Decreasing the load? Is a Multidisciplinary Multistep Medication Review in older people an effective intervention to reduce a patient's Drug Burden Index? Protocol of a randomised controlled trial.

INTRODUCTION: Older people often use medications with anticholinergic or sedative side effects which increase the risk of falling and worsen cognitive impairment. The Drug Burden Index (DBI) is a measure of the burden of anticholinergic and sedative medications. Medication reviews are typically done by a pharmacist in collaboration with a general practitioner to optimise the medication use and reduce these adverse drug events. We will evaluate whether a Multidisciplinary Multistep Medication Review (3MR) is an effective intervention to reduce a patient's DBI. METHODS: A randomised controlled trial including 160 patients from 15 community pharmacies will be conducted. Per pharmacy, 1 pharmacist will perform a structured 3MR in close collaboration with the general practitioner, including the objective to reduce the DBI. ANALYSIS: Primary outcome--the difference in proportion of patients having a decrease in DBI ≥ 0.5 in the intervention and control groups at follow-up. Secondary outcomes--anticholinergic and sedative side effects, falls, cognitive function, activities of daily living, quality of life, hospital admission, and mortality. ETHICS AND DISSEMINATION: The burden of patients will be kept at a minimum. The 3MR can be considered as usual care by the pharmacist and general practitioner. Medical specialists will be consulted, if necessary. The intervention is specifically aimed at older community-dwelling patients in an attempt to optimise prescribing, in particular, to reduce medication with anticholinergic and sedative properties. Study results will be published in peer-reviewed journals and will be distributed through information channels targeting professionals. TRIAL REGISTRATION NUMBER: NCT02317666; Pre-results.

A phytochemical study of lignans in whole plants and cell suspension cultures of Anthriscus sylvestris.

In the roots of Anthriscus sylvestris 12 different lignans were detected. Arctigenin, dimethylmatairesinol, dimethylthujaplicatin, podophyllotoxin, 7-hydroxyyatein and 7-hydroxyanhydropodorhizol have not been previously reported to be present in A. sylvestris. In the cell suspension cultures, which were initiated for this study, trace amounts of deoxypodophyllotoxin could be detected. With these cell suspension cultures we carried out feeding experiments using deoxypodophyllotoxin, yatein and, anhydropodorhizol. Yatein had a toxic effect on the cell cultures and was, like anhydropodorhizol, not converted into any detectable product. Deoxypodophyllotoxin, in contrast, was converted into podophyllotoxin, yielding significantly higher concentration than measured in whole plants.

The bioconversion process of deoxypodophyllotoxin with Linum flavum cell cultures.

The in vitro cell suspension culture of Linum flavum is able to convert high amounts of the 2,7'-cyclolignan deoxypodophyllotoxin into 6-methoxypodophyllotoxin 7- O-glucoside. We studied this conversion in detail by monitoring the intermediates and side-products after feeding different concentrations of deoxypodophyllotoxin. At a low concentration (0.1 mM) deoxypodophyllotoxin is rapidly converted into 6-methoxypodophyllotoxin 7- O-glucoside, 6-methoxypodophyllotoxin and traces of beta-peltatin and podophyllotoxin. The feeding of 0.5 and 2.0 mM also shows a rapid conversion into 6-methoxypodophyllotoxin 7- O-glucoside, but a delayed formation of 6-methoxypodophyllotoxin and beta-peltatin. By using different extraction methods we delivered proof in favour of the hypothesis that a part of the deoxypodophyllotoxin after uptake is temporarily stored as beta-peltatin glucoside.

Volatile components from Anthriscus sylvestris (L.) Hoffm.

The volatile components of fresh leaves and roots from Anthriscus sylvestris (L.) Hoffm., obtained through hydrodistillation, were analysed by GC and GC-MS. This was compared to dichloromethane extracts of both fresh and dried leaf and root material. The monoterpene fraction (69-70%) dominated, while beta-phellandrene (39-45%) was the main component in both the leaf and the root oil. Other components in the leaf oil were beta-myrcene (17%), sabinene (6.2%), Z-beta-ocimene (5.4%) and benzene acetaldehyde (4.1%). In the roots we found Z-beta-ocimene (16.9%) and alpha-pinene (4.6%) as other major components. These principle constituents of both essential oils were also present in the dichloromethane extracts of the fresh and dried leaves and the roots, although in much smaller percentages. Comparing hydrodistillation of fresh plant material with a dichloromethane extract, the latter yielded a considerably lower amount of constituents. In addition, air drying and freeze drying resulted in a significant loss of volatile constituents as compared to fresh material (dichloromethane extract).

Determination of valepotriates.

In this paper an overview is given of qualitative and quantitative methods of analysis used for valepotriates. Methods like spectophotometry, titrimetry, TLC, GC, HPLC, MS, CE as well as p-SFC have been applied. Today HPLC is the method of choice. The usefulness of the individual methods are discussed.