Download Meeting 5

Welcome
To the
Edinburgh University Young Scientific
Researchers Association
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
The Sympathetic Re-Tasking
of Nature
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Evaluation of a pharmacist-led
cardiovascular risk clinic for
patients with diabetes attending a
hospital out-patient clinic at the
Western General Hospital,
Edinburgh
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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%
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Diabetes mellitus
 Two types of DM:
• Type 1 DM
• Type 2 DM
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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.
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Epidemiology of diabetes mellitus
 prevalence of DM is 8.3%
number of diabetic patients worldwide is
estimated to be 366 millions in the year 2011
estimated to increase to 552 million by the year
2030
80% of these diabetic patients live in developing
countries
 183 million people with diabetes are
undiagnosed.
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Epidemiology of diabetes mellitus
 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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Diabetes Complications
 Acute complications
• Polyurea ( frequent urinations)
• Polydipsia (excessive thirst)
• Dehydration
• Weight loss
• Ketoacidosis
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Diabetes complications
 Long term complications
 Macrovascular (damage to the large blood
vessels)
 Microvascular (damage to the small blood
vessels)
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Risk factors for CVD
1) Hypertension
2) Hyperlipidemia
3) Hyperglycemia
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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 annum
Diabetes clinic can treat up to 3.000 patients per
annum
WH Y FOL L OW… WH EN Y OU C A N L EA D !
pharmacist-led cardiovascular risk clinic
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 changes
Patients are discharged when target BP is reached or
when no further changes can be obtained.
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Aim
To 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 clinic
To 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 calculations
To explore the feasibility of including economic
evaluation.
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Method
4) Drug history form
5) Admission data form
6) Medication related incidence form
7) Guidelines adherence form
1) Run queries to generate table to compare
the results.
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Evaluation of a pharmacist-led
cardiovascular risk clinic for
patients with diabetes attending a
hospital out-patient clinic at the
Western General Hospital,
Edinburgh
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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%
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Diabetes mellitus
 Two types of DM:
• Type 1 DM
• Type 2 DM
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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.
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Epidemiology of diabetes mellitus
 prevalence of DM is 8.3%
number of diabetic patients worldwide is
estimated to be 366 millions in the year 2011
estimated to increase to 552 million by the year
2030
80% of these diabetic patients live in developing
countries
 183 million people with diabetes are
undiagnosed.
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Epidemiology of diabetes mellitus
 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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Diabetes Complications
 Acute complications
• Polyurea ( frequent urinations)
• Polydipsia (excessive thirst)
• Dehydration
• Weight loss
• Ketoacidosis
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Diabetes complications
 Long term complications
 Macrovascular (damage to the large blood
vessels)
 Microvascular (damage to the small blood
vessels)
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Risk factors for CVD
1) Hypertension
2) Hyperlipidemia
3) Hyperglycemia
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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 annum
Diabetes clinic can treat up to 3.000 patients per annum
WH Y FOL L OW… WH EN Y OU C A N L EA D !
pharmacist-led cardiovascular risk clinic
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 changes
Patients are discharged when target BP is reached or when no
further changes can be obtained.
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Master project
Retrospective study design
 comparing outcomes for patients attending the pharmacistled 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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Aim
To 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 clinic
To 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 calculations
To explore the feasibility of including economic evaluation.
WH Y FOL L OW… WH EN Y OU C A N L EA D !
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
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Method
4) Drug history form
5) Admission data form
6) Medication related incidence form
7) Guidelines adherence form
1) Run queries to generate table to compare
the results.
WH Y FOL L OW… WH EN Y OU C A N L EA D !
For longevity
Eleanor Drinkwater
WH Y FOL L OW… WH EN Y OU C A N L EA D !
WH Y FOL L OW… WH EN Y OU C A N L EA D !
WH Y FOL L OW… WH EN Y OU C A N L EA D !
$ 41
billion
WH Y FOL L OW… WH EN Y OU C A N L EA D !
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Ranulf Fiennes – climbing
Everest at 65
David Attenborough
presented Frozen Planet at
84
WH Y FOL L OW… WH EN Y OU C A N L EA D !
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Against Longevity
Adelina Manzatneau
WH Y FOL L OW… WH EN Y OU C A N L EA D !
PSYCHOLOGICAL CONSEQUENCES



Older people lack passion
Madness from repetition and predictability
Boredom
WH Y FOL L OW… WH EN Y OU C A N L EA D !
SOCIAL CONSEQUENCES
Cost prohibitive

Unequal access

Overpopulation
The current world population
is 7 billion.
Growth rate is 1.1%.
Imagine if it had been
higher!

WH Y FOL L OW… WH EN Y OU C A N L EA D !
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Other arguments against longevity


Population ageing
Old people have lower memorising and learning
capacity

Pensions crisis

Traffic congestion
WH Y FOL L OW… WH EN Y OU C A N L EA D !
Contact:
[email protected]
Facebook Group: EUYSRA
Social on Friday at Teviot
Room at 34
WH Y FOL L OW… WH EN Y OU C A N L EA D !
In memory of Gerda Merrild: 1923 - 2012
And Bjarne Merrild
WH Y FOL L OW… WH EN Y OU C A N L EA D !