Impact of a pharmacist-led weight management service in a cardiology clinic.

BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) for weight management require frequent dose titration, patient education, and insurance coverage navigation, which pharmacists are well equipped to manage. Data are lacking regarding the benefit of a pharmacist-managed service using GLP-1 RAs for weight loss in a high-risk cardiac population. OBJECTIVE: This study aimed to evaluate the impact of a pharmacist-led weight loss service within a cardiology clinic using GLP-1 RAs and lifestyle counseling in patients with overweight and obesity. PRACTICE DESCRIPTION: An outpatient cardiology clinic employs clinical pharmacists who use collaborative practice agreements to provide cardiovascular risk reduction services that did not include weight management at baseline. PRACTICE INNOVATION: This is the first description of a pharmacist-led weight management clinic using solely GLP-1 RAs in a cardiology practice. Patients were referred to the clinical pharmacist, who initiated and titrated GLP-1 RA and provided lifestyle counseling. EVALUATION METHODS: This was a single-center, prospective, pre-post analysis of adults with a body mass index of at least 30 kg/m2 or 27 kg/m2 with a weight-related comorbidity, with a preceding failed dietary effort and insurance coverage for semaglutide (Wegovy, Novo Nordisk) or liraglutide (Saxenda, Novo Nordisk) and managed by a pharmacist. The primary outcome was patients achieving ≥ 5% weight loss at 6 months, assessed via descriptive statistics. RESULTS: Between March 2022 and March 2023, 204 patients were referred by their cardiologist, and 59 patients started treatment with semaglutide (Wegovy, Novo Nordisk) or liraglutide (Saxenda, Novo Nordisk). A total of 31 patients completed 6 months of treatment at time of study completion, and all achieved ≥ 5% weight loss at 6 months, with a mean weight loss of 12.6%. Glycated hemoglobin improved by 0.6%, low-density lipoprotein by 18 mg/dL, triglycerides by 29 mg/dL, systolic blood pressure by 9 mm Hg, and diastolic blood pressure by 2 mm Hg. CONCLUSION: Pharmacist-led management of GLP-1 RA in patients with obesity or overweight led to clinically meaningful weight loss and improvements in weight-related comorbidities.

Multiomic approach and Mendelian randomization analysis identify causal associations between blood biomarkers and subcortical brain structure volumes.

Alterations in subcortical brain structure volumes have been found to be associated with several neurodegenerative and psychiatric disorders. At the same time, genome-wide association studies (GWAS) have identified numerous common variants associated with brain structure. In this study, we integrate these findings, aiming to identify proteins, metabolites, or microbes that have a putative causal association with subcortical brain structure volumes via a two-sample Mendelian randomization approach. This method uses genetic variants as instrument variables to identify potentially causal associations between an exposure and an outcome. The exposure data that we analyzed comprised genetic associations for 2994 plasma proteins, 237 metabolites, and 103 microbial genera. The outcome data included GWAS data for seven subcortical brain structure volumes including accumbens, amygdala, caudate, hippocampus, pallidum, putamen, and thalamus. Eleven proteins and six metabolites were found to have a significant association with subcortical structure volumes, with nine proteins and five metabolites replicated using independent exposure data. We found causal associations between accumbens volume and plasma protease c1 inhibitor as well as strong association between putamen volume and Agouti signaling protein. Among metabolites, urate had the strongest association with thalamic volume. No significant associations were detected between the microbial genera and subcortical brain structure volumes. We also observed significant enrichment for biological processes such as proteolysis, regulation of the endoplasmic reticulum apoptotic signaling pathway, and negative regulation of DNA binding. Our findings provide insights to the mechanisms through which brain volumes may be affected in the pathogenesis of neurodevelopmental and psychiatric disorders and point to potential treatment targets for disorders that are associated with subcortical brain structure volumes.

Multiomic approach and Mendelian randomization analysis identify causal associations between blood biomarkers and subcortical brain structure volumes.

Alterations in subcortical brain structure volumes have been found to be associated with several neurodegenerative and psychiatric disorders. At the same time, genome-wide association studies (GWAS) have identified numerous common variants associated with brain structure. In this study, we integrate these findings, aiming to identify proteins, metabolites, or microbes that have a putative causal association with subcortical brain structure volumes via a two-sample Mendelian randomization approach. This method uses genetic variants as instrument variables to identify potentially causal associations between an exposure and an outcome. The exposure data that we analyzed comprised genetic associations for 2,994 plasma proteins, 237 metabolites, and 103 microbial genera. The outcome data included GWAS data for seven subcortical brain structure volumes including accumbens, amygdala, caudate, hippocampus, pallidum, putamen, and thalamus. Eleven proteins and six metabolites were found to have a significant association with subcortical structure volumes. We found causal associations between amygdala volume and granzyme A as well as association between accumbens volume and plasma protease c1 inhibitor. Among metabolites, urate had the strongest association with thalamic volume. No significant associations were detected between the microbial genera and subcortical brain structure volumes. We also observed significant enrichment for biological processes such as proteolysis, regulation of the endoplasmic reticulum apoptotic signaling pathway, and negative regulation of DNA binding. Our findings provide insights to the mechanisms through which brain volumes may be affected in the pathogenesis of neurodevelopmental and psychiatric disorders and point to potential treatment targets for disorders that are associated with subcortical brain structure volumes.

Mid-fidelity manikins improve first-year pharmacy students' confidence and accuracy with performing physical assessment.

INTRODUCTION: As clinical roles for pharmacists expand, effective physical assessment training for pharmacy students is essential. The study objective was to determine whether doctor of pharmacy students taught physical assessment using mid-fidelity manikins improved in confidence and accuracy. Long-term retention of skills was also measured. METHODS: First-year (P1) pharmacy students were enrolled in a case-based course over two semesters between August 2018 and May 2019. Manikins were incorporated into the fall semester course for students to perform physical assessment as part of the individual case workup process. Students completed surveys before and after the course to evaluate differences in their confidence and accuracy with detecting normal vs. abnormal vital signs. After 21 weeks of no manikin exposure, students were again surveyed and assessed to evaluate long-term retention of physical assessment skills. RESULTS: Fifty-six students were included. Student confidence in assessing heart rate, blood pressure (BP), and lung sounds improved significantly between pre-exposure and post-exposure (34%, 39%, and 71% improvement, respectively), and accuracy in assessing BP and lung sounds improved significantly between pre-exposure and post-exposure (28% and 23% improvement, respectively). Confidence and accuracy were maintained throughout the study including follow-up. CONCLUSIONS: Early introduction of mid-fidelity manikins to P1 pharmacy students in a case-based, spaced learning strategy provided a successful approach to teach physical assessment skills.