Pharmacist Assisted Medication Program Enhancing the Regulation of Diabetes (PAMPERED) study.

OBJECTIVES: To demonstrate that pharmacists working with physicians and other providers in an ambulatory care setting can improve glucose, blood pressure, and lipid control for patients with type 2 diabetes and to report patient adherence to screening and general preventive measures. DESIGN: Prospective, randomized, clinical practice study. SETTING: Burlington, MA, between January 2001 and August 2003. PATIENTS: 164 patients patients with type 2 diabetes older than 18 years with glycosylated hemoglobin (A1C) greater than 8%. INTERVENTION: Pharmacist-patient clinic visits included obtaining a comprehensive medication review; performing targeted physical assessment; ordering laboratory tests; reviewing, modifying, and monitoring patients' medication therapy and providing detailed counseling on all therapies; facilitating self-monitoring of blood glucose; and providing reinforcement of dietary guidelines and exercise. MAIN OUTCOME MEASURE: Effect of clinical pharmacists working with physicians in an ambulatory setting on health measures (e.g., A1C, blood pressure, cholesterol) of patients with diabetes. RESULTS: Baseline characteristics were similar between the two groups. After 1 year, significant improvements occurred for A1C and low-density lipoprotein (LDL) cholesterol in the intervention group compared with the control group (A1C, 7.7% vs. 8.4%; LDL, 93.7 vs. 105.1 mg/dL; P < 0.05). Systolic blood pressure improved for all study patients without a difference between the two groups. Diastolic blood pressure improved significantly in the intervention group compared with the control group (73.4 mm Hg vs. 77.6 mm Hg, P < 0.05). Significantly more intervention patients were screened for retinopathy, neuropathy, and microalbuminuria than control patients ( P < 0.05). CONCLUSION: For all indices measured, this study demonstrated that collaborative diabetes management with a clinical pharmacist can improve overall care.

The influence of natural organic matter on the toxicity of multiwalled carbon nanotubes.

Engineered carbon nanostructures, such as multiwalled carbon nanotubes (MWNTs), are inherently hydrophobic and are not readily stable in aqueous media. However, the aqueous stability and bioavailability of these nanotubes may be influenced by the water quality parameters such as ionic strength, pH, and natural organic matter (NOM). Natural organic matter adsorbs onto the surface of MWNTs, effectively covering the hydrophobic surface and resulting in increased aqueous stability. This enhanced stability is likely to lead to an increased residence time in the water column and increased exposure times for pelagic organisms. In the current study, NOM from three different river systems in the southeast United States increased the stability of MWNT suspensions. The effects of these suspensions were evaluated using acute and chronic bioassays with Daphnia magna and Ceriodaphnia dubia. The 96-h LC50 for D. magna exposed to MWNTs suspended in Suwannee River (USA) NOM was approximately 2.0 mg/L and was not significantly influenced by NOM concentrations ranging from 1.79 to 18.5 mg/L DOC. However, there were differences in 96-h LC50 values among different sources of NOM (Suwannee, Black, and Edisto Rivers, USA). Daphnid growth was reduced in both D. magna and C. dubia, whereas reproduction was reduced in C. dubia. Characterization of the different NOM sources and MWNT suspensions was conducted. Visual inspection using transmission electron microscopy (TEM) and gut elimination observations suggested that the toxicity was attributable to ingested MWNTs clogging the gut tract of D. magna. The TEM micrographs indicated that MWNTs can disaggregate within the gut tract, but single MWNTs are unable to absorb across the gut lumen.