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R Gregory

Publications and source records attributed to R Gregory.

At least 109 records · Page 6Linked 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↗
PubMed1992

Diabetic pregnancy 1977-1990: have we reached a plateau?

We have compared 81 pregnancies in women with type 1 (insulin dependent) diabetes in 1984-1990 with 58 in 1977-1983. In 1984-1990, women booked earlier (8 weeks [median] vs 12 weeks), mean haemoglobin A1 was lower in each trimester, and fewer days were spent in hospital before delivery (5.3 days [mean] vs 15). The latter was due to more experience in managing diabetic control as outpatients and fewer admissions for fetal monitoring. Most admissions are now for pre-eclampsia and intercurrent illnesses. The proportion of deliveries by caesarean section has not changed significantly (53% in 1984-1990 vs 66% in 1977-1983), but most are now done as emergencies. The incidence of macrosomia is constant (26% in 1984-1990 vs 21% in 1977-1983). There was one stillbirth, one intra-uterine death (complicating maternal ketoacidosis) and one perinatal death in 1984-1990, compared with no losses in 1977-1983. Two babies had major congenital abnormalities in 1984-1990, compared with one in 1977-1983. These results compare favourably with those from other centres in the United Kingdom. We conclude we have reached a nearly irreducible minimum for hospital days before delivery and congenital abnormalities, but that there is scope for a small reduction in the caesarean section rate.

Adult↗
PubMed1991

Course of brittle diabetes: 12 year follow up.

OBJECTIVE: To determine the course of brittle diabetes. DESIGN: 12 year follow up of patients identified in 1977-9 as having brittle diabetes; retrospective review of the case notes. SETTING: Nottingham health district. SUBJECTS: 25 brittle diabetic patients were identified in 1979-9; 11 (five men) had three or more admissions with ketoacidosis between June 1977 and 1979 and 14 (eight men) had three or more attendances at the accident and emergency department with hypoglycaemia in 1978. Two controls from our diabetic register were matched to each patient for age, sex, and duration of diabetes. MAIN OUTCOME MEASURES: Frequency of ketoacidosis and severe hypoglycaemia in the 12 years after ascertainment; diabetic control and complications in 1988-90; retrospective attribution of the cause of brittleness. RESULTS: Patients with recurrent ketoacidosis had had a median (range) of 28 (8-67) episodes. One man died of a cerebral tumour but five of the surviving nine patients had not been admitted in the past two years, although diabetic control remained poor (median haemoglobin A1 concentration 14%). Seven patients had pure hypoglycaemic brittleness, and five had also had eight or more admissions with ketoacidosis (mixed brittleness). Two died of uraemia within a year after ascertainment and two others in hypoglycaemic coma seven and 12 years later. Brittle diabetes was in most cases related to a specific situation, usually unhappiness at home or school. CONCLUSIONS: Brittle diabetes is often episodic and almost always related to stressful life circumstances. Once the underlying cause is removed it tends to improve. Recurrent hypoglycaemic brittleness of psychological origin has a poor prognosis.

Adolescent↗
PubMed1991

Uncompacted lamellae as a feature of tomaculous neuropathy.

Clinical findings suggested an inherited tendency to pressure palsies, but in this case without a family history. This was confirmed pathologically by the identification of a tomaculous neuropathy showing some atypical features including the presence of uncompacted lamellae in a high proportion of fibres.

Action Potentials↗
PubMed1991

Does knowledge of islet cell antibody status help in managing diabetes presenting in middle and old age?

It has been suggested that screening all patients with diabetes diagnosed in later life for islet cell antibodies (ICA) would help predict insulin dependence. We have surveyed the case notes of 55 patients (22 male; ages 37-88 years) who were found to be ICA positive over a 9-year screening period to assess what contribution knowledge of ICA status made to their management. Forty-two patients had been put on insulin (half within 6 months of diagnosis and the rest after up to 6 years). Of the 13 patients not on insulin, six were on diet alone and seven on oral hypoglycaemic agents after a median follow-up of 3 years. In 37 of the 42 patients, insulin treatment was started for clinical rather than immunological reasons (diabetic ketoacidosis, ketonuria, weight loss and/or severe symptoms). Five patients were started on insulin because of ICA status when there was no compelling reason on clinical grounds. Knowledge that seven non-insulin-treated patients were ICA positive made doctors reluctant to discharge them from clinic. The data suggest that routine ICA estimation in this age group is unnecessary, as the decision to treat with insulin is best made on clinical grounds, and ICA estimation can lead to unwarranted insulin treatment, or anxiety in patients and doctors who are aware of a positive result.

Adult↗
PubMed1991

Critical thinking for environmental health risk education.

This article proposes an approach for helping school-age children to think critically about environmental health risks. It discusses three key elements of a school curriculum--defining a decision perspective, making choices under uncertainty, and thinking about consequences--and recommends procedures to aid in classroom implementation of the proposed ideas. Critical thinking skills are shown to enhance childrens' ability to anticipate the health or safety consequences of a decision by distinguishing automatic from decision thinking, by detecting inconsistent objectives or neglected consequences, and by making explicit value-based tradeoffs. Training in critical thinking also should empower children because it acknowledges the power of personal initiatives in decreasing health risks and, in general, because it focuses the classroom experience on learning about how to think rather than merely learning about what to think.

Adolescent↗
PubMed1991

Demonstration of insulin transformation products in insulin vials by high-performance liquid chromatography.

OBJECTIVE: To assess the importance of temperature, light, agitation, and regular withdrawal of insulin on the rates of appearance of three groups of insulin transformation products (ITPs) in vials of human and beef soluble insulin. RESEARCH DESIGN AND METHODS: Twelve insulin-treated patients (6 receiving human soluble insulin, 6 receiving beef soluble insulin) participated in the study. Reverse-phase high-performance liquid chromatography was used to measure ITP in serial samples from vials stored in various laboratory environments or issued to patients. Vials in the laboratory were analyzed on nine occasions over 26 wk; those issued to patients were analyzed weekly. RESULTS: Results were expressed as rates of change (% total protein/wk). Except for human insulin stored at 4 degrees C, sampling did not accelerate transformation. Storage at higher temperatures caused more rapid transformation to all ITP groups, and human insulin was more susceptible than beef insulin. Exposure to light accelerated transformation mainly to group 3 ITP. Fibrillation occurred in beef but not human insulin carried in a shirt pocket. Results from patients' vials were consistent with reported storage conditions. CONCLUSIONS: All three ITP groups form in human and beef soluble insulin. Their rate of production is a function of temperature and light exposure. Differences between the two insulins were probably due to differences in formulation. Patients should be discouraged from hoarding vials and storing insulin in direct sunlight. One or more ITPs could contribute to the residual immunogenicity of modern insulin preparations.

Analysis of Variance↗
PubMed1990

von Recklinghausen neurofibromatosis and myelomatosis.

We report a case of von Recklinghausen neurofibromatosis associated with myelomatosis. The association of these two relatively common conditions has not been described previously. We discuss the hypothesis that the NF-1 gene confers a degree of protection from certain common adult malignancies.

Aged↗
PubMed1989

Regional cerebral function and blood flow: complementary single photon emission computed tomography of the brain using xenon-133 and [123I]iodoamphetamine.

Regional cerebral function and blood flow can be imaged using isopropyl[123I]iodoamphetamine (IMP), or 133Xe (DSPECT), respectively. Both of these essentially non-invasive, quantitative, methods are suitable for many nuclear medicine laboratories. This study assessed the in vivo information about intracerebral disease provided by IMP and DSPECT techniques to determine the optimal diagnostic use of these modalities. Single photon emission computed tomograms of 53 subjects were acquired using similar displays for IMP and DSPECT data. Lobar tracer distributions were graded by three experienced observers and analyzed using a kappa statistic to eliminate chance agreements. Overall, both IMP and DSPECT had similar patterns. However, while similar, one or the other technique often displayed abnormalities not present on both. Although technical factors may account for some differences between the modalities, a case of arteriovenous malformation proves that discordant findings can result directly from tracer localization properties. Thus at least some discordances provide truly complementary diagnostic information lacking in either single study taken alone.

Adult↗