Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic.

BACKGROUND: Seven-day clinical pharmacy services in the acute sector of the National Health Service are limited. There is a paucity of evidential patient benefit. This limits investment and infrastructure, despite United Kingdom wide calls. AIM: To optimise medicines seven-days a week during surge-2 of the COVID-19 pandemic through implementation of a seven-day clinical pharmacy service. This paper describes service development, evaluation and sustainability. SETTING: A tertiary-referral teaching hospital, London, United Kingdom. DEVELOPMENT: The seven-day clinical pharmacy service was developed to critical care, acute and general medical patients. Clinical leads developed the service specification and defined priorities, targeting complex patients and transfer of care. Contributing staff were briefed and training materials developed. IMPLEMENTATION: The service was implemented in January 2021 for 11 weeks. Multidisciplinary team communication brought challenges; strategies were employed to overcome these. EVALUATION: A prospective observational study was conducted in intervention wards over two weekends in February 2021. 1584 beds were occupied and 602 patients included. 346 interventions were reported and rated; 85.6% had high or moderate impact; 56.7% were time-critical. The proportion of medicines reconciliation within 24-h of admission was analysed across the hospital between November 2020 and May 2021. During implementation, patients admitted Friday-Sunday were more likely to receive medicines reconciliation within 24-h (RR 1.41 (95% CI 1.34-1.47), p < 0.001). Rostered services were delivered sustainably in terms of shift-fill rate and medicines reconciliation outcome. CONCLUSION: Seven-day clinical pharmacy services benefit patient outcome through early medicines reconciliation and intervention. Investment to permanently embed the service was sustained.

The Necrotrophic Fungus Macrophomina phaseolina Promotes Charcoal Rot Susceptibility in Grain Sorghum Through Induced Host Cell-Wall-Degrading Enzymes.

The cell-wall-degrading enzymes (CWDE) secreted by necrotrophs are important virulence factors. Although not unequivocally demonstrated, it has been suggested that necrotrophs induce hosts to cooperate in disease development through manipulation of host CWDE. The necrotrophic fungus Macrophomina phaseolina causes charcoal rot disease in Sorghum bicolor. An RNA-seq experiment was conducted to investigate the behavior of sorghum CWDE-encoding genes after M. phaseolina inoculation. Results revealed M. phaseolina's ability to significantly upregulate pectin methylesterase-, polygalacturonase-, cellulase-, endoglucanase-, and glycosyl hydrolase-encoding genes in a charcoal rot-susceptible sorghum genotype (Tx7000) but not in a resistant genotype (SC599). For functional validation, crude enzyme mixtures were extracted from M. phaseolina- and mock-inoculated charcoal-rot-resistant (SC599 and SC35) and -susceptible (Tx7000 and BTx3042) sorghum genotype stalks. A gel diffusion assay (pectin substrate) revealed significantly increased pectin methylesterase activity in M. phaseolina-inoculated Tx7000 and BTx3042. Polygalacturonase activity was determined using a ruthenium red absorbance assay (535 nm). Significantly increased polygalacturonase activity was observed in two susceptible genotypes after M. phaseolina inoculation. The activity of cellulose-degrading enzymes was determined using a 2-cyanoacetamide fluorimetric assay (excitation and emission maxima at 331 and 383 nm, respectively). The assay revealed significantly increased cellulose-degrading enzyme activity in M. phaseolina-inoculated Tx7000 and BTx3042. These findings revealed M. phaseolina's ability to promote charcoal rot susceptibility in grain sorghum through induced host CWDE.

Stalk Rot Fungi Affect Leaf Greenness (SPAD) of Grain Sorghum in a Genotype- and Growth-Stage-Specific Manner.

Stalk rots are among the most prevalent and destructive sorghum diseases worldwide. Although experimental evidence is limited, delayed postflowering senescence due to the staygreen trait is accepted as a physiological means of stalk rot resistance. Staygreen has been shown to be correlated with chlorophyll content (as measured by a soil and plant analytical development [SPAD] meter). Field experiments were conducted to test the effects of Fusarium stalk rot and charcoal rot on SPAD readings at three developmental stages, to test whether staygreen genotypes are more resilient to stalk-rot-mediated chlorophyll degradation, and to examine the relationships between SPAD and stalk rot resistance and tolerance when plants were inoculated with causal organisms. Staygreen and nonstaygreen lines (two) and hybrids (two) established in the field were inoculated with Fusarium thapsinum, F. proliferatum, F. andiyazi, and Macrophomina phaseolina at 14 days after flowering. SPAD readings were obtained at soft-dough, hard-dough, and physiological maturity. Most pathogens significantly reduced the SPAD of the genotypes over the mock-inoculated control at three developmental stages. The stalk-rot-resistant and staygreen check line, SC599, showed a remarkable feature of negative senescence from soft dough to physiological maturity under disease pressure. Disease severity was significantly and negatively correlated with SPAD at all developmental stages, revealing the potential impact of the staygreen trait on stalk rot resistance. The difference between control and pathogen-treated total seed weight per panicle (i.e., tolerance) was significantly and positively correlated with the difference between control and pathogen-treated SPAD at physiological maturity, demonstrating the ability of staygreen trait to enhance stalk rot tolerance under disease pressure.