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Developing a pharmacist-led transition of care programme in the emergency department of a secondary care teaching hospital: a qualitative participatory co-design protocol

Por: Alhmoud · E. · Barazi · R. · Zakaria · A. · Andraous · L. · El Enany · R. · Thomas · B. · Abdulrouf · P. V. · Pathan · S. A. · Nazar · H. · Ibrahim · M. I. M. · Hadi · M. A.
Introduction

Transitions from the emergency department (ED) to home are high-risk periods for medication-related harm. Pharmacist-led interventions during this period may improve medication safety and care continuity, yet co-design approaches to develop such interventions remain underused. The aim of this study is to co-design a pharmacist-led transition of care programme for patients discharged from the ED.

Methods and analysis

This study will be conducted at a 371-bed secondary-care teaching hospital in Qatar and will follow two sequential phases using qualitative and participatory methods. Phase I will involve focus groups and semistructured interviews with key stakeholders (clinical pharmacists, physicians, nurses and patients or patient representatives). Phase II will consist of an intervention co-design workshop with decision makers (leaders, policymakers and representatives from Phase I). Participants will be recruited using purposive and snowball sampling. Interviews will be audio recorded and transcribed verbatim. Data will be analysed using an inductive-deductive approach, guided by the Theoretical Domains Framework, the Care Transitions Framework and the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria for evaluation of intervention feasibility.

The anticipated outcome is a prototype intervention detailing target recipients, core components, workflow, implementation strategies and supporting tools. This prototype will be pilot-tested to assess feasibility and inform further refinement.

Ethics and dissemination

The study was approved by the Medical Research Centre of Hamad Medical Corporation-Qatar (MRC-01-24-699) and Qatar University Institutional Review Board (QU-IRB 009/2025-EM). Written informed consent will be obtained from all study participants prior to participation. Research findings will be disseminated through institutional stakeholder briefings, presentations at national and international scientific conferences and publication in peer-reviewed journals. Patient representatives will contribute throughout the intervention development process.

Random capillary blood glucose in the diagnosis of diabetes: a cross-sectional study in Bangladesh

Por: Bhowmik · B. · Siddiquee · T. · Munir · S. B. · Parvin · S. · Ahmed · T. · Afsana · F. · Pathan · M. F. · Qureshi · N. K. · Mir · A. S. · Islam · R. · Milon · M. S. U. · Chowdhury · R. I. · Ozaki · R. · Ray · D. C. · Chowdhury · S. R. · Aufi · S. S. · Akhtar · S. · Afroz · T. · Samad · M. A
Objective

To assess the effectiveness of random capillary blood glucose as a diagnostic tool for type 2 diabetes and determine optimal cut-off values for adults in Bangladesh.

Design

Cross-sectional diagnostic accuracy study.

Setting

16 diabetes centres were selected randomly from all eight administrative divisions of Bangladesh.

Participants

A total of 3200 adults aged 18 years and older were recruited using systematic random sampling between May and September 2022.

Primary and secondary outcome measures

The primary outcome was the diagnostic accuracy of random capillary blood glucose compared to fasting plasma glucose, 2-hour plasma glucose after a 75-gram glucose load and glycated haemoglobin. Secondary outcomes included sensitivity, specificity, area under the curve and agreement with the other diagnostic tests.

Results

Random capillary blood glucose showed a strong positive correlation and high concordance with fasting plasma glucose, 2-hour plasma glucose and glycated haemoglobin. A cut-off value of ≥8.7 mmol/L demonstrated improved diagnostic performance compared with the currently used cut-off of ≥11.1 mmol/L. This new threshold yielded higher sensitivity, specificity, area under the curve and agreement with other standard diagnostic tests. Notably, hyperglycaemic symptoms were not required for diagnosis. The number needed to screen to identify one case of type 2 diabetes using the ≥8.7 mmol/L cut-off was 2.74, lower than that for fasting plasma glucose (2.86) and random capillary blood glucose ≥11.1 mmol/L (4.68).

Conclusions

Random capillary blood glucose may be an effective and affordable diagnostic tool for type 2 diabetes in resource-limited settings. The proposed cut-off of ≥8.7 mmol/L offers improved diagnostic accuracy and reflects the population’s glucose distribution pattern.

Targeting tumor-associated genes, immune response, and circulating tumor cells in intrahepatic cholangiocarcinoma: Therapeutic potential of <i>Atractylodes lancea</i> (Thunb.) DC

by Pongsakorn Martviset, Pathanin Chantree, Nisit Tongsiri, Tullayakorn Plengsuriyakarn, Kesara Na-Bangchang

Cholangiocarcinoma (CCA) is one of the most aggressive cancers with a poor prognosis. Current treatment strategies involve hepatobiliary surgery, chemotherapy, radiotherapy, and supportive care; however, the success of these treatments remains limited. Therefore, this study investigated the potential of Atractylodes lancea (Thunb) D.C. (AL) in limiting the progress of CCA by targeting the expression of cancer-related genes involved in immune responses and circulating tumor cells. The study was part of Phase 2A clinical trial in advanced-stage intrahepatic iCCA (iCCA) patients: Group 1 (n = 16) received low-dose AL (capsule formulation of the standardized extract of AL: CMC-AL) with standard supportive care, Group 2 (n = 16) received high-dose AL with standard supportive care, and Group 3 (n = 16) received standard supportive care alone. Venous whole blood samples (EDTA, 5 ml) were collected from each patient on Day 1 and Day 90 and the non-CCA subjects (n = 16) on Day 1. Fifty-nine samples (48 and 11 samples for Day 1 and Day 90, respectively) were processed for total RNA isolation. Gene expression was evaluated using reverse transcription followed by a PCR array. Regardless of dosage, gene expression patterns in the AL-treated groups closely resembled those of the healthy subjects. Specifically, cancer-associated genes, including VEGF-A, NR4A3, Ki-67, and EpCAM, were significantly down-regulated. Additionally, the expression levels of immune-related genes were modulated in AL-treated patients. The treatment groups exhibited lower levels of the pro-inflammatory cytokine IL-6, increased expression of the anti-inflammatory cytokine IL-10, and cell-mediated immune-related molecules such as CTLA4 and PFR1. These findings suggest the potential of AL for iCCA treatment. However, additional studies are required to confirm the correlation between gene and protein expression profiles, as well as CTCs profile.
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