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1.
New Phytol ; 242(4): 1576-1588, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38173184

RESUMEN

Phosphorus (P) for carbon (C) exchange is the pivotal function of arbuscular mycorrhiza (AM), but how this exchange varies with soil P availability and among co-occurring plants in complex communities is still largely unknown. We collected intact plant communities in two regions differing c. 10-fold in labile inorganic P. After a 2-month glasshouse incubation, we measured 32P transfer from AM fungi (AMF) to shoots and 13C transfer from shoots to AMF using an AMF-specific fatty acid. AMF communities were assessed using molecular methods. AMF delivered a larger proportion of total shoot P in communities from high-P soils despite similar 13C allocation to AMF in roots and soil. Within communities, 13C concentration in AMF was consistently higher in grass than in blanketflower (Gaillardia aristata Pursh) roots, that is P appeared more costly for grasses. This coincided with differences in AMF taxa composition and a trend of more vesicles (storage structures) but fewer arbuscules (exchange structures) in grass roots. Additionally, 32P-for-13C exchange ratios increased with soil P for blanketflower but not grasses. Contrary to predictions, AMF transferred proportionally more P to plants in communities from high-P soils. However, the 32P-for-13C exchange differed among co-occurring plants, suggesting differential regulation of the AM symbiosis.


Asunto(s)
Carbono , Micorrizas , Fósforo , Suelo , Micorrizas/fisiología , Micorrizas/metabolismo , Fósforo/metabolismo , Carbono/metabolismo , Suelo/química , Brotes de la Planta/metabolismo , Raíces de Plantas/microbiología , Raíces de Plantas/metabolismo , Isótopos de Carbono , Plantas/metabolismo , Plantas/microbiología , Ambiente , Poaceae/metabolismo
2.
J Appl Microbiol ; 134(5)2023 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-37113015

RESUMEN

AIMS: The American leaf spot, caused by Mycena citricolor, is an important disease of coffee (Coffea arabica), mostly in Central America. Currently, there are limited pathogen control alternatives that are environment friendly and economically accessible. The use of fungi isolated from the plant endomycobiota in their native habitats is on the rise because studies show their great potential for biological control. To begin to generate a green alternative to control M. citricolor, the objectives of the present study were to (i) collect, identify, screen (in vitro and in planta), and select endophytic fungi from wild Rubiaceae collected in old-growth forests of Costa Rica; (ii) confirm endophytic colonization in coffee plantlets; (iii) evaluate the effects of the endophytes on plantlet development; and (iv) corroborate the antagonistic ability in planta. METHODS AND RESULTS: Through in vitro and in planta antagonism assays, we found that out of the selected isolates (i.e. Daldinia eschscholzii GU11N, Nectria pseudotrichia GUHN1, Purpureocillium aff. lilacinum CT24, Sarocladium aff. kiliense CT25, Trichoderma rifaii CT5, T. aff. crassum G1C, T. aff. atroviride G7T, T. aff. strigosellum GU12, and Xylaria multiplex GU14T), Trichoderma spp. produced the highest growth inhibition percentages in vitro. Trichoderma isolates CT5 and G1C were then tested in planta using Coffea arabica cv. caturra plantlets. Endophytic colonization was verified, followed by in planta growth promotion and antagonism assays. CONCLUSIONS: Results show that Trichoderma isolates CT5 and G1C have potential for plant growth promotion and antagonism against Mycena citricolor, reducing incidence and severity, and preventing plant mortality.


Asunto(s)
Agaricales , Coffea , Rubiaceae , Café , Hongos , Coffea/microbiología
4.
Acta Neuropathol Commun ; 10(1): 87, 2022 06 15.
Artículo en Inglés | MEDLINE | ID: mdl-35706005

RESUMEN

Thalamic volume is associated with clinical disability in multiple sclerosis (MS) and is vulnerable to secondary neurodegeneration due to its extensive connectivity throughout the central nervous system (CNS). Using a model of autoimmune demyelination that exhibits CNS-infiltrating immune cells in both spinal cord white matter and optic nerve, we sought to evaluate neurodegenerative changes due to lesions affecting the spino- and retino-thalamic pathways. We found comparable axonal loss in spinal cord white matter and optic nerve during the acute phase of disease consistent with synaptic loss, but not neuronal cell body loss in the thalamic nuclei that receive input from these discrete pathways. Loss of spinal cord neurons or retinal ganglion cells retrograde to their respective axons was not observed until the chronic phase of disease, where optical coherence tomography (OCT) documented reduced inner retinal thickness. In patients with relapsing-remitting MS without a history of optic neuritis, OCT measures of inner retinal volume correlated with retino-thalamic (lateral geniculate nucleus) and spino-thalamic (ventral posterior nucleus) volume as well as neuroperformance measures. These data suggest retinal imaging may serve as an important noninvasive predictor of neurodegeneration in MS.


Asunto(s)
Esclerosis Múltiple , Neuritis Óptica , Sustancia Blanca , Humanos , Esclerosis Múltiple/diagnóstico por imagen , Neuritis Óptica/diagnóstico por imagen , Células Ganglionares de la Retina , Tomografía de Coherencia Óptica/métodos
5.
Environ Entomol ; 49(5): 1214-1225, 2020 10 17.
Artículo en Inglés | MEDLINE | ID: mdl-32860049

RESUMEN

Beneficial root microbes may mitigate negative effects of crop pests by enhancing plant tolerance or resistance. We used a greenhouse experiment to investigate impacts of commercially available microbial root inoculants on growth and biomass allocation of wheat (Triticum aestivum L. [Cyperales: Poaceae]) and on survival and growth of the gall-inducing wheat pest Hessian fly, Mayetiola destructor (Say). A factorial design was used, with two near-isogenic wheat lines (one susceptible to Hessian fly, the other resistant), two levels of insect infestation (present, absent), and four inoculants containing: 1) Azospirillum brasilense  Tarrand et al. (Rhodospirillales: Azospirillaceae), a plant growth-promoting bacterium, 2) Rhizophagus intraradices (N.C. Schenck & G.S. Sm.) (Glomerales: Glomeraceae), an arbuscular mycorrhizal fungus, 3) A. brasilense + R. intraradices, and 4) control, no inoculant. Larval feeding stunted susceptible wheat shoots and roots. Plants had heavier roots and allocated a greater proportion of biomass to roots when plants received the inoculant with R. intraradices, regardless of wheat genotype or insect infestation. Plants receiving the inoculant containing A. brasilense (alone or with R. intraradices) had comparable numbers of tillers between infested and noninsect-infested plants and, if plants were susceptible, a greater proportion of aboveground biomass was allocated to tillers. However, inoculants did not impact density or performance of Hessian fly immatures or metrics associated with adult fitness. Larvae survived and grew normally on susceptible plants and mortality was 100% on resistant plants irrespective of inoculants. This initial study suggests that by influencing plant biomass allocation, microbial inoculants may offset negative impacts of Hessian flies, with inoculant identity impacting whether tolerance is related to root or tiller growth.


Asunto(s)
Inoculantes Agrícolas , Dípteros , Animales , Biomasa , Hongos , Triticum
6.
Mycorrhiza ; 30(4): 513-527, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32500441

RESUMEN

The composition of arbuscular mycorrhizal fungal (AMF) communities should reflect not only responses to host and soil environments, but also differences in functional roles and costs vs. benefits among arbuscular mycorrhizal fungi. The coffee agroecosystem allows exploration of the effects of both light and soil fertility on AMF communities, because of the variation in shade and soil nutrients farmers generate through field management. We used high-throughput ITS2 sequencing to characterize the AMF communities of coffee roots in 25 fields in Costa Rica that ranged from organic management with high shade and no chemical fertilizers to conventionally managed fields with minimal shade and high N fertilization, and examined relationships between AMF communities and soil and shade parameters with partial correlations, NMDS, PERMANOVA, and partial least squares analysis. Gigasporaceae and Acaulosporaceae dominated coffee AMF communities in terms of relative abundance and richness, respectively. Gigasporaceae richness was greatest in conventionally managed fields, while Glomeraceae richness was greatest in organic fields. While total AMF richness and root colonization did not differ between organic and conventionally managed fields, AMF community composition did; these differences were correlated with soil nitrate and shade. OTUs differing in relative abundance between conventionally managed and organic fields segregated into four groups: Gigasporaceae associated with high light and nitrate availability, Acaulosporaceae with high light and low nitrate availability, Acaulosporaceae and a single relative of Rhizophagus fasciculatus with shade and low nitrate availability, and Claroideoglomus/Glomus with conventionally managed fields but uncorrelated with shade and soil variables. The association of closely related taxa with similar shade and light availabilities is consistent with phylogenetic trait conservatism in AM fungi.


Asunto(s)
Micobioma , Micorrizas , Café , Costa Rica , Nitrógeno , Filogenia , Raíces de Plantas , Suelo , Microbiología del Suelo
7.
Glob Chang Biol ; 26(6): 3417-3428, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32196863

RESUMEN

Climate change is predicted to result in warmer and drier Neotropical forests relative to current conditions. Negative density-dependent feedbacks, mediated by natural enemies, are key to maintaining the high diversity of tree species found in the tropics, yet we have little understanding of how projected changes in climate are likely to affect these critical controls. Over 3 years, we evaluated the effects of a natural drought and in situ experimental warming on density-dependent feedbacks on seedling demography in a wet tropical forest in Puerto Rico. In the +4°C warming treatment, we found that seedling survival increased with increasing density of the same species (conspecific). These positive density-dependent feedbacks were not associated with a decrease in aboveground natural enemy pressure. If positive density-dependent feedbacks are not transient, the diversity of tropical wet forests, which may rely on negative density dependence to drive diversity, could decline in a future warmer, drier world.


Asunto(s)
Bosques , Árboles , Cambio Climático , Puerto Rico , Plantones , Clima Tropical
8.
Appl Environ Microbiol ; 86(11)2020 05 19.
Artículo en Inglés | MEDLINE | ID: mdl-32220838

RESUMEN

The structure and function of fungal communities in the coffee rhizosphere are influenced by crop environment. Because coffee can be grown along a management continuum from conventional application of pesticides and fertilizers in full sun to organic management in a shaded understory, we used coffee fields to hold host constant while comparing rhizosphere fungal communities under markedly different environmental conditions with regard to shade and inputs. We characterized the shade and soil environment in 25 fields under conventional, organic, or transitional management in two regions of Costa Rica. We amplified the internal transcribed spacer 2 (ITS2) region of fungal DNA from coffee roots in these fields and characterized the rhizosphere fungal community via high-throughput sequencing. Sequences were assigned to guilds to determine differences in functional diversity and trophic structure among coffee field environments. Organic fields had more shade, a greater richness of shade tree species, and more leaf litter and were less acidic, with lower soil nitrate availability and higher soil copper, calcium, and magnesium availability than conventionally managed fields, although differences between organic and conventionally managed fields in shade and calcium and magnesium availability depended on region. Differences in richness and community composition of rhizosphere fungi between organic and conventionally managed fields were also correlated with shade, soil acidity, and nitrate and copper availability. Trophic structure differed with coffee field management. Saprotrophs, plant pathogens, and mycoparasites were more diverse, and plant pathogens were more abundant, in organic than in conventionally managed fields, while saprotroph-plant pathogens were more abundant in conventionally managed fields. These differences reflected environmental differences and depended on region.IMPORTANCE Rhizosphere fungi play key roles in ecosystems as nutrient cyclers, pathogens, and mutualists, yet little is currently known about which environmental factors and how agricultural management may influence rhizosphere fungal communities and their functional diversity. This field study of the coffee agroecosystem suggests that organic management not only fosters a greater overall diversity of fungi, but it also maintains a greater richness of saprotrophic, plant-pathogenic, and mycoparasitic fungi that has implications for the efficiency of nutrient cycling and regulation of plant pathogen populations in agricultural systems. As well as influencing community composition and richness of rhizosphere fungi, shade management and use of fungicides and synthetic fertilizers altered the trophic structure of the coffee agroecosystem.


Asunto(s)
Coffea/microbiología , Hongos/aislamiento & purificación , Micobioma , Agricultura Orgánica , Raíces de Plantas/microbiología , Rizosfera , Costa Rica , Hongos/clasificación , Hongos/fisiología
10.
Children (Basel) ; 4(8)2017 Jul 31.
Artículo en Inglés | MEDLINE | ID: mdl-28758968

RESUMEN

Strokes as amusement park injuries are rare, but have been reported in the literature. Only about 20 cases of cerebrovascular accidents after amusement park visits have been described. We report a healthy 12-year-old boy who presented with facial droop, slurred speech, and inability to use his right arm after riding roller coasters at a local amusement park. He was evaluated and found to have a left middle cerebral artery (MCA) infarction. The patient was treated with anticoagulants and has recovered with no major residual symptoms. It is likely that his neurological symptoms occurred due to the high head accelerations experienced on the roller coasters, which are more detrimental to children due to immature cervical spine development and muscle strength. Early diagnosis of dissection and stroke results in a favorable prognosis. Providers and parents should be aware of the potential risk of roller coasters and act quickly on neurologic changes in children that have recently been to an amusement park.

11.
AoB Plants ; 2017 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-28122737

RESUMEN

While the soil environment is generally acknowledged as playing a role in plant competition, the relative importance of soil resources and soil microbes in determining outcomes of competition between native and exotic plants has rarely been tested. Resilience of plant communities to invasion by exotic species may depend on the extent to which native and exotic plant performance are mediated by abiotic and biotic components of the soil. We used a greenhouse experiment to compare performance of two native prairie plant species and one exotic species, when grown in intraspecific competition and when each native was grown in interspecific competition with the exotic species, in the presence and absence of a native prairie soil community, and when nitrogen availability was elevated or was maintained at native prairie levels. We found that elevated nitrogen availability was beneficial to the exotic species and had no effect on or was detrimental to the native plant species, that the native microbial community was beneficial to the native plant species and either had no effect or was detrimental to the exotic species, and that intraspecific competition was stronger than interspecific competition for the exotic plant species and vice-versa for the natives. Our results demonstrate that soil nitrogen availability and the soil microbial community can mediate the strength of competition between native and exotic plant species. We found no evidence for native microbes enhancing the performance of the exotic plant species. Instead, loss of the native soil microbial community appears to reinforce the negative effects of elevated N on native plant communities and its benefits to exotic invasive species. Resilience of plant communities to invasion by exotic plant species is facilitated by the presence of an intact native soil microbial community and weakened by anthropogenic inputs of nitrogen.

12.
PLoS One ; 11(12): e0167914, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27992464

RESUMEN

Phthalates are a group of plasticizers that are widely used in many consumer products and medical devices, thus generating a huge burden to human health. Phthalates have been known to cause a number of developmental and reproductive disorders functioning as endocrine modulators. They are also involved in carcinogenesis with mechanisms less understood. To further understand the molecular mechanisms of phthalate toxicity, in this study we reported a new effect of phthalates on mRNA translation/protein synthesis, a key regulatory step of gene expression. Butyl benzyl phthalate (BBP) was found to directly inhibit mRNA translation in vitro but showed a complicated pattern of affecting mRNA translation in cells. In human kidney embryonic cell (HEK-293T), BBP increased cap-dependent mRNA translation at lower concentrations but showed inhibitory effect at higher concentrations. Cap-independent translation was not affected. On the other hand, mono (2-ethylhexyl) phthalate (MEHP) as a major metabolite of another important phthalate di (2-ethylhexyl) phthalate (DEHP) inhibited both can-dependent and -independent mRNA translation in vivo. In contrast, BBP and MEHP exhibited an overall promoting effect on mRNA translation in cancer cells. Mechanistic studies identified that the level and phosphorylation of eIF4E-BP (eIF4E binding protein) and the amount of eIF4GI in eIF4F complex were altered in accordance with the effect of BBP on translation. BBP was also identified to directly bind to eIF4E, providing a further mechanism underlying the regulation of mRNA by phthalate. At the cellular level BBP inhibited normal cell growth but slightly promoted cancer cells (HT29) growth. Overall, this study provides the first evidence that phthalates can directly regulate mRNA translation as a novel mechanism to mediate their biological toxicities.


Asunto(s)
Ácidos Ftálicos/toxicidad , Biosíntesis de Proteínas/efectos de los fármacos , ARN Mensajero/metabolismo , Supervivencia Celular/efectos de los fármacos , Dietilhexil Ftalato/toxicidad , Relación Dosis-Respuesta a Droga , Factores Eucarióticos de Iniciación/genética , Regulación de la Expresión Génica/efectos de los fármacos , Células HEK293 , Células HT29 , Humanos , Caperuzas de ARN/efectos de los fármacos , Caperuzas de ARN/metabolismo , ARN Mensajero/efectos de los fármacos
13.
Interv Cardiol Clin ; 5(2): 187-200, 2016 04.
Artículo en Inglés | MEDLINE | ID: mdl-28582203

RESUMEN

High-risk percutaneous coronary intervention (PCI) encompasses a growing portion of total PCIs performed and typically includes patients with high-risk clinical and anatomic characteristics. Such patients may represent not only a high-risk group for complications but also a group who may derive the most benefit from complete revascularization. Several hemodynamic support devices are available. Trial data, consensus documents, and guidelines currently recommend high-risk PCI aided by hemodynamic support devices, and this article discusses the patient populations who would benefit from such an approach, the available devices and strategies, and expected outcomes.


Asunto(s)
Enfermedad de la Arteria Coronaria/terapia , Corazón Auxiliar , Intervención Coronaria Percutánea , Hemodinámica , Humanos , Intervención Coronaria Percutánea/instrumentación , Intervención Coronaria Percutánea/métodos , Medición de Riesgo
14.
PLoS One ; 10(9): e0139188, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26417989

RESUMEN

Sclerotinia sclerotiorum is an important pathogen of numerous crops in the North Central region of the United States. The objective of this study was to examine the genetic diversity of 145 isolates of the pathogen from multiple hosts in the region. Mycelial compatibility groups (MCG) and microsatellite haplotypes were determined and analyzed for standard estimates of population genetic diversity and the importance of host and distance for genetic variation was examined. MCG tests indicated there were 49 different MCGs in the population and 52 unique microsatellite haplotypes were identified. There was an association between MCG and haplotype such that isolates belonging to the same MCG either shared identical haplotypes or differed at no more than 2 of the 12 polymorphic loci. For the majority of isolates, there was a one-to-one correspondence between MCG and haplotype. Eleven MCGs shared haplotypes. A single haplotype was found to be prevalent throughout the region. The majority of genetic variation in the isolate collection was found within rather than among host crops, suggesting little genetic divergence of S. sclerotiorum among hosts. There was only weak evidence of isolation by distance. Pairwise population comparisons among isolates from canola, dry bean, soybean and sunflower suggested that gene flow between host-populations is more common for some crops than others. Analysis of linkage disequilibrium in the isolates from the four major crops indicated primarily clonal reproduction, but also evidence of genetic recombination for isolates from canola and sunflower. Accordingly, genetic diversity was highest for populations from canola and sunflower. Distribution of microsatellite haplotypes across the study region strongly suggest that specific haplotypes of S. sclerotiorum are often found on multiple crops, movement of individual haplotypes among crops is common and host identity is not a barrier to gene flow for S. sclerotiorum in the north central United States.


Asunto(s)
Ascomicetos/genética , Productos Agrícolas/microbiología , Variación Genética/genética , Repeticiones de Microsatélite/genética , Enfermedades de las Plantas/microbiología , Ascomicetos/clasificación , Ascomicetos/aislamiento & purificación , Brassica napus/microbiología , ADN de Hongos/genética , Flujo Genético , Geografía , Haplotipos/genética , Helianthus/microbiología , Desequilibrio de Ligamiento/genética , Análisis de Componente Principal , Glycine max/microbiología , Estados Unidos
16.
Appl Plant Sci ; 1(4)2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25202536

RESUMEN

PREMISE OF THE STUDY: Primers for 31 microsatellite-containing loci were developed for the threatened orchid Platanthera praeclara to enable characterization of the population genetics of this tallgrass prairie native. • METHODS AND RESULTS: Sixteen polymorphic microsatellite loci were identified from four populations. Six of these loci were not in linkage disequilibrium. The average number of alleles per locus per population ranged from 6.4 to 8.9. • CONCLUSIONS: The results indicate that six of the polymorphic loci will be useful in future studies of population structure, gene flow, and genetic diversity.

17.
Alzheimer Dis Assoc Disord ; 27(2): 153-6, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-22596080

RESUMEN

Several studies have shown that the levels of sex hormones in men with Alzheimer disease (AD) differ from men without AD. Therefore, male sex hormones have been postulated as risk modifiers in AD, possibly through immunomodulatory effects on known inflammatory AD risk factors, such as tumor necrosis factor α (TNF-α). We conducted a cross-sectional study of sex hormones and TNF-α levels in 94 community-dwelling men with AD. Comparisons were made with normal values derived from the literature. Men with AD had lower free testosterone levels than non-AD men (1-sample t test: age <80, P=0.0002; age ≥80, P<0.0001), and higher luteinizing hormone (LH) levels (Wilcoxon signed rank test: age <80, P=0.001; age ≥80, P<0.0001). Within the cohort of men with AD, there was a positive correlation between LH and TNF-α (Spearman r=0.25, P=0.019), and this remained significant after correcting for age (partial r=0.21, P=0.05). These data support the hypothesis that sex hormones and the immune system influence each other in AD. Furthermore, modulatory effects between LH and TNF-α may provide a mechanism for an effect of male sex hormones on AD risk.


Asunto(s)
Enfermedad de Alzheimer/sangre , Hormona Luteinizante/sangre , Neuroinmunomodulación/fisiología , Testosterona/sangre , Factor de Necrosis Tumoral alfa/sangre , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/inmunología , Estudios Transversales , Humanos , Inmunoensayo , Inflamación/sangre , Inflamación/complicaciones , Inflamación/inmunología , Masculino
18.
New Phytol ; 191(2): 515-527, 2011 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-21463329

RESUMEN

Ericoid mycorrhizal fungi differ in their abilities to use nitrogen sources and may be integral to maintaining fungal and plant diversity in ecosystems in which Ericaceae occur. In this study, we tested whether the fungal communities differ among three species of co-occurring Ericaceae. Fungi colonizing Cassiope tetragona, Empetrum nigrum and Vaccinium vitis-idaea roots in the Arctic tundra were characterized via culture-dependent and culture-independent techniques. The cultured fungi were tested for their ability to colonize Vaccinium uliginosum in laboratory-based assays. The pure-cultured Helotiales were grouped into eight clades and dominated by the Phialocephala-Acephala complex. Representatives of these clades, plus an unknown basidiomycete with affinity to the genus Irpex (Polyporales), colonized V. uliginosum intracellularly. The Helotiales detected by direct PCR, cloning and sequencing were assigned to 14 clades and dominated by members of the Rhizoscyphus ericae complex. Ordination analyses indicated that culture-dependent and culture-independent assays provided distinct views of root fungal communities, but no evidence for host specificity. These data suggest that ericaceous roots host diverse fungal communities dominated by the Helotiales. However, these fungal communities are unlikely to be controlled by fungal host preferences. The mechanisms maintaining high diversity in root-symbiotic communities remain to be elucidated.


Asunto(s)
Ascomicetos/clasificación , Basidiomycota/clasificación , Ericaceae/microbiología , Micorrizas/clasificación , Alaska , Regiones Árticas , Ascomicetos/genética , Ascomicetos/aislamiento & purificación , Secuencia de Bases , Basidiomycota/genética , Basidiomycota/aislamiento & purificación , ADN de Hongos/química , ADN de Hongos/genética , Ecosistema , Especificidad del Huésped , Datos de Secuencia Molecular , Técnicas de Tipificación Micológica , Micorrizas/genética , Micorrizas/aislamiento & purificación , Filogenia , Raíces de Plantas/genética , Raíces de Plantas/microbiología , Análisis de Secuencia de ADN , Simbiosis
19.
Anesth Analg ; 112(1): 207-12, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21081771

RESUMEN

BACKGROUND: Nearly 20 years ago it was shown that patients are exposed to unnecessary preoperative testing that is both costly and has associated morbidity. To determine whether such unnecessary testing persists, we performed internal and external surveys to quantify the incidence of unnecessary preoperative testing and to identify strategies for reduction. METHODS: The medical records of 1000 consecutive patients scheduled for surgery at our institution were examined for testing outside of our approved guidelines. Subsequently, 4 scenarios were constructed to solicit physician views of appropriate testing: a 45-year-old woman for a laparoscopic ovarian cystectomy, a 23-year-old woman for right inguinal herniorrhaphy, a 50-year-old man for a hemithyroidectomy, and a 50-year-old man for a total hip replacement. One or more of these scenarios were sent to directors of preoperative clinics (all), United States anesthesiologists (all), gynecologists (cystectomy), general surgeons (herniorrhaphy), otolaryngologists (thyroidectomy), and orthopedists (hip replacement). Potential predictors of ordering and demographic information were collected. RESULTS: More than half of our patients had at least 1 unnecessary test based on our testing guidelines (95% lower confidence limit = 52%). The 17 responding preoperative directors were unanimous for 36 of the 72 combinations of test or consult (henceforth "test") and scenario as being unnecessary. Among the 175 anesthesiologists responding to the survey, 46% ordered 1 or more of the tests unanimously considered unnecessary by the preoperative directors for the given scenario. Among 17 potential predictors of anesthesiologists' unnecessary ordering, only training completed before 1980 significantly increased the risk of ordering at least 1 unnecessary test (by 48%, 95% confidence limits >29%). Anesthesiologists were 53% less likely to order at least 1 unnecessary test relative to gynecologists for the cystectomy scenario, 64% less likely than general surgeons for the herniorrhaphy scenario, 66% less likely than otolaryngologists for the thyroidectomy scenario, and 67% less likely than orthopedists for the hip replacement scenario. The 95% lower confidence limits were all >40%. CONCLUSIONS: The percentage of patients with at least 1 unnecessary test is a suitable end point for monitoring providers' ordering. The incidence can be high despite efforts at improvement, but may be reduced if anesthesiologists rather than surgeons order presurgical tests and consults. However, anesthesia groups should be cognizant of potential heterogeneity among them based on time since training.


Asunto(s)
Anestesiología/métodos , Pruebas Diagnósticas de Rutina/normas , Encuestas de Atención de la Salud , Médicos/normas , Cuidados Preoperatorios/métodos , Procedimientos Innecesarios , Anestesiología/estadística & datos numéricos , Pruebas Diagnósticas de Rutina/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Médicos/estadística & datos numéricos , Guías de Práctica Clínica como Asunto/normas , Valor Predictivo de las Pruebas , Cuidados Preoperatorios/estadística & datos numéricos , Procedimientos Innecesarios/estadística & datos numéricos , Adulto Joven
20.
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