OBJECTIVE -To evaluate whether group visits, delivered as routine diabetes care and structured according to a systemic education approach, are more effective than individual consultations in improving metabolic control in non-insulin-treated type 2 diabetes.RESEARCH DESIGN AND METHODS -In a randomized controlled clinical trial of 112 patients, 56 patients were allocated to groups of 9 or 10 individuals who participated in group consultations, and 56 patients (considered control subjects) underwent individual visits plus support education. All visits were scheduled every 3 months. RESULTS -After 2 years, HbA 1c levels were lower in patients seen in groups than in control subjects (P Ͻ 0.002). Levels of HDL cholesterol had increased in patients seen in groups but had not increased in control subjects (P ϭ 0.045). BMI (P ϭ 0.06) and fasting triglyceride level (P ϭ 0.053) were lower. Patients participating in group visits had improved knowledge of diabetes (P Ͻ 0.001) and quality of life (P Ͻ 0.001) and experienced more appropriate health behaviors (P Ͻ 0.001). Physicians spent less time seeing 9 -10 patients as a group rather than individually, but patients had longer interaction with health care providers.

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Oligoanalgesia in Emergency Departments (ED) is known to be common. The aim of our study is to determine how often patients in pain desire and receive analgesics while in the ED. Four main outcomes have been considered: desire of analgesics, administration of analgesics in the ED, correlation between initial analgesic administration and triage priority scores, patients' satisfaction at discharge during the ED visit. Pain severity was evaluated by a 10-point numerical rating scale (0 = no pain, 10 = worst possible pain) A total of 393 patients were enrolled in the study. The majority were non-Hispanic whites with a median age of 62 years. Of the 393 patients, 202 expressed desire for analgesics, but only 146 received a treatment. Among patients refusing analgesics (48.6%), the most common reasons were to diagnose pain causes and pain tolerance. In multivariate analysis, pain score severity was significant factor that predicted wanting analgesics, whereas desiring analgesics was predictive factor to receive them. On the other hand, patients with pain localized in lower extremities and in nose or ear less probably received analgesia. In conclusion, the underuse of analgesics in the ED continues to represent a problem and our study demonstrates that half of all ED patients in pain desire analgesics and that only half of those wanting analgesics receive them. Patients that desired and received analgesic treatment represented the group with a higher degree of satisfaction.

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