The Obesity Paradox in Type 2 Diabetes Mellitus: Relationship of Body Mass Index to Prognosis: A Cohort Study

The study focused on the issue of type 2 diabetes and the relationship between body mass index. During the study 10,568 patients were followed for an average of 10 years. The study was a prospective cohort and showed very unique trends. It showed that being overweight was associated with a lower mortality and obese patients had similar to that of a normal weight individual. It should be noted that these individuals were all diagnosed with type 2 diabetes. The study found that patients with type 2 diabetes who were overweight or obese were more likely to be hospitalized for cardiovascular reasons. I think it is interesting that those who are considered overweight have a lower mortality and is something that further research could expand upon.

As pharmacists I believe we are on the front lines of treating and identifying patients with type 2 diabetes. While pharmacists cannot prescribe diabetic medications they are often very knowledgeable on how to treat type 2 diabetes and the necessary lifestyle changes that need to be made. They also know the many health issues that often accompany type 2 diabetes. I think shows that diabetes is a spreading epidemic and needs to be confronted head on. Through collaborative care agreements patients would be better to able manage their diabetes since the pharmacist can adjust dosing of diabetic medications that best fit the patients needs. Pharmacist are also great in helping those taking injectable insulin feel more comfortable taking the medication. Pharmacists are also the most accessible healthcare professional and can offer immediate information and help in the treatment of diabetes.

 

http://annals.org.pitt.idm.oclc.org/article.aspx?articleid=2288519

 

Costanzo P, Cleland JG, Pellicori P, Clark AL, Hepburn D, Kilpatrick ES, et al. The Obesity Paradox in Type 2 Diabetes Mellitus: Relationship of Body Mass Index to Prognosis: A Cohort Study. Ann Intern Med. 2015;162:610-618. doi:10.7326/M14-1551

Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice Guideline From the American College of Physicians

This study analyzed nonpharmacological versus pharmacologic treatment of adults with major depressive disorder. More specifically the study compared how treatments such as acupuncture, exercise, yoga, St.John’s wort etc.. worked compared to that of second generation antidepressants. Depressive disorders are a growing concern in the health community since it affects a broad range of patients. In recent years more has been done to try to educate others on depression and possible treatments. The study was done by collecting randomized controlled trials through the years of 1990 through September 2015. The study utilized several databases to find appropriate studies that fit into the desired criteria. After comparing multiple studies, the data concluded that clinicians should choose between cognitive behavioral therapy or second generation antidepressants. The major point was made that the therapy should be picked based on the patient’s lifestyle, desires, and needs.

 

After reading the study and the conclusion of the data I found it refreshing that there are ways to manage Major Depressive Disorder without the use of medications. While as pharmacist our whole business is drugs, but this doesn’t mean we push unnecessary drugs onto our patients. As pharmacists we are obligated to provide the best possible information to patients in order to help them lead healthier lives. I think the big take away point it which therapy is more beneficial and which therapy is a patient more likely to stick with. If a patient is often considered with the possible side effects of antidepressants and doesn’t like the idea of taking a medication. Then if cognitive behavioral therapy has been shown to replicate the same outcomes as a medication then that would be the best course of action for them since they are more likely to stick with it. Overall, I think it’s important to remember that there are other options for certain disease states that require life style changes and may offer the same benefits as a medication.

 

http://annals.org.pitt.idm.oclc.org/article.aspx?articleid=2490527

 

Qaseem A, Barry MJ, Kansagara D, for the Clinical Guidelines Committee of the American College of Physicians. Nonpharmacologic Versus Pharmacologic Treatment of Adult Patients With Major Depressive Disorder: A Clinical Practice

Unfettered Access to Reliable Contraception: Pharmacist Prescription Derails a Definitive Solution

In this article, the author describes the importance of access to birth control and other forms of contraceptives. In the article it makes the argument that often women are bared from obtaining birth control due to the need of prescription or the cost of the medication itself. It talks about how having birth control over the counter would help thousands have better access to birth control. They also argue that monitoring and screening for birth control can be done by the patient alone. It argues that while there is a risk for thrombosis, that risk is relatively low and should not be of concern for women. It also talked about how as study was done that showed women are able to accurately self-screen their own birth control.  The article only referenced one study that showed this which does not confirm this statement for me personally. It then describes how pharmacists in Oregon and California are able to prescribe and dispense contraceptive. It talked about how this was praised as a step in the right direction but the article criticizes the notion stating it was replacing one barrier with another one.

 

While I found the article interesting, and it offered a new perspective I highly disagree with most of the statements made. To begin with I think it is necessary the patients be counseled on birth control and possible side effects they may experience. Also, if a patient could simply purchase birth control over-the-counter there would be no indication in their profile at a pharmacy that indicates they were taking birth control. This creates a risk of pharmacists not being able to properly notify patients that certain medications such as antibiotics, anticonvulsants, mood stabilizers, and antipsychotics decrease the effectiveness of birth control. Which is important information a patient should be alerted to, since their chances of becoming pregnant would increase. The other statement made in the article that having a pharmacist prescribe adds another barrier is another point in which I disagree with. Pharmacists are the most accessible health care professional. Most people live within a few miles of a pharmacy. Meanwhile getting an appointment with your doctor may take weeks or months. Pharmacists can provide direct care for things like birth control in a faster more efficient matter. The article was written by a practicing medical doctor and while I think the authors perspective is important, I think it further shows how many doctors are still uniformed about the benefits that pharmacist can provide.

 

http://annals.org.pitt.idm.oclc.org/article.aspx?articleid=2498494

 

Lawrence HC. Unfettered Access to Reliable Contraception: Pharmacist Prescription Derails a Definitive Solution. Ann Intern Med. [Epub ahead of print 1 March 2016] doi:10.7326/M15-3003

Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

The point of this article focused on the impact of long-term aspirin and the risk of cancer. The study stemmed from the recommendation of the US Preventive Services Task Force that aspirin can be used to help prevent colorectal cancer and cardiovascular disease. The study wanted to address the effectiveness of aspirin in other cancers. In the study they took two large US prospective cohort studies that had over 135,000 participants. The studies were long term and done over many years and accessed medical records to evaluate a patient’s different types of cancers. The study was completed over 32 years. By the end of the study it was found that aspirin can reduce the overall risk, especially in GI cancers.

I think this study was important since aspirin is such a widely utilized and recommended medication by doctors and pharmacists. Aspirin is primarily recommended for heart protection and health, but now shows an even added benefit of cancer prevention. As pharmacists this gives another important tool for showing patients the benefit of taking aspirin on a regular basis. While I think this is an important indication, I do no think there is enough evidence to support aspirin therapy simply for cancer prevention. More research should be done to continue to weigh the pros and cons of aspirin therapy for the prevention of cancer.

 

Cao Y, Nishihara R, Wu K, et al. Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer. JAMA Oncol. Published online March 03, 2016. doi:10.1001/jamaoncol.2015.6396.

http://oncology.jamanetwork.com.pitt.idm.oclc.org/article.aspx?articleid=2497878

What Pediatricians and Other Clinicians Should Know About Zika Virus

The Zika virus is a recent epidemic that has been spreading across parts of Africa and much of South America. The virus has begun spreading at increasing alarming rates and is on its way to become a global health crisis. The issue with the virus is that while it may cause some symptoms in newly infected hosts, it has a large impact on those for women who may become pregnant. The virus can cause birth defects which will influence and often hinder a child’s development. Due to easier global travel the virus is able to spread more quickly and is no longer in isolated geographical location. The virus is often transmitted by mosquitos. There is not current cure of vaccine for the Zika virus, the only prevention and recommendations that have been made are to wear DEET or paricardian containing bug repellant along with long sleeves and long pants.

I think the major issue with the Zika virus is that it will be affecting a whole infant population in certain regions and countries. These regions and countries must then begin to develop programs and allocate appropriate resources for these affected infants as they grow and mature. These issues may place even more stress on areas with low levels of medical care and governmental resources. As healthcare providers I believe it is our job to help educate others and help find possible solutions in the battle against the virus. I think pharmacist would be essential in providing information and care for individuals who have infants affected by the virus.

 

 

http://archpedi.jamanetwork.com/article.aspx?articleid=2496286

 

Kline MW, Schutze GE. What Pediatricians and Other Clinicians Should Know About Zika Virus. JAMA Pediatr. Published online February 18, 2016. doi:10.1001/jamapediatrics.2016.0429.

Oncology Pathways- Preventing a Good Idea From Going Bad

The focus of this article, primarily was to review the possibility and feasibility of having pre-approved pathways when treating certain cancers. Meaning that when a patient is diagnosed with cancer they apply for pre-approved treatment plans for that specific cancer. Medicare have developed piolet programs to see the feasibility of such programs. Overall, these pre-approved pathways would cut down on drug costs for the insurance company. It would decrease the need for the often time consuming process of pre-authorization. Many cancer patients face the issue of having to wait for an insurance company to approve a drug or treatment plan. The process often involves a lot of paper work as the patient needs to prove to the insurer that they need this drug or treatment plan and there are no alternative, cheaper methods. This process often can elongate a treatment for a patient and often influences the overall recovery of a patient. These pathways would also allow for a degree of variation from the pathways at a predefined value such as 20%. Thus, allowing for a degree variation to better serve a specific patient. These plans would also incentivize drug companies to lower the cost of drugs. For example, if two drugs are both shown to be effective in treating a specific cancer but one costs less than the other. Within these set oncological pathways often clinicians would utilize the cheaper drug. Leading drug companies to be competitive when pricing.  Not only does the article talk about the pros of oncology pathways, but it discusses the cons as well.

One of the major cons is who decides what is approved in oncology pathways. Should it be the insurers we create these pathways, or should these pathways be designed by a group of physicians. Another issue presented was should physicians be allowed to utilize pathways that are accepted across all insurers, or should each individual insurer have their own unique approved pathways. The article went in to great detail about how physicians should control these oncology pathways. Yet, I think these pathways would greatly benefit by having input from a wide range of health professionals, including but not limited to pharmacists. More research needs to be done in terms of cost effectiveness of these oncology pathways. But, I think these pathways show promise in how healthcare is moving towards a more patient center focus.

Citation:

Polite BN, Page RD, Nabhan C. Oncology Pathways—Preventing a Good Idea From Going Bad. JAMA Oncol. Published online February 04, 2016. doi:10.1001/jamaoncol.2015.5778.

http://oncology.jamanetwork.com.pitt.idm.oclc.org/article.aspx?articleid=2485187#ArticleInformation