Trends in bed occupancy for inpatients with diabetes before and after the introduction of a diabetes inpatient specialist nurse service.

Aims: To compare diabetes bed occupancy and inpatient length of stay, before and after the introduction of a dedicated diabetes inpatient specialist nurse (DISN) service in a large UK Hospital.

Methods: We analysed bed occupancy data for medical or surgical inpatients for 6 years (1998-2004 inclusive), with a DISN service in the final 2 years. Excess bed days per diabetes patient were derived from age band, specialty, and seasonally matched data for all inpatients without diabetes.

A mobile screening programme for the cardiovascular and microvascular complications of Type 2 diabetes in primary care.

The Diabetes National Service framework (NSF), and the quality payments in the new contract for UK General Practitioners, promote regular screening for diabetes complications. The new contract also includes immediate incentives to meet screening and quality targets, but it will be difficult to meet these targets in primary care. We have developed a mobile 'annual review' programme for patients with Type 2 diabetes managed solely in primary care, that screens for cardiovascular disease, hypertension, retinopathy and neuropathy at the patient's general practice, and gives written foot care, dietary advice and level 1 smoking cessation advice to all patients.

An integrated mobile foot and retinal screening programme for people with Type 2 diabetes managed in primary care.

Aims: To undertake a vascular and neurological assessment on the feet of all patients with Type 2 diabetes managed solely in local primary care.

Methods: A mobile screening podiatrist (working with an existing mobile retinal screening programme) screened a selected population of 4022 patients with Type 2 diabetes managed solely in 82 general practices. Doppler pressure assessments of peripheral vasculature, bioesthesiometer and monofilament assessment of peripheral neuropathy.

Impact of pregnancy on the progression of diabetic retinopathy in Type 1 diabetes.

Aims: To evaluate the impact of pregnancy on the progression of diabetic retinopathy in women with Type 1 diabetes mellitus and to identify risk factors for the progression of retinopathy during pregnancy.

Methods: One hundred and seventy-nine pregnancies in 139 women with pregestational Type 1 diabetes were studied prospectively between January 1990 and December 1998. Dilated fundal examination was performed at booking, 24 weeks and 34 weeks or 4-6 weekly if retinopathy present at booking.

Prevalence of HFE (hemochromatosis gene) mutations in unselected male patients with type 2 diabetes.

To assess the prevalence of mutations in the HFE (hemochromatosis) gene in unselected male patients with type 2 diabetes, we examined 220 white men without known diabetes and 220 age-matched white men with type 2 diabetes for mutations in the HFE gene. Nucleotide 845 (C282Y) and 187(H63D) alleles were amplified by polymerase chain reaction (PCR) with lymphocyte DNA. The PCR products were analyzed by restriction enzyme digestion.

Pharmacokinetics of subcutaneously administered human, porcine and bovine neutral soluble insulin to normal man.

Highly purified neutral soluble human, porcine and bovine insulin (0.075 U/kg body weight) were administered randomly by subcutaneous injection to six normal men. Somatostatin by continuous intravenous infusion (100 micrograms/h) was used to suppress endogenous insulin secretion.

The effects of long term growth hormone releasing factor (GRF 1-40) administration on growth hormone secretion and synthesis in vitro.

The ability of human pancreatic GH releasing factor 1-40 (hpGRF 1-40) to release GH has been studied in rat anterior pituitary cells in primary culture. Over 24 hours hpGRF (1-40) increased total (cell content and secretion) production 2-fold with an ED50 of 20 pM. Subsequent hpGRF (1-40) stimulation of GH release was not affected by pretreatment when the fall in stored GH was taken into account.

Study of porcine and human isophane (NPH) insulins in normal subjects.

The plasma glucose, C-peptide and insulin responses to subcutaneously administered highly purified porcine, 'semi-synthetic' and 'biosynthetic' human isophane (NPH) insulin and diluting medium as control in normal male subjects were evaluated. Porcine and semi-synthetic human NPH insulins were administered at two dose levels of 0.15 and 0.

Vitamin D metabolites in post-menopausal women and their relationship to the myopathic electromyogram.

Proximal muscular weakness is a feature of many metabolic bone diseases but is not well recognized in spinal osteoporosis. Thirty-six post-menopausal women presenting with back pain, with or without osteoporosis, were therefore studied in order to define the relationship between abnormal electromyographic findings and disturbed vitamin D metabolism, as both low plasma 1,25 dihydroxy vitamin D concentrations and malabsorption of calcium have been reported in osteoporosis. Patients with abnormal electromyograms had lower concentrations of plasma 1,25 dihydroxy vitamin D (mean 78.

Parathyroid function during acute pancreatitis.

The renal handling of calcium and phosphate, which normally reflects parathyroid hormone (PTH) activity, was studied during the first 5 days after admission to hospital in 18 patients with acute pancreatitis. The ionized calcium level in plasma was calculated from the total calcium, albumin, total protein and pH. Hypocalcaemia (Ca less than 1.

Phosphate treatment of recurrent calcium stone disease.

A group of 38 male recurrent idiopathic calcium stone formers were treated with oral supplements of orthophosphate (1 g phosphorus extra in the diet per day) and followed at intervals up to 4 years. The urinary excretion of calcium decreased (p less than 0.001) and that of inorganic phosphate increased (p less than 0.

Relative importance of renal failure and increased bone resorption in the hypercalcaemia of myelomatosis.

In order to define the relative importance of renal failure and increased bone resorption in the hypercalcaemia of myelomatosis 22 untreated patients were studied, of whom 12 were hypercalcaemic. Most patients had malabsorption of radiocalcium from the gastrointestinal tract and evidence of increased bone resorption as assessed by fasting urinary hydroxyproline/creatinine ratio. The mean OHPr/Cr ratio, however, was similar in patients with and without hypercalcaemia.

Clinical and metabolic aspects of urinary stone disease in Leeds.

In summary, the persistent passage of urine excessively supersaturated with calcium oxalate and/or calcium phosphate in conjunction with a low level of inhibitory activity increases the risk of abnormal crystalluria and stones in a given individual. Treatment of the disorder must be aimed at correcting the abnormal risk factor(s) in that individual.

Should recurrent calcium oxalate stone formers become vegetarians?

The hypothesis that the incidence of calcium stone disease is related to the consumption of animal protein has been examined. Within the male population, recurrent idiopathic stone formers consumed more animal protein than did normal subjects. Single stone formers had animal protein intakes intermediate between those of normal men and those of recurrent stone formers.

The effect of high animal protein intake on the risk of calcium stone-formation in the urinary tract.

1. Studies were carried out on six normal male subjects to determine the short-term effect of increasing the dietary consumption of animal protein on the urinary risk factors for stone-formation, namely, volume, pH, calcium oxalate, uric acid and glycosaminoglycans. 2.

Urinary tract stone disease.

Patients suffering from urinary stone are traditionally referred to a surgeon. Most are investigated only as far as establishing the site of the stone and its effect on renal function. Although a number of patients may require surgery, the majority pass the stone spontaneously and are discharged within a few days.