bluuebunny/crossref_metadata_2025_split huggingface dataset:
Which dressing for diabetic foot ulcers?
Authors: Fisken RA , Digby Moira 
Published: March 2007

AbstractA wide variety of different dressings are used on diabetic foot ulcers and it is difficult to know how the choice of dressings is made. A questionnaire was sent to 250 diabetes specialist nurses and 249 state registered chiropodists in different parts of the United Kingdom and Ireland asking which dressings they would use on various categories of ulcer in a person with diabetes. A total of 192 questionnaires (38.5%) were returned, of which 188 (37.7%) were complete. There was no consensus at all on the choice of dressings in any ulcer category and, for most types of ulcer, between five and eight dressing types were used by respondents. In no category did a dressing achieve more than a 30% preference rating. Respondents also varied widely in their use of other types of ulcer treatment such as lowpower laser therapy. The findings suggest that either there is a great deal of ignorance about the best dressing to use, or it does not matter which dressing is used. As dressings vary widely in cost, it is likely that the best policy is to use the safest, simplest and cheapest dressing.
Effect of an intensive education programme on clinical management of diabetic inpatients
Authors: Davis TME , Hughes‐Anderson W. 
Published: March 2007

AbstractTo determine whether intensive education directed at clinical staff improves inpatient diabetes management, an initial cross‐sectional survey of all diabetic patients admitted to a metropolitan teaching hospital over three months was conducted, followed by a six‐month education programme based on deficiencies identified, and then a second survey to assess the effect of the intervention. Two groups of 226 diabetic inpatients were recruited before and after the programme. The age and sex distribution, type and duration of diabetes, body mass index and numbers of smokers in the groups were similar. The proportions who received general diabetes education and advice regarding exercise during admission were also similar, but the risks of smoking were explained more often post‐intervention (78% vs 90% respectively; p < 0.01). Plasma glucose, glycated haemoglobin and fasting serum lipids were requested in 88%, 41% and 23% respectively of patients overall with no significant differences between groups; treatment was changed in the minority of patients with abnormal results. Electrocardiography, palpation of peripheral pulses, ophthalmoscopy, sensory testing and measurement of urinary microalbumin estimation all increased significantly after intervention (p < 0.01). In the case of the microvascular complications, screening tests were performed in approximately twice as many patients after compared to before intervention. A programme of assessment of current practices and education/re‐education of hospital staff improves screening of vascular complications in diabetic inpatients but may have little effect on strategies to improve metabolic control.
The effect of a quality assurance scheme and compulsory training programme on the performance of ward‐based blood glucose measurements
Authors: Page SR , Scholey K , Clarke P , Daly H , Watson JB , Ambler J , Brown NS , Tattersall RB 
Published: March 2007

AbstractWard‐based blood glucose monitoring is used widely, but assuring the accuracy and overall reliability of such measurements has always been a problem. We describe our experience of a quality assurance (QA) scheme and compulsory training programme. Two samples of horse blood ‘spiked’ with glucose were distributed to participating wards every two weeks. A nurse tested the samples with a standard reflectance meter and the results were scored on a scale of 1–5. Each ward nominated a liaison nurse to attend the compulsory training programme at which the QA scheme and the significance of measurement errors were discussed and practical techniques were taught. Each liaison nurse was expected to train nurses on his or her ward.Compared with the 15 month pre‐training period, test samples were measured more accurately, with over 75% being within 10% of the distribution mean. Also, the non‐return rate fell to 8.1% after the compulsory training programme. However, it proved difficult to maintain this performance despite regular update meetings. Long‐term training programmes for ward‐based glucose testing require careful on‐going evaluation of their effectiveness and may need sanctions to achieve optimal performance.
Diabetes mellitus: An underdiagnosed condition?
Authors: Shotliff K. , Blight A. , Patel S. 
Published: March 2007

AbstractRandom blood glucose (RBG) assays are commonly used to screen for diabetes mellitus. Guidelines for investigation of patients with a RBG < 7.8mmol/l are included in a handbook given to all junior doctors in our hospital. We assessed how well this recommendation was known amongst junior doctors requesting and interpreting these tests, and also their knowledge of the World Health Organisation (WHO) criteria for the diagnosis of diabetes.Of the 58 doctors asked, 55% did not know the correct cut‐off for investigation of a RBG (19% used 10.0mmol/l and 12% used 11.1mmol/l). Knowledge of the WHO criteria for diagnosing diabetes was also poor, with only 72% (42/58) knowing the fasting venous plasma level and 52% (30/58) the two‐hour post‐prandial level.Many people have a RBG performed but these results suggest a significant proportion will not be adequately investigated. Junior doctors' knowledge of this important information should therefore be re‐assessed and improved when necessary.
Feeling stuck. Some useful questions for a diabetes team?
Authors: Josse J.D. , Cook G. , Donnelly D. , James J. , Maddison W. , Mungall H. , Roland J. 
Published: March 2007

AbstractA psychotherapist, meeting regularly with a diabetes care team, helped them to devise a series of questions about feelings, control, and problems with diabetes. These questions were used when the team felt ‘stuck’ with patients or when reviewing their diabetes management. The questions were ones frequently used by counsellors and were adapted for use in a diabetes clinic. The team found that the use of the questions enlarged their clinical repertoire, increased their empathy with their patients, and at times yielded surprising information. The questions allowed for exploration of highly charged emotional issues in a neutral manner. They at times ascertained how knowledge of diabetes was actually put into practice by revealing hidden behaviours. Occasionally unforseen answers posed difficulties for the team and left them feeling out of their depth, and strategies needed to be devised to cope with such important contingencies.
Prevention is better than cure. The routine examination of the feet of patients with diabetes. Part 1. The normal foot
Authors: Fawcett J. , Widdows C. , Wales J. K. 
Published: March 2007

AbstractThis series of articles describes (with photographs) some of the more common abnormalities which a routine foot inspection might reveal. Some indication is given of their importance to the diabetic patient and what action the nurse or GP should take.
Small vessel disease: a cause of foot ulceration in the neuropathic foot?
Authors: Tesfaye S. , Gill G. V. 
Published: March 2007

AbstractThere is increasing evidence for the involvement of small vessel disease in the aetiology of diabetic foot ulceration. We describe two diabetic neuropathic patients with toe ulceration despite bounding foot pulses, normal ankle brachial pressure indices and arteriograms. In both patients, toe pulp temperatures were markedly lower than mid‐foot temperatures. The presence of digital ischaemia in the absence of macroangiopathy suggests small vessel disease which may play an important role in the aetiology of diabetic foot ulceration. Furthermore, such patients should be given appropriate advice regarding foot care and shoe‐wear in order to reduce the risk of digital ulceration.
The diabetic male's perception of erectile dysfunction
Authors: Cummings M. H. , Meeking D. , Warburton F. , Alexander W. D. 
Published: March 2007

AbstractOne hundred and ninety four diabetic men completed a questionnaire designed to identify their perception of erectile dysfunction (ED). Nine per cent (17/186) of patients defined ED incorrectly. Thirty per cent (54/183) of patients were unaware that ED was a complication of diabetes and 42% (70/165) thought the problem was an inevitable consequence of advancing age. Nearly one half of the patients (47%, 87/188) were unaware that treatment was available for ED. In those patients who were aware of ED as a complication of diabetes or potential treatment for this problem, this information was more likely to have been obtained from sources other than a healthcare professional. Fifty per cent (96/194) of patients suffered from ED; 56% (54/96) of these patients felt the relationship with their partner had suffered as a consequence. Despite the high prevalence of ED and the misconceptions that existed, the questionnaire indicated that there had been little discussion between the patient and the healthcare professional about this problem. As a result of our questionnaire which enhanced the patient's knowledge of ED, the majority (>90%) said they would seek medical advice for the problem if it arose. We have also identified several key areas concerning ED that should be addressed by healthcare professionals involved in both primary and secondarydiabetes care.
Plantar load shifting in response to foreign body is impaired in patients with severe diabetic neuropathy
Authors: Uhlenbruck C. 
Published: March 2007

AbstractIn 14 diabetic patients with a history of neuropathic foot ulcers, dynamic foot pressure was measured during walking with and without a button‐shaped foreign body taped adjacent to the 1st metatarsal head. Center‐of‐pressure (COP) localisations were assessed in the metatarsal line, and shifting of plantar pressures between the medial and the lateral region of the forefoot were measured, and compared to 14 healthy control subjects matched for sex, age, and body weight. The results show a similar distribution of plantar peak pressures in the diabetic and the control forefeet without the foreign body. Walking on a foreign body induced load‐shifting from the medial to the lateral forefoot region, which was significant only in control subjects. Likewise, COP in the metatarsal line was significantly lateralised by 9.8 (95% Cl 6.7 to 110.8) mm in the control subjects, versus 3.4 (95% Cl −2.8 to 7.7) mm in the diabetic subjects (n.s.). All control subjects, but none of the patients felt uncomfortable while walking on the foreign body. Physiological load‐shifting to protect the planta pedis against injury from a foreign body is diminished in diabetic neuropathy.
Screening for diabetic retinopathy: the costs to patients — a pilot study
Authors: Phillips C. J. , Harper G. A. D. , Waheed N. , Owens D. R. , Gibbons R. L. , Allen J. , Wall S. 
Published: March 2007

AbstractThis study reports on the costs incurred by diabetic patients participating in a screening programme to identify those individuals who may develop blindness. The investigation was based on the Welsh Community Diabetic Retinopathy Study (WCDRS) which has as its aim to assess the relative abilities of general practitioners (GPs) and community optometrists to detect diabetic retinopathy and especially sight‐threatening diabetic retinopathy using direct ophthalmoscopy and multiple field 35mm fundal photography. Four practices, two urban and two rural, with a known prevalence of diabetes of at least 1.8% within their practice population have been participating in the WCDRS.All patients involved in the WCDRS (n=658) were sent questionnaires to complete. After one reminder letter a response rate of 89% was achieved. Questions related to the travel arrangements to and from the clinics for the eye examinations, including whether other people were involved, what people would have been doing if not attending the clinic, and the experiences of people attending the clinic.The majority of people travelled to the clinic by car and 80% arrived within 15 minutes. While large numbers of respondents did not specify whether any costs had been incurred, the average cost for those who did ranged from £0.55 in one urban practice to £1.75 in one of the rural practices. Only 18% of those who responded would have been working if not attending the clinic. The vast majority would have been engaged in other activities such as housework, visiting, socialising, leisure etc. The vast majority of those who accompanied the attendees would also have been engaged in ‘non‐work’ activities. The average time spent at the clinics was between 30 and 45 mintues.Translating these figures into costs incurred by patients and the companions accompanying them resulted in an average cost of £5.61 per patient and an additional £3.80 per companion. No attempt was made to assess the impact of the screening process on quality of life, although the patients reported no major problems in terms of anxiety, pain and effects of the eye drops, with only some inconveniences mentioned. What was more significant was that 96% stated that they would be prepared to return to the clinic an undergo the same procedures if necessary.
Palliative radiotherapy for acute osteoarthropathy of diabetic feet: a preliminary study
Authors: Chantelau E. , Schnabel T. 
Published: March 2007

AbstractThe effect of a palliative radiotherapy (local X‐ray irradiation with a total of 2.45 Gy) over standard treatment was assessed in a placebo‐controlled double blind study in 12 diabetic patients with acute neurogenic osteoarthropathy (Charcot foot). All patients received standard treament as performed in this institution, including absolute pressure relief (bed rest and/or wheel chair) and preventive application of antibiotics (oral cephalexin or clindamycin), and either radiotherapy or sham‐radiotherapy. The time until healing (defined as absence of swelling, redness and hyperthermia during mild to moderate weight‐bearing re‐calcification of previous fractures or osteolyses on the first of two consecutive roentgenogrammes) was recorded as outcome measure.There was no difference in healing time according to radiotherapy (7 [95% Cl 4–10] months versus 9.7 [4–15] months, p>0.05). However, compliance versus non‐compliance with non‐weight‐bearing was associated with a significant reduction in healing time (5.5[3–7] months versus 10.5[8–20]months, p < 0.05).In conclusion, non‐weight‐bearing supports healing of acute Charcot feet in diabetes, whereas radiotherapy does not.
Insulin wastage using a fixed mix of insulin with a pen The practice of patients in one clinic
Authors: Steel J. M. , Carmichael C. , Duncan C. 
Published: March 2007

AbstractPeople with diabetes who administer a premixed insulin with a pen may require a largedose. Pens contain 150 or 300 units of insulin which is unlikely to be an exact multiple of the dose. Patients were asked what they did when the reservoir approached exhaustion. Twenty seven out of 110 patients were regularly giving two injections of insulin to avoid waste, although none had been instructed to do so. Seven other patients were taking action to avoid waste including five who were giving the wrong dose. The wastage of insulin is much less when using a 3 ml disposable pen than when using a 1.5 ml cartridge. If patients are instructed to use pens containing 300 units and advised to use the insulin left at the end of a pen for the smaller injection, the amount of insulin wasted is 3.6% compared with 13.6% wasted when using 1.5 ml cartridges. The total cost of insulin when using a dis‐posable pen is approximately one and a half times more than when using a cartridge, twice as much as when using a vial of the same human insulin, and two and half times more than when using pork insulin.
Prevention is better than cure. The routine examination of the feet of patients with diabetes Part 4. Lack of care
Authors: Fawcett J. , Widdows C. , Wales J. K. 
Published: March 2007

AbstractThis series of articles describes (with accompanying photographs) some of the more common abnormalities which a routine inspection might reveal. Some indication is given of their importance to the diabetic patient and what action the nurse or GP should take.
Using a focus group to explore perceptions of diabetic severity
Authors: Dunning P. , Martin M. 
Published: March 2007

AbstractFocus groups are an ideal way to explore beliefs and attitudes. This paper gives a brief overview of focus groups as a research methodology and reports on a focus group conducted to gain insight into the diabetic severity beliefs of people with Type 2 diabetes.The group consisted of four men and six women with Type 2 diabetes, a facilitator and two data recorders. Discussion was open and interactive and all of the group participated. The indicators of illness severity emerging from the discussion were: if the disease was life‐threatening caused complications; needed medications and the care of experts in its management; restricted lifestyle; caused prolonged and acute pain; and if the person believed it was serious.A variety of illnesses were considered to be serious‐cancers, heart disease, stroke, AIDS, diabetes and infectious diseases. A dimension beyond serious was identified and labelled as severe, critical, life‐threatening or grave. A distinction was made between self‐inflicted disease (drug addition) and acquired diseases such as diabetes in terms of their severity. Self‐inflicted diseases were viewed as being mild because of the element of choice associated with their development. No connection between the modifiable risk factors for diabetes and developing the disease were raised. Insulin treatment was believed to indicate severe disease. Self‐care was viewed as important.
Managing the burden of Type 2 diabetes: an international survey of physicians
Authors: Southwell A. , Eckland D. 
Published: March 2007

AbstractThis prospective, cross‐sectional study was designed to gather information about the management of patients with Type 2 diabetes (NIDDM). It was conducted in three of the largest European healthcare providing countries: France, Germany and the UK. Three hundred and five physicians completed five sections of a diary card (covering aspects of workload, demography, treatment, condition and tests conducted) anonymously for 3,043 pharmacologically‐treated Type 2 patients attending for a consultation. The majority of the patient population were elderly, had had a long diagnosis of diabetes, were overweight and had several coexisting complications. Neuropathy, nephropathy and retinopathy were present in 23%, 24% and 15% of the patients, respectively. Concomitant cardiovascular risk factors such as hypertension, hypercholesterolaemia and ischaemic heart disease were present in 49%, 40% and 34% of patients, respectively. Fifty per cent of patients had undergone a change in therapy in the previous five years: the major reason being ‘insufficient glycaemic control’. In the remainder, adverse effects of weight gain and hypoglycaemia were most commonly reported. This information provides an insight into the present and future clinical burden that diabetes places on patients, physicians and healthcare systems.
Prevalence of complementary medicine usage within a diabetes clinic
Authors: Leese G. P. , Gill G. V. , Houghton G. M. 
Published: March 2007

AbstractComplementary medicine is being used increasingly within the UK, with large sums of money being spent. The utilisation of complementary medicines by patients with diabetes attending a hospital clinic was assessed using a questionnaire. Of 328 patients approached, 246 (75%) agreed to be interviewed. Of these, 17% had used complementary medicines, with acupuncture, homoeopathy and herbal therapy being used most often. The average annual cost of treatment was £69 ± 21 (range £0–£459). Complementary medicines were most commonly used for non‐diabetes‐related problems (91%) and 61% were perceived to be beneficial. In one patient there was a known adverse effect on diabetes control and two others complained of non‐diabetes‐related adverse events. There is apparently widespread use of complementary medicine within hospital diabetes clinics, which is often unrecognised but may have effects on the management of diabetes in such patients.
Factors related to lipohypertrophy in insulin‐treated diabetic patients: role of educational intervention
Authors: Ibarra L Saez‐De , Gallego F 
Published: March 2007

AbstractThe objective of this study was to relate the presence of lipohypertrophy in insulintreated diabetic patients with accessible clinical variables, with the aim of identifying risk factors associated with the development of lipohypertrophy which may be prevented through educational intervention.One hundred and fifty patients with insulin‐treated diabetes of at least one year's duration were recruited consecutively. Clinical and metabolical data and type of insulin therapy were evaluated. Injection sites and systematised rotation of injection site were also assessed.Female sex, Type I diabetes, higher body mass index (BMI) and missing rotation of injection sites were all identified as independent risk factors for the presence of lipohypertrophy. The need to change injection sites regularly was acknowledged by most of our patients (78.7%), however only 22.7% followed an organised rotation system. The latter group of patients had the lowest frequency of lipohypertrophy and the least unstable glycaemic profile.Therefore an essential issue in diabetes care for all patients on insulin therapy should be: (i) to establish with the patient an organised rotation system for insulin injections; (ii) to examine injection sites regularly; (iii) to train patients to recognize lipohypertrophy; and (iv) to make patients aware of the metabolic implications of missing rotation.
Do UK patients with complications of diabetes mellitus receive the financial State benefits to which they are entitled?
Authors: Simpson Aj , Hall A , Gray Rs 
Published: March 2007

AbstractWe interviewed 48 patients with complications of diabetes, assessing uptake of financial State benefits, eligibility for further benefits, demographic factors and clinical features. Forty seven (98%) of the patients satisfied criteria for financial State benefits, of whom 39 received less than their full entitlement, or no benefits at all. Patients not in receipt of full benefit entitlement tended to be older, of lower social class, more disabled and more likely to live alone than those who received their full entitlement. Patients most in need of benefits therefore appear least able to access these. A wide range of professional groups and contacts were quoted when patients were asked whom they would approach for more information about benefits.Patients with complicated diabetes generally appear to have low levels of awareness about, and uptake of, benefits to which they are entitled. Access to greater information for such patients is required, and this might, at least in part, be facilitated by increased availability of information in diabetes clinics.
Hyperchloraemic metabolic acidosis complicating management of a patient with diabetic ketoacidosis
Authors: Hellawell GO , Paton RC 
Published: March 2007

AbstractThe acute presentation of a Type 1 (insulin‐dependent) diabetic with a metabolic acidosis does not usually present diagnostic or therapeutic problems. A case of diabetic ketoacidosis is described, in which the coexistence of a bladder operation led to further, severe electrolyte disturbances. Chronic depletion of body buffer stores resulted in a tendency to acidosis in an otherwise stable diabetic, which accompanied profound electrolyte disturbances.