Objectives: Pen devices offer advantages compared with vial and syringe (VaS). The purpose of this article was to evaluate efficacy of pen devices compared to VaS. Methods: A systematic review of literature was performed in 8 different databases. References were independently screened and selected. Primary observational or experimental studies comparing pen devices with VaS for insulin administrations were included. Studies on specific populations were excluded. Risk of bias was evaluated using appropriate tools. Data on glycosylated hemoglobin (HbA1c), hypoglycemia, adherence, persistence, patient preference, and quality of life (QOL) were collected. Meta-analysis was performed when appropriate. Heterogeneity and risk of publication bias were evaluated. Otherwise, descriptive analyses of the available data was done. Results: In all, 10 348 articles were screened. A total of 17 studies were finally selected: 7 experimental and 10 analytical. The populations of the included articles were mainly composed of adults with type 2 diabetes mellitus. Important risk of bias was found in all of the articles, particularly experimental studies. Meta-analyses were performed for HbA1c, hypoglycemia, adherence and persistence. Pen device showed better results in mean HbA1c change, patients with hypoglycemia, adherence and persistence compared to VaS. No difference was observed in number of patients achieving <7% HbA1c. Preference studies showed a tendency favoring pen devices, however nonvalidated tools were used. One QoL study showed improvements in some subscales of SF-36. Conclusions: There is evidence that pen devices offer benefits in clinical and, less clearly, patient-reported outcomes compared to VaS for insulin administration. However, these results should be taken with caution.
Objective:Poor sleep patterns are common in undergraduates and may turn them prone to
mood disorders, substance abuse and impaired academic performance. The aim
of this study was to assess sleep disturbances among medical students, and
whether associations with academic performance, depressive symptoms or
substance use were present.Methods:Cross-sectional study in which 544 medical students of the Pontificia
Universidad Javeriana in Bogota, Colombia were included. Using a
computer-based survey, self-reported variables were assessed, including
demographics, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness
Scale (ESS), Berlin Questionnaire, Diagnostic and Statistical Manual
of Mental Disorders (DSM) - IV depression criteria, Grade Point
Average (GPA), and substance use. Associations between these variables were
obtained.Results:Fifty-four percent of students were women. Poor sleep quality (PSQI>5) and
daytime sleepiness (ESS>10) were found in 65% of the population. A higher
GPA was more frequent in students with good sleep quality (OR= 2.6
[1.5-4.5]), lack of daytime sleepiness (OR= 2 [1.3-3.1]) and low risk of
Obstructive Sleep Apnea Syndrome (OSAS) (OR= 3.1 [1.6-5.9]). DSM-IV
depression criteria were fulfilled by 26% of the students and were
associated with poor sleep patterns. Energy drinks use was associated with
poor sleep quality.Discussion:Poor sleep quality, daytime sleepiness and depressive symptoms are frequent
among medical students and are associated with lower academic performance.
The identification of students at risk and the implementation of targeted
interventions are warranted. Fostering adequate sleep habits and training on
sleep medicine may partly counteract these issues.
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