Education/empowerment is critical if successful self-management is to be achieved. All professional patient interactions have a learning component. Clinical outcomes in diabetes are as dependent on psycho-social factors or learned behaviour as on metabolic state or therapeutic interventions. These factors include targets set, self-management skills, influence of living with diabetes, emotional factors, role of other people, perceived benefits and barriers, feelings of self-efficacy, weight concern and diet barrier. Training in learning processes and factors governing behaviour are essential for all those involved in delivery of patient care. Educational programmes should recognise the wide range of learning strategies used by different people.

Attitude to Health↗

PubMedDate not supplied

A breast phantom method for evaluating mammography technique.

A new breast phantom has been designed for use in evaluating mammographic system performance. This phantom incorporates simulated calcifications and fibrillar objects in fat, of graded size, to permit measurements of detail visibility. A special methodology has been developed for measuring visible object size to achieve reproducible and clinically relevant results. Materials and construction of the phantom also permit carrying out dosimetry with an appropriate ionization chamber. Dosage and detail visibility measurements are reported for the Xerox 125, Min-R and Xonics systems. In addition to providing information regarding technique and image receptors, these results demonstrate the usefulness of the basic phantom design, and suggest possible improvements.

Breast Neoplasms↗

PubMedDate not supplied

District Diabetes Centres in the United Kingdom. A report on a workshop held by the Diabetes Education Study group on behalf of the British Diabetic Association.

Dissatisfaction with standards of diabetes care in general, and the traditional diabetic clinic in particular, is widespread. Problems include the large numbers of attenders, short consultation times (often with inexperienced medical staff), lack of continuity and prolonged waiting times. Standards of education and control fall woefully below those that are desired. In recent years several different strategies have been adopted to provide solutions, including general practitioner cooperative care schemes to reduce numbers and improve community care, the appointment of diabetes specialist nurses to take on the major educational role, and the commissioning of special education units designed to remove the educational element from the traditional clinic environment. Lately consideration has been given to the development of Diabetes Centres, to provide more comprehensive diabetes care, both educational and clinical. A workshop was held in January 1987 to analyse in greater detail the concept of Diabetes Centres and the consequences of their implementation.

Diabetes Mellitus↗

PubMedDate not supplied

Improved beta cell function, with reduction in secretion of intact and 32/33 split proinsulin, after dietary intervention in subjects with type 2 diabetes mellitus.

Diet in Type 2 diabetes often reduces both hyperglycaemia and weight and both these factors may contribute to improvement in beta cell function. Sixty-nine subjects with newly diagnosed Type 2 diabetes had their glucose, insulin, intact and 32/33 split proinsulin measured at diagnosis, and after 16 (12-20) weeks of conventional diet. In the whole group following diet there was reduction in weight (p < 0.0001), Haemoglobin A1 (p < 0.0001), and fasting glucose (p < 0.0001). There was a fall in fasting intact proinsulin (p < 0.03), 32/33 split proinsulin (p < 0.0001), and the percentage of fasting proinsulin to total insulin-like molecules (p < 0.0001). Subjects were separated according to weight loss (group 1 < 0.5 kg, group 2 0.5-4 kg, group 3 > 4 kg). Only subjects in group 3 (mean weight loss 6.2 kg) had a fall in fasting insulin (p < 0.04). The fasting glucose achieved following diet was positively correlated with the initial fasting glucose (r = 0.7) and negatively correlated with the degree of insulin deficiency at diagnosis (with the initial 30 min insulin r = -0.62). The effect of diet on the final concentration of insulin, 32/33 split proinsulin and intact proinsulin was examined using multiple regression. The final insulin concentration was determined by the initial BMI and absolute weight loss, 32/33 split proinsulin concentration by the initial fasting glucose and absolute glucose fall, and intact proinsulin concentration by a combination of both weight loss and glucose reduction.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Glucose↗

PubMedDate not supplied

Edge sharpness and enhancement of electron radiographs (ERGs) produced with powder cloud development.

Much renewed interest has developed in electrostatic imaging systems. This is partly because of their use of relatively inexpensive materials and their potential for improved diagnostic accuracy--a novel combination of image latitude with great detail contrast. All such systems can exhibit these image characteristics when developed by the generally used "powder cloud" technique or some similar partial development system. We have measured edge sharpness and enhancement of electron radiographs (ERGs) produced with the powder cloud technique. Edge sharpness can be excellent at low image-density levels, but deteriorates with increasing density. Edge enhancement is also appreciable; it appears to decrease somewhat with increasing image density, but no simple relationship has yet been shown.

Densitometry↗

PubMedDate not supplied

Comparison of ion chamber and TLD dosimetry in mammography.

An ionization chamber method has been developed to measure exposure vs depth in a uniform BR 12 "average breast" phantom. It employs a Memorial mammography chamber for exit exposure measurements; resulting data is then corrected for backscatter as well as for the exceptionally thin window of this chamber. A careful comparison has then been made with relative exposure vs depth curves obtained using TLD at several mammography beam qualities, for identical exposure factors and SSD values. Use of a correction for residual and background TL signals significantly improved agreement between TLD and ion chamber curves in the 28 to 35 kVp/0.03 mm Mo range of beam quality. Agreement was within +/- 5% for the Mo target tube, but TLD readings were 4%--8% higher than ion chamber values for the W/Mo target tube. At Xeromammography energies (45 kVp/1.6 mm Al), corrected TLD curve readings were 6% higher at depth than ion chamber curve values. TLD meaurements with 28 to 35 kVp/0.03 mm Mo beams tend to underestimate dosage to the midbreast parenchyma. For example, in a 5 cm "average breast", the underestimation ranges from 2%--10% for corrected, 10%--16% for uncorrected TLD readings.

Female↗

PubMedDate not supplied

Measurements of diagnostic x-ray backscatter by a novel ion chamber method.

There is a major gap in backscatter information for diagnostic x-ray beams. Such information is increasingly needed for dose measurements and calculations, as well as for designing devices and techniques. We have therefore carried out measurements on both low Z materials and metals, using an ion chamber method designed specifically for the purpose. Lucite and two D.R. White tissue substitutes were studied extensively (BR 12 "average breast" and MS 11 "water"). Measured percent backscatter (BS) was greatest for Lucite and least for MS 11, with BR 12 in between. Backscatter buildup is rapid: 50% of full backscatter is achieved with 6 mm thickness for all three materials using mammographic beams and with about 12 mm using general diagnostic beams. A simple relationship between BS and field area permits close estimates of BS values for fields for which measured data is not available. Among metals tested, copper exhibited greatest backscatter (39% BS maximum), aluminum least, and lead in between--information of potential importance in cassette design and similar applications.

Mammography↗

PubMedDate not supplied

'Learning Diabetes'--a multi-media learning package for patients, carers and professionals to improve chronic disease management.

A multi-media program for those with insulin and non-insulin dependent diabetes, and for their carers, has been produced. It is delivered on CDROM and contains an extensive amount of very high quality generated video of patients using short clips (maximum 2 min) totalling 2.5 h in 240 files using MPEG compression. The video is combined with a wide range of graphic based activities engaging the user in fully interactive processes and allowing them to obtain extensive understanding of the disease and to relate to attitudes and perceptions about it from those with the same condition. The program is robust and appears to meet the educational needs for its extent of interactivity, degree of choice for the user and provision of information based on real patient experience. It is easily used and modified to meet users of different socio-cultural needs and can be translated into different languages. It offers the opportunity not only for increased learning and improved self-management of those with diabetes, but also greater understanding by those who care for them, both professional and non-professional. Using the same framework, programs are being developed for other chronic diseases including asthma and hypertension.

CD-ROM↗