Day 3: Shadowing

I was at St.John Fisher for my third day of shadowing. Dr.Traina and her students met for journal club. They presented three articles. I was reminded of my first day of shadowing with the packets they used to present. Dr.Traina explained that all the students had read the articles but that each student had to pick from the articles to analyze one. All the articles were about a new form of medicine and a study conducted to see how effective this new medicine is. The first article was on insulin pumps and it was called Effectiveness of Sensor-Augmented Insulin-Pump Therapy in Type 1 Diabetes. The purpose of the study was to show that insulin pumps can help improve glycemic control in both adults and children when compared to multiple daily insulin injections. So basically this study was to find an easier and more effective method insulin management for people with Diabetes type one. The study was done on those between seven and seventy years old. Three months previously these patents' daily injections were looked and seen the insulin levels so the glycemic control before were known. Patients who had used a insulin pump in the past three years, used pharmacological non-insulin diabetes treatment in the past three months or were pregnant were excluded from this experiment. There were improvements seen but more in the adults than the children. The presenter decided this wasn't a very good study due to it having more weaknesses than strengths. The insulin pump was changed from the Telemetered Glucose Monitoring System to the MiniLink transmitter. Most of the patients in the study were white. The presenter also found a potential bias in the study due to the data being sent to the sponsor Medtronic, who designed the insulin pump studied. This was the process all the presenters went through there was obviously more in depth information with calculations of hemoglobin Alc levels which in the simplest explanation Dr.Traina could prove is what is used to measure the average glucose concentration. Dr.Traina also drew a pictures to explain the way the insulin pump works which is basically there is a part connected to a person's side that when sugar levels are starting to get low transmits from the sensor to little machine to warn the person that sugar levels are getting low. The other two articles presented were Niacin in Patients with Low HDL Cholesterol Levels Receiving Intensive Statin Therapy and Apixaban versus Warfarin in Patients with Atrial Fibrillation. The first one was a study to test whether adding extended release niacin to statin therapy would reduce the risk of cardiovascular events as compared to statin monotherapy in patients with low HDL levels and small,dense particles of LDL. This was when things got more complicated. The students tried to explain HDL and LDL but although I understood when LDL particles are small and dense are bad I didn't catch much else. So I went online and looked them up. I found that they are different kind of cholesterol. Cholesterol is a soft, waxy fat particle produced by the liver that circulates in the blood. I was on the right track with LDL. LDL stands for low-density lipoprotein and it is what is considered the "bad" cholesterol. HDL stands for high-density lipoprotein and it is considered the "good" cholesterol. So low levels of HDL is bad and can be caused by a generic predisposition, lack of exercise, smoking or obesity. Statins are a class of drugs used to lower cholesterol as the students and Dr.Traina explained. The difference between statin therapy and statin monotherapy is that statin monotherapy uses just one drug while statin therapy is more then one drug. So after going over this study the weaknesses still outweighed the strengths but the not by much. Weaknesses were over 85.2% were men, 92.2% were white and the study was ended too quickly. There wasn't much of a change in any levels with the addition of niacin but if longer there might have been a different result. The strengths were a large number of patients were part of the study and there were no major differences in characteristics between the two study groups. The last article presented compared two drugs, apixaban and warfarin, which both are used to thin blood to prevent strokes. The strengths outweighed the weaknesses in this one. In fact the presenter found only two weaknesses that there was no consort diagram, to see difference in results, and the patients taken out of the study halfway through were not accounted for. There was also sponsorship bias like mentioned with the first article. So day three of shadowing was overall informative. But I am starting to lean away from pharmacy and back to chemical engineering my original career choice. But for now until next time.
Dr.Traina's drawings she used to explain the insulin pump and the readings range it gets are below.

References:
http://www.healthcommunities.com/high-cholesterol/overview-of-high-cholesterol.shtml?c1=GAW_SE_NW&source=GAW&kw=what_is_ldl_and_hdl_cholesterol&cr5=11655462945