Assignment: Use of Microorganisms Metabolic Engineering for Production Optimization of Drugs

Assignment: Use of Microorganisms Metabolic Engineering for Production Optimization of Drugs ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Use of Microorganisms Metabolic Engineering for Production Optimization of Drugs write a “systematic review article” with the same format and shape as the attached file named Sample. every section should have the standard systematic review article sections like abstract, background, methods, results, discussion and conclusions. and each section should have the standard systematic review article content. for example; for the method section, the research timeline (for example articles used in this review are from 2009-2020), database used, keywords and what type of articles used should be mentioned exactly as it does in the sample file. Assignment: Use of Microorganisms Metabolic Engineering for Production Optimization of Drugs the 19 reference article files have been attached as well. please use them to write this article. _articles.zip sample_file.pdf Masnoon et al. BMC Geriatrics (2017) 17:230 DOI 10.1186/s12877-017-0621-2 RESEARCH ARTICLE Open Access What is polypharmacy? A systematic review of definitions Nashwa Masnoon1,2* , Sepehr Shakib3,4, Lisa Kalisch-Ellett1 and Gillian E. Caughey1,3,4 Abstract Background: Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. Methods: The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). Results: A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. Conclusions: Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting. Keywords: Polypharmacy, Multimorbidity, Comorbidity, Inappropriate prescribing, Aged, Systematic review Background Multimorbidity, commonly defined as the co-existence of two or more chronic health conditions, is common in the older population [1]. The presence of multiple chronic conditions increases the complexity of therapeutic management for both health professionals and patients, and impacts negatively on health outcomes. Multimorbidity is associated with decreased quality of * Correspondence: [email protected] 1 Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia, Australia 2 Department of Pharmacy, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia Full list of author information is available at the end of the article life, self-rated health, mobility and functional ability as well as increases in hospitalisations, physiological distress, use of health care resources, mortality and costs [2–4]. Assignment: Use of Microorganisms Metabolic Engineering for Production Optimization of Drugs Globally, the health burden of multimorbidity is expected to rise significantly as a result of the growing number of older people and increasing numbers of people living with multimorbidity [5]. The use of multiple medicines, commonly referred to as polypharmacy is common in the older population with multimorbidity, as one or more medicines may be used to treat each condition. Polypharmacy is associated with adverse outcomes including mortality, falls, adverse drug reactions, increased length of stay in hospital and readmission to hospital soon after discharge [6–8]. The © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Masnoon et al. BMC Geriatrics (2017) 17:230 risk of adverse effects and harm increases with increasing numbers of medications [9]. Harm can result due to a multitude of factors including drug-drug interactions and drug-disease interactions. Older patients are at even greater risk of adverse effects due to decreased renal and hepatic function, lower lean body mass, reduced hearing, vision, cognition and mobility [10]. While in many instances the use of multiple medicines or polypharmacy may be clinically appropriate, it is important to identify patients with inappropriate polypharmacy that may place patients at increased risk of adverse events and poor health outcomes. Studies have suggested a shift towards adopting the term ‘appropriate polypharmacy’ in order to differentiate between the prescribing of ‘many’ and ‘too many’ drugs instead of a simple numerical count of medications, which is of limited value in practice [11, 12]. In order to make this distinction between appropriate and inappropriate polypharmacy, the term polypharmacy needs to be clearly defined. We therefore conducted a systematic review to explore the definitions of polypharmacy in existing literature. We additionally aimed to explore whether articles differentiated between appropriate and inappropriate polypharmacy and how this distinction was made. Methods Data sources and search strategy The reporting of this systematic review conforms to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist. MEDLINE (Ovid), EMBASE and Cochrane databases were searched between 1st January 2000 and 30th May 2016. The following search terms (Medical Subject Headings or MESH and keywords) were used in EMBASE and MEDLINE (Ovid): polypharmacy/ (MESH) OR multiple medication* OR multiple medicine* OR multiple drug* (key words) OR many medication* OR many medicine* OR many drug* (key words) (for all articles referring to polypharmacy) AND. defin* (key word) or explan* (keyword) (for all articles defining or explaining polypharmacy). Assignment: Use of Microorganisms Metabolic Engineering for Production Optimization of Drugs For the review of the Cochrane database, the term “polypharmacy” was searched. The search was limited to primary research articles which defined the term polypharmacy in any shape or form, conducted in humans and published in English between the years 2000 and 2016. Articles were considered if the abstracts were available in English and were published or in press. Reference lists of relevant articles and grey literature were Page 2 of 10 screened to identify other relevant articles. The search strategy was developed in consultation with a librarian specialising in health databases, with a predetermined protocol developed collaboratively with the authors for methods to search and select relevant articles. Study selection and data extraction Articles that met the inclusion criteria and provided a definition of polypharmacy were included. One author (NM) conducted the initial database search and primary screening of article titles and abstracts and articles were categorised as: relevant, irrelevant or unsure. Three reviewers (NM, SS, GC) discussed the appropriateness of inclusion of each article classed as relevant or unsure. Once all relevant articles were identified, one author (NM) reviewed full texts of all identified articles and extracted the data. A pre-defined data extraction template was developed by all authors and then applied to ensure consistent data extraction from each of the identified studies. Data items extracted included the definitions of polypharmacy and associated terms such as minor, moderate and excessive polypharmacy and whether studies distinguished between appropriate and inappropriate polypharmacy and if so, how this distinction was made or defined. The definitions of polypharmacy and associated terms were categorised as: i. numerical only (using the number of medications to define polypharmacy), ii. numerical for a given duration of therapy or healthcare setting for e.g. during hospital stay or iii. Descriptive (using a brief description to define polypharmacy). Once the primary data extraction was complete all authors reviewed the content analysis for each of the extracted studies, with data further categorised and summarised in tables. Results A total of 1156 articles were identified and 110 articles met the full inclusion criteria for this systematic review [10–119]. Fig. 1 shows a flowchart of study selection according to the PRISMA checklist. Studies not only defined polypharmacy but also used associated terms to define the level of polypharmacy; including minor (8 studies, 7.3%), moderate (1 study, 0.9%), major (12 studies, 10.9%), hyper (2 studies, 1.8%), excessive (10 studies, 9.1%), severe (1 study, 0.9%), appropriate (1 study, 0.9%), rational polypharmacy and indiscriminate prescribing (1 study, 0.9%), persistent (1 study, 0.9%), chronic (1 study, 0.9%), and pseudopolypharmacy (1 study, 0.9%). As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which Masnoon et al. BMC Geriatrics (2017) 17:230 Page 3 of 10 Fig. 1 Study selection flowchart according to PRISMA checklist incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). Table 1 presents a breakdown of the number of definitions for each term. Out of the 110 identified articles, 81 (73.6%) included only a numerical definition of polypharmacy (i.e. did not specify duration of therapy or healthcare setting). Assignment: Use of Microorganisms Metabolic Engineering for Production Optimization of Drugs Nine articles (8.2%) included numerical definitions of polypharmacy for a given duration of time or healthcare setting and nine articles (8.2%) included descriptive definitions of polypharmacy. Four articles included two categories of polypharmacy definitions: two articles (1.8%) included both numerical only definitions and numerical definitions of polypharmacy for a duration of time or healthcare setting and two articles (1.8%) included both numerical only and descriptive definitions of polypharmacy. Numerical only definitions of polypharmacy in existing literature Table 2 shows the various numerical only categorisations of polypharmacy and associated terms and the number of studies using these definitions. There was a wide range of variability in the definitions of polypharmacy as well as associated terms such as minor, moderate and major polypharmacy. The most commonly used term was polypharmacy, but there was variation with regard to the actual definition of polypharmacy, which ranged from two or more medications to 11 or more medications [13, 90]. The most commonly used definition for polypharmacy was five or more medications daily, with 46.4% (n = 51) of studies using this definition [11, 24–73]. The second most common definition for polypharmacy was six or more medications, with ten studies using this definition [10, 74–82]. Only Masnoon et al. BMC Geriatrics (2017) 17:230 Page 4 of 10 Table 1 Breakdown of polypharmacy definitions according to the category of definition Table 2 Various numerical only definitions of polypharmacy and associated terms in existing literature Term Numerical Numerical in a Descriptive Total number only given duration of definitions of time or setting Term Number of medications Polypharmacy 81 Polypharmacy 9 9 99 Number of studies References ?2 1 [13] 2 to 9 1 [14] ?3 1 [15] 3 to 6 1 [16] Minor Polypharmacy 8 0 0 8 Moderate polypharmacy 1 0 0 1 Major polypharmacy 11 1 0 12 ?4 6 [17–22] Hyperpolypharmacy 1 1 0 2 ? 4 or ? 5 1 [23] Excessive polypharmacy 8 2 0 10 ?5 51 [11, 24–73] 10 [10, 74–82] Severe polypharmacy 1 0 0 1 ?6 Persistent polypharmacy 0 1 0 1 ?7 2 [83, 84] 5 to 9 3 [85–87] ?9 1 [88] ? 10 1 [89] ? 11 1 [90] number of drug classes 1 [91] 2 to 4 6 [92–97] 2 to 3 1 [98] 0 to 4 1 [99] Chronic polypharmacy 0 1 0 1 Appropriate polypharmacy 0 1 1 0 Rational polypharmacy 0 and indiscriminate prescribing 0 1 1 Pseudopolypharmacy 0 0 1 1 Total number of definitions according to category of definition 111 15 12 138 one study defined polypharmacy as the number of drug classes used by a patient [91]. Minor Polypharmacy Moderate polypharmacy 4 to 5 1 [98] Major polypharmacy ?5 6 [92–95, 97, 100] Numerical definitions of polypharmacy incorporating a duration of therapy or healthcare setting Eleven studies (10.0% of all studies) used numerical definitions of polypharmacy which incorporated a duration of therapy in the definition and four studies (3.6%) used definitions of polypharmacy which incorporated a healthcare setting (Table 3). The definitions of polypharmacy involving a duration of therapy, ranged from use of two or more medications for more than 240 days (‘long term use’) to five to nine medications used for 90 days or more [101, 108]. Polypharmacy definitions incorporating a healthcare setting included the use of five or more medications at hospital discharge, and the use of 10 or more medications during hospital stay [106, 110]. Descriptive definitions of polypharmacy Twelve studies used descriptive definitions of polypharmacy (Table 4). Some studies used different wording but conveyed the same definition of polypharmacy. Assignment: Use of Microorganisms Metabolic Engineering for Production Optimization of Drugs For example, the definitions “Co-prescribing multiple medications” [113] and “Simultaneous and long term use of different drugs by the same individual” [77] describe polypharmacy as the use of multiple medications concurrently. Other studies alluded to a different issue of medications being appropriate or inappropriate for a given patient [10, 79, 114–118]. ?6 3 [96, 98, 101] 5 to 9 1 [99] ? 11 1 [74] Hyperpolypharmacy ? 10 1 [102] Excessive polypharmacy ? 10 7 [30, 58, 65, 70, 85–87] ? 21 1 [74] ? 10 1 [99] Severe polypharmacy Appropriate and inappropriate polypharmacy Only seven studies (6.4% of all studies) defined appropriate or rational polypharmacy, or recognised the distinction between appropriate and inappropriate medications [10, 79, 114–118]. These studies either defined polypharmacy using a brief description only (n = 3) [79, 115, 117] or used a brief description and polypharmacy tools such as the Beers criteria and the Medication Appropriateness Index (MAI) (n = 4 studies) [10, 114, 116, 118]. An example of a polypharmacy definition which recognised the use of appropriate and inappropriate medications is “polypharmacy ranges from the use of a large number of medications, to the use of potentially inappropriate medications, medication underuse and duplication” and “potentially inappropriate medications” [114]. Out of the two studies defining polypharmacy as “potentially Masnoon et al. BMC Geriatrics (2017) 17:230 Page 5 of 10 Table 3 Numerical definitions of polypharmacy and associated terms by duration of therapy/ healthcare setting Term Number of medications Number of studies References Polypharmacy ? 2 for > 240 days (long term) 1 [101] ? 5 medications in the same month 1 [103] > 5 medications for ? 90 days 1 [104] ? 5 medications in the same quarter of a year 1 [105] ? 5 medicines at hospital discharge 1 [106] 5 to 9 medicines on the day of maximum number of prescriptions of the study year (on the day of the study year when the number of medications prescribed was highest) 1 [107] 5 to 9 medications for ? 90 days 1 [108] 5 to 9 medicines during hospital stay 1 [109] ? 10 medicines during hospital stay 1 [110] Major polypharmacy ? 10 on the day of maximum number of prescriptions of the study year (on the day of the study year when the number of medications prescribed was highest) 1 [107] Hyperpolypharmacy ? 10 medications for ?90 days 1 [108] ? 10 medications in the same quarter of a year 1 [105] ? 10 medications during hospital stay 1 [109] Persistent polypharmacy ? 5 medications for 181 days 1 [52] Chronic polypharmacy ? 5 medications in 1 month for 6 months (consecutive or not) in a year 1 [111] Excessive polypharmacy inappropriate medications”, one study simply mentioned “potentially inappropriate medications” without further explanation [79] and the other study included examples of potentially inappropriate medications from existing literature such as duplication of medications, drug-drug interactions, medications used to treat side effects of other medications and medications which are unnecessary for a specific patient [10]. Only one study explicitly defined appropriate polypharmacy, which was defined as “the optimisation of medications for patients with complex and/or multiple conditions where medicine usage agrees with best evidence” [117]. Four studies (3.6%) used polypharmacy tools or criteria to identify potentially inappropriate medications [10, 114, 116, 118].Assignment: Use of Microorganisms Metabolic Engineering for Production Optimization of Drugs The Beers criteria as an indicator of potentially inappropriate medications were used in all four (three studies used Beers criteria 2003 and one used Beers criteria 1997) [10, 114, 116, 118]. One study used the Medication Appropriateness Index (MAI) and the Healthcare Effectiveness Data and Table 4 Descriptive definitions of polypharmacy and associated terms Term Definition Number of studies References Polypharmacy Patients visiting multiple pharmacies to obtain medications 1 [112] Coprescribing multiple medications 1 [113] Simultaneous and long term use of different drugs by the same individual 1 [77] Polypharmacy definition ranges from the use of a large number of medications, to the use of potentially inappropriate medications, medication underuse and medication duplication 1 [114] Potentially inappropriate medications 2 [10, 79] Use of multiple medications concurrently and the use of additional medications to correct adverse effects 1 [115] Use of medications which are not clinically indicated 1 [116] More drugs being prescribed or taken than are clinically appropriate in the context of a patient’s comorbidities 1 [12] Appropriate polypharmacy Optimisation of medications for patients with complex and/or multiple conditions where medicine usage agrees with best evidence 1 [117] Rational polypharmacy and indiscriminate prescribing Rational polypharmacy recognizes legitimate prescribing and indiscriminate prescribing suggests inappropriate prescribing (the terms “legitimate prescribing” and “inappropriate prescribing” were not explained) 1 [118] Pseudopolypharmacy Patients being recorded as taking more medications than they are actually taking 1 [119] Masnoon et al. BMC Geriatrics (2017) 17:230 Information Set (HEDIS) [114]. None of the studies explicitly identified the need to distinguish between appropriate and inappropriate polypharmacy based on the pharmacology of medications involved, how they interact with each other and comorbidities for a specific patient. Of the 110 studies included in the review, only one highlighted the inconsistencies in the definitions of polypharmacy in the literature. The authors of this study suggested that polypharmacy be defined as patients visiting multiple pharmacies which may be associated w … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10