Family doctors' attitudes toward peer support programs for type 2 diabetes and/or coronary artery disease: an exploratory survey among German practitioners.

BACKGROUND: Type 2 diabetes (T2D) and coronary artery disease (CAD) are chronic illnesses where adherence to a healthy lifestyle is crucial. If organisational and cultural factors are well managed, Peer support programs (PSP) can improve self-management, quality of life, and health outcomes. In preparation for launching a PSP, we surveyed family doctors (FD) about their attitudes toward such a program and about potential barriers, and facilitators. METHODS: In March 2020 we surveyed 896 FDs from five university teaching practice networks in North-Rhine Westphalia, Germany, via an anonymous web-based survey. The questionnaire addressed details of PSPs, including suitable patients and FDs'role. Data were analysed using descriptive and inferential statistics; qualitative material underwent content analysis by two researchers. RESULTS: A total of 165 FDs responded (response rate: 18.4%), 97% were practice owners. Respondents viewed PSPs positively (T2D: 92.0%, CAD 89.9%), especially for patients with poor self-structuring (82.7%), low motivation (76.3%) and few social contacts (67.6%). On average, FDs were able to identify 4.0 ± 3.2 patients as potential group leaders. Major facilitators reported included motivation by peers (92.5%), exercise (79.1%), and social contacts (70.1%). Waning interest over time (73.1%) and poor motivation (70.9%) were considered barriers. The majority of FDs would recommend PSPs to their patients (89.5%). They considered such a program a valuable addition to current care (79.7%). The percentage of FDs' who expected long-term benefits for their workload was relatively low (37.6%). CONCLUSIONS: In an exploratory survey among German FDs on PSPs, respondents viewed PSPs as a valuable add-on for T2D and CAD patients, while not expecting a positive impact on their workload. Communication with FDs on PSPs may need to highlight anticipated implementation outcomes such as benefits of PSPs to the practice.

Oculomotor integration in patients with a pulvinar lesion.

The pulvinar nucleus of the thalamus, with its connections to visual areas and to frontal and parietal oculomotor cortex, might serve as a nexus for integrating cortical control of voluntary eye movements with reflexive eye movements generated by the superior colliculus. To investigate this hypothesis, we tested five patients with a unilateral lesion of the pulvinar on the oculomotor capture paradigm. In this task, participants have to ignore a distractor item and make a saccade to a target in a visual search display. Results showed that the interference of the distractor was stronger when it was presented contralateral to their lesion compared to when it was presented in the ipsilesional visual field. These findings were confirmed by an additional single case experiment in which we measured saccade trajectory deviations as evoked by a single distractor. These results show that the pulvinar is involved in the successful influence of higher order signals (like our goals and intentions) on the guidance of our eye movements.

Experts' opinions on the profile of optimal care for patients with diabetes mellitus type 2 in the Netherlands.

BACKGROUND: The St. Vincent Declaration has resulted in discussions and initiatives on optimal diabetes care during recent years. Both are based on two sources of knowledge: evidence and experience. We wanted to reveal the experience based knowledge in the Netherlands to identify essential elements or prerequisites for high quality type 2 diabetes care. METHODS: A group of 56 experts on diabetes care were invited to fill in a questionnaire. This included a ranking of 18 elements on the organization of diabetes care and 9 on patient education. RESULTS: The response rate was 87.5%. With regard to the organization of care 'active patient participation', 'protocolized care' and 'patient education' were evaluated as the most important. The integration in daily diabetes care was seen as the most important aspect of patient education. Optimal diabetes patient education would include five sessions (range: 1-10) of 1 h (range: 0.25-3) with active follow-up. The most appropriate disciplines for patient education are the diabetes nurse (chosen by 93% of the experts) and the dietician (77%). CONCLUSIONS: Optimal care for diabetes mellitus type 2 consists of structured care with integrated patient education. The majority of the experts indicated that this is not optimally organized within the Netherlands.

Education integrated into structured general practice care for Type 2 diabetic patients results in sustained improvement of disease knowledge and self-care.

AIMS: The objective of this study was to study the effectiveness of structured care with and without integrated education with regard to patients' knowledge, self-care behaviour and disease perception. METHODS: Four diabetes care programmes implemented in a daily primary care setting were compared, two based on structured care and two on education integrated into structured care. Measurements were taken at baseline and after 6 and 12 months. RESULTS: The study included 243 patients with Type 2 diabetes mellitus treated by a general practitioner (mean age 64.0 years; diabetes duration 7.1 years). The level of patients' disease knowledge increased in all programmes, was preserved at follow-up and differed between programmes with a specific educational component (37%) on one hand and the non-educational programmes (11%) on the other (P < 0.001). The percentage of patients performing self-care behaviour increased in all programmes, but more so in the programmes with an educational component. In addition, an increase in the frequency of self-care behaviour was observed, whereas no change in disease perception was found. In cross sectional analyses disease knowledge and self-care behaviour were positively related (partial correlation coefficient: 0.35; P < 0.001 adjusted for age, sex, level of education and duration of diabetes). CONCLUSIONS: The results indicate that primary care programmes which integrated education into structured care are able to improve both Type 2 diabetic patients' disease knowledge and their self-care behaviour. These improvements endured after the completion of the programmes, which suggests that they initiate lasting changes in the way patients handle their disease.

Management of type 2 diabetes: a challenge for patient and physician.

Type 2 diabetes mellitus is a chronic disease, associated with serious complications and co-morbidity and considerable costs. The number of people with diabetes mellitus is expected to increase with 40% in the next decade, due to prolonged life expectancy, the ageing of the population and developments in the health care sector, including more active screening strategies. The majority (40-60%) of type 2 diabetes patients in routine GP practice have a poor metabolic control (HbA1c > 8% or fasting blood glucose > 11 mmol/l). In this paper the obstacles in routine clinical practice for optimal type 2 diabetes care are discussed. Long-term complications are the major cause of morbidity and mortality in type 2 diabetes patients. Therefore, the primary aim of type 2 diabetes management is the prevention of complications, by lowering blood glucose levels and reducing the cardiovascular risk profile. An important component of type 2 diabetes management is an active role of the patient: diet, smoking habits, physical exercise and self-care behavior often need to change. In addition, the patient has to adhere to life long medical therapy. Motivating the patient for this active role is the challenge for health care providers. A complicating factor is that changes in lifestyle do not give immediate benefit for the patient, as the effects are seen in the reduction of the development of long-term complications. The cornerstones of health care to support active patient participation are: to guarantee the continuity of care, to integrate education in health care and to encourage the patient's attendance. It is the challenge for physicians to give type 2 diabetes patients the tools for active participation in the management of the disease.

[Clinical trial of tramadol by means of the "paired card" system (author's transl)]. / Klinische Prüfung von Tramadol nach dem Paarlingskarten-System.

1. 1-(m-Methoxyphenyl)-2-(dimethylaminomethyl)-cyclohexan-1-ol (tramadol; Tramal) was administered i.v. to patients suffering from pain of various origins. Its efficacy and side effects were compared with those of metamizole and placebo. 2. Tramadol (100 mg) was as effective as metamizole (2.5 mg) and significantly more effective than placebo. 3. All three compounds showed no significant differences in type and number of side effects.

[The effect of tramadol in an open clinical trial (author's transl)]. / Das Analgetikum Tramadol in der offenen klinischen Prüfung.

1. The new analgesic drug 1-(m-methoxyphenyl)-2-(dimethylaminomethyl)-cyclohexan-1-ol (tramadol; Tramal) was administered to a total of 840 patients by i.m. or i.v. injection or in suppository form in an open multi-center trial. The drug was found to be an effective and well-tolerated analgesic. 2. In all three forms of administration more than 80% of the patients treated rated the therapeutic efficacy of tramadol good to very good. In most cases the analgesic effect set in within 30 min and lasted 3--7 h. Tramadol was effective in relieving pain of various origins. 3. Serious side effects were not observed. The most frequent side effect was drowsiness. Transient hot flushes and outbreaks of sweating occurred occasionally following i.v. injection.