Loss of vision before ophthalmic referral in blind and partially sighted diabetics in Bristol.

Data from all patients registered blind from diabetic retinopathy in Avon during a 16 month period were analysed with regard to management before hospital referral. The main findings were: 50% of the patients had no screening for retinopathy and were known to be diabetic; 25% were regularly screened for retinopathy (three quarters by local opticians); 22% were newly diagnosed as diabetic at the time of hospital referral. The degree of visual loss at the time of first hospital attendance was found to be marked (average 4.4 Snellen lines of acuity) but was not significantly different for different sources of referral. Only one eye of one patient had normal acuity at first attendance and 88% had lost two or more lines; 72% of registrations were a result of diabetic maculopathy. Delay from waiting for hospital appointments did not contribute significantly to the outcome in the group of patients studied.

The MD thesis in the training of a consultant physician.

A postal survey was carried out among the 94 consultant physicians of the South Western region (83% response rate) to ascertain their attitudes to the tradition of obtaining an MD by thesis as part of a physician's training. Most felt that the practice was questionable, and only half felt that it made an important contribution. For some, doing an MD had been a painful experience, even a waste of time. Having an MD impressed selection committees, but did not appear to alter the length of training nor the probability of obtaining a consultant post in a teaching hospital. We suggest that the MD is of limited value in judging a junior doctor's suitability to be a consultant physician.

Blind and partial sight registration in Avon.

All blind and partially sighted registration forms for the county of Avon for a two-year period were analysed, and the findings are presented. Comparisons with the national figure published by Sorsby over 20 years ago show there has been no marked change in the rates of blind registration per 100,000 population with the exception of those for cataract, which show a large reduction. Diabetic registrations have remained similar, but this may represent an encouraging trend in view of the significant increase in the size of the diabetic population. Glaucoma may show some improvement in the future when time has elapsed for beta blockers and trabeculoplasty to be fully assessed. There has been an increase in the rate of registration from aging macular degeneration.

Trial of early nifedipine in acute myocardial infarction: the Trent study.

Over 30 months 9292 consecutive patients admitted to nine coronary care units with suspected myocardial infarction were considered for admission to a randomised double blind study comparing the effect on mortality of nifedipine 10 mg four times a day with that of placebo. Among the 4801 patients excluded from the study the overall one month fatality rate was 18.2% and the one month fatality rate in those with definite myocardial infarction 26.8%. A total of 4491 patients fulfilled the entry criteria and were randomly allocated to nifedipine or placebo immediately after assessment in the coronary care unit. Roughly 64% of patients in both treatment groups sustained an acute myocardial infarction. The overall one month fatality rates were 6.3% in the placebo treated group and 6.7% in the nifedipine treated group. Most of the deaths occurred in patients with an in hospital diagnosis of myocardial infarction, and their one month fatality rates were 9.3% for the placebo group and 10.2% for the nifedipine group. These differences were not statistically significant. Subgroup analysis also did not suggest any particular group of patients with suspected acute myocardial infarction who might benefit from early nifedipine treatment in the dose studied.

Screening of diabetics for retinopathy by ophthalmic opticians.

Diabetes mellitus is a major cause of blindness in England and Wales in those aged between 30 and 64. Photocoagulation can frequently prevent blindness provided the retinopathy is detected at an appropriate stage but unfortunately the benefits are small if the changes are advanced. Early detection of diabetic retinopathy by regular examination is needed. We have shown that ophthalmic opticians have the skill to detect retinal changes at a treatable stage. Out of 844 eye checks, 80 were reported by ophthalmic opticians to justify referral to an ophthalmologist and 20 of these required photocoagulation treatment. Of a sample of 197 patients rechecked by an ophthalmologist reported by ophthalmic opticians not to justify referral, only one needed treatment. With local agreement this system of detecting retinopathy could be easily applied anywhere in the United Kingdom. No extra personnel or facilities are needed.

Prevalence of ischaemic heart disease and associations with serum lipoproteins in subjects aged 45 to 64 years. The Speedwell study.

A longitudinal study has been set up to examine the incidence of ischaemic heart disease and its associations with serum lipoproteins including high density lipoprotein cholesterol and its subfractions, certain haemostatic factors, and other "risk' factors. We report here on our pilot study findings. Cross-sectional data were available on 283 men and 68 women aged 45 to 64 representing 85% of the available population randomly selected from the lists of 16 general practitioners. Reproducibility of the measurements of total serum cholesterol, triglyceride, and low density lipoprotein cholesterol was acceptable. The reproducibility of some of the other serum lipid fractions, for example high density lipoprotein cholesterol, was less good, in part because of the small range of the values found for these components. Univariate associations of physical and behavioural characteristics and serum lipoproteins of men and women, with and without ischaemic heart disease, disclosed small and statistically nonsignificant differences except for levels of blood pressure. In particular, there was no significant difference in mean levels of serum high density lipoprotein cholesterol between men with ischaemic heart disease (0.91 mmol/l) and men without it (0.94 mmol/l). In examining our data for the determinants of serum high density lipoprotein cholesterol using a linear multiple regression model, sex, serum high density lipoprotein cholesterol, and very low density lipoprotein triglyceride were the major factors, each individually explaining about 7% of the variance of serum high density lipoprotein cholesterol levels. In addition, alcohol intake and obesity each explained a further 2% of the variance. The experience of the pilot study has led to modifications in the collection of blood samples and the subsequent estimation of lipid fractions.

Deliberate self-harm: a follow-up study of 279 patients.

Two-hundred-and-seventy-nine patients (103 men, 176 women) were followed-up 1-2 years after an act of non-fatal deliberate self-harm. Of 155 patients offered a psychiatric out-patient appointment at the time, only 68 completed the treatment. A further act of deliberate self-harm was committed by 26 men and 41 women within twelve months. The factors most highly associated with repetition were previous psychiatric treatment, a previous act of deliberate self-harm, and a criminal record. These factors held good for a separate series of patients. Significantly more repeaters received prolonged psychiatric care after the initial episode of deliberate self-harm. The implications of these findings for the clinical management of such patients are discussed.