Family doctors’ attitudes toward peer support programs for type 2 diabetes and/or coronary artery disease: an exploratory survey among German practitioners

Background

Type 2 diabetes (T2D) and coronary artery disease (CAD) are chronic illnesses where adherence to a healthy lifestyle is crucial. If organisational and cultural factors are well managed, Peer support programs (PSP) can improve self-management, quality of life, and health outcomes. In preparation for launching a PSP, we surveyed family doctors (FD) about their attitudes toward such a program and about potential barriers, and facilitators.

Methods

In March 2020 we surveyed 896 FDs from five university teaching practice networks in North-Rhine Westphalia, Germany, via an anonymous web-based survey. The questionnaire addressed details of PSPs, including suitable patients and FDs‘role. Data were analysed using descriptive and inferential statistics; qualitative material underwent content analysis by two researchers.

Results

A total of 165 FDs responded (response rate: 18.4%), 97% were practice owners. Respondents viewed PSPs positively (T2D: 92.0%, CAD 89.9%), especially for patients with poor self-structuring (82.7%), low motivation (76.3%) and few social contacts (67.6%). On average, FDs were able to identify 4.0 ± 3.2 patients as potential group leaders. Major facilitators reported included motivation by peers (92.5%), exercise (79.1%), and social contacts (70.1%). Waning interest over time (73.1%) and poor motivation (70.9%) were considered barriers. The majority of FDs would recommend PSPs to their patients (89.5%). They considered such a program a valuable addition to current care (79.7%). The percentage of FDs’ who expected long-term benefits for their workload was relatively low (37.6%).

Conclusions

In an exploratory survey among German FDs on PSPs, respondents viewed PSPs as a valuable add-on for T2D and CAD patients, while not expecting a positive impact on their workload. Communication with FDs on PSPs may need to highlight anticipated implementation outcomes such as benefits of PSPs to the practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01827-3.

[Postoperative therapy for pain in children]

Treatment of acute pain is one of the most important tasks of perioperative pediatric anesthesia. Pain-relieving drugs are usually administered on the basis of the concept of balanced analgesia, which involves a combination of analgesics with either synergic or additive effects. The concept of balanced analgesia is successful under many circumstances, but continuous efforts are needed to improve management in dificult cases. The key problem is to decide if a child has pain. Establishing a high standard at an institution requires a regular evaluation and documentation of pain scores. Non-opioid analgesics are frequently administered just in the induction of anesthesia due to their long-term effects, and then combined with opioids or regional anesthetic techniques. The present review focuses on non-opioid analgesics that can be intravenously injected for the perioperative treatment of acute pain.

[Secretin-enhanced magnetic resonance cholangiopancreaticography: value for the diagnosis of chronic pancreatitis]

Endoscopic retrograde cholangiopancreaticography (ERCP) is the morphologic gold standard for the diagnosis of chronic pancreatitis. Magnetic Resonance Imaging (MRI) enables the visualization of not only the pancreatic duct but also the surrounding parenchyma using T2- and T1-weighted sequences before and after the application of a contrast agent. Moreover, it allows the depiction of ductal segments distal to a stenosis or occlusion. However, conventional Magnetic Resonance Cholangiopancreaticography (MRCP) was not able to achieve accuracy similar to that of ERCP. Despite many technological innovations, such as fast breath-hold acquisitions or respiratory-gated 3D sequences, this drawback could not be overcome. In recent years, secretin-enhanced MRCP has been used for the diagnosis of chronic pancreatitis. A recent study showed that secretin not only improves the visibility of the pancreatic duct and its side branches but it also enhances the diagnostic accuracy of MRCP. The sensitivity, specificity, and positive and negative predictive values were improved by the application of secretin. Moreover, the agreement between independent observers increased after the use of secretin. In addition, quantitative post-processing tools have been developed that enable the measurement of the exocrine pancreatic output non-invasively using secretin-enhanced MRCP. These tools facilitate applications, such as functional follow-up after pancreaticogastrostomy and pancreaticogastric anastomoses, evaluation of the functional status of the graft after pancreas transplantation and follow-up of pancreatic drainage procedures and duct disruption.

Otarine Herpesvirus-1, not papillomavirus, is associated with endemic tumours in California sea lions (Zalophus californianus)

The purpose of this study was to determine if Otarine Herpesvirus-1 (OtHV-1) is associated with the presence of urogenital carcinomas in California sea lions. Polymerase chain reaction (PCR) analysis with primers specific for OtHV-1 was used to compare the prevalence of OtHV-1 infection in 15 sea lions affected by urogenital carcinoma with that of age-matched and juvenile tumour-free animals, and animals with tumours of non-urogenital origin. The herpesvirus was more prevalent (100%) and more widespread in the 15 animals with urogenital carcinoma than in 25 control animals, and was most often found in the urogenital tissue (vagina and prostate) and in the draining lymph nodes. Moreover, OtHV-1 DNA was not found in any juvenile animal, or in the neoplastic tissues of animals with non-urogenital tumours. Papillomavirus-specific PCR analysis of urogenital carcinoma tissues detected papillomavirus sequences in only one carcinomatous tissue. Further studies are needed to determine if OtHV-1 contributes to oncogenesis in the California sea lion; these data show, however, that OtHV-1 is associated with urogenital carcinomas, is preferentially present in urogenital tissues, and may be sexually transmitted. Papillomaviruses, which are known to contribute to urogenital tumours in other species, did not appear to be associated with the sea lion carcinomas.

[Fractures of the cervical vertebrae: diagnosis with multi-slice spiral CT]

PURPOSE

It is the aim of this study to investigate the efficiency of multislice helical CT for the diagnosis of cervical spine fractures. The advantages of this technique are demonstrated by case reports.

MATERIAL AND METHODS

The entire cervical spine or selected vertebral bodies of 66 patients with cervical spine fractures known from preceding plain films were scanned with a multislice helical CT. The CT-scans were obtained with a slice thickness of 1.25 mm and with two different pitches (0.75 or 1.5) and table speeds (3.75 or 7.5 mm/rot.). Additionally, sagittal and coronal reformations were performed.

RESULTS

The mean scan-time for the cervical spine was 13 seconds. High quality sagittal and coronal reformations were obtained from axial images within a few minutes. Fractures of the dens (n = 17) and of the vertebral body of C3-C7 (n = 12) occurred predominantly.

CONCLUSION

Multislice helical CT is an effective tool to diagnose fractures of the cervical spine rapidly and exactly.

[Diagnosis of lung embolism and underlying venous thrombosis in multi-slice spiral CT]

AIM

To determine the value of multi-slice CT for the diagnosis of acute pulmonary embolism and an underlying venous thrombosis.

METHODS

70 patients with clinically suspected acute pulmonary embolism were examined. Using multi-slice CT a combined examination of the pulmonary arteries and the veins of the lower limb, pelvis and abdomen was performed. Only one single bolus of 150 ml iopromid 300 was injected into a cubital vein with a flow of 4 ml/s. First, the pulmonary arteries were scanned with a slice thickness of 2.5 mm and a pitch of 1.5. On arrival of the contrast medium at the popliteal veins, indicated by bolus trakking, the veins of the lower limbs up to the end of the inferior vena cava were imaged using a slice thickness of 3.75 mm and a pitch of 1.5. The results could be compared with a ventilation-perfusion scan in 48 cases, with a Doppler ultrasound examination in 46 cases, and with a venography in 10 cases. Furthermore, the image quality of all arterial and venous regions was subjectively assessed.

RESULTS

In all patients who underwent multi-slice CT the pulmonary arteries as well as the veins of the lower half of the body could be recorded completely. Regarding the pulmonary arteries the image quality showed excellent results for the central and segmental arteries. The region up to the 3rd division in subsegmental branches could be sufficiently judged. More peripherally, a diagnostic assessment was not possible. The image quality of the veins was excellent in all sections, except the calf, where a reliable diagnosis could not be made. The comparison with the other techniques confirmed the superiority of multi-slice CT concerning the central and segmental pulmonary arteries and the veins from the popliteal vein to the inferior vena cava. In contrast, peripheral pulmonary emboli can be detected more certainly in ventilation/perfusion scans. The veins of the calf can be evaluated more reliably with venography.

CONCLUSION

Multi-slice CT proved to be an outstanding tool in the diagnosis of acute pulmonary embolism. The clinically suspected disease and a causing venous thrombosis can be detected in a fast and reliable way. At present, multi-slice CT is not suitable for the recognition of peripheral emboli. However, expected technical developments hold promise for future improvements.

Changes in AV node conduction curves following slow pathway modification

Dual AV node physiology often persists after successful slow pathway (SP) ablation, and the mechanism of tachycardia elimination is unresolved. Therefore, AV node conduction curves were analyzed following successful ablation (4 +/- 1 energy applications) in 85 consecutive patients (58 women, age 50 +/- 2 years) with typical AVNRT. Twenty-seven patients (32%) had complete elimination (group 1) whereas 58 (68%) patients had persistence (group 2) of dual AV node physiology. A significant increase in the AV node Wenckebach cycle length (WB-CL) was observed in both groups (310 +/- 9 to 351 +/- 15 ms in group 1, and 325 +/- 8 to 369 +/- 9 ms in group 2, P < 0.05). A decrease in the fast pathway (FP) ERP (339 +/- 15 to 279 +/- 12 ms) and an increase in the maximum FP AH interval (141 +/- 5 to 171 +/- 7) were observed only in group 1 (P < 0.05). In group 2, no change in the SP ERP (267 +/- 7 to 280 +/- 10 ms) was observed, and the change in the maximum SP-AH following ablation showed a significant inverse relation to the maximum SP-AH at baseline in group 2. In conclusion, (1) an increase in the WB-CL is observed independent of the persistence or elimination of dual physiology after successful ablation; (2) when dual physiology is eliminated, significant changes in the FP ERP and the maximum FP-AH occur; (3) when dual physiology persists, FP physiology and the SP ERP remain unchanged, and a significant inverse relation between the change in the maximum SP-AH following ablation and the maximum baseline SP-AH is observed.

[Multislice CT angiography: optimization of scan parameters in a vascular phantom]

PURPOSE

The aim of this study is to determine the optimal scan parameters for the evaluation of experimental vascular stenoses with a multislice-helical CT.

MATERIAL AND METHODS

A vascular phantom consisting of four tubes with an inner diameter of 8 mm and with experimental stenoses of 50%, 75% and 90% was scanned in different tube orientations using a multislice-CT scanner (LightSpeed QX/i, GE, Milwaukee, USA). Examinations were performed with increasing collimations (1.25-5 mm), tube currents (100-300 mA) and two different table speeds (0.75 HQ mode and 1.5 HS mode).

RESULTS

The most exact measurements were obtained in tubes angulated parallel to the scan direction with a collimation of 2.5 mm in the HQ mode (7.5 mm/rot.). An almost equivalent accuracy was obtained in the HS mode (15 mm/rot.) with a collimation of 2.5 mm when higher tube currents (300 mA) were employed. The degree of stenoses was overestimated when the tube was angulated perpendicular to the z-axis.

CONCLUSION

Multislice-CT provides a good detection rate of vascular stenoses especially at 0 degree and also at 45 degrees angulation in the HQ mode. The use of the HS mode with higher tube currents allows scanning of longer distances with almost identical accuracy.

The morphogenesis of the arteries of the pelvic extremity. A comparative study of mammals with special reference to the tree shrew Tupaia belangeri (Tupaiidae, Scandentia, Mammalia)

The ontogeny of the arteries of the pelvic extremity of Tupaia belangeri was investigated by light microscopy on the basis of serial sections of 30 embryos, dating from day 17 to day 42 post-copulation. In Tupaia, the gestational period takes approximately 43 days. Additionally, a 3-D reconstruction of the pelvic region and the right leg of a 22-day embryo was prepared. The arteries of an adult Tupaia were studied on the basis of a corrosion cast. The results were compared with the ontogeny of the arterial system of other mammals. In the 17-day embryo, the anlage of the pelvic extremity is penetrated by a capillary plexus. In the 18-day embryo, the a. ischiadica reaches the pelvic limb bud, representing the primary axial artery. On day 19, its r. perforans tarsi extends from the plantar to the dorsal aspect of the foot plate. The a. ischiadica is the main artery of the leg until the stage of the 22-day embryo. Afterwards, the peripheral arteries supplied by it are taken over by the a. iliaca externa and its extension, the a. femoralis. The a. iliaca externa springs from the a. iliaca communis in the 19-day embryo. From day 21 to day 22, the capillary plexus, which is nourished by the a. femoralis, closely approaches the a. ischiadica, and finally, a connecting branch joins the a. ischiadica. The a. ischiadica is then reduced to the a. glutea caudalis, and the aa. femoralis, poplitea profunda (at the cranial aspect of the m. popliteus), and interossea become the main arteries of the pelvic extremity. The a. poplitea superficialis, lying at the caudal aspect of the m. popliteus, and its continuation in the crural region, the a. peronea, develop until the 25-day embryo. The a. peronea gives rise to an r. perforans which penetrates the membrana interossea towards the dorsum of the foot. As a result of a shift of the origin of the a. iliaca externa in the proximal direction, the length of the a. iliaca communis gradually decreases until, on day 24, the a. iliaca externa springs directly from the lateral wall of the aorta. In the 20-day embryo, the a. iliaca externa gives rise to an a. circumflexa ilium profunda towards the lateral pelvic wall, and in 23-day embryos, to the a. profunda femoris. The main branches of the a. profunda femoris develop until day 24. At the same time, the aa. circumflexa femoris lateralis and nutricia ossis femoris arise from the a. femoralis. The a. saphena, which is already recognizable in the 23-day embryo, gives rise to the a. genus descendens, and as an a. plantaris medialis, to four aa. digitales plantares communes (I-IV) at the planta pedis. The development of the a. tibialis cranialis on day 25 takes place independently and without any topographic relation to the a. saphena, which functionally replaces the a. tibialis cranialis in some other mammals. In the 26-day embryo, the aa. peronea and tibialis cranialis extend to the dorsum of the foot where they continue as the aa. dorsales pedis profunda and superficialis. The fourth main artery of the lower leg, the a. caudalis femoris, which is first observed in the 20-day embryo, reaches the lateral aspect of the foot on day 24. Its r. calcaneus runs to the planta pedis. In 30-day embryos, the aa. digitales plantares propriae have differentiated. The corresponding dorsal arteries and the superficial plantar vascular are develop until day 35, so that all important arteries of the pelvic extremity, which are seen in the corrosion cast of the adult, are recognizable. Among the embryos and the adult Tupaia studied, individual variation is minimal. The developmental stage at which the arteries of the leg acquired a secondary vascular wall was ascertained. Only a vessel with a primary vascular wall can dissolve into a capillary plexus later on (e.g., a. interossea). In contrast, the course of an artery which has acquired a secondary vascular wall is determined, because modifications of the course of a vessel often need a capillary plexus as an intermediate st

[Therapy of tumor pain]

The incidence of cancer pain is about 90%. The first step in the treatment strategy is a causal therapy, including tumor mass reduction. An adequate pain management should start sometimes before the onset of a causal treatment. A good pain relief in cancer patients is mostly possible by the consequent application of the World Health Organisation 3 step analgesic ladder for the treatment of cancer. Pain management has become more comfortable since the development of new ways of applications e.g. transdermal fentanyl, water soluble morphine granulate and retarded drugs. With those new preparations, we got new possibilities and a bigger variety in the practical use of the WHO analgesic ladder. Basics for a good social integration of the patient are treatment of side effects, periodic consultations and a professional psychological support.

Harbor seal (Phoca vitulina) C-reactive protein (C-RP): purification, characterization of specific monoclonal antibodies and development of an immuno-assay to measure serum C-RP concentrations

C-reactive protein (C-RP) was purified from harbor seal (Phoca vitulina) serum by calcium dependant phosphoryl-choline and protein A affinity chromatography. Polyacrylamide gel electrophoresis under reducing conditions revealed a single protein moiety with a molecular weight of approximately 25 kDa. An internal peptide derived from this purified protein was subjected to N-terminal amino acid sequencing. A high amino acid sequence similarity was obtained with other published mammalian C-RP molecules confirming that the purified protein was a C-RP homologue. Eight specific monoclonal antibodies (P13, P51, P87, P101, P106, P130, P157 and P219) were raised against this purified protein. All 8 monoclonal antibodies immunoblotted with the 25 kDa C-RP subunit under reducing conditions. A competitive immunoassay was developed identifying elevated C-RP concentrations in harbor seal serum samples with clinical evidence of inflammatory disease. Application of this immunoassay for the measurement C-RP may provide valuable information for the clinical assessment of harbor seal health.

A comparison of the physicochemical and biological properties of mirtazapine and mianserin

Although the chemical structures of the antidepressants mirtazapine and mianserin are closely related there are considerable differences in their biological properties. To find an explanation of this, various physicochemical properties of mirtazapine and mianserin were measured or calculated. Isosteric replacement of CH in mianserin by N in mirtazapine has profound effects on physicochemical properties. The charge distributions as indicated by NMR and calculated by semi-empirical quantum mechanics differ, not only for the changed aromatic A-ring (as expected), but also in other regions of the molecule. The N5 atom in particular, which is conjugated to the changed aromatic ring, is less negatively charged in mirtazapine than in mianserin. Consequently the oxidation potential of mirtazapine is significantly higher than that of mianserin. Another result of this difference in charge distribution is that the (calculated) dipole-moment vectors of the compounds are oriented roughly perpendicular to each other. The dipole moment of mirtazapine is, moreover, three times larger than that of mianserin; mirtazapine is, therefore, more polar than mianserin and this is reflected in a lower retention index. Finally, the basicity of mirtazapine, expressed as the pKa value, is slightly but significantly lower than that of mianserin. The observed differences between the physicochemical properties of mirtazapine and mianserin result in different interactions of these two antidepressants with macromolecules, such as receptors, transporters and metabolizing enzymes; this might explain the differences observed in pharmacological activity and metabolic and kinetic behaviour, that is, the reduced affinity for the alpha 1-adrenoceptor and negligible noradrenaline reuptake of mirtazapine compared with mianserin.

Termini of all mRNA species of Marburg virus: sequence and secondary structure

The 3' and 5' ends of Marburg virus (MBG)-specific mRNA species have been determined using reverse transcription-PCR, rapid amplification of cDNA ends, or the reverse ligation-mediated PCR procedure after removal of cap structures with tobacco acid pyrophosphatase. The polyadenylation sites of all MBG-specific mRNAs were strictly conserved and corresponded to the predicted transcriptional stop signals of genomic RNA. Determination of the 5' ends of the mRNA species showed that mRNA synthesis started precisely at the first nucleotide of a highly conserved transcriptional start site. The 5' ends of the mRNA species can build a stable secondary structure with the conserved nucleotides always located in the stem region of a hairpin. Nucleotide substitutions in the conserved 5' regions are accompanied by compensatory mutations of the complementary nucleotide thus leading to a conservation of the secondary structures. Compensatory mutations were also found when 5' ends of mRNA of MBG strain Musoke were compared with MBG strain Popp or the closely related Ebola virus, indicating that the secondary structures will be conserved even if the sequence is altered.

Acylation of the Marburg virus glycoprotein

The surface protein of Marburg virus (GP) is modified by acylation, as shown by labeling with [3H]myristic and [3H]palmitic acid. Acylation of GP also occurred when it was expressed in insect cells with the baculovirus expression system. Gas chromatographic analyses of the bound fatty acids indicated that exogenously added [3H]myristic acid was partly metabolized to palmitic and stearic acid. To elucidate the nature of the fatty acid bond, [3H]palmitic acid-labeled GP was treated with mercaptoethanol. Since the fatty acids were removed by this treatment, it is concluded that the linkage is of the thioester type. A putative attachment site for thioester-linked fatty acids consisting of two cysteine residues located between the transmembrane anchor and the carboxy-terminal cytoplasmic tail of GP (Cys671 and Cys673) could be identified. Site-directed mutagenesis of these two amino acids to alanine residues clearly demonstrated that both cysteines could serve as acylation sites.

Disposition of antipyrine in patients with extensive metastatic liver disease

In the present study the effect of metastatic liver disease on hepatic drug metabolism has been examined by studying the pharmacokinetics of antipyrine and the urinary excretion of antipyrine and its three major metabolites (4-hydroxyantipyrine, norantipyrine, and 3-hydroxymethylantipyrine) in 12 patients with extensive metastatic liver disease, and in 12 matched healthy controls. In the patients total liver volume, the volume of the liver parenchyma, and the volume of the liver metastases were determined by computed tomography. The volume of liver metastases always exceeded 35% of the total liver volume. There were no significant differences between the patients and controls in plasma half-life, plasma clearance, or apparent volume of distribution of antipyrine. The cumulative urinary excretion of antipyrine and its three major metabolites was significantly lower in patients [44 (18) %] than in controls [71 (8) %]. The excretion of antipyrine itself was unchanged and the decrease in cumulative excretion was due to reduced excretion of the three metabolites. The results show that the activity of the hepatic mixed function oxidases was not impaired even in patients with extensive metastatic liver disease. This may be because liver metastases do not cause a corresponding reduction in the volume of normal hepatic parenchyma. The decreased urinary excretion of the three major metabolites of antipyrine, which are mainly glucuronidated, may have been due to an alteration in the process of conjugation.

[Diagnosis of insufficient perforating veins using thermographic plates]

With the help of thermographic plates developed by the department of physical chemistry of the Martin Luther University Halle it was possible to detect in 50 patients 158 insufficient venae perforantes, which were found by x-ray examination, from total of 175. The causes for 17 insufficient venae perforantes not diagnosed thermographically were inadequate application of the plates in ulcus cruris, the existence of a pair of perforating veins and functionally unimportant bypasses. Plate thermography proved to be suitable in the lower leg for the detection of smaller differences in temperature. Evaluating these results in comparison to the literature references there was no difference between our method and the infrared thermovision. From an economic point of view plate thermography seems to be superior to infrared thermovision. In contrast to this, plate thermography has the disadvantage of a longer time for examination and problems in documentation and registration of the results.