ABSTRACT
The feasibility of using hospital discharge data to monitor six outcome indicators for diabetes care was assessed by reviewing retrospectively the occurrence of these events recorded in hospital records. The population studied was that of the Orkney Islands (19,500) over a 10-year period (1976-1985). During that time, 230 Orkney diabetic patients were treated in Orkney and/or Aberdeen hospitals. The six outcome indicators were: hospital admission rates for diabetic patients (609 in 230 patients), hospital admission rates specifically for diabetic ketoacidosis (29 in 20 patients), rates of diabetes-related lower limb amputations (36 in 23 patients), perinatal mortality rates related to maternal diabetes (nil), visual loss or blindness (13 eyes in 9 patients) and end-stage renal failure (one patient). Scottish Morbidity Returns (which collect data similar to that in the Hospital In-patient Enquiry in England) were shown by case note review to underestimate these outcomes by 41%. Cardiovascular disease, cerebrovascular disease, and peripheral vascular disease accounted for half of all in-patient bed use by diabetic patients (6077 of 13,951 days). The routinely available Scottish hospital discharge data, which are collected for a different purpose, are not sufficiently accurate or complete to reflect variations in actual diabetic events.
Subject(s)
Diabetes Mellitus/therapy , Amputation, Surgical , Diabetes Complications , Diabetic Ketoacidosis/therapy , Gangrene/surgery , Hospitalization , Humans , Patient Discharge , Retrospective Studies , ScotlandABSTRACT
In a detailed community study the total prevalence of idiopathic Parkinson's disease in Aberdeen was 164.2/10(5) of the population. The age and sex specific prevalence rose to 2657.8/10(5) (2.7%) of men and 2071.0/10(5) (2.0%) of women aged over 84. The mean age at onset, irrespective of sex, was 65.3 years (SD 12.6) and varied little compared with similar studies over the past 25 years. Half of patients were independent but 78/225 (34.7%) were considerably disabled and 23/225 (10.2%) were confined to bed or a wheelchair. Disability increased with age and also with a low minimental state questionnaire score. The score was less than or equal to 7/10 (graded 0-10) in 93/252 (37%) of patients and less than 5/10 in 28/252 (11%). Parkinson's disease remains a common and disabling condition in the community.
Subject(s)
Parkinson Disease/epidemiology , Adult , Age Factors , Aged , Disabled Persons , Female , Humans , Male , Middle Aged , Parkinson Disease/complications , Scotland , Sex FactorsABSTRACT
Knowledge of the symptoms of hypoglycaemia was assessed in 161 elderly diabetic patients using insulin or a sulphonylurea. Nine percent knew no symptoms. Patients on insulin and those with poorer control had significantly greater knowledge (p less than 0.01). Those reporting episodes of hypoglycaemia had significantly greater knowledge of some symptoms. Knowledge decreased with age, but was not related to sex, duration of diabetes or living alone. Patients and relatives had similar knowledge and education of both needs to be improved.
Subject(s)
Diabetes Mellitus/psychology , Hypoglycemia , Patient Education as Topic , Aged , Aged, 80 and over , Attitude to Health , Female , Humans , Male , Middle AgedABSTRACT
Twenty simulated consultations with patients having a respiratory illness were carried out by 20 trainees at the start and finish of a training year in general practice, using the same method as used in a previous study of principals in general practice.During the course of the year, the trainees as a group closely approached the behaviour-in the defined terms of the study-of principals as a group. The trend was more marked for doctors on a three-year training programme than for those on a one-year programme.In 11 cases direct comparison between trainee and trainer was possible. It was difficult to identify changes in behaviour as being due to either group influences or individual trainer influences, but it appeared that atypical trainers do not necessarily produce atypical trainees and typical trainers do not prevent the development of individuality in trainees.The technique of simulated consultation may assist the difficult task of evaluating training for general practice.
Subject(s)
Educational Measurement , Family Practice/education , Evaluation Studies as TopicSubject(s)
Diabetes Mellitus/mortality , Adult , Aged , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , England , Female , Humans , Male , Middle Aged , Scotland , WalesABSTRACT
More information is needed about the "natural history" of early diabetes mellitus. A report is presented of the progress over one to nine years of 72 patients who formed the control group of a clinical trial of chlorpropamide and placebo in the management of subclinical diabetes. Most patients showed no deterioration of carbohydrate tolerance, and only four (5.6%) progressed to overt diabetes. The findings of other published series are reviewed. Studies of the effect of treatment of early diabetes must be large scale and long term, and an untreated control group must be included to prevent apparent improvement in carbohydrate tolerance being wrongly attributed to the effect of therapy.
