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.

Animal mortality and illegal poison bait use in Greece.

The present study describes the use of poison baits against so-called pest species in Greece and explores various aspects of this illegal practice. Data were collected from 2000 to 2016, and a total of 1015 poisoning incidents in rural areas causing the death of 3248 animals were examined. In 58.7% of investigated cases, the motives remained unknown; in the remaining cases, human-wildlife conflicts and retaliatory actions among stakeholders (e.g., hunters vs. livestock breeders) were found to be the main reasons for poison bait use. The target animals for these actions were mainly mammalian carnivores, and stray canids, all of which were blamed for livestock and game losses. Avian scavengers were the wildlife species most affected by secondary poisoning (30% of the wildlife fatalities), whereas shepherd dogs accounted for 66.4% of domestic animal losses. Toxicological analyses showed that a wide range of chemical substances were used, mostly legal or banned pesticides (e.g., carbamates, organophosphates, and organochlorines) and potassium cyanide. Furthermore, the widespread trafficking of black marketed insecticides was also recorded, with methomyl (in powder form) and carbofuran being most common. The majority of poisoning events (72%) took place outside protected areas, while in approximately 73.4% of them, no official reporting to the competent authorities was made. Overall, the study highlights the significant impact of illegal poison bait use on wildlife in Greece and addresses its extreme socioeconomic complexity. The need for an integrated national anti-poison strategy is discussed.