Reducing admissions for people with diabetes.

Reversing the rise in emergency hospital admissions is an NHS priority. These admissions impact on elective capacity and waiting times and are unsustainable. The risk of hospitalisation for people with diabetes is almost twice that for others. Commissioners need to address admissions associated with diabetes and new guidance offers best-practice solutions.

Unilateral adrenal infarction in pregnancy with associated acute hypoadrenalism and subsequent spontaneous biochemical and radiological resolution.

Adrenal infarction is a rare cause of abdominal pain during pregnancy, and if missed, it can result in devastating clinical consequences for the mother and the child. The authors report a case of a young female who presented with severe abdominal pain and nausea. The biochemistry showed raised inflammatory markers and significant lactic acidosis. As the cause of the symptoms was not clear and the patient continued to deteriorate, a contrast-enhanced CT abdomen and pelvis was done which was suggestive of an acute left adrenal infarction. Subsequently, the patient was confirmed to have biochemical hypoadrenalism and required replacement doses of hydrocortisone until recovery of the adrenal glucocorticoid reserve and anticoagulation for the duration of pregnancy. We discuss the workup including diagnostic imaging, follow-up, and considerations for future pregnancies in this case.

GP interest in teaching junior doctors - Does practice location, size and infrastructure matter?

BACKGROUND: With the influx of Australian medical graduates into the workforce, new clinical prevocational training rotations within general practice need to be developed. This study describes the relationship between general practitioner teachers' interest in hosting junior doctor rotations, and general practice characteristics including rural location, size and infrastructure. METHOD: All GP teachers of registrars and medical students in the Australian Capital Territory and southeast New South Wales were sent a survey. The features of rural location, size and infrastructure of these teachers' general practices were analysed to determine their influence on teacher interest in hosting junior doctor rotations. RESULTS: Factors such as rural location and infrastructure did not influence willingness to host junior doctors significantly. However, those in medium sized practices were less interested than small or large practices. DISCUSSION: Rural location and teaching room infrastructure of practices need not be determinants in junior doctor teaching practice recruitment, while medium practice size is a significant determinant of lack of teacher interest in hosting junior doctors. This requires further investigation.

Sulphonyurea as a cause of severe hypoglycaemia in the community.

INTRODUCTION: Hypoglycaemia is a well recognised side effect of insulin and sulphonyurea therapy in the treatment of, patients with diabetes mellitus. METHODS: We performed a retrospective analysis of patients who developed severe hypoglycaemia in Hull and, East Yorkshire, United Kingdom over a 4-month period to assess the different therapies that contribute the most to the problem and the patient groups who are at greatest risk. RESULTS: Of the 75 patients with diabetes mellitus who developed severe hypoglycaemia, 61 (80%) were taking, insulin, 5 in combination with metformin. Ten (13%) patients were taking SU therapy; 5 in, combination with metformin, 2 in combination with a thiazolidinedione and 1 in combination with, insulin. When the SU-treated and non-SU treated groups were compared, patients taking SU therapy were, significantly older and had significantly lower HbA1c levels. CONCLUSIONS: All patients taking SU and insulin treatment are potentially at risk of developing hypoglycaemia. Our, analysis shows that almost 15% of patients in our region who suffered from severe hypoglycaemia, were on SU therapy. Patients in this group were older and had lower levels of HbA1c. Whilst national HbA1c targets may be useful for clinicians to define glycaemic targets for their, population, this has to be tempered by what is in the best interests of the patient and not what is, dictated by the Quality and Outcomes Framework. Possible alternatives to SU therapy should be, considered especially if hypoglycaemia is a concern.