1
|
Hermanns N, Ehrmann D, Schall S, Maier B, Haak T, Kulzer B. The effect of an education programme (MEDIAS 2 BSC) of non-intensive insulin treatment regimens for people with Type 2 diabetes: a randomized, multi-centre trial. Diabet Med 2017; 34:1084-1091. [PMID: 28257159 DOI: 10.1111/dme.13346] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 01/04/2023]
Abstract
AIMS A self-management oriented education programme (MEDIAS 2 BSC) for people with Type 2 diabetes who are on a non-intensive insulin treatment regimen was developed. In a randomized, multi-centre trial, the effect of MEDIAS 2 BSC was compared with an established education programme that acted as a control group. METHODS The primary outcome was the impact of MEDIAS 2 BSC on glycaemic control. Secondary outcomes included the incidence of severe hypoglycaemia, hypoglycaemia unawareness, diabetes-related distress, diabetes knowledge, quality of life and self-care behaviour. RESULTS In total, 182 participants were randomized to the control group or MEDIAS 2 BSC [median age 64.0 (interquartile range 58.0-68.5) vs. 63.5 (57.0-70.0) years; HbA1c 62.8 ± 12.7 mmol/mol vs. 63.7 ± 14.0 mmol/mol; 7.9% ± 1.2% vs. 8.0% ± 1.3%]. After a 6-month follow-up, there was a mean decrease in HbA1c of 3.5 mmol/mol (0.32%) in the control group and 6.7 mmol/mol (0.61%) in MEDIAS 2 BSC. After adjusting for baseline differences and study centre, the mean difference between the groups was -3.3 mmol/mol [95% confidence interval (CI) -0.54 to -5.90 mmol/mol] [-0.30% (95% CI -0.05 to -0.54)] in favour of MEDIAS 2 BSC (P = 0.018). There were no increases in severe hypoglycaemia or hypoglycaemia unawareness. The education programmes had no significant effects on psychosocial outcome variables. CONCLUSION MEDIAS 2 BSC was more effective in lowering HbA1c than the control condition. MEDIAS 2 BSC is a safe educational tool that improves glycaemic control without increasing the risk for hypoglycaemia. (Clinical Trials Registry No; NCT 02748239).
Collapse
Affiliation(s)
- N Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Centre Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology of the Otto Friedrich University Bamberg, Bamberg, Germany
| | - D Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology of the Otto Friedrich University Bamberg, Bamberg, Germany
| | - S Schall
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - B Maier
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Centre Mergentheim, Bad Mergentheim, Germany
| | - T Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Centre Mergentheim, Bad Mergentheim, Germany
| | - B Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Diabetes Centre Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology of the Otto Friedrich University Bamberg, Bamberg, Germany
| |
Collapse
|
2
|
Kulzer B, Hermanns N, Maier B, Schall S, Haak T. Effekte des MEDIAS2 BOT+SIT+CT Schulungs- und Behandlungsprogrammes für Menschen mit einem Typ-2-Diabetes und einer nicht-intensivierten Insulintherapie auf HbA1c und Hypoglykämierisiko. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
3
|
Hermanns N, Kulzer B, Maier B, Schall S, Haak T. Indikation zur Teilnahme an dem MEDIAS2 BOT+SIT+CT Schulungs- und Behandlungsprogramm für Menschen mit einem Typ-2-Diabetes und einer nicht-intensivierten Insulintherapie. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
4
|
Schall S, Hermanns N, Kulzer B, Haak T. Einflussfaktoren auf die gesundheitsbezogene Lebensqualität bei Menschen mit Typ-2-Diabetes. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
5
|
Hermanns N, Ehrmann D, Schall S, Kulzer B, Haak T. Entwicklung und Evaluation eines Assessment-Tools zur Erfassung von Barrieren der Blutzuckerselbstkontrolle. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
6
|
Schmitt A, Reimer A, Hermanns N, Schall S, Haak T, Kulzer B. Der Diabetes Self-Management Questionnaire (DSMQ) identifiziert Diabetespatienten mit hohem Risiko einer negativen Prognose. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
7
|
Schall S, Schmitt A, Hermanns N, Query S, Kulzer B, Haak T. Übereinstimmung von selbstberichtetem Behandlungsverhalten und klinisch-medizinischen Außenkriterien. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1375026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
8
|
Arnold L, Schall S, Gäng A, Fassnacht N, Hartter A, Lissandrello J, Schemm A, Gotzmer-Groß A, Kiß B, Keller B, Szagun B. Gesundheit im Bodenseekreis Gesundheitsberichterstattung als Kooperationsprojekt. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1371633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
9
|
He P, Xue K, Chen Q, Murka P, Schall S. A PC-based ultrasonic data acquisition system for computer-aided prosthetic socket design. IEEE Trans Rehabil Eng 1996; 4:114-9. [PMID: 8798078 DOI: 10.1109/86.506408] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A PC-based ultrasound data acquisition system has been developed which uses compound scanning techniques to image a residual limb in a water tank. From the received ultrasonic eco data, the system produces cross-sectional images and reconstructs a three-dimensional (3-D) model of the limb. A commercial software for computer-aided prosthetic socket design was modified so that it can display both the external shape and cross-sectional image of the limb and allow the prosthetist to perform socket design with the help of a visualization of the limb's internal structure. The image resolution and measurement accuracy of the system were tested using a wire phantom and a contrast tissue mimicking phantom, respectively. Preliminary results from amputee patients are presented and the sources of measurement error are discussed.
Collapse
Affiliation(s)
- P He
- Faculty of Biomedical and Human Factors Engineering, Wright State University, Dayton, OH 45435 USA
| | | | | | | | | |
Collapse
|
10
|
Gal P, Ransom JL, Shaffer CL, Smith MS, Carlos RQ, Brown Y, Schall S. Reopening of the ductus arteriosus after closure with indomethacin: importance of sustained effective indomethacin serum concentrations. J Pediatr 1996; 128:719. [PMID: 8627452 DOI: 10.1016/s0022-3476(96)80149-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
11
|
Affiliation(s)
- R Richard
- Miami Valley Hospital Regional Adult Burn Center, Dayton, OH 45409
| | | | | | | |
Collapse
|
12
|
Schall S, Schmidt A. [Dental assistants-continuing education in Munich (8)]. Quintessenz J 1991; 21:711-3. [PMID: 1946972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
13
|
Wiest DB, Pinson JB, Gal PS, Brundage RC, Schall S, Ransom JL, Weaver RL, Purohit D, Brown Y. Population pharmacokinetics of intravenous indomethacin in neonates with symptomatic patent ductus arteriosus. Clin Pharmacol Ther 1991; 49:550-7. [PMID: 2029829 DOI: 10.1038/clpt.1991.65] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The population pharmacokinetics of intravenous indomethacin were investigated with 665 indomethacin serum concentrations from 83 neonates (mean +/- SD: gestational age, 28.8 +/- 2.5 weeks; postnatal age, 5.7 +/- 4.7 days; birth weight, 1.13 +/- 0.40 kg) receiving indomethacin for symptomatic patent ductus arteriosus. A one-compartment open model was used for pharmacokinetic analysis. Hypotheses were tested to determine which developmental and demographic data influenced clearance (CL) and volume of distribution (V(area)). In the final regression equation CL and V(area) were modeled as a function of body weight and postnatal age (PNA) from 0 to 20 days. Final estimates were as follows: CL (ml/hr) = 2.63.weight (kg) + 0.244.PNA (days) and V(area) (L) = 0.28.weight (kg) + 0.0041.PNA (days). The coefficients of variation for interindividual variability in CL and V(area) were 77% and 28%, respectively. Intraindividual variability was 19%. These mean population parameter estimates should prove useful in designing dosage regimens to achieve desired indomethacin concentrations for neonates from 0 to 20 days of age with symptomatic patent ductus arteriosus.
Collapse
Affiliation(s)
- D B Wiest
- Department of Clinical Pharmacy, Medical University of South Carolina, Charleston 29425
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Gal P, Ransom JL, Weaver RL, Schall S, Wyble LE, Carlos RQ, Brown Y. Indomethacin pharmacokinetics in neonates: the value of volume of distribution as a marker of permanent patent ductus arteriosus closure. Ther Drug Monit 1991; 13:42-5. [PMID: 2057990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Indomethacin (INDO) pharmacokinetics were examined in 18 neonates on 19 occasions, before and after patent ductus arteriosus (PDA) closure. Patients received INDO as an initial dose of 0.25 mg/kg intravenously, and INDO serum concentrations were measured 2 and 8 h after the dose. Subsequent doses were individualized based on clinical response, toxicity, and INDO pharmacokinetics. PDA status was confirmed echocardiographically at the start and end of therapy. INDO pharmacokinetic parameters varied from dose-to-dose within the same patient, and wide interpatient variability was also observed. Pre- and post-PDA closure, only INDO volume of distribution differed significantly (p less than 0.001) with mean values of 0.36 (+/- 0.06) L/kg and 0.26 (+/- 0.08) L/kg. The reason for this occurrence remains unclear. However, a new application for pharmacokinetics as a probe of physiology is demonstrated.
Collapse
Affiliation(s)
- P Gal
- Greensboro Area Health Education Center, Moses H. Cone Memorial Hospital, NC 27401
| | | | | | | | | | | | | |
Collapse
|
15
|
Gal P, Ransom JL, Schall S, Weaver RL, Bird A, Brown Y. Indomethacin for patent ductus arteriosus closure. Application of serum concentrations and pharmacodynamics to improve response. J Perinatol 1990; 10:20-6. [PMID: 2313390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Indomethacin dosing for patent ductus arteriosus closure has been standardized despite wide interpatient variability in indomethacin pharmacokinetics. We compared a novel indomethacin dosing approach using individual pharmacokinetic and pharmacodynamic information (group A) with a control group from our institution (group B) and a level 3 university-based intensive care nursery (group C) who were dosed using current dosing guidelines. Permanent patent ductus arteriosus closure was achieved in 27 of 28 (96.4%) group A patients, 10 of 16 (62.5%) group B patients, and 7 of 13 (52.8%) group C patients. Success rates were significantly higher in group A than Groups B and C (P less than .02). Renal toxicity was the only toxicity reported in any group. The major manifestations of renal toxicity, ie, urine output below 1 mL/kg/h or increased serum creatinine by greater than or equal to 0.5 mg/dL, occurred in none of the group A patients but in seven (43.8%) group B and eight (61.5%) group C patients. Renal toxicity was significantly greater in groups B and C than group A (P less than .02). A pharmacodynamic concentration versus response curve was developed and proved predictive of patent ductus arteriosus closure rates in previous studies where indomethacin concentration versus response data were available. Serum concentration monitoring is a valuable adjunct to indomethacin therapy for patent ductus arteriosus closure, especially when a pharmacodynamic approach is used.
Collapse
Affiliation(s)
- P Gal
- Greensboro Area Health Education Center, NC
| | | | | | | | | | | |
Collapse
|
16
|
Abstract
The physiologic correlates of ejection sounds have been studied by simultaneous phonocardiograms, echocardiograms and high fidelity pressure tracings. Ejection sounds associated with semilunar valve stenosis or hypertension of the systemic or pulmonary circulation occur at the moment of complete opening of the aortic or pulmonary valve recorded echocardiographically. The start of opening of these valves occurs at the onset of the pressure rise in the corresponding great vessel and completion of valve opening always occurs on the pressure upstroke. The ejection sound in the presence of stenotic valves occurs with checking of the opening motion of the thickened valve cusps. Although the hypertensive ejection sounds also occur at the precise moment of full opening of the valve it remains to be seen whether this relationship is causal or coincidental.
Collapse
|