Biomedical subjects
D W Beaven
Publications and source records attributed to D W Beaven.
Alternative medicine a cruel hoax--your money and your life?
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Over nourishment in New Zealand.
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Diabetes care--a continuing challenge.
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Underfunding of health services.
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Are high blood sugar levels in the elderly ignored?
In a survey of 530 patients, aged 75 years and older, who were admitted to a general teaching hospital in Christchurch, 60 (11.3%) were known diabetics. One hundred and seventy-six other patients (33.2%) had a last measured laboratory blood glucose level of greater than 7.8 mmol/l, of whom 27 people (5.1% of all patients) had significant hyperglycemia (over 11 mmol/l). The Geriatric Assessment and Rehabilitation Unit (ARU) and acute general medical wards of the Princess Margaret Hospital made little use of the specialised Diabetes Services for help in managing known or newly diagnosed diabetics. The mean in-hospital laboratory blood glucose value for all diabetics was an unphysiological value of 12.2 mmol/l, compared with a community mean of 4.9 mmol/l and hyperglycemia persisted after resolution of acute medical problems. ARU diabetic patients had significantly lower blood glucose values than those achieved by physicians in acute medical wards. Prescribed medications such as steroids or diuretics contributing to insulin resistance were rarely modified. It is concluded that 16.4% of elderly patients had significant hyperglycemia or poorly managed diabetes mellitus, and that both general and geriatric physicians underestimated both the severity and consequences of elevated blood sugars in older patients in a regional New Zealand community with a 'high' diabetes profile.
Medical research funding: a series of crises.
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Theory and practice of decision making in coronary care in general practice.
Decisions about coronary care made by 39 randomly selected general practitioners in New Zealand over one year were investigated. Demographic variables and variables relating to the patient's condition, history, and social circumstances were assessed for 113 patients, and practitioners' belief about the relevance of each variable to the decision was elicited. A comparison was made between the objective criteria found to be related to the decision, the criteria believed by the practitioners to be relevant to the decision, and a theoretical model of what should govern the decision to admit. The theoretical model was found to be built into the beliefs of the practitioners, but the objective model was far simpler. Further research is needed to determine whether the use of the more complex, theoretical models will confer any benefit, in terms of patient wellbeing, over the pragmatic model in use at present.
Utilisation of health services by diabetic persons. III: Audit of hospital admissions and bed occupancy.
The extent and patterns of use of hospital services by diabetic persons in New Zealand are not well documented. The usage of all four major Canterbury hospitals was prospectively studied for the 12 month period 1 January to 31 December 1983. There were 889 admissions by 689 diabetic persons who were either discharged from or died in hospital within the 12 month survey period (F = 373, M = 316). Ages ranged from three to 95 years mean 64.6 yr (SEM 0.7). One hundred and fifty-one patients were hospitalised more than once. At admission, 63.9% of patients were treated with diet or diet plus oral hypoglycaemic agents, 27.6% with insulin and 8.5% were newly diagnosed. The mean hospital stay was 20.1 (1.1 days), but the longest admission stays were by those over 65 years of age. Overall diabetic persons accounted for 4.8% of the total bed occupancy of the four hospitals. During 1983 14.8% percent of the 1200 insulin treated diabetic persons and 10.2% of the estimated 4000 non-insulin treated diabetic persons in the Canterbury Hospital Board area were hospitalised. Conditions associated with or a consequence of diabetes precipitated 57.5% of admissions. The potentially preventible disorders of glycaemic control and infection were factors in 25% and 26.9% of admissions respectively. These data show high risk of hospitalisation amongst diabetic individuals, particularly for those using insulin, but there is scope for prevention of admission or at least for reduction in duration of hospital stay.
Diabetes mellitus in a Christchurch working population.
Using criteria recommended by the World Health Organisation, prevalence rates for diabetes mellitus have been determined in a Christchurch working population of adults aged 15-65 years. Ninety-three percent of 1047 workers employed by a large industrial group were screened for diabetes mellitus using 75 G oral glucose tolerance tests. Three point one percent of the survey group were diabetic--1.55% were known to have diabetes and a further 1.55% were new cases. In addition, 0.31% were considered to have gestational diabetes mellitus. Blood glucose elevations not diagnostic for diabetes mellitus were present in another 0.93%. By applying the criteria of the National Diabetes Data Group, slightly different prevalence rates were found--3.0% for diabetes mellitus and 1.14% for impaired glucose tolerance.
Treatment of poorly controlled non-insulin-dependent diabetic patients with Acarbose.
Acarbose, 300 mg/day, was administered over one month in a cross-over trial to 18 hyperglycemic patients aged 41-66 years with non-insulin-dependent diabetes mellitus (NIDDM). All showed "normal" or exaggerated insulin release after a glucose challenge and remained in poor control (random glucose levels greater than or equal to 13 mmol/l) despite involvement in a diabetes intervention programme and prior use of oral hypoglycemic agents. During the one month treatment with Acarbose, fasting glucose and % HbAl concentrations were not different from those observed during placebo therapy. Furthermore, glucose tolerance was unchanged by Acarbose treatment. Glucose concentrations after a 1.6 MJ test meal were reduced by Acarbose from peak values of 17.3 +/- 1.0 to 15.0 +/- 1.1 mmol/l and were associated with lower post-prandial C-peptide (CPR) and insulin responses. Nevertheless, daily insulin production, as assessed by CPR excretion rates and plasma CPR and insulin concentrations, was not reduced by Acarbose. In fact, fasting plasma insulin and CPR levels were significantly higher during Acarbose then placebo therapy. Acarbose (100-400 mg/day) was continued for six months in 12 of these patients. During treatment, post-prandial glucose levels remained lower but monthly MBG values, determined by self-measurement of blood glucose, were unchanged except for small reductions in the 4th and 5th treatment months. % HbAl levels did not change. These data show that Acarbose treatment of a defined group of patients with poorly controlled NIDDM: resulted in small but sustained reductions of post-prandial glucose levels but without improving glucose tolerance, and reduced the circulating concentrations of insulin and CPR postprandially, but overall did not reduce daily production.
The effectiveness of diabetes education for non-insulin-dependent diabetic persons.
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The enhancement of hospital environments.
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Diabetes services in Yugoslavia.
The Socialist Federal Republic of Yugoslavia lies in south east Europe between the Soviet block and the free enterprise countries of Western Europe. It was originally established as a confederation of independent Balkan states after the first world war; after the second world war it became an independent federation of the socialist republics of Bosnia, Herzegovnia, Montenegro, Croatia (including Dalmatia), Slovenia, and Serbia, together with the two small autonomous provinces of Kosovo and Vojvodina. In the subsequent 30 years the trend towards decentralised decision making and institutional self management has continued. Nevertheless, the federal authorities retain major control over economic decision making and policies. For example, they forbid anyone from owning more than two houses or 10 hectares of land, and no factory owner may employ more than 10 people. Capitalism in any other than this minor form is not allowed, and any businessman whose business expands must become involved in frustrating negotiations with the local government to set up a state industry. I recently visited Yugoslavia as a guest of the Institute for Diabetes, Endocrinology, and Metabolic Diseases and of the medical faculty of the University of Zagreb and visited various health care units which provide services for diabetics in Croatia. As well as Zagreb itself I visited units in Split on the Adriatic coast and at Varazdin, near the Hungarian border. Necessarily my observations are based on the diabetes services in Croatia, but although the other republics may have less developed services they follow similar principles.
Utilisation of health services by diabetic patients. 1: The district nursing service.
In 1981 the district nursing service in Christchurch was making 590 home visits, on a weekly basis, to 73 patients for the purposes of drawing up and injecting insulin. This was 13.9% of their total workload. Through a programme of education many were able to manage the injection technique totally. In other cases the provision of pre-loaded syringes permitted less frequent attendance by the district nurse. At survey, one year later, the patient numbers visited had fallen to 46, and the number of weekly visits had been reduced by half. These results show the benefits of research programmes, aimed at evaluation of health delivery, with a view to improving their efficiency and reducing their cost.