Impact of community pharmacy diabetes monitoring and education programme on diabetes management: a randomized controlled study.

AIMS: To evaluate the impact of a pharmacist-led patient education and diabetes monitoring programme on HbA(1c) and other cardiovascular risk factors in the community setting. METHODS: Patients with Type 2 diabetes (n = 46) attending two community pharmacies in Hertfordshire, UK were randomized to one of two groups. Patients in the intervention group (n = 23) received a programme of education about diabetes, its treatment and associated cardiovascular risk factors. These patients were seen for monitoring/counselling by a community pharmacist on six occasions over a 12-month period. Measures included HbA(1c), BMI, blood pressure, blood glucose and lipid profile. Patients in the control group (n = 23) underwent these measurements at baseline and at 12 months only, without specific counselling or education over and above usual care. RESULTS: HbA(1c) fell from 66 mmol/mol (8.2%) to 49 mmol/mol (6.6%) (P < 0.001) in intervention group, compared with reduction from 65 mmol/mol (8.1%) to 59 mmol/mol (7.5%) in the control group (P = 0.03). Blood pressure fell from 146/87 to 126/81 mmHg in the intervention group (P = 0.01) compared with no significant change in the control group (136/86 to 139/82 mmHg). Significant reductions in BMI (30.8 to 27 kg/m(2), P < 0.001) and blood glucose (8.8 to 6.9 mmol/l, P < 0.001) were also observed in the intervention group as compared with no significant changes in the control group. Lipid profile changes were mixed. In the intervention group, improvements were seen in diabetes-related quality of life (P = 0.001), diabetes knowledge (P = 0.018), belief about the need for medication (P = 0.004) and reduced concerns regarding medication (P < 0.001). CONCLUSIONS: Education and counselling by community pharmacists can result in favourable improvements to the cardiovascular risk profile of patients with Type 2 diabetes.

Diagnosis of myasthenia gravis in the 1990s.

We have tried to show through this analysis how an understanding of the characteristics of diagnostic tests can lead one to a rational strategy for making clinical decisions. The diagnosis of MG can be made with a high degree of confidence in most situations, but the amount of supporting test information necessary depends on the clinical situation. This analysis does show some general guiding principles. The first is that the results of the edrophonium test should be used to guide further diagnostic assessment in most situations. In the small number of cases in which an objective edrophonium test cannot be done, the pretesting estimate of certainty should be used to guide testing strategy. A second principle is that, if a second diagnostic test is required after edrophonium testing, it should be the acetylcholine receptor antibody assay. This test is less expensive and it has more overall reliability. EMG testing thus serves as a third-line test for MG, and it can be reserved for a small number of clinical situations in which certainty about the diagnostic test is too high to reject the possibility of MG, yet too low to initiate treatment confidently. The greatest attractiveness of this type of analysis is that one may take issue with one or more of the assumptions on which it is based without invalidating the conclusions. The conclusions can be tested by a process called sensitivity analysis, in which one or more of the variables can be changed to study its effect on the outcome of the analysis. For example, one could require that certainty exceed 99% (T1) prior to beginning treatment.(ABSTRACT TRUNCATED AT 250 WORDS)