Saxagliptin improves glycaemic control and is well tolerated in patients with type 2 diabetes mellitus and renal impairment.

AIM: To evaluate the efficacy and safety of saxagliptin vs. placebo in patients with type 2 diabetes mellitus (T2DM) and renal impairment. METHODS: In this multicentre, randomized, parallel-group, double-blind, placebo-controlled study, patients with glycated haemoglobin (HbA1c) 7-11% and creatinine clearance <50 ml/min were stratified by baseline renal impairment (moderate, severe or end-stage on haemodialysis), and randomized (1 : 1) to saxagliptin 2.5 mg once daily or placebo for 12 weeks. Oral antihyperglycaemic drugs and insulin therapy present at enrolment were continued throughout the study. The absolute change in HbA1c from baseline to week 12 (primary efficacy end-point) was analysed using an analysis of covariance model with last observation carried forward methodology. RESULTS: A total of 170 patients were randomized and treated. The adjusted mean decrease from baseline to week 12 in HbA1c was statistically significantly greater in the saxagliptin group than in the placebo group; the difference between treatments was -0.42% (95% confidence interval: -0.71 to -0.12%, p = 0.007). Adjusted mean HbA1c decreases from baseline to week 12 were numerically greater with saxagliptin than with placebo in the subgroups of patients with moderate (-0.64 vs. -0.05%) and severe (-0.95 vs. -0.50%) renal impairment. HbA1c reductions were similar between saxagliptin and placebo in the subgroup with end-stage renal disease on haemodialysis (-0.84 vs. -0.87%). Saxagliptin was generally well tolerated; incidences of adverse events and hypoglycaemic events were similar to placebo. CONCLUSIONS: Saxagliptin 2.5 mg once daily is a well-tolerated treatment option for patients with inadequately controlled T2DM and renal impairment.

A topography of self-help groups: an empirical analysis.

The current managed health care system creates an environment in which social workers need to be knowledgeable about low-cost interventions. Self-help groups have the potential to be beneficial to social workers' clients. Surprisingly, little is known about the characteristics and activities of many groups and the extent to which groups receive guidance and support from professionals and established national and local organizations. Whereas many social workers are aware of Alcoholics Anonymous (AA), there are thousands of other types of groups that could be helpful to their clients. This study examines the member and group characteristics, professional involvement, and local and national affiliations of 253 self-help groups. Results suggested that many groups have shared leadership, recruit group members, receive assistance from professionals, and receive guidance from national and local organizations. Results are discussed in terms of how social workers can assist and use self-help groups in the current managed health care system.

Collaborative practice teams: from multidisciplinary to interdisciplinary.

The current competitive health care market includes consumers and payers who are demanding that providers demonstrate and validate the effectiveness of their interventions in promoting patient outcomes. Collaboration in the form of interdisciplinary teams is an effective mechanism for enhancing patient outcomes. The CPT acts as the vehicle for driving the outcomes management process. Seven skills used by CPT members enhance collaboration: clinical competence, credibility, consistency, assertiveness, structured meetings, valuing of time, and marketing of the CPT. Change is inevitable, and strategies for change will be useful in achieving the outcomes of carefully planned objectives and goals.

Social support in persons with self-reported sensitivity to chemicals.

Social support was examined in 305 persons with multiple chemical sensitivity using the Personal Resource Questionnaire 85 (PRQ85; Weinert, 1987) and qualitative descriptions of respondents' social interactions. PRQ85 scores were lower than those of healthy populations, but similar to samples with chronic illness. Participants needed but were prevented from receiving support for personal difficulties due to their limited public access, their need for chemical avoidance including fragrances, and others' lack of information and negative attitudes regarding chemical sensitivities. Respondents drew some support and validation from support groups and from romantic relationships. Fatigue level, being in a romantic relationship, contact with a support group on a monthly or more frequent basis, chemical avoidance in the home, gender, and an improved course of illness predicted 19% of the variance for perceived social support. Qualitative data are used to illustrate particular problems of persons in this sample, and suggestions are made for practitioners who encounter this population.

A comparative study on the presence of the asymmetrical tonic neck reflex in adult hemiplegia.

In this study, the intensity of the asymmetrical tonic neck reflex (ATNR) was measured in post-cerebrovascular accident (CVA) adults with hemiplegia and in neurologically intact adults to determine if the reflex exaggerated following CVA. Fourteen subjects with right and left hemiplegia were matched to neurologically intact subjects by age and sex and tested for the ATNR. Intensity of the reflex was measured using electromyography (EMG) biofeedback. The results indicate that no difference exists between the two groups in intensity of the reflex. The method of rotation used to elicit the reflex did significantly affect the strength of the muscle response. A possible explanation for observation of the reflex in the hemiplegic individual's movement and its significance in neuromuscular re-education programs is discussed.