Shenzhu Tiaopi granule combined with lifestyle intervention therapy for impaired glucose tolerance: a randomized controlled trial.

OBJECTIVE: The purpose of the study was to evaluate the clinical effects of the Shenzhu Tiaopi granule (SZTP) combined with a lifestyle intervention in patients with impaired glucose tolerance (IGT), who also had a spleen deficiency and damp overabundance syndrome (SDDOS). METHODS: After a one-month washout period, a total of 514 patients were randomly assigned to the control (lifestyle intervention) and experimental (SZTP plus lifestyle intervention) groups, with 257 patients in each group. Patients in the control group received the lifestyle intervention (diet and exercise) for 12 months, while the patients in the experimental group were treated with SZTP plus the lifestyle intervention for 12 months. The Traditional Chinese Medicinal (TCM) symptom scores were observed in each group before and after treatment; the conversion rates from IGT to diabetes mellitus (DM) were also measured. RESULTS: Following 12 months of treatment, the conversion rate from IGT to DM in the experimental group was significantly lower than in the control group (8.52% vs. 15.28%, P<0.05). A significantly higher number of patients with IGT reverted to normal blood glucose levels in the experimental group than in the control group (42.15% vs. 32.87%, P<0.05). In addition, after following the treatment for 12 months, the TCM symptoms of patients in the experimental group were markedly alleviated, as compared to the control group (P<0.01). CONCLUSION: The combination of SZTP and lifestyle intervention showed a reduction in the conversion from IGT to DM, and an increase in the conversion from IGT to normal blood glucose levels.

Are residents more comfortable than faculty members when addressing sociocultural diversity in medicine?

PURPOSE: Sociocultural medicine is a growing curricular area in medical education. Because faculty members and residents will teach these curricula and model these skills in patient care, it is important to assess their attitudes toward diversity. This study examined faculty members' and residents' attitudes toward sociocultural issues in medicine. METHOD: In November 2000, 198 physicians from the Department of Pediatrics at the University of Michigan Medical School completed a questionnaire on demographics and sociocultural attitudes in medicine while they attended a department-wide retreat on cultural competency. A factor analysis of the sociocultural attitudes measure yielded five dimensions accounting for 70% of the variance. These factors included sexual orientation, diversity in professional functions, discussing race/ethnicity in teaching forums, clinical skills, and alternative medicine. RESULTS: Significant differences were found between faculty members and residents for sexual orientation issues (t = 2.76, p <.01) and alternative medicine (t = 2.84, p <.01), with residents endorsing greater comfort in these areas of patient care. When controlling for demographic/background variables, group differences disappeared. Past exposure to multiculturalism emerged as a significant predictor for both sociocultural attitude dimensions. CONCLUSIONS: Findings suggested while residents felt more comfortable than faculty members did with sexual orientation and alternative medicine issues in medicine, attitudes may have been related more to previous diversity education than to seniority of the physician. Integrating diversity education within departments and across the medical education continuum likely benefits all physicians. In the area of sociocultural medicine, both faculty members and residents can offer perspectives valuable to medical students, colleagues, and the larger medical community.

Changing office practice and health care systems to facilitate diabetes self-management.

Diabetes is a self-managed disease for which patients provide 99% of their own care. For patients to succeed as diabetes self-managers, they need office practices and health care systems that can prepare and support them in their diabetes self-management efforts over the long term. In order to provide effective diabetes education and ongoing support, office practices and health care systems will have to fundamentally redefine the roles of health professionals and patients with diabetes, and redesign practices and systems to allow for effective long-term self-management education and support. Although it is difficult for both people and systems to change, change is essential if we are going to provide self-management support for the majority of patients suffering from this serious chronic disease.