ABSTRACT
BACKGROUND: Diabetes is associated with increased risk of hospital readmission and imposes a significant economic burden on patients and healthcare systems. Literature suggests that pharmacist-led transitions-of-care (TOC) services reduce hospital readmissions and improve patient outcomes and data within safety-net hospitals is limited. METHODS: This was a single-center evaluation to assess the impact of pharmacist-led diabetes TOC services on hospital readmissions among diabetes patients vs standard care (SC). The evaluation included patients admitted from 11/1/2021-2/28/2022 and 10/19/2022-2/28/2023 who had a primary diagnosis of diabetes mellitus, were admitted for a diabetes-related reason, or were seen by the endocrine consult service during admission. The primary outcome was 30-day readmissions. Secondary outcomes included time to readmission, readmission diagnosis, changes in HbA1c, completion of follow-up visits, and number of pharmacist interventions at follow-up. RESULTS: There were 109 patients included (TOC n = 65; SC n = 44) and 13.8% (9/65) of TOC and 18.2% (8/44) of SC patients readmitted within 30 days (P = .235). Average time to readmission was 15.3 days in the TOC and 10.4 days in the SC cohorts. There were no diabetes-related readmissions in the TOC cohort. Over 60% (5/8) of readmissions in the SC cohort were diabetes-related. The average change in HbA1c was -2.5% in the TOC cohort and -1.2% in the SC cohort, P = .046. Approximately 51% of TOC patients completed an outpatient follow-up visit and nearly 70% of those patients had an intervention made at that time. CONCLUSION: Pharmacist-led diabetes TOC services within a safety-net hospital may reduce hospital readmissions and improve clinical outcomes.
ABSTRACT
To examine the roles of competing intermolecular interactions in differentiating the molecular packing arrangements of some isomeric phenylhydrazones from each other, the crystal structures of five nitrile-halogen substituted phenylhydrazones and two nitro-halogen substituted phenylhydrazones have been determined and are described here: (E)-4-cyanobenzaldehyde 4-chlorophenylhydrazone, C(14)H(10)ClN(3), (Ia); (E)-4-cyanobenzaldehyde 4-bromophenylhydrazone, C(14)H(10)BrN(3), (Ib); (E)-4-cyanobenzaldehyde 4-iodophenylhydrazone, C(14)H(10)IN(3), (Ic); (E)-4-bromobenzaldehyde 4-cyanophenylhydrazone, C(14)H(10)BrN(3), (IIb); (E)-4-iodobenzaldehyde 4-cyanophenylhydrazone, C(14)H(10)IN(3), (IIc); (E)-4-chlorobenzaldehyde 4-nitrophenylhydrazone, C(13)H(10)ClN(3)O(2), (III); and (E)-4-nitrobenzaldehyde 4-chlorophenylhydrazone, C(13)H(10)ClN(3)O(2), (IV). Both (Ia) and (Ib) are disordered (less than 7% of the molecules have the minor orientation in each structure). Pairs (Ia)/(Ib) and (IIb)/(IIc), related by a halogen exchange, are isomorphous, but none of the 'bridge-flipped' isomeric pairs, viz. (Ib)/(IIb), (Ic)/(IIc) or (III)/(IV), is isomorphous. In the nitrile-halogen structures (Ia)-(Ic) and (IIb)-(IIc), only the bridge N-H group and not the bridge C-H group acts as a hydrogen-bond donor to the nitrile group, but in the nitro-halogen structures (III) (with Z' = 2) and (IV), both the bridge N-H group and the bridge C-H group interact with the nitro group as hydrogen-bond donors, albeit via different motifs. The occurrence here of the bridge C-H contact with a hydrogen-bond acceptor suggests the possibility that other pairs of `bridge-flipped' isomeric phenylhydrazones may prove to be isomorphous, regardless of the change from isomer to isomer in the position of the N-H group within the bridge.
