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Blood Glucose Self-Monitoring --- instrumentation.

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In addition to the risk of treatment failure, the liability for elucidation errors forms the second pillar of medical care. An elucidation error occurs when the physician has not given the patient the necessary self-determination information. The self-determination investigation is intended to enable the patient to decide on his own responsibility whether he wants to undergo a specific procedure. The consent of the patient to a medical procedure is only effective if he has received a proper self-determination information beforehand. The doctor must prove that the patient has received a proper self-determination. Self-determination elucidation must be distinguished from the therapeutic elucidation. The therapeutic elucidation aims to avoid self-harming the patient and to lead him a therapy-friendly behavior. Therapeutic elucidation is assigned to the area of medical treatment, with all the consequences of evidence. Thus, inadequate or omitted therapeutic elucidation represents a treatment defect, which must in principle be proven by the patient. Against this background, the relationship between self-determination elucidation and therapeutic elucidation is becoming increasingly important.

Medical laws and legislation. --- Patient self-monitoring.

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Suicide --- Suicidal behavior --- Patient self-monitoring --- Prevention.

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Les études rapportant sur la fonction pancréatique après le traitement endoscopique de la pancréatite chronique sont peu nombreuses. Le but de notre étude a été d'évaluer de façon prospective l'évolution de la fonction endocrine et exocrine du pancréas après traitement endoscopique chez des patients souffrant de pancréatite chronique en suivant les paramètres de la fonction endocrine et des tests fécaux pour la fonction exocrine. Méthodes : De septembre 2015 à décembre 2016, les patients ayant une pancréatite chronique avec obstruction ' canalaire et nécessitant un drainage endoscopique ont été inclus et la fonction endocrine et exocrine du pancréas a été évaluée de façon prospective. La fonction endocrine a été évaluée par l'HbA1c, l'insuline sanguine à jeun, le peptide C et le test HOMA avant le drainage endoscopique et à 1,3 ,6 et 9 mois après le drainage. La fonction exocrine a été évaluée par les selles de 72h, la stéatocrite acide et l'élastase fécale. Une analyse comparative des valeurs avant le drainage et à 1, 3, 6 et 9 mois de chaque variable a été effectuée.34 patients (âge : 54±12, 67.6% hommes) ont été inclus. Une amélioration statistiquement significative de HbA1c a été obtenue à 1(6.6 vs. 6.2, p=0.001). 3 (6.6 vs. 6.1,p=0.005 ) et 9 mois (6.6 vs. 6.0, p=0.006) par rapport à avant le drainage. L'HOMA-B a été amélioré à 1(53.0 vs. 67.2, p=0.002), 3 (53.0 vs. 68.6, p=0.001), 6 (53.0 vs. 75.4, p<0.001) et 9 mois (53.0 vs. 75.0, p<0.001). Le succès clinique du drainage endoscopique défini comme une réduction de 50% du VAS a été rapporté chez 72, 84, 80 et 77% des patients à 1, 3,6 et 9 mois. Une anal11se quantitative et comparative de la fonction exocrine n'a pas pu 'être effectuée suite au manque de compliance des patients par rapport aux tests fécaux. A notre connaissance, notre étude est la première à évaluer de façon prospective l'effet du traitement endoscopique sur la fonction pancréatique endocrine comme objectif principal. Notre étude a montré une amélioration significative de la fonction endocrine à 1, 3 ,6 et 9 mois après le traitement endoscopique. Les valeurs de chaque paramètre de la fonction endocrine (HbA1C, FPG, FBIL, peptide C, HOMA-B) ont été améliorées chez chaque patient au cours du suivi. Des résultats similaires ont été obtenus chez les diabétiques sous insuline ou antidiabétiques oraux ainsi que chez les patients non diabétiques. Conclusion : Le traitement endoscopique dans la pancréatite chronique améliore le contrôle glycémique et la fonction Pancréatique endocrine au court et moyen terme. Studies reporting on function after endoscopic treatment of chronic pancreatitis are scarce. The aim of the study was to investigate prospectively the evolution of pancreatic endocrine and exocrine function in patients undergoing endoscopic treatment based on endocrine function parameters and fecal tests for exocrine function. Methods: Between September 2015 and December 2016, patients requiring endoscopic drainage for chronic pancreatitis with ductal obstruction were enrolled in the study and had a prospective evaluation of their endocrine and exocrine function. Endocrine function was evaluated by Hba1c, fasting blood insulin level, C peptide level and HOMA test before endotherapy and at 1, 3, 6 and 9 months following endotherapy. Exocrine function was evaluated by 72h fecal fat test, fecal acid steatocrit and fecal elastase level. A comparative analysis between follow-up points (1, 3, 6 and 9 months) and baseline values of variables was performed. Results: Thirty-four patients (age: 54±12yer, 67, 6% male) were included. Statistically significant improvement in Hba1c was attained at 1 (6,6 vs 6,2, p=0,001), 3 (6,6 vs. 6,1, p=0,005) and 9 months (6,6 vs 6.., p =0,006) compared to before drainage. HOMA-B values were statistically higher at 1 (53.0 vs 75.0, p=0,002), 3 (53.0 vs. 68.6, p= 0,001), 6 (53.0 vs. 75.4, p<0,001) and 9 months (53.0 vs.75.0, p<0,001). Clinical success of endoscopic drainage defined as 50% reduction in VAS score are compared to before drainage was recorded in 72, 84, 80 and 77% of patients at, 1, 3, 6 and 9 months, respectively. Exocrine function was not assessable due to patient’s poor compliance to stool sampling. Discussion: To our knowledge, our study is the first to evaluate prospectively the effect of endoscopic treatment on the endocrine function of the pancreas as the principal aim. Our study has shown significant improvement in endocrine function at 1, 3, 6 and 9 months following endoscopic drainage. Considering maximum follow-up in each patient all endocrine function variables (HbA1c, FPG, FBIL, C-peptide, and HOMA-B) improve their values at each follow-up point. Similar results were obtained in diabetic patients under insulin therapy or oral antidiabetic medications as well as in non-diabetic patients. Conclusion: Endoscopy therapy in chronic pancreatitis improves glycemic control and pancreatic endocrine function in the short-and mid-term follow-up.

Pancreatitis, Chronic --- Endoscopy --- Prospective Studies --- Blood Glucose Self-Monitoring

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Suicide --- Suicidal behavior --- Patient self-monitoring --- Hospitals --- Prevention. --- Emergency services.