why follow…when you can lead! welcome edinburgh university young scientific researchers...

EUYSRA

WHY FOLLOW…WHEN YOU CAN LEAD!

Welcome

Edinburgh University Young Scientific Researchers

Association

To the

EUYSRA


Line Up:

Introduction – Nicholas Groth Merrild

The Sympathetic Re-Tasking of Nature – Dr. Alistair Elfick

Evaluation of a Pharmacist-led Cardiovascular Risk Clinic – Ahmed Alwan

Principia Scientifica (Longevity) – Eleanor Drinkwater vs Adelina Manzateanu

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Research:

Biology – Plant Antibacterial Metabolites, Spiders Web, and Tree Rings

Chemistry – Caffeine levels in Coffee sold

Engineering – Biological Carbon Capture of Exhaust, Spring Energy Storage, Turbo Efficiency and the Arch Cable Bridge

IT – App Development

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The Sympathetic Re-Tasking of Nature

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Evaluation of a pharmacist-led

cardiovascular risk clinic for patients with diabetes attending a hospital out-

patient clinic at the Western General Hospital,

Edinburgh

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Researcher Ahmed Majid Alwan Final year pharmacy student

University of Tromsø, Norway Supervisors Alison Cockburn Clinical supervisor and Lead Diabetes Cardiovascular Risk Pharmacist, NHS Lothian and Honorary Lecturer, University of Strathclyde Moira Kinnear Academic supervisor and Head of pharmacy Educations, Research & Development, NHS Lothian and Honorary Senior Lecturer University of Strathclyde Alison Coll Principal Pharmacist, Education, Research and Development, NHS Lothian

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Diabetes mellitus

A chronic endocrine disorder affecting the metabolism of carbohydrates, proteins and lipids

Impairment in production of insulin with or without insulin resistance

Insulin is a hormone produced by Beta-cells in the pancreas. Insulin facilitate uptake and storage of carbohydrates, proteins and lipids into and the cells

EUYSRA


Diagnosis of Diabetes Mellitus

Easy to perform and inexpensive

Requires a single drop of blood

Fasting blood sugar level > 7mmol/l

at two different occasions

Non-fasting blood sugar level > 11

mmol/l at two different occasions

HbA1c > 7.0%

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Diabetes mellitus

Two types of DM:

• Type 1 DM

• Type 2 DM

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Type 1 DM• Accounts for 5-10 % of patients with

diabetes• Presented at puberty• Destruction of β -cells in the

pancreas which in 90% of the cases is due to autoimmune disease involving T-cell mediated destruction

• Individualised rate of destruction• inadequate insulin secretion

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Type 2 DM• Accounts for 90-95 % of all diabetic patients•More common among adults and obese people • The aetiology is not fully understood• β -cells destruction is not involved. • It is characterised by insulin resistance and inadequate insulin secretion.

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Epidemiology of diabetes mellitus

prevalence of DM is 8.3% number of diabetic patients worldwide is estimated to be 366 millions in the year 2011estimated to increase to 552 million by the year 203080% of these diabetic patients live in developing countries 183 million people with diabetes are undiagnosed.

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Diabetes and chronic diseases in developing countries

Population subjected to uncontrollable marketing for tobacco, alcohol and junk food Governments fail to regulate marketing which leaves the population prone to unhealthy marketing. Expenses of chronic disease treatment is not covered by health plan

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In Scotland the number of patients diagnosed with diabetes is estimated to be more than 228,000 More than 80% of diabetic patients in Scotland have type 2 DM and the number is currently increasing at a rate of 4% per year

at least 4% of the population (32,395 people) have diabetes in Lothian

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The cost of diabetes Accounts for 10% (0.9 billion £) of the NHS UK budget 1 in every 10 hospital admission is caused by DM or long term complications. In 2008, 28.4 million medications for DM treatment were prescribed at a cost of £ 561.4 million Diabetes patients occupy 80,000 bed days per year in the UK Presence of diabetes complications increases the cost of social services by four folds

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Diabetes Complications

Acute complications • Polyurea ( frequent urinations) • Polydipsia (excessive thirst) • Dehydration• Weight loss• Ketoacidosis

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Diabetes complications

Long term complications

Macrovascular (damage to the large blood vessels)

Microvascular (damage to the small blood vessels)

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Macrovascular complications

Cardiovascular disease (CVD):CHD, IHD, Angina, Heart failure and Cardiomyopathy

Peripheral vascular disease (PVD)obstruction of large arteries outside the heart

Cerebrovascular disease (CBVD)Stroke, TIA and subarachnoid haemorrhage

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Microvascular complications

Retinopathy Damage to the eye

Peripheral neuropathy Damages in nerves ( especially the legs and feet) leads to loss of sensations

Nephropathy Damages to the kidneys

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Risk factors for CVD

1)Hypertension

2)Hyperlipidemia

3)Hyperglycemia

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pharmacist-led cardiovascular risk clinic

Established in 2003 within primary and secondary care sites in NHS Lothian Specialises in monitoring and treating patients at high risk of CVD 4 clinics in NHS Lothian working at different capacity Referral criteria is broad Approximately 60 patients referred per annumDiabetes clinic can treat up to 3.000 patients per annum

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Patients referred are considered resistant to treatment The clinic can offer intensive monitoring and frequent follow up ( every 6 weeks) The pharmacist can recommend changes to the prescribed medicine regimen.the GP commences the changesPatients are discharged when target BP is reached or when no further changes can be obtained.

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Evaluation of the pharmacist-led cardiovascular risk clinic

Limited number of journals evaluating the clinic. The journals available indicate great impact of the clinic, reduced BP and lipids and increased adherence. Difficulty in evaluation Complex intervention

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Master project

Retrospective study design comparing outcomes for patients attending the pharmacist-led clinic ( intervention group) and the patients attending the Normal diabetes clinic (control group) Inclusion Criteria: • Patients attended the clinic for at least 4 months • Time interval 2003-2009 •Must have been discharged before 2009 • 3 years follow up post-discharge

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AimTo characterise the diabetic population managed in NHS Lothian To define outcome measures and the feasibility of data collection to inform a future RC prospective study evaluating the clinicTo measure impact of outcome measures such as proportion of patients reaching BP target, proportion of quality standards reached for prescribing and hospital admission after discharge from the clinic to inform future power calculationsTo explore the feasibility of including economic evaluation.

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Method

1)Using SCI-DC to choose 60 patients from the pharmacist-led clinic and 60 from the normal clinic

2)Design a spread sheet to collect data on patient:1)Patient detail form 2)Lab data form 3)Co-morbidities form

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Method

4) Drug history form 5)Admission data form 6) Medication related incidence

form7)Guidelines adherence form

1)Run queries to generate table to compare the results.

EUYSRA


Evaluation of a pharmacist-led

cardiovascular risk clinic for patients with diabetes attending a hospital out-

patient clinic at the Western General Hospital,

Edinburgh

EUYSRA


Researcher Ahmed Majid Alwan Final year pharmacy student

University of Tromsø, Norway Supervisors Alison Cockburn Clinical supervisor and Lead Diabetes Cardiovascular Risk Pharmacist, NHS Lothian and Honorary Lecturer, University of Strathclyde Moira Kinnear Academic supervisor and Head of pharmacy Educations, Research & Development, NHS Lothian and Honorary Senior Lecturer University of Strathclyde Alison Coll Principal Pharmacist, Education, Research and Development, NHS Lothian

EUYSRA


Diabetes mellitus

A chronic endocrine disorder affecting the metabolism of carbohydrates, proteins and lipids

Impairment in production of insulin with or without insulin resistance

Insulin is a hormone produced by Beta-cells in the pancreas. Insulin facilitate uptake and storage of carbohydrates, proteins and lipids into and the cells

EUYSRA


Diagnosis of Diabetes Mellitus Easy to perform and inexpensive

Requires a single drop of blood

Fasting blood sugar level > 7mmol/l at two

different occasions

Non-fasting blood sugar level > 11 mmol/l

at two different occasions

HbA1c > 7.0%

EUYSRA


Diabetes mellitus

Two types of DM:

• Type 1 DM

• Type 2 DM

EUYSRA


Type 1 DM• Accounts for 5-10 % of patients with

diabetes• Presented at puberty• Destruction of β -cells in the

pancreas which in 90% of the cases is due to autoimmune disease involving T-cell mediated destruction

• Individualised rate of destruction• inadequate insulin secretion

EUYSRA


Type 2 DM• Accounts for 90-95 % of all diabetic patients•More common among adults and obese people • The aetiology is not fully understood• β -cells destruction is not involved. • It is characterised by insulin resistance and inadequate insulin secretion.

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prevalence of DM is 8.3% number of diabetic patients worldwide is estimated to be 366 millions in the year 2011estimated to increase to 552 million by the year 203080% of these diabetic patients live in developing countries 183 million people with diabetes are undiagnosed.