Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE).

Objective To compare the effectiveness of insulin pumps with multiple daily injections for adults with type 1 diabetes, with both groups receiving equivalent training in flexible insulin treatment.Design Pragmatic, multicentre, open label, parallel group, cluster randomised controlled trial (Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE) trial).Setting Eight secondary care centres in England and Scotland.Participants Adults with type 1 diabetes who were willing to undertake intensive insulin treatment, with no preference for pumps or multiple daily injections. Participants were allocated a place on established group training courses that taught flexible intensive insulin treatment ("dose adjustment for normal eating," DAFNE). The course groups (the clusters) were then randomly allocated in pairs to either pump or multiple daily injections.Interventions Participants attended training in flexible insulin treatment (using insulin analogues) structured around the use of pump or injections, followed for two years.Main outcome measures The primary outcomes were a change in glycated haemoglobin (HbA1c) values (%) at two years in participants with baseline HbA1c value of ≥7.5% (58 mmol/mol), and the proportion of participants achieving an HbA1c value of <7.5%. Secondary outcomes included body weight, insulin dose, and episodes of moderate and severe hypoglycaemia. Ancillary outcomes included quality of life and treatment satisfaction.Results 317 participants (46 courses) were randomised (156 pump and 161 injections). 267 attended courses and 260 were included in the intention to treat analysis, of which 235 (119 pump and 116 injection) had baseline HbA1c values of ≥7.5%. Glycaemic control and rates of severe hypoglycaemia improved in both groups. The mean change in HbA1c at two years was -0.85% with pump treatment and -0.42% with multiple daily injections. Adjusting for course, centre, age, sex, and accounting for missing values, the difference was -0.24% (-2.7 mmol/mol) in favour of pump users (95% confidence interval -0.53 to 0.05, P=0.10). Most psychosocial measures showed no difference, but pump users showed greater improvement in treatment satisfaction and some quality of life domains (dietary freedom and daily hassle) at 12 and 24 months.Conclusions Both groups showed clinically relevant and long lasting decreases in HbA1c, rates of severe hypoglycaemia, and improved psychological measures, although few participants achieved glucose levels currently recommended by national and international guidelines. Adding pump treatment to structured training in flexible intensive insulin treatment did not substantially enhance educational benefits on glycaemic control, hypoglycaemia, or psychosocial outcomes in adults with type 1 diabetes. These results do not support a policy of providing insulin pumps to adults with poor glycaemic control until the effects of training on participants' level of engagement in intensive self management have been determined.Trial registration Current Controlled Trials ISRCTN61215213.This research was funded by the UK Health Technology Assessment Programme (project No 08/107/01) and will be published in full in Health Technology Assessment. See the HTA programme website for further project information. (http://www.nets.nihr.ac.uk/). This report presents independent research commissioned by the National Institute for Health Research (NIHR). We also acknowledge financial support from the Research and Development Programmes of the Department of Health for England and the Scottish Health and Social Care Directorates who supported the costs of consumables, and of Medtronic UK, which provided the insulin pumps for the trial. These funders had no involvement in the design of the protocol; the collection, analysis, and interpretation of the data; the writing of this paper; or the decision to submit this article for publication. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HTA, NIHR, NHS, the Department of Health, or Medtronic UK

Householders Attitude, Preferences, and Willingness to Have Home Garden at Time of Pandemics

The value of home gardens has become more apparent among tenants forced into isolation in difficult and uncertain times arising since the COVID-19 pandemic started at the beginning of 2020. While gardens make a significant contribution to the social and ecological environment of cities, most studies have focused on public green spaces. Investigating householder preferences for gardens during and after the mandatory lockdown period in the UAE is required. The main objective of this study is to analyze the householder&rsquo;s attitude, preferences, and willingness to have home gardens during the pandemic and after. The data were collected via an online survey of randomly selected respondents. A logistic econometrical model was utilized to analyze the factors affecting respondent preferences regarding having a garden. According to the results, the probability of having a garden increases among respondents who produce some crops, have attained Msc/PhD. level, a backyard, and a larger space to cultivate. It decreases among those who are married, find it hard to take care of a garden, and face a weed problem. In conclusions, it is highly recommended for householders to have home gardens, which can provide a quality lifestyle and enhance leisure time during the pandemic and after

Opioids and Migraine: Opioid Awareness and Frequency of Use among Turkish Migraineurs

Despite the inadequate evidence of effi cacy and safety of opioid use for the treatment of migraine, it has been reported that patients with moderate to severe migraine headaches are prescribed opioids. Migraineurs may experience serious health impacts from opioids such as headache-related disability, psychiatric and cardiovascular comorbidities. The reduction of the risk of opioid abuse and prevention of an opioid epidemic are important public health challenges. The aim of this study was to assess the awareness of opioid therapy for migraine and the frequency of use among Turkish patients with episodic and chronic migraine. Materials and methods: consecutive migraine patients were enrolled in this cross-sectional study. A semi-structured questionnaire was developed and used by the researchers to assess the patients’ awareness of an opiod treatment option and the frequency of use of opioids for migraine treatment. Results. One hundred two patients were enrolled, of which 72 had episodic migraine and 30 had chronic migraine. All subjects reported that they had not been offered or prescribed any kind of opioids by general practitioners and neurologists for their headache. Besides, only 7 % of patients declared that they had heard of opioid treatment for migraine but they had never consulted their doctors about its effects. Conclusions. Our fi ndings demonstrated that opioids were not preferred as an option for acute or preventive migraine treatment by Turkish migraineurs and their physicians. The reduction of opioid prescription will help to prevent the development of medication overuse and opiate-induced headaches and drug addiction

Recent Rrogresses on Solution-Processed Silver Nanowire Based Transparent Conducting Electrodes for Organic Solar Cells

Organic photovoltaics (OPVs) are considered as a future alternative for conventional silicon based solar cells, owing to their low cost, ease of production and high-throughput. The transparent conducting electrode (TCE) is a fundamental component of OPVs. Traditionally, indium tin oxide (ITO) has been mainly utilized as a TCE in OPV applications due to its relatively high transparency and low sheet resistance. However, increasing demand for the optoelectronic devices has led to large fluctuations in ITO prices in the past decade and ITO is known to account more than 50% of the total cost of OPV devices. Thus, it is believed that development of solution-processable alternative materials is of great importance in reducing the cost of OPVs. Numerous materials, including silver nanowires, carbon nanotubes, graphene and conducting polymers, have been offered as replacements for ITO. This article reviews recent progress on fabrication of TCE via solution based coating techniques of silver nanowires (Ag NWs). In addition, performance of the Ag NWs based TCE in OPVs is summarized. Finally, we explore the future outlook for Ag NWs based TCE at the end of the review. © 2017 Elsevier LtdNational Research Foundation of Korea: NRF-2015R1C1A1A02036599 111M510The authors would like to acknowledge the financial support from T?BITAK, Turkey (Grant No: 111M510) and National Research Foundation of Korea, South Korea (NRF-2015R1C1A1A02036599)

Householders Attitude, Preferences, and Willingness to Have Home Garden at Time of Pandemics

The value of home gardens has become more apparent among tenants forced into isolation in difficult and uncertain times arising since the COVID-19 pandemic started at the beginning of 2020. While gardens make a significant contribution to the social and ecological environment of cities, most studies have focused on public green spaces. Investigating householder preferences for gardens during and after the mandatory lockdown period in the UAE is required. The main objective of this study is to analyze the householder’s attitude, preferences, and willingness to have home gardens during the pandemic and after. The data were collected via an online survey of randomly selected respondents. A logistic econometrical model was utilized to analyze the factors affecting respondent preferences regarding having a garden. According to the results, the probability of having a garden increases among respondents who produce some crops, have attained Msc/PhD. level, a backyard, and a larger space to cultivate. It decreases among those who are married, find it hard to take care of a garden, and face a weed problem. In conclusions, it is highly recommended for householders to have home gardens, which can provide a quality lifestyle and enhance leisure time during the pandemic and after

Is a History of Cesarean Section a Risk Factor for Abnormal Uterine Bleeding in Patients with Uterine Leiomyoma?

Objectives: To determine whether a history of cesarean section was a risk factor for abnormal uterine bleeding in patients with uterine leiomyomas, and to identify other risk factors for this symptom. Methods: We analyzed retrospectively, the medical records of patients who underwent hysterectomies due to the presence of uterine leiomyomas during a 6-year period (2009 and 2014) at Etlik Zubeyde Hanim Women’s Health Training and Research Hospital, Ankara, Turkey. Uterine leiomyoma was diagnosed based on histopathological examination of hysterectomy specimens. Demographic characteristics, and laboratory and histopathological findings were compared between patients with uterine leiomyoma with and without abnormal uterine bleeding. Results: In total, 501 (57.9%) patients had abnormal uterine bleeding and 364 (42.1%) patients had other symptoms. A history of cesarean section was more common in patients with abnormal uterine bleeding than in those with other symptoms (17.6% versus 9.3%, p=0.001; odds ratio [OR]: 2.1; 95% confidence interval [CI]: 1.4-3.3). The presence of a submucosal leiomyoma (OR: 2.1; 95% CI: 1.5-3.1) and coexistent adenomyosis (OR: 1.6; 95% CI: 1.1-2.4) were also associated with abnormal uterine bleeding. Conclusion: A history of cesarean section was an independent risk factor for abnormal uterine bleeding in patients with uterine leiomyomas; submucosal leiomyoma and coexisting adenomyosis were also independent risk factors.PubMedWoSScopu

Desmopressin usage in elective cardiac surgery

WOS: 000172821600008PubMed ID: 11698939Background. Desmopressin acetate (DDAVP) has been implicated as a promising agent to reduce blood loss in patients undergoing cardiopulmonary bypass. Methods. The effects of intraoperative desmopressin were studied in 66 patients undergoing coronary artery bypass grafting, randomized equally into desmopressin and control groups. The desmopressin group received 0.3 mug/kg desmopressin at the end of cardiopulmonary bypass. Results. Fibrinogen level of both groups significantly reduced at postoperative 2(nd) hr, whereas a significant rise was observed at postoperative 24(th) hr with an intergroup difference favoring the control group (p=0.0307). In the desmopressin group, the activation time of factor VIII shortened during the whole postoperative period being significant (p=0.0127) at postoperative 24th hr. Postoperative von Willebrand factor (vWF) levels of the desmopressin group were significantly higher than the preoperative ones. The control group did not show such important changes in factor VIII and vWF measurements. Platelet aggregation times of both groups prolonged at postoperative 2nd hr. The control group showed significant elevation in ADP induced aggregation time at 2nd hr and significant reductions of platelet activation percents in response to ADP, epinephrine, collagen and ristocetin at 2nd hr. Postoperative blood loss as well as blood transfusion need did not differ between the two groups. Conclusions. Despite the improved platelet functions, desmopressin does not seem to have obvious beneficial effects on postoperative hemostasis in patients without any bleeding disorder and undergoing elective cardiac surgery