Deprescribing of Medicines in Care Homes-A Five-Year Evaluation of Primary Care Pharmacist Practices.

(1) Background: This project evaluates the outcomes of a novel pharmacy-led model of deprescribing unnecessary medications for care home patients. A feasibility study was conducted in 2015 to explore exposure to inappropriate polypharmacy in patients residing in care homes over a one-year timescale. The aim of this study was to present the results of this ongoing service evaluation over a five-year period. (2) Methods: Data collection and risk assessment tools developed during the feasibility study were used to measure the prevalence, nature, and impact of deprescribing interventions by primary care pharmacists over a five-year period. A random sample of approximately 5% of safety interventions were screened twice yearly by the pharmacist leads as part of standard practice. (3) Results: Over a period of five years there were 23,955 interventions (mean 2.3 per patient) reported from the 10,405 patient reviews undertaken. Deprescribing accounted for 53% of total estimated financial drug savings, equating to £431,493; and 16.1% of all interventions were related to safety. (4) Conclusions: Medication reviews in care homes, undertaken by primary care pharmacists who are linked to GP practices, generate a wide range of interventions commonly involving deprescribing, which contributes significantly to the continuous optimisation of the prescribing and monitoring of medicines.

Multiplex PCR and Next Generation Sequencing for the Non-Invasive Detection of Bladder Cancer.

BACKGROUND: Highly sensitive and specific urine-based tests to detect either primary or recurrent bladder cancer have proved elusive to date. Our ever increasing knowledge of the genomic aberrations in bladder cancer should enable the development of such tests based on urinary DNA. METHODS: DNA was extracted from urine cell pellets and PCR used to amplify the regions of the TERT promoter and coding regions of FGFR3, PIK3CA, TP53, HRAS, KDM6A and RXRA which are frequently mutated in bladder cancer. The PCR products were barcoded, pooled and paired-end 2 x 250 bp sequencing performed on an Illumina MiSeq. Urinary DNA was analysed from 20 non-cancer controls, 120 primary bladder cancer patients (41 pTa, 40 pT1, 39 pT2+) and 91 bladder cancer patients post-TURBT (89 cancer-free). RESULTS: Despite the small quantities of DNA extracted from some urine cell pellets, 96% of the samples yielded mean read depths >500. Analysing only previously reported point mutations, TERT mutations were found in 55% of patients with bladder cancer (independent of stage), FGFR3 mutations in 30% of patients with bladder cancer, PIK3CA in 14% and TP53 mutations in 12% of patients with bladder cancer. Overall, these previously reported bladder cancer mutations were detected in 86 out of 122 bladder cancer patients (70% sensitivity) and in only 3 out of 109 patients with no detectable bladder cancer (97% specificity). CONCLUSION: This simple, cost-effective approach could be used for the non-invasive surveillance of patients with non-muscle-invasive bladder cancers harbouring these mutations. The method has a low DNA input requirement and can detect low levels of mutant DNA in a large excess of normal DNA. These genes represent a minimal biomarker panel to which extra markers could be added to develop a highly sensitive diagnostic test for bladder cancer.

A dimeric magnesium(I) compound as a facile two-center/two-electron reductant.

The odd couple: A dimeric magnesium(I) complex acts as a facile and selective two-center/two-electron reductant towards a series of unsaturated substrates (see scheme; Ar = 2,6-iPr(2)C(6)H(3), Ad = 1-adamantyl). The novel reduced or reductively coupled products obtained from these reductions suggest that magnesium(I) compounds may find wide use in organic and organometallic syntheses.

Synthesis and structural characterisation of a soluble, metastable indium(I) halide complex, [InBr(tmeda)].

The first example of an indium(i) halide complex, [InBr(tmeda)], has been prepared by the reversible dissolution of InBr in a tmeda-toluene mixture. The structural characterisation of the metastable compound shows it to be monomeric with weak InIn interactions in the solid state. In solution, it decomposes to either InBr or [In2Br4(tmeda)2].

Stable magnesium(I) compounds with Mg-Mg bonds.

The chemistry of the group 2 metals (beryllium, magnesium, calcium, strontium, and barium) is dominated by the +2 oxidation state. Here, we report the reductions of two magnesium(II) iodide complexes with potassium metal in toluene, leading to thermally stable magnesium(I) compounds, (L)MgMg(L) (where L is [(Ar)NC(NPri2)N(Ar)]- or {[(Ar)NC(Me)]2CH}-, Ar is 2,6-diisopropylphenyl, Me is methyl, and Pri is isopropyl) in moderate yields. The results of x-ray crystallographic and theoretical studies are consistent with central Mg2+(2) units that have single, covalent magnesium-magnesium bonding interactions with 2.8508 +/- 0.0012 (standard deviation) and 2.8457 +/- 0.0008 angstrom bond lengths, respectively, and predominantly ionic interactions with the anionic ligands (L).

Base-stabilized amidodiarsenes: synthesis, structure, and theoretical studies.

The guanidinato- or amidinato-bridged diarsenes [As2{mu-(ArN)2CR}2] (Ar = C6H3Pri2-2,6; R = N(C6H11)2, NPri2, or But) have been prepared by reduction of the corresponding As(III) precursors, [Cl2As{kappa2-N,N'-(ArN)2CR}]. Theoretical studies suggest that the As-As bonds of the dimers have significant double-bond character, the sigma and pi components of which are derived mainly from As p orbital overlaps.

Homo- and heteroleptic complexes of four-membered group 13 metal(I) N-heterocyclic carbene analogues with group 10 metal(0) fragments.

A series of complexes between recently developed four-membered group 13 metal(I) heterocycles and group 10 metal(0) fragments have been prepared and structurally characterized. One prepared complex, [Pt{Ga[N(Ar)]2CNCy2}3] (Ar = C6H3Pri2-2,6; Cy = cyclohexyl), possesses the shortest Pt-Ga bonds yet reported, the covalent components of which are suggested by theoretical studies to have significant pi character.

Synthetic, structural and theoretical studies of amidinate and guanidinate stabilised germanium(I) dimers.

The neutral germanium(i) dimers, [{Ge(Piso)}(2)] and [{Ge(Giso)}(2)], Piso = [(ArN)(2)CBu(t)](-), Giso = [(ArN)(2)CNPr(i)(2)](-), Ar = C(6)H(3)Pr(i)(2)-2,6, which are stabilised by bulky amidinate and guanidinate ligands respectively, have been prepared by reduction of the corresponding germanium(ii) chlorides, [Ge(Piso)Cl] and [Ge(Giso)Cl]; theoretical studies suggest that the Ge-Ge bonds of [{Ge(Piso)}(2)] and [{Ge(Giso)}(2)] are associated with their HOMOs, whilst their LUMOs have substantial Ge-Ge pi-bonding character.

Complexes of an anionic gallium(I) N-heterocyclic carbene analogue with group 14 element(II) fragments: synthetic, structural and theoretical studies.

The reactions of the anionic gallium(I) N-heterocyclic carbene (NHC) analogue, [K(tmeda)][:Ga{[N(Ar)C(H)]2}], Ar = C6H3Pri2-2,6, with the heavier group 14 alkene analogues, R2E=ER2, E = Ge or Sn, R = -CH(SiMe3)2, have been carried out. In 2:1 stoichiometries, these lead to the ionic [K(tmeda)][R2EGa{[N(Ar)C(H)]2}] complexes which exhibit long E-Ga bonds. The nature of these bonds has been probed by DFT calculations, and the complexes have been compared to neutral NHC adducts of group 14 dialkyls. The 4:1 reaction of [K(tmeda)][:Ga{[N(Ar)C(H)]2}] with R2Sn=SnR2 leads to the digallyl stannate complex, [K(tmeda)][RSn[Ga{[N(Ar)C(H)]2}]2], presumably via elimination of KR. In contrast, the reaction of the gallium heterocycle with PbR2 affords the digallane4, [Ga{[N(Ar)C(H)]2}]2, via an oxidative coupling reaction. For sake of comparison, the reactions of [K(tmeda)][:Ga{[N(Ar)C(H)]2}] with Ar'2E=EAr'2, E = Ge, Sn or Pb, Ar' = C6H2Pri3-2,4,6, were carried out and led to either no reaction (E = Ge), the formation of [K(tmeda)][Ar'2SnGa{[N(Ar)C(H)]2}] (E = Sn), or the gallium(III) heterocycle, [Ar'Ga{[N(Ar)C(H)]2}] (E = Pb). Salt elimination reactions between [K(tmeda)][:Ga{[N(Ar)C(H)]2}] and the guanidinato group 14 complexes [(Giso)ECl], E = Ge or Sn, Giso = [Pri2NC{N(Ar)}2]-, gave the neutral [(Giso)EGa{[N(Ar)C(H)]2}] complexes. All complexes have been characterized by NMR spectroscopy and X-ray crystallographic studies.

Variation of oxo-transfer reactivity of (nitro)cobalt picket fence porphyrin with oxygen-donating ligands.

Derivatives of (nitro)cobalt picket fence porphyrin with oxygen-donating ligands have been prepared in solution and in the solid state. Crystal structures of two of these derivatives, (H2O)CoTpivPP(NO2) and (CH3OH)CoTpivPP(NO2), have been determined. The ethanol complex (C2H5OH)Co(TPP)(NO2) has been obtained and spectrally characterized using sublimed layers methodology. The formation constant and the DeltaH degrees value of the association reaction with ethanol have been determined by FTIR measurements in CCl4 solution. Catalytic oxygen activation and oxo-transfer reactions of these derivatives have been assessed in solution. Correlations between the oxo-transfer reactivity, thermodynamics, and characteristics of the nitro ligand show that although calculated and observed ONO vibrational spectra and bond lengths suggest activation of the NO2 ligand and enhanced oxo-transfer reactions as seen in the analogous five-coordinate complexes, density functional theory calculations support that thermodynamics limits oxo-atom transfer reactions in these six-coordinate systems.