Prädiktiver Wert eines Scores über die Selbstbehandlungskompetenz von Patienten mit Diabetes mellitus Typ 1 und Typ 2 am Endes eines strukturierten Behandlungs- und Schulungsprogramms mit Insulintherapie

Eine Therapie des Diabetes mellitus erfordert die Abstimmung von Ernährung, körperlicher Aktivität und Diabetesmedikamenten bzw. der restlichen eigenen Insulinsekretion. Eine erfolgreiche Behandlung ist nur möglich, wenn der Patient selbst aktiv in die Behandlung einbezogen wird und die persönlichen Ziele des Patienten bei der Behandlung berücksichtigt werden. Die Fähigkeit zur Selbstbehandlung erwirbt der Patient in zielgruppenspezifischen Behandlungs- und Schulungsprogrammen. Diese werden von speziell dafür ausgebildetem Personal durchgeführt, von Diabetesassistent/-in und Diabetesberater/-in. Der Erfolg eines solchen strukturierten Programms kann kurzfristig durch Wissenstests und/oder eine praktische Überprüfung von Fähigkeiten und Fertigkeiten am Ende des Programms gemessen werden. Mittelfristige Erfolge können an der Behandlungszufriedenheit, der diabetesbezogenen Lebensqualität, der Inzidenz von schweren Hypoglykämien oder Ketoazidosen/Komata und an den Surrogatparametern glykiertes Hämoglobin A1c und Blutdruck gemessen werden. Langfristige Behandlungserfolge sind die Verminderung von diabetesbedingten Folgeerkrankungen und die Verminderung der Lebensverkürzung

Was tun, damit die Kooperation von Jugendhilfe und Schule gelingt? Ergebnisse einer Befragung von Fachkräften der Kinder- und Jugendhilfe sowie von Lehrern und Lehrerinnen an ausgewählten Schulen im Rahmen des Modellprojektes: "Praxisentwicklung durch Fortbildung: Qualifizierte Kooperation von Jugendhilfe und Schule im (Vor-)Feld von Hilfen zur Erziehung"

"Der vorliegende Bericht dokumentiert die Ergebnisse einer Befragung zu Kooperationserfahrungen und Fortbildungsbedarfen an der Schnittstelle von Jugendhilfe und Schule. In die Befragung einbezogen wurden Fachkräfte öffentlicher und freier Träger der Jugendhilfe sowie Lehrerinnen und Lehrer ausgewählter Schulen in drei rheinland-pfälzischen Gebietskörperschaften. Hintergrund der Befragung ist die Konzeption eines Modellprojektes, das über gemeinsame Fortbildungen für Jugendhilfe und Schule auf die Qualifizierung von Kooperation und regionale Praxisentwicklung an den Schnittstellen beider Institutionen zielt. Mit Hilfe dieser Befragung sollten die wechselseitigen Kooperationserfahrungen abgebildet und die konkreten Fortbildungsbedarfe der Fach- und Lehrkräfte erhoben werden, um die Modellprojektkonzeption möglichst nahe an den örtlichen Fragestellungen ansetzen zu lassen." (Textauszug

Metabolic Control, Diabetic Complications and Drug Therapy in a Cohort of Patients with Type 1 and Type 2 Diabetes in Secondary and Tertiary Care between 2004 and 2019

This paper studies the features of metabolic parameters, diabetic complications and drug therapy of a single-centre cohort of patients with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) in secondary care and tertiary care over a 15-year period. Methods: Retrospective cross-sectional analysis of four single-centre cohorts between 2004 and 2019. All patients with T1DM or T2DM in secondary care ( n = 5571) or tertiary care ( n = 2001) were included. Statistical analyses were performed using linear mixed models. Results: Diabetes duration increased in both patients with T1DM and T2DM in secondary care and tertiary care ( p < 0.001). Patients in secondary care consistently showed good glycaemic control, while patients in tertiary care showed inadequate glycaemic control. All four cross-sectional cohorts showed a significant increase in the prevalence of nephropathy over time and three out of four cohorts (T1DM and T2DM in secondary care and T2DM in tertiary care) showed an increase in the prevalence of neuropathy (all p < 0.001). The incidence of severe hypoglycaemia was consistently low. The use of insulin pumps and insulin analogues in the therapy of T1DM increased significantly. Conclusions: The increased prevalence of complications is likely due to older age and longer diabetes duration. Low rates of hypoglycaemia, lower limb amputations and good glycaemic control in secondary care patients indicate a good structure of patient care

Ethyl lithiodiazoacetate: extremely unstable intermediate handled efficiently in flow

Ethyl diazoacetate (EDA) is one of the most prominent diazo reagents. It is frequently used in metal–carbene-type reactions. However, EDA can also be used as a nucleophile under base catalysis. Whilst the addition of EDA to aldehydes can be performed using organic bases, the addition of EDA to other carbonyl electrophiles requires the use of organometallics such as lithium diisopropylamide (LDA). The generated ethyl lithiodiazoacetate is highly reactive and decomposes rapidly, even at low temperatures. Herein, we report a continuous flow protocol that overcomes the problems associated with the instantaneous decomposition of ethyl lithiodiazoacetate. The addition of ethyl lithiodiazoacetate to ketones provides direct access to tertiary diazoalcohols in good yields

C–H insertion as a key step to spiro-oxetanes, scaffolds for drug discovery

A new route to spiro-oxetanes, potential scaffolds for drug discovery, is described. The route is based on the selective 1,4-C–H insertion reactions of metallocarbenes, generated from simple carbonyl precursors in flow or batch mode, to give spiro-β-lactones that are rapidly converted into spiro-oxetanes. The three-dimensional and lead like-properties of spiro-oxetanes is illustrated by the conversion of the 1-oxa-7-azaspiro[3,5]nonane scaffold into a range of functionalized derivatives

Enantioselective synthesis of trans-2,3-Dihydro-1H-indoles through C-H Insertion of a-Diazocarbonyl compounds

A stereoselective synthesis of 2,3-dihydro-1H-indoles with a RhII-catalyzed C–H insertion is reported. The α-diazo carbonyl intermediates can be obtained by a diazo-transfer reaction of 2-aminophenylacetic acids. Optimization and kinetic studies were performed, which resulted to increased yields of the diazo transfer after mechanistic evaluation of the side-product formation. trans-2,3-Dihydro-1H-indoles were obtained in high diasteromeric excesses (up to 94 % de) and enantiomeric excesses (up to 94 % ee)

Communicative, cognitive and behavioral impairments associated with right hemisphere stroke: national and international publications

 The present paper aims to outline an overview of national and international publications concerning research on the communicative, cognitive and behavioral impairments associated with a right hemisphere stroke. Research on LILACS and MEDLINE databases were done using keywords in Portuguese and in English: syndrome, hemisphere and right for the search on the right hemisphere impairments. Studies were selected taking into account inclusion criteria. Only few studies about these disorders were found, all of them international investigations. Cognitive disorders were the most frequently described. Sequelae including all cognitive functions, emotional and communicative processing are considered part of this set of right hemisphere impairments. More studies about the RHS are necessary to identify different clinical profiles and increase the efficiency of assessment and rehabilitation process.Keywords: neuropsychology; cognition; right hemisphere; CVA.  Este artigo visa traçar um panorama das publicações nacionais e internacionais quanto ao estudo das alterações comunicativo-cognitivo-comportamentais associadas as lesões vasculares de hemisfério direito. As bases LILACS e MEDLINE foram consultadas com as palavras-chave em português e em inglês: síndrome, hemisfério e direito. Os estudos foram selecionados a partir de critérios de inclusão. Encontraram-se poucos estudos que abordam essas alterações, todos internacionais, sendo as dificuldades cognitivas as mais descritas. Sequelas em todas as funções cognitivas e nos processamentos comunicativo e emocional são consideradas parte deste quadro. São indispensáveis estudos a respeito das alterações comunicativo-cognitivo-comportamentais pós-AVC de hemisfério direito para identificar diferentes perfis clínicos e contribuir para o aumento da eficácia dos procedimentos de avaliação e de reabilitação.Palavras-chave: neuropsicologia; cognição; hemisfério direito; AVC

The history of leishmaniasis

In this review article the history of leishmaniasis is discussed regarding the origin of the genus Leishmania in the Mesozoic era and its subsequent geographical distribution, initial evidence of the disease in ancient times, first accounts of the infection in the Middle Ages, and the discovery of Leishmania parasites as causative agents of leishmaniasis in modern times. With respect to the origin and dispersal of Leishmania parasites, the three currently debated hypotheses (Palaearctic, Neotropical and supercontinental origin, respectively) are presented. Ancient documents and paleoparasitological data indicate that leishmaniasis was already widespread in antiquity. Identification of Leishmania parasites as etiological agents and sand flies as the transmission vectors of leishmaniasis started at the beginning of the 20th century and the discovery of new Leishmania and sand fly species continued well into the 21st century. Lately, the Syrian civil war and refugee crises have shown that leishmaniasis epidemics can happen any time in conflict areas and neighbouring regions where the disease was previously endemic