Background and Objectives: Globally, diabetes Mellitus (DM) is a life-threatening disease that, if it remains uncontrolled, can lead to mortality or serious complications. Despite the noticeable benefits of clinical pharmacist in managing diabetes, some institutions in Saudi Arabia are reluctant to establish a pharmacist-led diabetic clinic for monitoring and follow-up. The objective of this study is to assess the glycemic control by comparing the reduction in hemoglobin A1c (HbA1c) percentage between patients followed in the pharmacist-led diabetic clinics vs. those followed in physician-led diabetic clinics. Materials and Methods: A retrospective observational study with a 12-month follow-up were used to detect the difference in the glycemic control by comparing the reduction in HbA1c percentage from the baseline, and average changes in HbA1c, fasting blood glucose (FBG), blood pressure (BP), and lipid panel between the two groups. The level of self-care was assessed by Summary of Diabetes Self-Care Activities (SDSCA) Questionnaire. Results: The study involved 52 patients who visited the diabetic clinic at a community teaching hospital. Exactly 24 patients were followed by the pharmacist-led diabetic clinics, while 28 were followed by physician-led diabetic clinics. HbA1c baseline was 8.7% and 8.4% for pharmacist and physician, respectively. The average difference in HbA1c for the pharmacist-led diabetic clinics vs. the physician-led diabetic clinics was not statistically significant (8.67 vs. 8.56; p = 0.77). Moreover, no difference in the glucose profile, lipid panel, and blood pressure were seen between the two groups. However, the median HbA1c change from baseline between the two groups significantly favored the pharmacist-led clinic (0.7 vs. 0.003; p = 0.04).The average of responses in all four aspects of the SDSCA (diet, exercise, blood sugar testing, and foot care) was also higher among patients in the pharmacist-led diabetic clinic. Conclusions: Pharmacist-led diabetic clinics for glycemic control and follow-up showed efficient results that encourage the comprehensive and integral inter-professional patient care.

Intern assessment during advanced pharmacy practice experiences (APPEs) are generally based upon each individual preceptor’s perceptions without an objective measurement of intern understanding and performance. Therefore, we sought to determine whether a pre- and post-OSCE could be used to confirm that interns achieved the goals and objectives of the Ambulatory Care rotation. The aims of this study were to determine whether a pre-rotation OSCE can help pharmacy interns self-assess their clinical strengths and weaknesses and assess whether their knowledge and skills improved after completing a post-rotation OSCE. Pharmacy interns undergoing APPE Ambulatory Care rotations from September 2018 to March 2020 participated in a pre- and post-rotation OSCE to assess their knowledge of various chronic disease states. Interns completed pre- and post-OSCE surveys to assess their perceptions about their knowledge and the OSCE experience. Pharmacy intern knowledge about diabetes, hypertension, dyslipidemia, and atrial fibrillation significantly improved post-OSCE compared to their pre-OSCE scores (p < 0.001). The mean post-OSCE scores for diabetes (p < 0.001), dyslipidemia (P = 0.046), anticoagulation (P = 0.006), and the overall mean post-OSCE scores (P = 0.005) were significantly higher compared to interns’ pre-OSCE scores. Students believed that the post-OSCE significantly highlighted their strengths and weaknesses in skills and knowledge compared to the pre-OSCE (P = 0.008). Pre- and post-APPE OSCE assessments are important tools that can provide interns and preceptors with objective evaluations of student performance. OSCEs can either be used as an alternative to perception-based assessments or integrated into existing preceptor evaluations. Furthermore, OSCEs can help preceptors identify areas that require more emphasis in their rotations.

Background: Liraglutide, a long-acting glucagon-like peptide-1 receptor agonist (GLP1RA), is a well-established anti-diabetic drug, has also been approved for the treatment of obesity at a dose of 3 mg. There are a limited number of studies in the literature that have looked at changes in metabolite levels before and after liraglutide treatment in patients with obesity. To this end, in the present study we aimed to explore the changes in the plasma metabolomic profile, using liquid chromatography-high resolution mass spectrometry (LC-HRMS) in patients with obesity. Methods: A single-center prospective study was undertaken to evaluate the effectiveness of 3 mg liraglutide therapy in twenty-three patients (M/F: 8/15) with obesity, mean BMI 40.81 ± 5.04 kg/m², and mean age of 36 ± 10.9 years, in two groups: at baseline (pre-treatment) and after 12 weeks of treatment (post-treatment). An untargeted metabolomic profiling was conducted in plasma from the pre-treatment and post-treatment groups using LC-HRMS, along with bioinformatics analysis using ingenuity pathway analysis (IPA). Results: The metabolomics analysis revealed a significant (FDR p-value ≤ 0.05, FC 1.5) dysregulation of 161 endogenous metabolites (97 upregulated and 64 downregulated) with distinct separation between the two groups. Among the significantly dysregulated metabolites, the majority of them were identified as belonging to the class of oxidized lipids (oxylipins) that includes arachidonic acid and its derivatives, phosphorglycerophosphates, N-acylated amino acids, steroid hormones, and bile acids. The biomarker analysis conducted using MetaboAnalyst showed PGP (a21:0/PG/F1alpha), an oxidized lipid, as the first metabolite among the list of the top 15 biomarkers, followed by cysteine and estrone. The IPA analysis showed that the dysregulated metabolites impacted the pathway related to cell signaling, free radical scavenging, and molecular transport, and were focused around the dysregulation of NF-κB, ERK, MAPK, PKc, VEGF, insulin, and pro-inflammatory cytokine signaling pathways. Conclusions: The findings suggest that liraglutide treatment reduces inflammation and modulates lipid metabolism and oxidative stress. Our study contributes to a better understanding of the drug’s multifaceted impact on overall metabolism in patients with obesity.

Background and objectives High-quality documentation is critical in medical settings for providing safe patient care. This study was done with the objective of assessing the standard of medical records in anticoagulation clinics and investigating the distinctions between notes written by pharmacists and physicians. Methods: A retrospective cross-sectional analysis of data from electronic health records (EHRs) was performed on patients who received anticoagulation and were observed at anticoagulation clinics from October to December 2020. Patients were monitored in two anticoagulation clinics, one administered by pharmacists and the other by physicians. The quality of the documentation was assessed using a score, and the note was assigned one of five categories according to its score: very good, good, average, poor, and very poor. The data was analyzed using Stata/SE 13.1. P value<0.05 was considered significant in all analytical tests. Results: A total of 331 patients were included. While 160 patients (48.3%) were followed by the physician-led clinic, 171 (51.6%) were by the pharmacist-led clinic. The average age of the patients was 54 ± 15. 60.73% of them were female, and 90.3% of them were Saudi nationals. Warfarin was the most widely used anticoagulant (70%), followed by rivaroxaban (15.7%). Compared to physicians, pharmacists demonstrated very strong documentation (54% vs. 18%). The examination of the variables considered in the study revealed that physicians had significantly less drug-drug interaction documentation (17 vs. 71 times) or drug-food interaction documentation (23 vs. 71 times) than pharmacists. In terms of follow-up frequency, pharmacists were found to adhere to the clinic protocol (150 times) more frequently than physicians (104 times). However, there was no significant difference in therapeutic plan documentation between the two groups. (p = 0.416). Conclusion: Pharmacists were more comprehensive in their documentation than physicians in anticoagulation clinics. Unified clinic documentation can ensure consistent documentation within EHRs across all disciplines.

Purpose: This study aimed to assess patient activation using patient activation measure 13 (PAM-13) in systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), and axial spondyloarthritis (axSPA). Patients and methods: A cross-sectional study was conducted involving patients with three rheumatological conditions (SLE, PsA, and axSPA). Patients were contacted either at the clinic or through social media platforms. Data, including demographics, PAM 13, Arabic compliance questionnaire for rheumatology (ACQR), and disease-related activity scores, were collected electronically. The analyses included Chi-squared tests, linear regression, and binary logistic regression. Results: Overall, 418 patients were recruited (SLE = 323, PsA = 65, and axSPA = 30), with a mean (±SD) age of 42 ± 11 years and a female predominance (88%). PAM-13 scores did not significantly differ between the rheumatological disorders. Patients with axSPA showed significantly higher compliance than those with SLE or PsA (p = 0.012). In regression models, patients with PsA were more likely to be in activation level 1, with an OR of 2.890 (95% CI: 1.044–8.000, p = 0.0041), whereas patients with axSPA were more likely to be in activation level 4, with an OR of 2.460 (95% CI: 1.122–5.393, p = 0.025). The SLEDAI score was inversely related to the PAM-13 score (Pearson’s correlation coefficient = −0.221, p < 0.001). Conclusions: This study explored the levels of activation and medication compliance in different rheumatological conditions. Larger studies are needed to confirm these findings and explore the challenges and opportunities for improving compliance and activation.