A-TAPER: A Framework for Deprescribing Medications effectively.

Inappropriate medication use creates avoidable safety issues for older adults. Deprescribing medications that are high risk and/or of minimal benefit is important for reducing morbidity and adverse effects, especially in this population. A variety of deprescribing resources and algorithms are available, but a singular framework to effectively approach and implement the deprescribing of unnecessary medications in practice does not exist. An interprofessional team of pharmacists, geriatricians, and researchers developed a framework to guide providers in deprescribing medications. This framework is represented by the acronym A-TAPER, which stands for Assess medication use, Talk about risks versus benefits, select Alternatives, Plan next steps, Engage patient, and Reduce dose. Within this framework, comprehensive, medication-specific deprescribing toolkits can be created.

Effects of zinc source and dietary concentration on serum zinc concentrations, growth performance, wool and reproductive characteristics in developing rams.

Dietary Zn has significant impacts on the growth and development of breeding rams. The objectives of this study were to evaluate the effects of dietary Zn source and concentration on serum Zn concentration, growth performance, wool traits and reproductive performance in rams. Forty-four Targhee rams (14 months; 68 ± 18 kg BW) were used in an 84-day completely randomized design and were fed one of three pelleted dietary treatments: (1) a control without fortified Zn (CON; n = 15; ~1 × NRC); (2) a diet fortified with a Zn amino acid complex (ZnAA; n = 14; ~2 × NRC) and (3) a diet fortified with ZnSO4 (ZnSO4; n = 15; ~2 × NRC). Growth and wool characteristics measured throughout the course of the study were BW, average daily gain (ADG), dry matter intake (DMI), feed efficiency (G : F), longissimus dorsi muscle depth (LMD), back fat (BF), wool staple length (SL) and average fibre diameter (AFD). Blood was collected from each ram at four time periods to quantify serum Zn and testosterone concentrations. Semen was collected 1 to 2 days after the trial was completed. There were no differences in BW (P = 0.45), DMI (P = 0.18), LMD (P = 0.48), BF (P = 0.47) and AFD (P = 0.9) among treatment groups. ZnSO4 had greater (P ≤ 0.03) serum Zn concentrations compared with ZnAA and CON treatments. Rams consuming ZnAA had greater (P ≤ 0.03) ADG than ZnSO4 and CON. There tended to be differences among groups for G : F (P = 0.06), with ZnAA being numerically greater than ZnSO4 and CON. Wool staple length regrowth was greater (P < 0.001) in ZnSO4 and tended to be longer (P = 0.06) in ZnAA treatment group compared with CON. No differences were observed among treatments in scrotal circumference, testosterone, spermatozoa concentration within ram semen, % motility, % live sperm and % sperm abnormalities (P ≥ 0.23). Results indicated beneficial effects of feeding increased Zn concentrations to developing Targhee rams, although Zn source elicited differential responses in performance characteristics measured.

Effects of organic complexed or inorganic Co, Cu, Mn and Zn supplementation during a 45-day preconditioning period on productive and health responses of feeder cattle.

This experiment evaluated production and health parameters among cattle offered concentrates containing inorganic or organic complexed sources of supplemental Cu, Co, Mn and Zn during a 45-day preconditioning period. In total, 90 Angus×Hereford calves were weaned at 7 months (day -1), sorted by sex, weaning BW and age (261±2 kg; 224±2 days), and allocated to 18 drylot pens (one heifer and four steers per pen) on day 0; thus, all pens had equivalent initial BW and age. Pens were randomly assigned to receive a corn-based preconditioning concentrate containing: (1) Cu, Co, Mn and Zn sulfate sources (INR), (2) Cu, Mn, Co and Zn complexed organic source (AAC) or (3) no Cu, Co, Mn and Zn supplementation (CON). From day 0 to 45, cattle received concentrate treatments (2.7 kg/animal daily, as-fed basis) and had free-choice access to orchardgrass (Dactylis glomerata L.), long-stem hay and water. The INR and AAC treatments were formulated to provide the same daily amount of Co, Cu, Mn and Zn at a 50-, 16-, 8- and ninefold increase, respectively, compared with the CON treatment. On day 46, cattle were transported to a commercial feedlot, maintained as a single pen, and offered a free-choice receiving diet until day 103. Calf full BW was recorded on days -1 and 0, 45 and 46, and 102 and 103 for average daily gain (ADG) calculation. Liver biopsy was performed on days 0 (used as covariate), 22 and 45. Cattle were vaccinated against respiratory pathogens on days 15, 29 and 46. Blood samples were collected on days 15, 29, 45, 47, 49, 53 and 60. During preconditioning, mean liver concentrations of Co, Zn and Cu were greater (P⩽0.03) in AAC and INR compared with CON. No treatment effects were detected (P⩾0.17) for preconditioning feed intake, ADG or feed efficiency. No treatment effects were detected (P⩾0.48) for plasma concentrations of antibodies against Mannheimia haemolytica, bovine viral diarrhea types 1 and 2 viruses. Plasma haptoglobin concentrations were similar among treatments (P=0.98). Mean plasma cortisol concentration was greater (P⩽0.04) in CON compared with INR and AAC. No treatment effects were detected (P⩾0.37) for cattle ADG during feedlot receiving. Hence, INR and AAC increased liver concentrations of Co, Zn and Cu through preconditioning, but did not impact cattle performance and immunity responses during preconditioning and feedlot receiving.

Effects of organic or inorganic cobalt, copper, manganese, and zinc supplementation to late-gestating beef cows on productive and physiological responses of the offspring.

Eighty-four multiparous, nonlactating, pregnant Angus × Hereford cows were ranked by pregnancy type (56 AI and 28 natural service), BW, and BCS and allocated to 21 drylot pens at the end of their second trimester of gestation (d 0). Pens were assigned to receive forage-based diets containing 1) sulfate sources of Cu, Co, Mn, and Zn (INR); 2) an organic complexed source of Cu, Mn, Co, and Zn (AAC; Availa 4; Zinpro Corporation, Eden Prairie, MN); or 3) no supplemental Cu, Co, Mn, and Zn (CON). Diets were offered from d 0 until calving and formulated to meet requirements for energy, protein, macrominerals, Se, I, and vitamins. The INR and AAC diets provided the same daily amount of Cu, Co, Mn, and Zn. Cow BW and BCS were recorded and liver samples were collected on d -10 and 2 wk (d 75) before the calving season. Within 3 h after calving, calf BW was recorded, liver samples were collected, and the expelled placenta was retrieved ( = 47 placentas). Calves were weaned on d 283 of the experiment, preconditioned for 45 d (d 283 to 328), transferred to a growing lot on d 328, and moved to a finishing lot on d 440 where they remained until slaughter. Liver Co, Cu, and Zn concentrations on d 75 were greater ( ≤ 0.05) for INR and AAC cows compared with CON cows, whereas INR cows had reduced ( = 0.04) liver Co but greater ( = 0.03) liver Cu compared with AAC cows. In placental cotyledons, Co concentrations were greater ( ≤ 0.05) in AAC and INR cows compared with CON cows, whereas Cu concentrations were increased ( = 0.05) only in AAC cows compared with CON cows. Calves from INR and AAC cows had greater ( < 0.01) liver Co concentrations at birth compared with calves from CON cows. Liver Cu and Zn concentrations at birth were greater ( ≤ 0.05) in calves from AAC cows compared with cohorts from CON cows. Weaning BW was greater ( ≤ 0.05) in calves from AAC cows compared with cohorts from CON cows, and this difference was maintained until slaughter. In the growing lot, calves from AAC cows had reduced ( < 0.01) incidence of bovine respiratory disease compared with CON and INR cohorts. Collectively, these results suggest that feeding the AAC diet to late-gestating beef cows stimulated programming effects on postnatal offspring growth and health compared with the CON diet. Therefore, supplementing late-gestating beef cows with an organic complexed source of Co, Cu, Zn, and Mn instead of no supplementation appears to optimize offspring productivity in beef production systems.

Effect of supplemental trace mineral level and form on peripubertal bulls.

Objectives were to determine if supplemental trace mineral levels and/or forms (sulfate and metal amino acid complexes) influence age at puberty, semen quality, endocrine status, and scrotal circumference in peripubertal bulls. Fifty peripubertal bulls were blocked by age and scrotal circumference and assigned to one of five treatments: (1) 1x sulfate form (1S); (2) 1x complexed form (1C); (3) 1S+1C (2SC); (4) 1S + 2 × 1 C (3SCC); and (5) 3 × 1S (3S). Each 1x supplementation level contained 360 mg Zn, 125 mg Cu, 200mg Mn and 12.5mg Co. Liver biopsies were collected on d -21 and 100, and scrotal circumference, semen, and blood samples were collected on d -14, 14, 42, 70, and 98. All bulls were deficient in Cu yet adequate in Zn on d -21. Following 100 d on treatment, liver Zn concentrations decreased (P<0.01) and liver Cu concentrations increased (P<0.01) in bulls regardless of treatment. Day 100 liver Zn concentrations were similar (P=0.50) across treatments, but liver Cu concentrations were greater (P=0.07) in 3SCC and 3S bulls compared to 1C and 1S bulls, whereas 2SC bulls were intermediate. Bulls fed complexed minerals tended to reach puberty after fewer (P=0.11) days on treatment (43.9 ± 5.7 d) than bulls fed only sulfate minerals (58.5 ± 6.7 d). Supplementing complexed Cu and Zn to prepubertal bulls may lower the age at puberty, however, no differences (P ≥ 0.40) in semen characteristics or scrotal measurements (P ≥ 0.11) were observed.

Effect of selenium supplementation and source on the selenium status of horses.

This study was conducted to determine the effect of Se supplementation and source on the Se status of horses. Eighteen 18-mo-old nonexercised horses were randomly assigned within sex to 1 of 3 treatments: 1) control (CTRL, no supplemental Se, 0.15 mg of Se/kg of total diet DM); 2) inorganic Se (INORG, CTRL + 0.45 mg of Se/kg of total diet DM from NaSeO3); or organic Se [ORG, CTRL + 0.45 mg of Se/kg of total diet DM from zinc-L-selenomethionine (Availa Se, Zinpro, Corp., Eden Prairie, MN)]. Horses were acclimated to the CTRL diet (7.1 kg of DM alfalfa hay and 1.2 kg of DM concentrate per horse daily) for 28 d. After the acclimation period, the appropriate treatment was top-dressed on the individually fed concentrate for 56 d. Jugular venous blood samples were collected on d 0, 28, and 56. Middle gluteal muscle biopsies were collected on d 0 and 56. Muscle and plasma were analyzed for Se concentrations. Glutathione peroxidase activity was measured in muscle (M GPx-1), plasma (P GPx-3), and red blood cells (RBC GPx-1). Data were analyzed as a repeated measures design. Mean plasma Se concentration on d 28 and 56 was greater (P < 0.05) for Se-supplemented horses compared with CTRL horses, and tended (P < 0.1) to be greater in ORG vs. INORG on d 28. Mean muscle Se concentration and P GPx-3 activities increased (P < 0.05) from d 0 to 56 but were not affected by treatment. Mean RBC GPx-1 activity tended to be greater (P < 0.1) in ORG than INORG or CTRL horses on d 28, and tended to be greater (P < 0.1) for INORG compared with ORG horses on d 56. Mean RBC GPx-1 activity of INORG and ORG horses was not different from that of CTRL on d 56. Mean M GPx-1 activity decreased (P < 0.01) from d 0 to 56. In conclusion, zinc-L-selenomethionine was more effective than NaSeO3 at increasing plasma Se concentration from d 0 to 28; however, both supplemental Se sources had a similar effect by d 56. No difference in Se status due to Se supplementation or source could be detected over a 56-d supplementation period by monitoring middle gluteal muscle Se, M GPx-1, or P GPx-3. Results for RBC GPx-1 also were inconclusive relative to the effect of Se supplementation and source.