Search

Perla Abigail Alvarado-Vázquez,1 Rachel L Grosick,2 Carolina Moracho-Vilrriales,2 Eileen Ward,2 Tiffaney Threatt,2 Edgar Alfonso Romero-Sandoval3 1Department of Medical Biochemistry and Microbiology, Uppsala University, SE-751 23 Uppsala, Sweden; 2Department of Pharmacy Practice, Presbyterian College School of Pharmacy, Clinton, SC, USA; 3Department of Anesthesiology, Pain Mechanisms Laboratory, Wake Forest University School of Medicine, Winston-Salem, NC, USA Introduction: Monocytes from patients with diabetes mellitus type 2 (DM2) are dysfunctional, persistently primed, and prone to a proinflammatory phenotype. This may alter the phenotype of their differentiation to macrophages and result in diabetic peripheral neuropathy (DPN), nerve damage, nerve sensitization, and chronic pain. We have previously demonstrated that CD163 is a molecule that promotes an anti-inflammatory cellular phenotype in human primary macrophages, but this has not been proven in macrophages from patients with DM2 or DPN. Thus, we hypothesize that macrophages from patients with DM2 or DPN display an altered proinflammatory functional phenotype related to cytokine production and that the induction of CD163 expression will promote a more homeostatic phenotype by reducing their proinflammatory responsiveness.Patients and methods: We tested these hypotheses in vitro using blood monocyte-derived macrophages from healthy subjects and patients with DM2 with and without DPN. Cells were incubated in the presence or the absence of 5 µg/mL of lipopolysaccharide (LPS). The concentrations of interleukin-10, interleukin-6, tumor necrosis factor-alpha (TNF-α), TGF-β, and monocyte chemoattractant protein-1 (MCP-1) were measured using ELISA assays. Macrophages were transfected with an empty vector plasmid or a plasmid containing the CD163 gene using mannosylated polyethylenimine nanoparticles.Results: Our results show that nonstimulated DM2 or DPN macrophages have a constitutive primed proinflammatory state and display a deficient production of proinflammatory cytokines upon a proinflammatory challenge when compared to healthy macrophages. CD163 induction produced an anti-inflammatory phenotype in the healthy control group, and this effect was partial in DM2 or DPN macrophages.Conclusion: Our results suggest that diabetic macrophages adopt a complex phenotype that is only partially reversed by CD163 induction. Future experiments are focused on elucidating this differential responsiveness between healthy and diabetic macrophages. Keywords: primary human macrophages, CD163, transfection, LPS

Jimmy Pruitt III,1 Carolina Moracho-Vilrriales,1,2 Tiffaney Threatt,3 Sarah Wagner,3 Jun Wu,1 E Alfonso Romero-Sandoval1 1Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC, USA; 2Department of Biochemistry and Biotechnology, University of Alcalá de Henares, Madrid, Spain; 3Department of Pharmacy Practice, Presbyterian College School of Pharmacy, Clinton, SC, USA Abstract: Diabetic peripheral neuropathy (DPN) represents significant burdens to many patients and the public health-care system. Patients with diabetes in rural areas have higher risk of developing complications and having less access to proper treatment. We studied a rural population of patients with diabetes who attended a pharmacist-led free clinic for a diabetic education program. Our objectives were to 1) determine the prevalence of DPN and painful diabetic neuropathy (p-DN) in patients with type 2 diabetes; 2) assess the proportion of patients with DPN and p-DN left undocumented upon physician referral to a pharmacist-led free clinic; and 3) determine the appropriateness of pain medication regimen. We performed a retrospective analysis of clinical records of patients from the Presbyterian College School of Pharmacy (PCSP) Wellness Center located in Clinton, SC. Diagnoses of DPN and/or p-DN were obtained from referral notes in the clinical records and compared with results from foot examinations performed in the free clinic and clinical features. Medication regimens were also obtained and compared using American Academy of Neurology (AAN) treatment guidelines. Within our study population (n=111), the prevalence of DPN was 62.2% (national average of 28%–45%) and that of p-DN was 23.4% (national average of 11%–24%). In p-DN patients (n=26), 53.8% (n=14) had a documented diagnosis of p-DN by the referring physician, and 46.2% (n=12) were identified by the pharmacists. A total of 95% (19 of 20) of the patients treated for p-DN received adequate pharmacological agents, though suboptimal as per clinical guidelines. More than 50% of the patients used subtherapeutic doses of their medications. Gabapentin was the most frequently used medication in our population (65.4%). Patients in rural South Carolina had a higher prevalence of DPN and p-DN with >60% undocumented cases of p-DN. More than 95% of treated patients did not receive optimum therapy according to AAN guidelines. Keywords: polysensory neuropathy, pharmacist-led diabetes clinic, diabetes educator, gabapentin, chronic pain free clinic, pain, gabapentin

Objectives: Institutions cite managing the modification in infrastructure, technical support, and process change as substantial barriers to a successful electronic health record (EHR) implementation. In an effort to organize and centralize the complex scheduling, task completion and communication needs of a "big-bang" EHR go-live, we developed a unified communication system with the goal of improving implementation process efficiency. Our goal was to create a platform that would work across the medical enterprise., Materials and Methods: We employed an agile process to design the application, called Hubbl, based on initial requirements and iteratively obtained stakeholder user. The final feature set included role-specific organization, integrated communication, task and content management tooling, and embedded project information retrieval, all embedded into the end user's day to day activities., Results: User enrollment continually increased from launch in February of 2017 through go-live day. During the pre-go-live period, usage increased from an average of 7.37 events/user/day to 18.65 events/user/day with over 97 communications sent across all periods. 5400 unique users accessed tip sheets and information retrieval tools averaged 28.84 searches/user/day during the go-live period with an average high of 46.33 searches/user/day 5 days post-go-live. User access during go-live and post-go-live averaged 12.82 accesses/user/day and decreased from 20.42 average accesses on day one of go live to 14.07 averaged accesses on day 60 of post-go-live with over 727 tasks monitored to completion during all periods., Conclusion: Hubbl was an essential component of our communication, task coordination, and change management strategy, for our EHR go live. Institutions that choose a unified mobile and web-based platform during a substantial IT (information technology) implementation can feasibly ensure task completion, project coordination, and timely information dissemination., (© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Objectives: To describe prescribing patterns of metformin in low-income and Medicaid-insured patients with prediabetes and to identify common demographic characteristics and comorbid conditions of low-income and Medicaid-insured patients receiving metformin for treatment of prediabetes., Design: Retrospective observational study., Setting and Participants: Patients (18-60 years old) who were enrolled in South Carolina Medicaid and diagnosed with prediabetes between January 2009 and December 2013., Main Outcome Measures: Metformin prescribing to treat prediabetes identified from pharmacy claims., Results: Among 7102 patients who met the study criteria, 7.4% (n = 520) were prescribed metformin for prediabetes. Nearly 45% (n = 238) of eligible patients prescribed metformin initiated treatment within 30 days after diagnosis of prediabetes. Twenty-five percent of those prescribed metformin took 280 days or longer to initiate treatment after diagnosis of prediabetes. Older age, black race, managed care plan, comorbid hypertension and obesity, and longer enrollment period significantly increased the likelihood of metformin prescribing to treat prediabetes., Conclusion: Prevalence of metformin prescription to treat prediabetes is less than 8% in low-income and Medicaid-insured patients. Sociodemographic characteristics and comorbid conditions influenced metformin prescribing in the low-income population., (Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Concentrated insulin analogs have recently been approved and are available for clinical use in the management of diabetes mellitus. One new product is insulin glargine U-300 (Sanofi), a basal concentrated insulin of 300 U/mL. Several studies have been conducted and completed evaluating blood samples for the pharmacokinetics of insulin glargine U-300 and euglycemic clamp procedures for the pharmacodynamics. This concentrated insulin has a low within-day variability and high day-to-day reproducibility, allowing for a more constant and prolonged duration of action, compared with insulin glargine U-100 (100 U/mL). Insulin glargine U-300 is equally effective, when compared with insulin glargine U-100 for glycemic control in patients with type 1 and 2 diabetes mellitus. Insulin glargine U-300 has a similar efficacy profile to insulin glargine U-100 for glycemic control, yet with lower rates of nocturnal and severe hypoglycemia. Insulin glargine U-300 can be considered an acceptable basal insulin for patients with type 1 and 2 diabetes mellitus, and it has a potential role among patients who are naïve to insulin therapy or require titration of basal insulin. Titration of insulin glargine U-300 would result in less volume and a lower risk of hypoglycemia, compared with insulin glargine U-100. This article evaluates and summarizes the pharmacokinetics and pharmacodynamics of insulin glargine U-300, for patients with type 1 or 2 diabetes mellitus, and summarizes its application to clinical practice.

Purpose: This article describes the health testing training process used at Presbyterian College School of Pharmacy and evaluates perceptions of the sequential training model among students in their first, second, and third professional years., Educational Activity and Setting: After observing student deficiencies in the knowledge and skills necessary for performing health tests, despite receiving didactic training within the core curriculum, faculty members searched for supplemental training programs used by other schools of pharmacy. No literature regarding structured programs was found. Consequently, faculty developed test-specific training modules for a variety of health screenings. Students who participated in the sequential self-learning followed by a live skills assessment were surveyed to determine their perceptions of the training., Findings: During the 2014-2015 academic year, 78 students successfully completed health testing training modules. Of these students, 56 (72%) completed an attitudinal survey designed to assess their perceptions. Nearly 93% of respondents perceived improved confidence after completing the training. Regardless of the year in pharmacy school, 88% of respondents believe they would not have been adequately prepared to conduct the health test(s) without this training., Summary: Student perception and acceptance of health testing training were positive. Using sequential training modules to teach and reinforce the skills necessary for performing health tests can improve student ability and confidence. Consequently, students have the opportunity to impact the health of the community while becoming practice ready in the area of health testing., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Prediabetes is a high-risk factor for progression to diabetes. Without lifestyle changes, such as weight loss and moderate physical activity, 15%-30% of people with prediabetes are projected to develop type 2 diabetes within 5 years. Progression to diabetes increases the financial burden significantly for patients and health care systems. Populations with low socioeconomic status are associated with a higher risk of diabetes. However, knowledge is limited about the effect of transition to diabetes on future costs incurred in low-income populations., Objectives: To (a) describe the characteristics of low-income and insured patients with prediabetes and (b) examine the effect of progression to type 2 diabetes on health care utilization and costs., Methods: This study used South Carolina Medicaid claims data (2009-2014) to identify patients (aged ≥18 years) with newly diagnosed prediabetes. All patients were enrolled in Medicaid continuously for at least 1 year before and after the diagnosis of prediabetes and were followed for at least 1 year and up to 6 years. The time to progression to type 2 diabetes was measured by a Kaplan Meier curve, and risk factors associated with onset of type 2 diabetes were identified by Cox regression. Generalized linear models were applied to assess the effect of progression to type 2 diabetes on total health care costs during the first 3-year period., Results: A total of 7,650 patients with prediabetes met the study criteria. During the follow-up period, 30.3% of the study population developed type 2 diabetes within 3 years. Older age, African-American race, fee-for-service plan, comorbid hypertension, obesity, and dyslipidemia were associated with higher risk for onset of type 2 diabetes. Compared with patients who did not progress to type 2 diabetes, the progression to type 2 diabetes increased total health care costs by 22.1% (P < 0.001), 39.1% (P < 0.001), and 47.6% (P < 0.001) during the first 3 years after adjusting for demographic and comorbid conditions., Conclusions: Age, race, type of Medicaid plan, and diabetes-related comorbidities were associated with risk for progression of prediabetes. Progression to type 2 diabetes significantly increased total health care costs in the first 3 years. Early detection and intervention to prevent or delay onset of type 2 diabetes are needed to control health care utilization and costs., Disclosures: This study was funded by Small Pharmacy Awards for Research and Collaboration, Presbyterian College. The funding resource had no role in the design and conduct of the study, analysis or interpretation of the data, or the preparation or final approval of the manuscript before publication. The authors declare no conflicts of interest. Study concept and design were contributed by Wu, Ward, and Lu, along with Threatt. Wu took the lead in data collection, along with Ward and Lu, with assistance from Threat. Data interpretation was provided by Wu, Ward, Threatt, and Lu. The manuscript was written and revised by Wu, Ward, and Threatt, along with Lu.

Progress in personal computing has recently permitted small research programs to design and simulate application-specific integrated circuits (ASICs). Inexpensive fabrication of silicon chips can then be obtained using chip foundries, and quite complex circuits can be greatly reduced in size with an accompanying increase in certain performance characteristics. Within the past 5 years it has also become possible to design ASICs which can transmit and receive radio signals and which thus may be employed in applications in which wired connections for input and output of signals are not practicable. We are currently developing research-grade prototype ASICs for the monitoring of human vital signs. In this case one or more sensors placed on an ASIC provides a signal to be transmitted a distance of 2-3 meters to a receiver/display unit. The use of ASIC telesensors provides the possibility of wireless monitoring, including long-term monitoring, with inexpensive and unencumbering devices. Their self-contained nature permits a number of potential uses in future biomedical applications as new sensors are devised which are amenable to deployment on silicon.