We conducted a literature search in MEDLINE and EMBASE to identify all published ABS and a Web of Science citation (WoS) analysis to track validation studies implying clinical outcomes. Quality of the ABS was assessed using an adapted AGREE II tool. For the validation studies, we used the Newcastle-Ottawa Scale and the Cochrane tool Rob2.0. The validation studies were categorized into six evidence levels based on the propositions of the Oxford Center for Evidence-Based Medicine with respect to their quality. At least two researchers independently performed screening and quality assessments. Out of 1297 records, we identified 19 ABS and 104 validations studies. Despite differences in quality, all ABS were recommended for use. The anticholinergic cognitive burden (ACB) scale and the German anticholinergic burden scale (GABS) achieved the highest percentage in quality. Most ABS are validated, yet validation studies for newer scales are lacking. Only two studies compared eight ABS simultaneously. The four most investigated clinical outcomes delirium, cognition, mortality and falls showed contradicting results. There is need for good quality validation studies comparing multiple scales to define the best scale and to conduct a meta-analysis for the assessment of their clinical impact

    Ultrafast Dynamics of the Photo-Excited Hemes b and cn in the Cytochrome b6f Complex

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    The dynamics of the heme b and cn within the cytochrome b6f complex are investigated by means of ultrafast broad-band transient absorption spectroscopy. On one hand, the data reveals that, subsequent to visible light excitation, part of the b hemes undergo a pulse limited photo-oxidation, with the liberated electron supposedly being admited in one of the adjacent aromatic amino acid. The photo-oxidation is followed by a charge recombination in about 8.2 ps. Subsequent to the charge recombination, the heme is promoted to an vibrationally excited ground state that relaxes in about 4.6 ps. On the other hand, the heme cn undergoes an ultrafast ground state recovery in about 140 fs. Interestingly, the data also shows that, contrarely to previous beliefs, Chl a is involved in the hemes photochemistry. Indeed, subsequently to the hemes excitation, the Chl a bleaches and recovers its ground state in 90 fs and 650 fs, respectively. The Chl a bleaching allegedly corresponds to the formation of a short lived Chl a anion. Beyond the previously suggested structural role, this study gives unique evidences that Chl a is directly involved in the photochemistry of the hemes
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