Glycaemic control, treatment satisfaction and quality of life in type 2 diabetes patients in Greece: The PANORAMA study Greek results

AIM: To provide an update on glycaemic control inEuropean patients with type 2 diabetes mellitus(T2DM). We present the Greek population data of the study. METHODS: An observational multicenter, cross-sectional study evaluating glycaemic control and a range of other clinical and biological measures as well as quality of life(Qo L) and treatment satisfaction in 375 patients with T2 DM enrolled by 25 primary care sites from Greece. RESULTS: The mean age of the patients was 63.5 years and the male/female ratio 48.9%/51.1%. 79.7% of the patients exerted none or light physical activity, 82.4% were overweight or obese and 32.9% did not meet Hb A1 c target of less than 7.0%(53 mmol/mol). Patients reported high satisfaction to continue with treatment, high satisfaction with administered treatment and increased willingness to recommend treatment to others(mean Diabetes Treatment Satisfaction Questionnaire score 29.1 ± 5.6). However, 80% of the patients reported that their Qo L would be better without diabetes. Finally, the most challenging parameter reported was the lack of freedom to eat and drink. CONCLUSION: This analysis of the Greek Panorama study results showed that a considerable percentage of T2 DM patients in Greece do not achieve glycaemic target levels, despite the favourably reported patient satisfaction from administered therapy. Additionally, the majority of primary care T2 DM patients in Greece depict the negative effect of the disease in their Qo L.

Prognostic Potential of B - type Natriuetic Peptide and Quality of Life in Patients with Chronic Heart Failure

Objectives To study wheth- er change of BNP levels reflect the change of cardiac function and to investigate the short - term prognostic potential of BNP and QOL in patients with CHF. Methods 96 consecutive patients admittedwith CHF between September 2002 and January 2003 were stud- ied , upon entry the study, BNP levels were measured, Patients administered the disease - specificquality of life questionnaire Minnesota living with heart failure questionnaire (LiHFe) within 1 day. BNP levels and administering LiHFe were repeated three months later. Results BNP levels were increased proportional to the severity of cardiac function. Physical domain and total score of LiHFe were significantly correlated to the severity of CHF ( p < 0. 05 ). BNP levels were de- creased in improving group(p =0. 032) . In deteriora- ting group BNP levels increased (P = 0. 043 ) . Kaplan - meier analysis according to BNP level cutoff point 150 ng/1, the life curve of higher BNP level group was significantly lower than the lower group ( p = 0. 001 ) . In univariate logistic regression, NYHA class, BNP, LVEF, LVEDD, heart size, total score of LiHFe, phys- ical domain of LiHFe and the emotional domain of LiH- Fe were all significant prognostic factors of CHF ( p < 0. 05 for all). While in multiple regression, only BNP level( p = 0. 036) and the emotional domain of LiHFe ( p = 0. 025 ) were independent prognostic factors. Conclusions Change of BNP reflects the treatment efficacy of CHF. BNP and QOL are the two major short - time prognostic factors of the chronic heart failure patients.

Inference for constant-stress accelerated life test with Type-I progressively hybrid censored data from Burr-XII distribution

This paper proposes a simple constant-stress accel- erated life test （ALT） model from Burr type XII distribution when the data are Type-I progressively hybrid censored. The maximum likelihood estimation （MLE） of the parameters is obtained through the numerical method for solving the likelihood equations. Approxi- mate confidence interval （CI）, based on normal approximation to the asymptotic distribution of MLE and percentile bootstrap Cl is derived. Finally, a numerical example is introduced and then a Monte Carlo simulation study is carried out to illustrate the pro- posed method.

Health Related Quality of Life in Adult with Type 2 Diabetes Mellitus

Introduction: The health related quality of life (HRQoL) has an important role in adults suffering from diabetes. Objective: To assess the health related quality of life in adult with type 2 diabetes mellitus. Materials and methods: A cross-sectional study was conducted to assess diabetic patient’s HRQoL on 119 purposively selected type-2 DM patients (aged ≥ 18 years and duration of diabetes ≥ 1 year). Data were collected by face-to-face interview and by medical record review through a Bangle version of SF-36 semi-structured questionnaire and a checklist. Place and period of study: The study was conducted at outpatient department in Gopalganj 50 bedded diabetic hospital from 1st January, 2018 to 31st December 2018. Results: The mean age of the respondents was 52.34 (SD ± 10.19) years. Age group shows a significant difference associated with all domains of quality of life except role emotion (>0.05), gender shows the significant in social and pain domain (0.05) respectively co-morbidity shows the significant difference with all domains expect pain (>0.05). Physical functioning, emotional, pain and general health of the quality of life show the significant difference associated with use of insulin (Conclusion: The overall QoL of type-2 DM patients was poor and had lower score of health related quality of life.

Fifteen-year follow-up of quality of life in type 1 diabetes mellitus

AIM:To evaluate metabolic control and health-related quality of life(HRQOL)in a type 1 diabetes mellitus(T1DM)population.METHODS:As part of a prospective cohort study,283T1DM patients treated with various insulin treatment modalities including multiple daily injections(MDI)and continuous subcutaneous insulin infusion(CSII)were examined annually.HRQOL was measured using the SF-36 and EuroQol questionnaires.Data regarding HRQOL,glycaemic and metabolic control from baseline and follow-up measures in 2002 and 2010 were analysed.Linear mixed models were used to calculate estimated values and differences between the three moments in time and the three treatment modalities.RESULTS:Significant changes[meanΔ(95%CI)]in body mass index[2.4 kg/m2(1.0,3.8)],systolic blood pressure[-6.4 mmHg(-11.4,-1.3)]and EuroQol-VAS[-7.3(-11.4,-3.3)]were observed over time.In 2010,168 patients were lost to follow-up.Regarding mode of therapy,52 patients remained on MDI,28 remained on CSII,and 33 patients switched from MDI to CSII during follow-up.Among patients on MDI,HRQOL decreased significantly over time:mental component summary[-9.8(-16.3,-3.2)],physical component summary[-8.6(-15.3,-1.8)]and EuroQol-VAS[-8.1(-14.0,-2.3)],P<0.05 for all.For patients using CSII,the EuroQol-VAS decreased[-9.6(-17.5,-1.7)].None of the changes over time in HRQOL differed significantly with the changes over time within the other treatment groups.CONCLUSION:No differences with respect to metabolic and HRQOL parameters between the various insulin treatment modalities were observed after 15 years of follow-up in T1DM patients.

中国特有植物泰顺杜鹃所处群落特征与物种多样性分析

为了解中国特有植物泰顺杜鹃(Rhododendron taishunense B.Y.Ding et Y.Y.Fang)所处群落的结构和物种多样性特征以及更好地保护该物种,在其分布区浙江温州市和福建宁德市设立9个面积20 m×20 m的样地并进行群落学调查,分析了泰顺杜鹃所处群落物种组成、群落类型和物种多样性。结果表明:泰顺杜鹃所处群落植物种类丰富,9个样地共有63科107属182种(含种下等级,下同),其中高位芽植物139种(占比76.4%)、地下芽植物28种(占比15.4%)、地上芽植物10种(占比5.5%)、地面芽植物3种(占比1.6%)、一年生植物2种(占比1.1%)。基于群落乔木层种类重要值的聚类分析结果显示:泰顺杜鹃所处群落可分为甜槠林(Form.Castanopsis eyrei(Champ.ex Benth.)Tutcher)、木荷林(Form.Schima superba Gardner et Champ.)、杉木林(Form.Cunninghamia lanceolata(Lamb.)Hook.)、短尾柯林(Form.Lithocarpus brevicaudatus(Skan)Hayata)和细柄蕈树林(Form.Altingia gracilipes Hemsl.)。在9个样地中,泰顺杜鹃所处群落灌木层的各物种多样性指数总体高于乔木层和草本层。综合来看,泰顺杜鹃所处群落主要为常绿阔叶林或暖性针叶林,具有明显的中亚热带群落特性,但群落尚处不稳定阶段,应开展保护措施以维持群落的稳定性。

基于经筋理论指导下运用火针治疗寒湿型腰椎间盘突出症的临床观察

【目的】观察基于经筋理论指导下运用火针疗法治疗寒湿型腰椎间盘突出症的临床疗效。【方法】将2023年3月至2023年12月广东省第二中医院收治的70例寒湿型腰椎间盘突出症患者按随机数字表法随机分为观察组和对照组,每组各35例。对照组给予常规针刺治疗,观察组在对照组治疗的基础上,采用经筋理论指导下的火针治疗,治疗1周为1个疗程,共治疗3个疗程。治疗3个疗程后,评价2组临床疗效,观察2组患者治疗前后疼痛视觉模拟量表(VAS)评分的变化情况,以及日本骨科协会(JOA)评分的情况。比较2组患者治疗前后中医证候积分的变化情况。【结果】(1)研究过程中,观察组失访3例,对照组失访5例。最终观察组32例、对照组30例纳入疗效统计。(2)观察组总有效率为93.75%(30/32),对照组为86.67%(26/30)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。(3)治疗后,2组患者的VAS、JOA评分明显改善(P<0.05),且观察组在改善VAS、JOA评分方面明显优于对照组,差异有统计学意义(P<0.05)。(4)治疗后,2组患者的中医证候评分明显改善(P<0.05),且观察组在改善中医证候评分方面明显优于对照组,差异有统计学意义(P<0.05)。【结论】基于经筋理论指导下运用火针治疗寒湿型腰椎间盘突出症,能明显降低患者的疼痛程度,改善患者的腰椎功能,减轻患者的相关症状,从而提高患者的生活质量,临床疗效显著。

提升新能源消纳的多类型储能复合控制与经济性分析

为了提升新能源消纳水平,提出一种考虑充、放电能量不平衡的3组电池复合控制策略,并构建全寿命周期成本模型,综合分析多类型储能复合控制下的成本,为经济有效平抑风功率波动提供参考。以并网标准为依据,采用自适应完全集合经验模态分解算法得到储能系统的参考功率,且在混合储能模式下,以模态混叠最少为原则解耦内部功率;提出基于3组电池的储能复合控制策略,相较于双电池储能模式,以1组电池作为备用,提高了对充、放电能量不平衡度的容忍度,使每组电池均能运行于最优放电深度,并分别采用单电池储能、混合储能、双电池储能和3组电池集成储能跟踪功率指令;以储能系统的充放电效率和荷电状态为约束配置多类型储能容量,基于全寿命周期成本模型综合分析多类型储能复合模式的平抑成本;基于实际风电场数据分析多类型储能复合控制下的经济性,并给出参考方案。

医学生-病友参与式健康管理对合并2型糖尿病的脑梗死患者生活质量的影响

目的探讨医学生-病友参与式健康管理对合并2型糖尿病的脑梗死患者生活质量的影响。方法选取首次发作、美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分为1~4分且合并2型糖尿病的脑梗死患者随机分为对照组(49例)和研究组(47例),对照组行常规健康管理,研究组在此基础上,结合Learns模式,引入医学生和病友参与。对比管理前后2组患者血糖水平、生活质量、Barthel指数(Barthel Index,BI)等变化。采用Spearman相关性分析探讨SF-36评分与BI评分的相关性。结果干预前,2组FBG、2 h PG、HbA1c、BI评分比较差异无统计学意义(P>0.05);干预后,研究组FBG、2 h PG、HbA1c、BI评分均优于对照组(P<0.05)。研究组SF-36评分的8个维度评分均优于对照组(P<0.05)。Spearman相关性分析结果显示:干预后研究组精力、社会活动、情感职能与BI正相关(r分别为0.469、0.758、0.453,P<0.01)。结论医学生-病友参与式健康管理能够改善合并2型糖尿病的脑梗死患者的血糖水平、改善生活质量、日常生活活动能力;关注患者的精力、社会活动、情感职能有助于提高其生活质量。

基于心理资本干预模型的团体护理对社区老年2型糖尿病患者血糖、心理状态及生活质量的影响

目的探讨基于心理资本干预(PCI)模型的团体护理对社区老年2型糖尿病患者血糖、心理状态及生活质量的影响。方法选取2022年6~11月成都市龙泉驿区某社区卫生服务中心的85例老年2型糖尿病患者为研究对象,按照随机数字表法分成试验组(n=42)和对照组(n=43)。试验组给予基于PCI模型的团体护理,对照组给予常规心理护理。4个月后,比较两组患者的血糖、心理状态及生活质量变化。结果干预后试验组患者血糖、焦虑(SAS)、抑郁(SDS)评分、纽芬兰纪念大学幸福度量表(MUNSH)中负性维度评分及糖尿病患者生存质量量表(DSQL)(除治疗维度外)的各维度评分均低于对照组(P﹤0.05);积极心理资本问卷(PPQ)评分及MUNSH中正性维度评分较对照组显著提高(P﹤0.05)。结论基于PCI模型的团体护理应用于老年2型糖尿病患者,可提升患者心理资本水平及主观幸福感,有助于改善患者的血糖水平及生活质量。

案例教学在材料与化工专业硕士学位教学中的应用研究——以“材料结构与性能”中高分子材料教学为例

为了适应“材料结构与性能”课程综合性强、知识点多、抽象度高等特点,经过三年的探索,教学团队将实验型、知识型、实用型和解决现实问题型等教学案例引入课程教学中,激发了学生学习积极性,不仅能更好掌握高分子材料模块相关知识,而且还能提升分析问题和解决问题的能力。通过知识点与教学案例的融合,强化了知识在生产生活中的深度应用,让学生学有所成、学有所思,对促进专业学位研究生的整体培养有重要意义。

化痰通络汤加味方治疗冠心病PCI术后心绞痛痰瘀互结型的临床研究

【目的】探讨化痰通络汤加味方(由半夏、橘红、茯苓、枳实、丹参、川芎、红花、石菖蒲、远志等组成)对冠心病经皮冠状动脉介入(PCI)术后心绞痛痰瘀互结型患者的临床疗效及生活质量的影响。【方法】将广州中医药大学附属阳江市中医医院2023年1月至2024年1月期间收治的80例冠心病PCI术后心绞痛痰瘀互结型患者按随机数字表法随机分为对照组和治疗组,每组各40例。对照组给予常规西药治疗,治疗组在对照组的基础上联合化痰通络汤加味方治疗,疗程为1个月。观察2组患者治疗前后中医证候积分、生活质量西雅图心绞痛量表(SAQ)评分的变化情况,并评价2组患者的中医证候疗效和心电图疗效。【结果】(1)SAQ评分方面,治疗后,2组患者的躯体活动受限程度、心绞痛稳定状态、心绞痛发作情况、治疗满意程度、疾病认知程度等各项SAQ评分均较治疗前升高(P<0.05),且治疗组的升高幅度均明显优于对照组(P<0.05)。(2)中医证候积分方面,治疗后,2组患者的中医证候积分均较治疗前降低(P<0.05),且治疗组的降低幅度明显优于对照组,差异有统计学意义(P<0.05)。(3)中医证候疗效方面,治疗1个月后,治疗组的总有效率为90.00%(36/40),对照组为82.50%(33/40);组间比较,治疗组的总体疗效(秩和检验)明显优于对照组,差异有统计学意义(P<0.05);总有效率(χ^(2)检验)有优于对照组趋势,但差异无统计学意义(P>0.05)。(4)心电图疗效方面,治疗1个月后,2组患者的心电图均呈现出明显的改善趋势,治疗组的总有效率为87.50%(35/40),对照组为70.00%(28/40);组间比较,治疗组的总体疗效(秩和检验)和总有效率(χ^(2)检验)均明显优于对照组(P<0.05)。【结论】针对冠心病PCI术后心绞痛痰瘀互结型患者,在常规西药治疗基础上联合化痰通络汤加味方治疗,对提高患者临床疗效、改善患者生活质量有积极影响。

基于nCode DesignLife的电机耐久寿命仿真研究

针对电机耐久寿命评估需要专用试验设备,且存在试验周期长、费用高的问题,结合电机典型的损耗型故障模式,建立了高速电机的有限元模型,提出了基于nCode DesignLife的电机耐久寿命仿真方法,对高速电机的核心部件轴和轴承进行了耐久寿命仿真分析,得到了轴和轴承的应变分布、应力分布、损伤分布和耐久寿命分布。研究表明,耐久寿命仿真技术能够实现电机的寿命薄弱环节的快速挖掘和耐久寿命的快速评估,对于提高电机的耐久寿命具有一定的参考价值。

Application of Holdridge life-zone model based on the terrain factor in Xinjiang Automous Region

This study improved the application of the Holdridge life-zone model to simulate the distribution of desert vegetation in China which gives statistics to support eco-recovery and ecosystem reconstruction in desert area. This study classified the desert vegetation into four types： （1） LAD： little arbor desert; （2） SD： shrub desert： （3） HLHSD： half-shrub, little half-shrub desert; （4） LHSCD： little halfshrub cushion desert. Based on the classification of Xinjiang desert vegetation, the classical Holdridge life-zone model was used to simulate Xinjiang desert vegetation＇s distribution and compare the Kappa coefficient result of the model with table of accuracy represented by Kappa values. The Kappa value of the model was only 0.19, it means the simulation result was poor. To improve the life-zone model application to Xinjiang desert vegetation type, a set of plot standards for terrain factors was developed by using the plot standard as the reclassification criterion to climate sub-regime. Then the desert vegetation in Xinjiang was simulated. The average Kappa value of the second simulation to the respective climate regime was 0.45. The Kappa value of final modeling result was 0.64, which is the better value. The modification of the model made it in more application region. In the end, the model＇ s ecological relevance to the Xinjiang desert vegetation types was studied.

Inference and optimal design on step-stress partially accelerated life test for hybrid system with masked data

Under Type-Ⅱ progressively hybrid censoring, this paper discusses statistical inference and optimal design on stepstress partially accelerated life test for hybrid system in presence of masked data. It is assumed that the lifetime of the component in hybrid systems follows independent and identical modified Weibull distributions. The maximum likelihood estimations(MLEs)of the unknown parameters, acceleration factor and reliability indexes are derived by using the Newton-Raphson algorithm. The asymptotic variance-covariance matrix and the approximate confidence intervals are obtained based on normal approximation to the asymptotic distribution of MLEs of model parameters. Moreover,two bootstrap confidence intervals are constructed by using the parametric bootstrap method. The optimal time of changing stress levels is determined under D-optimality and A-optimality criteria.Finally, the Monte Carlo simulation study is carried out to illustrate the proposed procedures.

橡胶垫板刚度对弹条及T型螺栓受力特性的影响分析

为探究高速铁路无砟轨道WJ-7型扣件系统中橡胶垫板刚度对弹条及T型螺栓受力特性的影响,通过Abaqus-Simpack联合仿真研究了传统沟槽型和新型网孔式橡胶垫板频变刚度对钢轨垂向位移的影响,并建立扣件系统有限元模型,以钢轨垂向位移为输入荷载进行仿真分析。结果表明,当轨道下方使用圆形、五边形和六边形网孔式橡胶垫板时,与传统的沟槽型橡胶垫板相比,钢轨垂向位移分别下降了40.7%、38.6%和38.3%,此外,弹条的最大Mises应力分别下降了0.52%、0.39%和0.38%,而T型螺栓的最大Mises应力差异不大。可见,相较于传统沟槽型橡胶垫板,新型网孔式橡胶垫板的减震性能大幅提升,轨下垫板为新型网孔式橡胶垫板时更有利于提高弹条的疲劳寿命,其中圆形网孔式橡胶垫板在以上2个方面的性能最佳,而橡胶垫板频变刚度对T型螺栓受力特性的影响较小。

Optimized health care for subjects with type 1 diabetes in a resource constraint society: A three-year follow-up study from Pakistan

BACKGROUND Inadequate health infrastructure and poverty especially in rural areas are the main hindrance in the optimal management of subjects with type 1 diabetes (T1D) in Pakistan. AIM To observe effectiveness of diabetes care through development of model clinics for subjects with T1D in the province of Sindh Pakistan. METHODS A welfare project with name of “Insulin My Life”, was started in province of Sindh, Pakistan. This was collaborative work of Baqai Institute of Diabetology and Endocrinology, World Diabetes Foundation and Baqai Medical University between February 2010 to February 2013. Under this project thirty-four T1D clinics were established. Electronic database was designed for demographic, biochemical, anthropometric and medical examination. Monthly consultation was part of the standardized diabetes care. All the recruited subjects with T1D were provided free insulins and related materials. RESULTS Out of 1428 subjects, 795 (55.7%) were males and 633 (44.3%) were females. Subjects were categorized into ≤ 5 years of age 103 (7.2%), between 6-12 years 323 (22.6%), between 13–18 years 428 (29.7%) and ≥ 19 years of age 574 (40.2%) groups. Glycemic control as assessed by HbA1c was significantly improved (P <0.0001) at three years follow up as compared to baseline in all age groups. Decreasing trends of mean self-monitoring blood glucose were observed at different meal timings in all age groups. No significant change was found in the frequency of neuropathy, nephropathy and retinopathy during the study period (P > 0.05). CONCLUSION This study gives us long-term longitudinal data of people with T1D in a resource constraint society. With provision of standardized and comprehensive care significant improvement in glycemic control without any change in the frequency of microvascular complications was observed over 3 years.

山东省黄河三角洲水生耐盐药用植物资源调查与分析

对山东省黄河三角洲地区水生耐盐药用植物的种类、生活型及对应药材入药部位、药性、功效进行统计调查分析。共调查到野生水生耐盐药用植物299种。根据恩格勒分类系统,这些植物隶属于76科204属;生活型以草本型为主,共222种。以299种药用植物为基源的药材共338种,其中全草入药药材144种,占药材种类数的42.60%;平性药材最多,共85种;苦味药、甘味药和辛味药数量较其他药味具有明显优势;以功效分类,清热药、利水渗湿类、活血化瘀类、化痰止咳类、止血药和补虚药占优势。针对水生耐盐药用植物特点,结合该区域自然状况,提出了合理开发和综合利用的建议。

gastrointestinal symptom prevalence depends on disease duration and gastrointestinal region in type 2 diabetes mellitus

AIM To unravel relationships between gastrointestinal(GI)symptoms impairing quality of life(QOL)and clinical profiles of diabetes mellitus(DM)patients. METHODS We enrolled 134 outpatients with type 2 DM.Mean age was 64.7 years,mean body mass index was 24.7 RESULTS Lower abdominal symptoms were found to be more frequent than those affecting the upper abdomen.Diabetic duration and medications showed associations with GI symptoms.We identified differences in peak prevalences of the five symptoms.Gastralgia(P=0.02vs 10-14 years)and total GI symptoms(P=0.01 and P=0.02 vs 5-9 years and 10-14 years,respectively)peaked at a diabetes duration of 15-19 years.Heartburn(P=0.004)and postprandial fullness(P=0.03)tended to increase with disease duration.Constipation and diarrhea showed bimodal peaks,with the first early and the second late(e.g.,P=0.03 at 15-19 years vs 10-14years for diarrhea)in the disease course.Finally,GI symptoms showed clustering that reflected the region of the GI tract affected,i.e.,constipation and diarrhea had similar frequencies(P<0.0001). CONCLUSION Our study highlights the importance of questioning patients about QOL impairment due to abdominal symptoms,especially in the early and the late periods of diabetes.

Insulin Glargine 300 Units/mL Effectiveness in Patients with T2DM Uncontrolled by Basal Insulin in Real-Life Settings in the Czech Republic

Introduction: To evaluate the clinical effectiveness of Gla-300 units/mL (Gla-300) in the treatment of patients with type 2 diabetes (T2DM) uncontrolled by basal insulin in real-life clinical settings in the Czech Republic (TOPAZ study). Methods: TOPAZ was a prospective, multi-center, non-interventional, 6-month study. Of the 312 patients screened, 289 were evaluated at month 6. The primary objective was the change of HbA1c after 6 months. The proportion of patients with HbA1c < 7.0% DCCT (< 53 mmol/mol), and those with a decrease of at least 0.5% of HbA1c at month 6, change in FPG, body weight and insulin dose at month 3 and 6 were analysed as secondary objectives. Incidence of hypoglycemia, adverse events and patient treatment satisfaction were also assessed. Results: HbA1c decreased significantly after 6 months (mean change 0.9% ± 1.1% DCCT [−9.9 ± 11.6 mmol/mol], p < 0.0001). HbA1c target < 7.0% DCCT was achieved in 17.6% of patients, 66.1% of patients showed mean HbA1c decrease of 0.5% ± 0.8%. At month 6, FPG decreased (mean change from baseline −1.8 ± 3.1 mmol/L) as well as the incidence of hypoglycemia decreased by 49% (p < 0.0001) while no weight gain was observed. No significant safety signals were identified. Conclusion: In a real-life setting, switching to Gla-300 in T2DM patients uncontrolled with other basal insulin was associated with improved glycemic control and reduced risk of hypoglycemia without weight gain, while patients’ satisfaction with treatment increased.