tbuckley/cabot-search huggingface dataset:
Is it difficult for someone to be selected to work in a practice in England as a general practitioner if they completed their vocational training scheme in Scotland?
Authors: Brian Keighley
Journal: BMJ (2004)

Have a career or related problem that needs answering? Can9t find the right person to point you in the right direction? Log on to the Advice Zone (www.bmjcareers.com/advicezone) for reliable medical careers advice. You can post a question or see if one of our 300 advisers has already answered a similar question. Here is a selection of questions and answers posted on the site.
INFLUENCE OF THE ACUTE HEMODYNAMIC INDEX ON INTRA-HOSPITAL MORTALITY OF HEART FAILURE PATIENTS: INSIGHTS FROM BREATHE REGISTRY
Authors: Renata R.T. Castro, Luka D. Lechinewski, Luis Rohde, Fernando Bacal, Salvador Rassi, Dirceu Almeida, Denilson Albuquerque, Lidia Moura
Journal: Journal of the American College of Cardiology (2018)
Surfen and oxalyl surfen decrease tau hyperphosphorylation and mitigate neuron deficits in vivo in a zebrafish model of tauopathy
Authors: Seyedeh Maryam Alavi Naini, Constantin Yanicostas, Rahma Hassan-Abdi, Sébastien Blondeel, Mohamed Bennis, Ryan J. Weiss, Yitzhak Tor, Jeffrey D. Esko, Nadia Soussi-Yanicostas
Journal: Translational Neurodegeneration (2018)

Abstract Background Tauopathies comprise a family of neurodegenerative disorders including Alzheimer’s disease for which there is an urgent and unmet need for disease-modifying treatments. Tauopathies are characterized by pathological tau hyperphosphorylation, which has been shown to correlate tightly with disease progression and memory loss in patients suffering from Alzheimer’s disease. We recently demonstrated an essential requirement for 3- O -sulfated heparan sulfate in pathological tau hyperphosphorylation in zebrafish, a prominent model organism for human drug discovery. Here, we investigated whether in vivo treatment with surfen or its derivatives oxalyl surfen and hemisurfen, small molecules with heparan sulfate antagonist properties, could mitigate tau hyperphosphorylation and neuronal deficits in a zebrafish model of tauopathies. Results In vivo treatment of Tg[HuC::hTau P301L ; DsRed] embryos for 2 days with surfen or oxalyl surfen significantly reduced the accumulation of the pThr181 tau phospho-epitope measured by ELISA by 30% and 51%, respectively. Western blot analysis also showed a significant decrease of pThr181 and pSer396/pSer404 in embryos treated with surfen or oxalyl surfen. Immunohistochemical analysis further confirmed that treatment with surfen or oxalyl surfen significantly decreased the AT8 tau epitope in spinal motoneurons. In addition, in vivo treatment of Tg[HuC::hTau P301L ; DsRed] embryos with surfen or oxalyl surfen significantly rescued spinal motoneuron axon-branching defects and, as a likely consequence, the impaired stereotypical touch-evoked escape response. Importantly, treatment with hemisurfen, a surfen derivative devoid of heparan sulfate antagonist activity, does not affect tau hyperphosphorylation, nor neuronal or behavioural deficits in Tg[HuC::hTau P301L ; DsRed] embryos. Conclusion Our findings demonstrate for the first time that surfen, a well-tolerated molecule in clinical settings, and its derivative, oxalyl surfen, could mitigate or delay neuronal defects in tauopathies, including Alzheimer’s disease.
GPs have lowest morale of any specialty, BMA survey finds
Authors: Abi Rimmer
Journal: BMJ (2014)

General practitioners have the lowest morale of any specialty, and nearly two thirds know colleagues who have recently retired or are planning retirement, a BMA survey has found.1

The eighth cohort survey questioned 431 doctors who had graduated in 2006 about their career paths. As of August 2012, 35% of the cohort worked in general practice and 23% were qualified GPs.

Doctors …
ELECTIVE CIRCULATORY SUPPORT ASSISTING TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR) IN A HIGH SURGICAL RISK PATIENT WITH CONCOMITANT AORTIC AND MITRAL VALVE DISEASE AND LEFT VENTRICULAR DYSFUNCTION
Authors: Vicente Jimenez Franco, Guillermo Torre-Amione, Carlos Sanchez-Diaz, Juan Quintanilla, Felipe Valdes, José Gildardo Paredes-Vázquez, Hernan Azpiri
Journal: Journal of the American College of Cardiology (2018)
Replacing grants with loans will narrow access to medicine, BMA warns
Authors: Abi Rimmer
Journal: BMJ (2015)

Government plans to replace university maintenance grants with a loans system will dissuade disadvantaged students from entering a career in medicine, the BMA has warned. 

Presenting the Budget for 2015 in the House of Commons on Wednesday, George Osborne, chancellor of the exchequer, said that student maintenance grants had become unaffordable.

He said, “From the 2016-17 academic year we will replace maintenance grants with loans for new students—loans that only have to be paid back once they earn over £21 000 a year. And to …
IMPACT OF RIGHT ATRIAL REMODELING ON CLINICAL OUTCOME IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION
Authors: Kyuyong Ko, Sung-Hee Shin, Mi-Hye Jung, Ji-Hun Jang, Yong-Soo Beak, Sung-Woo Kwon, Sang-Don Park, Seong-Ill Woo, Dae-Hyeok Kim, Jun Kwan
Journal: Journal of the American College of Cardiology (2018)
Britons in last year of life had 1.6 million emergency admissions in 2016
Authors: Jacqui Thornton
Journal: BMJ (2018)

The NHS is struggling to cope with end-of-life emergency admissions, particularly in England, says an analysis by the terminal illness charity Marie Curie.

Researchers studied data from NHS Digital, NHS Wales, and NHS Scotland on emergency admissions of people in their last year of life from 2011 to 2016. They found over 1.6 million admissions in 2016, leading to around 11 million days in hospital and costing the NHS £2.5bn (€2.86bn; $3.52bn).1

In England the average number of admissions per person (3.16) was nearly twice as high as in Scotland (1.65) or Wales (1.61). Wales had the highest average number of days spent in hospital at 27.56, compared with 18.42 in England, but the patients in England were admitted more often.

The charity also estimated that, by 2041, the cost …
T cell receptor activation status as biological context for interpreting PD1/PDL1 biomarker measurements.
Authors: Ralph E. Parchment, Tony Navas, Kristin Fino, Andy Fung, Facundo Cutuli, Lihua Wang, Robert J. Kinders, James H. Doroshow
Journal: Journal of Clinical Oncology (2018)

54 Background: Direct cytolysis of tumor cells by CD8+ T cells results from the net effect of at least two biochemical pathways: (1) stimulatory signaling from the activated T cell receptor (TCR) complex in response to its recognition of a tumor neoantigen presented in the context of autologous MHC class I, and (2) suppressive signaling from immune checkpoints, such as the response of PD1 to binding its ligand, PDL1. Because the PD1:PDL1 immune checkpoint is significant for therapy only when there is tumor cell-specific TCR activation and signaling, it is not surprising that simple measurements of either PD1 or PDL1 in tumor biopsies are, at best, imperfect predictive biomarkers. Instead, a more precise test that quantifies PD1 signaling due to PDL1 binding only in the subset of CD8+ T cells exhibiting activated TCR signaling should provide a more accurate assessment of the extent of immune checkpoint suppression of tumor immunity and therefore be a more predictive biomarker of response to PD1/PDL1-targeted immunotherapy. Methods: We have developed a multiplexed immunofluorescence microscopy test capable of simultaneous quantitation of TCR activation (phospho-CD3zeta), immune checkpoint signaling via PD1 (phospho-SHP1 and -SHP2), and the net stimulation or inhibition resulting from the integration of these two pathways (phospho-ZAP70). Results: Specific antibodies to these biomarkers have been qualified, including peptide inhibition studies to establish antibody specificity, and their performance established by fit-for-purpose studies of in vitro models of CD8+ T cell activation. This multiplex biomarker panel is suitable for clinical use with formalin-fixed, paraffin embedded core needle biopsies of tumor and quantitative immunofluorescence microscopy (qIFA). Conclusions: The additional biomarkers of tumor immunity are expected to add an important context for interpreting PD1/PDL1 measurements. Funded by NCI Contract No. HHSN261200800001E.
General practices should beware CCG constitutions with performance management clauses, says BMA
Authors: Helen Jaques
Journal: BMJ (2012)

General practices should not sign up to constitutions that allow clinical commissioning groups (CCGs) to manage the performance of member practices, the BMA’s General Practitioners Committee has warned.

The committee has received reports of constitutions having inappropriate clauses with respect to performance management and of CCGs acting beyond the provisions in the Health and Social Care Act.

The committee …
Self-assembling toxin-based nanoparticles as self-delivered antitumoral drugs
Authors: Laura Sánchez-García, Naroa Serna, Patricia Álamo, Rita Sala, María Virtudes Céspedes, Mònica Roldan, Alejandro Sánchez-Chardi, Ugutz Unzueta, Isolda Casanova, Ramón Mangues, Esther Vázquez, Antonio Villaverde
Journal: Journal of Controlled Release (2018)
In vitro models and systems for evaluating the dynamics of drug delivery to the healthy and diseased brain
Authors: Hassan Pezeshgi Modarres, Mohsen Janmaleki, Mana Novin, John Saliba, Fatima El-Hajj, Mahdi RezayatiCharan, Amir Seyfoori, Hamid Sadabadi, Milène Vandal, Minh Dang Nguyen, Anwarul Hasan, Amir Sanati-Nezhad
Journal: Journal of Controlled Release (2018)
Progression in a Patient With Previously Treated Atherosclerotic Disease
Authors: Sue Wang, Devin S. Zarkowsky, Charles M. Eichler
Journal: JAMA Surgery (2018)

A 71-year-old man with a history of coronary artery bypass graft using the left internal mammary artery to the left anterior descending in 1997 presented with frequent ventricular tachycardia on routine pacemaker interrogation. What is your diagnosis?
Interventional management of hyperhidrosis in secondary care: a systematic review
Authors: R. Wade, A. Llewellyn, J. Jones-Diette, K. Wright, S. Rice, A.M. Layton, N.J. Levell, D. Craig, N. Woolacott
Journal: British Journal of Dermatology (2018)

Hyperhidrosis is uncontrollable excessive sweating, which occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. To undertake a systematic review of the clinical effectiveness and safety of treatments available in secondary care for the management of primary hyperhidrosis. Fifteen databases (including trial registers) were searched to July 2016 to identify studies of secondary‐care treatments for primary hyperhidrosis. For each intervention randomized controlled trials (RCTs) were included where available; where RCT evidence was lacking, nonrandomized trials or large prospective case series were included. Outcomes of interest included disease severity, sweat rate, quality of life, patient satisfaction and adverse events. Trial quality was assessed using a modified version of the Cochrane Risk of Bias tool. Results were pooled in pairwise meta‐analyses where appropriate, otherwise a narrative synthesis was presented. Fifty studies were included in the review: 32 RCTs, 17 nonrandomized trials and one case series. The studies varied in terms of population, intervention and methods of outcome assessment. Most studies were small, at high risk of bias and poorly reported. The interventions assessed were iontophoresis, botulinum toxin (BTX) injections, anticholinergic medications, curettage and newer energy‐based technologies that damage the sweat gland. The evidence for the effectiveness and safety of treatments for primary hyperhidrosis is limited overall, and few firm conclusions can be drawn. However, there is moderate‐quality evidence to support the use of BTX for axillary hyperhidrosis. A trial comparing BTX with iontophoresis for palmar hyperhidrosis is warranted.
Phenotypic differences in tumor-associated macrophages between metastatic and primary sites of clear cell renal cell carcinoma.
Authors: Yuji Miura, Takanobu Motoshima, Nanako Wakigami, Natsuki Kusada, Toshikazu Okaneya, Naoko Inoshita, Toshimi Takano, Tomomi Kamba, Yoshihiro Komohara
Journal: Journal of Clinical Oncology (2018)

105 Background: Tumor-associated macrophages (TAMs) are one of the key contributors to the tumor microenvironment and are phenotypically differentiated into M1 and M2 macrophages. M1 macrophages stimulate anti-tumor immune responses, whereas M2 macrophages promote immunosuppression and are associated with tumor progression in clear cell renal cell carcinoma (ccRCC). However, little information is available regarding the difference in TAM polarization between primary and metastatic lesions of ccRCC. Methods: We collected paired samples of primary and matched metastatic sites from the first recurrence in 41 metastatic ccRCC patients. Immunohistochemistry (IHC) for Iba1, which is a common pan-macrophage marker, and CD163 and CD204, which are considered to be M2 macrophage markers, was performed on all paired samples. Results: Thirty-three paired primary and metastatic samples were available for IHC assessment in this analysis. The most common metastatic sites were lung (N = 26, 78.8 %) and lymph node (N = 3, 9.1 %). The mean (± standard deviation) cell density of Iba1 + TAMs was higher in metastatic lesions than in primary lesions (756 ± 267 mm 2 vs. 581 ± 155 mm 2 , P = 0.0012). By contrast, the ratio of CD163 + and CD204 + to Iba1 + TAMs was significantly lower in metastatic lesions than in primary lesions (0.76 ± 0.30 vs. 0.90 ± 0.24, P = 0.0067 and 0.39 ± 0.27 vs. 0.67 ± 0.29, P = 0.0001, respectively). The median overall survival of patients with high- vs. low-density Iba1 + , CD163 + , and CD204 + TAMs in metastatic lesions was 120 vs. 92 months (log-rank P = 0.67), 120 vs. 58 months (log-rank P = 0.056), and 120 vs. 92 months (log-rank P = 0.35), respectively. Conclusions: TAMs in the metastatic lesions of ccRCC polarized towards an M1-like phenotype, although the total number of TAMs was greater in metastatic compared with primary lesions. The cell density of Iba1 + , CD163 + , and CD204 + TAMs in metastatic sites was not associated with overall survival in patients with ccRCC.
Pharmacokinetics (PK) of S-1 monotherapy in plasma and in tears for gastric cancer patients (pts).
Authors: Takeshi Kawakami, Hiroya Kashiwagi, Keita Mori, Katsuhiro Omae, Jun Kasai, Kunihiro Yoshisue, Masahiro Kawahira, Takahiro Tsushima, Nozomu Machida, Akira Fukutomi, Ken Yamaguchi, Hirofumi Yasui
Journal: Journal of Clinical Oncology (2018)

175 Background: S-1 is an oral anticancer drug that contains of tegafur (FT), which is a prodrug of 5-FU, 5-chloro-2,4-dihydroxypyridine (CDHP), and potassium oxonate. S-1 is a key, important drug for the treatment of various cancers including gastric cancer. Recently, we demonstrated that Grade 2 or 3 watering eyes was observed in 25% of gastric cancer pts who received S-1 as adjuvant treatment for 1 year (Tabuse H, et al. Gastric Cancer 2017;19:894-901). However, the mechanism of watering eyes caused by S-1 is still unclear. The aim of this study is to investigate the association of the PK of FT, 5-FU, and CDHP, which are components of S-1, in plasma and tears. Methods: We prospectively investigated the PK of FT, 5-FU, and CDHP in plasma and in tears of gastric cancer pts who were treated with S-1 monotherapy at the dose of 80 mg/m 2 /day. Plasma and tears from both eyes were obtained 1, 2, 4, and 8 hours after S-1 administration on day 1 and 14 of cycle 1. Results: Total of 8 pts were enrolled. PK parameters on day 14 was shown in Table. The concentration of 5-FU in the tears tended to be higher than that in the plasma. There was a strong association between the PK of FT, 5-FU and CDHP in the plasma and that in the tears on day 14 (correlation coefficients r 2 , right eye/left eye: r 2 = 0.7778/0.7773, 0.7687/0.7913, and 0.7823/0.7717, respectively). Conclusions: There is a strong association between the PK of FT, 5-FU and CDHP in the tears and that in the plasma. Therefore, the concentration of S-1 in the plasma may be substituted for that in the tears. Clinical trial information: UMIN000021610. [Table: see text]
DIABETIC PATIENTS WITH ACUTE MYOCARDIAL INFARCTION HAD DELAYED HOSPITAL ADMISSION THAN NON-DIABETIC PATIENTS
Authors: Katsuomi Iwakura, Atsunori Okamura, Yasushi Koyama, Koichi Inoue, Mutsumi Iwamoto, Hiroyuki Nagai, Yuko Hirao, Koji Tanaka, Takafumi Oka, Yuichi Ninomiya, Nobuaki Tanaka, Tomohiro Yamasaki, Masato Okada, Akinori Sumiyoshi, Ryo Nakamaru, Takamasa Tanaka, Hiroyuki Inoue, Kohtaro Takayasu, Kota Tanaka, Ryo Kitagaki, Kenshi Fujii
Journal: Journal of the American College of Cardiology (2018)
Pharmacokinetic study of ATI-1123 (docetaxel) Azaya Therapeutics protein stabilized liposome technology (PSLTM)
Authors: Joshua Cooper, Sam Pardo, Michael Wick, Chris Takimoto, Jeffrey Kahl, Michael Dwyer, Chandra Signh, Steven Weitman
Journal: Cancer Research (2007)

1509    Background:  Docetaxel is a semi-synthetic taxane analog commonly used in the treatment of non-small cell lung, prostate, and breast cancer. Docetaxel is poorly water-soluble and must be formulated with co-solvents that can potentially contribute to treatment-related adverse events such as hypersensitivity reactions. Azaya Therapeutics, Inc. has developed a novel propriety nanotechnology-based platform called Protein Stabilized Liposomes (PSL TM ) that avoids these major formulation issues, producing a safer and more efficacious targeted drug delivery system. Pharmacokinetic (PK) and tumor growth inhibition studies were conducted in murine xenograft models using Azaya’s PSL formulated docetaxel (ATI-1123) preparation.   Methods:  Female Sprague-Dawley rats were dosed with 5, 10, or 20 mg/kg of standard docetaxel (13% ethanol, 25% Tween 80 (v/v), 62% saline (0.9%) vehicle) or ATI-1123 (sterile water vehicle). Plasma samples for PK analysis were obtained at 11 time points ranging from time zero to 72 hrs. Total plasma docetaxel concentrations were analyzed by LC-MS/MS and PK parameters were calculated by non-compartmental methods using WinNonlin 4.1.   Results:  Plasma elimination of docetaxel following ATI-1123 and standard docetaxel was initially rapid, followed by a slower elimination rate out to 72 hours. Overall, the docetaxel AUC values for ATI-1123 were 4-fold or greater than the AUC observed following treatment with standard docetaxel for all doses. At 20 mg/kg, the ATI-1123 docetaxel AUC was 8.13 mg-h/mL versus 1.27 mg-h/mL for standard docetaxel. The Cmax values were 3-fold or higher for the ATI-1123 formulation versus the standard formulation over all 3 dose levels. As the dose level increased from 5 to 20 mg/kg, both AUC and Cmax increased dose proportionally. Overall, these differences in systemic exposure corresponded to a 4 to 5-fold faster clearance of standard docetaxel compared to the ATI-1123 liposomal formulation, independent of the dose level tested.   Conclusions:  Total systemic docetaxel exposures were substantially enhanced following PSL-formulated ATI-1123 docetaxel  administration compared to standard docetaxel. Differences between the two formulations were consistent across the 5, 10, and 20 mg/kg doses explored in the study. These data strongly support further investigation of ATI-1123 to analyze alterations in drug distribution, tolerability, and anti-tumor efficacy.
Response to Comment on Jaiswal et al. Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth With Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study. Diabetes Care 2017;40:1226–1232
Authors: Mamta Jaiswal, Jasmin Divers, Rodica Pop-Busui, Eva L. Feldman
Journal: Diabetes Care (2018)

We thank Simoneau et al. (1) for their comment on our article (2). In the SEARCH for Diabetes in Youth study, our primary aim was to evaluate the prevalence and risk factors for diabetic peripheral neuropathy (DPN) in youth and adolescents with type 1 and type 2 diabetes. We used the validated Michigan Neuropathy Screening Instrument (MNSI) to assess the burden of DPN in this large cohort because it is a simple measure to assess peripheral neuropathy. As vibration …
CLINICAL OUTCOMES OF FRACTIONAL FLOW RESERVE (FFR) BASED PERFORMANCE OR DEFERRAL OF REVASCULARIZATION IN ACUTE CORONARY SYNDROME (ACS) PATIENTS
Authors: Hussain Ibrahim, Fawad Virk, Wasiq Zaidi, Mohamed Faher Almahmoud, Muhammad Choudhry, Adnan Khan, Wissam Khalife, Syed Gilani
Journal: Journal of the American College of Cardiology (2018)
Nivolumab safety profile in Asian and Western patients with chemotherapy-refractory (CTx-R) advanced gastric/gastroesophageal junction (adv G/GEJ) cancer from the ATTRACTION-2 and CheckMate-032 trials.
Authors: Ian Chau, Li-Tzong Chen, Yoon-Koo Kang, Taroh Satoh, Ken Kato, Hyun Cheol Chung, Won Ki Kang, Yee Chao, Jen-Shi Chen, Patrick Alexander Ott, Dung T. Le, Huanyu Zhao, Maria Jesus Jimenez-Exposito, Yelena Yuriy Janjigian, Narikazu Boku
Journal: Journal of Clinical Oncology (2018)

e15127 Background: Nivolumab (NIVO) monotherapy demonstrated a survival benefit and durable responses in pts with CTx-R adv G/GEJ cancer (Boku N et al ESMO 2017; Janjigian Y et al ASCO 2017). Here we describe the safety profile of NIVO in Asian (A) and Western (W) pts with CTx-R adv G/GEJ who had received ≥ 2 prior CTx in the ATTRACTION-2 and CheckMate-032 trials, respectively. Methods: The safety population included pts who received ≥ 1 dose of study drug at the data cutoff of August 2016 for ATTRACTION-2 and March 2016 for CheckMate-032. TRAEs, serious TRAEs, and select TRAEs (sTRAE; with a potential immune-related etiology) were assessed. sTRAEs were managed using protocol-specified algorithms, which included corticosteroids as immune-modulating treatment (tx). Time to onset and resolution of sTRAEs were also assessed. Results: Median duration of NIVO tx was 1.9 mo in A and 2.3 mo in W pts. TRAEs (any grade) were reported in 43% of A and 64% of W pts; grade 3–4 TRAEs (A pts:10%; W pts:14%), serious TRAEs (A pts:10%; W pts:7%) and TRAEs leading to discontinuation (≤ 3% of pts in both groups) were infrequent. Most sTRAEs were grade 1–2 (Table) and occurred within the first 3 mo of NIVO tx. In A and W pts, median time to resolution of sTRAEs ranged from 3–19 wk. For those sTRAEs that required tx with immune-modulating agents, the median time to resolution of most sTRAEs ranged from 3–35 wk. Clinical trial information: NCT02267343 and NCT01928394. Conclusions: NIVO demonstrated an acceptable safety profile in both A and W pts with CTx-R adv G/GEJ cancers with no clinically meaningful racial differences. Most sTRAEs were grade 1–2 in both cohorts and manageable using the recommended tx algorithms. Table. Summary of sTRAEs Events, n (%) ATTRACTION-2 NIVO 3 mg/kg IV Q2W (n = 330) ATTRACTION-2 PBO (n = 161) CheckMate-032 NIVO 3 mg/kg IV Q2W (n = 42)a Any Grade Grade 3-4 Any Grade Grade 3-4 Any Grade Grade 3-4 Endocrine 16 (5) 4 (1) 1 ( < 1) 0 4 (10) 1 (2) Gastrointestinalb 23 (7) 3 (1) 4 (2) 0 7 (17) 1 (2) Hepatic 18 (5) 5 (2) 5 (3) 1 ( < 1) 2 (5) 2 (5) Pulmonary 7 (2) 2 ( < 1) 0 0 2 (5) 0 Renal 1 ( < 1) 0 0 0 0 0 Skin 51 (15) 0 13 (8) 0 10 (24) 0 aPts with G/GEJ cancer and ≥ 2 prior txs. bOne pt in the PBO arm had a grade 5 gastrointestinal perforation.
Dose adjustment for normal eating (DAFNE): doctor programme
Authors: Jonathan Schofield
Journal: BMJ (2012)

The dose adjustment for normal eating (DAFNE) course for people with type 1 diabetes is an evidence based, structured education programme that provides them with the skills they need to estimate the carbohydrate content in each meal and inject the right dose of insulin. A total of 3387 DAFNE courses were delivered up to June 2012.

The DAFNE course is delivered to small groups by trained diabetes specialist nurses and dietitians over five consecutive days. Participants are taught to match their insulin dose to their chosen food intake on a meal by meal basis.

The DAFNE doctor programme enables doctors to provide leadership and clinical support to DAFNE educators in the delivery of DAFNE courses. Doctors who have completed the doctor programme can deliver the introduction and facilitate the question …