Decision aids for people with Type 2 diabetes mellitus: an effectiveness rapid review and meta-analysis.

AIMS: To perform a rapid review and meta-analysis of randomized controlled trials (RCTs) evaluating patient decision aids (PtDAs) for people with Type 2 diabetes mellitus. METHODS: We searched Medline and the Cochrane Library for RCTs assessing PtDAs in people with Type 2 diabetes. PtDAs were defined as tools designed to help people engage in decision-making about healthcare options, such as making treatment choices or setting therapeutic goals. The study selection process was facilitated by an automated screening tool to identify RCTs. We classified outcomes into seven domains and conducted meta-analyses using random effects models. RESULTS: We included a total of 15 studies, nine of which were cluster RCTs, that evaluated 10 PtDAs. Thirteen trials compared a PtDA with usual care or usual care plus educational material, whereas two RCTs compared individually tailored vs. non-tailored PtDAs. Meta-analyses showed a favourable effect of PtDAs compared with usual care in reducing decisional conflict [weighted mean difference (WMD) -4.66, 95% confidence interval (CI) -7.93 to -1.39] and in improving knowledge (WMD 20.46, 95% CI 9.13 to 3.77). Use of PtDAs resulted in more active involvement in decision-making during the consultation, although no effect was evident in terms of glycaemic control or self-reported medication adherence. CONCLUSIONS: PtDAs for people with Type 2 diabetes can improve the quality of decision-making and increase knowledge transfer. Interpretation of our findings is attenuated due to limitations related to the rapid review approach, including searching only two databases and performing data extraction and risk of bias assessment by a single reviewer.

Feeding behavior and an oropharyngeal component of satiety in a two-headed snake.

We studied the feeding behavior of a dicephalous Black Rat Snake (Elaphe o. obsoleta) whose heads attack and ingest prey independently. Both heads were given satiation feedings with mouse prey at either 5-day intervals (1989, n = 16 feedings) or 9-11 day intervals (1990, n = 4 feedings). In 1989, a meal pattern was manifested as a negative correlation between total (left + right) meal size (g) and total size of the last meal. Meal sizes of the heads were consistently different (L > R) despite their apparently identical genotypes. We confirmed tongue-flicking rate and swallowing time as indices of satiety/hunger in each head. In order to test whether oropharyngeal stimulation is involved in satiation, we analyzed three measures: willingness to feed, and intrameal changes in swallowing, and tongue-flicking rates. Data for these tests were taken from experimental feedings in which one head was fed to satiation (first head) before the other head (second head) was fed. The second head generally did eat (8 of 10 experimental feedings) after the first head had become satiated. In addition, while the time to swallow a mouse generally increased as the snake neared satiety, swallowing time decreased significantly (p = 0.04) from the first head's last mouse to the second head's first mouse. Finally, in two of three feedings, the first head's tongue-flicking rate decreased before the second head's. These results, which take advantage of this unique animal, indicate that oropharyngeal stimulation is involved in meal termination.

[Nonocclusive vascular insufficiency of the bowel (author's transl)]. / Die funktionelle intestinale Perfusionsischämie.

The particular problems of nonocclusive mesenteric vascular insufficiency are discussed on the basis of reports in the literature and 4 patients observed by the authors. Diminution in splanchnic blood flow as a manifestation of splanchnic compensation to low cardiac output seems to be the most common cause. The symptoms are described and the necessity for early diagnosis and immediate treatment are stressed. Our results of treatment in 4 patients with nonocclusive mesenteric vascular insufficiency are presented.