Epidemiological burden of depression and its impact on adherence to oral hypoglycemic agents and related economic outcomes in patients with type 2 diabetes

Presence of depression in patients with type 2 diabetes may affect their adherence to oral hypoglycemics and consequently glycemic control and economic outcomes. These potential effects may be more significant when one considers that depression is highly prevalent in patients with diabetes. This study involved two phases. Phase one of the study examined the epidemiological relationship between depression and type 2 diabetes. Phase two of the study examined the impact of depression on patterns of use and adherence to oral hypoglycemics in newly diagnosed type 2 diabetes patients. Impact of depression on expenditures related to type 2 diabetes and overall health care was also estimated. The study also tested the mediating influence of adherence between depression and type 2 diabetes expenditures. Results of phase one of the study indicated that depression was more prevalent in patients with type 2 diabetes as compared to a control group. Results also indicated that females with depression were more likely to develop type 2 diabetes as compared to those without depression. Phase two results indicated that patients without depression had a more favorable pattern of oral hypoglycemic use with a significantly lower proportion of non-depressed patients switching, augmenting, or discontinuing their oral hypoglycemics as compared to depressed patients. Depressed patients were also found to have significantly lower adherence to oral hypoglycemics as compared to non-depressed patients. Multivariate analyses indicated that patients with depression incurred 21.30% higher type 2 diabetes related costs as compared to non-depressed patients. This difference was primarily due to a higher probability of an ER/hospitalization episode in depressed patients. Similarly, patients with depression had 32.10% higher overall health care costs as compared to patients without depression. Depression was associated with increased costs in all areas of health care such as ER/hospitalization, outpatient, and prescription costs. Mediation analysis indicated that adherence to oral hypoglycemics was not a mediator between depression and type 2 diabetes related expenditures. Thus, depression could have potentially impacted type 2 diabetes related outcomes directly through a physiological effect on glycemic levels or indirectly through its impact on adherence to other behaviors such as diet or exercise

The Impact of an Immunization Training Certificate Program on the Perceived Knowledge, Skills and Attitudes of Pharmacy Students Toward Pharmacy-Based Immunizations

Objective: To assess the impact of a national immunization training certificate program on the perceived knowledge, skills and attitudes of pharmacy students toward pharmacy-based immunizations. Methods: The study design utilized a pre- and post- survey administered to pharmacy students before and after the American Pharmacists Association’s (APhA) Pharmacy-Based Immunization Delivery program. The primary outcome explored was a change in the perceived knowledge, skills, and attitudes of the pharmacy students. A five-point Likert scale (i.e. strongly agree = 5, strongly disagree = 1) was used for measuring the main outcomes, which was summated by adding the individual item scores in each section to form a composite score for each outcome. Results: The certificate training program resulted in a significant improvement in knowledge (38.5% increase in score, p\u3c0.001) and skills (34.5% increase in score, p\u3c0.001), but not attitudes (1% increase in score, p=0.210). Conclusions: The national immunization training certificate program had a positive impact on the perceived knowledge and skills of pharmacy students. However, no change was observed regarding students’ perceived attitudes toward pharmacy-based immunizations

Design and process optimization of a hot embossing machine for microfluidics with high aspect ratios

Thesis: M. Eng. in Manufacturing, Massachusetts Institute of Technology, Department of Mechanical Engineering, 2013.Cataloged from PDF version of thesis.Includes bibliographical references (pages 138-140).Microfluidics is a growing technology in the field of medical diagnostics. Daktari Diagnostics is a startup located in Cambridge, MA that seeks to introduce a lab-on-a-chip device for monitoring HIV in patients. This work investigates hot embossing as a prototyping process for Daktari's microfluidic device. A hot embossing system was designed and built for the purpose of prototyping a critical feature of their microfluidic network. The machine was designed for an embossing area of 6 square inches, and was found to have a maximum positional repeatability of 43 microns. The purpose of this research was to find the capabilities of the system used for hot embossing and optimize the process for maximizing the performance. The system was validated for alignment, measurement procedure and the process control. The measuring procedure was analyzed to find the best possible metric which could serve as a response variable for the performance of the process. The 'Fill ratio' of height and width were chosen as metrics for the experimental design which had precision to tolerance ratios of 0.44 and 0.33 respectively. An analysis of the factors affecting the hot embossing process was carried out using experimental design and the optimal parameters were identified. The tool temperature, pressure and the holding time were the most significant in that order. The Cp for the process with respect to the height fill was found to be 4.71 and for the width fill ratio was found to be 1.97. Using the optimal parameters the process variation of six standard deviations was found to lie within the specification limits. Hot embossing was recommended as a possible method for rapid prototyping of the assay channel and the complete cartridge at Daktari Diagnostics.by Viren Sunil Kalsekar.M. Eng. in Manufacturin

Correlation between adherence rates measured by MEMS and self-reported questionnaires: a meta-analysis

<p>Abstract</p> <p>Purpose</p> <p>It is vital to understand the associations between the medication event monitoring systems (MEMS) and self-reported questionnaires (SRQs) because both are often used to measure medication adherence and can produce different results. In addition, the economic implication of using alternative measures is important as the cost of electronic monitoring devices is not covered by insurance, while self-reports are the most practical and cost-effective method in the clinical settings. This meta-analysis examined the correlations of two measurements of medication adherence: MEMS and SRQs.</p> <p>Methods</p> <p>The literature search (1980-2009) used PubMed, OVID MEDLINE, PsycINFO (EBSCO), CINAHL (EBSCO), OVID HealthStar, EMBASE (Elsevier), and Cochrane Databases. Studies were included if the correlation coefficients [Pearson (r_p) or Spearman (r_s)] between adherences measured by both MEMS and SRQs were available or could be calculated from other statistics in the articles. Data were independently abstracted in duplicate with standardized protocol and abstraction form including 1) first author's name; 2) year of publication; 3) disease status of participants; 4) sample size; 5) mean age (year); 6) duration of trials (month); 7) SRQ names if available; 8) adherence (%) measured by MEMS; 9) adherence (%) measured by SRQ; 10) correlation coefficient and relative information, including p-value, 95% confidence interval (CI). A meta-analysis was conducted to pool the correlation coefficients using random-effect model.</p> <p>Results</p> <p>Eleven studies (N = 1,684 patients) met the inclusion criteria. The mean of adherence measured by MEMS was 74.9% (range 53.4%-92.9%), versus 84.0% by SRQ (range 68.35%-95%). The correlation between adherence measured by MEMS and SRQs ranged from 0.24 to 0.87. The pooled correlation coefficient for 11 studies was 0.45 (p = 0.001, 95% confidence interval [95% CI]: 0.34-0.56). The subgroup meta-analysis on the seven studies reporting r_pand four studies reporting r_sreported the pooled correlation coefficient: 0.46 (p = 0.011, 95% CI: 0.33-0.59) and 0.43 (p = 0.0038, 95% CI: 0.23-0.64), respectively. No differences were found for other subgroup analyses.</p> <p>Conclusion</p> <p>Medication adherence measured by MEMS and SRQs tends to be at least moderately correlated, suggesting that SRQs give a good estimate of medication adherence.</p

Patterns, control and complications of diabetes from a hospital based registry established in a low income country.

Background: Diabetes registry enables practitioners to measure the characteristics and patterns of diabetes across their patient population. They also provide insight into practice patterns which can be very effective in improving care and preventing complications. The aim of this study was to assess the patterns, control levels and complications at the baseline of the patients attending clinic at the large tertiary care hospital in Karachi, Pakistan with the help of the registry. This can be used as a reference to monitor the control and also for a comparison between peer groups. Methods: This was a cross sectional study with the data obtained from diabetes registry collected with the help of pre-designed questionnaire. HbA1c was used as a central diabetes measure and other related factors and complications were assessed with it. Results: Only 16.6% of the participants had optimal HbA1c≤7.0%. 52.9% of the patients were classified as having poor control defined by HbA1c of \u3e8%. Three fourth of the study population were obese according to Asian specific BMI cutoffs and majority had type 2 diabetes with duration of diabetes ranging from less than one to about 35 years, mean(SD) duration being 7.6 years (7.1). Overall only 4% of the patients were on combine target of HbA1c, LDL and BP.Results of multivariable logistic regression showed that the odds of having optimal glycemic control increased by 3% with every one year increase in age. In addition, having longer duration of diabetes was associated with 56% lower odds of having good glycemic control. Moreover, having higher triglyceride levels was associated with 1% lower odds of having good glycemic control. Conclusion: This highlights the large burden of sub optimally controlled people with diabetes in Pakistani population, a low income country with huge diabetes prevalence and ineffective primary health care system creating enormous health and economic burden

Impact of Decmedetomidine on Opioid and Benzodiazepine Dosing Requirements in Children.

Poster presented at: Annual Update on Pediatric Cardiovascular Disease; February 2008; Scottsdale Arizona

A comparison of efficacy of heparin 0.5 unit/ml versus heparin 1 unit/mL in parenteral nutrition administrated in the neonatal population

Abstract from Clinical Nutrition Week, Las Vegas, NV, February 8-10, 2010

Insulin use and persistence in patients with type 2 diabetes adding mealtime insulin to a basal regimen: a retrospective database analysis

BACKGROUND: The objective of this study was to characterize insulin use and examine factors associated with persistence to mealtime insulin among patients with type 2 diabetes (T2D) on stable basal insulin therapy initiating mealtime insulin therapy. METHODS: Insulin use among patients with T2D initiating mealtime insulin was investigated using Thomson Reuters MarketScan(® )research databases from July 2001 through September 2006. The first mealtime insulin claim preceded by 6 months with 2 claims for basal insulin was used as the index event. A total of 21 months of continuous health plan enrollment was required. Patients were required to have a second mealtime insulin claim during the 12-month follow-up period. Persistence measure 1 defined non-persistence as the presence of a 90-day gap in mealtime insulin claims, effective the date of the last claim prior to the gap. Persistence measure 2 required 1 claim per quarter to be persistent. Risk factors for non-persistence were assessed using logistic regression. RESULTS: Patients initiating mealtime insulin (n = 4752; 51% male, mean age = 60.3 years) primarily used vial/syringe (87%) and insulin analogs (60%). Patients filled a median of 2, 3, and 4 mealtime insulin claims at 3, 6, and 12 months, respectively, with a median time of 76 days between refills. According to measure 1, persistence to mealtime insulin was 40.7%, 30.2%, and 19.1% at 3, 6, and 12 months, respectively. Results for measure 2 were considerably higher: 74.3%, 55.3%, and 42.2% of patients were persistent at 3, 6, and 12 months, respectively. Initiating mealtime insulin with human insulin was a risk factor for non-persistence by both measures (OR < 0.80, p < 0.01). Additional predictors of non-persistence at 12 months included elderly age, increased insulin copayment, mental health comorbidity, and polypharmacy (p < 0.05 for all). CONCLUSIONS: Mealtime insulin use and persistence were both considerably lower than expected, and were significantly lower for human insulin compared to analogs