Evaluative Research on Pharmacist-managed Diabetes Care: Focus on Self-Monitoring of Blood Glucose / Investigación Evaluativa sobre Atención a la Diabetes Gestionada por los Farmacéuticos: Enfoque del Automonitoreo de la Glucosa en Sangre

ABSTRACT Objective: Pharmacists have not demonstrated the ability to manage chronic diseases such as Type 2 Diabetes Mellitus, which is an ongoing problem in Trinidad and Tobago. The primary objective was to demonstrate that pharmacists can assist patients to achieve at least a 1% decrease in glycosylated haemoglobin (HbA1c). Methods: A randomized, controlled Pharmacist Evaluative Research Study compared the efficacy of pharmacist-managed care (the intervention), and routine standard management (control) of poorly controlled (abnormal HbA1c, blood pressure, blood glucose and lipid panel) adult diabetic patients. Participants in the intervention group met with the pharmacist at their respective primary care sites on a regular basis for an assessment of adherence to medications, barriers to adherence and education. Control group participants consisted of patients receiving routine care by their primary physician but with no direct intervention by the pharmacist except for the filling of prescriptions. Results: Seventy-five patients were initially recruited. Of these, 48 (20 intervention and 28 control) met the inclusion criteria. It was only possible to analyse the result from 20 patients: 14 (70%) intervention and 6 (21.4%) control because of incomplete collected data. A minimum decrease of at least 1% HbA1c was obtained by 8 (57%) intervention participants compared to 2 (33%) in the control group; while HbA1c remained unchanged for two participants, each in the intervention and control groups (14% and 33%, respectively). Conclusion: We could not conclude any statistical or clinical significance in the paper as the data could only be analysed using descriptive methods. Building a culture of research among pharmacists may promote the use of pharmacists as adjunctive healthcare practitioners to achieve better patient outcomes.

RESUMEN Objetivo: Los farmacéuticos no han demostrado ser capaces de manejar el tratamiento de enfermedades crónicas como el tipo 2 Diabetes mellitus, que es un problema actual en Trinidad y Tobago. El objetivo principal fue demostrar que los farmacéuticos pueden ayudar a los pacientes a lograr al menos una disminución del 1% en hemoglobina (Hba1C). Métodos: Un Estudio de Investigación Evaluativa Farmacéutico controlado aleatorio, comparó la eficacia de la atención gestionada por los farmacéuticos (intervención) y el manejo estándar de rutina (control) de pacientes diabéticos adultos con pobre control (niveles anormales de hemoglobina glicosilada, presión arterial, glucosa en sangre, y perfil lipídico). Los participantes en el grupo de intervención se reunieron de manera regular con el farmacéutico en sus respectivos centros de atención primaria para evaluar el cumplimiento con los medicamentos, así como los obstáculos a la observancia y la educación. Los participantes del grupo de control eran pacientes que recibían atención de rutina de parte de su médico primario, pero sin intervención directa del farmacéutico, excepto para el llenado de prescripciones. Resultados: Setenta-cinco pacientes fueron reclutados inicialmente. De estos, 48 (20 de intervención y 28 de control) cumplían los criterios de inclusión. Debido a que los datos recopilados estaban incompletos, sólo fue posible analizar el resultado de 20 pacientes: 14 (70%) de intervención y 6 (21.4%) de control. Una disminución mínima de al menos 1% de HbA1C fue obtenida por 8 (57%) participantes de intervención en comparación con 2 (33%) en el grupo de control, mientras que el HbA1C permaneció inalterado para 2 participantes, cada uno en los grupos de intervención y control (14% y 33%, respectivamente). Conclusión: Los datos apoyan la hipótesis de que la gestión de los farmacéuticos como profesionales complementarios de la salud, posibilita lograr mejores resultados en los pacientes, a diferencia de lo que ocurre en ausencia de tal gestión.

Unlocking the Anti - Prostate Cancer Potential of Some Tropical and Sub - Tropical Plants

Prostate cancer is the third leading cause of cancer death among men worldwide and is the leading cause of cancer mortality in males greater than 60 years in Trinidad and Tobago. Although there are some treatment options for the metastatic disease, the impact on overall survival rate has not improved in the last two decades. In particular, the mortality rate from prostate cancer is high among men of African descent in Trinidad and Tobago and the Americas. These groups manifest aggressive cancers that are often less responsive to available therapies. We hypothesize that phytochemical screening of tropical plants, coupled to cell culture studies would identify other potential treatments for prostate cancer. In separate experiments, the roots or leaves of five plants indigenous to the Caribbean and the skin of the muscadine grape, indigenous to North America were dried, crushed and suspended in 100% methanol. The respective methanol extracts were fractionated and the fractions dried. Next the ability of the extracts to halt the growth of or kill PC-3 prostate cancer cells was assessed by MTT assays. Colony formation, cell migration studies, cell cycle studies and western blots were performed to determine probable mechanism of action. The categories of chemical compounds present in the extracts were determined by Thin Layer chromatography (TLC). Results from MTT assays showed that compared to the control cells (ie those treated with DMSO only), treatment with at least four plant extracts significantly (p<0.05) inhibited the growth of the cancer cells; decreases as large as 95 % were observed. On the other hand these extracts had a limited or delayed effect on the "normal" PNT1A cells. Results from the cell cycle assay demonstrated that one extract, now identified as plant-A extract, caused the arrest of the G1/S phase of PC-3 cells i.e. leading to an increase in the number of cells that remained in the growth phase. On the other hand the total ethanol extract of muscadine grape skin decreased the expression of heat shock protein-40, possibly causing deactivation of the androgen receptor. This suggests that extracts prepared from Plant A and the muscadine grape have the potential for use as anticancer drugs.

An evaluation of treatment strategies for head and neck cancer in an African American population / Evaluación de las estrategias del tratamiento para el cáncer de cabeza y cuello en una población afroamericana

OBJECTIVE: This study evaluated treatment strategies for head and neck cancers in a predominantly African American population. METHODS: Data were collected utilizing medical records and the tumour registry at the Howard University Hospital. Kaplan-Meier method was used for survival analysis and Cox proportional hazards regression analysis predicted the hazard of death. RESULTS: Analysis revealed that the main treatment strategy was radiation combined with platinum for all stages except stage I. Cetuximab was employed in only 1% of cases. Kaplan-Meier analysis revealed stage II patients had poorer outcome than stage IV while Cox proportional hazard regression analysis (p = 0.4662) showed that stage I had a significantly lower hazard of death than stage IV (HR = 0.314; p = 0.0272). Contributory factors included tobacco and alcohol but body mass index (BMI) was inversely related to hazard of death. CONCLUSIONS: There was no difference in survival using any treatment modality for African Americans.

OBJETIVO: Este estudio evaluó las estrategias del tratamiento para los cánceres de cabeza y cuello en una población predominantemente afroamericana. MÉTODOS: Se recopilaron datos utilizando historias clínicas y el registro de tumores del Hospital Universitario Howard. Se utilizó el método de Kaplan-Meier para el análisis de supervivencia, y el análisis de regresión de riesgos proporcionales de Cox para predecir los riesgos de muerte. RESULTADOS: El análisis reveló que la estrategia principal para el tratamiento fue la radiación combinada con platino para todas las etapas, excepto la etapa I. Se empleó cetuximab en sólo 1% de los casos. El análisis de Kaplan-Meier reveló que los pacientes de etapa II tuvieron resultados más pobres que los de la etapa IV, mientras que el análisis de regresión de riesgos proporcionales de Cox (p = 0.4662) mostró que la etapa I tenía un riesgo de muerte significativamente menor que la etapa IV (HR = 0.314; p = 0.0272). Los factores contribuyentes incluyeron el tabaco y el alcohol, pero el índice de masa (IMC) fue inversamente proporcional al riesgo de muerte. CONCLUSIONES: No hubo diferencias en la supervivencia con ninguna de las modalidades de tratamiento para los afroamericanos.