Pharmacist intervention for glycaemic control in the community (the RxING study)

OBJECTIVE: To determine the effect of a community pharmacist prescribing intervention on glycaemic control in patients with poorly controlled type 2 diabetes. DESIGN: Pragmatic, before–after design. SETTING: 12 community pharmacies in Alberta, Canada. PARTICIPANTS: Type 2 diabetes receiving oral hypoglycaemic medications and with glycated haemoglobin (HbA1c) of 7.5–11%.INTERVENTION: Pharmacists systematically identified potential candidates by inviting patients with type 2 diabetes to test their HbA1c using validated point-of-care technology. Pharmacists prescribed 10 units of insulin glargine at bedtime, adjusted by increments of 1 unit daily to achieve a morning fasting glucose of ≤5.5 mmol/L. The patients were followed up at 2, 4, 8, 14, 20 and 26 weeks. PRIMARY OUTCOME: Change in HbA1c from baseline to week 26. SECONDARY OUTCOMES: Proportion of patients achieving target HbA1c, changes in oral hypoglycaemic agents, quality of life and patient satisfaction, persistence on insulin glargine, number of insulin dosage adjustments per patient and number of hypoglycaemic episodes.RESULTS: We screened 365 patients of whom 111 were eligible. Of those, 100 (90%) were enrolled in the study; all 11 patients who did not consent refused to use insulin. Average age was 64 years (SD 10.4), while average diabetes duration was 10.2 years (SD 7). HbA1c was reduced from 9.1% (SD 1) at baseline to 7.3% (SD 0.9); a change of 1.8% (95% CI 1.4 to 2, p<0.001). Fasting plasma glucose was reduced from 11 (SD 3.3) to 6.9 mmol/L (SD 1.8); a change of 4.1 mmol/L (95% CI of 3.3 to 5, p=0.007). Fifty-one per cent of the patients achieved the target HbA1c of ≤7% at the end of the study.CONCLUSIONS: This is the first completed study of independent prescribing by pharmacists. Our results showed similar improvements in glycaemic control as previous physician-led studies. RxING provides further evidence for the benefit of pharmacist care in diabetes

Random walker image registration with inverse consistency

One important property of a registration solution is in-verse consistency. While often overlooked, this property is critical in many medical applications, including radiation-therapy treatment planning and unbiased atlas-construction. In this paper, we propose a novel extension to the graph-based random walker image registration (RWIR) algorithm to ensure its inverse consistency. In contrast to many exist-ing inverse-consistent algorithms, where two bi-directional transformations are independently sought and subsequently averaged, we calculate both transformations simultaneously by performing a constrained graph labeling in a common domain onto which both images are mapped, and employ a set of coupled labels so that both transformations are computed within a single optimization step. As our results on synthetic and real problems involving cardiac, thigh and brain images demonstrate, our method not only improved in-verse consistency of RWIR, but also statistically significantly improved its accuracy. Comparison to another state-of-the-art symmetric algorithm on various datasets also gave highly encouraging results. 1

Use of soy proteins in polyketone-based wood adhesives

This paper describes the preparation of aqueous emulsions consisting of soy proteins and chemically modified thermosetting aliphatic polyketones. Emulsions were prepared in a range of total solids contents and different addition protocols were tested. Room temperature stability and structure of the prepared emulsions were studied as a function of time using dynamic light scattering, rheology, cryo-scanning electron microscopy (Cryo-SEM) and confocal fluorescence microscopy. Emulsions at 4045 wt% total solids content with an average particle size less than 1 μm, and a viscosity less than 1 Pa s could be prepared and were shown to be stable for more than 6 months. Emulsions with protein contents up to 40 wt% with respect to the unmodified polyketone fulfill wood adhesive requirements according to the European Standard EN-314. Confocal fluorescence pictures clearly demonstrate a better penetration of the protein/polyketone adhesive into the wood surface as compared to the one of the adhesive based on polyketones only.

Evaluating the impact of patient-reported outcome measures on depression and anxiety levels in people with multiple sclerosis: a study protocol for a randomized controlled trial

Abstract Background Multiple sclerosis (MS) is a chronic disease affecting multiple functional aspects of patients’ lives. Depression and anxiety are common amongst persons with MS (PwMS). There has been an interest in utilizing patient-reported outcome measures (PROMs) to capture and systematically assess patient’s perceptions of their MS experience in addition to other clinical measures, but PROMs are not usually collected in routine clinical practice. Therefore, this study aims to systematically incorporate periodic electronically administered PROMs into the care of PwMS to evaluate its effects on depression and anxiety. Methods A randomized controlled trial will be conducted with patients allocated 1:1 to either intervention or conservative treatment groups. Patients in the intervention group will complete PROMs at the start of the study and then every 6 months for 1 year, in addition to having their MS healthcare provider prompted to view their scores. The conservative treatment group will complete PROMs at the start of the study and again after 12 months, and their neurologist will not be able to view their scores. For both groups, pre-determined critical PROM scores will trigger an alert to the patient’s MS provider. The difference in change in Hospital Anxiety and Depression Scale score between the intervention and conservative treatment groups at 12 months will be the primary outcome, along with difference in Consultation Satisfaction Questionnaire and CollaboRATE scores at 12 months, and proportion and type of healthcare provider intervention/alerts initiated by different PROMs as secondary outcomes. Discussion This study will determine the feasibility of utilizing PROMs on an interval basis and its effects on the psychological well-being of PwMS. Findings of this study will provide evidence on use of PROMs in future MS clinical practice. Trial registration This trial is registered at the National Institutes of Health United States National Library of Medicine, ClinicalTrials.gov NCT04979546 . Registered on July 28, 2021