Electron-spin resonance has been used to measure the decay of the concentration of polymerization radicals in polymethyl methacrylate (PMMA) bone cement and the kinetics of the decay determined. Thermal annealing at various temperatures has shown that the logarithm of the concentration of radicals varies linearly with time, but with a nonzero intercept. These results have been analyzed by including both first- and second-order decay processes. The first-order process has an activation energy of 39 +/- 2 kcal/mol and is probably due to a diffusion-limited termination. The second-order process has an activation energy of 36 +/- 5 kcal/mol and is probably due to bimolecular termination.

Bone Cements↗

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General medicine conferences.

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Curriculum↗

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Can residents be trained to counsel patients about quitting smoking? Results from a randomized trial.

STUDY OBJECTIVE: To evaluate the effectiveness of two teaching interventions to increase residents' performance of smoking cessation counseling. DESIGN: Randomized controlled factorial trial. SETTING: Eleven residency programs, in internal medicine (six), family medicine (three), and pediatrics (two). Programs were located in three university medical centers and four university-affiliated community hospitals. PARTICIPANTS: 261 residents who saw ambulatory care patients at least one half-day per week, and 937 returning patients aged 17 to 75 years who reported having smoked five or more cigarettes in the preceding seven days. Of the 937, 843 were eligible for follow-up, and 659 (78%) were interviewed by phone at six months. INTERVENTIONS: Two interventions (tutorial and prompt) and four groups. The tutorial was a two-hour educational program in minimal-contact smoking cessation counseling for residents. The prompt was a chart-based reminder to assist physician counseling. One group of residents received the tutorial; one, the prompt; and one, both. A fourth group received no intervention. MEASUREMENT AND RESULTS: Six months after the intervention, physician self-reports showed that residents in the tutorial + prompt and tutorial-only groups had used more counseling techniques (1.5-1.9) than had prompt-only or control residents (0.9). Residents in all three intervention groups advised more patients to quit smoking (76-79%) than did control group residents (69%). The tutorial had more effect on counseling practices than did the prompt. Physician confidence, perceived preparedness, and perceived success followed similar patterns. Exit interviews with 937 patients corroborated physician self-reports of counseling practices. Six months later, self-reported and biochemically verified patient quitting rates for residents in the three intervention groups (self-reported: 5.3-8.2%; biochemically verified: 3.4-5.7%) were higher than those for residents in the control group (self-reported: 5.2%; biochemically verified: 1.7%), though the differences were not statistically significant. CONCLUSION: A simple and feasible educational intervention can increase residents' smoking cessation counseling.

Counseling↗

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Alcohol withdrawal syndromes: a review of pathophysiology, clinical presentation, and treatment.

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Alcohol Amnestic Disorder↗

PubMedDate not supplied

Glycosylated haemoglobin measurement on blood samples taken by patients: an additional aid to assessing diabetic control.

200 patients attending a diabetic outpatient clinic were each asked to post to the hospital, prior to their three-monthly routine clinic visit, a finger-prick capillary blood sample for glycosylated haemoglobin assay (HbA1). Patients took their own blood into UNISTEP bottles, which automatically measure a 53 microliters aliquot and mix it with 150 microliters of diluent suitable for transport to the laboratory. During 1 year 883 (84%) of 1046 bottles sent out were returned of which 776 (87%) were suitable for analysis. The availability of the result at the time of the patients' clinic visit aided assessment of diabetic control and was associated with a mean reduction of the HbA1 by 0.8% (p less than 0.001) over a twelve-month period. This simple system facilitates remote monitoring of HbA1 levels, is suitable for both hospital and general practice use and may allow a reduction in the number of patient visits.

Diabetes Mellitus, Type 1↗

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Sulphonylurea failure in type 2 diabetes: treatment with a basal insulin supplement.

Many diabetic patients continue to have hyperglycaemia on maximal sulphonylurea therapy. Five different therapeutic options, with the prime aim of achieving normal fasting plasma glucose concentrations, have been compared in 15 asymptomatic, sulphonylurea-treated type 2 diabetic patients in a randomized crossover study of 8-week periods. In 24 h metabolic profiles the overnight mean (+/- 1SD) basal plasma glucose level on sulphonylurea therapy was 8.9 +/- 4.2 mmol/l. This was slightly improved with added metformin therapy (7.3 +/- 4.3 mmol/l, p = 0.013), but reduced to normal by added ultralente insulin (5.2 +/- 3.2 mmol/l, p less than 0.001), ultralente insulin alone (5.1 +/- 1.6 mmol/l, p = 0.005) or by ultralente and soluble insulin (4.7 +/- 1.4 mmol/l, p = 0.003). The mean glycosylated haemoglobin concentration was reduced significantly only by the treatments which included insulin. None of the patients had severe or incapacitating hypoglycaemia and only when on additional soluble insulin did patients show a significant gain in weight. Combining sulphonylurea therapy with ultralente insulin did not significantly improve overall glucose control over treatment with ultralente alone, although the insulin dose required to restore fasting normoglycaemia was significantly lower (median (interquartile range), 25 (12-41) versus 40 (27-80) U/day, p = 0.001). In type 2 diabetic patients who continue to have fasting hyperglycaemia on maximal sulphonylurea therapy, fasting normoglycaemia can be achieved easily, without minimal changes in diet or lifestyle, by means of a basal insulin supplement.

Adult↗

PubMedDate not supplied

The Christmas feast.

Twenty two normal subjects and 13 maturity onset diabetic patients completed an observational study with repeated weighing and fasting blood tests from one month before to one month after Christmas. Over the Christmas period in all subjects an increase in weight was observed (mean 0.8 (SD 0.1) kg, p less than 0.001), which was maintained through January. This may signify an average additional 6000 kcal ingested. By three to six days after Christmas a slight but significant increase in fasting plasma triglyceride (p less than 0.03) and cholesterol (p less than 0.02) concentrations occurred, with a subsequent rise in glycosylated haemoglobin concentration (p less than 0.001). This study is not likely to affect any future Christmas.

Blood Glucose↗

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No glycemic benefit from guar administration in NIDDM.

A randomized crossover study of 5-g guar minitablets against placebo, given three times per day with main meals for 8 wk, was done in 29 non-insulin-dependent diabetes mellitus (NIDDM) patients who had near-normal fasting plasma glucose concentrations on treatment with diet alone, additional sulfonylurea, or ultralente insulin. Guar did not reduce the excessive postprandial glycemic excursion, glycosylated hemoglobin values, basal plasma glucose concentrations, basal or incremental plasma C-peptide values, or body weight. There were few side effects with either guar or placebo therapy. Mean low-density lipoprotein cholesterol levels were significantly reduced (P less than .001) by guar administration (116 +/- 23 vs. 104 +/- 19 mg/dl). Guar additives did not improve the excessive postprandial glycemia found in NIDDM patients in whom near-normal fasting plasma glucose levels had been obtained.

Adult↗

PubMedDate not supplied

Clinic- rather than self-monitoring of home blood samples: relevance of day-to-day variability to decision making.

The day-to-day variability of blood glucose concentrations in juvenile diabetes means that it is often more reasonable to aim to achieve a generally good pattern of blood glucose control, rather than regularly to assess the next insulin dose after each blood glucose measurement. This means that immediate assessment by the patient of his blood glucose concentrations is not always necessary. We have investigated control in 22 insulin-requiring diabetic patients by means of a monthly series of four blood samples taken during a day into collector bottles and transported to a laboratory for blood glucose assay. The overall means before breakfast, before lunch, before dinner, and before bed were 6.1, 5.8, 7.3, and 7.2 mmol/L, respectively. In many patients, sufficiently good control can be obtained by this method so that it is not necessary to ask them to measure their own blood glucose concentrations or to ask them to obtain the fairly expensive meters for reading glucose oxidase strips. Control would then probably be best assessed by a series of three daily profiles taken once per month, with, if necessary, the results being discussed with the patient. On the other hand, in more unstable diabetes, home assessment by patients of blood glucose measurements is indicated.

Blood Glucose↗

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Control of maturity-onset diabetes by monitoring fasting blood glucose and body weight.

The feasibility of reducing the fasting blood glucose (FBG) level to < 6 mmol/L has been studied in all 84 maturity-onset diabetic (MOD) patients in three general practices. Only 35 (48%) were initially "well controlled" by this criterion, although 72 (86%) had no postprandial glycosuria. Seventy-one patients were monitored for 6 mo. With additional oral hypoglycemic therapy where necessary, the number of "well controlled" increased from 29 (41%) to 54 (76%), associated with a significant decrease in the hemoglobin A1. The patients were subsequently assessed at two 3-monthly intervals, and a fasting plasma glucose > 4 and < 6 mmol/l was usually maintained. All but two patients with a fasting glucose level < 6 mmol/l had fasting triglyceride concentrations < 2 mmol/l. The fasting blood glucose can be assayed in general practice with glucose-oxidase strips, and control by this means is simpler, cheaper, and more effective than regular urine glucose monitoring.

Adult↗

PubMedDate not supplied

Comparison of chlorpropamide and glibenclamide treatment of maturity-onset diabetes: control assessed by fasting plasma glucose concentrations.

Twelve maturity-onset diabetic subjects were treated with chlorpropamide once daily, glibenclamide once daily, or glibenclamide twice daily in a crossover design study. Doses were increased until the fasting blood glucose concentrations became less than 6 mmol/L (108 mg/dl), at which time the patients were admitted for a 24-h study period. There was little difference between the plasma glucose and insulin responses to chlorpropamide or glibenclamide given twice daily (mean doses 489 and 11 mg/day, respectively). When glibenclamide was given once daily (mean dose 9 mg/day), similar plasma glucose concentrations during the day were obtained with slightly higher plasma glucose concentrations during the night. Four patients had chlorpropamide-induced flushing with alcohol, and six patients had postprandial hypoglycemia on glibenclamide. Chlorpropamide once daily or glibenclamide twice daily are suitable for control based on fasting blood glucose measurements.

Adult↗

PubMedDate not supplied

Induced basal normoglycemia and altered platelet aggregation in non-insulin-dependent diabetes.

Non-insulin-dependent diabetic subjects had abnormally raised in vitro platelet aggregation rates to collagen or ristocetin when thought to be "well-controlled" on diet alone but shown to have raised basal plasma glucose levels. Basal normoglycemia, induced with either ultralente insulin or chlorpropamide, was associated with a significant reduction of the enhanced platelet aggregation rates to normal. Some sulfonylurea drugs have been reported to have specific anti-platelet aggregatory properties, but the degree of plasma glucose control is probably more relevant.

Blood Glucose↗

PubMedDate not supplied

A regular meal and insulin infusion regimen: its use in the treatment of acute-onset ketotic diabetes and in stabilization of poorly controlled established diabetic subjects.

A simple regimen, consisting of a constant intravenous insulin infusion at either a basal, nocturnal rate or at a daytime rate matched by seven small, isocaloric meals taken every 2 h, has been applied to two clinical situations requiring optimal blood glucose control. In eight poorly controlled established diabetic subjects, quantitative estimates of daily insulin requirements were possible, with consequent improved control upon reinstitution of twice-daily subcutaneous insulin. In five acute-onset, ketotic diabetic subjects first treated by intravenous saline and low-dose intramuscular insulin, the regimen was used to achieve and maintain basal and postprandial normoglycemia. Ketonuria was abolished quickly in these patients, and falling insulin requirements and large doses of insulin were handled easily. In both clinical situations, subsequent subcutaneous insulin doses required little adjustment. The regimen is cheap, convenient to use, and widely applicable.

Blood Glucose↗