PubMed Health⌕ Search

Biomedical subjects

S P Allison

Publications and source records attributed to S P Allison.

At least 19 recordsLinked to original sources
PubMed1992

The quality and relevance of peripheral neuropathy data on a diabetic clinical information system.

Routinely collected peripheral neuropathy data entered on a diabetic clinical information system since 1979 have been audited for completeness, consistency, accuracy (inter-observer variation), validity by comparison with biothesiometry, and relevance by life table analysis for foot ulceration. Peripheral neuropathy was defined by a neuropathy disability score > or = 4. The data were 98% complete. Forty-nine of 3405 (1.4%) had inconsistent records. Agreement between observers for clinical examination was significant (p < 0.05) for aggregate neuropathy score and its individual components except the knee jerk: Kappa score for observer variation for neuropathy score 0.56 (95% confidence interval 0.36-0.76). There was good agreement between neuropathy defined as aggregate score > or = 4, and as combined vibration perception thresholds for both feet > 60 V: Kappa statistic 0.62 (95% confidence interval 0.44-0.80). The chance of developing a foot problem in 3 years increased from 3% for patients with a score of zero to 45% for people with a score of between 9 and 12. We conclude that the calculation of a clinical neuropathy score is a simple, valid and relevant method for diabetes care both in hospital and the community. When combined with palpation of peripheral pulses most patients at risk of foot ulceration can be identified allowing targeting of preventive chiropody and orthotic resources.

Diabetic Neuropathies↗
PubMed1990

Defect in thermoregulation in malnutrition reversed by weight gain. Physiological mechanisms and clinical importance.

Previous studies in infants and in the elderly have shown that a low body weight is associated with a defect in thermoregulation and an increased risk of hypothermia. In the present study, thermoregulatory responses to a cooling stimulus were measured in 10 young and middle-aged patients who lost at least 10 per cent of their body weight during illness. Investigations were performed before and after restoration of body weight (mean weight gain 7.2 kg, SE 1.2 kg, p less than 0.001). The cooling stimulus was provided by a special suit perfused with water at 28 degrees C and then at 23 degrees C. Before weight gain, there was no increase in metabolic rate in response to cooling, despite a fall in core temperature. Following weight gain, the thermogenic response to cooling was restored towards normal. Peripheral vasoconstriction, the principal mechanism for heat conservation, was similar before and after weight gain. The thermogenic response to an infusion of adrenaline (25 ng/kg/min) was not abolished by weight loss, suggesting that the defect in cold-induced thermogenesis following weight loss is due to a change in central control mechanisms of thermoregulation, and not to tissue unresponsiveness. The phenomenon of abnormal thermoregulation following weight loss and the return to normal with subsequent weight gain may be clinically important, particularly in the elderly, since quite small falls in core temperature may impair both neuromuscular coordination and cerebral function.

Adult↗
PubMed1988

Group education for obese patients with type 2 diabetes: greater success at less cost.

It has been suggested that much effort expended in teaching diabetic diets is ineffective and wasteful. We have tested a different system by randomly allocating 75 newly diagnosed obese Type 2 diabetic patients to usual 'unstructured' clinic care or to group education by diabetes specialist nurses and a dietitian. Patients allocated to group education attended five 90-min group sessions during the first 6 months. Six months after diagnosis they had lost more weight (median (95% Cl), 7 (5.5-9) vs 2(1-5)kg, p less than 0.002) and were better controlled (HbA1:7.5 (7.0-8.1) vs 9.5 (8.7-10.4)%, p less than 0.001) than those randomized to the usual clinic system. At 1 year (after no further visits) the difference in weight loss was less (5.5 (4-6.5) vs 3 (2-4) kg, p less than 0.05) and diabetic control was similar (HbA1:9.0(8.2-9.8) vs 9.9(8.9-10.9)%. At 1 year only 14(39%) of the education group and 9(23%) of those attending the clinic had a fasting blood glucose less than 7.0 mmol l-1.

Blood Glucose↗
PubMed1988

Censoring of patient-held records by doctors.

Computer-held information is increasingly shared between general practice and hospitals and with the provisions of the Data Protection Act now in operation, the practical issues of disclosure to patients need to be reviewed. Patients attending diabetic clinics at University Hospital, Nottingham, are routinely issued with a copy of their computerheld record but a previous study showed a high level of censoring by the hospital doctors. This paper reports a review of a sample of 251 censored records, containing 426 problems, whereby the doctors concerned provided reasons for the censoring and restored information they thought suitable. After the review, only 8% of censored problems, that is 1% of all problems, remained censored. An additional 2% of all problems were deleted from the patient's copy at the request of the patient. It is essential that systems which allow censoring of patient records have continuous built-in audit to monitor the reasons for censoring.

Computers↗
PubMed1986

Some psychological and physiological aspects of enteral nutrition.

This review discusses three main topics: the first relates to the effects of underlying disease, malnutrition, and nutritional support on appetite; the second is concerned with the role of enteral feeding in short bowel syndrome; and the third deals with the clinical benefits of enteral nutrition.

Anorexia↗
PubMed1986

Enteral nutrition.

The introduction of fine-bore tubes and other equipment for tube feeding and the appearance on the market of defined formula nutritional preparations have revolutionised the technique of enteral feeding making it cheap, effective and relatively free of complications when used correctly. Although primarily a clinical exercise, it relies very much on biochemical support, particularly in difficult cases. The clinical biochemist should therefore have a general understanding of this and other aspects of clinical nutrition if he is going to provide that support appropriately.

Carbohydrate Metabolism↗
PubMed1985

The effect of undernutrition on thermoregulation in the elderly.

With use of a liquid-conditioned coverall, the thermoregulatory responses to a lowering of environmental temperature from 35 degrees C to 23 degrees C were assessed in eight normally nourished and six undernourished elderly female patients, during their convalescence after surgical repair of a fracture of the femoral neck. There was no difference in the peripheral vasoconstriction of the two groups in response to a cold environment. On lowering the environmental temperature, the increase in metabolic rate was significantly impaired in the undernourished group compared with the normally nourished group (P less than 0.05). There was a small decrease in core temperature in the undernourished group (median change -0.1 degree C) during the period of exposure to the lowest environmental temperature (23 degrees C). This was significantly different from the lack of change (median change 0 degrees C) in core temperature observed in the normally nourished group (P less than 0.05). This defect of thermogenesis may underlie the propensity of undernourished elderly patients to suffer hypothermia and fracture of the femoral neck in the winter months.

Aged↗
PubMed1983

Adrenocortical suppression in multiply injured patients: a complication of etomidate treatment.

Three patients admitted to the intensive care unit after multiple injury were observed to suffer episodes of adrenocortical insufficiency suggested by clinical manifestations and confirmed by appropriately low cortisol concentrations. This prompted a prospective study of pituitary-adrenocortical function in six multiply injured patients, three of whom showed evidence of adrenocortical suppression. The only factor common to the six patients with abnormally low adrenocortical function was an association between periods of adrenocortical suppression and intravenous infusion of etomidate; when the drug was stopped adrenocortical function was restored, and renewed administration of the drug caused further inhibition. Etomidate infusions lasting only six hours were found to cause low, flat responses to short tetracosactrin tests and grossly raised plasma concentrations of adrenocorticotrophic hormone, suggesting direct suppression of the adrenal cortex. Median plasma cortisol concentrations measured at 0900 were significantly lower and median plasma concentrations of adrenocorticotrophic hormone measured at 0900 were significantly higher in the three patients studied prospectively who were receiving etomidate infusions compared with the three patients who did not receive etomidate (p = 0.05).

Adolescent↗
PubMed1983

Benefits of supplementary tube feeding after fractured neck of femur: a randomised controlled trial.

A total of 744 elderly women with fractured neck of femur were classified into three groups according to anthropometric measurements on admission: group 1, well nourished; group 2, thin; group 3, very thin. Group 1 ate well and had a low mortality and a short rehabilitation time. The thinner the patients the lower their voluntary food intake, the higher their mortality and the longer their rehabilitation time. A series of 122 patients from groups 2 and 3 were entered postoperatively into a randomised controlled trial of overnight supplementary nasogastric tube feeding (4.2 MJ (1000 kcal), including 28 g protein) in addition to their normal ward diet. This treatment was associated with improvements not only in anthropometric and plasma protein measurements but also in clinical outcome, especially in the very thin group 3 patients. Rehabilitation time and hospital stay were shortened. Mortality in group 3 was less in the tube fed patients (8%) than in the controls (22%) but this difference did not reach statistical significance. One in five patients could not tolerate the nasogastric tube, but in the remainder the treatment caused no side effects and did not seriously diminish voluntary oral food intake by day.

Aged↗
PubMed1983

Testing the anterior pituitary: hypoglycaemia produced by continuous intravenous insulin infusion.

The response of growth hormone, cortisol, and catecholamines to hypoglycaemia produced by a continuous intravenous infusion of insulin was investigated in 10 normal subjects and 15 patients with pituitary disease. The insulin infusion rate was started at 2 U/hour for adolescents, 4 U/hour for adults, and 6 U/hour for patients with acromegaly. If required the rate was increased during the test depending on changes in blood glucose, measured by a Reflomat with low reading glucose oxidase strips. Stopping the infusion when the blood glucose concentration had fallen to 2.0 mmol/l (36 mg/100 ml) resulted in a maximum further fall of 0.7 mmol/l (13 mg/100 ml) and a subsequent spontaneous rise in blood glucose concentration. The rise was identical in normal subjects and in patients with hypopituitarism, further evidence that pituitary hormones--in contrast to glucagon and catecholamines--are relatively unimportant in the recovery from hypoglycaemia. The only patient who required intravenous glucose to restore normoglycaemia was a patient with longstanding insulin dependent diabetes. A comparison with the conventional bolus injection test showed that continuous intravenous insulin infusion was more reliable in producing adequate but not excessive hypoglycaemia and the hormone responses were equivalent. The continuous intravenous insulin infusion may offer particular advantages in the investigation of growth hormone deficiency.

Adolescent↗