Hypoglycaemia in older people with dementia and diabetes

Objective To explore the effect of hypoglycaemia on adverse events in older people with diabetes and dementia and determine the feasibility of using continuous glucose monitoring in this patient group. Methods Systematic review on continuous glucose monitoring in older people with diabetes: Hypothesis-generating systematic review to inform my feasibility study and to identify gaps in the evidence. Feasibility study: I conducted a feasibility study of continuous blood glucose monitoring to explore continuous glucose monitoring in older people with diabetes and memory problems. Pharmacoepidemiological study: Retrospective cohort study using the Clinical Research Practice Datalink database to test the effect of exposure to hypoglycaemia in older patients with dementia. Systematic review and meta-analysis on the associations between hypoglycaemia and adverse events in older people treated with glucose-lowering agents: Updated systematic review and meta-analysis of serious adverse events associated with hypoglycaemia in older patients treated with glucose-lowering agents. Findings Systematic review on continuous glucose monitoring in older people with diabetes: 9 studies were included with a total of nearly 1000 patients. Hypoglycaemic episodes occurred in a sizeable proportion and most of these episodes were asymptomatic. Some patients spent nearly 2 hours per day in the hypoglycaemic range. CGM is acceptable to patients and improved health-related well-being. Feasibility study: 12 participants completed the study and found using CGM device acceptable. Data capture with this device varied considerably (3%-92%). The device captured hypoglycaemic episodes in 6 participants, two of which lasted for over 300 minutes. Pharmacoepidemiological study: Older people with dementia and diabetes who have had a hypoglycaemic event are at substantially higher risk of death, cardiovascular events, falls, fractures and emergency department attendances, than those who have not had a hypoglycaemic event. Systematic review and meta-analysis on the associations between hypoglycaemia and adverse events in older people treated with glucose-lowering agents: 42 included studies with over 2 million patients. Hypoglycaemia is associated with an 80% increased risk in vascular complications, a doubling in risk of all-cause mortality, a 55% increased risk in dementia, and a 78% and 68% increased risk in falls and fractures respectively. Conclusions My research has highlighted the complications associated with hypoglycaemia in older people with diabetes and dementia and set the ground work for future studies using continuous glucose monitoring in this patient group

Communicating post-market safety risks of medicines with regulatory safety advisories: an international comparison of policy and perceptions

Background Information about the safety of medicines often emerges after approval. Medicines’ regulators use post-market safety advisories to communicate potential new harms. Advisories can influence medicines use, helping users to weigh benefits and harms. This thesis compared regulatory policy and outcomes for post-market safety communication in Australia, Canada, the United Kingdom (as part of the European Union) and the United States (US). Methods The four regulators were compared using: • A regulatory policy analysis. • An in-depth case study of safety communications for SGLT2 inhibitors (2012-2018). • A content analysis of safety advisories issued for new drugs approved in Australia 2010-2016. • Qualitative interviews exploring prescriber awareness and use of medicines safety information (Boston and Australia). Results Differences in regulatory policy among the European Medicines Agency, the US Food and Drug Administration, Health Canada, and the Therapeutic Goods Administration (TGA) included: their legislated authority for safety advisories, transparency, and interactions with pharmaceutical industry. SGLT2 inhibitor safety advice differed among regulators in number, timing, and strength. TGA advisories were issued for 20.5% of 73 safety concerns communicated by other regulators, for new drugs approved in Australia (2010-2016). Differences were not explained by the seriousness of safety concerns. Prescribers’ awareness of regulatory safety advisories was relatively low, particularly in Australia. While respecting regulators’ institutional authority, regulatory warnings may lack clinical authority. Conclusions There are considerable differences amongst the EMA, FDA, Health Canada and the TGA in policy and use of post-market safety advisories. Recommendations for improving safety and policy are discussed

In Silico Strategies for Prospective Drug Repositionings

The discovery of new drugs is one of pharmaceutical research's most exciting and challenging tasks. Unfortunately, the conventional drug discovery procedure is chronophagous and seldom successful; furthermore, new drugs are needed to address our clinical challenges (e.g., new antibiotics, new anticancer drugs, new antivirals).Within this framework, drug repositioning—finding new pharmacodynamic properties for already approved drugs—becomes a worthy drug discovery strategy.Recent drug discovery techniques combine traditional tools with in silico strategies to identify previously unaccounted properties for drugs already in use. Indeed, big data exploration techniques capitalize on the ever-growing knowledge of drugs' structural and physicochemical properties, drug–target and drug–drug interactions, advances in human biochemistry, and the latest molecular and cellular biology discoveries.Following this new and exciting trend, this book is a collection of papers introducing innovative computational methods to identify potential candidates for drug repositioning. Thus, the papers in the Special Issue In Silico Strategies for Prospective Drug Repositionings introduce a wide array of in silico strategies such as complex network analysis, big data, machine learning, molecular docking, molecular dynamics simulation, and QSAR; these strategies target diverse diseases and medical conditions: COVID-19 and post-COVID-19 pulmonary fibrosis, non-small lung cancer, multiple sclerosis, toxoplasmosis, psychiatric disorders, or skin conditions

Biotechnology to Combat COVID-19

This book provides an inclusive and comprehensive discussion of the transmission, science, biology, genome sequencing, diagnostics, and therapeutics of COVID-19. It also discusses public and government health measures and the roles of media as well as the impact of society on the ongoing efforts to combat the global pandemic. It addresses almost every topic that has been studied so far in the research on SARS-CoV-2 to gain insights into the fundamentals of the disease and mitigation strategies. This volume is a useful resource for virologists, epidemiologists, biologists, medical professionals, public health and government professionals, and all global citizens who have endured and battled against the pandemic

The South African community pharmacist and Type 2 Diabetes Mellitus a pharmaceutical care intervention

Type 2 diabetes mellitus is a chronic disease of pandemic magnitude, increasingly contributing to the disease burden of countries in the developing world, largely because of the effects of unhealthy lifestyles fuelled by unbridled urbanisation. In certain settings, patients with diabetes are more likely to have a healthcare encounter with a pharmacist than with any other healthcare provider. The overall aim of the study was to investigate the potential of South African community pharmacists to positively influence patient adherence and metabolic control in Type 2 diabetes. The designated primary endpoint was glycated haemoglobin, with the intermediate health outcomes of blood lipids, serum creatinine, blood pressure and body mass index serving as secondary endpoints. Community pharmacists and their associated Type 2 diabetes patients were recruited from areas throughout South Africa using the communication media of various nonstatutory pharmacy organisations. Although 156 pharmacists initially indicated interest in participating in the study, only 28 pharmacists and 153 patients were enrolled prior to baseline data collection. Of these, 16 pharmacists and 57 patients participated in the study for the full twelve months. Baseline clinical and psychosocial data were collected, after which pharmacists and their patients were randomised, nine pharmacists and 34 patients to the intervention group and 8 pharmacists and 27 patients to the control group. The sample size calculation revealed that each group required the participation of a minimum of 35 patients. Control pharmacists were requested to offer standard pharmaceutical care, while the intervention pharmacists were provided with a scope of practice diabetes care plan to guide the diabetes care they were to provide. Data were again collected 12-months postbaseline. At baseline, proportionally more intervention patients (82.4%) than control patients (59.3%) were using only oral anti-diabetes agents (i.e. not in combination with insulin), while insulin usage, either alone or in combination with oral agents was conversely greater in the control group (40.7%) than in the intervention group (17.6%) (Chi-squared test, p=0.013). Approximately half of the patients (53.8% control and 47.1% intervention) reported having their HbA1c levels measured in terms of accepted guidelines. There was no significant difference in HbA1c between the groups at the end of the study (Independent t-test, p=0.514). In the control group, the mean HbA1c increased from 7.3±1.2% to 7.6±1.5%, while for the intervention patients the variable remained almost constant (8.2±2.0% at baseline and 8.2±1.8% at post-baseline). Similarly, there were no significant differences between the groups with regard to any of the designated secondary clinical endpoints. Adherence to medication and self-management recommendations was similarly good for both groups. There were no significant differences between the two groups for any of the other psychosocial variables measured. In conclusion, intervention pharmacists were not able to significantly influence glycaemic control or therapeutic adherence compared to the control pharmacists

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

Molecular Probes, Chemosensors, and Nanosensors for Optical Detection of Biorelevant Molecules and Ions in Aqueous Media and Biofluids

Synthetic molecular probes, chemosensors, and nanosensors used in combination with innovative assay protocols hold great potential for the development of robust, low-cost, and fast-responding sensors that are applicable in biofluids (urine, blood, and saliva). Particularly, the development of sensors for metabolites, neurotransmitters, drugs, and inorganic ions is highly desirable due to a lack of suitable biosensors. In addition, the monitoring and analysis of metabolic and signaling networks in cells and organisms by optical probes and chemosensors is becoming increasingly important in molecular biology and medicine. Thus, new perspectives for personalized diagnostics, theranostics, and biochemical/medical research will be unlocked when standing limitations of artificial binders and receptors are overcome. In this review, we survey synthetic sensing systems that have promising (future) application potential for the detection of small molecules, cations, and anions in aqueous media and biofluids. Special attention was given to sensing systems that provide a readily measurable optical signal through dynamic covalent chemistry, supramolecular host–guest interactions, or nanoparticles featuring plasmonic effects. This review shall also enable the reader to evaluate the current performance of molecular probes, chemosensors, and nanosensors in terms of sensitivity and selectivity with respect to practical requirement, and thereby inspiring new ideas for the development of further advanced systems