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R D Forrest

Publications and source records attributed to R D Forrest.

32 records · Page 2Linked to original sources
PubMed1987

Screening for diabetes mellitus in general practice using a reflectance meter system. The Islington Diabetes Survey.

The feasibility of using a blood-glucose reflectance meter to identify subjects with abnormal glucose tolerance in a community-based screening programme for diabetes mellitus has been assessed. 530 (51.0%) of 1,040 screened subjects had a finger-prick capillary blood-glucose level estimated 2 h after a 75 g oral glucose load. Blood-glucose estimations were performed on this sample by an automated glucose-oxidase method and by a reflectance meter system (Reflocheck, BCL (London) Ltd., Lewes, East Sussex, UK). Blood-glucose values measured by the meter were found to be higher than those assayed by the glucose-oxidase method by a mean ratio of 1.16:1. This overestimation could not wholly be explained by the meter being calibrated to measure plasma- rather than whole blood-glucose. This ratio was constant in specimens assayed by the glucose-oxidase method within 24 h of sampling or within 7 days of sampling. The meter system gave a good approximation of the prevalence of DM in the sample (14 "diabetics" identified by the meter, 15 by the glucose-oxidase 2hBG). The optimal test characteristics of the meter 2hBG as a screening test for DM were at a cut-off level of 9.7 mmol/l (sensitivity and specificity 98.4%, CI 85.8-100%, for sensitivity, 97.3-99.5% for specificity). However, in order to be 100% sensitive for DM, confirmatory GTTs would be necessary on all subjects with meter 2hBG greater than 9.5 mmol/l, providing a specificity of 98.2% (CI 97.0-99.7%). The unit cost of detecting 1 case of DM using a single meter became cheaper than using the laboratory glucose-oxidase method when 143 subjects had been screened.

Autoanalysis↗
PubMed1987

Screening for diabetic retinopathy--comparison of a nurse and a doctor with retinal photography.

The efficacy of diabetic retinal screening by a nurse trained in ophthalmoscopy and of a diabetologist was assessed by comparison with fundal photography. The study was performed in 282 subjects, 59 with known diabetes and 223 participating in a screening survey, of whom 13 had diabetes and 43 impaired glucose tolerance. The prevalence of retinopathy in the diabetic subjects was 36.8% and serious retinopathy 9.5% while in the screened subjects it was 3.5% and 0.9% respectively. The characteristics of nurse examination as a test to detect retinopathy was: sensitivity 50.0% +/- CL16.8%, specificity 99.2% +/- CL0.9%, which compared with 51.3% +/- CL15.7% and 98.7% +/- CL1.2% for the doctor. The nurse failed to detect serious retinopathy as accurately as the doctor, although new vessels were missed in 5 of 6 cases by the doctor. Screening for retinopathy requires either ophthalmoscopy by an observer trained to a higher level than is common in doctors, or non-mydriatic retinal photography.

Adult↗
PubMed1984

Wound assessment in clinical practice. A critical review of methods and their application.

This review describes the methods that may be used clinically for the assessment of open wounds and indicates potential limitations in their usefulness. None of the methods available for the appraisal of wounds in human subjects measures healing directly but a number of objective variables may be used to shed light on the healing process. Research methods have been suggested that may be clinically useful in assessing healing but are not generally available at present.

Humans↗
PubMedDate not supplied

Glucose intolerance and hypertension in north London: the Islington Diabetes Survey.

In a general practice-based screening survey, 1040 (63.3%) of a randomly selected sample of 1644 people over the age of 40 years were examined for diabetes mellitus (DM) and hypertension (HT). Glucose intolerance was assessed by a single 2 h post-load blood glucose estimation and HT (diastolic blood pressure greater than or equal to 95mmHg by a single blood pressure reading) or being on anti-hypertensive treatment. The sample included 41 patients (2.1%) with known DM and 135 (12.5%) with known HT. Screening identified 27 (2.6%) new diabetics (16 women) and 43 subjects (4.1%) with impaired glucose tolerance (30 women). A further 30 known diabetics over the age of 40 and 12 diabetics under 40 were registered at the practice. The estimated prevalence of diabetes in the over 40s was 4.6% and in all ages was 1.6%. DM appeared to affect Afro-Caribbeans more commonly than Caucasians among those examined (5.9% versus 2.6%) though this difference did not reach statistical significance (z = 1.1106, p = 0.134). A total of 190 subjects (17.5%) were found to have HT, of whom 55 (5.1%) were newly diagnosed; 10.2% of the sample were on anti-hypertensive treatment, and in 79.3% of these the blood pressure was well controlled (diastolic less than 100 mmHg). HT was more common among known diabetics with a prevalence of 35.4%, of whom one-third were previously undiagnosed. HT affected Afro-Caribbeans significantly more commonly than Caucasians (z = 4.206, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

The glycohaemoglobin assay as a screening test for diabetes mellitus: the Islington Diabetes Survey.

Blood glucose 2 h after an oral glucose load (2hBG) and glycohaemoglobin (GHb) (Corning agar-gel electrophoresis) levels were used as screening tests in a general practice diabetic screening programme. The diagnosis of diabetes (DM) was based on a separate oral glucose tolerance test (OGTT) in 223 of 1040 screened subjects, selected as a stratified sample biased towards higher levels of 2hBG and GHb. The GHb assay was also repeated at the recall examination and urine was tested for glycosuria before and after glucose administration. At a cut-off level of 8.1%, the screening GHb assay correctly identified 90% of all probable diabetics with a specificity of 85.3% (95% Cl 83.3-87.3%) and a positive predictive value of 14.0% (9.0-19.0%). The specificity of the screening GHb assay as a screening test for true DM was 45.8% (39.0-52.4%) at 90% sensitivity, and that of the recall GHb assay was 64.5% (57.9-71.1%). The screening 2hBG was 93.3% (88.9-97.7%) specific at 90% sensitivity as a screening test for true DM diagnosed by OGTT at recall. The test characteristics for fasting glycosuria were: sensitivity 16.7% (0-37.8%) and specificity 98.0% (96.0-100.0%). Equivalent values for the post-glucose test for glycosuria were: 72.7% (46.4-99.0%) and 77.4% (70.1-84.7%), respectively. While GHb assay is a poorer screening test for DM than the 2hBG at the single cut-off level quoted, comparison of the accuracy of the two tests shows that the GHb assay is only marginally less accurate. It is superior to testing for glycosuria as a screening test for DM and can be performed on any random blood sample, facilitating its use in population screening.

Adult↗
PubMedDate not supplied

Glucose tolerance and glycohaemoglobin: a population study of male-to-female ratios.

We have studied blood glucose concentrations 2 h after a 75g glucose load, and glycohaemoglobin as assayed by agar gel electrophoresis, in 1084 subjects over the age of 40 in a community screening survey. There were 16 newly diagnosed diabetic women (2.7%) and 11 men (2.5%). The mean level of 2h blood glucose was 5.6 +/- 2.04 mmol/l in women and 5.33 +/- 2.14 mmol/l in men (p less than 0.002) but when corrected for age and weight the mean levels were 5.55 mmol/l in women and 5.40 mmol/l in men (p greater than 0.2). Mean levels of glycohaemoglobin were 7.30 +/- 1.10% in women and 7.17 +/- 1.18% in men (p less than 0.02) but when adjusted for blood glucose and age these were 7.25% in both sexes (p greater than 0.9). Differences in glucose tolerance in this population are related to differences in age and weight. There is no evidence for differences in glycosylation in men and women.

Adult↗