[Which patients are (not) included in the DMP diabetes programme?]. / Welche Patienten werden (nicht) in das DMP Diabetes eingeschlossen?

AIM: The disease management programme for diabetes mellitus type 2 (DMP) is joined by many General Practitioners. Aim of the study is to compare patients included in this programme with patients not included and to explore reasons for the selection. METHODS: 10 GPs in Hamburg participated. From each patient list 10 participants in the DMP and the same number of non-participants were randomly selected. HbA1c before start of the programme, presence of insulin therapy, comorbidity and language skills were documented. GPs reported their estimation of the compliance and their reasoning in the selection process. The hypothesis for the primary endpoint was: Diabetics not included have a worse HbA1c value than those included in the DMP. RESULTS: The hypothesis was not confirmed. In both groups similarly good HbA1c values were observed (7.0 in DMP participants, 7.3 in non-participants). The included participants differed from those not included with respect to age (statistically significantly younger) and a better compliance. In the subgroup of patients younger than 70 years the patients included have a better HbA1c and get insulin more frequently (both n. s.). CONCLUSIONS: One part of the patients seems to be not included into the DMP for good reasons. Two questions should be further evaluated: To what extent are patients included although they already have a good metabolic situation? And to what extent are patients with a poor compliance not included, although they might benefit from participation?

[Disease Management Program for diabetes mellitus type 2: cooperation or resistance of the general practitioner]. / DMP Diabetes mellitus Typ 2: kooperation oder widerstand der hausärzte?

AIM: of the study was to seize the attitudes of General Practitioners (GPs) towards the disease management program (DMP) for type 2 diabetes implemented in summer 2003 in Germany. Moreover we were interested in the way GPs realise the program in daily practice, e. g. how many patients and which patients they include. METHOD: A postal questionnaire was sent twice to all GPs in the region of Hamburg (n = 1.230), in November 2003 and in December 2004. Response rate without reminder was 20 respective 16 percent. RESULTS: In 2004 81 percent of the GPs taking part in the survey participate in the DMP. These doctors include a third of their patients with type 2 diabetes into the program. 65 percent of the GPs nevertheless do not believe, that the patients will benefit from the program. 47 percent of the participating GPs object to DMP in general. Only 66 percent say they follow the DMP guidelines for pharmacotherapy. Half of the doctors state they actively canvass patients for the program, while one fifth says they advice patients against participation. The GPs participate in first line to supply the demand of the patients and because of the public pressure less because they think the DMP is good in respect of content. In 2003 critics and pessimism regarding benefit for patients were even stronger than in 2004. CONCLUSIONS: GPs participate in the DMP diabetes half-heartedly and with doubts. The results suggest selections in the inclusion of patients. Further research should find out whether patients being likely to profit from the DMP are systematically not included.

Agar sublimation test for the in vitro determination of the antifungal activity of morpholine derivatives.

We studied the in vitro antifungal activities of a wide range of antimycotic agents, including amorolfine, terbinafine, naftifine, five morpholine derivatives, ciclopiroxolamine, bifonazole, clotrimazole, ketoconazole, itraconazole, fluconazole, voriconazole, flucytosine, amphotericin B, nystatin, and caspofungin, against Candida albicans and Trichophyton rubrum by conventional agar diffusion tests and by a novel sublimation method. For the sublimation method, 6 mm filter paper disks were soaked with defined amounts of antimycotic drugs, air dried, placed in the center of the lids of 9 cm Petri dishes, and incubated upside down with inoculated agar plates 10 mm above the disks. The conventional disk diffusion tests produced inhibition zones as previously described. The disk sublimation tests produced large inhibition zones with amorolfine, five amorolfine derivatives, and terbinafine, but with none of the other antifungal agents. Possible therapeutic advantages of agents, which are able to overcome air cavities in mycotic lesions, e.g. in onychomycosis, are discussed.

Synthesis and spectral characterization of a new class of heterocyclic analogues of crystal violet dyes.

Deep purple: By the transformation of readily available N,N-disubstituted 2-aminothiophenes and 2-aminothiazoles into heterocyclic analogues of Crystal Violet, such as, tris(2-dimethylamino-5-thienyl)methinium prechlorate (cation shown), the series of dyes derived from these heterocyclic structural units as the important chromophoric component is significantly extended and a gap in the class of heteroanalogous triphenylmethane dyes has been closed.