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Article ; Online: Development of a list of Australian potentially inappropriate medicines using the Delphi technique.

Wang, Kate N / Etherton-Beer, Christopher D / Sanfilippo, Frank / Page, Amy T

2024

Abstract: Background: Older people are at high risk of medicines-related harms. otentially inappropriate medicines (PIMs) list has been developed to assist clinicians and researchers to identify medicines with risks that may potentially outweigh their benefits in ...

Abstract	Background: Older people are at high risk of medicines-related harms. otentially inappropriate medicines (PIMs) list has been developed to assist clinicians and researchers to identify medicines with risks that may potentially outweigh their benefits in order to improve medication management and safety. Aim: To develop a list of PIMs for older people specific to Australia. Methods: The study obtained expert consensus through the utilisation of the Delphi technique in Australia. A total of 33 experts partook in the initial round, while 32 experts engaged in the subsequent round. The primary outcomes encompass medicines assessed as potentially inappropriate, the specific contexts in which their inappropriateness arises and potentially safer alternatives. Results: A total of 16 medicines or medicine classes had one or more medicines deemed as potentially inappropriate in older people. Up to 19 medicines or medicine classes had specific conditions that make them more potentially inappropriate, while alternatives were suggested for 16 medicines or classes. Conclusion: An explicit PIMs list for older people living in Australia has been developed containing 19 drugs/drug classes. The PIMs list is intended to be used as a guide for clinicians when assessing medication appropriateness in older people in Australian clinical settings and does not substitute individualised treatment advice from clinicians.
Language	English
Publishing date	2024-02-02
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2045436-3
ISSN	1445-5994 ; 1444-0903
ISSN (online)	1445-5994
ISSN	1444-0903
DOI	10.1111/imj.16322
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Article ; Online: Mild cognitive impairment: To diagnose or not to diagnose.

Wang, Kate N / Page, Amy T / Etherton-Beer, Christopher D

Australasian journal on ageing

2021 Volume 40, Issue 2, Page(s) 111–115

Abstract: Older people living with mild cognitive impairment (MCI) have a slight but noticeable decline in their cognitive function, though do not meet the diagnostic criteria for dementia. MCI is controversial, with some saying it is a condition that does not ... ...

Abstract	Older people living with mild cognitive impairment (MCI) have a slight but noticeable decline in their cognitive function, though do not meet the diagnostic criteria for dementia. MCI is controversial, with some saying it is a condition that does not require diagnosis, and others stating that it is a genuine clinical syndrome. Many people with MCI will improve, and most will not progress to dementia. Managing co-morbidities and exercising are likely to be the best treatment options. With limited evidence for effective interventions and uncertainty as to the prognostic value of the condition, the benefit of diagnosing MCI remains unclear.
MeSH term(s)	Aged ; Cognition ; Cognitive Dysfunction/diagnosis ; Cognitive Dysfunction/epidemiology ; Dementia/diagnosis ; Exercise ; Humans
Language	English
Publishing date	2021-02-18
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1457406-8
ISSN	1741-6612 ; 0726-4240 ; 1440-6381
ISSN (online)	1741-6612
ISSN	0726-4240 ; 1440-6381
DOI	10.1111/ajag.12913
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Article ; Online: Cost-Consequence Analysis of Deprescribing to Optimize Health Outcomes for Frail Older People: A Within-Trial Analysis.

Okafor, Charles E / Keramat, Syed Afroz / Comans, Tracy / Page, Amy T / Potter, Kathleen / Hilmer, Sarah N / Lindley, Richard I / Mangin, Dee / Naganathan, Vasi / Etherton-Beer, Christopher

Journal of the American Medical Directors Association

2024 Volume 25, Issue 3, Page(s) 539–544.e2

Abstract: Objectives: The structured, clinically supervised withdrawal of medicines, known as deprescribing, is one strategy to address inappropriate polypharmacy. This study aimed to evaluate the costs and consequences of deprescribing in frail older people ... ...

Abstract	Objectives: The structured, clinically supervised withdrawal of medicines, known as deprescribing, is one strategy to address inappropriate polypharmacy. This study aimed to evaluate the costs and consequences of deprescribing in frail older people living in residential aged care facilities (RACFs) in Australia. Design: A within-trial cost-consequence analysis of a deprescribing intervention-Opti-Med. The Opti-Med double-blind randomized controlled trial of deprescribing included 3 groups: blinded control, blinded intervention, and an open intervention group. Setting and participants: Seventeen RACFs in Western Australia and New South Wales. Participants were 303 older people living in participating RACFs from March 2014 to February 2019. Methods: Analysis was conducted from the health sector perspective. Health economic outcomes assessed include cost saved from deprescribed medicines and the incremental quality-adjusted life-years. Costs were presented in 2022 Australian dollars. Results: The total cost of the Opti-Med intervention was $239.13 per participant. The costs saved through deprescribed medicines over 12 months after adjusting for mortality within the trial period was $328.90 per participant in the blinded intervention group and $164.00 per participant in the open intervention group. On average, the cost of the intervention was more than offset by the cost saved from deprescribed medicines. Extrapolating these findings to the Australian population suggests a potential net cost saving of about $1 to $16 million per annum for the health system nationally. The incremental quality-adjusted life-years were very similar across the 3 groups within the trial period. Conclusions and implications: Deprescribing for frail older people living in RACFs can be a cost-saving intervention without reducing the quality of life. Systemwide implementation of deprescribing across RACFs in Australia has the potential to improve health care delivery through the cost savings, which could be reapplied to further optimize care within RACFs.
MeSH term(s)	Humans ; Aged ; Australia ; Deprescriptions ; Frail Elderly ; Quality of Life ; Cost Savings ; Outcome Assessment, Health Care
Language	English
Publishing date	2024-01-30
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2171030-2
ISSN	1538-9375 ; 1525-8610
ISSN (online)	1538-9375
ISSN	1525-8610
DOI	10.1016/j.jamda.2023.12.016
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Article ; Online: ASAS centennial paper: animal growth and development research: historical perspectives.

Etherton, T D

Journal of animal science

2009 Volume 87, Issue 9, Page(s) 3060–3064

Abstract: From a historical perspective, it is difficult to identify a specific date that launched the field of endocrinology. One "biomarker" of the inception of endocrinology traces back to Ernest Henry Starling, who first introduced the word hormone in a talk ... ...

Abstract	From a historical perspective, it is difficult to identify a specific date that launched the field of endocrinology. One "biomarker" of the inception of endocrinology traces back to Ernest Henry Starling, who first introduced the word hormone in a talk given in 1905 at the Royal College of Physicians in London (Starling, 1905). A historical look at the field of endocrine regulation of animal growth since 1905 conveys that countless scientists worldwide worked to advance the scientific evidence base, which led to the commercial development of hormone-based products that enhanced growth and beneficially changed carcass composition of meat animals. This review will discuss some of seminal contributions that include the discovery of hormones (like ST and beta-adrenergic agonists) that have been shown to play key roles in regulating growth and nutrient partitioning of livestock, the mechanisms by which these hormones act, and the development of products for application in animal agriculture.
MeSH term(s)	Animal Husbandry/history ; Animal Husbandry/methods ; Animals ; Endocrinology/history ; Growth and Development ; History, 20th Century ; History, 21st Century ; Hormones
Chemical Substances	Hormones
Language	English
Publishing date	2009-09
Publishing country	United States
Document type	Historical Article ; Journal Article ; Review
ZDB-ID	390959-1
ISSN	1525-3163 ; 0021-8812
ISSN (online)	1525-3163
ISSN	0021-8812
DOI	10.2527/jas.2009-1805
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Article ; Online: Exploring stakeholder roles in medication management for people living with dementia.

Cross, Amanda J / Etherton-Beer, Christopher D / Clifford, Rhonda M / Potter, Kathleen / Page, Amy T

Research in social & administrative pharmacy : RSAP

2020 Volume 17, Issue 4, Page(s) 707–714

Abstract: Background: Therapeutic decision making, prescribing, administering and managing medications can be difficult for people with dementia.: Objectives: To explore stakeholder roles in medication management for people with dementia, including barriers ... ...

Abstract	Background: Therapeutic decision making, prescribing, administering and managing medications can be difficult for people with dementia. Objectives: To explore stakeholder roles in medication management for people with dementia, including barriers and enablers to achieving those roles. Methods: Focus groups were held with stakeholders (consumers, general practitioners, nurses and pharmacists) from both rural and metropolitan communities in two Australian states. Focus groups were audio-recorded, transcribed and thematically analysed using an inductive approach. Results: Nine focus groups were held with 55 participants. Four major themes were identified: supporting the role of the person with dementia, carer roles and challenges, health professional roles, and process and structure barriers to medication management. Stakeholders discussed the importance of advance care planning, and the potential benefits of early implementation of dose administration aids to support patients in self-managing their medication. Carers were seen to have a vital role as patient advocates, but carer burden and changes in the patient-carer roles acted as barriers to this role. General practitioners were perceived as the main care coordinator for a person with dementia, with effective interprofessional collaboration and communication with allied health professionals and specialists further enabling optimisation of medication use. A lack of evidence, guidelines and practitioner training to guide prescribing and deprescribing decisions in people with dementia were mentioned as barriers to medication management. Conclusion: Medication management is increasingly challenging for people with dementia and each stakeholder perceives that they have a different role and faces different barriers and enablers. Future research should focus on improving the evidence base to guide prescribing, facilitating stakeholder communication and ensuring early documentation of patient wishes for the future.
MeSH term(s)	Australia ; Caregivers ; Dementia/drug therapy ; General Practitioners ; Humans ; Medication Therapy Management ; Stakeholder Participation
Language	English
Publishing date	2020-06-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2192059-X
ISSN	1934-8150 ; 1551-7411
ISSN (online)	1934-8150
ISSN	1551-7411
DOI	10.1016/j.sapharm.2020.06.006
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Article ; Online: Are avocados toast? A framework to analyze decision-making for emerging epidemics, applied to laurel wilt

Etherton, Berea A. / Choudhury, R.A. / Alcalá-Briseño, R.I. / Xing, Y. / Plex Sulá, A.I. / Carrillo, D. / Wasielewski, J. / Stelinski, L.L. / Grogan, K.A. / Ballen, F. / Blare, T. / Crane, J. / Garrett, K.A.

Agricultural Systems. 2023 Mar., v. 206 p.103615-

2023

Abstract: When emerging pathogens threaten global food security, collective action for disease management is key for protecting food systems. We evaluate how the informal exchange of information about epidemic and economic outcomes can influence the management ... ...

Abstract	When emerging pathogens threaten global food security, collective action for disease management is key for protecting food systems. We evaluate how the informal exchange of information about epidemic and economic outcomes can influence the management decisions of individuals and the resulting epidemics, in the context of the avocado laurel wilt epidemic in south Florida. In scenario analyses, we addressed how socioeconomic networks, laurel wilt epidemic networks, policy incentive structures, and social behaviors combine to influence (a) information exchange across this region, (b) growers' decisions about disease management, and (c) epidemic spread and yield loss. We identified the scenarios in which regional avocado health fared best. We built an agent-based model to simulate laurel wilt epidemic expansion and establishment across south Florida over a 10-year period. The model used parameters specific to patterns observed and quantified from the laurel wilt epidemic in south Florida. Based on the locations and sizes of avocado orchards there, we simulated disease expansion and information dissemination through multilayer socioeconomic and epidemic networks and evaluated the effects of "carrot" and "stick" policy incentive structures and behaviors like "stubbornness" in decision making. Scenarios were simulated for multiple parameters across a 10-year time period, and the regional health of avocado and management decisions of growers were analyzed. Increased social connections led to lower regional crop health due to increased exchange of information reinforcing selection of less expensive but less effective management choices. This information exchange was particularly impactful during the lag phase of epidemic expansion, when the cost of disease management outweighed the cost of disease. Managers who were resistant or "stubborn" against adopting these less expensive and less effective management strategies, particularly during the lag phase of epidemic expansion, contributed to greater regional health. In these scenarios, growers responded more to policies which penalized individuals than to policies which rewarded individuals. By quantifying varying degrees of stubbornness, and how growers may weight past experiences and new information, we represented key aspects of decision making and its many influences on regional collective action in this novel agent-based model. The model demonstrates the caveats of information exchange across social networks during epidemics, and the valuable role that policy makers and informed educators can have, particularly during the lag phase of epidemic expansion. Decision makers and stakeholders must understand the influences of information exchange to overcome the challenges of collective action for crop health.
Keywords	avocados ; collective action ; decision making ; disease control ; food security ; information dissemination ; information exchange ; issues and policy ; laurel wilt ; simulation models ; stakeholders ; Florida ; Network analysis ; Invasion biology ; Avocado laurel wilt ; Epidemiology ; Agent-based model ; Decision support
Language	English
Dates of publication	2023-03
Publishing place	Elsevier Ltd
Document type	Article ; Online
Note	Use and reproduction
ZDB-ID	413255-5
ISSN	0308-521X
ISSN	0308-521X
DOI	10.1016/j.agsy.2023.103615
Database	NAL-Catalogue (AGRICOLA)

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Article: Contribution of circulating host and microbial tryptophan metabolites towards Ah receptor activation.

Morgan, Ethan W / Dong, Fangcong / Annalora, Andrew / Murray, Iain A / Wolfe, Trenton / Erickson, Reece / Gowda, Krishne / Amin, Shantu G / Petersen, Kristina S / Kris-Etherton, Penny M / Marcus, Craig / Walk, Seth T / Patterson, Andrew D / Perdew, Gary H

bioRxiv : the preprint server for biology

2023

Abstract: The aryl hydrocarbon receptor (AHR) is a ligand activated transcription factor that plays an integral role in homeostatic maintenance by regulating cellular functions such as cellular differentiation, metabolism, barrier function, and immune response. An ...

Abstract	The aryl hydrocarbon receptor (AHR) is a ligand activated transcription factor that plays an integral role in homeostatic maintenance by regulating cellular functions such as cellular differentiation, metabolism, barrier function, and immune response. An important but poorly understood class of AHR activators are compounds derived from host and bacterial metabolism of tryptophan. The commensal bacteria of the gut microbiome are major producers of tryptophan metabolites known to activate the AHR, while the host also produces AHR activators through tryptophan metabolism. We used targeted mass spectrometry-based metabolite profiling to determine the presence and metabolic source of these metabolites in the sera of conventional mice, germ-free mice, and humans. Surprisingly, sera concentrations of many tryptophan metabolites are comparable between germ-free and conventional mice. Therefore, many major AHR-activating tryptophan metabolites in mouse sera are produced by the host, despite their presence in feces and mouse cecal contents. AHR activation is rarely studied in the context of a mixture at relevant concentrations, as we present here. The AHR activation potentials of individual and pooled metabolites were explored using cell-based assays, while ligand binding competition assays and ligand docking simulations were used to assess the detected metabolites as AHR agonists. The physiological and biomedical relevance of the identified metabolites was investigated in the context of cell-based models for cancer and rheumatoid arthritis. We present data here that reframe AHR biology to include the presence of ubiquitous tryptophan metabolites, improving our understanding of homeostatic AHR activity and models of AHR-linked diseases.
Language	English
Publishing date	2023-01-27
Publishing country	United States
Document type	Preprint
DOI	10.1101/2023.01.26.525691
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Article: Contribution of Circulating Host and Microbial Tryptophan Metabolites Toward Ah Receptor Activation.

Morgan, Ethan W / Dong, Fangcong / Annalora, Andrew J / Murray, Iain A / Wolfe, Trenton / Erickson, Reece / Gowda, Krishne / Amin, Shantu G / Petersen, Kristina S / Kris-Etherton, Penny M / Marcus, Craig B / Walk, Seth T / Patterson, Andrew D / Perdew, Gary H

International journal of tryptophan research : IJTR

2023 Volume 16, Page(s) 11786469231182510

Abstract	The aryl hydrocarbon receptor (AHR) is a ligand activated transcription factor that plays an integral role in homeostatic maintenance by regulating cellular functions such as cellular differentiation, metabolism, barrier function, and immune response. An important but poorly understood class of AHR activators are compounds derived from host and bacterial metabolism of tryptophan. The commensal bacteria of the gut microbiome are major producers of tryptophan metabolites known to activate the AHR, while the host also produces AHR activators through tryptophan metabolism. We used targeted mass spectrometry-based metabolite profiling to determine the presence and metabolic source of these metabolites in the sera of conventional mice, germ-free mice, and humans. Surprisingly, sera concentrations of many tryptophan metabolites are comparable between germ-free and conventional mice. Therefore, many major AHR-activating tryptophan metabolites in mouse sera are produced by the host, despite their presence in feces and mouse cecal contents. Here we present an investigation of AHR activation using a complex mixture of tryptophan metabolites to examine the biological relevance of circulating tryptophan metabolites. AHR activation is rarely studied in the context of a mixture at relevant concentrations, as we present here. The AHR activation potentials of individual and pooled metabolites were explored using cell-based assays, while ligand binding competition assays and ligand docking simulations were used to assess the detected metabolites as AHR agonists. The physiological and biomedical relevance of the identified metabolites was investigated in the context of a cell-based model for rheumatoid arthritis. We present data that reframe AHR biology to include the presence of a mixture of ubiquitous tryptophan metabolites, improving our understanding of homeostatic AHR activity and models of AHR-linked diseases.
Language	English
Publishing date	2023-07-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	2517435-6
ISSN	1178-6469
ISSN	1178-6469
DOI	10.1177/11786469231182510
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Article ; Online: Deprescribing to optimise health outcomes for frail older people: a double-blind placebo-controlled randomised controlled trial-outcomes of the Opti-med study.

Etherton-Beer, Christopher / Page, Amy / Naganathan, Vasi / Potter, Kathleen / Comans, Tracy / Hilmer, Sarah N / McLachlan, Andrew J / Lindley, Richard I / Mangin, Dee

Age and ageing

2023 Volume 52, Issue 5

Abstract: Background: potentially harmful polypharmacy is very common in older people living in aged care facilities. To date, there have been no double-blind randomised controlled studies of deprescribing multiple medications.: Methods: three-arm (open ... ...

Abstract	Background: potentially harmful polypharmacy is very common in older people living in aged care facilities. To date, there have been no double-blind randomised controlled studies of deprescribing multiple medications. Methods: three-arm (open intervention, blinded intervention and blinded control) randomised controlled trial enrolling people aged over 65 years (n = 303, noting pre-specified recruitment target of n = 954) living in residential aged care facilities. The blinded groups had medications targeted for deprescribing encapsulated while the medicines were deprescribed (blind intervention) or continued (blind control). A third open intervention arm had unblinded deprescribing of targeted medications. Results: participants were 76% female with mean age 85.0 ± 7.5 years. Deprescribing was associated with a significant reduction in the total number of medicines used per participant over 12 months in both intervention groups (blind intervention group -2.7 medicines, 95% CI -3.5, -1.9, and open intervention group -2.3 medicines; 95% CI -3.1, -1.4) compared with the control group (-0.3, 95% CI -1.0, 0.4, P = 0.053). Deprescribing regular medicines was not associated with any significant increase in the number of 'when required' medicines administered. There were no significant differences in mortality in the blind intervention group (HR 0.93, 95% CI 0.50, 1.73, P = 0.83) or the open intervention group (HR 1.47, 95% CI 0.83, 2.61, P = 0.19) compared to the control group. Conclusions: deprescribing of two to three medicines per person was achieved with protocol-based deprescribing during this study. Pre-specified recruitment targets were not met, so the impact of deprescribing on survival and other clinical outcomes remains uncertain.
MeSH term(s)	Aged ; Humans ; Female ; Aged, 80 and over ; Male ; Frail Elderly ; Deprescriptions ; Homes for the Aged ; Double-Blind Method ; Polypharmacy ; Outcome Assessment, Health Care ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2023-05-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	186788-x
ISSN	1468-2834 ; 0002-0729
ISSN (online)	1468-2834
ISSN	0002-0729
DOI	10.1093/ageing/afad081
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Article ; Online: The underappreciated diversity of bile acid modifications.

Mohanty, Ipsita / Mannochio-Russo, Helena / Schweer, Joshua V / El Abiead, Yasin / Bittremieux, Wout / Xing, Shipei / Schmid, Robin / Zuffa, Simone / Vasquez, Felipe / Muti, Valentina B / Zemlin, Jasmine / Tovar-Herrera, Omar E / Moraïs, Sarah / Desai, Dhimant / Amin, Shantu / Koo, Imhoi / Turck, Christoph W / Mizrahi, Itzhak / Kris-Etherton, Penny M /

Petersen, Kristina S / Fleming, Jennifer A / Huan, Tao / Patterson, Andrew D / Siegel, Dionicio / Hagey, Lee R / Wang, Mingxun / Aron, Allegra T / Dorrestein, Pieter C

Cell

2024 Volume 187, Issue 7, Page(s) 1801–1818.e20

Abstract: The repertoire of modifications to bile acids and related steroidal lipids by host and microbial metabolism remains incompletely characterized. To address this knowledge gap, we created a reusable resource of tandem mass spectrometry (MS/MS) spectra by ... ...

Abstract	The repertoire of modifications to bile acids and related steroidal lipids by host and microbial metabolism remains incompletely characterized. To address this knowledge gap, we created a reusable resource of tandem mass spectrometry (MS/MS) spectra by filtering 1.2 billion publicly available MS/MS spectra for bile-acid-selective ion patterns. Thousands of modifications are distributed throughout animal and human bodies as well as microbial cultures. We employed this MS/MS library to identify polyamine bile amidates, prevalent in carnivores. They are present in humans, and their levels alter with a diet change from a Mediterranean to a typical American diet. This work highlights the existence of many more bile acid modifications than previously recognized and the value of leveraging public large-scale untargeted metabolomics data to discover metabolites. The availability of a modification-centric bile acid MS/MS library will inform future studies investigating bile acid roles in health and disease.
MeSH term(s)	Animals ; Humans ; Bile Acids and Salts/chemistry ; Metabolomics/methods ; Polyamines ; Tandem Mass Spectrometry/methods ; Gastrointestinal Microbiome ; Databases, Chemical
Chemical Substances	Bile Acids and Salts ; Polyamines
Language	English
Publishing date	2024-03-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	187009-9
ISSN	1097-4172 ; 0092-8674
ISSN (online)	1097-4172
ISSN	0092-8674
DOI	10.1016/j.cell.2024.02.019
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