Effects of Lifestyle Intervention Performed by Community Pharmacists on Glycemic Control in Patients with Type 2 Diabetes: The Community Pharmacists Assist (Compass) Project, a Pragmatic Cluster Randomized Trial

Background: Community pharmacists should be involved in diabetes care, while there has been less evidence about whether a brief lifestyle intervention is effective for diabetes care in community pharmacies. Objectives: To examine the effects of brief lifestyle intervention on glycemic control in patients with type 2 diabetes mellitus (T2D) by using a coaching style, provided by community pharmacists. Methods: A prospective, cluster-randomized, controlled trial was conducted in 50 groups of community pharmacies in Japan. In all, 132 patients with T2D (age, 20 - 75 years, ≥8.0% of hemoglobin A1c (HbA1c)) were assigned to the intervention group (n = 90) or the usual care group (n = 42). The intervention group (IG) underwent brief lifestyle coaching for self-care of T2D for 6 months. The standard care group (CG) received usual care by pharmacists and was given a general newsletter. The primary outcome was changes in HbA1c levels. Results: After 6 months, the IG had significantly improved HbA1c (IG: -0.6 ± 0.9 vs. CG: -0.2% ± 0.9%;p = 0.021 using the last observation carried forward analysis). Although the number of drugs reduced from 2.3 ± 0.8 to 2.0 ± 1.2 in the IG, the number increased from 2.3 ± 1.1 to 2.5 ± 1.1 in the CG (-0.2 ± 0.9 in IG vs. 0.2 ± 0.6 in CG;p = 0.023). Conclusions: The brief lifestyle intervention by community pharmacists improved glycemic control in patients with T2D. Community pharmacists may more positively participate as lifestyle coaches for diabetes care.

Efficacy and safety of distal radial approach for cardiac catheterization: A systematic review and meta-analysis

BACKGROUND The traditional radial approach(RA)is recommended as the standard method for coronary angiography(CAG),while a distal RA(DRA)has been recently used for CAG.AIM To assess the efficacy and safety of the DRA vs RA during CAG.METHODS The following databases were searched through December 2020:MEDLINE,the Cochrane Central Register of Controlled Trials,EMBASE,the World Health Organization International Clinical Trials Platform Search Portal,and Clinical-Trials.gov.Individual randomized-controlled trials for adult patients undergoing cardiac catheterization were included.The primary outcomes were the successful cannulation rate and the incidence of radial artery spasm(RAS)and radial artery occlusion(RAO).Study selection,data abstraction and quality assessment were independently performed using the Grading of Recommendations,Assessment,Development,and Evaluation approach.RESULTS Three randomized control trials and 13 registered trials were identified.The two approaches showed similar successful cannulation rates[risk ratio(RR)0.90,95%confidence interval(CI):0.72-1.13].The DRA did not decrease RAS(RR 0.43,95%CI:0.08-2.49)and RAO(RR 0.48,95%CI:0.18-1.29).Patients with the DRA had a shorter hemostasis time in comparison to those with the RA(mean difference-6.64,95%CI:-10.37 to-2.90).The evidence of certainty was low.CONCLUSION For CAG,the DRA would be safer than the RA with comparable cannulation rates.Given the limited data,additional research,including studies with standard protocols,is necessary.

Perinatal veterinary medicine‐related evaluation in hematological and serum biochemical profiles of experimental beagles throughout pregnancy and parturition

Background: The aims of this study were(a) to ascertain age-related changes in the reference values in hematological and serum biochemical examinations of beagles,and(b) to clarify the changes in these findings, including acute phase proteins and oxidative stress, throughout pregnancy and after parturition.Methods: Clinicopathological parameters were measured in young beagles at 6, 9 and 12 months and in adult beagles aged from 24 to 60 months. Likewise, pregnant beagles were investigated throughout the pregnancy and after parturition.Results: Apparent age-related changes were found in erythrocytic parameters during the growth and development of beagles. Most of the parameters(total protein,albumin, blood urea nitrogen, creatinine, urate, alkaline phosphatase(ALP) and creatine kinase(CK) exhibited age-dependent transitions. White cell count significantly increased after 30 days of pregnancy. The values of erythrocytic parameters moderately decreased during the second half of the pregnancy. Triglycerides, total cholesterol, free cholesterol and phospholipid concentrations increased in the mid- and late stages of pregnancy. ALP, lactate dehydrogenase, CK and cholinesterase activities markedly increased during pregnancy and/or after parturition. C-reactive protein(CRP) concentrations gradually increased and reached a maximum after 30-40 days of pregnancy. Serum amyloid A(SAA) levels markedly increased at 30 days of pregnancy before subsiding, and then increased again 3 days after parturition. Reactive oxygen metabolites(d-ROMs) showed significant increases after 30 and 40 days of pregnancy.Conclusions: Reference values for hematological and serum biochemical examinations should be used for health evaluation of dogs, taking sex, age and the stage of pregnancy into consideration. Measurements of CRP, SAA and d-ROM levels are also useful for assessing maternal conditions in mid-pregnancy.

Utility of FibroScan-based scoring systems to narrow the risk group of nonalcoholic fatty liver disease with comorbidities

BACKGROUND Vibration-controlled transient elastography(VCTE)is proposed as a second step of examination to assess liver fibrosis in patients with nonalcoholic fatty liver disease(NAFLD)after triaging by the fibrosis-4(FIB-4)index.Recently,VCTEbased scoring systems,including FibroScan-AST(FAST),Agile 3+,and Agile 4,emerged to determine the status of NAFLD.However,the significance of these scoring systems remains unknown in narrowing the high-risk group of NAFLD patients with comorbidities,including hepatocellular carcinoma(HCC)and esophagogastric varices(EGV).AIM To clarify the significance of VCTE-based scoring systems to narrow the high-risk group of NAFLD patients with comorbidities.METHODS We performed a cross-sectional study to investigate the usefulness of VCTE-based scoring systems and other fibrosis markers to narrow the high-risk group of patients with NAFLD.FIB-4 index was used for the first triage.Risk groups of FAST,Agile 3+,and Agile 4 were stratified according to the published data.Among the 191 patients with NAFLD,there were 26(14%)and 25 patients(13%)with HCC and EGV,respectively.RESULTS When 1.3 was used as a cutoff value,the FIB-4 index narrowed the risk group to 120 patients,in which all patients with HCC and/or EGV were included.High risk group of Agile 3+could subsequently narrow the risk group.The prevalence of HCC and EGV at this step were 33%(26/80)and 31%(25/80),respectively.In further narrowing of EGV,Agile 4 aggregated the patients with EGV into 43 patients,of whom 23(53%)had EGV.FAST failed to narrow the risk group of patients with comorbidities.When 2.6 was used as a cutoff value of the FIB-4 index,three patients with HCC and two patients with EGV were missed at the first triage.CONCLUSION Agile 3+and Agile 4 are useful to narrow the NAFLD patient group,in which patients may have HCC and/or EGV.