One Health Determinants of Escherichia coli Antimicrobial Resistance in Humans in the Community:An Umbrella Review

To date, the scientific literature on health variables for Escherichia coli antimicrobial resistance (AMR) has been investigated throughout several systematic reviews, often with a focus on only one aspect of the One Health variables: human, animal, or environment. The aim of this umbrella review is to conduct a systematic synthesis of existing evidence on Escherichia coli AMR in humans in the community from a One Health perspective. PubMed, EMBASE, and CINAHL were searched on “antibiotic resistance” and “systematic review” from inception until 25 March 2022 (PROSPERO: CRD42022316431). The methodological quality was assessed, and the importance of identified variables was tabulated across all included reviews. Twenty-three reviews were included in this study, covering 860 primary studies. All reviews were of (critically) low quality. Most reviews focused on humans (20), 3 on animals, and 1 on both human and environmental variables. Antibiotic use, urinary tract infections, diabetes, and international travel were identified as the most important human variables. Poultry farms and swimming in freshwater were identified as potential sources for AMR transmission from the animal and environmental perspectives. This umbrella review highlights a gap in high-quality literature investigating the time between variable exposure, AMR testing, and animal and environmental AMR variables.</p

RDGAC grant report : barriers and facilitators to the provision of clinical pharmacy services in aboriginal communities

Australia's indigenous population has significantly poorer health outcomes than the rest of the Australian population. Continuity in medication management, an important step in achieving better health outcomes, requires a number of steps to be accomplished. Clinical pharmacy services such as the provision of medicines information, clinical interventions and medication reviews have been shown to improve the quality use of medicines; yet little is known about the current provision of clinical services to people served by Aboriginal medical services, or about the barriers and facilitators experienced by pharmacists in providing clinical pharmacy services to indigenous Australians.1 page(s

Drug metabolism in older people - a key consideration in achieving optimal outcomes with medicines

Hepatic clearance plays a key role in determining the systemic exposure of drugs and metabolites, which in turn has a major effect on variability in the beneficial and adverse effects of medicines. Aging results in a number of significant changes in the human liver including reductions in liver blood flow, size, drug-metabolizing enzyme content, and pseudocapillarization. Drug metabolism is also influenced by comorbid disease, frailty, concomitant medicines, and (epi)genetics. These changes have the potential to alter the hepatic clearance of drugs but need to be interpreted in the context of the pharmacokinetic (and pharmacodynamic) characteristics of the drug of interest. There is growing evidence that the age-related changes in the liver not only result in a decrease in the hepatic clearance of unbound drug but also influence variability in response to medicines in older people.6 page(s

Hypertension in older persons : a systematic review of national and international treatment guidelines

Despite good evidence regarding the benefits of managing hypertension in elderly populations, the extent to which this evidence has been incorporated into national and international clinical hypertension treatment guidelines is unknown. A systematic review was conducted to identify recommendations in current national and international hypertension treatment guidelines with a focus on specific targets and treatment recommendations for older persons with uncomplicated hypertension. Guidelines for the management of hypertension published or updated over a 5-year period (2009-2014) were identified by searching Medline, Google, and Google Scholar. Thirteen guidelines that met the predefined inclusion criteria were included in the review. Among these guidelines was considerable variation regarding who is considered an older person. However, there was general consensus regarding blood pressure targets. While current hypertension guidelines do include recommendations regarding management of uncomplicated hypertension in older populations, the depth and breadth of these recommendations vary considerably between guidelines and may limit the usefulness of such treatment guidelines to clinicians.7 page(s

Prevalence, prescribing and barriers to effective management of hypertension in older populations : a narrative review

Objectives: Hypertension is the leading modifiable cause of mortality worldwide. Unlike many conditions where limited evidence exists for management of older individuals, multiple large, robust trials have provided a solid evidence-base regarding the management of hypertension in older adults. Understanding the impact of age on how the prevalence of hypertension and the role of pharmacotherapy in managing hypertension among older persons is a critical element is the provision of optimal health care for older populations. The aim of this study was to explore how the prevalence of hypertension changes with age, the evidence regarding pharmacological management in older adults and to identify known barriers to the optimal management of hypertension in older patients. Methods: A review of English language studies published prior to 2013 in Medline, Embase and Google scholar was conducted. Key search terms included hypertension, pharmacotherapy, and aged. Results: The prevalence of hypertension was shown to increase with age, however there is good evidence for the use of a number of pharmacological agents to control blood pressure in older populations. System, physician and patient related barriers to optimal blood pressure control were identified. Conclusions: Despite good evidence for pharmacological management of hypertension among olderpopulations, under treatment of hypertension is an issue. Concerns regarding adverse effects appearcentral to under treatment of hypertension among older populations.6 page(s

Identifying general practice patients diagnosed with asthma and their exacerbation episodes from prescribing data

OBJECTIVE: To determine the reliability of identifying patients diagnosed with asthma in general practice and their asthma exacerbation episodes from prescribing data. DATA SOURCE: Automated database from 17 general practitioners (29,805 patients) in the northern Netherlands. STUDY DESIGN: Sensitivity, specificity and predictive values of four criteria for identifying patients diagnosed with asthma and two criteria for identifying asthma exacerbation episodes were calculated using the registered diagnosis as gold standard. RESULTS: Prescription of one or more anti-asthma medications identified 95% of patients with an asthma diagnosis (positive predictive value 0.70), while two or more anti-asthma medications identified 71% (positive predictive value 0.79). A combination of oral corticosteroids or antibiotics identified 55% of exacerbations. CONCLUSIONS: Asthma patients can be identified reliably from prescribing data, but identification of asthma exacerbations was poor. The preference for one criterion over another for identifying patients diagnosed with asthma will depend on the reason for patient selection. No. Records Request 1 44 "brachial-plexus-neuropathy"/ all subheadings 2 167 "shoulder-impingement-syndrome"/ all subheadings 3 1450 "shoulder"/ all subheadings 4 951 "shoulder-pain"/ all subheadings 5 2503 #1 or #2 or #3 or #4 6 523 "kinesiology"/ all subheadings 7 1760 "manipulative-medicine"/ all subheadings 8 2266 #6 or #7 9 47732 "prognosis"/ all subheadings 10 132327 explode "treatment-outcome"/ all subheadings 11 161750 explode "epidemiology"/ all subheadings 12 305862 #9 or #10 or #11 13 4393 "low-back-pain"/ all subheadings 14 1221 "neck-pain"/ all subheadings 15 2322 "cervical-spine"/ all subheadings 16 7596 #13 or #14 or #15 17 471 #5 and (#8 or #12) 18 939 #8 in dem 19 425 #8 and #16 20 1619 #17 or #18 or #19 Searches and records above from: Selected Databases 21 1 (nolan in au) and (markert in au) 22 3 denig in au Searches and records above from: SilverPlatter MEDLINE(R) 2002/01-2002/09 * 23 2 #22 Record 1 of 2 - PreMedline on SilverPlatter November Week 4

A Longitudinal study of constipation and laxative use in a community-dwelling elderly population

Background: Little is known about laxative use, the association of constipation with laxative use, risk factors for constipation and how each of these changes over time in the community-dwelling elderly. Objective: The aim was to explore the prevalence of laxative use and of self-reported constipation, and identify risk factors (including age) associated with constipation, in a cohort of community-dwelling elderly residents. Methods: Data from the Australian Longitudinal Study of Ageing (ALSA) was used to compare differences in constipation and laxative use in the community-dwelling elderly between 1992-1993 and 2003-2004. Results: Relevant data was available for 239 ALSA participants. The prevalence of self-reported constipation increased from 14% in 1992-1993 to 21% in 2003-2004. There was a corresponding increase in the prevalence of laxative use from 6% to 15% over the same period. At both time points, females reported a higher prevalence of both constipation and laxative use however the female:male prevalence ratios decreased over time indicating higher increases in the prevalence of each among males. Persistent chronic constipation occurred in 9% of the cohort. The association between laxative use and self-reported constipation was poor and laxative use was associated with self-reported constipation in less than a third of cases. Conclusion: The prevalence of both constipation and laxative use increases with age in the elderly, and these increases are greater for males than for females. Discrepancies between self-reported constipation and laxative use may suggest sub-optimal management of constipation in the community-dwelling elderly and further work is needed to fully understand this.7 page(s

Terbinafine in combination with other antifungal agents for treatment of resistant or refractory mycoses : investigating optimal dosing regimens using a physiologically based pharmacokinetic model

Terbinafine is increasingly used in combination with other antifungal agents to treat resistant or refractory mycoses due to synergistic in vitro antifungal activity; high doses are commonly used, but limited data are available on systemic exposure, and no assessment of pharmacodynamic target attainment has been made. Using a physiologically based pharmacokinetic (PBPK) model for terbinafine, this study aimed to predict total and unbound terbinafine concentrations in plasma with a range of high-dose regimens and also calculate predicted pharmacodynamic parameters for terbinafine. Predicted terbinafine concentrations accumulated significantly during the first 28 days of treatment; the area under the concentration-time curve (AUC)/MIC ratios and AUC for the free, unbound fraction (fAUC)/MIC ratios increased by 54 to 62% on day 7 of treatment and by 80 to 92% on day 28 compared to day 1, depending on the dose regimen. Of the high-dose regimens investigated, 500 mg of terbinafine taken every 12 h provided the highest systemic exposure; on day 7 of treatment, the predicted AUC, maximum concentration (Cmax), and minimum concentration (Cmin) were approximately 4-fold, 1.9-fold, and 4.4-fold higher than with a standard-dose regimen of 250 mg once daily. Close agreement was seen between the concentrations predicted by the PBPK model and the observed concentrations, indicating good predictive performance. This study provides the first report of predicted terbinafine exposure in plasma with a range of high-dose regimens.7 page(s

Antihypertensive medication utilization and adverse drug reactions in the elderly : study design and baseline characteristics

Adverse Drug Reactions (ADRs) may result in significant burden to both individual patients and health systems. A number of risk factors have been identified for ADRs, and the elderly have long been recognised as a high‐risk group for medication misadventure, including ADRs. Previous studies have explored the role of high‐risk medications such as digoxin and warfarin in ADRs however little work has been done on the contribution of antihypertensive medications to ADRs in the elderly. Hypertension is one of the most common cardiovascular conditions and antihypertensive medications are considered among the most commonly prescribed medications in the elderly. A cross sectional observational study of patients aged 65 years and over, admitted to a major metropolitan teaching hospital during 2010 was conducted to explore the role of antihypertensive medication in adverse drug reactions. This paper presents the study design and baseline characteristics of the study population. The study population comprised 503 patients. The mean age was 80.3 years and 59% of the study population were female. Over two thirds of patients (69.1%) had a documented diagnosis of hypertension in their medical record and 67.3% were using antihypertensive medications on admission to hospital.5 page(s