Approaches for reducing the iodine content of the brown seaweed Saccharina latissima—effects on sensory properties

The effects of steam- or warm water treatments of the brown seaweed Saccharina latissima on iodine content and nutrient and sensory profiles were investigated. Warm freshwater or seawater treatments reduced the dry weight iodine content by 73% and 59%, respectively. Steam treatment was less efficient and only reduced the iodine content by 26%. Freshwater treatment resulted in a greater reduction in total solids and loss of water-soluble components, mainly reducing the content of ash and carbohydrates. Seawater treatment had a small effect on total solid content but altered the mineral profile leading to an increase in sodium and decrease in potassium content. The sensory profiles reflected the observed differences in composition as it revealed a significantly higher saltiness of the seawater-treated sample compared to other treatments, as well as a higher umami intensity compared to the freshwater-treated sample. The latter was characterized by low scores across all sensory attributes, indicating greater loss of flavour-active compounds. Further, including seawater-treated S. latissima at relatively low levels (0.5% and 1%) significantly altered the flavour of a commercial spinach soup compared to the same preparation without seaweed. Therefore, warm water treatment using seawater could be an alternative method for lowering the iodine content in brown seaweed while limiting nutrient loss and maintaining its flavour potential for applications in the food industry.publishedVersio

Insulin detemir is associated with more predictable glycemic control and reduced risk of hypoglycemia than NPH insulin in patients with type 1 diabetes on a basal-bolus regimen with premeal insulin aspart

WSTĘP. Insulina detemir jest rozpuszczalnym, długodziałającym analogiem insuliny. Cechuje się wyjątkowym, wydłużonym profilem działania, pozwalającym na zmniejszenie zmienności glikemii, związanej ze stosowaniem konwencjonalnych insulin długodziałających. W badaniu porównano insulinę detemir i insulinę NPH pod względem uzyskanej kontroli glikemii, ryzyka hipoglikemii oraz wpływu na masę ciała u chorych na cukrzycę typu 1, otrzymujących przedposiłkowe wstrzyknięcia insuliny krótkodziałającej aspart. MATERIAŁ I METODY. Do badania zakwalifikowano metodą randomizacji 448 chorych na cukrzycę typu 1, którym podawano insulinę detemir lub NPH w stosunku 2:1. Badanie typu otwartego, w którym porównywano równolegle obie grupy pacjentów, trwało 6 miesięcy i było prowadzone w 46 ośrodkach, w 5 krajach. WYNIKI. Po 6 miesiącach badania wartości hemoglobiny glikowanej (HbA1c) w obu grupach były porównywalne. Glikemia na czczo była nieco niższa u chorych leczonych insuliną detemir, jednak różnica ta nie była istotna statystycznie (&#8211;0,76 mmol/l; p = 0,097). Zmienność glikemii na czczo określana na podstawie samokontroli u poszczególnych pacjentów była mniejsza przy stosowaniu insuliny detemir niż insuliny NPH (SD 3,37 vs. 3,78 mmol/l; p < 0,001). Ryzyko niedocukrzenia było o 22% niższe w grupie leczonej insuliną detemir niż w grupie przyjmującej insulinę NPH (p < 0,05); a ryzyko nocnych niedocukrzeń (23.00-06.00) &#8212; o 34% niższe (p < 0,005). Profil glikemii w porze nocnej był bardziej stabilny i stały podczas stosowania insuliny detemir (p = 0,05). Na końcu badania u pacjentów leczonych insuliną detemir zaobserwowano istotnie niższą masę ciała (p < 0,001). WNIOSKI. Leczenie insuliną detemir wiąże się z bardziej przewidywalną kontrolą glikemii, z mniejszymi wahaniami glikemii w ciągu doby oraz istotnym zmniejszeniem ryzyka niedocukrzeń w porównaniu ze stosowaniem insuliny NPH. Zmniejszenie masy ciała podczas terapii insuliną detemir jest dodatkowym, potencjalnie korzystnym efektem. Schematy leczenia oparte na insulinie detemir mogą umożliwić lepszą kontrolę glikemii niż schematy oparte na insulinie NPH.INTRODUCTION. Insulin detemir is a soluble basal insulin analog with a unique mechanism of protracted action designed to reduce the variability associated with conventional basal insulins. This trial compared the glycemic control, risk of hypoglycemia, and effect on body weight of insulin detemir and NPH insulin in patients with type 1 diabetes treated with rapid-acting insulin aspart at meals. MATERIAL AND METHODS. This study was a 6-month multinational open parallel-group comparison conducted at 46 centers in five countries and included 448 patients with type 1 diabetes randomized 2:1 to insulin detemir or NPH insulin, respectively. RESULTS. After 6 months, comparable HbA1c levels were found between the two treatment groups. Fasting plasma glucose tended to be lower in patients treated with insulin detemir, but this difference was not statistically significant (&#8211;0.76 mmol/l, P = 0.097). Within-subject variation in self-measured fasting blood glucose was lower with insulin detemir than with NPH insulin (SD 3.37 vs. 3.78 mmol/l, P < 0.001). Risk of hypoglycemia was 22% lower with insulin detemir than with NPH insulin (P < 0.05) and 34% lower for nocturnal (2300&#8211;0600) hypoglycemia (P < 0.005). Nightly plasma glucose profiles were smoother and more stable with insulin detemir (P < 0.05). Body weight was significantly lower with insulin detemir at the end of the trial (P < 0.001). CONCLUSIONS. Treatment with insulin detemir resulted in more predictable glycemic control, with smoother plasma glucose profiles than NPH insulin and a significant reduction in the risk of hypoglycemia. The reduction in body weight with insulin detemir is a potential additional advantage. Regimens optimized for insulin detemir may be able to improve glycemic control beyond that possible with NPH insulin

Prostate Biopsies Can Be Omitted in Most Patients with a Positive Stockholm3 Test and Negative Prostate Magnetic Resonance Imaging

Background Magnetic resonance imaging (MRI) combined with the Stockholm3 test can be used to inform biopsy decision-making in patients with a suspicion of prostate cancer. Objective To determine the consequence of omitting biopsies in men with a positive Stockholm3 test and a negative MRI. Design, setting, and participants In a real-life setting, 438 men with a positive Stockholm3 test and a negative MRI underwent systematic biopsies from 2017 to 2020. Outcome measurements and statistical analysis The Stockholm3 test result is a percentage risk score with or without a prostate volume cutoff. The main outcomes were the number of clinically significant (Gleason grade group [GG] ≥2) and nonsignificant (GG 1) prostate cancers. Results and limitations Median prostate-specific antigen was 4.5 ng/ml (interquartile range 2.8–6.4 ng/ml) and the median age was 69 yr. Systematic biopsies detected grade group (GG) ≥2 disease in 48 men (11%, 95% confidence interval [CI] 8.4–14.2%) and GG 1 disease in 94 men (21.5%, 95% CI 17.9–25.6%). Of 256 patients without a volume cutoff in the test report, GG ≥2 was detected in 37 men (14.5%, 95% CI 10.7–19.3%). Omitting biopsies in patients with a volume cutoff would miss 11 GG ≥2 cases (6%, 95% CI 3.4–10.5%), reduce the number of GG 1 cases detected by 37 (39.4%, 95% CI 30.1–49.5%), and avoid a total of 182 biopsies (41.6%, 95% CI 37.0–46.2%). Limitations include the lack of follow-up data. Conclusions Systematic biopsies can be omitted in patients with a positive Stockholm3 test and a negative MRI when there is a volume cutoff in the test report. With no volume cutoff, biopsies can be considered with shared decision-making. Patient summary When investigated on suspicion of prostate cancer with a positive Stockholm3 test and a negative MRI (magnetic resonance imaging), prostate biopsies are only necessary for a subgroup of patients. This can spare some men from undergoing biopsies and reduce the detection of clinically insignificant cancers.publishedVersio

Effects of replacing PSA with Stockholm3 for diagnosis of clinically significant prostate cance in a health care system – the Stavanger Experience

Objective To describe early experience of replacing PSA with Stockholm3 for detection of prostate cancer in primary care. Design and methods Longitudinal observations, comparing outcome measures before and after the implementation of Stockholm3. Setting Stavanger region in Norway with about 370,000 inhabitants, 304 general practitioners (GPs) in 97 primary care clinics, and one hospital. Intervention GPs were instructed to use Stockholm3 instead of PSA as standard procedure for diagnosis of prostate cancer. Main outcome measures Proportion of GP clinics that had ordered a Stockholm3 test. Number of men referred to needle biopsy. Distribution of clinically significant prostate cancer (csPC) (Gleason Score ≥7) and clinically non-significant prostate cancer (cnsPC) (Gleason Score 6), in needle biopsies. Estimation of direct healthcare costs. Results Stockholm3 was rapidly implemented as 91% (88/97) of the clinics started to use the test within 14 weeks. After including 4784 tested men, the percentage who would have been referred for prostate needle biopsy was 29.0% (1387/4784) if based on PSA level ≥3ng/ml, and 20.8% (995/4784) if based on Stockholm3 Risk Score (p < 0.000001). The proportion of positive biopsies with csPC increased from 42% (98/233) before to 65% (185/285) after the implementation. Correspondingly, the proportion of cnsPC decreased from 58% (135/233) before to 35% (100/285) after the implementation (p < 0.0017). Direct healthcare costs were estimated to be reduced by 23–28% per tested man. Conclusion Replacing PSA with Stockholm3 for early detection of prostate cancer in primary care is feasible. Implementation of Stockholm3 resulted in reduced number of referrals for needle-biopsy and a higher proportion of clinically significant prostate cancer findings in performed biopsies. Direct healthcare costs decreased. KEY POINTS A change from PSA to Stockholm3 for the diagnosis of prostate cancer in primary care in the Stavanger region in Norway is described and assessed. •Implementation of a new blood-based test for prostate cancer detection in primary care was feasible. A majority of GP clinics started to use the test within three months. •Implementation of the Stockholm3 test was followed by: –a 28% reduction in number of men referred for urological prostate cancer work-up –an increase in the proportion of clinically significant cancer in performed prostate biopsies from 42 to 65% –an estimated reduction in direct health care costs between 23 and 28%.publishedVersio

Self-Monitoring of Blood Glucose in Type 1 Diabetes Patients with Insufficient Metabolic Control: Focused Self-Monitoring of Blood Glucose Intervention Can Lower Glycated Hemoglobin A1C

OBJECTIVE: Little attention has been given and few studies have been published focusing on how to optimize self-monitoring of blood glucose (SMBG) use to monitor daily therapy for persons with type 1 diabetes mellitus. This study was designed to evaluate the effect on glycated hemoglobin (A1C) of a structured intervention focused on SMBG in type 1 diabetes patients with insufficient metabolic control (A1C >/= 8%) using a randomized clinical trial design. METHOD: One hundred fifty-nine outpatients with type 1 diabetes on multiple injection therapy with insulin and A1C >/=8% were recruited and randomized to one group receiving a focused, structured 9-month SMBG intervention (n = 59) and another group receiving regular care based on guidelines (n = 64). RESULTS: Glycated hemoglobin values (mean % +/- standard deviation) at study start was similar: 8.65 +/- 0.10 in the intervention group and 8.61 +/- 0.09 in the control group. The two groups were comparable (age, gender, body mass index, complication rate, and treatment modality) at study start and had mean diabetes duration and SMBG experience of 19 and 20 years, respectively. At study end, there was decrease in A1C in the intervention group (p < .05), and the A1C was 0.6% lower compared with the control group (p < .05). No increase in the number of minor or major hypoglycemia episodes was observed in the intervention group during the study period. CONCLUSIONS: A simple, structured, focused SMBG intervention improved metabolic control in patients with longstanding diabetes type 1 and A1C >/= 8%. The intervention was based on general recommendations, realistic in format, and can be applied in a regular outpatient setting

Effects of replacing PSA with Stockholm3 for diagnosis of clinically significant prostate cancer in a healthcare system – the Stavanger experience

Objective To describe early experience of replacing PSA with Stockholm3 for detection of prostate cancer in primary care. Design and methods Longitudinal observations, comparing outcome measures before and after the implementation of Stockholm3. Setting Stavanger region in Norway with about 370,000 inhabitants, 304 general practitioners (GPs) in 97 primary care clinics, and one hospital. Intervention GPs were instructed to use Stockholm3 instead of PSA as standard procedure for diagnosis of prostate cancer. Main outcome measures Proportion of GP clinics that had ordered a Stockholm3 test. Number of men referred to needle biopsy. Distribution of clinically significant prostate cancer (csPC) (Gleason Score ≥7) and clinically non-significant prostate cancer (cnsPC) (Gleason Score 6), in needle biopsies. Estimation of direct healthcare costs. Results Stockholm3 was rapidly implemented as 91% (88/97) of the clinics started to use the test within 14 weeks. After including 4784 tested men, the percentage who would have been referred for prostate needle biopsy was 29.0% (1387/4784) if based on PSA level ≥3ng/ml, and 20.8% (995/4784) if based on Stockholm3 Risk Score (p < 0.000001). The proportion of positive biopsies with csPC increased from 42% (98/233) before to 65% (185/285) after the implementation. Correspondingly, the proportion of cnsPC decreased from 58% (135/233) before to 35% (100/285) after the implementation (p < 0.0017). Direct healthcare costs were estimated to be reduced by 23–28% per tested man. Conclusion Replacing PSA with Stockholm3 for early detection of prostate cancer in primary care is feasible. Implementation of Stockholm3 resulted in reduced number of referrals for needle-biopsy and a higher proportion of clinically significant prostate cancer findings in performed biopsies. Direct healthcare costs decreased

Effects of replacing PSA with Stockholm3 for diagnosis of clinically significant prostate cance in a health care system – the Stavanger Experience

Objective To describe early experience of replacing PSA with Stockholm3 for detection of prostate cancer in primary care. Design and methods Longitudinal observations, comparing outcome measures before and after the implementation of Stockholm3. Setting Stavanger region in Norway with about 370,000 inhabitants, 304 general practitioners (GPs) in 97 primary care clinics, and one hospital. Intervention GPs were instructed to use Stockholm3 instead of PSA as standard procedure for diagnosis of prostate cancer. Main outcome measures Proportion of GP clinics that had ordered a Stockholm3 test. Number of men referred to needle biopsy. Distribution of clinically significant prostate cancer (csPC) (Gleason Score ≥7) and clinically non-significant prostate cancer (cnsPC) (Gleason Score 6), in needle biopsies. Estimation of direct healthcare costs. Results Stockholm3 was rapidly implemented as 91% (88/97) of the clinics started to use the test within 14 weeks. After including 4784 tested men, the percentage who would have been referred for prostate needle biopsy was 29.0% (1387/4784) if based on PSA level ≥3ng/ml, and 20.8% (995/4784) if based on Stockholm3 Risk Score (p < 0.000001). The proportion of positive biopsies with csPC increased from 42% (98/233) before to 65% (185/285) after the implementation. Correspondingly, the proportion of cnsPC decreased from 58% (135/233) before to 35% (100/285) after the implementation (p < 0.0017). Direct healthcare costs were estimated to be reduced by 23–28% per tested man. Conclusion Replacing PSA with Stockholm3 for early detection of prostate cancer in primary care is feasible. Implementation of Stockholm3 resulted in reduced number of referrals for needle-biopsy and a higher proportion of clinically significant prostate cancer findings in performed biopsies. Direct healthcare costs decreased. KEY POINTS A change from PSA to Stockholm3 for the diagnosis of prostate cancer in primary care in the Stavanger region in Norway is described and assessed. •Implementation of a new blood-based test for prostate cancer detection in primary care was feasible. A majority of GP clinics started to use the test within three months. •Implementation of the Stockholm3 test was followed by: –a 28% reduction in number of men referred for urological prostate cancer work-up –an increase in the proportion of clinically significant cancer in performed prostate biopsies from 42 to 65% –an estimated reduction in direct health care costs between 23 and 28%

Effect of a telemedicine intervention for diabetes-related foot ulcers on health, well-being and quality of life: secondary outcomes from a cluster randomized controlled trial (DiaFOTo)

Background Follow-up care provided via telemedicine (TM) is intended to be a more integrated care pathway to manage diabetes-related foot ulcers (DFU) than traditionally-delivered healthcare. However, knowledge of the effect of TM follow-up on PROMs including self-reported health, well-being and QOL in patients with DFUs is lacking and often neglected in RCT reports in general. Therefore, in this study of secondary outcomes from the DiaFOTo trial, the aim was to compare changes in self-reported health, well-being and QOL between patients with DFUs receiving telemedicine follow-up care in primary healthcare in collaboration with specialist healthcare, and patients receiving standard outpatient care. Methods The current study reports secondary endpoints from a cluster randomized controlled trial whose primary endpoint was ulcer healing time. The trial included 182 adults with diabetes-related foot ulcers (94/88 in the telemedicine/standard care groups) in 42 municipalities/districts, recruited from three clinical sites in Western Norway. Mean (SD) diabetes duration for the study population was 20.8 (15.0). The intervention group received care in the community in collaboration with specialist healthcare using an asynchronous telemedicine intervention. The intervention included an interactive web-based ulcer record and a mobile phone enabling counseling and communication between the community nurses and specialist healthcare; the control group received standard outpatient care. In total 156 participants (78/78) reported on secondary endpoints: self-reported health, well-being and quality of life evaluated by generic and disease-specific patient-reported outcome measures (e.g. Euro-QOL, the Hospital Anxiety and Depression Scale (HADS), Problem Areas in Diabetes (PAID), Neuropathy and Foot Ulcer–Specific Quality of Life Instrument (NeuroQOL)). Linear mixed-effects regression was used to investigate possible differences in changes in the scores between the intervention and control group at the end of follow-up. Results In intention to treat analyses, differences between treatment groups were small and non-significant for the health and well-being scale scores, as well as for diabetes-related distress and foot ulcer-specific quality of life. Conclusions There were no significant differences in changes in scores for the patient reported outcomes between the intervention and control group, indicating that the intervention did not affect the participants’ health, well-being and quality of life