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Objective The Medicare Hospital Readmissions Reduction Program (MHRRP) which took effect on October 1st, 2012 holds providers accountable for quality of care delivered, placing a greater focus on care coordination. Innovative strategies in medication management in the acute care and outpatient primary care settings require vigilant pharmacist intervention. The objective of this study is to determine if pharmacist-provided medication reconciliation service in conjunction with hospital follow-up outpatient physician visits reduces hospital readmission rate. Methods This was a prospective study in which physician-initiated outpatient hospital follow-up appointment scheduling was used to identify patients at time of hospital discharge. All patients ≥50 years of age were eligible for outpatient pharmacist visits. Emergency room visits were excluded. Data collected included: patient demographics, characteristics of identified drug therapy problems, accuracy of outpatient medication histories and time required by pharmacist to perform the reviews. Patient adherence to early (24–72 hours) outpatient hospital follow-up visit was also evaluated. Previous year’s readmission data for high risk patients who received only physician visits were also collected for comparison with those who were jointly visited by pharmacists and physicians. Results A total of 98 patients were assigned to receive pharmacist intervention in conjunction with physician hospital follow-up visits. Nine of the 98 patients seen by pharmacists at hospital follow-up visits were readmitted (9.2%) to a hospital within 30 days of discharge. Out of the 236 patients seen during the same period the previous year (2011) for physician alone hospital follow-up visits 46 were readmitted (19.4%) within 30-days of hospital discharge. The difference between these groups was statistically significant ( p = 0.023), with patients in the pharmacist intervention group experiencing a reduction in 30-day readmission risk. Physician alone outpatient follow-up was associated with earlier mean time to readmission, 12.8 days vs. 18.3 days in the pharmacist intervention group ( p = 0.042). Conclusion Pharmacist involvement in hospital discharge follow-up visits reduced overall readmission rate in high risk patients and improved monitoring of drug therapy, and medication history accuracy when compared to physician-alone visits.

A new pterocarpan, (+)-3,4-dihydroxy-8,9-methylenedioxypterocarpan [1], was isolated from the flowers of Petalostemon purpureus by a DNA strand-scission assay-guided fractionation procedure. Compound 1 demonstrated activity in a standard in vitro DNA strand-scission assay, and cytotoxicity toward a KB tumor cell line. Two other related pterocarpans [2, 3] isolated from same plant were found to be moderately active for KB cells, but were inactive in the DNA strand-scission assay. (+)-4-Hydroxy-3-methoxy-8,9-methylenedioxypterocarpan [2] has not been reported previously as a natural product, while (+)-maackiain [3] has been isolated only as an optically inactive racemate along with its optical antipode, the (-)-isomer.

Pentacyclic triterpenoids based on the taraxer-14-ene skeleton with a C-28 attached carboxylic acid group have been isolated from the roots of Maprounea africana. These compounds were identified as 1 beta,2 alpha-dihydroxyaleuritolic acid 2,3-bis-p-hydroxybenzoate [1], 2 alpha-hydroxyaleuritolic acid 3-p-hydroxybenzoate [2], 2 alpha-hydroxyaleuritolic acid 2,3-bis-p-hydroxybenzoate [4], aleuritolic acid 3-p-hydroxybenzoate [5], aleuritolic acid [6], and aleuritolic acid 3-acetate [7]. Compounds 1 and 2 are new triterpene esters. Compound 3 was previously reported as 7 beta-hydroxymaprounic acid 3-p-hydroxybenzoate [13]. However, based on detailed nmr studies, its structure has been revised.

Ethyl acetate and aqueous extracts of tannin-containing topoisomerase inhibitory plant samples were subjected to one or more of seven tannin removal procedures, and the resulting products were subsequently evaluated for topoisomerase inhibitory activity. In most of the samples investigated, the initial activity was lost after tannin removal. It was concluded that the activity initially observed was primarily due to tannins. Procedures are presented for routinely obtaining tannin-free organic and aqueous fractions.

Purpose Six extended-interval gentamicin dosing regimens were comparatively evaluated in premature and full-term neonates. Methods Data regarding six physician-ordered dosing regimens of gentamicin for neonates in a hospital neonatal intensive care unit were collected and analyzed. Neonates of gestational age (GA) 29 weeks or younger received 4.5 mg/kg every 48 hours. Neonates of GA 30–34 weeks received one of three dosing regimens: 3.5, 4, or 4.5 mg/kg every 36 hours. Neonates of GA 35 weeks or older received either 3.5 or 4 mg/kg every 24 hours. Blood samples were collected 30 minutes before and 30 minutes after the third dose was infused for binary trough and peak level determinations, respectively. Results Peak gentamicin concentrations in the target range were attained most often in neonates of GA 29 weeks or younger who received gentamicin 4.5 mg/kg every 48 hours, in neonates of GA 30–34 weeks treated with gentamicin 3.5 mg/kg every 36 hours, and in neonates of GA 35 weeks or older treated with gentamicin 3.5 mg/kg every 24 hours. Conclusion For neonates of GA 30–34 weeks, gentamicin 3.5 mg/kg every 36 hours resulted in the highest percentage of peaks in the target range compared with 4 and 4.5 mg/kg every 36 hours. For neonates of GA 35 weeks or older, gentamicin 3.5 mg/kg every 24 hours provided the highest percentage of peaks in the target range compared with 4 mg/kg every 24 hours. The differences between the percentages of trough values in the target range of 0.5–2 μg/mL were not significant among dosing subgroups within each age group.

A new prenylated flavonol, petalopurpurenol (1), and a known dihydroflavonol, petalostemumol (2), have been isolated by DNA scission-guided fractionation of the organic portion of a 20% MeOH/CHCl 3 /H 2 O partition of a 50% MeOH/CHCl 3 extract of the roots of Petalostemon purpureus. Compound 2 displayed moderate activity in DNA-scission assay. Both compounds 1 and 2 were evaluated for cytotoxicity in a panel of human cancer cell lines. The structures of petalopurpurenol (1) and petalostemumol (2) were determined by spectroscopic analysis.

The rootwood of Aeschynomene mimosifolia Vatke (Leguminosae) has yielded a new neoflavonoid, mimosifoliol (1), and an unusual C16-styrylcycloheptenone derivative, mimosifolenone (2). The structures of these compounds were determined on the basis of spectral analysis. Compound 1 demonstrated weak activity in DNA-strand scission assay, while compound 2 was found to be inactive. Mimosifoliol (1) was inactive toward several human cell lines, while 2 was moderately active against the KB cell line.

A new polyacetylenic diepoxide compound, gummiferol [1] was isolated from the leaves of Adenia gummifera by KB cytotoxicity-guided fractionation. Compound 1 exhibited significant activity against the KB human cell line and a broad cytotoxic spectrum against other human cancer cell lines. The structure of 1 was established primarily on the basis of its spectral data.

Three new labdane diterpenes, gaudichaudols A-C [1-3], a new clerodane diterpenoid, gaudichaudone [4], and the known clerodane, articulin acetate [5] have been isolated from the aerial parts of Baccharis gaudichaudiana, together with the known compounds, apigenin, hispidulin, spathulenol, and ursolic acid. Through the application of 1D- and 2D nmr spectroscopy, the structures of the new diterpenoids [1-4] were, in turn; elucidated as 15,16,18,19-tetrahydroxylabd-5-ene, 15-O-acetyl-16,18,19-trihydroxylabd-5-ene, 16-O-p-trans-coumaroyl-15,18,19-trihydroxylabd-5-ene, and 2 beta-hydroxy-15,16-epoxycleroda-1(10),15,16-trien-18,19-olide++ +. The isolated compounds were evaluated in P-388 lymphocytic leukemia cells as well as a battery of human cancer cell lines. Among the diterpenoids, gaudichaudol C [3], gaudichaudone [4], and articulin acetate [5] exhibited significant cytotoxic activity against certain cancer cells.