Pharmaceutical consultation as a tool to improve health outcomes for patients with type 2 diabetes

This study develops and evaluates a pharmaceutical consultation program (PCP) to improve treatment for Type 2 diabetes patients (T2DP) and reduce risk factors for diabetic complications with possible application in other chronic diseases. We recruited T2DP receiving conventional medical treatment but with fasting glycemia >140mg/dl and/or glycated hemoglobin >7%. The PCP includes strategies obtained from Dader's method, the PWDT (Pharmacist's Workup of Drug Therapy method) model of pharmaceutical care, the SOAP (Subjective data, Objective data, Assessment, and Plan of care) method, and concepts based on a nursing care model. The PCP evaluated lifestyle, pharmacotherapy and monitoring it using laboratory tests, vital signs, and anthropometry. These procedures were repeated every 4 months for 1 year. Data obtained in each consultation were used to provide patient education focusing on healthy lifestyles and medications. Fifty patients completed the PCP. There were reductions in glycemia (PNeste estudo, desenvolvemos e avaliamos um programa de consulta farmacêutica (PCF) visando melhorar o tratamento de pacientes diabéticos tipo 2 (PDT2) e reduzir os fatores de risco de complicações diabéticas com possibilidade de aplicação em outras doenças crônicas. Para alcançar este propósito, PDT2 recebendo tratamento médico convencional, apresentando glicemia de jejum > 140 mg/dl e/ou hemoglobina glicada >7% foram selecionados. O PCF inclui estratégias obtidas a partir do método de Dader, do modelo de cuidados farmacêuticos PWDT (Pharmacist's Workup of Drug Therapy method), do método SOAP (Subjective data, Objective data, Assessment, and Plan of care) e conceitos baseados em um modelo de cuidados em enfermagem. O PCF avaliou o estilo de vida, farmacoterapia e seu monitoramento através de exames laboratoriais, sinais vitais e antropometria. Estes procedimentos foram repetidos a cada 4 meses durante 1 ano. Os dados obtidos em cada consulta possibilitaram oferecer educação focada no estilo de vida e uso de medicamentos. Para os 50 pacientes que concluiram o PCF houve redução da glicemia (P < 0.0001), hemoglobina glicada (P = 0.0022), colesterolemia (P = 0.0072), triacilgliceridemia (P= 0.0204) e pressão arterial (P < 0.0001). O aumento da concordância e a correção dos problemas relacionados a medicamentos contribuíram para melhoria do tratamento. Assim, podemos concluir que o PCF foi adequado para melhorar a saúde de PDT2 ao reduzir fatores de risco de complicações diabéticas

Comparative performance of lab tests and blood testing device to monitor glucose, total cholesterol and triacylglycerol in type 2 diabetic patients

The performance of lab tests (LT) and blood testing devices (BTD) to monitor glycemia vs. glycated hemoglobin A1c (A1c) were compared. In addition, the performance of blood glucose, total cholesterol (TC) and triacylglycerol measured by LT and BDT were compared. All parameters were measured based on the same blood samples from overnight fasted type 2 diabetic patients (T2DP). Linear regression analysis was used for all comparisons. The results showed that A1c correlated better with LT-glucose (r = 0.58) than BTD-glucose (r = 0.42). Moreover, LT vs. BTD showed r values of 0.90, 0.82 and 0.92 for glucose, TC and triacylglycerol, respectively. It was concluded that the performance of LT-glucose was better than BDT-glucose. Moreover, since triacylycerol and TC measured by BTD correlated better with LT compared to BDT-glucose vs. LT-glucose, the inclusion of BTD-TC and BTD-triacylglycerol for detecting and monitoring hyperlipidemia in T2DP should be considered.Comparou-se a performance de avaliação da glicemia através de dosagens laboratoriais (DL) ou dispositivo para teste de sangue capilar (DTSC) vs. hemoglobina glicada A1c (A1c). Comparou-se ainda a performance de avaliação da glicemia, colesterol total (CT) e triacilglicerol (DL vs. DTSC). Avaliou-se estes parametros a partir das mesmas amostras de sangue coletadas em pacientes diabéticos tipo 2 (PDT2) em jejum noturno, sendo as comparações realizadas através de análise de regressão linear. A A1c correlacionou-se melhor com a glicemia-DL (r = 0,58) em relação a glicemia-DTSC (r = 0,42). Comparou-se DL vs. DTSC obtendo se r = 0,90, 0,82 e 0,92 para glicemia, CT e triacilglicerol, respectivamente. Concluiu-se que houve melhor performance da glicose-DL em relação a glicose-DTSC. Além disso, considerando que o triacilglicerol e TC avaliado através de DTSC correlaciona-se melhor com DL em comparação a DTSC-glicose vs. DL-glicose, a inclusão de DTSC-TC e DTSC-triacilglicerol visando detectar e monitorar hyperlipidemia in PDT2 deve ser considerada

Clusters Of Brazilian Spotted Fever In São Paulo State, Southeastern Brazil. A Review Of Official Reports And The Scientific Literature

[No abstract available]15SUPPL. 2202204Angerami, R.N., Resende, M.R., Feltrin, A.F.C., Brazilian spotted fever: a case series from an endemic area in Southeastern Brazil. Epidemiological aspects (2006) Ann N Y Acad Sci, 1078, pp. 170-172Sexton, D.J., Muniz, M., Corey, G.R., Brazilian spotted fever in Espirito Santo, Brazil: description of a focus of infection in a new endemic region (1993) Am J Trop Med Hyg, 49, pp. 222-226Galvão, M.A.M., Dumler, S., Mafra, C.L., Fatal spotted fever Rickettsiosis, Minas Gerais, Brazil (2003) Emerg Infect Dis, 9, pp. 1402-1405Jones, T.F., Craig, A.S., Paddock, C.D., Family cluster of Rocky Mountain spotted fever (1999) Clin Infect Dis, 28, pp. 853-859Oteo, J.A., Portillo, A., Santibáñez, S., Blanco, J.R., Pérez-Martinez, L., Ibarra, V., Cluster of cases of Rickettsia felis infection from Southern Europe (Spain) diagnosed by PCR (2006) J Clin Microbiol, 44, pp. 2669-267