Assessment of three frequently used blood glucose monitoring devices in clinical routine

Self-monitoring of blood glucose plays an important role in the management of diabetes and has been shown to improve metabolic control. The use of blood glucose meters in clinical practice requires sufficient reliability to allow adequate treatment. Direct comparison of different blood glucose meters in clinical practice, independent of the manufactures is scarce. We, therefore, aimed to evaluate three frequently used blood glucose meters in daily clinical practice.

The role of self-monitoring of blood glucose in glucagon-like Peptide-1-based treatment approaches: a European expert recommendation

The role of glucagon-like peptide (GLP)-1-based treatment approaches for type 2 diabetes mellitus (T2DM) is increasing. Although self-monitoring of blood glucose (SMBG) has been performed in numerous studies on GLP-1 analogs and dipeptidyl peptidase-4 inhibitors, the potential role of SMBG in GLP-1-based treatment strategies has not been elaborated. The expert recommendation suggests individualized SMBG strategies in GLP-1-based treatment approaches and suggests simple and clinically applicable SMBG schemes. Potential benefits of SMBG in GLP-1-based treatment approaches are early assessment of treatment success or failure, timely modification of treatment, detection of hypoglycemic episodes, assessment of glucose excursions, and support of diabetes management and diabetes education. Its length and frequency should depend on the clinical setting and the quality of metabolic control. It is considered to play an important role for the optimization of diabetes management in T2DM patients treated with GLP-1-based approaches.

A self-developed and constructed robot for minimally invasive cochlear implantation

Conclusion: A robot built specifically for stereotactic cochlear implantation provides equal or better accuracy levels together with a better integration into a clinical environment, when compared to existing approaches based on industrial robots. Objectives: To evaluate the technical accuracy of a robotic system developed specifically for lateral skull base surgery in an experimental setup reflecting the intended clinical application. The invasiveness of cochlear electrode implantation procedures may be reduced by replacing the traditional mastoidectomy with a small tunnel slightly larger in diameter than the electrode itself. Methods: The end-to-end accuracy of the robot system and associated image-guided procedure was evaluated on 15 temporal bones of whole head cadaver specimens. The main components of the procedure were as follows: reference screw placement, cone beam CT scan, computer-aided planning, pair-point matching of the surgical plan, robotic drilling of the direct access tunnel, and post-operative cone beam CT scan and accuracy assessment. Results: The mean accuracy at the target point (round window) was 0.56 ± 41 mm with an angular misalignment of 0.88 ± 0.41°. The procedural time of the registration process through the completion of the drilling procedure was 25 ± 11 min. The robot was fully operational in a clinical environment.

Back related outcome assessment instruments

A literature review of the most widely used condition specific, self administered assessment questionnaires for low back pain had been undertaken. General and historic aspects, reliability, responsiveness and minimum clinically important difference, external validity, floor and ceiling effects, and available languages were analysed. These criteria, however, are only part of the consideration. Of similar importance are the content, wording of questions and answers in each of the six questionnaires and an analysis of the different score results. The issue of score bias is discussed and suggestions are given in order to increase the construct validity in the practical use of the individual questionnaires.

Traditional chinese medicine (phytotherapy): health technology assessment report - selected aspects

Objective: A summary of main aspects from a Health Technology Assessment report on Traditional Chinese Medicine (TCM) in Switzerland concerning effectiveness and safety is given. Materials and Methods: Literature search was performed through 13 databases, by scanning reference lists of articles and by contacting experts. Assessed were quality of documentation, internal and external validity. Results: Effectiveness: 43 articles concerning 'gastrointestinal tract and liver' were assessed. The studies covering 7,436 patients were undertaken in China (35), Japan (3), USA (2) and Australia (3); 33/43 being controlled studies. 34/40 show significantly better results in the TCM-treated group. A comparison of studies on results of treatment based on a diagnosis according to TCM criteria and studies on results of treatment according to Western diagnosis shows that treatment based on TCM diagnosis improves the result. The comparison of treatment by individual medication and standard medication showed a trend in favor of individual medication. Safety: TCM training and practice for physicians in Switzerland are officially regulated. Side effects occur, but no severe effects have been registered up to now in Switzerland. TCM medicinals are imported; admission regulations are being installed. Problems due to production abroad, Internet trade, self-medication or admixtures are possible. Conclusion: The evaluation of the literature search provides evidence for a basic clinical effectiveness of TCM therapy. Severe side effects were not observed in Switzerland. Regulations for trading and use of medicinals prevent treatment risks. Further clinical studies in a Western context are required.

Psychophysiological ambulatory assessment of affective dysregulation in borderline personality disorder

Many experts now believe that pervasive problems in affect regulation constitute the central area of dysfunction in borderline personality disorder (BPD). However, data is sparse and inconclusive. We hypothesized that patients with BPD, in contrast to healthy gender and nationality-matched controls, show a higher frequency and intensity of self-reported emotions, altered physiological indices of emotions, more complex emotions and greater problems in identifying specific emotions. We took a 24-hour psychophysiological ambulatory monitoring approach to investigate affect regulation during everyday life in 50 patients with BPD and in 50 healthy controls. To provide a typical and unmanipulated sample, we included only patients who were currently in treatment and did not alter their medication schedule. BPD patients reported more negative emotions, fewer positive emotions, and a greater intensity of negative emotions. A subgroup of non-medicated BPD patients manifested higher values of additional heart rate. Additional heart rate is that part of a heart rate increase that does not directly result from metabolic activity, and is used as an indicator of emotional reactivity. Borderline participants were more likely to report the concurrent presence of more than one emotion, and those patients who just started treatment in particular had greater problems in identifying specific emotions. Our findings during naturalistic ambulatory assessment support emotional dysregulation in BPD as defined by the biosocial theory of [Linehan, M.M., 1993. Cognitive-Behavioral Treatment of Borderline Personality Disorder. The Guildford Press, New York.] and suggest the potential utility for evaluating treatment outcome.

Impact of a self-developed planning and self-constructed navigation system on skull base surgery: 10 years experience

CONCLUSION: Our self-developed planning and navigation system has proven its capacity for accurate surgery on the anterior and lateral skull base. With the incorporation of augmented reality, image-guided surgery will evolve into 'information-guided surgery'. OBJECTIVE: Microscopic or endoscopic skull base surgery is technically demanding and its outcome has a great impact on a patient's quality of life. The goal of the project was aimed at developing and evaluating enabling navigation surgery tools for simulation, planning, training, education, and performance. This clinically applied technological research was complemented by a series of patients (n=406) who were treated by anterior and lateral skull base procedures between 1997 and 2006. MATERIALS AND METHODS: Optical tracking technology was used for positional sensing of instruments. A newly designed dynamic reference base with specific registration techniques using fine needle pointer or ultrasound enables the surgeon to work with a target error of < 1 mm. An automatic registration assessment method, which provides the user with a color-coded fused representation of CT and MR images, indicates to the surgeon the location and extent of registration (in)accuracy. Integration of a small tracker camera mounted directly on the microscope permits an advantageous ergonomic way of working in the operating room. Additionally, guidance information (augmented reality) from multimodal datasets (CT, MRI, angiography) can be overlaid directly onto the surgical microscope view. The virtual simulator as a training tool in endonasal and otological skull base surgery provides an understanding of the anatomy as well as preoperative practice using real patient data. RESULTS: Using our navigation system, no major complications occurred in spite of the fact that the series included difficult skull base procedures. An improved quality in the surgical outcome was identified compared with our control group without navigation and compared with the literature. The surgical time consumption was reduced and more minimally invasive approaches were possible. According to the participants' questionnaires, the educational effect of the virtual simulator in our residency program received a high ranking.

The self-administered 24-item geriatric pain measure (GPM-24-SA): psychometric properties in three European populations of community-dwelling older adults

OBJECTIVE: To explore the feasibility and psychometric properties of a self-administered version of the 24-item Geriatric Pain Measure (GPM-24-SA). DESIGN: Secondary analysis of baseline data from the Prevention in Older People-Assessment in Generalists' practices trial, an international multi-center study of a health-risk appraisal system. PARTICIPANTS: One thousand seventy-two community dwelling nondisabled older adults self-reporting pain from London, UK; Hamburg, Germany; and Solothurn, Switzerland. OUTCOME MEASURES: GPM-24-SA as part of a multidimensional Health Risk Appraisal Questionnaire including self-reported demographic and health-related information. RESULTS: Among the 1,072 subjects, 655 had complete GPM-24-SA data, 404 had 30% missing GPM-24-SA data. In psychometric analyses across the three European populations with complete GPM-24-SA data, the measure exhibited stable internal consistency, good convergent, divergent and discriminant validity, and produced stable pain measurements. However, factor analysis indicated differences in the GPM-24-SA across sites with discrepancies mainly related to items of a single subscale that failed to load appropriately. Analyses including imputation for subjects with

Prevalence of halitosis in young male adults: a study in swiss army recruits comparing self-reported and clinical data

BACKGROUND: Sound epidemiologic data on halitosis are rare. We evaluated the prevalence of halitosis in a young male adult population in Switzerland using a standardized questionnaire and clinical examination. METHODS: Six hundred twenty-six Swiss Army recruits aged 18 to 25 years (mean: 20.3 years) were selected as study subjects. First, a standardized questionnaire focusing on dental hygiene, self-reported halitosis, smoking, and alcohol consumption was filled out by all participants. In the clinical examination, objective values for the presence of halitosis were gathered through an organoleptic assessment of the breath odor and the measurement of volatile sulfur compounds (VSCs). Additionally, tongue coating, plaque index, and probing depths were evaluated for each recruit. RESULTS: The questionnaire revealed that only 17% of all included recruits had never experienced halitosis. The organoleptic evaluation (grades 0 to 3) identified eight persons with grade 3, 148 persons with grade 2, and 424 persons with grade 1 or 0. The calculation of the Pearson correlation coefficient to evaluate the relationship among the three methods of assessing halitosis revealed little to no correlation. The organoleptic score showed high reproducibility (kappa = 0.79). Tongue coating was the only influencing factor found to contribute to higher organoleptic scores and higher VSC values. CONCLUSIONS: Oral malodor seemed to pose an oral health problem for about one-fifth of 20-year-old Swiss males questioned. No correlation between self-reported halitosis and organoleptic or VSC measurements could be detected. Although the organoleptic method described here offers a high reproducibility, the lack of correlation between VSC values and organoleptic scores has to be critically addressed. For further studies assessing new organoleptic scores, a validated index should always be included as a direct control.

An Assessment of Trends in the Extent of Swidden in Southeast Asia

Swidden systems consisting of temporarily cultivated land and associated fallows often do not appear on land use maps or in statistical records. This is partly due to the fact that swidden is a diverse and dynamic land use system that is difficult to map and partly because of the practice of grouping land covers associated with swidden systems into land use or land cover categories that are not self-evidently linked to swiddening. Additionally, in many parts of Southeast Asia swidden systems have changed or are in the process of changing into other land use systems. This paper assesses the extent of swidden on the basis of regional and national sources for nine countries, and determines the pattern of changes of swidden on the basis of 151 cases culled from 67 articles. Findings include (1) a majority of the cases document swidden being replaced by other forms of agriculture or by other livelihood systems; (2) in cases where swiddening is still practiced, fallow lengths are usually, but not always, shorter; and (3) shortened fallow length does not necessarily indicate a trend away from swidden since it is observed that short fallow swidden is sometimes maintained along with other more intensive farming practices and not completely abandoned. The paper concludes that there is a surprising lack of conclusive data on the extent of swidden in Southeast Asia. In order to remedy this, methods are reviewed that may lead to more precise future assessments.

A comparative assessment of torque generated by lingual and conventional brackets

The aim of this study was to assess the effect of bracket type on the labiopalatal moments generated by lingual and conventional brackets. Incognito™ lingual brackets (3M Unitek), STb™ lingual brackets (Light Lingual System; ORMCO), In-Ovation L lingual brackets (DENTSPLY GAC), and conventional 0.018 inch slot brackets (Gemini; 3M Unitek) were bonded on identical maxillary acrylic resin models with levelled and aligned teeth. Each model was mounted on the orthodontic measurement and simulation system and 10 0.0175 × 0.0175 TMA wires were used for each bracket type. The wire was ligated with elastomerics into the Incognito, STb, and conventional brackets and each measurement was repeated once after religation. A 15 degrees buccal root torque (+15 degrees) and then a 15 degrees palatal root torque (-15 degrees) were gradually applied to the right central incisor bracket. After each activation, the bracket returned to its initial position and the moments in the sagittal plane were recorded during these rotations of the bracket. One-way analysis of variance with post hoc multiple comparisons (Tukey test at 0.05 error rate) was conducted to assess the effect on bracket type on the generated moments. The magnitude of maximum moment at +15 degrees ranged 8.8, 8.2, 7.1, and 5.8 Nmm for the Incognito, STb, conventional Gemini, and the In-Ovation L brackets, respectively; similar values were recorded at -15 degrees: 8.6, 8.1, 7.0, and 5.7 Nmm, respectively. The recorded differences of maximum moments were statistically significant, except between the Incognito and STb brackets. Additionally, the torque angles were evaluated at which the crown torque fell well below the minimum levels of 5.0 Nmm, as well as the moment/torque ratio at the last part of the activation/deactivation curve, between 10 and 15 degrees. The lowest torque expression was observed at the self-ligating lingual brackets, followed by the conventional brackets. The Incognito and STb lingual brackets generated the highest moments.

Self-Reported Capabilities Among Young Male Adults in Switzerland: Translation and Psychometric Evaluation of a German, French and Italian Version of a Closed Survey Instrument

There is a shortage of empirical applications of the capability approach that employ closed survey instruments to assess self-reported capabilities. However, for those few instruments that have been designed and administered through surveys until now, no psychometric properties (reliability, validity, and factor structure) were reported. The purpose of this study is the assessment of the psychometric properties of three new language versions (German, French, and Italian) of an established (English) set of eight self-reported capability items. The set of items is taken from a previously published British study by Anand and van Hees (J Soc Econ 35(2):268–284, 2006). Our sample consists of 17,152 young male adults aged 18–25 years from the three major language regions in Switzerland. The results indicate good reliability of the three language versions. The results from the exploratory factor analyses suggest a one-dimensional factor structure for seven domain specific items. Furthermore, the results from multiple regression analyses suggest that a global summary item on overall capabilities represents a measurement alternative to the set of seven domain specific capability items. Finally, the results confirm the applicability of the closed capability instrument in a large scale survey questionnaire and represent the first attempt to measure self-reported capabilities in Switzerland.

Agency and ownership are independent components of 'sensing the self' in the auditory-verbal domain

'Sensing the self' relies on the ability to distinguish self-generated from external stimuli. It requires functioning mechanisms to establish feelings of agency and ownership. Agency is defined causally, where the subjects action is followed by an effect. Ownership is defined by the features of the effect, independent from the action. In our study, we manipulated these qualities separately. 13 right-handed healthy individuals performed the experiment while 76-channel EEG was recorded. Stimuli consisted of visually presented words, read aloud by the subject. The experiment consisted of six conditions: (a) subjects saw a word, read it aloud, heard it in their own voice; (b) like a, but the word was heard in an unfamiliar voice; (c) subject heard a word in his/her own voice without speaking; (d) like c, but the word was heard in an unfamiliar voice; (e) like a, but subjects heard the word with a delay; (f) subjects read without hearing. ERPs and difference maps were computed for all conditions. Effects were analysed topographically. The N100 (86-172 ms) displayed significant main effects of agency and ownership. The topographies of the two effects shared little common variance, suggesting independent effects. Later effects (174-400 ms) of agency and ownership were topographically similar, suggesting common mechanisms. Replicating earlier studies, significant N100 suppression was observed, with a topography resembling the agency effect. 'Sensing the self' appears to recruit from at least two very distinct processes: an agency assessment that represents causality and an ownership assessment that compares stimulus features with memory content.

Influence of general self-efficacy as a mediator in Taiji-induced stress reduction – Results from a randomized controlled trial

Aim of the study In this study we examined the effects of Taiji on perceived stress and general self-efficacy (GSE), and investigated the mediating role of a Taiji-induced GSE increase on Taiji-related reduction of perceived stress. Materials and methods 70 healthy participants were randomly allocated either to the Taiji intervention group or the waiting list control group. The intervention lasted for 12 weeks comprising two Taiji classes per week. Before, shortly after, and two months after the intervention, we assessed the degree of perceived stress and GSE in all participants by employing the Perceived Stress Scale (PSS) and the GSE-Scale. Results Compared to controls, participants of the Taiji group showed a significantly stronger decrease of perceived stress and a higher increase in GSE from pre- to post-intervention assessment (PSS: p = 0.009; GSE: p = 0.006), as well as from pre-intervention to follow-up assessment (PSS: p = 0.018; GSE: p = 0.033). A mediator analysis based on a multiple regression approach revealed that a Taiji-related increase in GSE statistically mediated the reduction in perceived stress after Taiji as compared to baseline. Post hoc testing showed that the mediating effect of GSE was significant (p = 0.043). Conclusions Our findings confirm previously reported Taiji-related stress reducing and GSE enhancing effects with GSE increase mediating Taiji related reduction of perceived stress.

Identifying Distinct Quitting Trajectories after an Unassisted Smoking Cessation Attempt: An Ecological Momentary Assessment Study

Objectives: This study aimed at identifying distinct quitting trajectories over 29 days after an unassisted smoking ces- sation attempt by ecological momentary assessment (EMA). In order to validate these trajectories we tested if they predict smoking frequency up to six months later. Methods: EMA via mobile phones was used to collect real time data on smoking (yes/no) after an unassisted quit attempt over 29 days. Smoking frequency one, three and six months after the quit attempt was assessed with online questionnaires. Latent class growth modeling was used to analyze the data of 230 self-quitters. Results: Four different quitting trajectories emerged: quitter (43.9%), late quitter (11.3%), returner (17%) and persistent smoker (27.8%). The quitting trajectories predicted smoking frequency one, three and six months after the quit attempt (all p < 0.001). Conclusions: Outcome after a smoking cessation attempt is better described by four distinct trajectories instead of a binary variable for abstinence or relapse. In line with the relapse model by Marlatt and Gordon, late quitter may have learned how to cope with lapses during one month after the quitting attempt. This group would have been allocated to the relapse group in traditional outcome studies.