Competitive fungal commensalism mitigates candidiasis pathology.

The mycobiota are a critical part of the gut microbiome, but host-fungal interactions and specific functional contributions of commensal fungi to host fitness remain incompletely understood. Here, we report the identification of a new fungal commensal, Kazachstania heterogenica var. weizmannii, isolated from murine intestines. K. weizmannii exposure prevented Candida albicans colonization and significantly reduced the commensal C. albicans burden in colonized animals. Following immunosuppression of C. albicans colonized mice, competitive fungal commensalism thereby mitigated fatal candidiasis. Metagenome analysis revealed K. heterogenica or K. weizmannii presence among human commensals. Our results reveal competitive fungal commensalism within the intestinal microbiota, independent of bacteria and immune responses, that could bear potential therapeutic value for the management of C. albicans-mediated diseases.

Movement Synchrony Over Time: What Is in the Trajectory of Dyadic Interactions in Workplace Coaching?

Background: Coaching is increasingly viewed as a dyadic exchange of verbal and non-verbal interactions driving clients' progress. Yet, little is known about how the trajectory of dyadic interactions plays out in workplace coaching. Method: This paper provides a multiple-step exploratory investigation of movement synchrony (MS) of dyads in workplace coaching. We analyzed a publicly available dataset of 173 video-taped dyads. Specifically, we averaged MS per session/dyad to explore the temporal patterns of MS across (a) the cluster of dyads that completed 10 sessions, and (b) a set of 173 dyadic interactions with a varied number of sessions. Additionally, we linked that pattern to several demographic predictors. The results indicate a differential downward trend of MS. Results: Demographic factors do not predict best fitting MS curve types, and only client age and coach experience show a small but significant correlation. Discussion: We provide contextualized interpretations of these findings and propose conceptual considerations and recommendations for future coaching process research and practice.

Commentary on the EMA reflection paper on the pharmaceutical development of medicines for use in the older population.

Older people are often affected by impaired organ and bodily functions resulting in multimorbidity and polypharmacy, turning them into the main user group of many medicines. Very often, medicines have not specifically been developed for older people, causing practical medication problems for them like limited availability of easy to swallow formulations, easy to open packaging and dosing instructions for enteral administration. In 2020, the European Medicines Agency (EMA) published a reflection paper 'Pharmaceutical development of medicines for use in the older population', which discusses how the emerging needs of an ageing European population can be addressed by medicines regulation. The paper intends to help industry to better consider the needs of older people during pharmaceutical/clinical medicines development by summarising data on the most relevant topics, providing early suggestions on how to move forward and prompting expert discussions and studies into knowledge gaps. Topics include patient acceptability, (dis)advantages of an administration route, formulation, dosage form, packaging, dosing device and user instruction. While the paper is directed at older people and the pharmaceutical industry, the reflections are also relevant to younger patients with similar disease-related needs and of value to other stakeholders parties, e.g., healthcare professionals, academics, patients and caregivers, as the paper makes clear what can be expected from industry and where collaborative work is needed. This commentary provides an overview of the different steps in the development of the reflection paper, discusses points considered most controversial and/or subject to (multidisciplinary) expert discussions and indicates their value for real world clinical practice.

Development and validation of the leadership learning agility scale.

Introduction: Learning agility is key in the selection and development of future leaders. However, prior research has failed to clearly conceptualize learning agility and to empirically clarify its dimensions. Method: We developed the Leadership Learning Agility Scale (LLAS) by using a combination of both deductive and inductive approaches and established scale development and validation procedures. We administered the LLAS among three independent samples of workers and leaders (N = 907; N = 196; N = 219). Results: Our results indicate that our 18-item LLAS measures the willingness to learn from social experiences, and the drive to apply those lessons in new and challenging leadership roles, and comprises a Developing Leadership, Seeking Feedback, and Developing Systematically dimension. Furthermore, the LLAS showed adequate internal consistency. Leadership learning agility was positively related to achievement motivation, extraversion, and conscientiousness but unrelated to openness to experience. Discussion: We provided a new scale to measure leadership learning agility that can be applied in both research and practitioner settings.

Ionization Energy of the Metastable 2

In a recent breakthrough in first-principles calculations of two-electron systems, Patkós, Yerokhin, and Pachucki [Phys. Rev. A 103, 042809 (2021)PLRAAN2469-992610.1103/PhysRevA.103.042809] have performed the first complete calculation of the Lamb shift of the helium 2 ^{3}S_{1} and 2 ^{3}P_{J} triplet states up to the term in α^{7}m. Whereas their theoretical result of the frequency of the 2 ^{3}P←2 ^{3}S transition perfectly agrees with the experimental value, a more than 10σ discrepancy was identified for the 3 ^{3}D←2 ^{3}S and 3 ^{3}D←2 ^{3}P transitions, which hinders the determination of the He^{2+} charge radius from atomic spectroscopy. We present here a new measurement of the ionization energy of the 2 ^{1}S_{0} state of He [960 332 040.491(32) MHz] which we use in combination with the 2 ^{3}S_{1}←2 ^{1}S_{0} interval measured by Rengelink et al. [Nat. Phys. 14, 1132 (2018).NPAHAX1745-247310.1038/s41567-018-0242-5] and the 2 ^{3}P←2 ^{3}S_{1} interval measured by Zheng et al. [Phys. Rev. Lett. 119, 263002 (2017)PRLTAO0031-900710.1103/PhysRevLett.119.263002] and Cancio Pastor et al. [Phys. Rev. Lett. 92, 023001 (2004)PRLTAO0031-900710.1103/PhysRevLett.92.023001] to derive experimental ionization energies of the 2 ^{3}S_{1} state [1152 842 742.640(32) MHz] and the 2 ^{3}P centroid energy [876 106 247.025(39) MHz]. These values reveal disagreements with the α^{7}m Lamb shift prediction by 6.5σ and 10σ, respectively, and support the suggestion by Patkós et al. of an unknown theoretical contribution to the Lamb shifts of the 2 ^{3}S and 2 ^{3}P states of He.

Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM): cluster randomised controlled trial.

OBJECTIVE: To examine the effect of optimising drug treatment on drug related hospital admissions in older adults with multimorbidity and polypharmacy admitted to hospital. DESIGN: Cluster randomised controlled trial. SETTING: 110 clusters of inpatient wards within university based hospitals in four European countries (Switzerland, Netherlands, Belgium, and Republic of Ireland) defined by attending hospital doctors. PARTICIPANTS: 2008 older adults (≥70 years) with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 drugs used long term). INTERVENTION: Clinical staff clusters were randomised to usual care or a structured pharmacotherapy optimisation intervention performed at the individual level jointly by a doctor and a pharmacist, with the support of a clinical decision software system deploying the screening tool of older person's prescriptions and screening tool to alert to the right treatment (STOPP/START) criteria to identify potentially inappropriate prescribing. MAIN OUTCOME MEASURE: Primary outcome was first drug related hospital admission within 12 months. RESULTS: 2008 older adults (median nine drugs) were randomised and enrolled in 54 intervention clusters (963 participants) and 56 control clusters (1045 participants) receiving usual care. In the intervention arm, 86.1% of participants (n=789) had inappropriate prescribing, with a mean of 2.75 (SD 2.24) STOPP/START recommendations for each participant. 62.2% (n=491) had ≥1 recommendation successfully implemented at two months, predominantly discontinuation of potentially inappropriate drugs. In the intervention group, 211 participants (21.9%) experienced a first drug related hospital admission compared with 234 (22.4%) in the control group. In the intention-to-treat analysis censored for death as competing event (n=375, 18.7%), the hazard ratio for first drug related hospital admission was 0.95 (95% confidence interval 0.77 to 1.17). In the per protocol analysis, the hazard ratio for a drug related hospital admission was 0.91 (0.69 to 1.19). The hazard ratio for first fall was 0.96 (0.79 to 1.15; 237 v 263 first falls) and for death was 0.90 (0.71 to 1.13; 172 v 203 deaths). CONCLUSIONS: Inappropriate prescribing was common in older adults with multimorbidity and polypharmacy admitted to hospital and was reduced through an intervention to optimise pharmacotherapy, but without effect on drug related hospital admissions. Additional efforts are needed to identify pharmacotherapy optimisation interventions that reduce inappropriate prescribing and improve patient outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02986425.

A concerted probiotic activity to inhibit periodontitis-associated bacteria.

Periodontitis can result in tooth loss and the associated chronic inflammation can provoke several severe systemic health risks. Adjunctive to mechanical treatment of periodontitis and as alternatives to antibiotics, the use of probiotic bacteria was suggested. In this study, the inhibitory effect of the probiotic Streptococcus salivarius subsp. salivarius strains M18 and K12, Streptococcus oralis subsp. dentisani 7746, and Lactobacillus reuteri ATCC PTA 5289 on anaerobic periodontal bacteria and Aggregatibacter actinomycetemcomitans was tested. Rarely included in other studies, we also quantified the inverse effect of pathogens on probiotic growth. Probiotics and periodontal pathogens were co-incubated anaerobically in a mixture of autoclaved saliva and brain heart infusion broth. The resulting genome numbers of the pathogens and of the probiotics were measured by quantitative real-time PCR. Mixtures of the streptococcal probiotics were also used to determine their synergistic, additive, or antagonistic effects. The overall best inhibitor of the periodontal pathogens was L. reuteri ATCC PTA 5289, but the effect is coenzyme B12-, anaerobiosis-, as well as glycerol-dependent, and further modulated by L. reuteri strain DSM 17938. Notably, in absence of glycerol, the pathogen-inhibitory effect could even turn into a growth spurt. Among the streptococci tested, S. salivarius M18 had the most constant inhibitory potential against all pathogens, followed by K12 and S. dentisani 7746, with the latter still having significant inhibitory effects on P. intermedia and A. actinomycetemcomitans. Overall, mixtures of the streptococcal probiotics did inhibit the growth of the pathogens equally or-in the case of A. actinomycetemcomitans- better than the individual strains. P. gingivalis and F. nucleatum were best inhibited by pure cultures of S. salivarius K12 or S. salivarius M18, respectively. Testing inverse effects, the growth of S. salivarius M18 was enhanced when incubated with the periodontal pathogens minus/plus other probiotics. In contrast, S. oralis subsp. dentisani 7746 was not much influenced by the pathogens. Instead, it was significantly inhibited by the presence of other streptococcal probiotics. In conclusion, despite some natural limits such as persistence, the full potential for probiotic treatment is by far not utilized yet. Especially, further exploring concerted activity by combining synergistic strains, together with the application of oral prebiotics and essential supplements and conditions, is mandatory.

Manipulating beams of paramagnetic atoms and molecules using inhomogeneous magnetic fields.

We review methods to manipulate the motion of pulsed supersonic atomic and molecular beams using time-independent and -dependent inhomogeneous magnetic fields. In addition, we discuss current and possible future applications and research directions.

A Unified Framework for Understanding Nucleophilicity and Protophilicity in the SN 2/E2 Competition.

The concepts of nucleophilicity and protophilicity are fundamental and ubiquitous in chemistry. A case in point is bimolecular nucleophilic substitution (SN 2) and base-induced elimination (E2). A Lewis base acting as a strong nucleophile is needed for SN 2 reactions, whereas a Lewis base acting as a strong protophile (i.e., base) is required for E2 reactions. A complicating factor is, however, the fact that a good nucleophile is often a strong protophile. Nevertheless, a sound, physical model that explains, in a transparent manner, when an electron-rich Lewis base acts as a protophile or a nucleophile, which is not just phenomenological, is currently lacking in the literature. To address this fundamental question, the potential energy surfaces of the SN 2 and E2 reactions of X- +C2 H5 Y model systems with X, Y = F, Cl, Br, I, and At, are explored by using relativistic density functional theory at ZORA-OLYP/TZ2P. These explorations have yielded a consistent overview of reactivity trends over a wide range in reactivity and pathways. Activation strain analyses of these reactions reveal the factors that determine the shape of the potential energy surfaces and hence govern the propensity of the Lewis base to act as a nucleophile or protophile. The concepts of "characteristic distortivity" and "transition state acidity" of a reaction are introduced, which have the potential to enable chemists to better understand and design reactions for synthesis.

Precision Measurements in Few-Electron Molecules: The Ionization Energy of Metastable

Molecular helium represents a benchmark system for testing ab initio calculations on few-electron molecules. We report on the determination of the adiabatic ionization energy of the a ^{3}Σ_{u}^{+} state of He_{2}, corresponding to the energy interval between the a ^{3}Σ_{u}^{+} (v^{''}=0, N^{''}=1) state of He_{2} and the X^{+} ^{2}Σ_{u}^{+} (v^{+}=0, N^{+}=1) state of He_{2}^{+}, and of the lowest rotational interval of He_{2}^{+}. These measurements rely on the excitation of metastable He_{2} molecules to high Rydberg states using frequency-comb-calibrated continuous-wave UV radiation in a counterpropagating laser-beam setup. The observed Rydberg states were extrapolated to their series limit using multichannel quantum-defect theory. The ionization energy of He_{2} (a ^{3}Σ_{u}^{+}) and the lowest rotational interval of He_{2}^{+} (X^{+} ^{2}Σ_{u}^{+}) are 34 301.207 002(23)±0.000 037_{syst} cm^{-1} and 70.937 589(23)±0.000 060_{syst} cm^{-1}, respectively.

Prescribing medicines to older people-How to consider the impact of ageing on human organ and body functions.

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.

Reducing Inappropriate Drug Use in Older Patients by Use of Clinical Decision Support in Community Pharmacy: A Mixed-Methods Evaluation.

INTRODUCTION: Older people are prone to drug-related harm. Clinical decision support systems (CDSSs) in community pharmacies may improve appropriate prescribing in this population. OBJECTIVE: This study investigated (persistent) drug therapy changes and its determinants to reduce potentially inappropriate medication (PIM) in older patients based on CDSS alerts and to investigate barriers and facilitators for implementation of drug therapy changes based on these CDSS alerts. METHODS: Five clinical decision rules based on national guidelines for inappropriate drugs in older patients were incorporated in a web-based CDSS in 31 community pharmacies between February and April 2017. The CDSS generated alerts for patients aged > 70 years who had prescriptions for one of the following drugs: alprazolam, amitriptyline, barnidipine, duloxetine, fluoxetine, trazodone, quetiapine and olanzapine. The registered alert management data and medication dispensing histories were analysed to find potential determinants of persistent drug therapy changes. Ten pharmacists were interviewed about the barriers and facilitators for implementing drug therapy changes based on CDSS alerts. An inductive thematic analysis of the transcripts was performed. RESULTS: The pharmacists recorded the management of 1810 of the 2589 generated alerts, and 158 (8.7%) alerts were associated with a persistent drug therapy change. A logistic regression analysis found that the drug triggering the alert and the type of prescription [first dispensing vs. repeat; odds ratio 2.1 (95% confidence interval 1.4-3.2)] were significantly associated with persistent drug therapy changes. No association was found between persistent changes and age, sex, number of medicines in use, or recent clinical medication review. Analysis of the interviews revealed nine barriers and facilitators associated with drug therapy change. CONCLUSION: When community pharmacists implemented CDSS alerts to reduce inappropriate drug use in older patients, they registered a persistent drug therapy change in 8.7% of the cases. Alerts triggered by a first prescription were two times more likely to be associated with a persistent drug therapy change than alerts triggered by repeat prescriptions. This study found that clinical rules can be used to detect inappropriate drug use in older patients and that drug therapy can change based on the alerts. This suggests that CDSS alerts are a useful tool for implementing guidelines on PIM in older patients in daily practice.

Effects of Pharmacogenetic Screening for CYP2D6 Among Elderly Starting Therapy With Nortriptyline or Venlafaxine: A Pragmatic Randomized Controlled Trial (CYSCE Trial).

PURPOSE/BACKGROUND: The duration of untreated depression is a predictor for poor future prognosis, making rapid dose finding essential. Genetic variation of the CYP2D6 isoenzyme can influence the optimal dosage needed for individual patients. The aim of this study was to determine the effectiveness of CYP2D6 pharmacogenetic screening to accelerate drug dosing in older patients with depression initiating nortriptyline or venlafaxine. METHODS/PROCEDURES: In this randomized controlled trial, patients were randomly allocated to one of the study arms. In the intervention arm (DG-I), the specific genotype accompanied by a standardized dosing recommendation based on the patients' genotype and the prescribed drug was directly communicated to the physician of the participant. In both the deviating genotype control arm (DG-C) and the nonrandomized control arm, the physician of the participants was not informed about the genotype and the associated dosing advise. The primary outcome was the time needed to reach adequate drug levels: (1) blood levels within the therapeutic range and (2) no dose adjustments within the previous 3 weeks. FINDINGS/RESULTS: No significant difference was observed in mean time to reach adequate dose or time to adequate dose between DG-I and DG-C. Compared with the nonrandomized control arm group, adequate drug levels were reached significantly faster in the DG-I group (log-rank test; P = 0.004), and there was a similar nonsignificant trend for the DG-C group (log-rank test; P = 0.087). IMPLICATIONS/CONCLUSIONS: The results of this study do not support pharmacogenetic CYP2D6 screening to accelerate dose adjustment for nortriptyline and venlafaxine in older patients with depression.

Rationale and design of OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people (OPERAM): a cluster randomised controlled trial.

INTRODUCTION: Multimorbidity and polypharmacy are important risk factors for drug-related hospital admissions (DRAs). DRAs are often linked to prescribing problems (overprescribing and underprescribing), as well as non-adherence with drug regimens for different reasons. In this trial, we aim to assess whether a structured medication review compared with standard care can reduce DRAs in multimorbid older patients with polypharmacy. METHODS AND ANALYSIS: OPtimising thERapy to prevent Avoidable hospital admissions in Multimorbid older people is a European multicentre, cluster randomised, controlled trial. Hospitalised patients ≥70 years with ≥3 chronic medical conditions and concurrent use of ≥5 chronic medications are included in the four participating study centres of Bern (Switzerland), Utrecht (The Netherlands), Brussels (Belgium) and Cork (Ireland). Patients treated by the same prescribing physician constitute a cluster, and clusters are randomised 1:1 to either standard care or Systematic Tool to Reduce Inappropriate Prescribing (STRIP) intervention with the help of a clinical decision support system, the STRIP Assistant. STRIP is a structured method performing customised medication reviews, based on Screening Tool of Older People's Prescriptions/Screening Tool to Alert to Right Treatment criteria to detect potentially inappropriate prescribing. The primary endpoint is any DRA where the main reason or a contributory reason for the patient's admission is caused by overtreatment or undertreatment, and/or inappropriate treatment. Secondary endpoints include number of any hospitalisations, all-cause mortality, number of falls, quality of life, degree of polypharmacy, activities of daily living, patient's drug compliance, the number of significant drug-drug interactions, drug overuse and underuse and potentially inappropriate medication. ETHICS AND DISSEMINATION: The local Ethics Committees in Switzerland, Ireland, The Netherlands and Belgium approved this trial protocol. We will publish the results of this trial in a peer-reviewed journal. MAIN FUNDING: European Union's Horizon 2020 programme. TRIAL REGISTRATION NUMBER: NCT02986425 , SNCTP000002183 , NTR6012, U1111-1181-9400.

Psychological Safety, Job Crafting, and Employability: A Comparison Between Permanent and Temporary Workers.

Employability is one of the leading challenges of the contemporary organizational environment. While much is known about the positive effects of job crafting on employees' employability in general, little is known about its effects when employment contacts are different. Differentiating between temporary and permanent workers, in this article we investigate how in the environment of psychological safety, these two types of employees engage in job crafting, and how job crafting is related to their perceived employability. Data were collected among two samples, consisting of temporary agency workers (N = 527), and permanent employees (N = 796). Structural equation modeling (SEM) analyses indicated a different pattern of results for the two groups: for permanent employees, increasing challenging job demands was positively, and decreasing hindering job demands was negatively related to perceived employability. Moreover, psychological safety was related to all job crafting dimensions. For agency workers, only increasing structural job resources was related to employability, while psychological safety was negatively associated with crafting hindrances. These findings suggest that a climate of psychological safety is particularly effective for permanent employees in fostering job crafting and employability.

How Do Career Aspirations Benefit Organizations? The Mediating Roles of the Proactive and Relational Aspects of Contemporary Work.

This paper examines how employees' career aspirations benefit organizations, i.e., contribute to strengthening organizational capabilities and connections, by means of two aspects of contemporary work: proactive and relational. Data were collected from alumni of a public university in Amsterdam, the Netherlands, in two waves with a 1-year time lag. The results showed that employees with career aspirations strengthen: (a) organizational capabilities; and (b) organizational connections through their instrumental and psychosocial relationships. Interestingly, although employees' career aspirations were positively associated with taking charge, we did not find that taking charge mediates the relationship between career aspirations and employees' individual contributions to organizational capabilities. This study is the first to examine how individual career aspirations benefit organizations, and it discusses the results in light of their novel contributions to theory and practice.

Fundamental vibration frequency and rotational structure of the first excited vibrational level of the molecular helium ion ( He 2 + ).

The term values of the rotational levels of the first excited vibrational state of the electronic ground state of He 2 + with a rotational quantum number N + ≤ 13 have been determined with an accuracy of 1.2 × 10-3 cm-1 (∼35 MHz) by multichannel-quantum-defect-theory-assisted Rydberg spectroscopy of metastable He2. Comparison of the experimental term values with the most accurate ab initio results for He 2 + available in the literature [W.-C. Tung, M. Pavanello, and L. Adamowicz, J. Chem. Phys. 136, 104309 (2012)] reveals inconsistencies between the theoretical and experimental results that increase with increasing rotational quantum numbers. The fundamental vibrational wavenumber of He 2 + was determined to be 1628.3832(12) cm-1 by fitting effective molecular constants to the obtained term values.

Determination of the Spin-Rotation Fine Structure of He_{2}

Measuring spin-rotation intervals in molecular cations is challenging, particularly so when the ions do not have electric-dipole-allowed rovibrational transitions. We present a method, based on an angular-momentum basis transformation, to determine the spin-rotational fine structure of molecular ions from the fine structure of high Rydberg states. The method is illustrated by the determination of the so far unknown spin-rotation fine structure of the fundamentally important He_{2}^{+} ion in the X ^{2}Σ_{u}^{+} state. The fine-structure splittings of the v^{+}=0, N^{+}=1, 3, and 5 levels of He_{2}^{+} are 7.96(14), 17.91(32), and 28.0(6) MHz, respectively. The experiment relies on the use of single-mode cw radiation to record spectra of high Rydberg states of He_{2} from the a ^{3}Σ_{u}^{+} metastable state.

International core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy.

BACKGROUND: Comparisons of clinical trial findings in systematic reviews can be hindered by the heterogeneity of the outcomes reported. Moreover, the outcomes that matter most to patients might be underreported. A core outcome set can address these issues, as it defines a minimum set of outcomes that should be reported in all clinical trials in a particular area of research. The objective in this study was to develop a core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy. METHODS: Firstly, eligible outcomes were identified through a systematic review of trials of medication review in older patients (≥65 years) and interviews with 15 older patients. Secondly, an international three-round Delphi survey in four countries involving patients, healthcare professionals, and experts was conducted to validate outcomes to be included in the core outcome set. Consensus meetings were conducted to validate the results. RESULTS: Of the 164 participants invited to take part in the Delphi survey, 150 completed Round 1, including 55 patients or family caregivers, 55 healthcare professionals, and 40 experts. A total of 129 participants completed all three rounds. Sixty-four eligible outcomes were extracted from 47 articles, 32 clinical trial protocols, and patient interviews. Thirty outcomes were removed and one added after Round 1, 18 outcomes were removed after Round 2, and seven after Round 3. Results were discussed during consensus meetings. Consensus was reached on seven outcomes, which constitute the core outcome set: drug-related hospital admissions; drug overuse; drug underuse; potentially inappropriate medications; clinically significant drug-drug interactions; health-related quality of life; pain relief. CONCLUSIONS: We developed a core outcome set of seven outcomes which should be used in future trials of medication review in multi-morbid older patients with polypharmacy.

The Systematic Tool to Reduce Inappropriate Prescribing (STRIP): Combining implicit and explicit prescribing tools to improve appropriate prescribing.

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.