1. WHY FOLLOW…WHEN YOU CAN LEAD! Welcome Edinburgh University Young Scientific Researchers Association To the

2. WHY FOLLOW…WHEN YOU CAN LEAD! 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

3. WHY FOLLOW…WHEN YOU CAN LEAD! 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

4. WHY FOLLOW…WHEN YOU CAN LEAD! The Sympathetic Re-Tasking of Nature

5. WHY FOLLOW…WHEN YOU CAN LEAD!

6. 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 CollPrincipal Pharmacist, Education, Research and Development, NHS Lothian

7. WHY FOLLOW…WHEN YOU CAN LEAD! 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

8. WHY FOLLOW…WHEN YOU CAN LEAD! 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%

9. WHY FOLLOW…WHEN YOU CAN LEAD! Diabetes mellitus  Two types of DM: Type 1 DM Type 2 DM

10. WHY FOLLOW…WHEN YOU CAN LEAD! 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

11. WHY FOLLOW…WHEN YOU CAN LEAD! 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.

12. WHY FOLLOW…WHEN YOU CAN LEAD! 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.

13. WHY FOLLOW…WHEN YOU CAN LEAD! 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

14. WHY FOLLOW…WHEN YOU CAN LEAD! 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

15. WHY FOLLOW…WHEN YOU CAN LEAD! 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

16. WHY FOLLOW…WHEN YOU CAN LEAD! Diabetes Complications  Acute complications Polyurea ( frequent urinations) Polydipsia (excessive thirst) Dehydration Weight loss Ketoacidosis

17. WHY FOLLOW…WHEN YOU CAN LEAD! Diabetes complications  Long term complications  Macrovascular (damage to the large blood vessels)  Microvascular (damage to the small blood vessels)

18. WHY FOLLOW…WHEN YOU CAN LEAD! 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

19. WHY FOLLOW…WHEN YOU CAN LEAD! 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

20. WHY FOLLOW…WHEN YOU CAN LEAD! Risk factors for CVD 1)Hypertension 2)Hyperlipidemia 3)Hyperglycemia

21. WHY FOLLOW…WHEN YOU CAN LEAD! 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

22. WHY FOLLOW…WHEN YOU CAN LEAD! 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.

23. WHY FOLLOW…WHEN YOU CAN LEAD! 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

24. WHY FOLLOW…WHEN YOU CAN LEAD! 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

25. WHY FOLLOW…WHEN YOU CAN LEAD! 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.

26. WHY FOLLOW…WHEN YOU CAN LEAD! 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

27. WHY FOLLOW…WHEN YOU CAN LEAD! 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.

28. WHY FOLLOW…WHEN YOU CAN LEAD!

29. 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 CollPrincipal Pharmacist, Education, Research and Development, NHS Lothian

30. WHY FOLLOW…WHEN YOU CAN LEAD! 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

31. WHY FOLLOW…WHEN YOU CAN LEAD! 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%

32. WHY FOLLOW…WHEN YOU CAN LEAD! Diabetes mellitus  Two types of DM: Type 1 DM Type 2 DM

33. WHY FOLLOW…WHEN YOU CAN LEAD! 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

34. WHY FOLLOW…WHEN YOU CAN LEAD! 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.

35. WHY FOLLOW…WHEN YOU CAN LEAD! 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.

36. WHY FOLLOW…WHEN YOU CAN LEAD! 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

37. WHY FOLLOW…WHEN YOU CAN LEAD! 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

38. WHY FOLLOW…WHEN YOU CAN LEAD! 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

39. WHY FOLLOW…WHEN YOU CAN LEAD! Diabetes Complications  Acute complications Polyurea ( frequent urinations) Polydipsia (excessive thirst) Dehydration Weight loss Ketoacidosis

40. WHY FOLLOW…WHEN YOU CAN LEAD! Diabetes complications  Long term complications  Macrovascular (damage to the large blood vessels)  Microvascular (damage to the small blood vessels)

41. WHY FOLLOW…WHEN YOU CAN LEAD! 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

42. WHY FOLLOW…WHEN YOU CAN LEAD! 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

43. WHY FOLLOW…WHEN YOU CAN LEAD! Risk factors for CVD 1)Hypertension 2)Hyperlipidemia 3)Hyperglycemia

44. WHY FOLLOW…WHEN YOU CAN LEAD! 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

45. WHY FOLLOW…WHEN YOU CAN LEAD! 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.

46. WHY FOLLOW…WHEN YOU CAN LEAD! 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

47. WHY FOLLOW…WHEN YOU CAN LEAD! 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

48. WHY FOLLOW…WHEN YOU CAN LEAD! 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.

49. WHY FOLLOW…WHEN YOU CAN LEAD! 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

50. WHY FOLLOW…WHEN YOU CAN LEAD! 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.

51. WHY FOLLOW…WHEN YOU CAN LEAD! For longevity Eleanor Drinkwater

52. WHY FOLLOW…WHEN YOU CAN LEAD!

54. $ 41 billion

55. WHY FOLLOW…WHEN YOU CAN LEAD!

56. Ranulf Fiennes – climbing Everest at 65 David Attenborough presented Frozen Planet at 84

57. WHY FOLLOW…WHEN YOU CAN LEAD!

58. Against Longevity Adelina Manzatneau

59. WHY FOLLOW…WHEN YOU CAN LEAD! PSYCHOLOGICAL CONSEQUENCES Older people lack passion Madness from repetition and predictability Boredom

60. WHY FOLLOW…WHEN YOU CAN LEAD! 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!

61. WHY FOLLOW…WHEN YOU CAN LEAD!

62. Other arguments against longevity Population ageing Old people have lower memorising and learning capacity Pensions crisis Traffic congestion

63. WHY FOLLOW…WHEN YOU CAN LEAD! Contact: EUYSRA@gmail.com Facebook Group: EUYSRA Social on Friday at Teviot Room at 34

64. WHY FOLLOW…WHEN YOU CAN LEAD! In memory of Gerda Merrild: 1923 - 2012 And Bjarne Merrild