Appropriateness of proton pump inhibitor therapy in an ambulatory geriatrics clinic: A retrospective cross-sectional analysis.

Background: Proton pump inhibitors are considered potentially inappropriate medications in the geriatric population. The use of proton pump inhibitors by older adults has increased over the past several decades; however, existing literature suggests that only one-third of patients prescribed these medications have a valid indication for use. The aim of this study was to assess the appropriateness of proton pump inhibitor therapy in a population of ambulatory geriatric patients and to determine the impact of an interdisciplinary clinic on their use. Methods: This was a retrospective, cross-sectional study of patients referred to an ambulatory geriatrics clinic between October 2017 and March 2021. Participants were eligible for inclusion if they were taking a proton pump inhibitor at the time of clinic admission. Appropriateness of proton pump inhibitor therapy was assessed based on indication and dosing regimen. Results: In total, 280 participants were included. The mean age was 79.6 years (SD 7.7) and 60% were female. Overall, 94 of 280 (33.6%) participants had a documented valid indication for their proton pump inhibitor. The clinic team intervened to reduce the dose or discontinue 76 of 186 (40.8%) inappropriate proton pump inhibitors. Interpretation: Only one-third of proton pump inhibitors used by ambulatory geriatric patients have a documented appropriate indication for use. Given the medical complexity of this population and their vulnerability to adverse effects, the ambulatory geriatric population should be a priority target for proton pump inhibitor deprescribing initiatives.

An optimised MALDI-TOF assay for phosphatidylcholine-specific phospholipase C.

The Bacillus cereus phosphatidylcholine-specific phospholipase C (PC-PLCBc) is an enzyme that catalyses the hydrolysis of phosphatidylcholines into phosphocholine and 1,2-diacylglycerols. PC-PLCBc has found applications in both the food industry and in medicinal chemistry. Herein, we report our work in the development and optimisation of a matrix assisted laser desorption ionisation time-of-flight (MALDI-TOF) mass spectrometry-based assay to monitor PC-PLCBc activity. The use of one-phase and two-phase reaction systems to assess the inhibition of PC-PLCBc with different structural classes of inhibitors was compared. We also highlighted the advantage of our assay over the commonly used commercially available Amplex Red assay. This method will also be applicable to work on the activity and inhibition of other phospholipases.

Groundwater-induced alterations in elemental concentration and interactions in semi-arid soils of the Southern High Plains, USA.

This study examined and compared arsenic (As) and other element [copper (Cu), iron (Fe), potassium (K), manganese (Mn), rubidium (Rb), and zinc (Zn)] distribution, as well as their interactions in historically irrigated and non-irrigated semi-arid agricultural soils of the Southern High Plains (SHP) in the USA, using findings from a portable X-ray fluorescence spectrometer. The portable X-ray fluorescence (PXRF) findings revealed that the concentrations of As (5.1 vs. 3.1 mg kg(-1)), Cu (7.2 vs. 6.2), Fe (7398 vs. 5677), K (8638 vs. 7061), Mn (80 vs. 68), Rb (36 vs. 27), and Zn (19.3 vs. 13.8) were higher in the historically irrigated field compared to the non-irrigated and, when examined within depths, were consistently and significantly higher (P<0.001) in the subsurface soils of the non-irrigated field, a trend not evident in the irrigated field. The strengths of the correlation among elements were higher in the non-irrigated field compared to the irrigated (average R of 0.60 vs. 0.54), suggesting a possible external input of these pollutants in the historically irrigated field which could have altered the natural background concentration and association among them. Furthermore, findings from principal component analysis (PCA) indicated that As, Mn, Rb, Fe, Zn, and K were more closely associated in the non-irrigated field and likely of lithogenic origin. The observed differences in elemental concentration and interaction between the irrigated and non-irrigated soils support the hypothesis that water from the local aquifer could be a potential source of pollutant addition to these semi-arid alkaline soils.

Transformation from the top.

Transforming a hospital's culture leads to improved patient satisfaction and physician loyalty.