Inappropriate prescribing of medicines may lead to a significant risk of an adverse drug-related event. In particular, prescribing may be regarded as inappropriate when alternative therapy that is either more effective or associated with a lower risk exists to treat the same condition. This review aims to identify interventions and strategies that can significantly reduce inappropriate prescribing in the elderly. The review is based on a search of electronic databases using synonyms of keywords such as 'elderly', 'interventions', 'optimized prescribing' and 'inappropriate prescribing' to identify reported interventions intended to improve inappropriate prescribing in the elderly. A total of 711 articles published in English were retrieved and considered. Of these, 24 original studies, involving 56 to 124,802 participants, met the inclusion criteria and were included in the systematic review. In 16 studies, the statistical power used to assess the impact of the intervention was >90% at a significance level of alpha=0.05. Various interventions were included in this study, such as educational interventions, medication reviews, geriatricians' services, multidisciplinary teams, computerized support systems, regulatory policies and multi-faceted approaches. Because of variability in assessment methodologies, mixed responses were found for education interventions aimed at improving inappropriate prescribing. For example, some studies did not assess what data were required to define whether a given level of intervention would be adequate, and others did not consider how many participants would be needed to demonstrate that a significant difference existed. Each of the three computerized support system interventions reported produced a significant enhancement in both prescribing and dispensing practices. Pharmacist interventions in community and hospital settings were evaluated in seven studies. However, variable criteria were used, with two studies using the Medication Appropriateness Index, another two studies using self-designed criteria for inappropriate prescribing, and the remaining three studies using Beers' criteria. A difficulty in assessing studies involving nursing home residents is that both consultant pharmacists and onsite pharmacist services may be involved, and, in one of the studies, only the role of the consultant pharmacist was considered. One of the most effective interventions appeared to be multidisciplinary case conferences involving a geriatrician, which resulted in a number of examples of reduced inappropriate prescribing in both community and hospital settings. As the effect of regulatory policies as an intervention is dependent on the target population involved, the effectiveness of this type of intervention was variable. Different strategies may be useful in reducing inappropriate prescribing in the elderly. It is not clear whether combined strategies undertaken simultaneously have a synergistic effect.

Metformin has been used for nearly a century to treat type 2 diabetes mellitus. Epidemiologic studies first identified the association between metformin and reduced risk of several cancers. The anticancer mechanisms of metformin involve both indirect or insulin-dependent pathways and direct or insulin-independent pathways. Preclinical studies have demonstrated metformin's broad anticancer activity across a spectrum of malignancies. Prospective clinical trials involving metformin in the chemoprevention and treatment of cancer now number in the hundreds. We provide an update on the anticancer mechanisms of metformin and review the results thus far available from prospective clinical trials investigating metformin's efficacy in cancer.

A Gram-stain-positive, rod-shaped, spore-forming and strictly anaerobic bacterium, designated UB-B.2T, was isolated from an industrial effluent anaerobic digester sample. It grew optimally at 30 °C and pH 7.0. Comparative analysis of the 16S rRNA gene sequence confirmed that strain UB-B.2T was closely related to Clostridium hathewayi DSM 13479T (97.84 % similarity), a member of rRNA gene cluster XIVa of the genus Clostridium , and formed a coherent cluster with other related members of the Blautia ( Clostridium ) coccoides rRNA group in phylogenetic analyses. The end products of glucose fermentation by strain UB-B.2T were acetate and propionate. The G+C content of the DNA was 51.4 mol%. Although strain UB-B.2T showed 97.8 % 16S rRNA gene sequence identity to the type strain of C. hathewayi , it exhibited only 38.4 % relatedness at the whole-genome level. It also showed differences from its closest phylogenetic relative, C. hathewayi DSM 13479T, in phenotypic characteristics such as hydrolysis of aesculin, starch and urea and fermentation end products. Both strains showed phenotypic differences from the members of rRNA gene cluster XIVa of the genus Clostridium . Based on these differences, C. hathewayi DSM 13479T and strain UB-B.2T were identified as representatives of a new genus of the family Clostridiaceae . Thus, we propose the reclassification of Clostridium hathewayi as Hungatella hathewayi gen. nov., comb. nov., the type species of the new genus (type strain DSM 13479T = CCUG 43506T = MTCC 10951T). Strain UB-B.2T ( = MTCC 11101T = DSM 24995T) is assigned to the novel species Hungatella effluvii gen. nov., sp. nov as the type strain.

M edication-related problems (MRPs), such as inappropriate drug selection, adverse drug reactions, and poor adherence, can be avoided or resolved by identifying high-risk patients and monitoring the effects of long-term treatment. 1,2 Ruths et al. showed that 3 of 4 nursing home residents had clinically relevant MRPs such as adverse drug reaction, inappropriate drug choice, and/or undertreatment. 3 Further, a study by Paulino et al. has shown a high prevalence of MRPs (63.7%) in communitydwelling patients who were discharged from hospitals. 4 It has been reported that inappropriate medication use may lead to adverse outcomes, causing 5.7-16.2% of medication-related hospital admissions. 5-8 A study conducted in the US reported that as many as 49.3% of these admissions were possibly preventable. 7 Australian data reported by Roughead et al. showed similar findings and suggested that 32-69% of medication-related hospital admissions may be preventable. 9 The presence of more medications and multiple comorbidities places elderly residents of long-term care facilities at particular risk of MRPs. 10-12 The frailest elderly persons live in residential agedcare facilities and take up to 4 times more medications than the average agematched community-dwelling person. 13 Furthermore, agerelated changes can lead to altered pharmacokinetics and pharmacodynamics, increasing the risk of MRPs such as drug-drug interactions, drug-disease interactions, inappropriate dosing, adverse drug reactions, and increased monitoring requirements. 13 Therefore, medications require significant attention in this population.