BACKGROUND: The insulinotropic hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (7-36 amide) (GLP-1), regulate insulin secretion to nutrient intake and constitute the endocrine arm of the entero-insular axis. Glucagon has been implicated in the pathophysiology of conditions characterised by abnormal glucose tolerance such as obesity and diabetes mellitus although its effect on the entero-insular axis is not fully understood. Materials and methods We investigated the effect of exogenous glucagon on the entero-insular axis and its relation to gastric emptying in six healthy men aged [mean (+/-S.E.M. )] 23.6 (0.9) years with a body mass index of 24.0 (1.5) kg/m(2). Plasma glucose, GIP, GLP-1, insulin and paracetamol concentrations were measured before and after a 100 g oral carhohydrate load containing 1.5 g of paracetamol for 6 h during intravenous infusion of either glucagon or saline. RESULTS: When compared to the saline infusion, peak and integrated insulin and glucose concentrations were higher (p<0.05) following glucagon infusion. After 60 min paracetamol concentrations were lower (p<0.05) following glucagon infusion. Integrated responses for GIP and GLP-1 were markedly reduced following glucagon infusion. CONCLUSIONS: Exogenous glucagon in addition to its well-documented action of increasing glucose and insulin concentrations and delaying gastric emptying also markedly reduces GIP and GLP-1 secretion. The inhibition of GLP-1 soon after commencement of glucagon infusion supports a direct effect of glucagon on intestinal L-cells. We speculate that the marked inhibition of postprandial GLP-1 secretion by glucagon may be of importance in the pathogenesis of relative insulinopenia in Type 2 diabetes and in the development of reduced satiety in obesity and diabetes.

Acetaminophen↗

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Dental treatment for deaf patients.

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Communication↗

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A decade review: methods to improve adherence to the treatment among haemodialysis patients.

Haemodialysis patients are asked to adhere to a very difficult treatment regimen consisting of fluid and diet restrictions, many daily medications, and usually 3 or 4 hour haemodialysis sessions three times each week. Many haemodialysis patients fail to adhere to their prescribed treatment and although this regimen is difficult, it is necessary for patients to adhere for optimal health and well-being. It is important for nephrology nurses to know what interventions help patients overcome the barriers that keep them from adhering to prescribed treatment The purpose of this paper is to review the literature to examine the research that has been published on methods to improve adherence among haemodialysis patients. Behavioural approaches, education, and primary nursing are interventions that have been researched More research has been reported on the demographics of noncompliant haemodialysis patients than on effective methods that help patients improve adherence to the treatment regimen. Demographic characteristics do not consistently predict compliance for individual patients. Each patient is unique. Research supports the idea that the nephrology nurse should spend time with the patient on a regular basis in order to understand the factors that hinder the individual patient from adhering to the treatment regimen. The nurse who knows the patient well is empowered to develop individualised interventions aimed at reducing barriers that interfere with the patient's ability to adhere to treatment.

Behavior Therapy↗

PubMedDate not supplied

Evidence-based care: can we overcome the barriers?

Evidence-based care has become the new mantra within the NHS, despite the fact that the concept of applying research to practice has been promoted for several decades. However, literature on the subject suggests that formidable obstacles remain to the integration of research into care delivery. This article describes a study which used Funk et al's (1991a,b) Barriers Scale with a population of nurses in a large teaching hospital in the UK. This scale was specifically developed to identify barriers to the introduction of research into practice, and modified for a UK context. The results suggest that a complex array of barriers exist but that foremost among these is the nature of the organizations within which nurses work. Comparisons are made with data from the USA, and the need to create time for nurses to implement change, and to empower them to do so, is stressed.

Attitude of Health Personnel↗

PubMedDate not supplied

Sharing best practice: developing a Web-based database.

This article reports on the development of a web-based interactive database that was designed to facilitate the dissemination of practice development, research and audit projects across a large NHS trust. A multidisciplinary team worked collaboratively to design the database in order to ensure that it incorporated features which made it easy for the end user. Concise structured information on each project was recorded and search facilities incorporated to facilitate access to information. Hyperlinks to other web pages on the Internet and the Trust intranet were created and full reports/publications of projects were included for those who wanted more information. The subsequent implementation across the organization involved promoting the database, helping practitioners develop skills to access information, setting up quality review procedures for projects and evaluating its use. The development of the database has highlighted that time, the availability of computers in clinical areas and skills development are important considerations when taking forward information technology (IT) initiatives.

Benchmarking↗

PubMedDate not supplied

The oral glucose tolerance test (OGTT): effect of rate of ingestion of carbohydrate and different carbohydrate preparations.

The glucose load of the oral glucose tolerance test (OGTT) is well standardized. However, recommendations on rate of ingestion and nature of the load are vague. In this study the effect on blood glucose, serum insulin, C-peptide, and plasma gastric inhibitory polypeptide (GIP) of giving 75 g glucose in 300 ml over 1 and 10 min (G1 and G10) was investigated in six subjects. In five an isocaloric amount of partially hydrolyzed starch (Hycal) was also used (H1 and H10). The fast glucose intake, compared with the slow ingestion, resulted in an earlier rise in blood glucose levels, accompanied by a faster serum insulin and C-peptide response. Between 90 and 135 min blood glucose concentrations were significantly higher after the 10-min glucose intake. At 120 min blood glucose levels were 5.5 +/- 0.5 and 4.7 +/- 0.5 mmol/L, respectively, for G10 and G1 (P less than 0.05). In the first half hour after slow and fast Hycal intake no differences were seen in blood glucose, serum insulin, and C-peptide levels. Between 45 and 120 min blood glucose levels were significantly higher after the 10-min Hycal intake. At 120 min blood glucose levels were 5.3 +/- 0.2 and 4.4 +/- 0.1 mmol/L, respectively, for H10 and H1 (P less than 0.01). Except for a faster rise in glucose and insulin levels after glucose loading in 1 min, no further differences were found, when compared with Hycal. No significant differences were seen in the GIP responses. Thus differences in rates of ingestion can cause significant differences in later results. A standard time for glucose ingestion should be specified.

Adult↗

PubMedDate not supplied

Pressure damage prevention: basing practice on evidence.

As part of an initiative to develop evidence-based practice at the Northern General Hospital, Sheffield, a three-part project was undertaken. The aims were to identify barriers to using research in nursing, establish a baseline of nurses' knowledge and its influence on their practice in one essential area of nursing care--pressure damage prevention--and develop a strategy for change which took account of the findings from the first two parts of the project. In this article, the authors describe the second part of the project which examined nursing knowledge and practice with reference to the management of pressure damage prevention. The findings are discussed and the authors recommend that nurses integrate into their practice evidence from sources such as systematic reviews.

Bandages↗

PubMedDate not supplied

Year one dental visit.

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Child, Preschool↗

PubMedDate not supplied

The chromosome complement of an Aotus hybrid.

Two divergent haploid chromosome sets were encountered in the chromosome complement of laboratory-born Aotus. Comparison of G-banded chromosomes of this individual with seven other established G-banded Aotus karyotypes revealed that this monkey is a hybrid offspring of two allopatric chromosome races (Brazilian Aotus X Colombian Aotus).

Animals↗

PubMedDate not supplied

Investigation of the possible associations between fluorosis, fluoride exposure, and childhood behavior problems.

PURPOSE: This study investigated the potential association between fluoride exposure and behavior problems in children, as well as the prevalence of and risk factors for fluorosis. METHODS: Children between the ages of 7 and 1 years (N = 197) were included in the study and were examined for dental fluorosis using the Modified Dean's Index. Parents of subjects completed and returned three questionnaires which investigated their children's history of exposures to fluoride, social and medical backgrounds, and behavior using the Child Behavior Checklist (CBCL). RESULTS: Sixty-nine percent of the study participants demonstrated fluorosis with very mild fluorosis being the most common (39%), while 13% demonstrated moderate to severe fluorosis. Using a summation of the Modified Dean's index (Sum of 8), we divided the children into high fluorosis (HF) and low fluorosis (LF) groups. These groups were compared to each other with respect to fluoride exposures and behavior. CONCLUSION: Although there was no association between the fluoride exposures in aggregate and fluorosis, there was a significant association between supplemental fluoride exposure from ages 0-3 years and fluorosis. There was no association between behavior problems and dental fluorosis in this population.

Age Factors↗