Improving medication adherence and effective prescribing through a patient-centered prescription model in patients with multimorbidity.

PURPOSE: This study aimed to assess the impact of the patient-centered prescription (PCP) model in medication adherence and effective prescribing in patients with multimorbidity. METHODS: Uncontrolled before-after study in an intermediate care facility in a mixed urban-rural district. Inpatients aged ≥ 65 years with multimorbidity exposed to polypharmacy before hospital admission were consecutively enrolled. Every patient's treatment plan was analyzed through the PCP model, which includes interventions aimed at improving medication adherence. The primary endpoint was the change in the proportion of adherent patients between pre-admission and after discharge for all regularly scheduled long-term medications, using the proportion of days covered (PDC). Secondary endpoints included the change on mean PDC for all long-term medications, number of long-term medications, proportion of patients with hyperpolypharmacy, medication regimen complexity index (MRCI) score, drug burden index (DBI) score, number of potential inappropriate prescribing (PIP), and proportion of patients with ≥ 2 PIPs. RESULTS: Ninety-three non-institutionalized patients were included (mean age 83.0 ± SD 6.1 years). The proportion of adherent patients increased from 22.1 to 51.9% (P < 0.001). Intervention also improved mean PDC [mean difference (95% CI) 10.6 (7.7, 13.5)] and effective prescribing through a reduction on the number of long-term medications [- 1.3 (- 1.7, - 0.9)], proportion of patients exposed to hyperpolypharmacy (- 16.1%, P < 0.001), MRCI score [- 2.2 (- 3.4, - 1.0)], DBI score [- 0.16 (- 1.8, - 1.3)], number of PIPs [- 1.6 (- 1.8, - 1.3)], and proportion of patients with ≥ 2 PIPs (- 53.7%, P < 0.001). CONCLUSION: Studied intervention provides significant effective prescribing and medication adherence enhancements in non-institutionalized older patients with multimorbidity and polypharmacy.

Optimizing drug therapy in frail patients with type 2 diabetes mellitus.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is closely linked with ageing. In frail diabetic patients, the risks of intensive antidiabetic therapy outweigh the potential benefits. AIMS: To study the prevalence of T2DM in frail elderly patients, to identify inappropriate prescription (IP) of antidiabetic drugs and to study the relationship between patients' frailty index (FI) with polypharmacy and IP. METHODS: This was a prospective, descriptive, observational study of elderly patients. Each patient's antidiabetic treatment was analysed by applying the patient-centred prescription model (PCP), which centres therapeutic decisions on the patient's global assessment and individual therapeutic goal. RESULTS: 210 patients with T2DM were included (25.15% prevalence). They were characterised by high multimorbidity and frailty. 93.3% presented polypharmacy and 51% excessive polypharmacy. IP was identified in 66.2% of patients. A statistically significant relationship was found between the progression in FI degree and IP prevalence (p < 0.05. During the admission, drug therapy regimens were modified in 97.1% of cases with IP (n = 136). DISCUSSION: These results suggest that in clinical practice T2DM treatment is not individualised, but rather is based on the same general recommendations for the population as a whole. CONCLUSIONS: There is a high prevalence of T2DM in the elderly. As the frailty of patients increases, so does the prevalence of IP. The application of PCP model enables drug therapy optimization in frail patients according to their main therapeutic goal, and contributes to provide clinical evidences on the applicability of a set of knowledge areas from the theoretical framework to the daily clinical practice.

Alpha power indexes task-related networks on large and small scales: A multimodal ECoG study in humans and a non-human primate.

Performing different tasks, such as generating motor movements or processing sensory input, requires the recruitment of specific networks of neuronal populations. Previous studies suggested that power variations in the alpha band (8-12Hz) may implement such recruitment of task-specific populations by increasing cortical excitability in task-related areas while inhibiting population-level cortical activity in task-unrelated areas (Klimesch et al., 2007; Jensen and Mazaheri, 2010). However, the precise temporal and spatial relationships between the modulatory function implemented by alpha oscillations and population-level cortical activity remained undefined. Furthermore, while several studies suggested that alpha power indexes task-related populations across large and spatially separated cortical areas, it was largely unclear whether alpha power also differentially indexes smaller networks of task-related neuronal populations. Here we addressed these questions by investigating the temporal and spatial relationships of electrocorticographic (ECoG) power modulations in the alpha band and in the broadband gamma range (70-170Hz, indexing population-level activity) during auditory and motor tasks in five human subjects and one macaque monkey. In line with previous research, our results confirm that broadband gamma power accurately tracks task-related behavior and that alpha power decreases in task-related areas. More importantly, they demonstrate that alpha power suppression lags population-level activity in auditory areas during the auditory task, but precedes it in motor areas during the motor task. This suppression of alpha power in task-related areas was accompanied by an increase in areas not related to the task. In addition, we show for the first time that these differential modulations of alpha power could be observed not only across widely distributed systems (e.g., motor vs. auditory system), but also within the auditory system. Specifically, alpha power was suppressed in the locations within the auditory system that most robustly responded to particular sound stimuli. Altogether, our results provide experimental evidence for a mechanism that preferentially recruits task-related neuronal populations by increasing cortical excitability in task-related cortical areas and decreasing cortical excitability in task-unrelated areas. This mechanism is implemented by variations in alpha power and is common to humans and the non-human primate under study. These results contribute to an increasingly refined understanding of the mechanisms underlying the selection of the specific neuronal populations required for task execution.

Contrast gain control and horizontal interactions in V1: a DCM study.

Using high-density electrocorticographic recordings - from awake-behaving monkeys - and dynamic causal modelling, we characterised contrast dependent gain control in visual cortex, in terms of synaptic rate constants and intrinsic connectivity. Specifically, we used neural field models to quantify the balance of excitatory and inhibitory influences; both in terms of the strength and spatial dispersion of horizontal intrinsic connections. Our results allow us to infer that increasing contrast increases the sensitivity or gain of superficial pyramidal cells to inputs from spiny stellate populations. Furthermore, changes in the effective spatial extent of horizontal coupling nuance the spatiotemporal filtering properties of cortical laminae in V1 - effectively preserving higher spatial frequencies. These results are consistent with recent non-invasive human studies of contrast dependent changes in the gain of pyramidal cells elaborating forward connections - studies designed to test specific hypotheses about precision and gain control based on predictive coding. Furthermore, they are consistent with established results showing that the receptive fields of V1 units shrink with increasing visual contrast.

Global overview of the risk linked to the Bacillus cereus group in the egg product industry: identification of food safety and food spoilage markers.

AIMS: To evaluate the food safety and spoilage risks associated with psychrotrophic Bacillus cereus group bacteria for the egg product industry and to search for relevant risk markers. METHODS AND RESULTS: A collection of 68 psychrotrophic B. cereus group isolates, coming from pasteurized liquid whole egg products, was analysed through a principal component analysis (PCA) regarding their spoilage and food safety risk potentials. The principal component analysis showed a clear differentiation between two groups within the collection, one half of the isolates representing a safety risk and the other half a spoilage risk. CONCLUSIONS: Relevant risk markers were highlighted by PCA, that is (i) for the food safety risk, the presence of the specific 16S rDNA-1m genetic signature and the ability to grow at 43°C on solid medium and (ii) for the spoilage risk, the presence of the cspA genetic signature. SIGNIFICANCE AND IMPACT OF THE STUDY: This work represents a first step in the development of new diagnostic technologies for the assessment of the microbiological quality of foods likely to be contaminated with psychrotrophic B. cereus group bacteria.

Biodiversity of psychrotrophic bacteria of the Bacillus cereus group collected on farm and in egg product industry.

The aim of the present study was (i) to type, by genotypic and phenotypic methods, a collection of psychrotrophic bacteria belonging to the Bacillus cereus group collected in a farm and in 6 egg breaking industries during a period covering a warm and a cold season, and (ii) to characterize the egg product spoilage (growth in liquid whole egg) and the sanitary risk potential (cytotoxic activity on Caco-2 cells and adhesion on stainless steel) of each isolate of the collection. The investigation of specific psychrotrophic and mesophilic signatures together with the study of ability to grow at 6 °C and/or at 43 °C on optimal agar medium allowed highlighting twelve profiles, the major one corresponding to the species Bacillus weihenstephanensis (46.2% of the collection). The diversity of the profiles depended on the season and on the origin of the isolates. In terms of food spoilage, all the isolates were able to grow at the same level in liquid whole egg and in optimal medium, even at low temperature. Under the same conditions, the cytotoxic activity depended on the isolate, the medium and the temperature. At 10 °C, no isolate was cytotoxic at 10 °C in liquid whole egg and only one, belonging to the Bacillus weihenstephansensis species, in the optimal medium. All the isolates were able to adhere on stainless steel at various levels, from 2.6±0.2 log cfu/cm(2) to 4.9±0.1 log cfu/cm(2). A large majority (80.8%) was strongly adhering and could lead to the formation of biofilms in industrial equipments.

Therapeutic optimization through goal-oriented prescription in nursing homes.

Background People living in nursing homes are highly vulnerable and frail. Polypharmacy and inappropriate prescription (IP) are also common problems. Objectives The objectives of the study are (i) to study the baseline situation and calculate the frailty index (FI) of the residents, (ii) to assess the results of routine clinical practice to do a pharmacotherapy review (patient-centred prescription (PCP) model) (Molist Brunet et al., Eur Geriatr Med. 2015;6:565-9) and (iii) to study the relationship between IP and frailty, functional dependence, advanced dementia and end-of-life situation. Setting Two nursing homes in the same geographical area in Catalonia (Spain). Method This was a prospective, descriptive and observational study of elderly nursing home residents. Each patient's treatment was analysed by applying the PCP model, which centres therapeutic decisions on the patient's global assessment and individual therapeutic goal. Main outcome measure Prevalence of polypharmacy and IP. Results 103 patients were included. They were characterized by high multimorbidity and frailty. Up to 59.2% were totally dependent. At least one IP was identified in 92.2% of residents. Prior to the pharmacological review, the mean number of chronic medications prescribed per resident was 6.63 (SD 2.93) and after this review it was 4.97 (SD 2.88). Polypharmacy decreased from 72.55% to 52.94% and excessive polypharmacy fell from 18.62% to 5.88%.The highest prevalence of IP was detected in people with a higher FI, in those identified as end-of-life, and also in more highly dependent residents (p < 0.05). Conclusions People who live in nursing homes have an advanced frailty. Establishing individualized therapeutic objectives with the application of the PCP model enabled to detect 92.2% of IP. People who are frailer, are functionally more dependent and those who are end-of-life are prescribed with inappropriate medication more frequently.

Contractile properties of muscle fibers from the deep and superficial digital flexors of horses.

Equine digital flexor muscles have independent tendons but a nearly identical mechanical relationship to the main joint they act upon. Yet these muscles have remarkable diversity in architecture, ranging from long, unipennate fibers ("short" compartment of DDF) to very short, multipennate fibers (SDF). To investigate the functional relevance of the form of the digital flexor muscles, fiber contractile properties were analyzed in the context of architecture differences and in vivo function during locomotion. Myosin heavy chain (MHC) isoform fiber type was studied, and in vitro motility assays were used to measure actin filament sliding velocity (V(f)). Skinned fiber contractile properties [isometric tension (P(0)/CSA), velocity of unloaded shortening (V(US)), and force-Ca(2+) relationships] at both 10 and 30°C were characterized. Contractile properties were correlated with MHC isoform and their respective V(f). The DDF contained a higher percentage of MHC-2A fibers with myosin (heavy meromyosin) and V(f) that was twofold faster than SDF. At 30°C, P(0)/CSA was higher for DDF (103.5 ± 8.75 mN/mm(2)) than SDF fibers (81.8 ± 7.71 mN/mm(2)). Similarly, V(US) (pCa 5, 30°C) was faster for DDF (2.43 ± 0.53 FL/s) than SDF fibers (1.20 ± 0.22 FL/s). Active isometric tension increased with increasing Ca(2+) concentration, with maximal Ca(2+) activation at pCa 5 at each temperature in fibers from each muscle. In general, the collective properties of DDF and SDF were consistent with fiber MHC isoform composition, muscle architecture, and the respective functional roles of the two muscles in locomotion.

Increased binding of concanavalin A at the cell surface following exposure to thyroliberin.

Thyroliberin (THR) binds specifically to SD1 rat prolactin cells and increases prolactin release. THR-induced modifications of surface membrane of intact SD1 cells were looked for, using concanavalin A (Con A) as a probe. At the electron microscope level the binding was restricted to the cell surface. Preexposure of the cells to TRH (27 nM) for 30 min at 37 degrees C increased the binding of Con A by 28--120%. Such an increase was not observed with low doses of TRH (13.5 and 2.7 nm) nor after only a 10-min exposure to 27 nM TRH. This effect is specific for TRH; it was not observed with other peptiDES. Simultaneous exposure to Con A and [3H] TRH did not alter [3H]TRH binding, but preexposure to Con A reduced the [3H]TRH binding by 10%, which may be due to steric hindrance. It is concluded that TRH induces an increased exposure of surface membrane glycoproteins in intact SD1 cells.

Effect of 17 beta-estradiol on thyroliberin responsiveness in GH3/B6 rat prolactin cells.

GH3/B6 rat prolactin cells were used to analyse at the cellular level the mechanisms by which 17 beta-estradiol (E2) regulates TRH responsiveness of prolactin cells. Before experiments, cells were grown for up to 7 days in 3 different media: normal medium (N) containing 15% horse serum and 2.5% fetal calf serum, CD medium prepared with charcoal-dextran extracted serum and CDE medium supplemented with 4 x 10(-8) M E2. The binding of 3H-TRH (30 min at 37 degrees C) and the TRH-induced percent increase of prolactin release as a function of TRH doses were compared in the 3 conditions. Preculture in E2 enriched medium increased by 50% the number of TRH high-affinity binding sites without modifying their affinity, increased by up to 3 times the percent of the TRH-induced stimulation of prolactin release and improved by one order of magnitude the ED50 of the TRH effect on prolactin release. The presence of HEPES (10 mM) during TRH challenge masked the effect of E2 on the increase in number of binding sites but respected its potentiating effect on prolactin release.

17 beta-Estradiol regulates prolactin secretion but not cell proliferation of GH3B6 cells in chemically defined medium.

The effects of 17 beta-estradiol on proliferation and prolactin secretion by a clonal rat pituitary cell, GH3B6, have been investigated in a chemically defined medium (Ham's F12, transferrin, insulin and parathyroid hormone). Under these conditions, 17 beta-estradiol alone (5 X 10(-14)-5 X 10(-9) M) was not a mitogen for GH3B6 cells as shown by cell counts and DNA measurements. However, it slowed down the drop in prolactin production induced by culture in this chemically defined medium. After 3 and 7 days it stimulated PRL production up to 5 times in a dose-dependent manner. This secretory response was abolished by tamoxifen, and not mimicked by progesterone, testosterone or dexamethasone. The thyroliberin-induced stimulation of prolactin production occurred more rapidly (24 h) than and was additive to the 17 beta-estradiol response, suggesting that these two factors act through independent mechanisms. PRL neosynthesis in culture was attested to by the incorporation of [35S]methionine (5 h) into immunoprecipitable prolactin. Neither 17 beta-estradiol nor thyroliberin increases specifically prolactin radioactivity, although they strongly decreased the specific activity of prolactin in both cells and medium. This suggests that they mostly acted by decreasing PRL turnover rate.

[Topical treatment with eberconazole of the experimental guinea pig cutaneous candidosis.]. / Tratamiento tópico de la candidosis cutánea experimental del cobayo con eberconazol.

Eberconazole is a new azole antifungal drug for topical treatment of superficial mycoses. The usefulness of this drug was evaluated in an experimental model of cutaneous candidosis in guinea pigs comparing with the classical clotrimazole in a single blind trial. Twenty-five animals were inoculated in two symmetrical areas of the back with Candida albicans developing skin infection. One group of 10 animals were treated once per day with clotrimazole 1% cream in one side and with excipient in the other. Other group of 10 guinea pigs received eberconazole 1% cream and excipient. Five animals did not receive any treatment and were used as controls. After five days of treatment most lesions cured or improved and cultures were negative when clotrimazole or eberconazole were applied. Seventy per cent of lesions treated with excipient were clinically improved and 10% cured, but 85% of cultures remained positive for C. albicans. The therapeutic efficacy of eberconazole 1% cream was similar to clotrimazole 1% cream in the guinea ping model of cutaneous candidosis. Tolerance of both drugs was excellent. These results suggest the usefulness of eberconazole in human cutaneous infections due to C. albicans.

[Oral terbinafine for the tinea unguium of the toenails. Efficacy between 12 and 24 weeks of treament.]. / Terbinafina por vía oral en el tratamiento de la tinea unguium de los pies. Eficacia entre 12 y 24 semanas de tratamiento.

Terbinafine 250 mg po daily was administered to 21 patients affected by tinea unguium of the toenails. In 14 cases Trichophyton rubrum was the aetiological agent while Trichophyton mentagrophytes var. interdigitale affected the rest. The treatment was administered randomized during 12 or 24 weeks in two groups of 11 (group A) and 10 (group B) patients. The clinical and mycological response was evaluated at week 12, 24 and 48. Adverse events were registered during the therapeutic period. At week 24, 55.5% of patients from group A were cured, only one patient did not improve and cultures were positive. In group B 66.6% were cured and three were clinically improved but cultures were positive. In the last control after 48 weeks the results were similar except one patient of the group B who worsened of his nails lesions. Only one case of acute urticaria was noted, the symptoms disappeared after the withdrawal of terbinafine. Terbinafine per os is a safe and effective antifungal for the treatment of the tinea unguium of the toenails. A period of 12 weeks of administration is enough in most of cases but when T. rubrum is the aetiology relapse could be possible.

[Validation of a diagnostic algorithm in non severe pulmonary embolism at the Annecy general hospital. D-dimers, venous lower limb ultra-sound and spiral CT scan]. / Evaluation d'un algorithme diagnostique de l'embolie pulmonaire non grave avec successivement: D-Dimères, échodoppler veineux des membres inférieurs et tomodensitométrie hélicoïdale au centre hospitalier d'annecy.

OBJECTIVE AND METHOD: We have evaluated the sensitivity of a diagnostic algorithm for all patients suspected of pulmonary embolism using: D-Dimer, lower limb venous ultrasonography and helical computed tomography. To validate this approach, a lung scan is systematically carried out if the pulmonary embolism diagnosis is not withheld as a result of the algorithm. Clinical tests are organised between the 3rd and 6th month. RESULTS: Two hundred patients were involved between January 1998 and October 1999. One hundred and six pulmonary embolisms were diagnosed. Out of the 200 ultrasonography tests carried out we found: 71 proximal deep-vein thrombosis (popliteal or supra-popliteal), 33 distal thrombosis (infra-popliteal). Ninety-two cases were negative (4 tests non conclusive). We have deduced that a deep-vein thrombosis permits the diagnosis of thrombo-embolic illness without any further diagnostic approach (no computed tomography). Out of the 129 computed tomographies carried out we found: 35 pulmonary embolisms and 23 other diagnoses. Seventy-one lung scans were therefore carried out. We recorded 7 discordances (scans showed high and very high probability for pulmonary embolism whilst computed tomographies did not): pulmonary angiography was negative 4 times and diagnosed pulmonary embolism once and two patients refused to take the test (Table 2). There are two recurrences in the follow-up: proximal thrombosis and a pulmonary embolism. This involved two patients who had refused to undergo pulmonary angiography. CONCLUSION: This diagnostic approach therefore seems satisfactory but would require further investigation on a wider scale.

[Health status and its effects on the work of national education nurses]. / Santé ressentie et implication au travail des infirmier(e)s de l'Education nationale.

This study presents a pedagogical work carried out with a group of 13 school nurses of the Academy of Rennes, as part of a course in survey methodology. A descriptive survey aiming to achieve a better understanding of experienced health status of nurses, and of its repercussions on the execution of their missions, was implemented during the course, as a result of the demand and the expertise of the participants. Overall, nurses report to be in good health. However, one can not underestimate the existence of a group at risk (5% of the sample) that often suffers somatic troubles accompanied by sleep disorders and anxiety, as these risks concern primarily permanent staff nurses working in boarding establishments, with half of them falling into this category. A demand for regular monitoring of their health was clearly expressed through the study. This may be the object of a subsequent study by an academic team.

Lithium prevents excitotoxic cell death of motoneurons in organotypic slice cultures of spinal cord.

Several studies have reported the neuroprotective effects of lithium (Li) suggesting its potential in the treatment of neurological disorders, among of them amyotrophic lateral sclerosis (ALS). Although the cause of motoneuron (MN) death in ALS remains unknown, there is evidence that glutamate-mediated excitotoxicity plays an important role. In the present study we used an organotypic culture system of chick embryo spinal cord to explore the presumptive neuroprotective effects of Li against kainate-induced excitotoxic MN death. We found that chronic treatment with Li prevented excitotoxic MN loss in a dose dependent manner and that this effect was mediated by the inhibition of glycogen synthase kinase-3beta (GSK-3beta) signaling pathway. This neuroprotective effect of Li was potentiated by a combined treatment with riluzole. Nevertheless, MNs rescued by Li displayed structural changes including accumulation of neurofilaments, disruption of the rough endoplasmic reticulum and free ribosome loss, and accumulation of large dense core vesicles and autophagic vacuoles. Accompanying these changes there was an increase in immunostaining for (a) phosphorylated neurofilaments, (b) calcitonin gene-related peptide (CGRP) and (c) the autophagic marker LC3. Chronic Li treatment also resulted in a reduction in the excitotoxin-induced rise in intracellular Ca(2+) in MNs. In contrast to the neuroprotection against excitotoxicity, Li was not able to prevent normal programmed (apoptotic) MN death in the chick embryo when chronically administered in ovo. In conclusion, these results show that although Li is able to prevent excitotoxic MN death by targeting GSK-3beta, this neuroprotective effect is associated with conspicuous cytopathological changes.

[Correlation between the various measurements of obesity and the degree of resistance to insulin]. / Correlación entre las diferentes medidas de obesidad y el grado de resistencia a la insulina.

OBJECTIVE: To determine the correlation between certain obesity measurements and insulin resistance (measured by HOMA). DESIGN: Descriptive cross-sectional study. SETTING: Urban health centre with elderly population. PARTICIPANTS: A random sample of 70 people was chosen from among an adult population with risk factors for DM2 or already diagnosed. MAIN MEASUREMENTS: Parameters of obesity were collected (weight, BMI, body perimeters, waist/hip index, and cutaneous folds), as were clinical parameters (blood pressure and cardiovascular risk), and analyses (glycaemia and insulinaemia--both basal and after 2 hours of oral overload of glucose--, HOMA, lipid profile, and microalbuminuria study). Resistance to insulin (IR) was defined as a HOMA > or =3.8. RESULTS: Individuals with IR had significantly higher values of weight (85.5 vs 75.5 kg), BMI (35.1 vs 29.4 kg/m2), waist perimeter (108 vs 100.3 cm) than those without IR. In neither group were any significant differences as to the waist/hip index found. The BMI and/or waist perimeter values that were more likely to suffer IR were established. In men, the values were waist >107 cm (sensitivity, 43%; specificity, 62%) and BMI>29 (sensitivity, 57%; specificity, 50%). In women, they were a waist >102 cm (sensitivity, 64%; specificity, 89%) and BMI>34 (sensitivity, 91%; specificity, 89%). CONCLUSIONS: In clinical practice the BMI and the diameter of the waist are very good predictors of IR, whilst the waist/hip index and cutaneous folds do not provide any information of value.

[Variability in the calculation of coronary risk in type-2 diabetes mellitus]. / Variabilidad en la estimación del riesgo coronario en la diabetes mellitus tipo 2.

OBJECTIVE: To determine the concordance and predictive capacity of various methods for calculating coronary risk in diabetic patients. DESIGN: Prospective study of cohorts, with a 10-year follow-up. SETTING: Urban health centre in a socially depressed area, with high prevalence of DM2. PARTICIPANTS: Population diagnosed with type-2 diabetes mellitus in 1991-93 (112 individuals, with an average age of 66.7+/-11.6 years, 59% of whom were male). MAIN MEASUREMENTS: At the moment of diagnosis, the parameters normally used to calculate coronary risk were determined. The tables of the Framingham scale '91 and '98, of the United Kingdom Prospective Study (UKPDS) (based on an exclusively diabetic population) and of the REgistre GIroni del COr (REGICOR-Girona Heart Register) (based on a Mediterranean population) were each used to calculate individually coronary risk at 10 years. The coronary events suffered in the 10 years following DM2 diagnosis were recorded. The Kappa indices for concordance of the tables and their predictive capacity were calculated. RESULTS: 18.2% of men and 15.2% of women suffered some coronary event. The coronary risk calculations were, for men and women, 30%-20% (Framingham '91), 36%-21% (Framingham '98), 38%-23% (UKPDS), and 15%-10% (REGICOR). CONCLUSIONS: The various methods for calculating coronary risk in diabetics suffer large variability. We should highlight their low diagnostic value in individual cases, with sensitivities of 25%-75% and low specificity (mainly in men) regarding real risk of coronary disease.